CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2014 ending 03/31/2014 Date of Report:06/03/2014 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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.000000 145.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 97.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.000000 48.5000 48.5000
Subtotal (Total Children Is Unduplicated) 4 6.000000 291.0000 48.5000
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 107 3551.000000 88775.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 15 148.000000 7400.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 55 277.750000 18853.6700 67.8800
PHY-97110-PT SESSION BY LICENSED PT 75 242.500000 16460.9000 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 90 339.750000 23062.2300 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 7 26.000000 343.2000 13.2000
Subtotal (Total Children Is Unduplicated) 169 4585.000000 154895.0000 33.7830
-----------------------------------------------------------------------------------------------------------------------
Total 4591.000000 155186.0000 33.8022
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 169
-----------------------------------------------------------------------------------------------------------------------
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
375 3331.750000 95968.3300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 375 3331.750000 95968.3300 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
271 1259.250000 59217.6700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 271 1259.250000 59217.6700 0.0000