CMS/EIP Fiscal Report Center: 54
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 843 492.75 18157.75 36.85
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 784 998.00 262.50 0.26
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1311 2108.50 77591.00 36.80
TCM-T1017TL-TARGETED CASE MANAGEMENT 2120 13324.0 488607.00 36.67
TCON-TCON-TRANSITION CONFERENCE 1 1.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2125 16924.3 584618.25 34.54
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Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 3 4.00 610.80 152.70
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.00 50.00 50.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 17 27.00 2550.00 94.44
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 69 96.00 9703.13 101.07
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 43 54.50 3024.75 55.50
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 77 110.50 9431.26 85.35
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 155 197.00 10933.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 317 428.00 43528.15 101.70
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 7 7.00 1043.80 149.11
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
Subtotal (Total Children Is Unduplicated) 511 926.00 80925.39 87.39
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 6.50 325.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.50 12.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 27 28.25 1412.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 8 3.00 75.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 38 48.50 2425.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 3 0.75 18.75 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.00 50.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 0.25 6.25 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 210 1819.50 102870.74 56.54
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 6 15.00 750.00 50.00
INTR-INTR-INTERPRETER 7 27.00 1350.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 6 30.25 4553.93 150.54
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 6 9.00 450.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 332 78911.0 70977.50 0.90
Subtotal (Total Children Is Unduplicated) 340 80900.5 185277.17 2.29
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Total 98750.75 850820.81 8.62
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Number of Children (Unduplicated) With at Least One Service 2126
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Center 54
Flag Claims Units Chgs Paid
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R 17 11.25 407.00 0.00
U 0 0.00 0.00 0.00
B 4077 2717.00 102439.23 0.00
P 7267 4911.50 210332.25 237434.14
D 397 249.00 9722.01 0.00
S 3 99.75 499.35 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
17508 90762.25 527420.97 129.94
Other 0 0.00 0.00 0.00
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Total 29269 98750.75 850820.81 237564.08