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
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 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 147 382.50 14023.00 36.66
TCON-TCON-TRANSITION CONFERENCE 24 24.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 372 815.25 24484.75 30.03
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 2.00 100.00 50.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 4.00 222.00 55.50
Subtotal (Total Children Is Unduplicated) 4 6.00 322.00 53.67
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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
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Total 832.25 26910.05 32.33
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Number of Children (Unduplicated) With at Least One Service 376
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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 9 11.00 2103.30 2103.30
979 821.25 24806.75 0.00
Other 0 0.00 0.00 0.00
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Total 988 832.25 26910.05 2103.30