CMS/EIP Fiscal Report Center: 06
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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
CASE-CASE-NON-TCM CASE MANAGEMENT 5 4.25 157.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 18 18.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 25 22.50 832.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 10 20.50 758.50 37.00
TCON-TCON-TRANSITION CONFERENCE 2 2.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 40 67.25 1748.25 26.00
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 15.00 750.00 50.00
INTR-INTR-INTERPRETER 1 8.00 520.00 65.00
PHY-97110-PT SESSION BY LICENSED PT 1 2.50 169.70 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 14.25 775.29 54.41
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 12 1607.00 803.50 0.50
Subtotal (Total Children Is Unduplicated) 13 1646.75 3018.49 1.83
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Total 1714.00 4766.74 2.78
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Number of Children (Unduplicated) With at Least One Service 41
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Center 06
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
193 1714.00 4766.74 0.00
Other 0 0.00 0.00 0.00
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Total 193 1714.00 4766.74 0.00