CMS/EIP Fiscal Report Center: 05
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 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 445 183.500000 6826.2000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 131 117.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 464 974.500000 36251.4000 37.2000
Subtotal (Total Children Is Unduplicated) 716 1275.250000 43077.6000 33.7797
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 1133.9000 1133.9000
Subtotal (Total Children Is Unduplicated) 1 1.000000 1133.9000 1133.9000
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Total 1276.250000 44211.5000 34.6417
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Number of Children (Unduplicated) With at Least One Service 716
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Center 05
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 6 3.000000 111.6000 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
2476 1272.500000 44072.0000 1133.9000
Other 1 0.750000 27.9000 0.0000
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Total 2483 1276.250000 44211.5000 1133.9000