CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/15/2012 Page: 1
List order: No List
Payclass Filters:GR
Eligibility Filter:DEI Only
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 16 6.000000 222.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 2.750000 101.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 18 40.000000 1480.0000 37.0000
Subtotal (Total Children Is Unduplicated) 31 48.750000 1803.7500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 0.500000 37.5000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 0.500000 37.5000 75.0000
Subtotal (Total Children Is Unduplicated) 2 2.000000 130.5000 65.2500
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EI Services,Class #03
INTR-INTR-INTERPRETER 1 0.250000 7.5000 30.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 4 75.000000 37.5000 0.5000
Subtotal (Total Children Is Unduplicated) 5 75.250000 45.0000 0.5980
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Total 126.000000 1979.2500 15.7083
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Number of Children (Unduplicated) With at Least One Service 37
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Center 01
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 4 21.750000 110.5000 110.5000
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 3 55.000000 27.5000 27.5000
62 49.250000 1841.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 69 126.000000 1979.2500 138.0000