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
Payclass Filters:GR
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 701 2613.50 96440.50 36.90
TCON-TCON-TRANSITION CONFERENCE 62 62.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1029 3563.00 112184.00 31.49
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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 3 3.50 262.50 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 4 6.00 333.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 124 160.00 12000.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 131 208.00 11544.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 8.00 600.00 75.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.00 145.50 48.50
Subtotal (Total Children Is Unduplicated) 209 464.00 28672.50 61.79
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EI Services,Class #03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 10 12.50 848.50 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 5 300.00 150.00 0.50
Subtotal (Total Children Is Unduplicated) 15 312.50 998.50 3.20
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Total 4339.50 141855.00 32.69
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Number of Children (Unduplicated) With at Least One Service 1061
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Center 57
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
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
4044 4260.75 138822.75 120.00
Other 0 0.00 0.00 0.00
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Total 4124 4339.50 141855.00 915.50