CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/15/2012 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 748 817.000000 30219.7500 36.9887
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 717 814.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 691 704.250000 26048.0000 36.9869
TCM-T1017TL-TARGETED CASE MANAGEMENT 1596 7174.000000 265077.2500 36.9497
TCON-TCON-TRANSITION CONFERENCE 172 174.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1617 9683.250000 321345.0000 33.1857
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 68 126.000000 6300.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 42 83.000000 6225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 13.500000 1012.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 14.000000 1050.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 26 49.500000 3712.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 24 47.500000 2636.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 164 311.000000 23250.0000 74.7588
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 107 195.500000 14587.5000 74.6164
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 51 100.000000 7500.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 195 375.000000 20757.0000 55.3520
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 37 72.000000 5400.0000 75.0000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
Subtotal (Total Children Is Unduplicated) 389 1388.000000 92479.2500 66.6277
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 20 26.000000 1300.0000 50.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 13 5.250000 262.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.500000 25.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 4.000000 200.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 29 28.000000 1400.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 85 321.250000 16062.5000 50.0000
INTR-INTR-INTERPRETER 133 234.500000 11700.0000 49.8934
OCCT-97530-OT SESSION BY LICENSED OT 1 3.000000 203.6400 67.8800
PHY-97110-PT SESSION BY LICENSED PT 29 123.250000 8366.2100 67.8800
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.000000 50.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 34 181.750000 12337.1900 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 175 16320.00000 8133.0000 0.4983
Subtotal (Total Children Is Unduplicated) 295 17248.50000 60040.0400 3.4809
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Total 28319.750000 473864.2900 16.7326
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Number of Children (Unduplicated) With at Least One Service 1636
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Center 09
Flag Claims Units Chgs Paid
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R 3 1.750000 64.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 5406 5073.250000 219569.4800 0.0000
P 9161 22301.500000 222707.2100 222750.4350
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
331 941.500000 31458.1000 0.0000
Other 3 1.750000 64.7500 0.0000
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Total 14904 28319.750000 473864.2900 222750.4350