CMS/EIP Fiscal Report Center: 55
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 133 65.50 2423.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 228 295.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 85 69.75 2580.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 604 1653.25 61151.75 36.99
TCON-TCON-TRANSITION CONFERENCE 56 56.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 607 2139.50 66156.00 30.92
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Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 2 3.00 375.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 52 77.50 3875.00 50.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.00 225.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 46.50 3487.50 75.00
Subtotal (Total Children Is Unduplicated) 87 130.00 7962.50 61.25
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Total 2269.50 74118.50 32.66
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Number of Children (Unduplicated) With at Least One Service 607
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Center 55
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 129 154.75 6181.75 0.00
P 745 738.75 27828.25 27828.25
D 11 10.75 474.25 55.50
S 11 12.75 471.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
1494 1352.50 39162.50 0.00
Other 0 0.00 0.00 0.00
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Total 2390 2269.50 74118.50 27883.75