CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.00 100.00 33.33
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 2.00 111.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 34.00 1287.50 37.87
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 29 42.00 1644.00 39.14
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EI Services,Class #03
ECE-ECE-EARLY CHILDHOOD EDUCATION 105 17468.0 157212.00 9.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 46 1797.00 44925.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 62 2151.25 53781.25 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 96 609.00 25900.00 42.53
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 54 439.00 20250.00 46.13
OCCT-97530-OT SESSION BY LICENSED OT 78 381.50 25896.22 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 1.50 81.48 54.32
PHY-97110-PT SESSION BY LICENSED PT 84 337.75 22926.47 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 163 599.25 40677.09 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.50 19.80 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 3 122.00 12200.00 100.00
Subtotal (Total Children Is Unduplicated) 379 23907.8 403869.31 16.89
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Total 23949.75 405513.31 16.93
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Number of Children (Unduplicated) With at Least One Service 406
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Center 01
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
1 1.00 50.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1 1.00 50.00 0.00
Center 04
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
703 4832.75 154890.63 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 703 4832.75 154890.63 0.00
Center 05
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
157 5189.50 172296.88 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 157 5189.50 172296.88 0.00
Center 06
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
77 5231.75 175145.43 0.00
Other 0 0.00 0.00 0.00
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Total 77 5231.75 175145.43 0.00
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
2 5233.75 175256.43 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2 5233.75 175256.43 0.00
Center 52
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
190 5695.25 191705.33 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 190 5695.25 191705.33 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
649 23949.75 405513.31 0.00
Other 0 0.00 0.00 0.00
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Total 649 23949.75 405513.31 0.00