CMS/EIP Fiscal Report Center: 10
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 34 17.25 638.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 709 789.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 713 860.75 31847.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1946 7692.25 284567.00 36.99
TCON-TCON-TRANSITION CONFERENCE 169 169.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1954 9528.25 317053.00 33.28
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 35 59.50 4462.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 16 22.50 1687.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 14 20.50 1537.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 10 17.00 1275.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 28 51.50 2858.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 197 333.50 25012.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 139 235.50 17662.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 98 160.00 12000.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 172 311.00 17260.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 142 186.00 13912.50 74.80
Subtotal (Total Children Is Unduplicated) 361 1397.00 97668.75 69.91
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 6.50 325.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 10 7.75 387.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 43 330.25 16512.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 2 2.00 135.76 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 48 14265.0 7132.50 0.50
Subtotal (Total Children Is Unduplicated) 49 14611.5 24493.26 1.68
----------------------------------------------------------------------------------------------------------------
Total 25536.75 439215.01 17.20
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1957
----------------------------------------------------------------------------------------------------------------
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 2 1.75 64.75 0.00
U 0 0.00 0.00 0.00
B 6270 3994.00 149230.50 0.00
P 595 808.25 52993.75 53021.50
D 93 76.75 3644.75 3644.75
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
8196 20656.00 233281.26 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 15156 25536.75 439215.01 56666.25