CMS/EIP Fiscal Report Center: 55
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 175 78.00 2886.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 277 379.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 87 71.25 2636.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 565 1620.00 59653.25 36.82
TCON-TCON-TRANSITION CONFERENCE 31 31.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 571 2179.25 65175.50 29.91
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 4.50 225.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 1 2.00 112.50 56.25
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 0.53 39.92 75.32
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 74 111.00 8325.00 75.00
Subtotal (Total Children Is Unduplicated) 79 118.03 8702.42 73.73
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EI Services,Class #03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.50 101.82 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 30.00 22.00 0.73
Subtotal (Total Children Is Unduplicated) 1 31.50 123.82 3.93
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Total 2328.78 74001.74 31.78
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Number of Children (Unduplicated) With at Least One Service 571
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Center 55
Flag Claims Units Chgs Paid
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R 5 4.75 175.75 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 914 898.75 35413.50 35413.50
D 40 36.75 1758.75 0.00
S 2 2.25 83.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
1579 1386.28 36570.49 0.00
Other 0 0.00 0.00 0.00
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Total 2540 2328.78 74001.74 35413.50