CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 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 812 432.750000 16011.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6 2.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 783 1883.750000 69680.2500 36.9902
Subtotal (Total Children Is Unduplicated) 1284 2318.750000 85692.0000 36.9561
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 11 19.000000 1425.0000 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 5 7.500000 562.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 9 17.500000 971.2500 55.5000
Subtotal (Total Children Is Unduplicated) 14 48.000000 3258.7500 67.8906
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 4.000000 100.0000 25.0000
Subtotal (Total Children Is Unduplicated) 2 4.000000 100.0000 25.0000
-----------------------------------------------------------------------------------------------------------------------
Total 2370.750000 89050.7500 37.5623
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1286
-----------------------------------------------------------------------------------------------------------------------
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 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
3549 2086.750000 78561.2500 0.0000
Other 394 284.000000 10489.5000 0.0000
---------------------------------------------------------
Total 3943 2370.750000 89050.7500 0.0000