CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:GR
Eligibility Filter:Not Part C
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 75 34.75 1285.75 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 161 188.25 6965.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 119 355.25 13107.25 36.90
Subtotal (Total Children Is Unduplicated) 205 578.25 21358.25 36.94
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 1 4.00 200.00 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 16.00 1200.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 5.00 375.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 15.00 832.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 4.50 337.50 75.00
Subtotal (Total Children Is Unduplicated) 15 44.50 2945.00 66.18
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EI Services,Class #03
INTR-INTR-INTERPRETER 13 35.75 1072.50 30.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 19 2622.00 1311.00 0.50
Subtotal (Total Children Is Unduplicated) 22 2657.75 2383.50 0.90
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Total 3280.50 26686.75 8.13
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Number of Children (Unduplicated) With at Least One Service 208
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Center 01
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 42 1118.50 909.00 909.00
D 0 0.00 0.00 0.00
S 7 7.25 268.25 0.00
H 0 0.00 0.00 0.00
T 36 1495.25 1522.00 1522.00
856 583.50 21891.00 0.00
Other 24 76.00 2096.50 0.00
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Total 965 3280.50 26686.75 2431.00