CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/17/2009 Page: 1
Agency Filter:EXT
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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 10.50 350.00 33.33
Subtotal (Total Children Is Unduplicated) 7 10.50 350.00 33.33
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 3.50 175.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 2 2.00 100.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 2 1.00 30.00 30.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 85 7328.00 65952.00 9.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 99 4527.00 113175.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 59 986.00 24650.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 35 77.50 2475.00 31.94
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 34 161.00 7330.00 45.53
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 4 9.25 462.50 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 5 10.75 537.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 60 201.25 13660.85 67.88
PHY-97110-PT SESSION BY LICENSED PT 64 173.00 11743.24 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 8 10.50 525.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 113 251.75 17088.79 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 17 23.00 303.60 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 38.00 19.00 0.50
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 11 53.75 2687.50 50.00
Subtotal (Total Children Is Unduplicated) 353 13857.3 260914.98 18.83
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Total 13867.75 261264.98 18.84
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Number of Children (Unduplicated) With at Least One Service 360
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Center 04
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 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
459 5722.00 155401.78 0.00
Other 0 0.00 0.00 0.00
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Total 459 5722.00 155401.78 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 3 8.00 543.04 543.04
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 5722.00 155401.78 0.00
Other 0 0.00 0.00 0.00
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Total 3 5730.00 155944.82 543.04
Center 10
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 0 8.00 543.04 543.04
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
57 5865.75 163456.46 0.00
Other 0 0.00 0.00 0.00
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Total 57 5873.75 163999.50 543.04
Center 52
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 0 8.00 543.04 543.04
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
60 5985.75 167150.40 0.00
Other 0 0.00 0.00 0.00
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Total 60 5993.75 167693.44 543.04
Center 57
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 0 8.00 543.04 543.04
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
411 13859.75 260721.94 0.00
Other 0 0.00 0.00 0.00
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Total 411 13867.75 261264.98 543.04