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
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 808 352.750000 13051.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 476 497.250000 18398.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 720 1904.000000 70457.2500 37.0049
Subtotal (Total Children Is Unduplicated) 1421 2754.000000 101907.2500 37.0034
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Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 3 4.000000 500.0000 125.0000
EXIT-EXIT-TRANSITION ASSESSMENT 2 4.000000 200.0000 50.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 7.500000 416.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 12.000000 900.0000 75.0000
Subtotal (Total Children Is Unduplicated) 18 29.000000 2128.7500 73.4052
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 26 4211.000000 2105.5000 0.5000
Subtotal (Total Children Is Unduplicated) 27 4213.000000 2205.5000 0.5235
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Total 6996.000000 106241.5000 15.1860
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Number of Children (Unduplicated) With at Least One Service 1434
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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 0 0.000000 0.0000 0.0000
D 28 10.750000 397.7500 0.0000
S 1 2.000000 250.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4713 6982.250000 105543.7500 0.0000
Other 1 1.000000 50.0000 0.0000
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Total 4743 6996.000000 106241.5000 0.0000