CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EXT
Payclass Filters:OTHER
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
EXIT-EXIT-TRANSITION ASSESSMENT 1 1.00 50.00 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 7.50 403.50 53.80
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 6.00 242.50 40.42
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.00 198.50 66.17
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 16 19.50 991.50 50.85
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 6 8.00 400.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 3.00 150.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 7 5.00 125.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 2.00 100.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 2.00 100.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 16 23.00 1150.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 2 0.50 12.50 25.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 9 1372.00 12348.00 9.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 60 2021.00 50525.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 68.00 1700.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 9 60.25 3012.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 10 80.00 4000.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 18 86.25 5803.80 67.29
PHY-97110-PT SESSION BY LICENSED PT 15 36.75 2494.59 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 25 47.25 3207.33 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.00 13.20 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 29 1020.00 93841.00 92.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 70 3480.00 4119.25 1.18
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 6 43.00 2150.00 50.00
Subtotal (Total Children Is Unduplicated) 220 8359.00 185252.17 22.16
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Total 8378.50 186243.67 22.23
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Number of Children (Unduplicated) With at Least One Service 233
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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
93 259.00 11250.00 0.00
Other 2 4.00 200.00 0.00
-------------------------------------------------
Total 95 263.00 11450.00 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
155 2280.00 61775.00 0.00
Other 0 4.00 200.00 0.00
-------------------------------------------------
Total 155 2284.00 61975.00 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
6 2315.00 61976.76 0.00
Other 0 4.00 200.00 0.00
-------------------------------------------------
Total 6 2319.00 62176.76 0.00
Center 07
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
5 2324.75 62638.59 0.00
Other 0 4.00 200.00 0.00
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Total 5 2328.75 62838.59 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
14 2359.75 65039.31 0.00
Other 0 4.00 200.00 0.00
-------------------------------------------------
Total 14 2363.75 65239.31 0.00
Center 51
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 2 88.00 143.00 143.00
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
28 2547.00 69453.61 0.00
Other 0 4.00 200.00 0.00
-------------------------------------------------
Total 30 2639.00 69796.61 143.00
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 88.00 143.00 143.00
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
85 3973.50 72817.76 0.00
Other 0 4.00 200.00 0.00
-------------------------------------------------
Total 85 4065.50 73160.76 143.00
Center 53
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 88.00 143.00 143.00
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
3 4069.50 72906.51 0.00
Other 0 4.00 200.00 0.00
-------------------------------------------------
Total 3 4161.50 73249.51 143.00
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 88.00 143.00 143.00
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
122 8134.00 183027.25 0.00
Other 37 156.50 3073.42 2873.42
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Total 159 8378.50 186243.67 3016.42