CMS/EIP Fiscal Report Center: 57
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
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 11 9.25 342.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 62 62.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 31 28.25 1045.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 90 383.00 14171.00 37.00
TCON-TCON-TRANSITION CONFERENCE 1 1.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 91 483.50 15558.50 32.18
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 2.00 100.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.50 112.50 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 58 66.50 4987.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 59 91.00 5050.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 1.50 112.50 75.00
Subtotal (Total Children Is Unduplicated) 62 164.00 10446.25 63.70
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EI Services,Class #03
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 40.00 28.00 0.70
Subtotal (Total Children Is Unduplicated) 1 40.00 28.00 0.70
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Total 687.50 26032.75 37.87
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Number of Children (Unduplicated) With at Least One Service 91
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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 174 249.50 10574.75 0.00
P 26 36.50 2053.75 2053.75
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 1 40.00 28.00 28.00
301 361.50 13376.25 0.00
Other 0 0.00 0.00 0.00
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Total 502 687.50 26032.75 2081.75