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
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 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 597 2127.00 78547.00 36.93
TCON-TCON-TRANSITION CONFERENCE 3 3.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 886 3154.50 91737.50 29.08
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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 3 3.00 225.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 3.00 166.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 85 85.00 6348.50 74.69
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 25 25.00 1875.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 127 127.00 7048.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 16.00 1175.00 73.44
SCREEN-T1023-INTERDISCIPLINARY SCREENING 4 4.00 200.00 50.00
Subtotal (Total Children Is Unduplicated) 143 274.00 17448.50 63.68
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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
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Total 3536.00 109363.50 30.93
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Number of Children (Unduplicated) With at Least One Service 886
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Center 57
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 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 12 46.00 17.50 424.50
3689 3490.00 109346.00 0.00
Other 0 0.00 0.00 0.00
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Total 3701 3536.00 109363.50 424.50