CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2016 ending 03/31/2016 Date of Report:05/12/2016 Page: 1
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.500000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1 0.500000 0.0000 0.0000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 10 19.000000 950.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 16 85.000000 4250.0000 50.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 32 115.000000 5929.2000 51.5583
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 150 227.250000 11362.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 30 27.000000 675.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 177 355.750000 17787.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 59 152.000000 3800.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 5.000000 250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 11 11.000000 550.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 4 6.000000 150.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 6 6.000000 300.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 6 7.000000 175.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 867 6372.000000 318251.2600 49.9453
INTR-T1013-INTERPRETER 1 42.000000 1808.0000 43.0476
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1272 12858.00000 128513.1200 9.9948
OCCT-97530-OT SESSION BY LICENSED OT 139 1058.000000 75583.5200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 194 1687.000000 118640.6100 70.3264
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 428 3690.000000 262183.7300 71.0525
SPL-92508-GROUP SPL SESSION PER CHILD 1 2.000000 104.8800 52.4400
TRAV-TRAVS-Travel by mile 1243 130090.0000 57099.7200 0.4389
Subtotal (Total Children Is Unduplicated) 1306 156596.0000 997234.8400 6.3682
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Total 156711.500000 1003164.0400 6.4013
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Number of Children (Unduplicated) With at Least One Service 1306
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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 10767 146155.000000 662971.4300 662988.5100
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
2159 10556.500000 340192.6100 418.5700
Other 0 0.000000 0.0000 0.0000
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Total 12926 156711.500000 1003164.0400 663407.0800