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
Agency Filter:EIP DEI DEIP
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
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 0.250000 12.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 21 17.500000 875.0000 50.0000
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 115 5506.000000 2753.0000 0.5000
Subtotal (Total Children Is Unduplicated) 126 5524.750000 3690.5000 0.6680
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Total 5548.000000 4550.7500 0.8203
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Number of Children (Unduplicated) With at Least One Service 133
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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 249 5424.750000 3640.5000 3640.5000
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
20 123.250000 910.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 269 5548.000000 4550.7500 3640.5000