CMS/EIP Fiscal Report Center: 52
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 392 185.750000 6863.5000 36.9502
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 55 25.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 309 905.250000 33466.5000 36.9693
Subtotal (Total Children Is Unduplicated) 610 1116.500000 40330.0000 36.1218
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
Subtotal (Total Children Is Unduplicated) 4 12.500000 873.5000 69.8800
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 27 29.750000 1487.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 20 20.500000 1025.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 11 8.500000 212.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 39 49.750000 2487.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 3 3.250000 162.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.750000 18.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 9 10.000000 500.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 2 2.000000 100.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 31 34.250000 1712.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1 0.750000 37.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 142 226.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 29.000000 1450.0000 50.0000
INTR-T1013-INTERPRETER 5 12.000000 600.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 162 781.000000 7810.0000 10.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 10.000000 714.4000 71.4400
TRAV-TRAVS-Travel by mile 218 15116.00000 6725.8700 0.4450
Subtotal (Total Children Is Unduplicated) 332 16336.25000 25156.5200 1.5399
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Total 17465.250000 66360.0200 3.7995
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Number of Children (Unduplicated) With at Least One Service 738
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Center 52
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 0 0.000000 0.0000 0.0000
D 2 3.000000 161.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1039 16071.750000 23612.7700 21968.3700
2220 1389.500000 42549.2500 0.0000
Other 3 1.000000 37.0000 0.0000
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Total 3264 17465.250000 66360.0200 21968.3700