CMS/EIP Fiscal Report Center: 57
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
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 607 452.000000 16724.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 236 178.250000 6595.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1217 3939.000000 145743.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1245 4569.250000 169062.2500 37.0000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 112 112.000000 5600.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 15.000000 1125.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 14.000000 777.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 162 187.000000 14025.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 13.500000 1012.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 208 271.500000 15068.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 104 142.000000 10650.0000 75.0000
Subtotal (Total Children Is Unduplicated) 363 767.500000 49195.2500 64.0980
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EI Services,Class #03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 10.000000 678.8000 67.8800
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 1 15.000000 10.5000 0.7000
Subtotal (Total Children Is Unduplicated) 3 25.000000 689.3000 27.5720
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Total 5361.750000 218946.8000 40.8350
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Number of Children (Unduplicated) With at Least One Service 1251
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Center 57
Flag Claims Units Chgs Paid
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R 31 21.000000 777.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1655 1295.750000 52108.2500 0.0000
P 1231 1197.750000 50249.5000 50203.2500
D 36 30.250000 1317.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 15.000000 10.5000 10.5000
3893 2802.000000 114484.0500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6847 5361.750000 218946.8000 50213.7500