CMS/EIP Fiscal Report Center: 55
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 202 107.250000 3931.2500 36.6550
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 259 342.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 53 40.750000 1507.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 603 1807.250000 66415.0000 36.7492
TCON-TCON-TRANSITION CONFERENCE 18 19.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 607 2316.250000 71854.0000 31.0217
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Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 4 8.000000 1000.0000 125.0000
EXIT-EXIT-TRANSITION ASSESSMENT 1 1.500000 75.0000 50.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 56 83.500000 6262.5000 75.0000
Subtotal (Total Children Is Unduplicated) 65 99.000000 7729.0000 78.0707
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 16 115.000000 5750.0000 50.0000
Subtotal (Total Children Is Unduplicated) 16 115.000000 5750.0000 50.0000
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Total 2530.250000 85333.0000 33.7251
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Number of Children (Unduplicated) With at Least One Service 608
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Center 55
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 13 14.000000 490.2500 0.0000
P 1296 1227.487999 47334.8500 47222.3500
D 33 31.750000 1630.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 2 3.000000 225.0000 0.0000
T 0 0.000000 0.0000 0.0000
1544 1254.012001 35652.1500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2888 2530.250000 85333.0000 47222.3500