CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
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 446 317.250000 11801.7000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1099 2567.750000 95514.0000 37.1975
Subtotal (Total Children Is Unduplicated) 1160 2885.000000 107315.7000 37.1978
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 6.000000 450.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 77 146.500000 8130.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 23 42.000000 3150.0000 75.0000
SCREEN-T1023-SCREENING 29 29.000000 1450.0000 50.0000
Subtotal (Total Children Is Unduplicated) 138 237.500000 13977.2500 58.8516
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 11 18.000000 900.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 5 4.750000 237.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 9 11.500000 575.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 3 5.250000 262.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 23 61.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 16 73.000000 3650.0000 50.0000
TRAV-TRAVS-Travel by mile 1 1.000000 0.4400 0.4400
Subtotal (Total Children Is Unduplicated) 35 175.000000 5625.4400 32.1454
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Total 3297.500000 126918.3900 38.4893
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Number of Children (Unduplicated) With at Least One Service 1184
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Center 03
Flag Claims Units Chgs Paid
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R 46 27.500000 1023.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2064 1444.250000 55638.8500 0.0000
P 39 45.750000 2056.7500 2056.7500
D 3 4.250000 214.8000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 3.000000 150.4400 150.4400
T 0 0.000000 0.0000 0.0000
2596 1632.500000 62338.6000 0.0000
Other 134 140.250000 5495.9500 0.0000
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Total 4884 3297.500000 126918.3900 2207.1900