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
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 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 554 1616.75 59542.25 36.83
Subtotal (Total Children Is Unduplicated) 920 2568.00 86709.50 33.77
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.50 187.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 6.00 333.00 55.50
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 9.50 712.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 14 17.00 943.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 27.00 2025.00 75.00
Subtotal (Total Children Is Unduplicated) 41 62.00 4201.50 67.77
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EI Services,Class #03
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 35 175.00 8750.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 6.50 325.00 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 193 26094.0 22036.60 0.84
Subtotal (Total Children Is Unduplicated) 195 26305.8 32611.60 1.24
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Total 28935.75 123522.60 4.27
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Number of Children (Unduplicated) With at Least One Service 969
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Center 54
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 1 1.50 55.50 129.50
D 56 37.75 1396.75 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
4445 28896.50 122070.35 0.00
Other 0 0.00 0.00 0.00
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Total 4502 28935.75 123522.60 129.50