CMS/EIP Fiscal Report Center: 57
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
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 309 205.50 7603.50 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 619 634.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 214 192.75 7131.75 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 1396 5366.25 198551.25 37.00
TCON-TCON-TRANSITION CONFERENCE 179 185.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1416 6583.50 213286.50 32.40
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 4 4.00 200.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 79 79.00 3950.00 50.00
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 14.00 1050.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.00 150.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 18.50 1026.75 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 289 332.50 24937.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 6.00 450.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 6.00 450.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 298 455.50 25280.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 13.50 1012.50 75.00
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 14 15.00 727.50 48.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 14 14.00 679.00 48.50
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 11 11.00 533.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 17 18.00 873.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 140 143.00 6935.50 48.50
Subtotal (Total Children Is Unduplicated) 537 1133.00 68330.50 60.31
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.00 50.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 172 232.00 11600.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 38 44.50 1112.50 25.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.00 50.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 8.00 400.00 50.00
CONPP-CONPP-CONSULT, PT, PHONE 1 1.00 25.00 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 200 273.00 13650.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 36 42.50 1062.50 25.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 63 9107.00 81963.00 9.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 10 289.00 7225.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 763 6636.50 331825.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 131 650.50 44155.94 67.88
PHY-97110-PT SESSION BY LICENSED PT 148 643.75 43697.75 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 459 2247.75 152577.27 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 6 5.50 72.60 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 836 176923 92017.10 0.52
Subtotal (Total Children Is Unduplicated) 1107 197106 781483.66 3.96
----------------------------------------------------------------------------------------------------------------
Total 204822.50 1063100.66 5.19
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1603
----------------------------------------------------------------------------------------------------------------
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 2635 2721.50 104969.90 0.00
P 160 227.47 12566.96 12566.97
D 6 2.75 101.75 0.00
S 149 4704.00 7558.66 7636.24
H 0 0.00 0.00 0.00
T 4608 174185.03 378571.19 378617.01
6998 22014.00 555975.50 245925.28
Other 59 967.75 3356.70 3356.70
-------------------------------------------------
Total 14615 204822.50 1063100.66 648102.20