CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:OTHER
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 1 3.750000 139.5000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 100 223.000000 8295.6000 37.2000
Subtotal (Total Children Is Unduplicated) 100 226.750000 8435.1000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 7.500000 562.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 5.500000 412.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 9 13.000000 721.5000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 35 48.000000 3600.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 38 53.000000 3975.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 73 101.000000 5605.5000 55.5000
Subtotal (Total Children Is Unduplicated) 82 228.000000 14877.0000 65.2500
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 3 1.750000 0.0000 0.0000
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
Subtotal (Total Children Is Unduplicated) 4 3.750000 143.9200 38.3787
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Total 458.500000 23456.0200 51.1582
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Number of Children (Unduplicated) With at Least One Service 104
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Center 09
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 2 1.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 246 342.000000 19117.8000 0.0000
T 0 0.000000 0.0000 0.0000
93 115.500000 4338.2200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 341 458.500000 23456.0200 0.0000