CMS/EIP Fiscal Report Center: 06
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 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 5.75 212.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 13 13.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 31 24.75 915.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 24 55.75 2062.75 37.00
Subtotal (Total Children Is Unduplicated) 51 99.25 3191.25 32.15
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 8.00 400.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 2.00 135.76 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 6 1083.00 541.50 0.50
Subtotal (Total Children Is Unduplicated) 6 1093.00 1077.26 0.99
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Total 1192.25 4268.51 3.58
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Number of Children (Unduplicated) With at Least One Service 53
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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 62 1093.00 1077.26 1077.26
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
158 99.25 3191.25 92.50
Other 0 0.00 0.00 0.00
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Total 220 1192.25 4268.51 1169.76