CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Payclass Filters:GR
Eligibility Filter:DEI Only
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 148 101.00 3729.75 36.93
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 52 54.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 98 96.00 3552.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 121 246.75 9129.75 37.00
TCON-TCON-TRANSITION CONFERENCE 4 4.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 300 501.75 16411.50 32.71
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 8 7.00 350.00 50.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.00 150.00 75.00
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 3 6.00 333.00 55.50
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 4.00 300.00 75.00
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 1 1.00 185.00 185.00
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 20 22.00 1441.50 65.52
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 7.75 387.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 2 1.50 37.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.00 50.00 50.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.00 50.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.00 50.00 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 22.00 1100.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 19.00 822.04 43.27
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 42.00 2100.00 50.00
INTR-INTR-INTERPRETER 5 15.25 817.50 53.61
OCCT-97530-OT SESSION BY LICENSED OT 1 7.00 220.60 31.51
PHY-97110-PT SESSION BY LICENSED PT 1 2.50 169.70 67.88
PHY-97110HM-PT SESSION BY PT ASST 1 0.50 27.16 54.32
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 4.00 200.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 25.50 1538.94 60.35
TRAN-TRAN-FAMILY TRANSPORTATION 7 7.00 56.00 8.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 63 9590.00 5101.10 0.53
Subtotal (Total Children Is Unduplicated) 71 9747.00 12728.04 1.31
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Total 10270.75 30581.04 2.98
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Number of Children (Unduplicated) With at Least One Service 314
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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 36 1024.00 759.50 759.50
D 0 0.00 0.00 0.00
S 1 1.75 64.75 0.00
H 51 1169.50 1151.00 1151.00
T 45 1196.25 1377.50 1377.50
288 165.25 6107.00 0.00
Other 1 1.00 50.00 0.00
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Total 422 3557.75 9509.75 3288.00
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 6 312.00 156.00 156.00
D 14 8.50 314.50 314.50
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
341 159.75 5617.75 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 361 480.25 6088.25 470.50
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 8 424.00 305.66 225.66
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
59 190.00 1785.38 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 67 614.00 2091.04 225.66
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 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
193 1714.00 4766.74 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 193 1714.00 4766.74 0.00
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 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
1 1.00 37.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 1 1.00 37.00 0.00
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 12 200.00 500.20 500.20
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
12 7.75 286.75 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 24 207.75 786.95 500.20
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
21 45.50 366.50 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 21 45.50 366.50 0.00
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 17 811.00 862.00 862.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 15 622.00 954.50 954.50
T 0 0.00 0.00 0.00
88 1026.00 2581.00 0.00
Other 0 0.00 0.00 0.00
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Total 120 2459.00 4397.50 1816.50
Center 54
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 7 497.75 484.00 484.00
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
18 274.75 563.15 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 25 772.50 1047.15 484.00
Center 55
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 26 294.75 979.39 979.39
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 12 123.00 464.52 464.52
2 1.25 46.25 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 40 419.00 1490.16 1443.91