CMS/EIP Fiscal Report Center: 06
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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 15 7.50 277.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 16 16.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 21 17.25 638.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 17 38.00 1406.00 37.00
TCON-TCON-TRANSITION CONFERENCE 3 3.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 43 81.75 2321.75 28.40
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 9.00 450.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 0.50 22.69 45.38
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 7 695.00 347.50 0.50
Subtotal (Total Children Is Unduplicated) 8 704.50 820.19 1.16
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Total 786.25 3141.94 4.00
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Number of Children (Unduplicated) With at Least One Service 44
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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 23 439.00 467.00 467.00
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 0 0.00 0.00 0.00
148 347.25 2674.94 92.50
Other 0 0.00 0.00 0.00
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Total 171 786.25 3141.94 559.50