CMS/EIP Fiscal Report Center: 06
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 13 6.25 231.25 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 10 11.25 416.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 57 218.75 8093.75 37.00
Subtotal (Total Children Is Unduplicated) 57 236.25 8741.25 37.00
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 2.00 150.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.00 150.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 26 33.50 2512.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 24.00 1800.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.50 83.25 55.50
Subtotal (Total Children Is Unduplicated) 31 63.00 4695.75 74.54
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
INTR-INTR-INTERPRETER 1 2.00 117.00 58.50
Subtotal (Total Children Is Unduplicated) 1 2.00 117.00 58.50
----------------------------------------------------------------------------------------------------------------
Total 301.25 13554.00 44.99
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 57
----------------------------------------------------------------------------------------------------------------
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 23 18.50 684.50 0.00
P 49 40.25 1489.25 1489.25
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
295 242.50 11380.25 27.75
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 367 301.25 13554.00 1517.00