CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 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 529 224.75 8315.75 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 483 510.50 18879.25 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 1869 4669.00 172743.75 37.00
Subtotal (Total Children Is Unduplicated) 1890 5404.25 199938.75 37.00
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 5.00 250.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 2 2.50 125.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 5.50 412.50 75.00
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 6 8.00 444.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 62 91.50 6862.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.50 112.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 68 93.50 5189.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 56 81.50 6112.50 75.00
Subtotal (Total Children Is Unduplicated) 132 292.00 19733.25 67.58
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EI Services,Class #03
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 2 2.50 125.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.50 75.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 18 68.00 3400.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 5.00 250.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 4 10.00 5.00 0.50
Subtotal (Total Children Is Unduplicated) 21 87.00 3855.00 44.31
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Total 5783.25 223527.00 38.65
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Number of Children (Unduplicated) With at Least One Service 1894
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Center 01
Flag Claims Units Chgs Paid
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R 1 0.25 9.25 0.00
U 0 0.00 0.00 0.00
B 776 509.25 18842.25 0.00
P 4 5.00 222.00 0.00
D 179 152.50 6341.25 0.00
S 490 388.00 14356.00 0.00
H 46 64.00 4069.75 0.00
T 2 1.25 46.25 0.00
5173 3091.50 115593.00 0.00
Other 2432 1571.50 64047.25 0.00
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Total 9103 5783.25 223527.00 0.00