CMS/EIP Fiscal Report Center: 07
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 1143 914.25 33827.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 203 208.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 659 941.25 34752.25 36.92
TCM-T1017TL-TARGETED CASE MANAGEMENT 1603 5226.25 193315.75 36.99
TCON-TCON-TRANSITION CONFERENCE 39 39.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1681 7328.75 261895.25 35.74
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 7 13.25 662.50 50.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 14.00 1050.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.00 222.00 55.50
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 73 142.50 7908.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 176 499.00 37350.00 74.85
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 4 4.00 291.12 72.78
NUTR-97802-NUTRITIONAL EVAL, INITIAL 4 3.75 187.50 50.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 40 40.00 2000.00 50.00
Subtotal (Total Children Is Unduplicated) 225 720.50 49671.87 68.94
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EI Services,Class #03
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.50 12.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 2.50 125.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 3 0.75 18.75 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 21 13.00 650.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 2.00 100.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 86 4666.00 2318.00 0.50
Subtotal (Total Children Is Unduplicated) 96 4684.75 3224.25 0.69
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Total 12734.00 314791.37 24.72
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Number of Children (Unduplicated) With at Least One Service 1683
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Center 07
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 11 8.00 296.00 0.00
P 4847 3261.25 133146.75 133146.75
D 0 0.00 0.00 0.00
S 280 138.75 5124.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
8686 9325.00 176187.12 0.00
Other 2 1.00 37.00 0.00
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Total 13826 12734.00 314791.37 133146.75