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
Payclass Filters:GR
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 35 75.750000 2802.7500 37.0000
Subtotal (Total Children Is Unduplicated) 59 104.750000 3579.7500 34.1742
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 5 4.500000 225.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 7 8.000000 487.5000 60.9375
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EI Services,Class #03
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 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) 10 895.250000 527.0000 0.5887
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Total 1008.000000 4594.2500 4.5578
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Number of Children (Unduplicated) With at Least One Service 60
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Center 01
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 5 62.250000 113.0000 113.0000
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 2 125.000000 62.5000 62.5000
48 35.750000 1360.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 55 223.000000 1536.2500 175.5000
Center 04
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 4 220.000000 110.0000 90.1000
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
103 57.250000 1904.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 107 277.250000 2014.7500 90.1000
Center 51
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 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 19 7.500000 277.5000 0.0000
Center 53
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 2 145.000000 72.5000 72.5000
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
7 234.000000 239.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10 489.000000 366.5000 127.5000
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 0 0.000000 0.0000 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 9 11.250000 399.2500 112.5000