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: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 11184 13229.25000 489330.7500 36.9885
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7517 11930.00000 25.0000 0.0021
TCM-T1017TL-TARGETED CASE MANAGEMENT 19754 59301.00000 2192104.7500 36.9657
Subtotal (Total Children Is Unduplicated) 20937 84460.25000 2681460.5000 31.7482
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 15 16.000000 776.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 114 155.000000 20099.0000 129.6710
EXIT-EXIT-EXIT ASSESSMENT 444 675.000000 33750.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 128 192.500000 14247.5000 74.0130
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 76 111.500000 8362.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 22 28.500000 2137.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 75 119.500000 9510.5500 79.5862
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 168 254.000000 14069.2500 55.3907
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1399 2169.500000 161127.5200 74.2694
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 736 1080.500000 80028.5200 74.0662
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 328 434.500000 32355.0000 74.4649
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1885 2867.000000 158664.5200 55.3417
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 857 1332.000000 101186.5800 75.9659
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 59 59.000000 5252.8500 89.0314
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 5 5.000000 286.3500 57.2700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 12 12.000000 684.5100 57.0425
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.000000 255.2500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 117 143.000000 7104.8900 49.6845
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 43 43.000000 2344.1000 54.5140
Subtotal (Total Children Is Unduplicated) 3865 9703.500000 652293.4400 67.2225
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 237 292.750000 14634.2500 49.9889
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 5 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 979 1283.750000 64143.7500 49.9659
CONIP-CONIP-CONSULT, ITDS PHONE 23 9.750000 243.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 52 60.750000 3037.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 84 103.750000 5187.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 151 204.000000 10200.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 2.500000 62.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 20 55.000000 4032.6000 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 15 23.750000 593.7500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1333 6530.250000 326501.0000 49.9982
INTR-T1013-INTERPRETER 245 582.750000 29137.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1742 9060.000000 90511.0000 9.9902
OCCT-97530-OT SESSION BY LICENSED OT 45 181.000000 12930.6400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 62 178.750000 16787.4400 93.9157
PHY-97110HM-PT SESSION BY PT ASST 7 69.000000 3944.0400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 201 971.250000 78449.7400 80.7719
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TRAV-TRAVS-Travel by mile 495 29705.00000 13219.7100 0.4450
Subtotal (Total Children Is Unduplicated) 2807 49317.50000 673718.0500 13.6608
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Total 143481.250000 4007471.9900 27.9303
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Number of Children (Unduplicated) With at Least One Service 21127
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 46 20.500000 758.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 7748 5148.000000 190947.0200 0.2500
P 0 0.000000 0.0000 0.0000
D 2 3.000000 166.5000 0.0000
S 506 495.500000 26369.8000 0.0000
H 49 63.000000 4628.8000 0.0000
T 17 43.250000 448.3100 429.4200
6089 4205.250000 123193.9800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14457 9978.500000 346512.9100 429.6700
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 1 0.500000 18.5000 0.0000
0 0.000000 0.0000 0.0000
Other 4485 6686.250000 88826.0600 0.0000
---------------------------------------------------------
Total 4486 6686.750000 88844.5600 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 201 133.500000 6193.9400 0.0000
P 3614 2248.500000 92913.2500 30577.5000
D 44 26.000000 968.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 149 145.750000 36092.6900 0.0000
T 0 0.000000 0.0000 0.0000
5635 3243.250000 95168.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9643 5797.000000 231336.8400 30577.5000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 759 1102.250000 44402.7500 0.0000
P 2450 3528.250000 143076.8700 143246.9500
D 31 52.000000 1924.0000 0.0000
S 1 2.000000 74.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3278 3062.250000 132419.2100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6520 7748.750000 321970.8300 143246.9500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2352 1598.250000 66439.5000 0.0000
P 14 1507.750000 1307.0000 1307.0000
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
2573 2182.750000 51176.6100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4939 5288.750000 118923.1100 1307.0000
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
12519 7642.500000 285932.5400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12519 7642.500000 285932.5400 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 3.750000 138.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 359 251.000000 9485.5000 0.0000
P 4853 3636.000000 146864.2500 146836.5000
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
5887 3480.250000 102713.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11106 7371.000000 259202.2500 146836.5000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 233 220.500000 8704.1300 12.5000
P 11573 10075.500000 372673.0500 372153.3100
D 2 2.000000 142.8800 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
4080 3245.750000 122490.4000 1589.7900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15888 13543.750000 504010.4600 373755.6000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1235 961.750000 45407.5000 0.0000
P 3909 2834.500000 125446.2500 125446.2500
D 30 25.250000 1048.2500 0.0000
S 1 0.500000 18.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3117 2546.750000 98126.5000 0.0000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 8293 6369.000000 270056.2500 125446.2500
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2850 1762.250000 67726.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 10 4.500000 166.5000 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
5207 3254.250000 111149.2100 0.0000
Other 2 2.500000 187.5000 0.0000
---------------------------------------------------------
Total 8069 5023.500000 179229.2100 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 17.500000 1255.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2224 2144.750000 90675.5000 0.0000
P 594 684.000000 39612.7900 35413.6300
D 3 4.000000 253.8800 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2444 25027.000000 54267.6100 49290.0100
3666 2692.250000 91845.8800 10.8900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8941 30569.500000 277911.1600 84714.5300
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.250000 83.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1895 1776.250000 81669.7900 0.0000
P 1900 1749.000000 77322.0000 77272.0000
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
11952 9583.500000 186990.5100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15749 13111.000000 346065.5500 77272.0000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.000000 100.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 5067 4110.500000 171562.0000 0.0000
P 723 752.750000 39573.2500 39623.0500
D 0 0.000000 0.0000 0.0000
S 21 21.500000 1187.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.000000 37.0000 0.0000
11903 9017.000000 153860.2500 0.0000
Other 2 1.750000 64.7500 0.0000
---------------------------------------------------------
Total 17719 13906.500000 366384.7500 39623.0500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 146 112.750000 4171.7500 3496.5000
P 2236 2151.782400 86975.9300 88112.2500
D 1 2.000000 150.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 18 36.000000 2700.0000 0.0000
T 0 0.000000 0.0000 0.0000
3103 2067.467600 76552.6400 47739.1600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5504 4370.000000 170550.3200 139347.9100
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3447 3386.000000 134692.2500 0.0000
P 9 7.500000 447.0000 0.0000
D 13 17.500000 704.0000 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
2945 2663.750000 104698.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6414 6074.750000 240541.2500 0.0000