CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2016 ending 12/31/2016 Date of Report:02/04/2017 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 99 133.000000 4921.0000 37.0000
Subtotal (Total Children Is Unduplicated) 99 133.000000 4921.0000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 11.000000 825.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 12.000000 900.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 11 19.500000 1462.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 31 51.000000 2830.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 108 162.000000 12076.0000 74.5432
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 41 71.500000 5362.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 92 157.000000 11750.0000 74.8408
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 143 235.500000 13070.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 119 183.000000 13651.0000 74.5956
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 6 6.000000 306.3000 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 29 29.000000 1480.4500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 27 27.000000 1378.3500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 579 1010.500000 67584.8500 66.8826
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 7.360000 764.3700 103.8546
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 10.000000 250.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4600 32930.25000 1646343.5000 49.9949
OCCT-97530-OT SESSION BY LICENSED OT 275 1505.250000 107350.7400 71.3175
OCCT-97530HM-OT SESSION BY OT ASST 131 616.500000 35263.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 270 1433.250000 102370.9900 71.4258
PHY-97110HM-PT SESSION BY PT ASST 74 362.500000 20720.5000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 507 3017.500000 215532.2000 71.4274
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 7 11.500000 657.8000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 10 32.000000 444.1600 13.8800
Subtotal (Total Children Is Unduplicated) 5377 39926.11000 2129698.0600 53.3410
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Total 41069.610000 2202203.9100 53.6213
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Number of Children (Unduplicated) With at Least One Service 5796
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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 24 23.500000 1412.4000 1412.4000
D 48 62.000000 3676.6300 0.0000
S 18 28.000000 2100.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3 3.000000 214.3200 214.3200
3 2.500000 138.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 96 119.000000 7542.1000 1626.7200
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 0 0.000000 0.0000 0.0000
7 7.000000 414.3200 0.0000
Other 2 4.000000 300.0000 0.0000
---------------------------------------------------------
Total 9 11.000000 714.3200 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 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
2 2.000000 142.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2 2.000000 142.8800 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 1 1.250000 46.2500 0.0000
P 159 131.750000 4874.7500 4874.7500
D 0 0.000000 0.0000 0.0000
S 1 5.000000 250.0000 0.0000
H 2091 7744.500000 391214.2700 357.2000
T 0 0.000000 0.0000 0.0000
144 354.250000 24859.0400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2396 8236.750000 421244.3100 5231.9500
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
2501 2313.750000 122185.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2501 2313.750000 122185.8800 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 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
12 39.000000 1961.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12 39.000000 1961.0000 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 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
2008 6066.500000 338693.5200 0.0000
Other 81 115.500000 8637.5000 0.0000
---------------------------------------------------------
Total 2089 6182.000000 347331.0200 0.0000
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
2857 9579.250000 493609.7600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2857 9579.250000 493609.7600 0.0000
Center 51
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
837 2515.500000 150888.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 837 2515.500000 150888.7000 0.0000
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 1 2.000000 142.8800 142.8800
566 1262.000000 74863.1800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 567 1264.000000 75006.0600 142.8800
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
1432 1483.000000 76290.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1432 1483.000000 76290.5000 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
2145 2205.110000 113885.2900 85228.7100
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2145 2205.110000 113885.2900 85228.7100
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
2994 2771.750000 169229.7600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2994 2771.750000 169229.7600 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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 -2.000000 -100.0000 -100.0000
1286 4349.500000 222272.3300 222172.1700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1287 4347.500000 222172.3300 222072.1700