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
Payclass Filters:GR
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 193 197.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 393 448.50 16511.25 36.81
TCM-T1017TL-TARGETED CASE MANAGEMENT 520 1455.00 53178.25 36.55
Subtotal (Total Children Is Unduplicated) 839 2201.50 73426.50 33.35
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.00 50.00 50.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.00 225.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 3.50 194.25 55.50
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 5.00 375.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 20 24.50 1359.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 16.50 1237.50 75.00
Subtotal (Total Children Is Unduplicated) 39 53.50 3441.50 64.33
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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 34 195.25 9712.50 49.74
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 1 1.00 50.00 50.00
INTR-INTR-INTERPRETER 7 23.00 1150.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 1 2.75 186.67 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 3 5.00 250.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 151 25245.0 21806.80 0.86
Subtotal (Total Children Is Unduplicated) 153 25495.0 34293.47 1.35
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Total 27750.00 111161.47 4.01
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Number of Children (Unduplicated) With at Least One Service 877
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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 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 1 98.00 235.80 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
3853 27652.00 110925.67 0.00
Other 0 0.00 0.00 0.00
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Total 3854 27750.00 111161.47 0.00