CMS/EIP Fiscal Report Center: 54
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 272 113.25 4190.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 204 209.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 482 637.25 23504.25 36.88
TCM-T1017TL-TARGETED CASE MANAGEMENT 1145 4080.00 150599.25 36.91
Subtotal (Total Children Is Unduplicated) 1156 5039.50 178293.75 35.38
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 13 27.25 1362.50 50.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 16.00 1200.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 17 29.50 2212.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 12.00 666.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.00 525.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 47.00 3525.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 52 88.50 4911.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 47 76.50 5737.50 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 15 15.00 727.50 48.50
Subtotal (Total Children Is Unduplicated) 147 318.75 20867.75 65.47
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 10 12.00 600.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 28 28.50 1425.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 2 1.00 25.00 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 11 11.00 500.00 45.45
CONOP-CONOP-CONSULT, OT, PHONE 2 2.00 50.00 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 3.00 125.00 41.67
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.50 37.50 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 170 921.50 46050.00 49.97
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 8 18.00 900.00 50.00
INTR-INTR-INTERPRETER 9 24.00 1200.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 7 44.00 2986.72 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 7 7.00 350.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 24 217.50 14848.75 68.27
SPL-92508-GROUP SPL SESSION PER CHILD 1 0.50 6.60 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 260 46119.0 32947.35 0.71
Subtotal (Total Children Is Unduplicated) 267 47410.5 102051.92 2.15
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Total 52768.75 301213.42 5.71
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Number of Children (Unduplicated) With at Least One Service 1169
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Center 54
Flag Claims Units Chgs Paid
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R 24 26.25 1117.25 0.00
U 0 0.00 0.00 0.00
B 4397 3262.25 135279.71 0.00
P 233 185.75 9890.79 9822.91
D 30 17.00 756.27 0.00
S 2 0.75 27.75 0.00
H 0 0.00 0.00 0.00
T 1 0.25 9.25 0.00
4686 49275.25 154086.15 0.00
Other 2 1.25 46.25 0.00
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Total 9375 52768.75 301213.42 9822.91