CMS/EIP Fiscal Report Center: 55
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
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 212 112.000000 4125.5000 36.8348
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 303 413.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 65 48.250000 1785.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 690 2155.500000 79346.2500 36.8111
TCON-TCON-TRANSITION CONFERENCE 19 19.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 691 2747.750000 85257.0000 31.0279
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 8 15.500000 775.0000 50.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 70 104.500000 7837.5000 75.0000
Subtotal (Total Children Is Unduplicated) 82 127.500000 9145.7500 71.7314
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 84.500000 4225.0000 50.0000
Subtotal (Total Children Is Unduplicated) 14 84.500000 4225.0000 50.0000
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Total 2959.750000 98627.7500 33.3230
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Number of Children (Unduplicated) With at Least One Service 693
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Center 55
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 41 43.000000 1591.0000 0.0000
P 1631 1534.000000 59537.7500 59537.7500
D 39 47.500000 2518.5000 0.0000
S 4 3.500000 129.5000 0.0000
H 1 1.500000 112.5000 0.0000
T 0 0.000000 0.0000 0.0000
1662 1330.250000 34738.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3378 2959.750000 98627.7500 59537.7500