CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 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 132 79.75 2950.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 39 39.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 68 62.75 2321.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 140 339.50 12561.50 37.00
Subtotal (Total Children Is Unduplicated) 279 521.00 17834.00 34.23
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 5 3.50 175.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 0.50 37.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.00 55.50 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.00 150.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 3.00 225.00 75.00
OCTH-97003-OT EVAL BY LICENSED OT, 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) 15 13.00 815.00 62.69
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 4.25 212.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.25 6.25 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.00 50.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.25 12.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 1.75 87.50 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 3.00 150.00 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 6 39.00 1950.00 50.00
INTR-INTR-INTERPRETER 3 5.00 250.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 2 8.50 576.98 67.88
PHY-97110-PT SESSION BY LICENSED PT 2 9.50 644.86 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 23.25 1578.21 67.88
TRAN-TRAN-FAMILY TRANSPORTATION 8 8.00 64.00 8.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 46 7198.00 3620.10 0.50
Subtotal (Total Children Is Unduplicated) 54 7305.75 9402.90 1.29
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Total 7839.75 28051.90 3.58
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Number of Children (Unduplicated) With at Least One Service 296
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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 79 2363.50 2647.51 2647.51
D 0 0.00 0.00 0.00
S 5 7.25 268.25 0.00
H 0 0.00 0.00 0.00
T 31 1194.00 1064.52 1064.52
172 89.50 3311.50 0.00
Other 1 15.00 7.50 0.00
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Total 288 3669.25 7299.28 3712.03
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 17 3305.00 3879.21 3879.21
D 3 1.50 55.50 0.00
S 0 7.25 268.25 0.00
H 0 0.00 0.00 0.00
T 0 1194.00 1064.52 1064.52
449 340.50 12230.50 0.00
Other 0 15.00 7.50 0.00
-------------------------------------------------
Total 469 4863.25 17505.48 4943.73
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 3305.00 3879.21 3879.21
D 0 1.50 55.50 0.00
S 0 7.25 268.25 0.00
H 0 0.00 0.00 0.00
T 0 1194.00 1064.52 1064.52
115 391.50 13784.50 0.00
Other 0 15.00 7.50 0.00
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Total 115 4914.25 19059.48 4943.73
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 62 4398.00 4956.47 4956.47
D 0 1.50 55.50 0.00
S 0 7.25 268.25 0.00
H 0 0.00 0.00 0.00
T 0 1194.00 1064.52 1064.52
158 490.75 16975.75 92.50
Other 0 15.00 7.50 0.00
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Total 220 6106.50 23327.99 6113.49
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 4398.00 4956.47 4956.47
D 0 1.50 55.50 0.00
S 0 7.25 268.25 0.00
H 0 0.00 0.00 0.00
T 0 1194.00 1064.52 1064.52
3 493.75 17086.75 92.50
Other 0 15.00 7.50 0.00
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Total 3 6109.50 23438.99 6113.49
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 4398.00 4956.47 4956.47
D 0 1.50 55.50 0.00
S 0 7.25 268.25 0.00
H 0 0.00 0.00 0.00
T 0 1194.00 1064.52 1064.52
6 497.25 17179.25 92.50
Other 0 15.00 7.50 0.00
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Total 6 6113.00 23531.49 6113.49
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 40 5542.25 7999.05 7999.05
D 0 1.50 55.50 0.00
S 0 7.25 268.25 0.00
H 0 0.00 0.00 0.00
T 0 1194.00 1064.52 1064.52
19 506.00 17503.00 92.50
Other 0 15.00 7.50 0.00
-------------------------------------------------
Total 59 7266.00 26897.82 9156.07
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 5542.25 7999.05 7999.05
D 0 1.50 55.50 0.00
S 0 7.25 268.25 0.00
H 0 0.00 0.00 0.00
T 0 1194.00 1064.52 1064.52
6 608.75 17581.25 92.50
Other 0 15.00 7.50 0.00
-------------------------------------------------
Total 6 7368.75 26976.07 9156.07
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 5542.25 7999.05 7999.05
D 0 1.50 55.50 0.00
S 0 7.25 268.25 0.00
H 1 90.00 45.00 45.00
T 6 1285.00 1146.52 1146.52
7 733.00 17787.50 92.50
Other 0 15.00 7.50 0.00
-------------------------------------------------
Total 14 7674.00 27309.32 9283.07
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 6 5650.75 8254.38 8254.38
D 6 5.25 194.25 0.00
S 0 7.25 268.25 0.00
H 0 90.00 45.00 45.00
T 0 1285.00 1146.52 1146.52
19 786.50 18136.00 92.50
Other 0 15.00 7.50 0.00
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Total 31 7839.75 28051.90 9538.40