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
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 869 1022.000000 37749.2500 36.9366
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 642 962.500000 111.0000 0.1153
TCM-T1017TL-TARGETED CASE MANAGEMENT 550 1853.500000 68570.2500 36.9950
Subtotal (Total Children Is Unduplicated) 1299 3838.000000 106430.5000 27.7307
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 26 46.000000 2300.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 0.500000 27.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 127 189.176237 13909.7602 73.5281
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 37 50.859600 3646.1500 71.6905
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 46 60.500000 4500.0000 74.3802
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 167 242.000000 13355.2900 55.1871
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 95 136.500000 10200.0000 74.7253
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 4 4.000000 162.0000 40.5000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 331 737.535837 48580.1502 65.8682
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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 1 1.000000 50.0000 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
TRAV-TRAVS-Travel by mile 158 4988.800000 2220.1800 0.4450
Subtotal (Total Children Is Unduplicated) 294 5406.800000 7905.6400 1.4622
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Total 9982.335837 162916.2902 16.3205
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Number of Children (Unduplicated) With at Least One Service 1374
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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 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
337 258.500000 7640.5000 0.0000
Other 26 246.000000 1223.1700 0.0000
---------------------------------------------------------
Total 363 504.500000 8863.6700 0.0000
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 17 345.000000 794.2000 8.0100
41 1116.000000 1740.3900 0.0000
Other 214 189.500000 3722.7100 0.0000
---------------------------------------------------------
Total 272 1650.500000 6257.3000 8.0100
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 1 0.250000 9.2500 9.2500
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
610 496.250000 24077.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 611 496.500000 24086.3000 9.2500
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 0 0.000000 0.0000 0.0000
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
232 307.250000 12367.8500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 233 311.750000 12534.3500 0.0000
Center 05
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 9 135.000000 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
219 247.750000 4516.3350 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 228 382.750000 4650.5900 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
274 151.750000 5064.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 277 157.750000 5415.7500 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 0 0.000000 0.0000 0.0000
P 41 77.500000 1191.1400 1191.1400
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
527 531.250000 13559.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 568 608.750000 14750.3900 1191.1400
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 576 601.000000 24230.4300 24230.4300
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
8 11.000000 825.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 585 614.000000 25167.9300 24267.9300
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 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
334 305.500000 10158.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 339 318.500000 10328.5000 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 0 0.000000 0.0000 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
207 149.250000 4708.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 229 172.250000 5413.2500 705.0000
Center 52
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 1 2.000000 35.2900 35.2900
H 0 0.000000 0.0000 0.0000
T 86 1127.750000 1822.7900 1773.4500
257 258.250000 4702.0100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 344 1388.000000 6560.0900 1808.7400
Center 53
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 40 489.500000 679.4700 679.4700
T 183 186.750000 2836.3600 2836.3600
422 503.750000 6215.4300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 645 1180.000000 9731.2600 3515.8300
Center 54
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 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
236 309.250000 3234.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 588 1048.300000 8386.2700 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 0 0.000000 0.0000 0.0000
P 15 24.704737 1644.6102 1644.6100
D 2 1.000000 37.0000 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
498 339.081100 12203.8300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 515 364.785837 13885.4402 1644.6100
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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 23 647.000000 1020.2000 1020.2000
128 137.000000 5865.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 151 784.000000 6885.2000 1020.2000