CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2012 ending 06/30/2012 Date of Report:08/16/2012 Page: 1
List order: No List
Payclass Filters:GR
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 479 342.000000 12654.0000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 220 228.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 705 774.500000 28656.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 640 2457.250000 90862.7500 36.9774
Subtotal (Total Children Is Unduplicated) 1280 3801.750000 132173.2500 34.7664
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 3 3.000000 35.5800 11.8600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.000000 24.8400 8.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.000000 31.1400 10.3800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 63.2400 21.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 54.3800 27.1900
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-TRANSITION ASSESSMENT 2 6.000000 300.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 15.000000 1125.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.435200 180.2100 74.0021
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 9.500000 712.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 15 25.000000 1387.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 164 224.467300 16748.1100 74.6127
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 47 75.000000 5587.5000 74.5000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 31 41.242300 3044.6700 73.8240
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 180 275.000000 15262.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 109 143.957867 10796.8400 75.0000
SCREEN-T1023-INTERDISCIPLINARY SCREENING 14 14.000000 700.0000 50.0000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 5 5.000000 242.5000 48.5000
Subtotal (Total Children Is Unduplicated) 385 855.102667 56584.0100 66.1722
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 6.000000 300.0000 50.0000
INTR-INTR-INTERPRETER 36 63.750000 3213.2500 50.4039
TRAN-TRAN-FAMILY TRANSPORTATION 110 114.000000 912.0000 8.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 331 24690.00000 12290.5000 0.4978
Subtotal (Total Children Is Unduplicated) 473 24876.75000 16865.7500 0.6780
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Total 29533.602667 205623.0100 6.9623
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Number of Children (Unduplicated) With at Least One Service 1340
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Center 01
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 44 1164.000000 2346.0000 2346.0000
D 4 1.500000 55.5000 0.0000
S 8 8.250000 305.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 31 482.000000 1868.0600 1868.0600
314 323.000000 9641.0000 0.0000
Other 5 7.500000 537.5000 0.0000
---------------------------------------------------------
Total 406 1986.250000 14753.3100 4214.0600
Center 02
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 38 1406.000000 2118.5000 2118.5000
186 1339.250000 7056.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 224 2745.250000 9174.5000 2118.5000
Center 03
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 12 62.000000 911.0000 911.0000
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 681 1817.000000 24039.5000 24039.5000
7 11.000000 610.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 700 1890.000000 25561.0000 24950.5000
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
567 670.750000 18465.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 567 670.750000 18465.5000 0.0000
Center 06
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 6 12.250000 731.2500 731.2500
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
26 30.750000 1237.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 32 43.000000 1969.0000 731.2500
Center 07
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 48 1378.000000 2365.5000 2365.5000
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
496 1302.000000 17966.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 544 2680.000000 20332.2500 2365.5000
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 453 1544.250000 21606.0000 21606.0000
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
---------------------------------------------------------
Total 455 1545.500000 21652.2500 21606.0000
Center 10
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 17 21.500000 584.1800 584.1800
D 1 0.250000 9.2500 9.2500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
658 706.500000 28733.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 676 728.250000 29326.6800 593.4300
Center 51
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 21 597.500000 493.0000 493.0000
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
220 1166.750000 7315.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 241 1764.250000 7808.7500 493.0000
Center 52
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
54 993.750000 2124.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 54 993.750000 2124.7500 0.0000
Center 53
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 26 735.000000 1360.5000 1360.5000
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 45 2061.500000 1390.0000 1390.0000
443 3157.250000 12980.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 514 5953.750000 15730.7500 2750.5000
Center 54
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 36 1123.500000 971.5000 971.5000
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 236 1175.685200 6640.4600 6640.4600
409 5716.500000 11976.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 681 8015.685200 19588.4600 7611.9600
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 12 19.500000 1462.5000 1462.5000
D 5 6.500000 468.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 7 9.709600 728.2200 728.2200
221 164.957867 4457.8400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 245 200.667467 7117.0600 2190.7200
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 2 61.000000 80.0000 80.0000
222 255.500000 11938.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 224 316.500000 12018.7500 80.0000