CMS/EIP Fiscal Report Center: 54
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 240 101.00 3737.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 195 199.00 262.50 1.32
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 397 451.25 16613.00 36.82
TCM-T1017TL-TARGETED CASE MANAGEMENT 1103 3255.25 118964.25 36.55
Subtotal (Total Children Is Unduplicated) 1111 4006.50 139576.75 34.84
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.00 50.00 50.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 5.00 375.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 17.00 1612.50 94.85
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 9.50 527.25 55.50
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 26 37.00 3262.50 88.18
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 47 59.50 3302.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 52 69.00 5775.00 83.70
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.00 408.90 102.23
Subtotal (Total Children Is Unduplicated) 119 202.00 15313.40 75.81
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.00 50.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 7 4.25 212.50 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 16 17.25 862.50 50.00
CONOP-CONOP-CONSULT, OT, PHONE 2 0.50 12.50 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 113 618.00 36212.40 58.60
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 3.00 150.00 50.00
INTR-INTR-INTERPRETER 7 23.00 1150.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 6 12.50 2165.11 173.21
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 5 8.00 400.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 151 25245.0 21806.80 0.86
Subtotal (Total Children Is Unduplicated) 159 25932.5 63021.81 2.43
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Total 30141.00 217911.96 7.23
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Number of Children (Unduplicated) With at Least One Service 1126
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Center 54
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 1962 1351.25 51931.00 0.00
P 711 483.25 21258.35 19552.44
D 0 0.00 0.00 0.00
S 2 99.00 471.60 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
4425 28207.50 144251.01 0.00
Other 0 0.00 0.00 0.00
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Total 7100 30141.00 217911.96 19552.44