CMS/EIP Fiscal Report Center: 57
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 230 139.75 5170.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 456 462.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 337 285.75 10572.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1258 4844.75 178996.75 36.95
TCON-TCON-TRANSITION CONFERENCE 62 62.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1265 5794.25 194740.25 33.61
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 7 9.00 450.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 66 66.00 3300.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 6.50 487.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 0.50 37.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 10.50 582.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 216 284.00 21300.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 229 359.00 19924.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 15.00 1125.00 75.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.00 145.50 48.50
Subtotal (Total Children Is Unduplicated) 310 753.50 47352.75 62.84
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EI Services,Class #03
ECE-ECE-EARLY CHILDHOOD EDUCATION 3 124.00 1116.00 9.00
OCCT-97530-OT SESSION BY LICENSED OT 3 4.00 271.52 67.88
PHY-97110-PT SESSION BY LICENSED PT 3 3.50 237.58 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 16 20.50 1391.54 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 7 342.00 171.00 0.50
Subtotal (Total Children Is Unduplicated) 21 494.00 3187.64 6.45
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Total 7041.75 245280.64 34.83
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Number of Children (Unduplicated) With at Least One Service 1286
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Center 57
Flag Claims Units Chgs Paid
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R 115 143.75 5488.25 0.00
U 0 0.00 0.00 0.00
B 435 494.00 20213.00 0.00
P 1734 1843.75 73087.50 73087.50
D 56 57.25 2569.75 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 24 21.50 462.50 795.50
4092 4481.50 143459.64 120.00
Other 0 0.00 0.00 0.00
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Total 6456 7041.75 245280.64 74003.00