CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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 1041 480.50 17760.25 36.96
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 700 722.75 26741.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 2426 7285.25 269165.75 36.95
Subtotal (Total Children Is Unduplicated) 2466 8488.50 313667.75 36.95
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 1 1.00 50.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 43 63.50 4762.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.00 225.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.00 300.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 31 50.00 3750.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 21 29.00 1609.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 268 392.50 29400.00 74.90
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 46.00 3450.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 64 85.00 6375.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 215 310.50 17232.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 117 168.50 12637.50 75.00
Subtotal (Total Children Is Unduplicated) 393 1153.00 79792.25 69.20
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 12 24.50 1225.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.50 12.50 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 1.50 75.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 0.50 25.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 38.00 1900.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9 2076.00 1038.00 0.50
Subtotal (Total Children Is Unduplicated) 24 2141.00 4275.50 2.00
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Total 11782.50 397735.50 33.76
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Number of Children (Unduplicated) With at Least One Service 2469
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Center 01
Flag Claims Units Chgs Paid
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R 15 7.25 306.25 0.00
U 0 0.00 0.00 0.00
B 4688 3219.75 127395.00 9.25
P 1899 1278.75 47989.50 47869.25
D 199 218.75 11771.75 0.00
S 862 672.75 28906.75 0.00
H 9 15.00 1025.00 0.00
T 0 0.00 0.00 0.00
6593 5853.25 142412.00 0.00
Other 359 517.00 37929.25 0.00
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Total 14624 11782.50 397735.50 47878.50