CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2012 ending 06/30/2012 Date of Report:08/16/2012 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 426 503.750000 18638.7500 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 274 327.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 427 704.000000 26048.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 223 625.250000 22875.2500 36.5858
TCON-TCON-TRANSITION CONFERENCE 67 68.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 635 2228.000000 67562.0000 30.3241
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 5.000000 242.5000 48.5000
EXIT-EXIT-TRANSITION ASSESSMENT 62 119.750000 5987.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 19.000000 1387.5000 73.0263
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 16.000000 888.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
Subtotal (Total Children Is Unduplicated) 86 185.750000 10260.5000 55.2382
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 63.9900 63.9900
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 61 81.000000 4050.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 20 17.000000 425.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 96 47.000000 2350.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 6 4.250000 106.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 19 19.500000 968.7500 49.6795
CONOP-CONOP-CONSULT, OT, PHONE 3 1.750000 43.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 32 40.500000 2025.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 7 2.250000 56.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 26 40.250000 2012.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 0.500000 12.5000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 45 154.500000 7725.0000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 4.500000 225.0000 50.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 3 6.000000 300.0000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 361 48996.00000 24490.5000 0.4998
Subtotal (Total Children Is Unduplicated) 392 49418.00000 44904.4900 0.9087
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Total 51831.750000 122726.9900 2.3678
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Number of Children (Unduplicated) With at Least One Service 682
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Center 53
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 6 4.000000 148.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 551 15293.000000 17926.7500 17926.7500
3914 36534.750000 104652.2400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4471 51831.750000 122726.9900 17926.7500