CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2013 ending 03/31/2013 Date of Report:05/17/2013 Page: 1
List order: No List
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 17 33.750000 1248.7500 37.0000
Subtotal (Total Children Is Unduplicated) 17 33.750000 1248.7500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
Subtotal (Total Children Is Unduplicated) 1 1.000000 75.0000 75.0000
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 5.000000 354.1900 70.8380
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 6 6.000000 300.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 8.000000 400.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 15.000000 1018.2000 67.8800
PHY-97110-PT SESSION BY LICENSED PT 1 3.500000 237.5800 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 20.500000 1391.5400 67.8800
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 22 1464.000000 828.8000 0.5661
Subtotal (Total Children Is Unduplicated) 39 1523.000000 4580.3100 3.0074
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Total 1557.750000 5904.0600 3.7901
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Number of Children (Unduplicated) With at Least One Service 56
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Center 03
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
3 5.000000 354.1900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3 5.000000 354.1900 0.0000
Center 09
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
32 34.000000 1271.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 32 34.000000 1271.0000 0.0000
Center 55
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
25 12.250000 808.3700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 25 12.250000 808.3700 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
3 7.000000 482.2800 407.2800
Other 57 1499.500000 2988.2200 2988.2200
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Total 60 1506.500000 3470.5000 3395.5000