     Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period                                             Statewide

    This report estimates subtotals of units and fees for the number of days of overlap between each included
    FSPSA record and the user-selected report period.  For example, if the FSPSA record authorizes services from
    01/01/01 to 08/01/01, and the Report Period is selected as 01/01/01 to 03/01/01, this summary calculates
    authorized units/fees for the 28 days of overlap (02/01/01 to 03/01/01).  Note that service authorization periods
    may range from 1 to 12 months and may vary in intensity from child to child.

    FSPSAs overlapping: 10/01/08 and 12/31/08                  Date of Report: 02-16-09                  Page: 1

    Eligibility Filter: Program Patients

    Services  Cpt Code                                       Number of   Number of   Total Units    Total Fees        Avg Fee
                                                             Children    Records     Overlapping    Overlapping     Per Unit Auth
                                                                                    Report Period  Report Period

    Service Coordination, Class # 01
     IFSP  -IFSP      INDIVIDUALIZED FAMILY SUPPORT PLAN         379        383          378.24           $0.00            $0.00
     SCTT  -SCTT      SERVICE COORDINATOR TRAVEL                  24         26           33.57        $1242.15           $37.00
     TCM   -T1017TL   TARGETED CASE MANAGEMENT                    12         12           15.21         $562.59           $37.00
     TCON  -TCON      TRANSITION CONFERENCE                        3          3            3.00           $0.00            $0.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                    399        424          430.02        $1804.73            $4.20

    Screening, Eval, and Assessment, Class # 02
     ASTE  -ASTE      ASSISTIVE TECHNOLOGY EVAL                   65         75           80.86        $3921.57           $48.50
     AUD   -92626     EVAL OF AUD REHAB STATUS                    33         33           46.49        $1676.80           $36.07
     AUDE  -92552     PURE TONE AUDIOMETRY -AIR ONLY             102        103          103.00        $1093.86           $10.62
     AUDE  -92553     PURE TONE AUDIOMETRY AIR & BONE              4          5            5.00          $81.50           $16.30
     AUDE  -92555     SPEECH AUD THRESHOLD (DETECTION)           102        103          103.00         $909.49            $8.83
     AUDE  -92557     COMP AUDIO THRESHOLD EVAL/SPCH RECO          3          3            3.00          $81.30           $27.10
     AUDE  -92567     TYPMANOMETRY (IMPEDANCE TESTING)           103        104          104.00        $1123.20           $10.80
     AUDE  -92579     VISUAL REINFORCEMENT AUDIOMETRY             97         98           98.00        $2135.42           $21.79
     AUDE  -92585     AUD EVOKED RESPONSE (DIAG)                   3          3            3.00         $163.14           $54.38
     AUDE  -92587     OTOACOUSTIC EMISSIONS (LIMITED)             89         90           90.00        $2545.20           $28.28
     AUDE  -92588     OTOACOUSTIC EMISSIONS (COMP)                 1          1            1.00          $31.81           $31.81
     AUDE  -92682     CONDITIONED PLAY AUDIOMETRY                  2          2            2.00          $42.68           $21.34
     AUDE  -AUDE      UNSPECIFIED AUDE SERVICES                  333        369          390.74       $23444.14           $60.00
     AUDE  -V5010     ASSESSMENT FOR HEARING AID                  62         70           70.37        $3293.16           $46.80
     AUDE  -V5090     DISPENSING FEE PER HEARING AID             285        295          359.36       $42979.07          $119.60
     BEHV  -90801     PSYCHIATRIC DIAG INTERVIEW                   3          3           13.29        $1660.71          $125.00
     BEHV  -BEHV      BEHAVIORAL ASSESSMENT                       11         11           14.70        $1837.50          $125.00
