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
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 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 114 434.500000 16076.5000 37.0000
Subtotal (Total Children Is Unduplicated) 179 656.000000 21608.0000 32.9390
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 10.0200 10.0200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 8.4100 8.4100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 21.0000 21.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 25 29.000000 2175.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 9.000000 675.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 5.000000 375.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 35 44.000000 2442.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 25 29.000000 2175.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 12 12.000000 486.0000 40.5000
Subtotal (Total Children Is Unduplicated) 73 131.000000 8367.4300 63.8735
-----------------------------------------------------------------------------------------------------------------------
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 7 182.000000 115.4000 0.6341
Subtotal (Total Children Is Unduplicated) 66 248.000000 1273.4000 5.1347
-----------------------------------------------------------------------------------------------------------------------
Total 1035.000000 31248.8300 30.1921
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 188
-----------------------------------------------------------------------------------------------------------------------
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 3 3.000000 39.4300 0.0000
---------------------------------------------------------
Total 3 3.000000 39.4300 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 0 0.000000 0.0000 0.0000
P 1 1.000000 0.0000 111.0000
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
349 432.500000 12788.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 353 441.000000 13066.0000 111.0000
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 128 198.000000 5672.0000 5672.0000
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 128 198.000000 5672.0000 5672.0000
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
64 75.750000 3378.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 64 75.750000 3378.0000 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 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
176 189.250000 8720.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 186 317.250000 9093.4000 85.4000