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
Payclass Filters:GR
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 226 548.500000 20248.2500 36.9157
TCON-TCON-TRANSITION CONFERENCE 40 42.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 493 1684.250000 48877.0000 29.0200
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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 7 19.000000 1425.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 20.500000 1137.7500 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 14 23.301800 1293.2499 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 30.363200 2277.2400 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 8.138730 610.4048 75.0003
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 35 66.308759 3680.1361 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 93.107733 6983.0800 75.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.000000 48.5000 48.5000
Subtotal (Total Children Is Unduplicated) 113 418.470222 25392.8608 60.6802
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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 5 5.000000 250.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.500000 37.5000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 34 136.000000 6800.0000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 5.000000 250.0000 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 2 3.000000 150.0000 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 1 8.000000 400.0000 50.0000
Subtotal (Total Children Is Unduplicated) 316 30445.00000 37853.5000 1.2433
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Total 32547.720222 112123.3608 3.4449
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Number of Children (Unduplicated) With at Least One Service 554
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Center 53
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 3 6.000000 333.0000 333.0000
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
1866 20950.753292 70976.6112 37.5000
Other 1 0.250000 9.2500 0.0000
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Total 2963 32547.720222 112123.3608 41175.0000