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
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 105 166.250000 6151.2500 37.0000
Subtotal (Total Children Is Unduplicated) 105 166.250000 6151.2500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 13.000000 975.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 9.500000 712.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 13.500000 1012.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 24 42.500000 2358.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 106 159.500000 11958.9400 74.9777
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 52 90.500000 6787.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 106 183.500000 13762.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 125 197.500000 10961.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 124 183.000000 13725.0000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 3 3.000000 153.1500 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 36 36.000000 1837.8000 51.0500
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 4 4.000000 204.2000 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 9 9.000000 459.4500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 28 28.000000 1429.4000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 572 977.000000 66627.5400 68.1960
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4152 28007.50000 1400165.0000 49.9925
OCCT-97530-OT SESSION BY LICENSED OT 236 1173.250000 83816.9800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 106 522.500000 29698.2000 56.8387
PHY-97110-PT SESSION BY LICENSED PT 226 1218.500000 86960.3900 71.3668
PHY-97110HM-PT SESSION BY PT ASST 51 272.000000 15547.5200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 470 2746.250000 196049.2200 71.3880
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 6.500000 371.8000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 2 4.000000 55.5200 13.8800
Subtotal (Total Children Is Unduplicated) 4799 33952.50000 1812714.6300 53.3897
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Total 35095.750000 1885493.4200 53.7243
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Number of Children (Unduplicated) With at Least One Service 5215
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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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 9 9.000000 516.4200 0.0000
S 68 69.500000 4829.0300 0.0000
H 0 0.000000 0.0000 0.0000
T 8 6.500000 400.0400 400.0400
83 123.500000 7809.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 168 208.500000 13555.2400 400.0400
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
17 17.000000 993.9300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17 17.000000 993.9300 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 60 65.750000 2432.7500 0.0000
P 95 103.500000 3868.5000 3748.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1957 7114.500000 359070.0400 210.0000
T 0 0.000000 0.0000 0.0000
72 159.000000 11032.7200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2184 7442.750000 376404.0100 3958.5000
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
11 37.000000 1850.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11 37.000000 1850.0000 0.0000
Center 09
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 3.500000 262.5000 262.5000
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
1945 6007.000000 336463.7200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1947 6010.500000 336726.2200 262.5000
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
2032 6893.000000 353380.2800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2032 6893.000000 353380.2800 0.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 75.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 1 1.000000 51.0500 51.0500
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
771 2330.500000 138023.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 773 2332.500000 138149.5100 51.0500
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 2 4.500000 271.6400 271.6400
559 1372.750000 80794.9300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 561 1377.250000 81066.5700 271.6400
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
1461 1508.500000 77310.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1461 1508.500000 77310.7500 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
1970 2004.750000 102869.5400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1970 2004.750000 102869.5400 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
3112 2890.750000 180765.0100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3112 2890.750000 180765.0100 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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 4 8.000000 400.0000 400.0000
H 0 0.000000 0.0000 0.0000
T 1 3.000000 214.3200 214.3200
1256 4362.250000 221808.0400 221808.0400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1261 4373.250000 222422.3600 222422.3600