CMS/EIP Fiscal Report Center: 55
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 194 92.50 3413.25 36.90
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 261 336.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 82 59.50 2201.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 593 1705.75 62446.75 36.61
TCON-TCON-TRANSITION CONFERENCE 35 35.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 601 2228.75 68061.50 30.54
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 2 3.50 225.00 64.29
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 49 73.00 5612.50 76.88
Subtotal (Total Children Is Unduplicated) 52 78.00 5950.00 76.28
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EI Services,Class #03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 2.00 135.76 67.88
Subtotal (Total Children Is Unduplicated) 1 2.00 135.76 67.88
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Total 2308.75 74147.26 32.12
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Number of Children (Unduplicated) With at Least One Service 601
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Center 55
Flag Claims Units Chgs Paid
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R 20 22.25 824.75 0.00
U 0 0.00 0.00 0.00
B 247 207.25 7437.00 0.00
P 809 732.25 28653.75 28644.50
D 34 34.25 1410.00 0.00
S 2 2.50 92.50 0.00
H 1 1.50 250.00 0.00
T 0 0.00 0.00 0.00
1624 1308.75 35479.26 0.00
Other 0 0.00 0.00 0.00
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Total 2737 2308.75 74147.26 28644.50