CMS/EIP Fiscal Report Center: 52
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/16/2009 Page: 1
Payclass Filters:GR
Eligibility Filter:DEI Only
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 8 8.50 314.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 5 5.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8 5.75 212.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 3 5.50 203.50 37.00
Subtotal (Total Children Is Unduplicated) 11 24.75 730.75 29.53
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Screening, Eval, and Assessment,Class #02
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 2.00 100.00 50.00
Subtotal (Total Children Is Unduplicated) 2 2.00 100.00 50.00
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EI Services,Class #03
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 5 333.00 166.50 0.50
Subtotal (Total Children Is Unduplicated) 5 333.00 166.50 0.50
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Total 359.75 997.25 2.77
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Number of Children (Unduplicated) With at Least One Service 11
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Center 52
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 3 26.00 112.00 112.00
80 333.75 885.25 0.00
Other 0 0.00 0.00 0.00
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Total 83 359.75 997.25 112.00