CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 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 58.00 2146.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 100 101.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 136 206.75 7649.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 153 301.25 11081.50 36.79
TCON-TCON-TRANSITION CONFERENCE 14 14.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 331 681.00 20877.25 30.66
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 7.50 388.50 51.80
Subtotal (Total Children Is Unduplicated) 5 7.50 388.50 51.80
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.00 347.09 173.55
Subtotal (Total Children Is Unduplicated) 2 2.00 347.09 173.55
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Total 690.50 21612.84 31.30
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Number of Children (Unduplicated) With at Least One Service 331
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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
901 690.50 21612.84 0.00
Other 0 0.00 0.00 0.00
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Total 901 690.50 21612.84 0.00