CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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 219 99.50 3635.25 36.54
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 134 136.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 153 225.00 8260.25 36.71
TCM-T1017TL-TARGETED CASE MANAGEMENT 191 430.25 15762.00 36.63
TCON-TCON-TRANSITION CONFERENCE 31 31.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 404 921.75 27657.50 30.01
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.50 112.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.00 225.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 6.00 305.25 50.88
Subtotal (Total Children Is Unduplicated) 4 10.50 642.75 61.21
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 9.00 770.36 85.60
Subtotal (Total Children Is Unduplicated) 4 9.00 770.36 85.60
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Total 941.25 29070.61 30.89
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Number of Children (Unduplicated) With at Least One Service 405
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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 1 2.00 523.80 523.80
1235 939.25 28546.81 0.00
Other 0 0.00 0.00 0.00
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Total 1236 941.25 29070.61 523.80