CMS/EIP Fiscal Report Center: 03
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: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 94 42.500000 1572.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 6 6.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 36 25.500000 943.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 73 216.500000 8010.5000 37.0000
Subtotal (Total Children Is Unduplicated) 127 290.500000 10526.5000 36.2358
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 8.500000 637.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 11.000000 825.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 9.000000 675.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 40 64.000000 3552.0000 55.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 3 3.000000 150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 49 100.000000 6118.5000 61.1850
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
INTR-INTR-INTERPRETER 2 6.000000 290.0000 48.3333
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 3 200.000000 100.0000 0.5000
Subtotal (Total Children Is Unduplicated) 5 206.000000 390.0000 1.8932
-----------------------------------------------------------------------------------------------------------------------
Total 596.500000 17035.0000 28.5583
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 130
-----------------------------------------------------------------------------------------------------------------------
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 13 20.000000 1069.0000 1069.0000
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 386 262.750000 10721.2500 10721.2500
156 313.750000 5244.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 555 596.500000 17035.0000 11790.2500