CMS/EIP Fiscal Report Center: 07
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 1044 1048.00 38776.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 407 421.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 628 820.50 30358.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1317 3604.00 133098.25 36.93
TCON-TCON-TRANSITION CONFERENCE 30 30.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1468 5923.50 202232.75 34.14
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 96 182.50 10128.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 129 266.00 19950.00 75.00
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 1.00 72.78 72.78
NUTR-NUTR-UNSPECIFIED NUTRITIONAL EVAL 1 1.00 50.00 50.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 42 42.00 2100.00 50.00
Subtotal (Total Children Is Unduplicated) 170 492.50 32301.53 65.59
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EI Services,Class #03
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 0.25 12.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 16 6.50 325.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 63 3679.00 1839.50 0.50
Subtotal (Total Children Is Unduplicated) 78 3685.75 2177.00 0.59
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Total 10101.75 236711.28 23.43
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Number of Children (Unduplicated) With at Least One Service 1468
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Center 07
Flag Claims Units Chgs Paid
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R 2 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 2846 1818.75 67733.00 0.00
P 2545 2763.50 62863.25 62863.25
D 0 0.00 0.00 0.00
S 214 139.75 5320.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
4729 5378.75 100757.28 0.00
Other 0 0.00 0.00 0.00
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Total 10336 10101.75 236711.28 62863.25