CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Payclass Filters:GR
Eligibility Filter:DEI Only
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 171 78.75 2913.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 53 53.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 61 62.50 2312.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 119 262.75 9721.75 37.00
Subtotal (Total Children Is Unduplicated) 297 457.00 14948.00 32.71
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 8 7.50 375.00 50.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 0.50 37.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 5.00 375.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 9.00 675.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.00 166.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 4.00 300.00 75.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 25 30.00 1977.50 65.92
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 4.00 400.37 100.09
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.50 75.00 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 7.00 350.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 4.00 200.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 40.00 2000.00 50.00
INTR-INTR-INTERPRETER 1 2.00 117.00 58.50
PHY-97110-PT SESSION BY LICENSED PT 1 6.25 424.25 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 36.00 2411.68 66.99
TRAN-TRAN-FAMILY TRANSPORTATION 11 11.00 88.00 8.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 41 5934.00 3084.65 0.52
Subtotal (Total Children Is Unduplicated) 52 6045.75 9150.95 1.51
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Total 6532.75 26076.45 3.99
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Number of Children (Unduplicated) With at Least One Service 323
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Center 01
Flag Claims Units Chgs Paid
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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 104 2666.75 3398.27 3398.27
D 1 1.00 75.00 0.00
S 7 6.50 240.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
144 151.00 2157.50 0.00
Other 6 6.00 430.50 0.00
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Total 262 2831.25 6301.77 3398.27
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 3 2828.25 3553.27 3553.27
D 0 1.00 75.00 0.00
S 0 6.50 240.50 0.00
H 1 4.00 200.00 200.00
T 0 0.00 0.00 0.00
403 365.50 9374.50 0.00
Other 0 6.00 430.50 0.00
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Total 407 3211.25 13873.77 3753.27
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 2828.25 3553.27 3553.27
D 0 1.00 75.00 0.00
S 0 6.50 240.50 0.00
H 0 4.00 200.00 200.00
T 0 0.00 0.00 0.00
111 417.50 10817.50 0.00
Other 0 6.00 430.50 0.00
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Total 111 3263.25 15316.77 3753.27
Center 06
Flag Claims Units Chgs Paid
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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 54 3529.25 5003.93 5003.93
D 0 1.00 75.00 0.00
S 0 6.50 240.50 0.00
H 0 4.00 200.00 200.00
T 0 0.00 0.00 0.00
140 797.00 13232.50 9.25
Other 0 6.00 430.50 0.00
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Total 194 4343.75 19182.43 5213.18
Center 10
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 3529.25 5003.93 5003.93
D 5 5.00 223.00 148.00
S 0 6.50 240.50 0.00
H 0 4.00 200.00 200.00
T 0 0.00 0.00 0.00
24 816.75 14002.25 9.25
Other 0 6.00 430.50 0.00
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Total 29 4367.50 20100.18 5361.18
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 36 5191.50 8298.30 8298.30
D 5 8.50 352.50 148.00
S 0 6.50 240.50 0.00
H 0 4.00 200.00 200.00
T 0 0.00 0.00 0.00
50 846.50 15355.37 9.25
Other 0 6.00 430.50 0.00
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Total 91 6063.00 24877.17 8655.55
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 5191.50 8298.30 8298.30
D 0 8.50 352.50 148.00
S 0 6.50 240.50 0.00
H 0 4.00 200.00 200.00
T 0 0.00 0.00 0.00
8 849.00 15447.87 9.25
Other 0 6.00 430.50 0.00
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Total 8 6065.50 24969.67 8655.55
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 5191.50 8298.30 8298.30
D 0 8.50 352.50 148.00
S 0 6.50 240.50 0.00
H 4 67.00 304.00 304.00
T 1 60.00 30.00 30.00
13 914.50 15644.37 9.25
Other 0 6.00 430.50 0.00
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Total 18 6254.00 25300.17 8789.55
Center 54
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 7 5351.75 8632.98 8632.98
D 1 9.00 371.00 148.00
S 0 6.50 240.50 0.00
H 0 67.00 304.00 304.00
T 0 60.00 30.00 30.00
27 1032.50 16067.47 9.25
Other 0 6.00 430.50 0.00
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Total 35 6532.75 26076.45 9124.23