CMS/EIP Fiscal Report Center: 07
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 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 1030 823.25 30460.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 390 405.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 564 821.75 30404.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1665 5047.00 186609.50 36.97
TCON-TCON-TRANSITION CONFERENCE 44 44.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1716 7141.00 247474.50 34.66
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 9 20.00 1000.00 50.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 22.50 1687.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.50 294.25 53.50
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 63 122.00 6771.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 179 507.50 37875.00 74.63
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 5 5.00 363.90 72.78
NUTR-97802-NUTRITIONAL EVAL, INITIAL 3 1.50 75.00 50.00
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 1 0.25 12.50 50.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 46 47.00 2350.00 50.00
Subtotal (Total Children Is Unduplicated) 239 731.25 50429.15 68.96
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 22 8.50 425.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.00 50.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 85 4786.00 2393.00 0.50
Subtotal (Total Children Is Unduplicated) 106 4795.50 2868.00 0.60
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Total 12667.75 300771.65 23.74
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Number of Children (Unduplicated) With at Least One Service 1716
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Center 07
Flag Claims Units Chgs Paid
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R 21 10.50 521.50 0.00
U 0 0.00 0.00 0.00
B 1136 697.25 26531.25 0.00
P 3309 2282.50 95849.53 95849.53
D 0 0.00 0.00 0.00
S 75 40.25 1489.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
8399 9637.25 176380.12 0.00
Other 0 0.00 0.00 0.00
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Total 12940 12667.75 300771.65 95849.53