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
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 842 492.25 18139.25 36.85
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 778 992.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1305 2101.50 77322.75 36.79
TCM-T1017TL-TARGETED CASE MANAGEMENT 1126 6178.25 226356.75 36.64
TCON-TCON-TRANSITION CONFERENCE 1 1.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1907 9765.00 321818.75 32.96
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Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 1.00 125.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.00 50.00 50.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.50 337.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 15 18.50 1026.75 55.50
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 8.50 637.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 75 98.50 5466.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 52 71.50 5362.50 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.00 50.00 50.00
Subtotal (Total Children Is Unduplicated) 140 204.50 13056.00 63.84
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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 72 590.25 29462.50 49.92
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 8.00 400.00 50.00
INTR-INTR-INTERPRETER 7 27.00 1350.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 4 10.50 712.74 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 3 5.00 250.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 332 78834.0 70900.50 0.90
Subtotal (Total Children Is Unduplicated) 336 79563.5 107400.74 1.35
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Total 89533.00 442275.49 4.94
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Number of Children (Unduplicated) With at Least One Service 1917
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Center 54
Flag Claims Units Chgs Paid
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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 386 240.75 9403.76 0.00
S 1 98.00 235.80 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
16045 89194.25 432635.93 0.00
Other 0 0.00 0.00 0.00
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Total 16432 89533.00 442275.49 0.00