CMS/EIP Fiscal Report Center: 55
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Eligibility Filter:Not Part C
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 31 12.50 453.25 36.26
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 27 30.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 35 15.25 564.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 66 290.25 10711.50 36.90
Subtotal (Total Children Is Unduplicated) 66 348.00 11729.00 33.70
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 34 64.00 4800.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 39.00 2887.50 74.04
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 4.50 337.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 47.00 2580.75 54.91
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 13.50 1012.50 75.00
Subtotal (Total Children Is Unduplicated) 47 172.00 11879.25 69.07
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EI Services,Class #03
INTR-INTR-INTERPRETER 1 2.00 70.00 35.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 56.00 24.92 0.45
Subtotal (Total Children Is Unduplicated) 1 58.00 94.92 1.64
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Total 578.00 23703.17 41.01
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Number of Children (Unduplicated) With at Least One Service 66
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Center 55
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 133 151.50 6220.75 6220.75
D 3 5.25 194.25 0.00
S 5 5.00 185.00 0.00
H 0 0.00 0.00 0.00
T 24 96.90 2788.29 2788.29
310 319.35 14314.88 0.00
Other 0 0.00 0.00 0.00
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Total 475 578.00 23703.17 9009.04