CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:GR
Eligibility Filter:DEI Only
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 2 2.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 0.75 27.75 37.00
Subtotal (Total Children Is Unduplicated) 2 2.75 27.75 10.09
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.00 48.50 48.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 3 5.50 305.25 55.50
Subtotal (Total Children Is Unduplicated) 4 6.50 353.75 54.42
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 2.00 100.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 1.75 43.75 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 11.00 550.00 50.00
INTR-INTR-INTERPRETER 2 5.00 250.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 8 2480.00 1240.00 0.50
Subtotal (Total Children Is Unduplicated) 8 2499.75 2183.75 0.87
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Total 2509.00 2565.25 1.02
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Number of Children (Unduplicated) With at Least One Service 8
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Center 53
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 13 620.00 630.00 630.00
T 7 488.00 392.50 392.50
36 1401.00 1542.75 0.00
Other 0 0.00 0.00 0.00
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Total 56 2509.00 2565.25 1022.50