CMS/EIP Fiscal Report Center: 54
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 302 120.00 4440.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 207 216.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 465 615.25 22727.25 36.94
TCM-T1017TL-TARGETED CASE MANAGEMENT 1152 3660.00 134874.25 36.85
Subtotal (Total Children Is Unduplicated) 1162 4611.25 162041.50 35.14
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 1.00 125.00 125.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 7.00 993.76 141.97
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 17 23.00 1940.63 84.38
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 11.00 610.50 55.50
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 39 51.50 3862.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 38 48.50 2691.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 78 98.00 8175.02 83.42
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 143 241.00 18447.66 76.55
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.00 50.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 5 4.25 212.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.50 12.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 15 16.50 825.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 136 693.25 35254.75 50.85
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 5 9.50 475.00 50.00
INTR-INTR-INTERPRETER 6 7.00 350.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 2.00 100.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 194 26144.0 22079.10 0.84
Subtotal (Total Children Is Unduplicated) 201 26878.0 59358.85 2.21
----------------------------------------------------------------------------------------------------------------
Total 31730.25 239848.01 7.56
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1186
----------------------------------------------------------------------------------------------------------------
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 3 1.75 64.75 0.00
U 0 0.00 0.00 0.00
B 1103 937.25 44332.25 0.00
P 2550 1664.75 64208.66 61824.69
D 56 37.75 1396.75 0.00
S 1 0.50 18.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
4589 29086.75 129771.60 0.00
Other 2 1.50 55.50 0.00
-------------------------------------------------
Total 8304 31730.25 239848.01 61824.69