CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2012 ending 09/30/2012 Date of Report:11/15/2012 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 73 102.500000 3792.5000 37.0000
Subtotal (Total Children Is Unduplicated) 73 102.500000 3792.5000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 21 32.000000 2400.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 11.000000 825.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 20 34.000000 1887.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 246 410.500000 30750.0000 74.9086
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 65 115.500000 8625.0000 74.6753
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 21 29.000000 2175.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 150 265.000000 14707.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 142 243.000000 18225.0000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 14 14.000000 679.0000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 34 34.000000 1649.0000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 9 9.000000 436.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 41 41.000000 1988.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 79 79.000000 3831.5000 48.5000
Subtotal (Total Children Is Unduplicated) 635 1323.000000 88629.0000 66.9909
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 11.000000 4832.9000 439.3545
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 25 102.000000 2550.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3689 27415.25000 1370663.5000 49.9964
OCCT-97530-OT SESSION BY LICENSED OT 302 1540.656800 104579.8000 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 10 35.000000 1901.2000 54.3200
PHY-97110-PT SESSION BY LICENSED PT 464 2297.992600 155987.7500 67.8800
PHY-97110HM-PT SESSION BY PT ASST 35 137.250000 7455.4200 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 593 2846.471400 193109.1200 67.8416
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 6.500000 353.0800 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 2 1.500000 19.8000 13.2000
VISN-T1027SC-EI VISION SERVICES, INDIVIDUAL 4 7.500000 375.0000 50.0000
Subtotal (Total Children Is Unduplicated) 4495 34401.12080 1841827.5700 53.5398
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Total 35826.620800 1934249.0700 53.9892
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Number of Children (Unduplicated) With at Least One Service 4861
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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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1263 3048.750000 161057.1500 0.0000
Other 162 278.000000 18883.7500 0.0000
---------------------------------------------------------
Total 1425 3326.750000 179940.9000 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
121 220.500000 15370.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 121 220.500000 15370.5000 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 39 33.750000 1248.7500 0.0000
P 72 72.750000 2769.7500 2519.7500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2110 6818.500000 345395.1200 327605.7200
T 0 0.000000 0.0000 0.0000
265 454.750000 25622.5300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2486 7379.750000 375036.1500 330125.4700
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
1203 3390.500000 173741.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1203 3390.500000 173741.7500 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
1751 5242.750000 295221.4900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1751 5242.750000 295221.4900 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 1 4.000000 200.0000 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
1674 4962.500000 270913.8300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1675 4966.500000 271113.8300 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 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
307 989.250000 59000.4500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 307 989.250000 59000.4500 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
1841 1867.250000 99098.2800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1841 1867.250000 99098.2800 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
2363 2366.120800 129758.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2363 2366.120800 129758.7700 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
2067 1857.000000 118181.6800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2067 1857.000000 118181.6800 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 1 3.000000 203.6400 203.6400
1254 4217.250000 217581.6300 217388.8900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1255 4220.250000 217785.2700 217592.5300