CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/16/2009 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 182 87.00 3219.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 320 379.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 388 352.50 13042.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 215 543.50 20109.50 37.00
TCON-TCON-TRANSITION CONFERENCE 53 53.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 535 1415.00 36371.00 25.70
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 0.91 44.01 48.36
EXIT-EXIT-TRANSITION ASSESSMENT 55 102.25 5112.50 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 1.50 83.25 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.00 166.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 78 145.85 8094.41 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 28.57 2143.06 75.01
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 25.44 1908.33 75.01
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 38 66.68 3700.69 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 28.96 2172.07 75.00
Subtotal (Total Children Is Unduplicated) 150 406.16 23649.82 58.23
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 112 140.75 7037.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 41 33.00 825.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 3.00 150.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 1.00 25.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 3.00 150.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 8 13.75 687.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 5 34.50 1725.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 4 31.75 793.75 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 7.00 175.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 27 105.00 5250.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 4.00 200.00 50.00
INTR-INTR-INTERPRETER 10 23.00 1150.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 4 7.00 350.00 50.00
TRAN-TRAN-FAMILY TRANSPORTATION 1 45.00 4500.00 100.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 333 35239.0 17619.50 0.50
Subtotal (Total Children Is Unduplicated) 382 35690.8 40638.25 1.14
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Total 37511.91 100659.07 2.68
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Number of Children (Unduplicated) With at Least One Service 587
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Center 53
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 7 10.00 535.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 1066 11120.18 28520.37 28520.37
2471 26381.73 71603.70 0.00
Other 0 0.00 0.00 0.00
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Total 3544 37511.91 100659.07 28520.37