CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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 187 103.00 3811.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 391 396.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 160 141.50 5235.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 514 1176.25 43521.25 37.00
TCON-TCON-TRANSITION CONFERENCE 47 47.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 813 1863.75 52567.75 28.21
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 12 13.50 675.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 62 62.00 3100.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.00 75.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.50 83.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 132 156.00 11700.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 127 195.00 10822.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 19.00 1425.00 75.00
Subtotal (Total Children Is Unduplicated) 211 448.00 27880.75 62.23
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EI Services,Class #03
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 5 270.00 135.00 0.50
Subtotal (Total Children Is Unduplicated) 5 270.00 135.00 0.50
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Total 2581.75 80583.50 31.21
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Number of Children (Unduplicated) With at Least One Service 835
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Center 57
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 10 9.50 483.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 25 19.25 379.25 712.25
2313 2553.00 79721.25 0.00
Other 0 0.00 0.00 0.00
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Total 2348 2581.75 80583.50 712.25