CMS/EIP Fiscal Report Center: 02
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 149 57.75 2118.25 36.68
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 135 140.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 148 230.00 8463.75 36.80
TCM-T1017TL-TARGETED CASE MANAGEMENT 497 1224.50 45231.50 36.94
TCON-TCON-TRANSITION CONFERENCE 9 9.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 510 1661.25 55813.50 33.60
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 2 2.00 100.00 50.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.00 55.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.50 112.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 14 20.50 1082.25 52.79
Subtotal (Total Children Is Unduplicated) 17 27.00 1500.25 55.56
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 6.00 156.39 26.07
Subtotal (Total Children Is Unduplicated) 3 6.00 156.39 26.07
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Total 1694.25 57470.14 33.92
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Number of Children (Unduplicated) With at Least One Service 511
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Center 02
Flag Claims Units Chgs Paid
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R 34 21.50 795.50 0.00
U 0 0.00 0.00 0.00
B 883 723.00 26686.25 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
1106 949.75 29988.39 0.00
Other 0 0.00 0.00 0.00
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Total 2023 1694.25 57470.14 0.00