CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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 153 80.00 2960.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 113 114.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 114 189.50 7011.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 385 852.50 31255.25 36.66
TCON-TCON-TRANSITION CONFERENCE 27 27.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 442 1263.00 41226.75 32.64
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.00 80.00 40.00
Subtotal (Total Children Is Unduplicated) 2 2.00 80.00 40.00
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Total 1265.00 41306.75 32.65
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Number of Children (Unduplicated) With at Least One Service 442
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Center 02
Flag Claims Units Chgs Paid
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R 17 13.50 499.50 0.00
U 0 0.00 0.00 0.00
B 649 536.50 19637.25 0.00
P 1 0.50 18.50 0.00
D 0 0.00 0.00 0.00
S 1 1.25 46.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
809 713.25 21105.25 0.00
Other 0 0.00 0.00 0.00
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Total 1477 1265.00 41306.75 0.00