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
Payclass Filters:OTHER
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 7 23.250000 860.2500 37.0000
Subtotal (Total Children Is Unduplicated) 7 23.250000 860.2500 37.0000
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 3.500000 175.0000 50.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 53 45.000000 2250.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 19 19.250000 962.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 21 18.500000 925.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 56 47.250000 2362.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 0.500000 12.5000 25.0000
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 953 79520.00000 39760.0000 0.5000
Subtotal (Total Children Is Unduplicated) 956 79655.00000 46472.5000 0.5834
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Total 79678.250000 47332.7500 0.5940
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Number of Children (Unduplicated) With at Least One Service 960
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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 0 0.000000 0.0000 0.0000
P 1575 77027.000000 44911.0000 44911.0000
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 2651.250000 2421.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1639 79678.250000 47332.7500 44911.0000