CMS/EIP Fiscal Report Center: 02
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
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 148 57.25 2099.75 36.68
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 135 138.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 148 230.00 8463.75 36.80
TCM-T1017TL-TARGETED CASE MANAGEMENT 160 379.00 14012.75 36.97
TCON-TCON-TRANSITION CONFERENCE 9 9.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 369 813.25 24576.25 30.22
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 2 2.00 100.00 50.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.00 55.50 55.50
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.50 112.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 9.00 499.50 55.50
Subtotal (Total Children Is Unduplicated) 10 13.50 767.50 56.85
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 6.00 156.39 26.07
Subtotal (Total Children Is Unduplicated) 3 6.00 156.39 26.07
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Total 832.75 25500.14 30.62
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Number of Children (Unduplicated) With at Least One Service 371
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Center 02
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 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
997 832.75 25500.14 0.00
Other 0 0.00 0.00 0.00
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Total 997 832.75 25500.14 0.00