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
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 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 280 736.50 27250.50 37.00
TCON-TCON-TRANSITION CONFERENCE 56 56.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 436 1222.75 32254.75 26.38
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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 47 70.00 3500.00 50.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 6.00 450.00 75.00
Subtotal (Total Children Is Unduplicated) 53 79.00 4325.00 54.75
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Total 1301.75 36579.75 28.10
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Number of Children (Unduplicated) With at Least One Service 437
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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 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 11 10.75 474.25 55.50
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
1444 1291.00 36105.50 0.00
Other 0 0.00 0.00 0.00
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Total 1455 1301.75 36579.75 55.50