CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 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 869 1023.250000 37795.5000 36.9367
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 642 963.750000 111.0000 0.1152
TCM-T1017TL-TARGETED CASE MANAGEMENT 1567 5345.750000 197228.5000 36.8944
Subtotal (Total Children Is Unduplicated) 1614 7332.750000 235135.0000 32.0664
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 52 92.000000 11500.0000 125.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 16.000000 1200.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 7.000000 525.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 4.500000 337.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 6.500000 487.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 14 21.000000 1165.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 503 784.000703 58423.0002 74.5191
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 163 234.000000 17381.6800 74.2807
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 180 260.500000 19500.0000 74.8560
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 602 941.000000 52010.2500 55.2713
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 361 552.500000 42462.5000 76.8552
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 11 11.000000 1451.5000 131.9545
SCREEN-T1023-SCREENING 6 6.000000 300.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 4.000000 204.2000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 1024 2941.000703 206999.6802 70.3841
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EI Services,Class #03
CONIF-CONIF-CONSULT, FACE TO FACE 2 1.750000 87.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 19.000000 950.0000 50.0000
INTR-T1013-INTERPRETER 18 33.250000 1727.5000 51.9549
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 209 382.000000 3820.4600 10.0012
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 3.000000 214.3200 71.4400
TRAV-TRAVS-Travel by mile 158 4988.800000 2220.1800 0.4450
Subtotal (Total Children Is Unduplicated) 295 5427.800000 9019.9600 1.6618
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Total 15701.550703 451154.6402 28.7331
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Number of Children (Unduplicated) With at Least One Service 1638
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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 298 236.250000 8937.7500 0.0000
P 1 0.250000 9.2500 9.2500
D 0 0.000000 0.0000 0.0000
S 7 4.750000 289.7500 0.0000
H 6 9.000000 675.0000 0.0000
T 0 0.000000 0.0000 0.0000
342 261.000000 7733.0000 0.0000
Other 31 251.500000 1528.4200 0.0000
---------------------------------------------------------
Total 685 762.750000 19173.1700 9.2500
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 23 357.000000 1655.2000 8.0100
50 1133.000000 2976.3900 0.0000
Other 286 261.500000 6553.2100 0.0000
---------------------------------------------------------
Total 359 1751.500000 11184.8000 8.0100
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.750000 27.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 41 53.750000 3745.0000 37.0000
P 316 280.750000 12132.7500 12057.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 45 45.000000 9000.0000 0.0000
T 0 0.000000 0.0000 0.0000
626 502.250000 24462.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1029 882.500000 49367.5500 12094.2500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 9.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 24 47.000000 1776.5000 0.0000
P 104 152.500000 8260.7500 7883.2900
D 1 4.500000 166.5000 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
291 357.250000 15868.8500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 421 561.500000 26081.8500 7883.2900
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 163 144.250000 6553.2500 0.0000
P 9 135.000000 134.2550 123.1300
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
223 253.250000 4928.8350 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 395 532.500000 11616.3400 123.1300
Center 06
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 3 6.000000 351.0000 351.0000
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
522 357.500000 15293.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 525 363.500000 15644.2500 351.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 1.500000 55.5000 0.0000
P 464 533.750000 22335.8900 22335.8900
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
529 535.250000 13859.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 994 1070.500000 36250.6400 22335.8900
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 28 40.750000 2588.2500 0.0000
P 928 1135.000000 51768.1800 51805.6800
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 2.000000 112.5000 37.5000
41 55.000000 4125.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 998 1232.750000 58593.9300 51843.1800
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 8.500000 314.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 598 622.250000 30798.5000 0.0000
P 5 13.000000 170.0000 170.0000
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
428 495.250000 22645.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1041 1139.000000 53928.7500 170.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 97 73.000000 2747.2500 0.0000
P 22 23.000000 705.0000 705.0000
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
219 162.750000 5694.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 338 258.750000 9146.3800 705.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 12.000000 900.0000 220.0000
U 0 0.000000 0.0000 0.0000
B 179 222.500000 10952.5000 1677.5000
P 108 103.750000 3819.4600 3819.4600
D 0 0.000000 0.0000 0.0000
S 2 4.000000 185.2900 35.2900
H 0 0.000000 0.0000 0.0000
T 102 1158.750000 3884.5400 3539.7200
296 326.250000 9143.9700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 693 1827.250000 28885.7600 9291.9700
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 149 166.750000 7144.5000 0.0000
P 151 162.250000 7658.5000 7658.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 40 489.500000 679.4700 679.4700
T 183 186.750000 2836.3600 2836.3600
544 670.250000 14861.4300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1067 1675.500000 33180.2600 11174.3300
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 396 413.500000 18860.5000 0.0000
P 0 0.000000 0.0000 0.0000
D 1 2.500000 92.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 161 273.950000 2035.2700 2035.2700
T 190 462.600000 3024.4500 3024.4500
353 443.750000 10515.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1101 1596.300000 34528.2700 5059.7200
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 22 28.000000 1036.0000 0.0000
P 435 547.454737 24672.3602 24662.6100
D 2 1.000000 37.0000 0.0000
S 23 12.000000 444.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
571 475.045966 21481.0800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1053 1063.500703 47670.4402 24662.6100
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 170 177.750000 7624.0000 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 23 647.000000 1020.2000 1020.2000
142 159.000000 7258.0500 1395.0500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 335 983.750000 15902.2500 2415.2500