CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2013 ending 03/31/2013 Date of Report:05/17/2013 Page: 1
List order: No List
Payclass Filters:GR
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 51 62.250000 2285.2500 36.7108
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 45 64.000000 2368.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 19 47.250000 1748.2500 37.0000
Subtotal (Total Children Is Unduplicated) 53 173.500000 6401.5000 36.8963
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 2.750000 137.5000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 13.000000 975.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 9.500000 527.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
Subtotal (Total Children Is Unduplicated) 10 30.250000 2014.7500 66.6033
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EI Services,Class #03
INTR-INTR-INTERPRETER 1 10.000000 500.0000 50.0000
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 28 1767.000000 883.5000 0.5000
Subtotal (Total Children Is Unduplicated) 28 1777.000000 1383.5000 0.7786
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Total 1980.750000 9799.7500 4.9475
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Number of Children (Unduplicated) With at Least One Service 53
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Center 02
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 23 642.500000 1026.5000 1026.5000
348 1338.250000 8773.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 371 1980.750000 9799.7500 1026.5000