CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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 1041 480.50 17760.25 36.96
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 700 722.75 26741.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 871 2499.25 92379.75 36.96
Subtotal (Total Children Is Unduplicated) 1795 3702.50 136881.75 36.97
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 1 1.00 50.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.50 262.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 7.50 562.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 2.50 138.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 29.50 2212.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 3.50 262.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 31.00 1720.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 7.00 525.00 75.00
Subtotal (Total Children Is Unduplicated) 30 85.50 5734.25 67.07
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 8 17.50 875.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.50 12.50 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 0.50 25.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.00 50.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 9 2076.00 1038.00 0.50
Subtotal (Total Children Is Unduplicated) 18 2095.50 2000.50 0.95
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Total 5883.50 144616.50 24.58
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Number of Children (Unduplicated) With at Least One Service 1801
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Center 01
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 2 1.75 92.50 9.25
D 1 0.50 12.50 0.00
S 5 4.50 257.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
6581 5844.75 142059.50 0.00
Other 23 32.00 2194.25 0.00
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Total 6612 5883.50 144616.50 9.25