CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2012 ending 09/30/2012 Date of Report:11/15/2012 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 27 13.500000 499.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5 5.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 3 1.750000 64.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 106 242.750000 8981.7500 37.0000
Subtotal (Total Children Is Unduplicated) 108 263.000000 9546.0000 36.2966
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 4 3.000000 150.0000 50.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 4.000000 222.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 9.000000 675.0000 75.0000
Subtotal (Total Children Is Unduplicated) 10 16.000000 1047.0000 65.4375
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EI Services,Class #03
INTR-INTR-INTERPRETER 1 1.750000 52.5000 30.0000
TRAN-TRAN-FAMILY TRANSPORTATION 4 4.000000 32.0000 8.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 3 108.000000 54.0000 0.5000
Subtotal (Total Children Is Unduplicated) 7 113.750000 138.5000 1.2176
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Total 392.750000 10731.5000 27.3240
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Number of Children (Unduplicated) With at Least One Service 108
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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 70 49.500000 2020.5000 0.0000
P 49 81.750000 1771.5000 1771.5000
D 5 11.500000 444.0000 0.0000
S 1 1.500000 55.5000 0.0000
H 1 1.000000 75.0000 0.0000
T 1 14.000000 7.0000 7.0000
42 33.000000 1391.5000 0.0000
Other 1 60.000000 30.0000 0.0000
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Total 170 252.250000 5795.0000 1778.5000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 39 31.500000 1165.5000 0.0000
P 95 56.500000 2090.5000 2090.5000
D 6 2.750000 101.7500 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
66 32.250000 968.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 206 123.000000 4326.0000 2090.5000
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
2 0.750000 27.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2 0.750000 27.7500 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 1.250000 46.2500 46.2500
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 1 0.250000 9.2500 9.2500
4 1.000000 37.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7 2.500000 92.5000 55.5000
Center 54
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 0.500000 18.5000 18.5000
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 0 0.000000 0.0000 0.0000
2 0.750000 27.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4 1.250000 46.2500 18.5000
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 11 9.750000 360.7500 360.7500
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
6 3.250000 83.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17 13.000000 444.0000 360.7500