CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2014 ending 03/31/2014 Date of Report:06/03/2014 Page: 1
List order: No List
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 86 117.250000 4338.2500 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 72 72.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 48 32.250000 1193.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 229 893.000000 33041.0000 37.0000
Subtotal (Total Children Is Unduplicated) 229 1114.500000 38572.5000 34.6097
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.000000 30.0600 10.0200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 16.8200 8.4100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 63.0000 21.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 2.500000 187.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 4.500000 249.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 100 131.500000 9862.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 36 51.500000 3862.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 45 54.500000 4087.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 156 208.500000 11571.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 100 122.000000 9150.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 19 19.000000 1987.2600 104.5926
Subtotal (Total Children Is Unduplicated) 224 604.000000 41218.6400 68.2428
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EI Services,Class #03
INTR-INTR-INTERPRETER 8 15.000000 750.0000 50.0000
TRAN-TRAN-FAMILY TRANSPORTATION 51 51.000000 408.0000 8.0000
TRAV-TRAV-PROV TRAVEL TO NATURAL ENV PER MINUTE 8 242.000000 145.4000 0.6008
Subtotal (Total Children Is Unduplicated) 67 308.000000 1303.4000 4.2318
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Total 2026.500000 81094.5400 40.0170
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Number of Children (Unduplicated) With at Least One Service 236
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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 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
0 0.000000 0.0000 0.0000
Other 8 8.000000 109.8800 0.0000
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Total 8 8.000000 109.8800 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 15 16.500000 876.0000 0.0000
P 113 202.750000 8584.6300 8739.1700
D 3 7.500000 277.5000 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
410 481.000000 17056.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 541 707.750000 26794.2600 8739.1700
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 124 195.000000 10300.0000 0.0000
P 129 258.000000 5702.0000 5702.0000
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
46 73.000000 5094.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 299 526.000000 21096.7500 5702.0000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 171 214.000000 10834.2500 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
102 140.750000 7648.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 273 354.750000 18482.7500 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 6 7.500000 484.5000 0.0000
P 83 102.750000 4874.7500 4874.7500
D 4 6.000000 287.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 6 122.000000 85.4000 85.4000
178 191.750000 8878.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 277 430.000000 14610.9000 4960.1500