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
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 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 655 2446.50 90520.50 37.00
TCON-TCON-TRANSITION CONFERENCE 93 93.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 959 3374.50 104062.50 30.84
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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 5 6.50 487.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 7.50 416.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 138 168.00 12600.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 168 220.00 12210.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 27 31.00 2325.00 75.00
Subtotal (Total Children Is Unduplicated) 222 479.00 30338.75 63.34
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EI Services,Class #03
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 3 260.00 130.00 0.50
Subtotal (Total Children Is Unduplicated) 3 260.00 130.00 0.50
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Total 4113.50 134531.25 32.70
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Number of Children (Unduplicated) With at Least One Service 969
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Center 57
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 1.25 46.25 64.75
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
3963 3847.25 131341.00 0.00
Other 0 0.00 0.00 0.00
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Total 4049 4113.50 134531.25 339.75