CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
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 16 7.75 286.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 26 46.25 1711.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 38 162.25 6003.25 37.00
Subtotal (Total Children Is Unduplicated) 40 217.25 8001.25 36.83
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 20.50 1481.50 72.27
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 23.00 1725.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 22.00 1221.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
Subtotal (Total Children Is Unduplicated) 20 67.00 4540.00 67.76
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EI Services,Class #03
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 27 2353.00 1176.50 0.50
Subtotal (Total Children Is Unduplicated) 27 2353.00 1176.50 0.50
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Total 2637.25 13717.75 5.20
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Number of Children (Unduplicated) With at Least One Service 42
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Center 02
Flag Claims Units Chgs Paid
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R 8 7.75 286.75 0.00
U 0 0.00 0.00 0.00
B 80 76.25 2821.25 0.00
P 0 0.00 0.00 0.00
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 41 1310.50 1955.50 1955.50
188 1242.75 8654.25 0.00
Other 0 0.00 0.00 0.00
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Total 317 2637.25 13717.75 1955.50