CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2012 ending 03/31/2012 Date of Report:05/16/2012 Page: 1
List order: No List
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
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 5 10.000000 250.0000 25.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 50.0000 25.0000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 11 19.000000 566.5000 29.8158
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 200.0000 25.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 50.0000 25.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 4 4.000000 194.0000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.000000 97.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 5.000000 242.5000 48.5000
Subtotal (Total Children Is Unduplicated) 30 53.000000 1698.5000 32.0472
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EI Services,Class #03
ECE-ECE-EARLY CHILDHOOD EDUCATION 94 16588.00000 16588.0000 1.0000
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 29 2796.000000 69900.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 90 2277.000000 56925.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 6 55.000000 2750.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 17 222.000000 11100.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 85 395.250000 26829.5700 67.8800
PHY-97110-PT SESSION BY LICENSED PT 76 341.500000 23181.0200 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 96 399.750000 27135.0300 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 17 12.500000 165.0000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 5 150.000000 86.0000 0.5733
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 16 209.000000 10450.0000 50.0000
Subtotal (Total Children Is Unduplicated) 249 23446.00000 245109.6200 10.4542
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Total 23499.000000 246808.1200 10.5029
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Number of Children (Unduplicated) With at Least One Service 269
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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
43 209.000000 10450.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 43 209.000000 10450.0000 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
696 5734.500000 171297.4200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 696 5734.500000 171297.4200 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
46 117.000000 4916.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 46 117.000000 4916.5000 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
484 17438.500000 60144.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 484 17438.500000 60144.2000 0.0000