CMS/EIP Fiscal Report Center: 07
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 920 790.25 29220.75 36.98
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 380 393.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 516 706.00 26122.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1388 4095.50 151348.50 36.95
TCON-TCON-TRANSITION CONFERENCE 36 36.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1486 6020.75 206691.25 34.33
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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 2 6.00 450.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 57 113.50 6291.00 55.43
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 158 477.50 35812.50 75.00
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 2 2.00 145.56 72.78
SCREEN-T1023-INTERDISCIPLINARY SCREENING 32 32.00 1600.00 50.00
Subtotal (Total Children Is Unduplicated) 189 642.00 44860.06 69.88
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 11 4.75 237.50 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 3 4.50 225.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 62 4059.00 1994.50 0.49
Subtotal (Total Children Is Unduplicated) 74 4068.25 2457.00 0.60
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Total 10731.00 254008.31 23.67
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Number of Children (Unduplicated) With at Least One Service 1488
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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 1965 1394.75 56018.75 0.00
P 5270 6048.00 128200.56 130368.31
D 61 38.00 1463.00 0.00
S 159 126.00 5480.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
2788 3123.75 62827.50 0.00
Other 0 0.00 0.00 0.00
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Total 10244 10731.00 254008.31 130368.31