CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2016 ending 09/30/2016 Date of Report:10/31/2016 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 694 706.500000 26105.5000 36.9505
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 656 915.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1334 5082.250000 187729.7500 36.9383
Subtotal (Total Children Is Unduplicated) 1357 6704.000000 213835.2500 31.8967
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 39 84.000000 10406.0000 123.8810
EXIT-EXIT-EXIT ASSESSMENT 2 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 24.500000 1837.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 14 20.500000 1537.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 10.500000 787.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 17 25.500000 1862.5000 73.0392
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 27 48.000000 2664.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 461 710.000000 52469.2700 73.9004
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 234 326.000000 24174.5000 74.1549
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 150 222.000000 16650.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 614 927.500000 51196.0000 55.1978
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 317 471.000000 36470.9200 77.4330
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 12 12.000000 1103.0500 91.9208
SCREEN-T1023-SCREENING 14 18.000000 900.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 1002 2906.500000 202411.8900 69.6411
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EI Services,Class #03
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 3 3.250000 162.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 14.000000 700.0000 50.0000
INTR-T1013-INTERPRETER 31 52.750000 2718.5000 51.5355
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 223 399.000000 4020.0000 10.0752
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 142.8800 71.4400
TRAV-TRAVS-Travel by mile 151 4955.000000 2203.6200 0.4447
Subtotal (Total Children Is Unduplicated) 317 5430.000000 10143.9400 1.8681
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Total 15040.500000 426391.0800 28.3495
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Number of Children (Unduplicated) With at Least One Service 1392
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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 319 252.250000 9390.2500 0.0000
P 23 84.500000 598.9500 598.9500
D 4 4.000000 160.0000 0.0000
S 56 59.500000 2941.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 65 874.500000 3449.4700 3244.0400
383 319.250000 10750.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 850 1594.000000 27289.6700 3842.9900
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 53 908.250000 2324.1600 1491.2600
27 304.000000 1370.7800 0.0000
Other 403 313.750000 9186.8400 0.0000
---------------------------------------------------------
Total 483 1526.000000 12881.7800 1491.2600
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 18 17.750000 922.7500 0.0000
P 283 253.500000 11416.5000 5228.2500
D 1 2.000000 74.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 28 28.000000 7456.0000 0.0000
T 0 0.000000 0.0000 0.0000
472 372.500000 14649.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 802 673.750000 34518.5000 5228.2500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 26 36.000000 1727.5000 0.0000
P 175 313.000000 14706.2200 14789.7500
D 2 3.000000 111.0000 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
294 331.250000 16095.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 497 683.250000 32640.1200 14789.7500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 235 228.750000 10078.7500 0.0000
P 40 346.500000 1062.5800 1062.5800
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
249 343.000000 5055.8400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 524 918.250000 16197.1700 1062.5800
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 2 4.000000 247.0000 247.0000
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
359 305.250000 13439.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 361 309.250000 13686.0000 247.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3 2.250000 83.2500 0.0000
P 529 606.000000 27365.2500 27365.2500
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
564 458.250000 13576.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1096 1066.500000 41025.0000 27365.2500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 4.000000 261.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4 5.000000 185.0000 0.0000
P 617 757.500000 33561.5200 33046.2700
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 17 291.500000 1583.5400 1583.5400
326 388.250000 20103.7500 459.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 966 1446.250000 55694.8100 35088.8100
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 108 127.000000 6718.0000 0.0000
P 288 325.750000 16841.5000 16841.5000
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
316 378.000000 17956.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 712 830.750000 41515.7500 16841.5000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 76 53.250000 2110.0000 0.0000
P 12 12.000000 345.0000 345.0000
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
170 131.000000 4954.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 258 196.250000 7409.0000 345.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 4.000000 300.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 179 214.750000 8896.0000 0.0000
P 46 88.500000 5615.1500 5615.1500
D 0 0.000000 0.0000 0.0000
S 3 6.000000 450.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 107 1142.000000 2482.4500 2401.4500
195 218.750000 9864.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 532 1674.000000 27608.1000 8016.6000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 80 84.500000 4072.0000 0.0000
P 152 183.750000 8602.5000 8602.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 11 46.000000 87.3700 87.3700
T 1 1.000000 37.0000 0.0000
518 690.750000 10999.7900 0.0000
Other 1 1.000000 10.0000 0.0000
---------------------------------------------------------
Total 764 1009.000000 23919.6600 8689.8700
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 414 436.250000 18492.0000 0.0000
P 28 40.000000 2795.2500 2795.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 41 318.250000 552.9700 552.9700
T 0 0.000000 0.0000 0.0000
622 695.500000 13972.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1105 1490.000000 35812.8000 3348.2200
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 20 18.250000 675.2500 573.5000
P 310 440.740400 20216.5300 20142.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 4 8.000000 600.0000 0.0000
T 0 0.000000 0.0000 0.0000
316 346.009600 17964.4100 4584.9700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 650 813.000000 39456.1900 25300.7200
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 158 203.000000 8925.0000 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 15 449.000000 616.0300 616.0300
136 158.250000 7195.5000 988.5000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 309 810.250000 16736.5300 1604.5300