CMS/EIP Fiscal Report Center: 10
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 5 1.75 64.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 804 888.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 772 838.25 30972.00 36.95
TCM-T1017TL-TARGETED CASE MANAGEMENT 2162 7900.00 292300.00 37.00
TCON-TCON-TRANSITION CONFERENCE 245 245.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 2165 9873.00 323336.75 32.75
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 32 53.50 4012.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 14 24.00 1800.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 14 23.00 1725.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 11.00 825.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 31 58.00 3219.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 207 379.00 28425.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 118 221.00 16575.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 104 177.50 13312.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 200 379.50 21062.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 122 164.00 12300.00 75.00
Subtotal (Total Children Is Unduplicated) 369 1490.50 103256.25 69.28
----------------------------------------------------------------------------------------------------------------
Total 11363.50 426593.00 37.54
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2165
----------------------------------------------------------------------------------------------------------------
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 18 9.00 333.00 0.00
U 0 0.00 0.00 0.00
B 5438 3521.50 137778.00 0.00
P 1328 1130.25 58523.75 58523.75
D 67 44.75 1655.75 1655.75
S 536 369.25 13662.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
8471 6288.75 214640.25 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 15858 11363.50 426593.00 60179.50