CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 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 34 15.000000 555.0000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 71 78.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 89 95.500000 3533.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 100 382.000000 14134.0000 37.0000
TCON-TCON-TRANSITION CONFERENCE 1 1.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 100 571.500000 18222.5000 31.8854
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.500000 562.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 13 26.000000 1443.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 18 36.999996 3097.9798 83.7292
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 25.500000 2033.1600 79.7318
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 67 150.999991 8803.9795 58.3045
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 57 156.500000 11783.1600 75.2918
Subtotal (Total Children Is Unduplicated) 80 412.999987 28290.0293 68.4989
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EI Services,Class #03
INTR-INTR-INTERPRETER 1 1.000000 50.0000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 78 7522.000000 3746.0000 0.4980
Subtotal (Total Children Is Unduplicated) 78 7523.000000 3796.0000 0.5046
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Total 8507.499987 50308.5293 5.9134
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Number of Children (Unduplicated) With at Least One Service 100
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Center 53
Flag Claims Units Chgs Paid
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R 14 20.250000 786.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 183 210.500000 9233.7500 0.0000
P 135 208.523707 10943.5900 10081.0900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 103 2804.000000 5352.5000 5352.5000
T 141 120.500000 3459.5000 3459.5000
438 5113.226280 20499.4393 0.0000
Other 2 30.500000 33.5000 0.0000
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Total 1016 8507.499987 50308.5293 18893.0900