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
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 11233 13909.75000 514374.5000 36.9794
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7766 17640.50000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 19696 60668.75000 2238811.5000 36.9022
Subtotal (Total Children Is Unduplicated) 20812 92219.00000 2753186.0000 29.8549
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 14 16.000000 776.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 149 220.500000 19675.0000 89.2290
EXIT-EXIT-EXIT ASSESSMENT 369 571.500000 28500.0000 49.8688
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 88 163.500000 11998.8700 73.3876
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 65 119.000000 8925.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 20 28.500000 1880.0000 65.9649
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 57 86.500000 6487.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 132 228.000000 12543.0000 55.0132
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1436 2240.499997 165506.6597 73.8704
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 488 782.000000 56403.8900 72.1277
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 398 527.000000 39189.5600 74.3635
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1981 3066.500000 169380.9000 55.2359
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 989 1491.500000 111629.5000 74.8438
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 65 65.000000 3950.0000 60.7692
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 4 4.000000 229.0800 57.2700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 12 12.000000 436.5400 36.3783
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 2.000000 102.1000 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 6 8.000000 306.3000 38.2875
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.000000 102.1000 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 8 9.000000 608.4000 67.6000
SCREEN-T1023-SCREENING 95 113.000000 5650.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 17 17.000000 867.8500 51.0500
Subtotal (Total Children Is Unduplicated) 3692 9772.999997 645148.2497 66.0133
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 20.9800 20.9800
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 316 303.500000 15175.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 6 4.000000 100.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1101 1710.500000 85362.5000 49.9050
CONIP-CONIP-CONSULT, ITDS PHONE 56 22.250000 556.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 9 8.500000 425.0000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 2 2.000000 146.6400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 17 33.000000 825.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 15.000000 750.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1093 5749.000000 287862.5000 50.0718
INTR-T1013-INTERPRETER 238 445.000000 22235.0000 49.9663
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1595 8389.000000 83880.0000 9.9988
OCCT-97530-OT SESSION BY LICENSED OT 36 191.000000 14164.3600 74.1590
PHY-97110-PT SESSION BY LICENSED PT 75 304.000000 33598.4800 110.5213
PHY-97110HM-PT SESSION BY PT ASST 8 82.000000 4294.7600 52.3751
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 162 868.000000 74624.0600 85.9724
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 3.000000 171.6000 57.2000
TRAV-TRAVS-Travel by mile 455 31850.00000 14175.6800 0.4451
Subtotal (Total Children Is Unduplicated) 2492 49981.75000 638417.8100 12.7730
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Total 151973.749997 4036752.0597 26.5622
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Number of Children (Unduplicated) With at Least One Service 20912
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 16 6.500000 231.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 7848 5027.500000 185228.4400 9.2500
P 0 0.000000 0.0000 0.0000
D 4 3.500000 101.7500 0.0000
S 293 248.500000 9194.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 2 2.000000 20.0000 20.0000
6278 4029.500000 113117.0000 0.0000
Other 10 8.000000 296.0000 0.0000
---------------------------------------------------------
Total 14451 9325.500000 308189.1900 29.2500
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 0 0.000000 0.0000 0.0000
9 9.000000 348.3200 0.0000
Other 4996 9799.500000 109398.7400 0.0000
---------------------------------------------------------
Total 5005 9808.500000 109747.0600 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 3.500000 213.5500 0.0000
U 0 0.000000 0.0000 0.0000
B 1591 983.500000 38967.5000 0.0000
P 2199 1331.500000 54683.7500 55146.5860
D 40 14.000000 518.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 331 323.250000 57194.5300 0.0000
T 0 0.000000 0.0000 0.0000
6908 4106.500000 123627.3500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11073 6762.250000 275204.6800 55146.5860
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 136 186.750000 7897.7500 0.0000
P 2687 3998.500000 155449.6400 155958.1900
D 45 62.500000 2312.5000 0.0000
S 2 4.250000 157.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3084 2940.750000 125001.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5954 7192.750000 290819.0600 155958.1900
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 1.500000 55.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2041 1309.750000 53341.7500 0.0000
P 5 82.500000 111.0500 111.0500
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
2629 1955.250000 53428.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4678 3349.000000 106936.4900 111.0500
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
12445 7343.500000 273992.3100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12445 7343.500000 273992.3100 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9 5.500000 203.5000 64.7500
P 5097 3732.250000 149042.7500 149024.2500
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
5879 3759.750000 111147.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10987 7498.500000 260430.5000 149089.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.750000 101.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 92 100.750000 5069.0000 58.5000
P 14945 12238.500000 461977.9700 721055.1600
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
145 172.750000 11558.1700 423.4200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15183 12514.750000 478706.8900 721537.0800
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 16 12.250000 453.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 4360 3445.750000 157163.7500 0.0000
P 2719 1785.250000 66156.2500 66156.2500
D 6 2.250000 83.2500 18.5000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5166 4143.000000 156505.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12267 9388.500000 380361.7500 66174.7500
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 18 12.750000 471.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2806 1836.500000 70173.0000 0.0000
P 2 30.000000 900.0000 900.0000
D 25 14.000000 518.0000 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
5468 3439.250000 117372.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8319 5332.500000 189434.8000 900.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 4.000000 300.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2031 1830.500000 84765.2500 35.0000
P 793 691.250000 27529.7800 27354.8000
D 21 7.500000 311.9400 0.0000
S 142 173.000000 8232.0800 5268.3100
H 0 0.000000 0.0000 0.0000
T 2525 26782.750000 54847.7300 50283.1500
3844 7779.750000 90527.0100 17.5700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9358 37268.750000 266513.7900 82958.8300
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 127 93.000000 3587.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2041 1856.750000 80312.5000 0.0000
P 1885 1797.500000 83583.0000 83527.5000
D 0 0.000000 0.0000 0.0000
S 6 10.000000 551.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.000000 20.9800 20.9800
11276 8610.500000 167323.8200 0.0000
Other 101 95.250000 2065.0000 0.0000
---------------------------------------------------------
Total 15437 12464.000000 337444.8000 83548.4800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 5041 4245.250000 181949.3000 0.0000
P 116 117.750000 6074.7500 6074.7500
D 1 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
11502 8551.500000 148407.2500 0.0000
Other 2 3.000000 111.0000 0.0000
---------------------------------------------------------
Total 16664 12920.500000 336653.3000 6074.7500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 14 12.500000 538.5000 0.0000
P 2629 2464.750000 99631.7500 99661.0000
D 30 43.000000 2503.0000 0.0000
S 2 2.250000 83.2500 0.0000
H 13 26.000000 1950.0000 0.0000
T 0 0.000000 0.0000 0.0000
3261 2115.499997 73598.4397 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5949 4663.999997 178304.9397 99661.0000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3762 3628.250000 145901.5000 111.0000
P 0 0.000000 0.0000 0.0000
D 8 8.000000 352.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.000000 75.0000 0.0000
T 1 1.000000 37.0000 0.0000
2908 2502.500000 97646.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6680 6140.750000 244012.5000 111.0000