CMS/EIP Fiscal Report Center: 57
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 276 181.00 6697.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 458 668.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 229 175.50 6493.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1037 3456.50 127738.50 36.96
TCON-TCON-TRANSITION CONFERENCE 3 3.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1069 4484.00 140929.00 31.43
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 4 4.00 200.00 50.00
FANE-FANE-FAMILY INTERVIEW BY COMMUNITY PROVIDER 7 7.00 210.00 30.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 5.00 375.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 8.00 444.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 131 131.00 9745.50 74.39
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 40 40.00 3000.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 191 191.00 10600.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 21 21.00 1550.00 73.81
SCREEN-T1023-INTERDISCIPLINARY SCREENING 6 6.00 300.00 50.00
Subtotal (Total Children Is Unduplicated) 214 414.00 26500.00 64.01
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 2.50 125.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 3 105.00 52.50 0.50
Subtotal (Total Children Is Unduplicated) 3 107.50 177.50 1.65
----------------------------------------------------------------------------------------------------------------
Total 5005.50 167606.50 33.48
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1069
----------------------------------------------------------------------------------------------------------------
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 1033 956.50 35403.50 18.50
P 408 374.00 13838.00 13819.50
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 12 46.00 17.50 424.50
3827 3629.00 118347.50 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 5280 5005.50 167606.50 14262.50