CMS/EIP Fiscal Report Center: 57
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 178 108.25 4005.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 463 469.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 303 257.75 9536.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1146 4196.00 155141.00 36.97
TCON-TCON-TRANSITION CONFERENCE 93 93.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1175 5124.00 168683.00 32.92
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 46 46.00 2300.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 18 22.50 1687.50 75.00
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 21 29.00 1609.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 240 286.50 21487.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 287 372.00 20646.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 42 49.50 3712.50 75.00
Subtotal (Total Children Is Unduplicated) 356 808.00 51630.50 63.90
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 6.00 300.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 3 260.00 130.00 0.50
Subtotal (Total Children Is Unduplicated) 3 266.00 430.00 1.62
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Total 6198.00 220743.50 35.62
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Number of Children (Unduplicated) With at Least One Service 1180
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Center 57
Flag Claims Units Chgs Paid
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R 242 244.00 9553.50 0.00
U 0 0.00 0.00 0.00
B 369 376.75 15993.25 0.00
P 1248 1332.00 52163.00 52181.50
D 79 80.00 3054.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 6 185.00 90.00 275.00
4087 3980.25 139889.75 0.00
Other 0 0.00 0.00 0.00
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Total 6031 6198.00 220743.50 52456.50