CMS/EIP Fiscal Report Center: 51
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 429 329.75 12191.50 36.97
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 310 409.50 15151.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 805 3230.25 119500.75 36.99
Subtotal (Total Children Is Unduplicated) 818 3969.50 146843.75 36.99
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.50 187.50 75.00
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 1.50 75.00 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 5.00 375.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 2.00 150.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 17.00 1275.00 75.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 4 6.00 291.00 48.50
Subtotal (Total Children Is Unduplicated) 23 34.00 2353.50 69.22
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 22 77.00 3850.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 19 120.00 7540.66 62.84
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 13.20 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 18 1840.00 914.00 0.50
Subtotal (Total Children Is Unduplicated) 39 2038.00 12317.86 6.04
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Total 6041.50 161515.11 26.73
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Number of Children (Unduplicated) With at Least One Service 823
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Center 51
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 2949 1928.00 72824.76 0.00
P 1 1.50 75.00 75.00
D 54 32.50 1202.50 0.00
S 0 0.00 0.00 0.00
H 1 2.00 150.00 0.00
T 1 0.50 18.50 0.00
3664 4077.00 87244.35 0.00
Other 0 0.00 0.00 0.00
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Total 6670 6041.50 161515.11 75.00