CMS/EIP Fiscal Report              Statewide 
Services beginning 04/01/2010 ending 06/30/2010                Date of Report:08/18/2010   Page:   1
         Agency Filter:EIP DEI DEIP     
      Payclass Filters:LEA    
    Eligibility Filter:Part C (excluding not eligible)
            List order: No List
 
 
Services                                              Number of        Number of    Fee Reported        Avg Fee
                                                      Children         Units                            Per/Unit
 
Screening, Eval, and Assessment,Class #02
  IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR   11              11.00          610.50           55.50
Subtotal (Total Children Is Unduplicated)                 11              11.00          610.50           55.50
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
  ECE-ECE-EARLY CHILDHOOD EDUCATION                        1              76.00          684.00            9.00
  OCCT-97530-OT SESSION BY LICENSED OT                     1               4.00          271.52           67.88
  PHY-97110-PT SESSION BY LICENSED PT                      1               2.00          135.76           67.88
  SPL-92507-SPL THERAPY SESSION BY LICENSED SLP            1               1.50          101.82           67.88
Subtotal (Total Children Is Unduplicated)                  1              83.50         1193.10           14.29
----------------------------------------------------------------------------------------------------------------
Total                                                                     94.50         1803.60           19.09
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service         12
----------------------------------------------------------------------------------------------------------------
 
Center 09
Flag      Claims      Units       Chgs       Paid
-------------------------------------------------
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 
              11      11.00     610.50       0.00 
Other          0       0.00       0.00       0.00 
-------------------------------------------------
Total         11      11.00     610.50       0.00 
 
Center 57
Flag      Claims      Units       Chgs       Paid
-------------------------------------------------
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 
               4      83.50    1193.10       0.00 
Other          0       0.00       0.00       0.00 
-------------------------------------------------
Total          4      83.50    1193.10       0.00