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
Agency Filter:EXT
Payclass Filters:MED
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 67 126.750000 4689.7500 37.0000
Subtotal (Total Children Is Unduplicated) 67 126.750000 4689.7500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 18 28.500000 2137.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 8.000000 600.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 10.500000 787.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 14.500000 804.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 282 456.000000 34200.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 81 132.500000 9900.0000 74.7170
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 41 54.500000 4087.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 124 214.500000 11904.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 146 270.500000 20287.5000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 23 24.000000 1164.0000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 35 35.000000 1697.5000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 27 27.000000 1309.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 37 37.000000 1794.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 79 82.000000 3977.0000 48.5000
Subtotal (Total Children Is Unduplicated) 670 1400.500000 95102.0000 67.9057
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 11.000000 4255.7900 386.8900
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 4 10.000000 696.5400 69.6540
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 19 53.000000 1325.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4044 29613.50000 1480477.0000 49.9933
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 3 7.000000 350.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 391 2138.532034 145087.0500 67.8442
OCCT-97530HM-OT SESSION BY OT ASST 20 110.500000 6002.3600 54.3200
PHY-97110-PT SESSION BY LICENSED PT 634 3131.711280 212580.1500 67.8799
PHY-97110HM-PT SESSION BY PT ASST 41 169.000000 9180.0800 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 753 4014.385600 272496.5000 67.8800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 18.000000 977.7600 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 8 11.250000 148.5000 13.2000
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 4 28.000000 1400.0000 50.0000
Subtotal (Total Children Is Unduplicated) 5111 39315.87891 2134976.7300 54.3032
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Total 40843.128914 2234768.4800 54.7159
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Number of Children (Unduplicated) With at Least One Service 5483
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 1 1.500000 112.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2321 3539.000000 186566.3500 0.0000
Other 151 236.000000 17002.5700 0.0000
---------------------------------------------------------
Total 2473 3776.500000 203681.4200 0.0000
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 0 0.000000 0.0000 0.0000
84 150.500000 10595.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 84 150.500000 10595.2500 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 104 72.500000 2682.5000 0.0000
P 83 54.250000 2059.2500 1890.0500
D 1 1.000000 37.0000 37.0000
S 0 0.000000 0.0000 0.0000
H 2024 6670.750000 339460.0700 301268.3700
T 0 0.000000 0.0000 0.0000
242 447.500000 28298.2200 0.0000
Other 2 3.500000 237.5800 0.0000
---------------------------------------------------------
Total 2456 7249.500000 372774.6200 303195.4200
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 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
904 832.750000 44867.0700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 904 832.750000 44867.0700 0.0000
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 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
1283 3606.750000 185209.8600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1283 3606.750000 185209.8600 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
1687 5047.750000 286932.7100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1687 5047.750000 286932.7100 0.0000
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 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
2021 5620.000000 317182.4900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2021 5620.000000 317182.4900 0.0000
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 3 12.000000 600.0000 200.0000
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
786 2369.250000 139796.9100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 789 2381.250000 140396.9100 200.0000
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
133 325.440000 19851.8700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 133 325.440000 19851.8700 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 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
2361 2380.500000 128787.1700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2361 2380.500000 128787.1700 0.0000
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 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
2577 2580.706800 143615.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2577 2580.706800 143615.1100 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
1982 1728.982114 110245.8100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1982 1728.982114 110245.8100 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 2 3.000000 111.0000 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 7 20.000000 1000.0000 1000.0000
1481 5139.500000 269517.1900 269518.6300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1490 5162.500000 270628.1900 270518.6300