CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2012 ending 09/30/2012 Date of Report:11/15/2012 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 484 432.500000 15863.7500 36.6792
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 246 274.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 358 495.750000 18305.7500 36.9254
TCM-T1017TL-TARGETED CASE MANAGEMENT 211 666.000000 24531.0000 36.8333
TCON-TCON-TRANSITION CONFERENCE 45 45.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 629 1913.250000 58700.5000 30.6810
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-TRANSITION ASSESSMENT 63 119.500000 5975.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 15.500000 860.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 81 161.500000 8650.0000 53.5604
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 70 89.750000 4487.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 16 12.500000 312.5000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 93 52.500000 2625.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 8 80.000000 4000.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 37 61.000000 3050.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 7 3.250000 81.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 39 72.250000 3612.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 11 8.250000 206.2500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 4.000000 100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 38 274.590000 13729.5000 50.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 13.000000 650.0000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 348 61439.00000 30640.5000 0.4987
Subtotal (Total Children Is Unduplicated) 368 62110.59000 63507.5000 1.0225
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Total 64185.340000 130858.0000 2.0388
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Number of Children (Unduplicated) With at Least One Service 661
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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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1604 20532.750000 37101.0000 37007.5000
3322 43643.590000 93307.0000 110.5000
Other 9 9.000000 450.0000 0.0000
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Total 4935 64185.340000 130858.0000 37118.0000