CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 1.50 48.50 32.33
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.50 198.50 56.71
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 4.00 145.50 36.38
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.00 145.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 12 14.00 635.00 45.36
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 8 6.50 325.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 2 2.00 50.00 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 18 30.00 1500.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.00 25.00 25.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 8 288.00 3012.00 10.46
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 87.00 2175.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 18 78.00 3900.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 89.00 4450.00 50.00
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 8 20.50 1025.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 20 83.25 5651.01 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 4.00 217.28 54.32
PHY-97110-PT SESSION BY LICENSED PT 9 27.75 1883.67 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 0.50 27.16 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 30 65.00 4620.14 71.08
SPL-92508-GROUP SPL SESSION PER CHILD 5 100.00 1320.00 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 30 1134.00 16290.00 14.37
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 66 2367.00 1490.50 0.63
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 16 115.25 5762.50 50.00
Subtotal (Total Children Is Unduplicated) 176 4498.75 53724.26 11.94
----------------------------------------------------------------------------------------------------------------
Total 4512.75 54359.26 12.05
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 183
----------------------------------------------------------------------------------------------------------------
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
122 349.75 15312.50 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 122 349.75 15312.50 0.00
Center 03
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
1 351.75 15462.50 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1 351.75 15462.50 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 11 9.25 512.50 512.50
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
0 351.75 15462.50 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 11 361.00 15975.00 512.50
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 9.25 512.50 512.50
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
52 452.75 16850.38 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 52 462.00 17362.88 512.50
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 1 7.25 362.50 362.50
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
2 564.75 16777.42 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 3 572.00 17139.92 362.50
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 1 12.25 701.90 701.90
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
20 637.25 21698.72 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 21 649.50 22400.62 701.90
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 0 12.25 701.90 701.90
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
34 696.75 25258.66 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 34 709.00 25960.56 701.90
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 12.25 701.90 701.90
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
92 1910.50 29537.48 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 92 1922.75 30239.38 701.90
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 12.25 701.90 701.90
D 0 0.00 0.00 0.00
S 3 122.00 160.00 160.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
84 4119.50 50071.40 0.00
Other 40 259.00 3425.96 3527.78
-------------------------------------------------
Total 127 4512.75 54359.26 4389.68