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
Payclass Filters:GR
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 8 7.500000 277.5000 37.0000
Subtotal (Total Children Is Unduplicated) 19 30.750000 989.7500 32.1870
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 3.500000 175.0000 50.0000
Subtotal (Total Children Is Unduplicated) 3 3.500000 175.0000 50.0000
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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 37.250000 1188.7500 31.9128
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Number of Children (Unduplicated) With at Least One Service 19
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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 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 0 0.000000 0.0000 0.0000
64 34.750000 1133.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 64 34.750000 1133.2500 0.0000
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 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 0 0.000000 0.0000 0.0000
5 2.500000 55.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5 2.500000 55.5000 0.0000