CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2013 ending 06/30/2013 Date of Report:08/18/2013 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 22 39.250000 1452.2500 37.0000
Subtotal (Total Children Is Unduplicated) 22 39.250000 1452.2500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 8.000000 600.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 136 234.500000 17587.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 37 67.000000 5025.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 19.500000 1462.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 42 78.500000 4356.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 23.000000 1725.0000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 12 12.000000 582.0000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 20 20.000000 970.0000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 11 11.000000 533.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 22 22.000000 1067.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 37 37.000000 1794.5000 48.5000
Subtotal (Total Children Is Unduplicated) 258 542.000000 36318.7500 67.0088
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2516 21860.25000 1092816.5000 49.9910
OCCT-97530-OT SESSION BY LICENSED OT 336 1760.000000 119468.8000 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 29 113.750000 6178.9000 54.3200
PHY-97110-PT SESSION BY LICENSED PT 436 2111.750000 143345.5900 67.8800
PHY-97110HM-PT SESSION BY PT ASST 36 169.750000 9220.8200 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 469 2544.750000 172703.6900 67.8667
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 7 20.000000 1086.4000 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 2 4.000000 52.8000 13.2000
Subtotal (Total Children Is Unduplicated) 3218 28585.25000 1544898.5000 54.0453
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Total 29166.500000 1582669.5000 54.2633
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Number of Children (Unduplicated) With at Least One Service 3368
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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
106 205.500000 14242.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 106 205.500000 14242.5000 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 4 5.000000 185.0000 0.0000
P 41 40.250000 1567.2500 1557.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2466 8356.000000 423206.6800 296661.1500
T 0 0.000000 0.0000 0.0000
167 303.000000 20117.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2678 8704.250000 445076.7100 298218.4000
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
1814 5550.500000 309462.3100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1814 5550.500000 309462.3100 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 9 22.000000 1100.0000 230.0000
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
2460 7040.250000 386968.7400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2469 7062.250000 388068.7400 230.0000
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
2201 1995.250000 127181.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2201 1995.250000 127181.8000 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
1687 5648.750000 298637.4400 298637.4400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1687 5648.750000 298637.4400 298637.4400