CMS/EIP Fiscal Report Center: 10
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:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 852 836.500000 30932.0000 36.9779
TCM-T1017TL-TARGETED CASE MANAGEMENT 883 2459.250000 90992.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1412 3295.750000 121924.2500 36.9944
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 6 14.500000 725.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.500000 487.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 37.000000 2775.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 9.000000 675.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 12.000000 900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 18 32.500000 1803.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 25.000000 1875.0000 75.0000
Subtotal (Total Children Is Unduplicated) 46 151.000000 10231.2500 67.7566
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
TRAV-FLAT-PROV TRAVEL TO NATL ENV $10 PER CHILD 1 1.000000 10.0000 10.0000
Subtotal (Total Children Is Unduplicated) 1 2.000000 60.0000 30.0000
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Total 3448.750000 132215.5000 38.3372
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Number of Children (Unduplicated) With at Least One Service 1425
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Center 10
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 2 2.000000 60.0000 60.0000
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
4935 3446.750000 132155.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4937 3448.750000 132215.5000 60.0000