CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2014 ending 03/31/2014 Date of Report:06/03/2014 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 12 34.500000 1276.5000 37.0000
Subtotal (Total Children Is Unduplicated) 12 34.500000 1276.5000 37.0000
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EI Services,Class #03
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 15 11.500000 575.0000 50.0000
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 119 5582.000000 2791.0000 0.5000
Subtotal (Total Children Is Unduplicated) 129 5596.500000 3516.0000 0.6283
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Total 5631.000000 4792.5000 0.8511
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Number of Children (Unduplicated) With at Least One Service 141
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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 265 5581.500000 3508.5000 3508.5000
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
44 49.500000 1284.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 309 5631.000000 4792.5000 3508.5000