CMS/EIP Fiscal Report Center: 02
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 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 18 69.75 2580.75 37.00
Subtotal (Total Children Is Unduplicated) 36 124.75 4578.75 36.70
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 10.50 731.50 69.67
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 13.00 975.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 10.00 555.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
Subtotal (Total Children Is Unduplicated) 11 35.00 2374.00 67.83
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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 2512.75 8129.25 3.24
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Number of Children (Unduplicated) With at Least One Service 39
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Center 02
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 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
166 1202.25 6173.75 0.00
Other 0 0.00 0.00 0.00
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Total 207 2512.75 8129.25 1955.50