CMS/EIP Fiscal Report Center: 05
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 261 114.50 4236.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 337 413.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 373 365.00 13505.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 356 1354.25 50088.75 36.99
Subtotal (Total Children Is Unduplicated) 638 2246.75 67830.25 30.19
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.00 375.00 75.00
Subtotal (Total Children Is Unduplicated) 3 5.00 375.00 75.00
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EI Services,Class #03
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 3.00 150.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 10 8.50 425.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 0.25 6.25 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 3.00 150.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 17 840.00 420.00 0.50
Subtotal (Total Children Is Unduplicated) 22 854.75 1151.25 1.35
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Total 3106.50 69356.50 22.33
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Number of Children (Unduplicated) With at Least One Service 641
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Center 05
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 10 4.00 148.00 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 0 0.00 0.00 0.00
3715 3102.50 69208.50 0.00
Other 0 0.00 0.00 0.00
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Total 3725 3106.50 69356.50 0.00