CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2012 ending 03/31/2012 Date of Report:05/15/2012 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:OTHER
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 28 63.500000 2349.5000 37.0000
Subtotal (Total Children Is Unduplicated) 28 63.500000 2349.5000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 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 4 7.500000 562.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 16.500000 915.7500 55.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 17 37.000000 2219.2500 59.9797
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EI Services,Class #03
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.250000 12.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 12 9.000000 450.0000 50.0000
INTR-INTR-INTERPRETER 2 5.000000 100.0000 20.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 3.000000 203.6400 67.8800
PHY-97110-PT SESSION BY LICENSED PT 4 5.000000 339.4000 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 20.000000 1357.6000 67.8800
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 30 945.000000 472.5000 0.5000
Subtotal (Total Children Is Unduplicated) 51 987.250000 2935.6400 2.9736
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Total 1087.750000 7504.3900 6.8990
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Number of Children (Unduplicated) With at Least One Service 93
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Center 09
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
97 62.000000 2294.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 97 62.000000 2294.0000 0.0000
Center 52
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 38 60.500000 3793.6600 0.0000
T 0 0.000000 0.0000 0.0000
63 964.000000 1370.4800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 101 1024.500000 5164.1400 0.0000
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
2 1.250000 46.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2 1.250000 46.2500 0.0000