CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 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 124 56.000000 2072.0000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 42 46.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 47 43.250000 1600.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 67 153.000000 5661.0000 37.0000
Subtotal (Total Children Is Unduplicated) 204 298.250000 9333.2500 31.2934
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 2.500000 125.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 2 3.000000 150.0000 50.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 4.000000 222.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 6.500000 531.7500 81.8077
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
Subtotal (Total Children Is Unduplicated) 12 17.000000 1077.2500 63.3676
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.500000 75.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 3 68.000000 1700.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 2.000000 100.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 15.000000 750.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 29.000000 1450.0000 50.0000
INTR-INTR-INTERPRETER 2 23.500000 1501.5000 63.8936
PHY-97110-PT SESSION BY LICENSED PT 2 9.000000 610.9200 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 8.000000 336.8000 42.1000
TRAN-TRAN-FAMILY TRANSPORTATION 4 4.000000 32.0000 8.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 43 7868.000000 4047.5500 0.5144
Subtotal (Total Children Is Unduplicated) 46 8028.000000 10603.7700 1.3208
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Total 8343.250000 21014.2700 2.5187
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Number of Children (Unduplicated) With at Least One Service 215
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 8 389.000000 590.5000 590.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2 226.000000 360.5000 360.5000
143 73.000000 2701.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 153 688.000000 3652.0000 951.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 7 422.000000 310.0000 310.0000
D 1 0.250000 9.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
168 88.500000 3138.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 176 510.750000 3457.2500 310.0000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 82.000000 151.0000 151.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
130 403.000000 2674.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 133 485.000000 2825.2500 151.0000
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 55 881.500000 2000.9200 2000.9200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
190 2076.250000 3152.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 245 2957.750000 5153.5800 2000.9200
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 4 160.000000 80.0000 80.0000
D 2 0.750000 27.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
16 6.500000 240.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 22 167.250000 348.2500 80.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5 34.000000 53.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5 34.000000 53.5000 0.0000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 34 1044.000000 1459.5000 1459.5000
T 28 846.250000 859.0100 859.0100
57 1002.500000 2536.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 119 2892.750000 4854.8900 2318.5100
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 3 170.000000 102.0000 102.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6 412.250000 355.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9 582.250000 457.2500 102.0000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 4 23.000000 119.8000 119.8000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2 2.500000 92.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6 25.500000 212.3000 119.8000