CMS/EIP Fiscal Report Center: 03
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 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 336 222.750000 8286.3000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1203 2921.250000 108670.5000 37.2000
Subtotal (Total Children Is Unduplicated) 1254 3144.000000 116956.8000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 222.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 64 122.500000 6798.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 6.000000 339.6300 56.6050
SCREEN-T1023-SCREENING 4 4.000000 200.0000 50.0000
Subtotal (Total Children Is Unduplicated) 76 138.500000 7690.8800 55.5298
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 5 28.000000 0.0000 0.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 1.750000 94.5000 54.0000
Subtotal (Total Children Is Unduplicated) 7 29.750000 94.5000 3.1765
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Total 3312.250000 124742.1800 37.6609
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Number of Children (Unduplicated) With at Least One Service 1256
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Center 03
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 2 1.000000 37.2000 37.2000
H 0 0.000000 0.0000 0.0000
T 1394 944.250000 35246.5500 35246.5500
3692 2367.000000 89458.4300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5088 3312.250000 124742.1800 35283.7500