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
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 808 352.750000 13051.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 476 497.250000 18398.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2119 5695.500000 210715.0000 36.9968
Subtotal (Total Children Is Unduplicated) 2168 6545.500000 242165.0000 36.9972
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Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 27 37.000000 4625.0000 125.0000
EXIT-EXIT-TRANSITION ASSESSMENT 4 6.000000 300.0000 50.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 16 24.000000 1800.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 14 20.500000 1137.7500 55.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 95 134.000000 7437.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 131 180.500000 13500.0000 74.7922
Subtotal (Total Children Is Unduplicated) 247 402.000000 28799.7500 71.6412
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 5.500000 275.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 23 84.000000 4200.0000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 26 4212.000000 2106.0000 0.5000
Subtotal (Total Children Is Unduplicated) 28 4301.500000 6581.0000 1.5299
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Total 11249.000000 277545.7500 24.6729
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Number of Children (Unduplicated) With at Least One Service 2170
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Center 01
Flag Claims Units Chgs Paid
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R 2 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1439 1011.500000 41104.7500 0.0000
P 3962 3008.250000 115234.7500 115234.7500
D 199 163.750000 8136.2500 0.0000
S 22 26.000000 3025.0000 0.0000
H 40 52.000000 4275.0000 0.0000
T 1 1.250000 46.2500 0.0000
4715 6983.250000 105599.7500 0.0000
Other 1 1.000000 50.0000 0.0000
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Total 10381 11249.000000 277545.7500 115234.7500