CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2008 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 283 169.25 6262.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 476 609.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 279 353.75 11628.75 32.87
TCM-T1017TL-TARGETED CASE MANAGEMENT 622 2408.00 89077.50 36.99
TCON-TCON-TRANSITION CONFERENCE 65 65.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 950 3605.00 106968.50 29.67
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.00 50.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 45 45.00 2250.00 50.00
FANE-FANE-FAMILY INTERVIEW BY COMMUNITY PROVIDER 3 4.00 120.00 30.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.00 75.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 5.00 277.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 115 116.00 8700.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 146 146.00 8103.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 27 27.00 2025.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 3 4.00 200.00 50.00
Subtotal (Total Children Is Unduplicated) 201 351.00 21950.50 62.54
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.00 50.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 5 155.00 77.50 0.50
Subtotal (Total Children Is Unduplicated) 6 156.00 127.50 0.82
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Total 4112.00 129046.50 31.38
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Number of Children (Unduplicated) With at Least One Service 967
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Center 57
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 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 23 16.50 425.50 610.50
4110 4095.50 128621.00 0.00
Other 0 0.00 0.00 0.00
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Total 4133 4112.00 129046.50 610.50