CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
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
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 0.75 37.50 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 1.00 55.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 20 20.00 1110.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 20 26.00 1125.00 43.27
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 3.00 150.00 50.00
Subtotal (Total Children Is Unduplicated) 42 50.75 2478.00 48.83
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 8 15.50 775.00 50.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 81 8316.00 74844.00 9.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 101 8645.00 216125.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 54 2297.00 57425.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 85 644.50 32187.50 49.94
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 28 443.00 22150.00 50.00
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 3 7.25 362.50 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 7 11.25 562.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 65 312.75 21229.47 67.88
PHY-97110-PT SESSION BY LICENSED PT 65 250.50 17003.94 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 11 10.50 525.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 110 462.50 31394.50 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 21 70.00 924.00 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 74.00 37.00 0.50
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 17 70.50 3525.00 50.00
Subtotal (Total Children Is Unduplicated) 390 21630.3 479070.41 22.15
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Total 21681.00 481548.41 22.21
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Number of Children (Unduplicated) With at Least One Service 431
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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 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
47 168.25 8412.50 0.00
Other 0 0.00 0.00 0.00
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Total 47 168.25 8412.50 0.00
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 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
729 11638.50 324117.83 0.00
Other 0 0.00 0.00 0.00
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Total 729 11638.50 324117.83 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 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
21 11659.50 325283.33 0.00
Other 0 0.00 0.00 0.00
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Total 21 11659.50 325283.33 0.00
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 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
97 11870.00 337439.88 0.00
Other 0 0.00 0.00 0.00
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Total 97 11870.00 337439.88 0.00
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 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
197 12371.75 362314.88 0.00
Other 0 0.00 0.00 0.00
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Total 197 12371.75 362314.88 0.00
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 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
407 21681.00 481548.41 0.00
Other 0 0.00 0.00 0.00
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Total 407 21681.00 481548.41 0.00