CMS/EIP Fiscal Report Center: 57
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:GR
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 12 10.75 397.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 36 36.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 25 22.25 823.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 22 97.75 3616.75 37.00
Subtotal (Total Children Is Unduplicated) 47 166.75 4837.75 29.01
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 0.50 37.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.50 83.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 22.50 1687.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 16 25.00 1387.50 55.50
Subtotal (Total Children Is Unduplicated) 17 49.50 3195.75 64.56
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Total 216.25 8033.50 37.15
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Number of Children (Unduplicated) With at Least One Service 47
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Center 57
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 0 0.00 0.00 0.00
171 216.25 8033.50 0.00
Other 0 0.00 0.00 0.00
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Total 171 216.25 8033.50 0.00