CMS/EIP Fiscal Report Center: 01
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Agency Filter:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 840 529.00 19573.00 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 589 582.75 21561.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 2166 5784.75 214017.25 37.00
Subtotal (Total Children Is Unduplicated) 2184 6896.50 255152.00 37.00
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 4.00 200.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 4 7.50 375.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 7.50 562.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 20 35.00 2625.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 17.50 971.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 26 36.50 2737.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 70 92.00 5106.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 91 130.50 9787.50 75.00
Subtotal (Total Children Is Unduplicated) 160 330.50 22364.75 67.67
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 9 18.00 900.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 1.00 25.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 26 99.00 4950.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8 1980.00 990.00 0.50
Subtotal (Total Children Is Unduplicated) 37 2099.00 6915.00 3.29
----------------------------------------------------------------------------------------------------------------
Total 9326.00 284431.75 30.50
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2184
----------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 2 2.50 158.25 0.00
D 0 0.00 0.00 0.00
S 1107 702.50 26020.25 0.00
H 34 40.50 2612.00 0.00
T 271 1780.00 20594.75 20594.75
7472 4557.50 150668.75 0.00
Other 3694 2243.00 84377.75 0.00
-------------------------------------------------
Total 12580 9326.00 284431.75 20594.75