CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 0.75 37.50 50.00
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) 21 29.75 1312.50 44.12
----------------------------------------------------------------------------------------------------------------
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 8244.00 74196.00 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 65 308.75 20957.95 67.88
PHY-97110-PT SESSION BY LICENSED PT 65 248.50 16868.18 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 11 10.50 525.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 110 460.50 31258.74 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 21550.3 477879.37 22.18
----------------------------------------------------------------------------------------------------------------
Total 21580.00 479191.87 22.21
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 410
----------------------------------------------------------------------------------------------------------------
Center 01
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
47 168.25 8412.50 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
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
-------------------------------------------------
Total 729 11638.50 324117.83 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 11849.00 336274.38 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 97 11849.00 336274.38 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 12350.75 361149.38 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 197 12350.75 361149.38 0.00
Center 57
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
403 21580.00 479191.87 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 403 21580.00 479191.87 0.00