CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2016 ending 03/31/2016 Date of Report:05/12/2016 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 942 1004.000000 37101.7500 36.9539
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 718 961.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1663 6118.250000 226208.7500 36.9728
Subtotal (Total Children Is Unduplicated) 1694 8083.750000 263310.5000 32.5728
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 70 122.500000 13670.0000 111.5918
EXIT-EXIT-EXIT ASSESSMENT 2 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 18 32.000000 2385.0000 74.5313
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 10 18.000000 1180.0000 65.5556
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 8.500000 637.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 21 36.000000 1859.2500 51.6458
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 581 928.000200 67843.6600 73.1074
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 177 259.000000 19068.7500 73.6245
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 178 263.500100 19492.2100 73.9742
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 719 1102.500000 60765.2300 55.1159
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 392 634.499997 47474.9997 74.8227
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 12 12.000000 749.5000 62.4583
SCREEN-T1023-SCREENING 7 10.000000 500.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 1190 3432.500297 236002.1497 68.7552
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 3.250000 137.5000 42.3077
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.500000 75.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 7.750000 387.5000 50.0000
INTR-T1013-INTERPRETER 42 85.500000 4171.9700 48.7950
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 237 414.000000 4077.6300 9.8493
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 4.000000 237.8700 59.4675
TRAV-TRAVS-Travel by mile 182 6154.000000 2739.1800 0.4451
Subtotal (Total Children Is Unduplicated) 359 6670.000000 11826.6500 1.7731
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Total 18186.250297 511139.2997 28.1058
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Number of Children (Unduplicated) With at Least One Service 1716
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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 352 289.250000 10702.2500 0.0000
P 30 267.250000 847.3600 847.3600
D 0 0.000000 0.0000 0.0000
S 16 13.250000 490.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 15 63.000000 361.3600 361.3600
356 274.000000 8389.3400 0.0000
Other 1 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 770 907.250000 20809.0600 1208.7200
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 67 1682.000000 3537.6500 2745.3600
1 2.000000 111.0000 0.0000
Other 385 425.500000 9342.6300 0.0000
---------------------------------------------------------
Total 453 2109.500000 12991.2800 2745.3600
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 160 144.500000 5864.2500 0.0000
P 341 320.250000 14769.7500 14676.2500
D 2 1.250000 46.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 55 61.000000 10820.0000 0.0000
T 0 0.000000 0.0000 0.0000
788 636.500000 28641.9700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1346 1163.500000 60142.2200 14676.2500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 8 15.000000 688.0000 0.0000
P 191 322.750000 13550.0000 13963.2400
D 1 3.750000 138.7500 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
247 269.250000 12077.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 447 610.750000 26453.8000 13963.2400
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 99 80.750000 3348.7500 0.0000
P 50 504.250000 1924.4500 1943.3700
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
269 243.250000 7162.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 418 828.250000 12435.4900 1943.3700
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
546 427.250000 18463.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 546 427.250000 18463.5000 0.0000
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 565 615.750000 28071.2500 28071.2500
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
671 576.500000 18307.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1236 1192.250000 46379.0000 28071.2500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 6 9.000000 519.0000 0.0000
P 907 1088.250000 50368.2900 50365.7900
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
29 40.250000 2855.2500 40.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 942 1137.500000 53742.5400 50405.7900
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 410 457.500000 24124.5000 0.0000
P 184 157.750000 5836.7500 5836.7500
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 0 0.000000 0.0000 0.0000
450 538.750000 25818.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1044 1154.000000 55779.5000 5836.7500
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 132 118.750000 4689.7500 0.0000
P 32 33.500000 1262.8800 1262.8800
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
343 269.000000 9921.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 507 421.250000 15873.8800 1262.8800
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 6.000000 450.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 152 189.750000 9958.7500 0.0000
P 81 94.500000 3542.6500 3412.6500
D 9 2.250000 83.2500 0.0000
S 17 33.500000 1346.2900 1078.0000
H 0 0.000000 0.0000 0.0000
T 106 1448.000000 1625.2200 1624.7300
347 318.250000 10903.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 715 2092.250000 27910.0800 6115.3800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 25 21.250000 786.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 199 210.500000 9064.2500 111.0000
P 166 202.500000 9905.0000 9905.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 35 206.000000 482.4600 482.4600
T 31 327.500000 410.5000 410.5000
669 743.250000 13410.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1125 1711.000000 34059.3800 10908.9600
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 443 464.500000 20659.2500 0.0000
P 2 3.000000 195.7500 195.7500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 39 277.000000 852.3400 852.3400
T 29 155.502222 341.6400 341.6400
659 770.247778 13765.2100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1172 1670.250000 35814.1900 1389.7300
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 682 939.581233 46796.0800 46700.0800
D 6 8.000000 448.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 10 18.000000 1350.0000 0.0000
T 0 0.000000 0.0000 0.0000
532 445.419064 20016.4197 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1230 1411.000297 68610.4997 46700.0800
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 225 255.750000 11309.2500 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 24 889.000000 697.6300 697.6300
172 205.500000 9668.0000 1991.2500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 421 1350.250000 21674.8800 2688.8800