CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 Page: 1
Agency Filter:EIP DEI DEIP
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 158 79.500000 2941.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 267 320.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 326 694.250000 25687.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 600 1739.000000 64121.0000 36.8723
TCON-TCON-TRANSITION CONFERENCE 40 42.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 615 2874.750000 92749.7500 32.2636
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 53 152.750000 7637.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 35.000000 2625.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.000000 525.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 20 41.500000 2267.2500 54.6325
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 14 24.499990 1359.7494 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 33 73.500000 5874.4800 79.9249
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 11.999890 899.9918 74.9999
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 98 223.499920 13042.8855 58.3575
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 73 212.000000 16503.3000 77.8458
SPCH-92506-SPEECH EVAL BY LICENSED SLP 8 10.000000 1217.5800 121.7580
Subtotal (Total Children Is Unduplicated) 184 791.749800 51952.7367 65.6176
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 88 231.500000 11575.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 21 25.000000 625.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 6 6.000000 300.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.500000 37.5000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 4.000000 100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 91 354.000000 17602.0000 49.7232
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 5 15.000000 750.0000 50.0000
INTR-INTR-INTERPRETER 10 14.000000 700.0000 50.0000
RSPT-RSPT-RESPITE 1 40.000000 0.0000 0.0000
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 3 4.000000 200.0000 50.0000
TRAN-TRAN-FAMILY TRANSPORTATION 1 20.000000 2000.0000 100.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 284 29953.00000 14941.0000 0.4988
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 2 9.000000 450.0000 50.0000
Subtotal (Total Children Is Unduplicated) 317 30679.00000 49380.5000 1.6096
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Total 34345.499800 194082.9867 5.6509
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Number of Children (Unduplicated) With at Least One Service 655
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Center 53
Flag Claims Units Chgs Paid
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R 80 83.250000 3321.2500 311.0000
U 0 0.000000 0.0000 0.0000
B 1139 1052.500000 43377.0000 0.0000
P 544 604.529578 29887.3759 29099.8800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 455 11036.216930 24394.9996 24395.0000
T 638 554.500000 16409.5000 16409.5000
1908 21010.003292 76489.3612 37.5000
Other 3 4.500000 203.5000 0.0000
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Total 4767 34345.499800 194082.9867 70252.8800