     BEHV  -H0031HO   COMP BEHAVIORAL HEALTH ASSESSMENT           67         69          150.47       $18809.15          $125.00
     EVAL  -EVAL      DEVELOPMENTAL EVALUATION                   252        281          387.65       $19382.39           $50.00
     EXIT  -EXIT      TRANSITION ASSESSMENT                      116        129          201.54       $10076.79           $50.00
     FANE  -FANE      FAMILY INTERVIEW BY COMMUNITY PROVI          6          6            6.00         $180.00           $30.00
     IPDEF -IPDEF     FOLLOW-UP PSYCH AND DEV EVAL                 3          4            4.50         $337.50           $75.00
     IPDEF -IPDEF_NM  F/U PSYCH & DEV EVAL BY NON-MED PRO          1          1            1.00          $55.50           $55.50
     IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT              35         35           50.07        $3755.36           $75.00
     IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT                 6          6            9.50         $712.50           $75.00
     IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT                 6          6           10.50         $787.50           $75.00
     IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF           10         10           14.07        $1055.36           $75.00
     IPDEF -T1024TS   F/U PSYCH AND DEV EVAL BY ITDS              49         50           68.00        $3774.00           $55.50
     IPDEI -IPDEI_NM  INITIAL PSYCH & DEV EVAL BY NON-MED         32         32           47.00        $2608.50           $55.50
     IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT         534        537          839.71       $62978.58           $75.00
     IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT           110        110          163.50       $12262.50           $75.00
     IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT           169        170          279.64       $20973.22           $75.00
     IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS         476        476          769.60       $42713.07           $55.50
     IPDEI -T1024TL   INITIAL PSYCH AND DEV EVAL BY EI PR        436        495          748.86       $56164.29           $75.00
     MED   -99205     OUTPATIENT VISIT, NEW, 60 MINS               4          4            6.00         $436.68           $72.78
     MED   -MED       UNSPECIFIED MED OFFICE VISIT                 1          1            1.00         $150.00          $150.00
     NURS  -NURS      NURSING ASSESSMENT                           4          4            2.80         $140.00           $50.00
     NUTR  -NUTR      UNSPECIFIED NUTRITIONAL EVAL                 4          5            5.00         $250.00           $50.00
     OCTF  -97004     OT EVAL BY LICENSED OT, FOLLOW-UP          217        252          274.51       $13313.87           $48.50
     OCTH  -97003     OT EVAL BY LICENSED OT, INITIAL           1057       1188         1314.93       $63774.16           $48.50
     PSTF  -97002     EVAL BY LICENSED PT, FOLLOW-UP             203        250          267.52       $12974.79           $48.50
     PSTH  -97001     EVAL BY LICENSED PT, INITIAL               804        889          943.73       $45770.84           $48.50
     SCREEN-T1023     INTERDISCIPLINARY SCREENING                 32         32           31.73        $1586.67           $50.00
     SPCH  -92506     SPEECH EVAL BY LICENSED SLP               2316       2626         2928.18      $142016.68           $48.50
     VISD  -VISD      VISION EVALUATION DIAGNOSTIC                 5          5           12.07        $1206.67          $100.00
     VISF  -VISF      VISION EVALUATION FUNCTIONAL                 9          9           15.57         $778.57           $50.00
     WHEELP-97001TG   WHEELCHAIR EVAL/ FITTING BY LICENSE          1          1            1.00          $48.50           $48.50
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                   5218       9051        11043.45      $626094.17           $56.69

