CMS/EIP Fiscal Report Center: 53
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 422 378.500000 13958.2500 36.8778
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 260 299.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 397 496.750000 18278.0000 36.7952
TCM-T1017TL-TARGETED CASE MANAGEMENT 216 611.000000 22505.2500 36.8335
TCON-TCON-TRANSITION CONFERENCE 74 75.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 630 1860.250000 54741.5000 29.4270
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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 52 94.000000 4700.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 15 30.000000 1665.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
Subtotal (Total Children Is Unduplicated) 75 154.000000 8406.0000 54.5844
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 26.4900 26.4900
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 58 85.500000 4275.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 15 10.000000 250.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 86 40.250000 2006.2500 49.8447
CONIP-CONIP-CONSULT, ITDS, PHONE 2 2.500000 62.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 26 38.250000 1912.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 0.750000 18.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 14.750000 737.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 6 34.750000 868.7500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 16.000000 400.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 36 173.250000 8662.5000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 4.000000 200.0000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 54.3200 54.3200
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 2.000000 100.0000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 309 35151.00000 17488.0000 0.4975
Subtotal (Total Children Is Unduplicated) 342 35575.00000 37062.5600 1.0418
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Total 37589.250000 100210.0600 2.6659
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Number of Children (Unduplicated) With at Least One Service 671
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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 891 621.000000 17740.2400 17740.1500
D 49 42.500000 1776.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 793 600.500000 17787.7500 17787.7500
2271 36325.250000 62905.5700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4004 37589.250000 100210.0600 35527.9000