CMS/EIP Fiscal Report Center: 07
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Payclass Filters:GR
Eligibility Filter:Not Part C
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 72 54.25 2007.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 68 91.25 3376.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 62 198.50 7344.50 37.00
Subtotal (Total Children Is Unduplicated) 106 345.00 12728.00 36.89
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.50 83.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 14.00 1050.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 2.50 187.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.00 150.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 26 47.00 2608.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 30.50 2287.50 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 11 11.00 550.00 50.00
Subtotal (Total Children Is Unduplicated) 39 110.00 7029.25 63.90
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 1.75 87.50 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 24 1610.00 805.00 0.50
Subtotal (Total Children Is Unduplicated) 28 1611.75 892.50 0.55
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Total 2066.75 20649.75 9.99
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Number of Children (Unduplicated) With at Least One Service 107
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Center 07
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 210 1403.75 9777.50 9777.50
D 0 0.00 0.00 0.00
S 2 0.75 27.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
380 662.25 10844.50 0.00
Other 0 0.00 0.00 0.00
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Total 592 2066.75 20649.75 9777.50