CMS/EIP Fiscal Report Center: 54
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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 266 103.50 3829.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 150 156.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 438 558.75 20572.00 36.82
TCM-T1017TL-TARGETED CASE MANAGEMENT 1160 3588.50 132247.25 36.85
TCON-TCON-TRANSITION CONFERENCE 1 1.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1176 4407.75 156648.75 35.54
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 0.50 25.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 1 2.00 100.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 9.50 712.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 20 27.00 2025.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 22 29.50 1637.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.00 675.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 27.50 2062.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 35 59.00 3274.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 55 88.00 6600.00 75.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.00 145.50 48.50
Subtotal (Total Children Is Unduplicated) 121 257.00 17407.25 67.73
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.00 50.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.50 12.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 12 8.75 437.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.50 12.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.00 50.00 50.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.00 25.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 166 918.00 45887.50 49.99
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 4 9.00 450.00 50.00
INTR-INTR-INTERPRETER 7 13.50 675.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 3 2.50 169.70 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 3 3.00 150.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 29 180.00 12218.40 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 5 16.50 217.80 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 223 40896.0 29153.90 0.71
Subtotal (Total Children Is Unduplicated) 228 42051.3 89509.80 2.13
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Total 46716.00 263565.80 5.64
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Number of Children (Unduplicated) With at Least One Service 1193
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Center 54
Flag Claims Units Chgs Paid
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R 68 65.00 2854.50 0.00
U 0 0.00 0.00 0.00
B 1842 1443.75 60635.18 0.00
P 2080 1495.50 61825.36 61787.48
D 111 74.75 3198.98 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
4278 43637.00 135051.78 0.00
Other 0 0.00 0.00 0.00
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Total 8379 46716.00 263565.80 61787.48