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: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 23 7.25 268.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 27 25.00 925.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 59 227.00 8399.00 37.00
Subtotal (Total Children Is Unduplicated) 75 260.25 9592.25 36.86
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 7.00 438.61 62.66
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 4.00 300.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.50 83.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
Subtotal (Total Children Is Unduplicated) 5 14.00 934.36 66.74
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EI Services,Class #03
INTR-INTR-INTERPRETER 3 6.00 351.00 58.50
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 2 91.00 45.50 0.50
Subtotal (Total Children Is Unduplicated) 5 97.00 396.50 4.09
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Total 371.25 10923.11 29.42
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Number of Children (Unduplicated) With at Least One Service 76
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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
343 371.25 10923.11 0.00
Other 0 0.00 0.00 0.00
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Total 343 371.25 10923.11 0.00