CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2011 ending 09/30/2011 Date of Report:11/30/2011 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 44 39.750000 1461.5000 36.7673
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 34 34.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 71 69.250000 2562.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 77 320.500000 11840.0000 36.9423
Subtotal (Total Children Is Unduplicated) 79 463.500000 15863.7500 34.2260
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 35 69.500000 3857.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 39 90.500000 6787.5000 75.0000
Subtotal (Total Children Is Unduplicated) 46 184.000000 12366.7500 67.2106
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
INTR-INTR-INTERPRETER 1 2.000000 100.0000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 48 3880.000000 1940.0000 0.5000
Subtotal (Total Children Is Unduplicated) 48 3883.000000 2090.0000 0.5382
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Total 4530.500000 30320.5000 6.6925
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Number of Children (Unduplicated) With at Least One Service 81
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Center 53
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 10 9.500000 427.5000 0.0000
P 251 294.250000 12501.5000 12501.5000
D 4 8.000000 600.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 25.000000 12.5000 12.5000
T 123 1160.000000 3167.0000 3167.0000
328 3033.750000 13612.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 717 4530.500000 30320.5000 15681.0000