CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2012 ending 06/30/2012 Date of Report:08/16/2012 Page: 1
List order: No List
Eligibility Filter:DEI Only
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 33 18.250000 675.2500 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 7 8.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 2.750000 101.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 117 297.750000 11016.7500 37.0000
Subtotal (Total Children Is Unduplicated) 123 326.750000 11793.7500 36.0941
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 5 4.500000 225.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 10.500000 787.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 7.000000 388.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 13.500000 1012.5000 75.0000
Subtotal (Total Children Is Unduplicated) 18 38.500000 2609.2500 67.7727
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EI Services,Class #03
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 20.000000 1000.0000 50.0000
INTR-INTR-INTERPRETER 1 0.250000 7.5000 30.0000
TRAN-TRAN-FAMILY TRANSPORTATION 3 3.000000 24.0000 8.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8 891.000000 445.5000 0.5000
Subtotal (Total Children Is Unduplicated) 10 915.250000 1527.0000 1.6684
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Total 1280.500000 15930.0000 12.4405
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Number of Children (Unduplicated) With at Least One Service 123
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 3.750000 138.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 71 75.250000 2812.0000 0.0000
P 53 102.250000 1706.5000 1706.5000
D 4 7.000000 323.7500 0.0000
S 4 2.750000 177.2500 0.0000
H 2 2.500000 187.5000 0.0000
T 2 125.000000 62.5000 62.5000
51 38.750000 1556.5000 0.0000
Other 6 8.500000 637.5000 0.0000
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Total 194 365.750000 7602.2500 1769.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 17 9.750000 360.7500 0.0000
P 167 309.250000 3412.2500 3392.3500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 4 11.000000 550.0000 450.0000
T 0 0.000000 0.0000 0.0000
103 57.250000 1904.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 291 387.250000 6227.7500 3842.3500
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.500000 18.5000 0.0000
P 0 0.000000 0.0000 0.0000
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
19 7.500000 277.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 20 8.000000 296.0000 0.0000
Center 52
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 1 0.250000 9.2500 9.2500
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 0.250000 9.2500 9.2500
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 1.000000 37.0000 0.0000
P 7 150.500000 352.0000 352.0000
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 1 110.000000 55.0000 55.0000
17 245.000000 839.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 26 506.500000 1283.0000 407.0000
Center 55
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.500000 112.5000 0.0000
T 1 1.500000 112.5000 112.5000
8 9.750000 286.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10 12.750000 511.7500 112.5000