CMS/EIP Fiscal Report Center: 02
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
Agency Filter:EIP DEI DEIP
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 212 104.00 3848.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 152 166.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 175 258.75 9527.50 36.82
TCM-T1017TL-TARGETED CASE MANAGEMENT 520 1281.25 47184.25 36.83
TCON-TCON-TRANSITION CONFERENCE 24 24.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 561 1834.00 60559.75 33.02
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.00 300.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.00 150.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.50 416.25 55.50
Subtotal (Total Children Is Unduplicated) 4 13.50 866.25 64.17
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.00 138.83 69.42
Subtotal (Total Children Is Unduplicated) 2 2.00 138.83 69.42
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Total 1849.50 61564.83 33.29
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Number of Children (Unduplicated) With at Least One Service 561
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Center 02
Flag Claims Units Chgs Paid
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R 12 9.25 342.25 0.00
U 0 0.00 0.00 0.00
B 932 755.00 27796.25 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 1.00 65.49 65.49
1286 1084.25 33360.84 0.00
Other 0 0.00 0.00 0.00
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Total 2231 1849.50 61564.83 65.49