CMS/EIP Fiscal Report Center: 53
Services beginning 10/01/2012 ending 12/31/2012 Date of Report:02/16/2013 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 232 157.500000 5827.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 65 66.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 159 159.750000 5910.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 111 186.250000 6891.2500 37.0000
TCON-TCON-TRANSITION CONFERENCE 14 14.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 348 583.500000 18629.5000 31.9272
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 18 152.000000 7600.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
Subtotal (Total Children Is Unduplicated) 22 160.000000 8122.0000 50.7625
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 20 25.500000 1275.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 3 1.750000 43.7500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 43 32.250000 1612.5000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 2 1.750000 43.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 11 14.000000 700.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 18 16.750000 837.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.250000 31.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 23 24.500000 1225.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 3.000000 75.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 29 72.736000 3636.8000 50.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 2.000000 100.0000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 215 20764.00000 10382.0000 0.5000
Subtotal (Total Children Is Unduplicated) 228 20959.48600 19962.5500 0.9524
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Total 21702.986000 46714.0500 2.1524
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Number of Children (Unduplicated) With at Least One Service 436
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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 1683 21507.986000 45874.0500 45833.0500
T 0 0.000000 0.0000 0.0000
29 195.000000 840.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1712 21702.986000 46714.0500 45833.0500