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
Payclass Filters:TPIN
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 6 3.75 138.75 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 14 15.00 555.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 73 159.00 5883.00 37.00
Subtotal (Total Children Is Unduplicated) 73 177.75 6576.75 37.00
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 3.00 150.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.50 112.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 7.50 562.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.00 166.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 7.00 525.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 17.50 971.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 25.00 1875.00 75.00
Subtotal (Total Children Is Unduplicated) 30 64.50 4362.75 67.64
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.00 50.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 10.00 500.00 50.00
Subtotal (Total Children Is Unduplicated) 4 12.00 600.00 50.00
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Total 254.25 11539.50 45.39
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Number of Children (Unduplicated) With at Least One Service 104
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Center 01
Flag Claims Units Chgs Paid
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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 4 4.00 148.00 0.00
H 21 26.00 1667.75 0.00
T 31 44.00 2891.00 2891.00
278 177.75 6674.50 0.00
Other 0 0.00 0.00 0.00
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Total 336 254.25 11539.50 2891.00