CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Agency Filter:EIP DEI DEIP
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 172 62.25 2294.00 36.85
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 125 125.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 135 221.50 8167.75 36.87
TCM-T1017TL-TARGETED CASE MANAGEMENT 438 1027.00 37555.00 36.57
TCON-TCON-TRANSITION CONFERENCE 24 24.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 495 1459.75 48016.75 32.89
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 2.00 100.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.00 150.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 5.50 305.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.00 150.00 75.00
Subtotal (Total Children Is Unduplicated) 6 13.50 855.25 63.35
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 8 11.00 2103.30 191.21
Subtotal (Total Children Is Unduplicated) 8 11.00 2103.30 191.21
----------------------------------------------------------------------------------------------------------------
Total 1484.25 50975.30 34.34
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 498
----------------------------------------------------------------------------------------------------------------
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 10 4.75 175.75 0.00
U 0 0.00 0.00 0.00
B 731 592.00 21719.00 0.00
P 2 1.00 37.00 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 9 11.00 2103.30 2103.30
1017 875.50 26940.25 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1769 1484.25 50975.30 2103.30