    EI Services, Class # 03
     ASST  -ASST      ASSISTIVE TECHNOLOGY                       197        228          311.74      $467604.75         $1500.00
     AUD   -92630     AUD REHAB PRELING HEARING LOSS               1          2            1.02          $70.40           $68.86
     AUD   -92633     AUD REHAB POSTLING HEARING LOSS              1          1            0.86          $58.92           $68.86
     AUD   -HA_FUP    AUDIOLOGY SERVICES                         264        297          633.03       $31651.39           $50.00
     COIFF -COIFF     IFSP CONSULT, PROF, FACE TO FACE           897       1781         3379.71      $168985.61           $50.00
     COIFP -COIFP     IFSP CONSULT, PRO, BY PHONE                 52         56           59.89        $1497.15           $25.00
     CONIF -CONIF     CONSULT ITDS, FACE TO FACE                2518       3068         6138.09      $306904.72           $50.00
     CONIP -CONIP     CONSULT, ITDS, PHONE                       145        158          307.54        $7688.57           $25.00
     CONOF -CONOF     CONSULT, OT, FACE TO FACE                 1188       1449         2549.31      $127465.34           $50.00
     CONOP -CONOP     CONSULT, OT, PHONE                          61         69          114.75        $2868.80           $25.00
     CONPF -CONPF     CONSULT, PT, FACE TO FACE                  859       1042         1944.71       $97235.63           $50.00
     CONPP -CONPP     CONSULT, PT, PHONE                          62         70          140.29        $3507.18           $25.00
     CONSF -CONSF     CONSULT, SLP, FACE TO FACE                2634       3214         5749.28      $287463.83           $50.00
     CONSP -CONSP     CONSULT, SLP, PHONE                        197        222          364.46        $9111.60           $25.00
     COUN  -H2019HR   INDIVIDUAL/FAMILY THERAPY                   60         63          232.94       $17102.26           $73.42
     ECE   -ECE       EARLY CHILDHOOD EDUCATION                   19         19         2901.86       $36273.21           $12.50
     EIGF  -EIGF_NM   EI GROUP SESSION BY NONMED PROF              8          9           17.77         $444.17           $25.00
     EIGF  -T1024TTHN *EI GROUP SESSION BY PROF                    1          1           52.57        $1314.29           $25.00
     EIGF  -T1027TTSC EI GROUP SESSION BY EI PROF                550        656         6113.59      $152839.85           $25.00
     EIIF  -90801     PSYCHIATRIC DIAG INTERVIEW                   1          1           13.14         $657.15           $50.00
     EIIF  -96154     HEALTH AND BEHAVIOR INTERVENTION            18         22          411.71       $20585.73           $50.00
     EIIF  -COUN      UNSPECIFIED COUNSELING                       5          5           18.87         $943.34           $50.00
     EIIF  -EIIF_NM   EI INDIVIDUAL SESSION BY NONMED PRO         47         51          542.14       $27107.21           $50.00
     EIIF  -T1024HN   *EI INDIVIDUAL SESSION BY PROF               5          5           37.43        $1871.43           $50.00
     EIIF  -T1027HM   EI INDIVIDUAL SESSION BY PARAPROF           12         15          116.71        $2917.87           $25.00
     EIIF  -T1027SC   EI INDIVIDUAL SESSION BY EI PROF          6693       8601        66010.74     $3300536.79           $50.00
     HERN  -EIIF_NM   EI HEARING SERVICES AFTER SHINE NON          2          2            2.68         $133.81           $50.00
     HERN  -T1027SC   EI HEARING SERVICES AFTER SHINE             74         89          426.88       $21343.98           $50.00
     INTR  -INTR      INTERPRETER                                117        136          814.99       $40749.56           $50.00
     OCCT  -97530     OT SESSION BY LICENSED OT                 3513       4619        29989.53     $2035689.63           $67.88
     OCCT  -97530HM   OT SESSION BY OT ASST                      303        340         2066.27      $112239.65           $54.32
     PHY   -97110     PT SESSION BY LICENSED PT                 3685       4835        31162.80     $2115331.11           $67.88
     PHY   -97110HM   PT SESSION BY PT ASST                      317        341         2117.99      $115049.44           $54.32
     RSPT  -RSPT      RESPITE                                      1          1           49.07           $0.00            $0.00
     SCONLY-SCONLY    SERVICE COORDINATION ONLY                  461        485          787.35         $787.35            $1.00
     SENS  -FM        FM RECEIVER HEARING AID                      9          9           10.00       $16500.00         $1650.00
     SENS  -HA_EIP    ONE UNIT UP TO $500 PER AID                 52         54           71.72       $35861.10          $500.00
     SENS  -HA_INS    SENSORY AID INSURANCE PER EAR               25         29           18.02        $1171.62           $65.00
     SENS  -V5014     HEARING AID REPAIR BY MANUFACTURER           3          3            5.00         $570.00          $114.00
     SENS  -V5050     MED HEARING AID - ANALOG/DIGITAL            19         21           78.14       $18529.24          $237.12
     SENS  -V5264     EARMOLD                                    118        134          201.99        $3781.31           $18.72
     SHIN  -EIIF_NM   INITIAL SHINE SERVICES, IND NONMED           1          2            7.57         $378.57           $50.00
     SHIN  -T1027SC   INITIAL SHINE SERVICES, INDIVIDUAL          98        117          588.24       $29411.79           $50.00
     SIC   -SIC       SPECIAL INSTRUCTION CONSULTATION             1          1           11.86         $592.86           $50.00
     SPL   -92507     SPL THERAPY SESSION BY LICENSED SLP       7637      10035        67684.56     $4594428.02           $67.88
     SPL   -92507HM   SPL THERAPY SESSION BY SLP ASST             20         23          139.87        $7597.83           $54.32
     SPL   -92508     GROUP SPL SESSION PER CHILD                602        638         5091.09       $67202.43           $13.20
     TRAN  -TRAN      FAMILY TRANSPORTATION                       17         20           83.57        $8357.13          $100.00
     TRAV  -TRAV      PROVIDER TRAVEL TO NATURAL ENVIRONM       4870       7991       795553.53      $397776.70            $0.50
     VISN  -EIIF_NM   EI VISION SERVICES, IND NONMED               2          2           31.57        $1578.58           $50.00
     VISN  -T1027SC   EI VISION SERVICES, INDIVIDUAL             118        149          868.20       $43409.85           $50.00
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                  14527      51181      1036026.65    $14743178.65           $14.23

    -----------------------------------------------------------------------------------------------------------------------------
    Total                                                                 60656      1047500.12    $15371077.55           $14.67
    -----------------------------------------------------------------------------------------------------------------------------

    Number of Children (Unduplicated) With at Least One Authorization  14976