CMS/EIP Fiscal Report Center: 05
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 182 76.500000 2830.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 319 360.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 315 287.750000 10646.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 281 986.000000 36454.2500 36.9719
Subtotal (Total Children Is Unduplicated) 575 1710.250000 49931.5000 29.1954
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.000000 30.0000 30.0000
Subtotal (Total Children Is Unduplicated) 1 1.000000 30.0000 30.0000
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EI Services,Class #03
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 4 302.000000 151.0000 0.5000
Subtotal (Total Children Is Unduplicated) 4 305.000000 301.0000 0.9869
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Total 2016.250000 50262.5000 24.9287
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Number of Children (Unduplicated) With at Least One Service 577
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Center 05
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2691 2016.250000 50262.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2691 2016.250000 50262.5000 0.0000