CMS/EIP Fiscal Report Center: 57
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 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 38 155.25 5744.25 37.00
TCON-TCON-TRANSITION CONFERENCE 1 1.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 80 255.75 7131.75 27.89
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 2.00 100.00 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 25.50 1912.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 24 39.00 2164.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 1.50 112.50 75.00
Subtotal (Total Children Is Unduplicated) 26 68.00 4289.50 63.08
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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 363.75 11449.25 31.48
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Number of Children (Unduplicated) With at Least One Service 80
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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 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 1 40.00 28.00 28.00
274 323.75 11421.25 0.00
Other 0 0.00 0.00 0.00
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Total 275 363.75 11449.25 28.00