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
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 68 115.750000 4282.7500 37.0000
Subtotal (Total Children Is Unduplicated) 68 115.750000 4282.7500 37.0000
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Screening, Eval, and Assessment,Class #02
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 9 9.000000 436.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 20 26.000000 1261.0000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 7 7.000000 339.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 27 27.000000 1309.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 36 36.000000 1746.0000 48.5000
Subtotal (Total Children Is Unduplicated) 76 105.000000 5092.5000 48.5000
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2001 10566.75000 528337.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 178 697.500000 47346.3000 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 10 46.750000 2539.4600 54.3200
PHY-97110-PT SESSION BY LICENSED PT 204 673.500000 45717.1800 67.8800
PHY-97110HM-PT SESSION BY PT ASST 42 162.500000 8827.0000 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 205 759.250000 51537.8900 67.8800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 10 33.500000 1819.7200 54.3200
Subtotal (Total Children Is Unduplicated) 2340 12939.75000 686125.0500 53.0246
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Total 13160.500000 695500.3000 52.8476
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Number of Children (Unduplicated) With at Least One Service 2390
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Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 5 2.250000 83.2500 0.0000
P 162 110.000000 4070.0000 4070.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1592 5185.000000 264380.6000 262183.1600
T 0 0.000000 0.0000 0.0000
198 304.250000 19439.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1957 5601.500000 287973.6000 266253.1600
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
567 1793.250000 98872.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 567 1793.250000 98872.2900 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
687 2108.250000 113343.7200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 687 2108.250000 113343.7200 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
1098 3657.500000 195310.6900 195310.6900
Other 0 0.000000 0.0000 0.0000
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Total 1098 3657.500000 195310.6900 195310.6900