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
Payclass Filters:GR
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 200 517.250000 19036.5000 36.8033
TCON-TCON-TRANSITION CONFERENCE 47 48.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 579 1496.000000 40533.5000 27.0946
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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 7 14.000000 1050.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 14.000000 777.0000 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 6 11.500000 862.5000 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 4 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 25.500000 1415.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 26.000000 1950.0000 75.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 80 200.750000 11825.2500 58.9054
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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 2 1.500000 37.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 29 102.377800 5118.8900 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 25.000000 1250.0000 50.0000
INTR-INTR-INTERPRETER 3 4.000000 200.0000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 4 16.000000 1086.0800 67.8800
PHY-97110HM-PT SESSION BY PT ASST 1 4.000000 217.2800 54.3200
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 4.000000 200.0000 50.0000
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) 352 41538.12780 39906.7000 0.9607
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Total 43234.877800 92265.4500 2.1341
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Number of Children (Unduplicated) With at Least One Service 633
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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 1 0.500000 18.5000 18.5000
D 56 44.750000 1604.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1201 13842.500000 28199.8400 28124.0900
2564 29347.127800 62443.1100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3822 43234.877800 92265.4500 28142.5900