CMS/EIP Fiscal Report Center: 55
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 133 63.00 2331.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 256 311.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 59 36.50 1350.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 626 1690.75 62400.50 36.91
TCON-TCON-TRANSITION CONFERENCE 37 37.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 629 2138.25 66082.00 30.90
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Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 6 9.00 1125.00 125.00
EVAL-EVAL-DEVELOPMENTAL EVALUATION 27 39.50 1975.00 50.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.00 225.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.00 675.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.50 112.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.00 333.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 49 73.00 5475.00 75.00
Subtotal (Total Children Is Unduplicated) 85 141.00 9920.50 70.36
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EI Services,Class #03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 0.75 50.91 67.88
Subtotal (Total Children Is Unduplicated) 1 0.75 50.91 67.88
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Total 2280.00 76053.41 33.36
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Number of Children (Unduplicated) With at Least One Service 629
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Center 55
Flag Claims Units Chgs Paid
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R 30 38.25 1415.25 0.00
U 0 0.00 0.00 0.00
B 11 15.00 1068.00 0.00
P 856 815.50 31115.75 31115.75
D 16 12.25 453.25 0.00
S 6 7.25 268.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
1543 1391.75 41732.91 0.00
Other 0 0.00 0.00 0.00
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Total 2462 2280.00 76053.41 31115.75