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
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 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 686 2833.250000 104589.7500 36.9151
TCON-TCON-TRANSITION CONFERENCE 172 174.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1365 5342.500000 160857.5000 30.1090
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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 4 8.000000 600.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 25.500000 1912.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 14.000000 1050.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 12.000000 900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 33.000000 1831.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
Subtotal (Total Children Is Unduplicated) 93 234.500000 13716.0000 58.4904
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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 28 133.500000 6675.0000 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 5 12.000000 814.5600 67.8800
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.000000 50.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 12 43.750000 2969.7500 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 175 16320.00000 8133.0000 0.4983
Subtotal (Total Children Is Unduplicated) 295 16811.50000 33733.4500 2.0066
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Total 22388.500000 208306.9500 9.3042
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Number of Children (Unduplicated) With at Least One Service 1418
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Center 09
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 8731 21884.250000 206886.7000 206886.7000
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
60 504.250000 1420.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 8791 22388.500000 208306.9500 206886.7000