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
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 95 137.000000 5069.0000 37.0000
Subtotal (Total Children Is Unduplicated) 95 137.000000 5069.0000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 10.500000 582.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 100 167.392800 12479.4600 74.5520
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 36.845800 2688.4300 72.9644
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 45 84.000000 6300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 119 204.000000 11322.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 99 154.500000 11587.5000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.000000 102.1000 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 33 33.000000 1684.6500 51.0500
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 7 8.000000 408.4000 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 15 15.000000 765.7500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 35 36.000000 1837.8000 51.0500
Subtotal (Total Children Is Unduplicated) 412 756.738600 50171.3400 66.2994
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EI Services,Class #03
AUD-92633-AUD REHAB POSTLING HEARING LOSS 1 2.000000 143.2200 71.6100
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 15.000000 375.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3784 29689.50000 1484176.0000 49.9899
OCCT-97530-OT SESSION BY LICENSED OT 258 1215.500000 86806.8400 71.4166
OCCT-97530HM-OT SESSION BY OT ASST 96 446.000000 25511.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 244 1337.220100 95304.6500 71.2707
PHY-97110HM-PT SESSION BY PT ASST 65 273.500000 15633.2600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 529 2949.250000 210521.7400 71.3814
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 55 159.000000 9094.8000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 5 13.750000 190.8500 13.8800
Subtotal (Total Children Is Unduplicated) 4525 36100.72010 1927757.5600 53.3994
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Total 36994.458700 1982997.9000 53.6026
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Number of Children (Unduplicated) With at Least One Service 4851
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 71.4400 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 22 28.000000 1690.5000 0.0000
---------------------------------------------------------
Total 23 29.000000 1761.9400 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 23 24.000000 1528.7200 0.0000
43 70.500000 4728.3700 0.0000
Other 3 5.500000 305.2500 0.0000
---------------------------------------------------------
Total 69 100.000000 6562.3400 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 5 4.750000 175.7500 0.0000
P 159 127.000000 4751.0000 4551.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2109 7514.000000 378460.4800 0.0000
T 0 0.000000 0.0000 0.0000
8 6.500000 240.5000 0.0000
Other 2 5.500000 392.9200 0.0000
---------------------------------------------------------
Total 2283 7657.750000 384020.6500 4551.0000
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 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
20 49.000000 2495.3200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 20 49.000000 2495.3200 0.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.750000 77.7500 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
1742 5239.000000 285565.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1744 5240.750000 285643.1400 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
2516 8061.500000 417678.6700 10.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2516 8061.500000 417678.6700 10.0000
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 1 1.000000 71.4400 71.4400
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
865 2570.250000 151301.3600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 866 2571.250000 151372.8000 71.4400
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.000000 71.4400 34.5000
487 972.250000 58059.7100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 488 973.250000 58131.1500 34.5000
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1910 1952.250000 99154.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1910 1952.250000 99154.0000 0.0000
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 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
2624 2646.250000 136457.4500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2624 2646.250000 136457.4500 0.0000
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 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
2600 2288.958700 153238.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2600 2288.958700 153238.5900 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 1 1.000000 37.0000 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 4 8.000000 485.7600 485.7600
1814 5415.500000 285959.0900 285873.2500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1819 5424.500000 286481.8500 286359.0100