CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2013 ending 03/31/2013 Date of Report:05/17/2013 Page: 1
List order: No List
Eligibility Filter:DEI Only
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 14 7.500000 277.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 3 3.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 29 79.250000 2932.2500 37.0000
Subtotal (Total Children Is Unduplicated) 31 89.750000 3209.7500 35.7632
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 3 2.000000 100.0000 50.0000
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EI Services,Class #03
TRAN-TRAN-FAMILY TRANSPORTATION 2 2.000000 16.0000 8.0000
Subtotal (Total Children Is Unduplicated) 2 2.000000 16.0000 8.0000
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Total 93.750000 3325.7500 35.4747
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Number of Children (Unduplicated) With at Least One Service 31
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Center 04
Flag Claims Units Chgs Paid
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R 10 7.500000 277.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 89 46.750000 1729.7500 0.0000
P 10 10.000000 370.0000 370.0000
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 0 0.000000 0.0000 0.0000
66 29.500000 948.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 175 93.750000 3325.7500 370.0000