CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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 13 6.75 249.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 18 18.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 23 22.75 841.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 19 29.00 1073.00 37.00
Subtotal (Total Children Is Unduplicated) 46 76.50 2164.50 28.29
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 13.00 650.00 50.00
INTR-INTR-INTERPRETER 1 2.00 117.00 58.50
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 7.00 443.16 63.31
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8 982.00 491.00 0.50
Subtotal (Total Children Is Unduplicated) 8 1004.00 1701.16 1.69
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Total 1080.50 3865.66 3.58
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Number of Children (Unduplicated) With at Least One Service 48
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Center 06
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 54 701.00 1450.66 1450.66
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
140 379.50 2415.00 9.25
Other 0 0.00 0.00 0.00
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Total 194 1080.50 3865.66 1459.91