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:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 10034 13284.00000 490793.0000 36.9462
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6741 13475.50000 1107.2500 0.0822
TCM-T1017TL-TARGETED CASE MANAGEMENT 18042 51989.00000 1912615.5000 36.7888
Subtotal (Total Children Is Unduplicated) 19258 78748.50000 2404515.7500 30.5341
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 23 27.000000 1309.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 116 159.000000 15425.0000 97.0126
EXIT-EXIT-EXIT ASSESSMENT 378 596.000000 29550.0000 49.5805
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 92 168.000000 12600.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 58 89.000000 6675.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 20 20.000000 1500.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 60 96.000000 7852.5000 81.7969
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 122 194.000000 10767.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1387 2158.500000 160529.7500 74.3710
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 542 847.500000 63296.8900 74.6866
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 406 529.000000 39566.2500 74.7944
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1674 2698.500000 149456.2300 55.3849
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 889 1340.000000 103967.5000 77.5877
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 70 70.000000 6092.5000 87.0357
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 8 8.000000 907.8900 113.4863
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 2 2.000000 113.2800 56.6400
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 15 15.000000 589.9600 39.3307
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 6 11.000000 561.5500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 11 15.000000 1063.6500 70.9100
SCREEN-T1023-SCREENING 46 46.000000 2300.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 25 26.000000 1327.3000 51.0500
Subtotal (Total Children Is Unduplicated) 3400 9115.500000 615451.7500 67.5171
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 321 280.500000 14012.5000 49.9554
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 12 7.000000 175.0000 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 978 1498.500000 74781.2500 49.9041
CONIP-CONIP-CONSULT, PHONE 43 42.500000 1059.5000 24.9294
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 3 11.000000 806.5200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 13 28.000000 700.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1065 5254.250000 262415.0000 49.9434
INTR-T1013-INTERPRETER 91 183.250000 9062.5000 49.4543
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1468 6743.000000 67342.0000 9.9869
OCCT-97530-OT SESSION BY LICENSED OT 43 174.500000 14201.8400 81.3859
PHY-97110-PT SESSION BY LICENSED PT 83 325.500000 31004.8400 95.2530
PHY-97110HM-PT SESSION BY PT ASST 6 22.500000 1286.1000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 126 731.000000 62279.4100 85.1976
SPL-92508-GROUP SPL SESSION PER CHILD 1 4.000000 55.5200 13.8800
TRAV-TRAVS-Travel by mile 524 28198.00000 12542.7550 0.4448
Subtotal (Total Children Is Unduplicated) 2243 43503.50000 551724.7350 12.6823
-----------------------------------------------------------------------------------------------------------------------
Total 131367.500000 3571692.2350 27.1886
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 19404
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 2.000000 47.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 6411 4320.750000 165477.6200 0.0000
P 0 0.000000 0.0000 0.0000
D 2 2.250000 159.2500 0.0000
S 177 157.000000 6130.0000 0.0000
H 28 39.500000 2930.3800 0.0000
T 0 0.000000 0.0000 0.0000
4755 3074.500000 83363.4200 0.0000
Other 94 102.250000 6224.8800 0.0000
---------------------------------------------------------
Total 11474 7698.250000 264332.5500 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 2 10.000000 4.4600 0.0000
10 11.250000 369.7500 0.0000
Other 3772 7766.250000 82053.5850 0.0000
---------------------------------------------------------
Total 3784 7787.500000 82427.7950 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 30 11.750000 447.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 140 144.000000 8593.3300 74.0000
P 2372 1391.750000 55470.7500 55626.9920
D 24 19.500000 914.4400 0.0000
S 0 0.000000 0.0000 0.0000
H 293 289.500000 46643.9700 0.0000
T 0 0.000000 0.0000 0.0000
4728 3126.250000 88366.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7587 4982.750000 200436.7400 55700.9920
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 53 66.750000 2469.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 552 742.000000 28170.5000 0.0000
P 1806 2489.000000 105028.3000 103403.6600
D 27 43.000000 1647.5000 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
3182 3161.750000 133173.2200 43.1800
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 5621 6502.750000 270498.5200 103446.8400
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2389 1488.000000 61002.0000 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
2369 1642.750000 39619.9800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4758 3130.750000 100621.9800 0.0000
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 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
11324 6581.250000 247184.8300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11324 6581.250000 247184.8300 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 28 18.000000 666.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 70 45.750000 1772.5000 0.0000
P 4189 3087.500000 125200.5000 125069.5000
D 0 0.000000 0.0000 0.0000
S 2 4.000000 300.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4898 3826.500000 103808.5950 543.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9187 6981.750000 231747.5950 125612.5000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 3.250000 120.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 162 185.750000 10037.6900 225.2500
P 15221 12436.000000 464452.0900 575451.3400
D 0 0.000000 0.0000 0.0000
S 1 1.250000 46.2500 46.2500
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
254 281.750000 17761.2200 233.2200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15641 12908.000000 492417.5000 575956.0600
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 260 166.750000 6169.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 5981 4512.750000 198000.7500 0.0000
P 3 4.500000 58.5000 40.0000
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
4352 3446.000000 128780.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10596 8130.000000 333009.2500 40.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 14 10.750000 415.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 2486 1608.750000 60430.5000 0.0000
P 0 0.000000 0.0000 0.0000
D 5 2.250000 83.2500 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
4412 3658.750000 99596.8200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6917 5280.500000 160525.8200 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 22 40.500000 3018.5000 830.0000
U 0 0.000000 0.0000 0.0000
B 1647 1580.000000 78091.7500 13382.5000
P 802 667.500000 24462.7400 24460.2400
D 0 0.000000 0.0000 0.0000
S 9 15.000000 477.1900 477.1900
H 0 0.000000 0.0000 0.0000
T 2246 20951.250000 57648.4250 48830.3600
3254 6566.250000 72267.1300 99.0800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7980 29820.500000 235965.7350 88079.3700
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1696 1575.000000 65186.0000 0.0000
P 1575 1553.000000 73303.0000 73367.7500
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 2867 2236.000000 36051.4600 36051.4600
7340 5597.750000 126731.3100 111.0000
Other 127 121.250000 2557.5000 0.0000
---------------------------------------------------------
Total 13606 11083.500000 303847.7700 109530.2100
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4400 3788.750000 165578.7500 0.0000
P 1 2.000000 74.0000 0.0000
D 2 3.000000 111.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2827 2150.000000 31463.5000 31453.5000
T 2411 1771.500000 25615.3000 25528.3000
4458 3667.250000 72111.2500 0.0000
Other 1 0.750000 27.7500 0.0000
---------------------------------------------------------
Total 14100 11383.250000 294981.5500 56981.8000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 149 134.750000 4985.7500 18.5000
P 1710 1557.000000 62502.7500 80411.0000
D 42 42.000000 1554.0000 0.0000
S 31 19.000000 703.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2843 1751.750000 61202.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4776 3505.500000 130985.1000 80429.5000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 6.750000 249.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 3322 3231.500000 128801.2500 0.0000
P 1 1.500000 55.5000 55.5000
D 8 7.750000 343.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 15 18.500000 1023.5000 0.0000
T 1 1.000000 10.0000 10.0000
2638 2324.250000 92226.2500 50.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5991 5591.250000 222709.5000 115.5000