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
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 210 103.25 3820.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 152 165.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 175 257.75 9490.50 36.82
TCM-T1017TL-TARGETED CASE MANAGEMENT 207 455.25 16761.00 36.82
TCON-TCON-TRANSITION CONFERENCE 24 24.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 446 1005.25 30071.75 29.91
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
Subtotal (Total Children Is Unduplicated) 1 2.00 111.00 55.50
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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 1009.25 30321.58 30.04
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Number of Children (Unduplicated) With at Least One Service 446
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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 1.00 65.49 65.49
1210 1008.25 30256.09 0.00
Other 0 0.00 0.00 0.00
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Total 1211 1009.25 30321.58 65.49