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
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 172 83.25 3071.00 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 261 804.00 29526.00 36.72
TCON-TCON-TRANSITION CONFERENCE 34 34.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 453 1365.00 35085.25 25.70
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 5.50 275.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 5 8.00 562.50 70.31
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 26.50 1987.50 75.00
Subtotal (Total Children Is Unduplicated) 27 41.50 2937.50 70.78
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Total 1406.50 38022.75 27.03
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Number of Children (Unduplicated) With at Least One Service 453
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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 0 0.00 0.00 0.00
D 44 47.25 1862.25 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
1594 1359.25 36160.50 0.00
Other 0 0.00 0.00 0.00
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Total 1638 1406.50 38022.75 0.00