CMS/EIP Fiscal Report Center: 55
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 175 78.00 2886.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 276 378.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 87 71.25 2636.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 265 737.50 27121.00 36.77
TCON-TCON-TRANSITION CONFERENCE 31 31.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 461 1295.75 32643.25 25.19
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 4.50 225.00 50.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 27 40.50 3037.50 75.00
Subtotal (Total Children Is Unduplicated) 30 45.00 3262.50 72.50
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EI Services,Class #03
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 30.00 22.00 0.73
Subtotal (Total Children Is Unduplicated) 1 30.00 22.00 0.73
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Total 1370.75 35927.75 26.21
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Number of Children (Unduplicated) With at Least One Service 461
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Center 55
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 39 35.75 1721.75 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
1531 1335.00 34206.00 0.00
Other 0 0.00 0.00 0.00
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Total 1570 1370.75 35927.75 0.00