CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2008 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 540 246.25 9083.50 36.89
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 385 480.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 540 977.25 35991.75 36.83
TCM-T1017TL-TARGETED CASE MANAGEMENT 1114 4885.00 180105.75 36.87
TCON-TCON-TRANSITION CONFERENCE 74 74.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1132 6662.50 225181.00 33.80
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.50 75.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 2 2.00 100.00 50.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.00 55.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.50 487.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 6.00 450.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.00 150.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 88 126.50 6882.00 54.40
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.00 75.00 75.00
Subtotal (Total Children Is Unduplicated) 96 146.50 8275.00 56.48
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 9 14.00 2592.49 185.18
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 2 3.25 162.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.00 50.00 50.00
Subtotal (Total Children Is Unduplicated) 12 18.25 2804.99 153.70
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Total 6827.25 236260.99 34.61
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Number of Children (Unduplicated) With at Least One Service 1132
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Center 02
Flag Claims Units Chgs Paid
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R 10 6.50 240.50 0.00
U 0 0.00 0.00 0.00
B 3512 2674.00 98623.50 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 0 0.00 0.00 0.00
5055 4146.75 137396.99 0.00
Other 0 0.00 0.00 0.00
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Total 8577 6827.25 236260.99 0.00