CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Agency Filter:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
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 92 35.00 1295.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 242 249.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 261 217.75 8056.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 476 1017.25 37638.25 37.00
TCON-TCON-TRANSITION CONFERENCE 24 25.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 481 1544.00 46990.00 30.43
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 56 108.00 5400.00 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 3 5.50 305.25 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 7.00 525.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 6.50 487.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 10.50 582.75 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 88 163.50 12327.16 75.40
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 31 59.50 5234.34 87.97
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 27 52.50 4091.14 77.93
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 22.00 1766.14 80.28
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 127 241.00 17149.33 71.16
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 92 190.00 16831.66 88.59
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 1.50 75.00 50.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 6 6.00 291.00 48.50
Subtotal (Total Children Is Unduplicated) 217 873.50 65066.27 74.49
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 81 95.75 4787.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 18 12.00 300.00 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 7 6.50 325.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.50 12.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 5.00 250.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 1 0.25 6.25 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 9.00 225.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 86 197.50 9875.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 8 12.00 600.00 50.00
INTR-INTR-INTERPRETER 8 20.00 1000.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 12 40.00 4850.84 121.27
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 7 7.00 350.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 338 27988.0 13994.00 0.50
Subtotal (Total Children Is Unduplicated) 359 28393.5 36576.09 1.29
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Total 30811.00 148632.36 4.82
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Number of Children (Unduplicated) With at Least One Service 549
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Center 53
Flag Claims Units Chgs Paid
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R 47 85.00 4640.00 0.00
U 0 0.00 0.00 0.00
B 288 301.00 13655.25 0.00
P 725 758.84 37341.57 37341.32
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
2493 29665.16 92945.54 0.00
Other 1 1.00 50.00 0.00
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Total 3554 30811.00 148632.36 37341.32