CMS/EIP Fiscal Report Center: 55
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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 219 144.50 5291.00 36.62
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 348 481.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 84 62.50 2312.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 612 1916.00 70596.00 36.85
TCON-TCON-TRANSITION CONFERENCE 35 35.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 615 2639.00 78199.50 29.63
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Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 4 6.00 750.00 125.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 4.50 512.50 113.89
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.00 75.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.50 83.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 91 93.50 8237.50 88.10
Subtotal (Total Children Is Unduplicated) 99 106.50 9658.25 90.69
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EI Services,Class #03
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.50 12.50 25.00
CONPP-CONPP-CONSULT, PT, PHONE 2 1.00 25.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 21.00 1050.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 1 2.50 169.70 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 2.00 135.76 67.88
Subtotal (Total Children Is Unduplicated) 7 27.00 1392.96 51.59
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Total 2772.50 89250.71 32.19
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Number of Children (Unduplicated) With at Least One Service 615
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Center 55
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 2 1.00 37.00 0.00
P 1198 1094.25 42752.75 42715.25
D 46 45.25 2634.25 0.00
S 1 0.50 18.50 0.00
H 9 9.00 2075.00 0.00
T 0 0.00 0.00 0.00
1981 1622.50 41733.21 0.00
Other 0 0.00 0.00 0.00
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Total 3237 2772.50 89250.71 42715.25