CMS/EIP Fiscal Report Center: 05
Services beginning 04/01/2025 ending 06/30/2025 Date of Report:07/19/2025 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 168 69.250000 2576.1000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 66 59.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 161 350.750000 13047.9000 37.2000
Subtotal (Total Children Is Unduplicated) 274 479.500000 15624.0000 32.5839
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 98.9100 98.9100
Subtotal (Total Children Is Unduplicated) 1 1.000000 98.9100 98.9100
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Total 480.500000 15722.9100 32.7220
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Number of Children (Unduplicated) With at Least One Service 274
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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 19 7.000000 260.4000 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
1063 471.250000 15378.8100 98.9100
Other 4 2.250000 83.7000 0.0000
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Total 1086 480.500000 15722.9100 98.9100