CMS/EIP Fiscal Report Center: 51
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 365 270.50 10008.50 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 299 410.25 15179.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 780 3297.75 121912.75 36.97
Subtotal (Total Children Is Unduplicated) 793 3978.50 147100.50 36.97
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 20 25.00 1875.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 15.00 1125.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 17.00 1275.00 75.00
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 10 12.00 486.00 40.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 35 71.00 4858.00 68.42
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 13.00 650.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 16 109.00 7398.92 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 15 1507.00 753.50 0.50
Subtotal (Total Children Is Unduplicated) 24 1629.00 8802.42 5.40
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Total 5678.50 160760.92 28.31
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Number of Children (Unduplicated) With at Least One Service 795
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Center 51
Flag Claims Units Chgs Paid
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R 2 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 3114 2125.75 80685.22 0.00
P 1 0.25 9.25 0.00
D 13 8.00 303.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
3390 3543.50 79726.45 0.00
Other 0 0.00 0.00 0.00
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Total 6520 5678.50 160760.92 0.00