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:OTHER
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 3 4.50 166.50 37.00
Subtotal (Total Children Is Unduplicated) 3 4.50 166.50 37.00
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Screening, Eval, and Assessment,Class #02
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 4 7.50 416.25 55.50
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.00 150.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.00 97.00 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 3 3.00 145.50 48.50
Subtotal (Total Children Is Unduplicated) 11 17.50 968.25 55.33
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 2.00 300.00 150.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.00 100.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 8 8.00 400.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 3 2.25 56.25 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.50 25.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.50 125.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 17 34.25 1712.50 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 3 2.25 56.25 25.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 3 356.00 3204.00 9.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 3 10.00 250.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 92.00 2300.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 33 176.25 8812.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 17 133.00 6650.00 50.00
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 10 70.00 3500.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 9 28.50 1934.58 67.88
OCCT-97530HM-OT SESSION BY OT ASST 2 8.50 461.72 54.32
PHY-97110-PT SESSION BY LICENSED PT 9 24.67 1674.91 67.89
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 24 46.75 3009.35 64.37
SPL-92508-GROUP SPL SESSION PER CHILD 11 194.00 2560.80 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 68 3216.00 1608.00 0.50
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 16 590.50 29525.00 50.00
Subtotal (Total Children Is Unduplicated) 195 4999.92 68265.86 13.65
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Total 5021.92 69400.61 13.82
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Number of Children (Unduplicated) With at Least One Service 204
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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
112 367.00 16050.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 112 367.00 16050.00 0.00
Center 05
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 33 46.50 2136.00 2136.00
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
72 538.50 20458.75 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 105 585.00 22594.75 2136.00
Center 06
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 46.50 2136.00 2136.00
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
97 732.50 23019.55 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 97 779.00 25155.55 2136.00
Center 07
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 46.50 2136.00 2136.00
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
5 745.50 24046.85 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 5 792.00 26182.85 2136.00
Center 51
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 46.50 2136.00 2136.00
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
43 838.00 29035.39 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 43 884.50 31171.39 2136.00
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 46.50 2136.00 2136.00
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
75 2250.42 59014.85 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 75 2296.92 61150.85 2136.00
Center 53
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 46.50 2136.00 2136.00
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
1 2251.42 59064.85 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1 2297.92 61200.85 2136.00
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 46.50 2136.00 2136.00
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
85 4813.92 64883.95 0.00
Other 37 161.50 2380.66 2380.66
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Total 122 5021.92 69400.61 4516.66