CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2011 ending 09/30/2011 Date of Report:11/30/2011 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 357 224.500000 8306.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 297 349.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 369 357.250000 13190.5000 36.9223
TCM-T1017TL-TARGETED CASE MANAGEMENT 682 2316.750000 85405.2500 36.8642
TCON-TCON-TRANSITION CONFERENCE 47 48.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 703 3295.500000 106902.2500 32.4389
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
EXIT-EXIT-TRANSITION ASSESSMENT 51 92.750000 4637.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 22 44.000000 3300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 26 50.500000 2802.7500 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 43.500000 3262.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 25.500000 1912.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 56 111.000000 5966.2500 53.7500
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 67.500000 4987.5000 73.8889
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 2.000000 100.0000 50.0000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 4 4.000000 194.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 11 11.000000 533.5000 48.5000
Subtotal (Total Children Is Unduplicated) 171 471.250000 29067.0000 61.6806
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 102 119.500000 5962.5000 49.8954
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 29 54.500000 1362.5000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 51 30.750000 1537.5000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 11 7.250000 181.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.500000 25.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 21 31.000000 1550.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 1.500000 37.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 10 14.000000 700.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 8 3.250000 81.2500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 13.500000 337.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 116 409.000000 20437.0000 49.9682
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 9 45.000000 2250.0000 50.0000
INTR-INTR-INTERPRETER 3 4.000000 200.0000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 10 39.500000 2681.2600 67.8800
PHY-97110HM-PT SESSION BY PT ASST 1 4.000000 217.2800 54.3200
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 11 20.000000 1000.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 13.000000 827.7600 63.6738
SPL-92508-GROUP SPL SESSION PER CHILD 2 1.000000 13.2000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 326 41118.00000 20346.2500 0.4948
Subtotal (Total Children Is Unduplicated) 356 41929.25000 59747.7500 1.4250
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Total 45696.000000 195717.0000 4.2830
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Number of Children (Unduplicated) With at Least One Service 732
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Center 53
Flag Claims Units Chgs Paid
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R 1 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 87 78.250000 3506.7100 203.5000
P 2113 1810.622200 72468.6100 72468.6100
D 324 275.500000 13916.4800 0.0000
S 1 0.250000 9.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 1204 13845.500000 28349.8400 28274.0900
2878 29684.377800 77410.6100 275.0000
Other 1 0.500000 18.5000 0.0000
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Total 6609 45696.000000 195717.0000 101221.2000