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
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 538 244.50 9018.75 36.89
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 384 477.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 538 974.50 35890.00 36.83
TCM-T1017TL-TARGETED CASE MANAGEMENT 412 1747.50 64480.75 36.90
TCON-TCON-TRANSITION CONFERENCE 73 73.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 940 3516.50 109389.50 31.11
----------------------------------------------------------------------------------------------------------------
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 1 1.50 112.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 42 60.50 3302.25 54.58
Subtotal (Total Children Is Unduplicated) 47 68.50 3795.25 55.41
----------------------------------------------------------------------------------------------------------------
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
Subtotal (Total Children Is Unduplicated) 11 17.25 2754.99 159.71
----------------------------------------------------------------------------------------------------------------
Total 3602.25 115939.74 32.19
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 941
----------------------------------------------------------------------------------------------------------------
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
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 0 0.00 0.00 0.00
4516 3602.25 115939.74 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4516 3602.25 115939.74 0.00