CMS/EIP Fiscal Report Statewide
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:LEA
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
ECE-ECE-EARLY CHILDHOOD EDUCATION 1 76.000000 76.0000 1.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 2.500000 169.7000 67.8800
PHY-97110-PT SESSION BY LICENSED PT 1 3.500000 237.5800 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 203.6400 67.8800
Subtotal (Total Children Is Unduplicated) 1 85.000000 686.9200 8.0814
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Total 85.000000 686.9200 8.0814
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Number of Children (Unduplicated) With at Least One Service 1
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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 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
4 85.000000 686.9200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4 85.000000 686.9200 0.0000