CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/16/2012 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:LEA
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 2 2.500000 125.0000 50.0000
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 5 10.000000 372.0000 37.2000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 14 24.000000 838.5000 34.9375
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
Subtotal (Total Children Is Unduplicated) 22 38.500000 1432.5000 37.2078
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EI Services,Class #03
ECE-ECE-EARLY CHILDHOOD EDUCATION 118 18484.00000 18484.0000 1.0000
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 40 3872.000000 96800.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 104 3005.000000 75125.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 9 83.500000 4175.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 15 218.000000 10900.0000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 8 28.500000 1425.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 104 473.500000 32141.1800 67.8800
PHY-97110-PT SESSION BY LICENSED PT 89 384.750000 26116.8300 67.8800
PHY-97110HM-PT SESSION BY PT ASST 1 2.000000 108.6400 54.3200
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 3.000000 150.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 104 468.500000 31801.7800 67.8800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 2.000000 108.6400 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 17 23.000000 303.6000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 38.000000 19.0000 0.5000
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 18 144.000000 7200.0000 50.0000
Subtotal (Total Children Is Unduplicated) 322 27229.75000 304858.6700 11.1958
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Total 27268.250000 306291.1700 11.2325
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Number of Children (Unduplicated) With at Least One Service 342
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
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
47 144.000000 7200.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 47 144.000000 7200.0000 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
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
774 7349.250000 211534.4300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 774 7349.250000 211534.4300 0.0000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
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
20 47.000000 2555.3200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 20 47.000000 2555.3200 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
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
44 117.500000 5385.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 44 117.500000 5385.5000 0.0000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
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
637 19610.500000 79615.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 637 19610.500000 79615.9200 0.0000