CMS/EIP Fiscal Report Center: 10
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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 6 2.25 83.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 769 871.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 768 897.75 33216.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 2131 7974.00 295038.00 37.00
TCON-TCON-TRANSITION CONFERENCE 218 218.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2134 9963.00 328338.00 32.96
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 23 40.00 3000.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 22 42.50 3187.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 18 32.00 2400.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 7.50 562.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 35 68.50 3801.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 203 362.50 27187.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 131 235.00 17625.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 115 190.00 14250.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 189 357.50 19841.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 114 161.00 12075.00 75.00
Subtotal (Total Children Is Unduplicated) 345 1496.50 103930.50 69.45
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.00 50.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 1 0.75 50.91 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 60.00 30.00 0.50
Subtotal (Total Children Is Unduplicated) 1 61.75 130.91 2.12
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Total 11521.25 432399.41 37.53
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Number of Children (Unduplicated) With at Least One Service 2135
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Center 10
Flag Claims Units Chgs Paid
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R 58 44.75 1655.75 0.00
U 0 0.00 0.00 0.00
B 4097 2721.00 104938.25 9.25
P 2362 1684.50 77192.00 77192.00
D 36 15.75 582.75 582.75
S 250 128.50 5198.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
8930 6926.75 242832.16 0.00
Other 0 0.00 0.00 0.00
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Total 15733 11521.25 432399.41 77784.00