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
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 504 506.250000 18555.5000 36.6528
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 240 270.000000 9953.0000 36.8630
TCM-T1017TL-TARGETED CASE MANAGEMENT 143 242.000000 8898.5000 36.7707
Subtotal (Total Children Is Unduplicated) 542 1018.250000 37407.0000 36.7366
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 1.500000 75.0000 50.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 15.000000 832.5000 55.5000
Subtotal (Total Children Is Unduplicated) 9 16.500000 907.5000 55.0000
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 325.0000 325.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 4.000000 200.0000 50.0000
Subtotal (Total Children Is Unduplicated) 2 5.000000 525.0000 105.0000
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Total 1039.750000 38839.5000 37.3547
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Number of Children (Unduplicated) With at Least One Service 542
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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 1 1.000000 325.0000 325.0000
2019 1038.750000 38514.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2020 1039.750000 38839.5000 325.0000