CMS/EIP Fiscal Report Center: 55
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 173 83.50 3080.25 36.89
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 289 376.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 89 67.75 2488.25 36.73
TCM-T1017TL-TARGETED CASE MANAGEMENT 559 1688.75 62021.25 36.73
TCON-TCON-TRANSITION CONFERENCE 34 34.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 563 2250.00 67589.75 30.04
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 4 7.00 350.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 11 19.00 1237.50 65.13
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.50 112.50 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 60 89.50 6712.50 75.00
Subtotal (Total Children Is Unduplicated) 76 118.50 8525.00 71.94
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Total 2368.50 76114.75 32.14
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Number of Children (Unduplicated) With at Least One Service 563
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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 9 9.25 399.25 0.00
P 943 892.25 34548.50 34586.00
D 44 47.25 1862.25 0.00
S 12 13.25 528.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
1631 1406.50 38776.00 0.00
Other 0 0.00 0.00 0.00
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Total 2639 2368.50 76114.75 34586.00