CMS/EIP Fiscal Report Center: 09
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 70 69.250000 2562.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 116 78.750000 2913.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 107 343.500000 12709.5000 37.0000
Subtotal (Total Children Is Unduplicated) 203 491.500000 18185.5000 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.000000 825.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 16.500000 915.7500 55.5000
Subtotal (Total Children Is Unduplicated) 10 40.000000 2678.2500 66.9563
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
INTR-INTR-INTERPRETER 48 82.500000 4125.0000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 14 1171.000000 585.5000 0.5000
Subtotal (Total Children Is Unduplicated) 59 1253.500000 4710.5000 3.7579
-----------------------------------------------------------------------------------------------------------------------
Total 1785.000000 25574.2500 14.3273
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 227
-----------------------------------------------------------------------------------------------------------------------
Center 09
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 594 1664.250000 25476.7500 25476.7500
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
3 120.750000 97.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 597 1785.000000 25574.2500 25476.7500