CMS/EIP Fiscal Report Center: 55
Services beginning 10/01/2013 ending 12/31/2013 Date of Report:02/18/2014 Page: 1
List order: No List
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
CASE-CASE-NON-TCM CASE MANAGEMENT 262 126.000000 4643.5000 36.8532
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 78 100.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 38 27.000000 999.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 275 920.750000 33808.7500 36.7187
TCON-TCON-TRANSITION CONFERENCE 1 1.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 484 1174.750000 39451.2500 33.5827
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Screening, Eval, and Assessment,Class #02
BEHV-BEHV-BEHAVIORAL ASSESSMENT 9 15.000000 1875.0000 125.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 24.000000 1800.0000 75.0000
Subtotal (Total Children Is Unduplicated) 25 39.000000 3675.0000 94.2308
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Total 1213.750000 43126.2500 35.5314
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Number of Children (Unduplicated) With at Least One Service 486
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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 45 50.750000 3058.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.500000 112.5000 0.0000
T 0 0.000000 0.0000 0.0000
1509 1161.500000 39955.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1555 1213.750000 43126.2500 0.0000