CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2013 ending 06/30/2013 Date of Report:08/18/2013 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 15 19.250000 712.2500 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 4 4.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 31 71.250000 2636.2500 37.0000
Subtotal (Total Children Is Unduplicated) 31 94.500000 3348.5000 35.4339
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 3.500000 175.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 0.500000 37.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
Subtotal (Total Children Is Unduplicated) 4 7.000000 437.5000 62.5000
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EI Services,Class #03
TRAN-TRAN-FAMILY TRANSPORTATION 3 3.000000 24.0000 8.0000
Subtotal (Total Children Is Unduplicated) 3 3.000000 24.0000 8.0000
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Total 104.500000 3810.0000 36.4593
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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 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9 6.500000 240.5000 0.0000
P 63 49.000000 1813.0000 1813.0000
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
67 36.250000 1207.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 139 91.750000 3261.2500 1813.0000
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 0 0.000000 0.0000 0.0000
P 7 8.750000 380.7500 380.7500
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
6 4.000000 168.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 13 12.750000 548.7500 380.7500