CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2013 ending 12/31/2013 Date of Report:02/18/2014 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1221 2474.250000 91519.5000 36.9888
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 887 973.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 903 958.500000 35464.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 643 3057.500000 113127.5000 37.0000
TCON-TCON-TRANSITION CONFERENCE 212 213.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1577 7676.250000 240111.5000 31.2798
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 94 152.750000 7637.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 7.500000 562.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 8.000000 600.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 12.000000 900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 20.000000 1110.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 13.000000 975.0000 75.0000
Subtotal (Total Children Is Unduplicated) 115 220.250000 12280.7500 55.7582
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 41 55.250000 2762.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 9 2.250000 56.2500 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 1.500000 75.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 4.250000 212.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 31 32.000000 1600.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 25.000000 1250.0000 50.0000
INTR-INTR-INTERPRETER 161 376.750000 18687.5000 49.6019
OCCT-97530-OT SESSION BY LICENSED OT 3 15.000000 1018.2000 67.8800
PHY-97110-PT SESSION BY LICENSED PT 4 28.000000 1900.6400 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 38 215.000000 14594.2000 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.2000 13.2000
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 243 20078.00000 10039.0000 0.5000
Subtotal (Total Children Is Unduplicated) 419 20835.00000 52258.9900 2.5082
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Total 28731.500000 304651.2400 10.6034
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Number of Children (Unduplicated) With at Least One Service 1609
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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 12042 28468.000000 302163.3200 302163.3200
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
74 263.500000 2487.9200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 12116 28731.500000 304651.2400 302163.3200