CMS/EIP Fiscal Report Center: 57
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 187 103.00 3811.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 396 401.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 160 141.50 5235.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 921 2150.25 79559.25 37.00
TCON-TCON-TRANSITION CONFERENCE 47 47.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1018 2842.75 88605.75 31.17
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 12 13.50 675.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 62 62.00 3100.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 8.00 600.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 7.50 416.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 240 283.00 21225.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 230 347.50 19286.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 29.00 2175.00 75.00
Subtotal (Total Children Is Unduplicated) 326 752.50 47627.50 63.29
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EI Services,Class #03
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 5 270.00 135.00 0.50
Subtotal (Total Children Is Unduplicated) 5 270.00 135.00 0.50
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Total 3865.25 136368.25 35.28
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Number of Children (Unduplicated) With at Least One Service 1033
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Center 57
Flag Claims Units Chgs Paid
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R 181 179.50 6726.25 0.00
U 0 0.00 0.00 0.00
B 875 905.00 37341.50 0.00
P 1 2.00 74.00 74.00
D 10 9.50 483.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 25 19.25 379.25 712.25
2475 2750.00 91364.25 0.00
Other 0 0.00 0.00 0.00
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Total 3567 3865.25 136368.25 786.25