CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2012 ending 03/31/2012 Date of Report:05/15/2012 Page: 1
List order: No List
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 72 79.750000 2941.5000 36.8840
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 50 50.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 104 125.500000 4625.0000 36.8526
TCM-T1017TL-TARGETED CASE MANAGEMENT 107 576.250000 21210.2500 36.8074
Subtotal (Total Children Is Unduplicated) 107 831.500000 28776.7500 34.6082
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 1 1.500000 75.0000 50.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 63 124.500000 6909.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 63 123.500000 9262.5000 75.0000
Subtotal (Total Children Is Unduplicated) 74 283.500000 18602.2500 65.6164
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.500000 75.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 21.000000 1050.0000 50.0000
INTR-INTR-INTERPRETER 1 2.000000 100.0000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 74 7541.000000 3770.5000 0.5000
Subtotal (Total Children Is Unduplicated) 74 7565.500000 4995.5000 0.6603
-----------------------------------------------------------------------------------------------------------------------
Total 8680.500000 52374.5000 6.0336
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 107
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 95 136.750000 5337.7500 0.0000
P 238 293.250000 13062.5000 13044.0000
D 38 47.500000 1807.5000 0.0000
S 50 55.250000 2344.2500 0.0000
H 24 785.000000 938.0000 938.0000
T 30 1322.000000 1405.0000 1405.0000
735 6040.750000 27479.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1210 8680.500000 52374.5000 15387.0000