CMS/EIP Fiscal Report Center: 07
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 2217 3435.75 127104.25 36.99
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1316 1791.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1755 3205.00 118585.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 2673 15468.8 571400.25 36.94
TCON-TCON-TRANSITION CONFERENCE 178 181.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2733 24081.5 817089.50 33.93
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 5 9.00 450.00 50.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 15.50 1162.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 11.50 638.25 55.50
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 366 709.00 39341.25 55.49
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 590 1319.50 98962.50 75.00
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 6 7.00 509.46 72.78
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 3 1.00 50.00 50.00
NUTR-NUTR-UNSPECIFIED NUTRITIONAL EVAL 3 3.00 150.00 50.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 187 187.00 9350.00 50.00
Subtotal (Total Children Is Unduplicated) 723 2262.50 150613.96 66.57
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EI Services,Class #03
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 0.25 12.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 60 25.00 1250.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 8 10.50 525.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 234 14265.0 7097.50 0.50
Subtotal (Total Children Is Unduplicated) 290 14300.8 8885.00 0.62
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Total 40644.75 976588.46 24.03
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Number of Children (Unduplicated) With at Least One Service 2734
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Center 07
Flag Claims Units Chgs Paid
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R 1 0.50 18.50 0.00
U 0 0.00 0.00 0.00
B 5539 3668.00 140503.25 0.00
P 29408 30605.25 689223.09 691340.84
D 119 70.75 2710.53 0.00
S 465 331.25 13425.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
5794 5969.00 130707.34 0.00
Other 0 0.00 0.00 0.00
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Total 41326 40644.75 976588.46 691340.84