CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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
Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 3 6.00 450.00 75.00
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 4.00 222.00 55.50
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.50 112.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.50 412.50 75.00
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.00 242.50 48.50
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.00 97.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 18 28.00 1744.50 62.30
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 5.00 2253.82 450.76
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 20 20.25 1012.50 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 2 2.00 50.00 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.25 12.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 15 15.50 775.00 50.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 6 375.00 3375.00 9.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 76 992.00 24800.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 48 337.00 8425.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 38 163.50 8175.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 29 169.25 8462.50 50.00
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 5 130.00 6500.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 11 34.50 2341.86 67.88
PHY-97110-PT SESSION BY LICENSED PT 3 15.25 1035.17 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 13 36.50 2477.62 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 11 260.00 3432.00 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 60 4439.00 2220.70 0.50
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 15 73.25 3662.50 50.00
Subtotal (Total Children Is Unduplicated) 299 7068.25 79011.17 11.18
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Total 7096.25 80755.67 11.38
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Number of Children (Unduplicated) With at Least One Service 310
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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
56 228.50 11828.82 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 56 228.50 11828.82 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
110 1213.50 30358.94 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 110 1213.50 30358.94 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 141 269.50 7696.00 6397.50
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
87 130.50 4605.50 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 228 400.00 12301.50 6397.50
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
130 260.00 3432.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 130 260.00 3432.00 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
2 6.00 407.28 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2 6.00 407.28 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 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
25 152.50 7988.54 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 25 152.50 7988.54 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
49 1014.75 3253.32 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 49 1014.75 3253.32 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 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
2 56.00 95.38 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2 56.00 95.38 0.00
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 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
16 14.25 967.29 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 16 14.25 967.29 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 1 3.00 2.70 2.70
H 0 0.00 0.00 0.00
T 2 1.50 75.00 75.00
106 2784.00 6998.96 0.00
Other 54 962.25 3045.94 3045.94
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Total 163 3750.75 10122.60 3123.64