CMS/EIP Fiscal Report Center: 05
Services beginning 10/01/2021 ending 12/31/2021 Date of Report:02/04/2022 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 428 188.500000 6974.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 38 20.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 408 895.000000 33115.0000 37.0000
Subtotal (Total Children Is Unduplicated) 678 1104.000000 40089.5000 36.3130
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EI Services,Class #03
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1 0.250000 12.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 14.000000 140.0000 10.0000
Subtotal (Total Children Is Unduplicated) 4 14.250000 152.5000 10.7018
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Total 1118.250000 40242.0000 35.9866
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Number of Children (Unduplicated) With at Least One Service 681
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Center 05
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 9 14.250000 152.5000 152.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2019 1104.000000 40089.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2028 1118.250000 40242.0000 152.5000