CMS/EIP Fiscal Report Center: 02
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 191 63.50 2331.00 36.71
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 149 149.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 197 302.00 11100.00 36.75
TCM-T1017TL-TARGETED CASE MANAGEMENT 170 384.25 14097.00 36.69
TCON-TCON-TRANSITION CONFERENCE 28 28.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 448 926.75 27528.00 29.70
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.00 50.00 50.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.00 55.50 55.50
Subtotal (Total Children Is Unduplicated) 2 2.00 105.50 52.75
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 8 10.00 1218.59 121.86
Subtotal (Total Children Is Unduplicated) 8 10.00 1218.59 121.86
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Total 938.75 28852.09 30.73
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Number of Children (Unduplicated) With at Least One Service 451
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Center 02
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 7 7.00 611.79 611.79
1130 931.75 28240.30 0.00
Other 0 0.00 0.00 0.00
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Total 1137 938.75 28852.09 611.79