CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2023 ending 09/30/2023 Date of Report:10/11/2023 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:LEA
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 57.6000 57.6000
Subtotal (Total Children Is Unduplicated) 1 1.000000 57.6000 57.6000
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Total 1.000000 57.6000 57.6000
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Number of Children (Unduplicated) With at Least One Service 1
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Center 57
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 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
1 1.000000 57.6000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1 1.000000 57.6000 0.0000