CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 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 737 357.00 13209.00 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 702 773.25 28610.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1055 2650.25 98022.25 36.99
Subtotal (Total Children Is Unduplicated) 1610 3780.50 139841.50 36.99
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 4.75 237.50 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 7 12.50 625.00 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 4.50 337.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 10.50 582.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 5.50 412.50 75.00
Subtotal (Total Children Is Unduplicated) 19 37.75 2195.25 58.15
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 18.25 912.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 2.50 125.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 5.00 250.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 6 140.00 70.00 0.50
Subtotal (Total Children Is Unduplicated) 15 165.75 1357.50 8.19
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Total 3984.00 143394.25 35.99
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Number of Children (Unduplicated) With at Least One Service 1619
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Center 01
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 1 1.00 0.50 0.00
S 420 338.00 12506.00 0.00
H 2 3.00 150.00 0.00
T 0 0.00 0.00 0.00
6030 3642.00 130737.75 0.00
Other 0 0.00 0.00 0.00
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Total 6453 3984.00 143394.25 0.00