CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 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 2 3.000000 150.0000 50.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 9.000000 499.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 4 4.000000 194.0000 48.5000
VISF-VISF-VISION EVALUATION FUNCTIONAL 1 0.750000 37.5000 50.0000
Subtotal (Total Children Is Unduplicated) 14 18.750000 1031.0000 54.9867
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EI Services,Class #03
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 7 6.500000 325.0000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.250000 6.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 13 16.500000 825.0000 50.0000
ECE-ECE-EARLY CHILDHOOD EDUCATION 4 84.000000 966.0000 11.5000
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 93 3430.000000 85750.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 45 865.000000 21625.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 25 86.500000 4325.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 46 184.250000 9212.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 6 20.500000 1391.5400 67.8800
PHY-97110-PT SESSION BY LICENSED PT 8 11.750000 797.5900 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 15 33.750000 2290.9500 67.8800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 1.000000 54.3200 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 5 79.000000 1042.8000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 75 6352.000000 20078.0000 3.1609
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 20 121.250000 6062.5000 50.0000
Subtotal (Total Children Is Unduplicated) 308 11292.25000 154752.4500 13.7043
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Total 11311.000000 155783.4500 13.7727
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Number of Children (Unduplicated) With at Least One Service 315
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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 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
63 218.250000 9837.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 63 218.250000 9837.5000 0.0000
Center 02
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
1 2.000000 100.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 2.000000 100.0000 0.0000
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 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
194 4136.750000 103536.6700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 194 4136.750000 103536.6700 0.0000
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 138 137.250000 6962.0000 6962.0000
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
58 56.250000 2812.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 196 193.500000 9774.5000 6962.0000
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 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
39 78.000000 1029.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 39 78.000000 1029.6000 0.0000
Center 07
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
1 3.000000 203.6400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 3.000000 203.6400 0.0000
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 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 15.000000 1018.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5 15.000000 1018.2000 0.0000
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
92 4408.750000 4573.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 92 4408.750000 4573.7900 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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
16 59.000000 760.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16 59.000000 760.3800 0.0000
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 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
19 16.750000 1117.6100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 19 16.750000 1117.6100 0.0000
Center 57
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 3 151.500000 158.9400 138.9400
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
69 1417.000000 21401.0000 21981.0000
Other 33 611.500000 2271.6200 2271.6200
---------------------------------------------------------
Total 105 2180.000000 23831.5600 24391.5600