CMS/EIP Fiscal Report Center: 54
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 293 120.50 4458.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 213 221.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 447 583.25 21571.00 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 1235 3836.50 141543.50 36.89
Subtotal (Total Children Is Unduplicated) 1253 4761.25 167573.00 35.20
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Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 1 1.00 125.00 125.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 4.00 300.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 16 19.00 1678.13 88.32
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 6.50 360.75 55.50
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 22 28.00 2100.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 28 38.50 2136.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 55 73.50 6918.78 94.13
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 114 172.50 13716.41 79.52
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 6 5.75 287.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 1.00 25.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 20 16.25 812.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 2 0.75 18.75 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 3.00 150.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.00 25.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 129 676.50 34177.46 50.52
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 7 13.00 650.00 50.00
INTR-INTR-INTERPRETER 10 15.50 775.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 1 2.00 135.76 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.00 50.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 166 23868.0 20045.67 0.84
Subtotal (Total Children Is Unduplicated) 171 24603.8 57152.64 2.32
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Total 29537.50 238442.05 8.07
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Number of Children (Unduplicated) With at Least One Service 1273
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Center 54
Flag Claims Units Chgs Paid
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R 4 2.50 92.50 0.00
U 0 0.00 0.00 0.00
B 94 89.00 4788.26 0.00
P 3530 2413.75 98584.37 96969.55
D 254 172.00 6778.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 1 0.25 9.25 0.00
4574 26860.00 128189.67 0.00
Other 0 0.00 0.00 0.00
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Total 8457 29537.50 238442.05 96969.55