CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2013 ending 12/31/2013 Date of Report:02/18/2014 Page: 1
List order: No List
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 111 115.250000 4264.2500 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 95 53.250000 1970.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 188 667.750000 24706.7500 37.0000
Subtotal (Total Children Is Unduplicated) 195 837.250000 30941.2500 36.9558
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 5.000000 375.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 3.500000 262.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 10.000000 555.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 94 158.500000 11887.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 60 82.000000 6150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 43 71.000000 5325.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 101 188.500000 10461.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 79 121.500000 9112.5000 75.0000
SCREEN-T1023-SCREENING 1 3.000000 150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 190 648.000000 44654.2500 68.9109
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EI Services,Class #03
INTR-INTR-INTERPRETER 46 86.750000 4337.5000 50.0000
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 10 780.000000 390.0000 0.5000
Subtotal (Total Children Is Unduplicated) 54 866.750000 4727.5000 5.4543
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Total 2352.000000 80323.0000 34.1509
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Number of Children (Unduplicated) With at Least One Service 201
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Center 09
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 477 773.750000 40692.2500 0.0000
P 547 1333.000000 22861.2500 22861.2500
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
151 245.250000 16769.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1175 2352.000000 80323.0000 22861.2500