CMS/EIP Fiscal Report Center: 55
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 218 144.25 5281.75 36.62
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 347 479.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 84 62.50 2312.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 260 782.00 28860.00 36.91
TCON-TCON-TRANSITION CONFERENCE 35 35.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 514 1502.75 36454.25 24.26
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Screening, Eval, and Assessment,Class #02
BEHV-H0031HO-COMP BEHAVIORAL HEALTH ASSESSMENT 3 5.00 625.00 125.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.00 75.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 22.00 1650.00 75.00
Subtotal (Total Children Is Unduplicated) 25 28.00 2350.00 83.93
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EI Services,Class #03
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.50 12.50 25.00
CONPP-CONPP-CONSULT, PT, PHONE 2 1.00 25.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 18.00 900.00 50.00
Subtotal (Total Children Is Unduplicated) 4 19.50 937.50 48.08
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Total 1550.25 39741.75 25.64
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Number of Children (Unduplicated) With at Least One Service 514
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Center 55
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 46 45.25 2634.25 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
1854 1505.00 37107.50 0.00
Other 0 0.00 0.00 0.00
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Total 1900 1550.25 39741.75 0.00