CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/16/2012 Page: 1
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 3 3.750000 138.7500 37.0000
Subtotal (Total Children Is Unduplicated) 3 3.750000 138.7500 37.0000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 12 12.000000 600.0000 50.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 20 20.000000 970.0000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 8 8.000000 388.0000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 11 11.000000 533.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 14 15.000000 727.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 66 66.000000 3201.0000 48.5000
Subtotal (Total Children Is Unduplicated) 111 132.000000 6420.0000 48.6364
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EI Services,Class #03
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 3.000000 150.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 37 37.000000 1850.0000 50.0000
ECE-ECE-EARLY CHILDHOOD EDUCATION 118 18604.00000 18604.0000 1.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 269.000000 6725.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 767 7012.000000 350600.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 144 889.500000 60379.2600 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 3 19.500000 1059.2400 54.3200
PHY-97110-PT SESSION BY LICENSED PT 153 775.000000 52607.0000 67.8800
PHY-97110HM-PT SESSION BY PT ASST 7 33.500000 1819.7200 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 288 1643.500000 111560.7800 67.8800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 28 93.500000 5078.9200 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 2 5.500000 72.6000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 830 159360.0000 82987.4000 0.5208
Subtotal (Total Children Is Unduplicated) 1029 188745.0000 693493.9200 3.6742
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Total 188880.750000 700052.6700 3.7063
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Number of Children (Unduplicated) With at Least One Service 1036
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Center 57
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 8 13.315500 867.4900 867.4900
D 0 0.000000 0.0000 0.0000
S 45 1289.500000 2778.1400 2778.1400
H 0 0.000000 0.0000 0.0000
T 3256 158557.684500 268982.8800 268982.8800
2828 28913.500000 426099.6900 343322.4800
Other 15 106.750000 1324.4700 1324.4700
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Total 6152 188880.750000 700052.6700 617275.4600