CMS/EIP Fiscal Report Center: 57
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 212 124.500000 4606.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2 2.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 192 176.000000 6512.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1132 4523.750000 167378.7500 37.0000
TCON-TCON-TRANSITION CONFERENCE 1 1.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1144 4827.250000 178497.2500 36.9770
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.000000 50.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 82 82.500000 4125.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 10.500000 787.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 15.500000 860.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 202 239.000000 17925.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 221 336.000000 18648.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 26.000000 1950.0000 75.0000
Subtotal (Total Children Is Unduplicated) 316 715.500000 44720.7500 62.5028
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EI Services,Class #03
ECE-ECE-EARLY CHILDHOOD EDUCATION 1 76.000000 76.0000 1.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 2.500000 169.7000 67.8800
PHY-97110-PT SESSION BY LICENSED PT 1 3.500000 237.5800 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 271.5200 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 38.000000 19.0000 0.5000
Subtotal (Total Children Is Unduplicated) 2 124.000000 773.8000 6.2403
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Total 5666.750000 223991.8000 39.5274
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Number of Children (Unduplicated) With at Least One Service 1151
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Center 57
Flag Claims Units Chgs Paid
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R 75 75.250000 2784.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1060 1088.500000 48540.2500 0.0000
P 2012 1930.750000 71474.7500 71395.3300
D 15 13.000000 481.0000 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
2632 2559.250000 100711.5500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5794 5666.750000 223991.8000 71395.3300