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
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 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 201 633.000000 23263.7500 36.7516
TCON-TCON-TRANSITION CONFERENCE 19 19.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 472 1225.250000 29174.5000 23.8111
-----------------------------------------------------------------------------------------------------------------------
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 1 1.500000 112.5000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 27.000000 2025.0000 75.0000
Subtotal (Total Children Is Unduplicated) 27 44.000000 2912.5000 66.1932
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 44.000000 2200.0000 50.0000
Subtotal (Total Children Is Unduplicated) 6 44.000000 2200.0000 50.0000
-----------------------------------------------------------------------------------------------------------------------
Total 1313.250000 34287.0000 26.1085
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 474
-----------------------------------------------------------------------------------------------------------------------
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 1.500000 55.5000 0.0000
P 0 0.000000 0.0000 0.0000
D 39 47.500000 2518.5000 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
1595 1264.250000 31713.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1636 1313.250000 34287.0000 0.0000