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: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 10494 12329.25000 456054.7500 36.9897
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7762 12128.75000 1300.0000 0.1072
TCM-T1017TL-TARGETED CASE MANAGEMENT 19746 57996.75000 2144655.0000 36.9789
Subtotal (Total Children Is Unduplicated) 20975 82454.75000 2602009.7500 31.5568
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 6 7.000000 339.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 108 198.500000 11203.0000 56.4383
EXIT-EXIT-EXIT ASSESSMENT 460 711.750000 35587.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 124 211.000000 15825.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 72 117.500000 8685.0200 73.9151
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 26 30.000000 2250.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 98 141.500000 10846.2700 76.6521
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 134 210.500000 11617.7500 55.1912
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1457 2249.000000 167808.5403 74.6147
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 681 1020.000000 75619.0200 74.1363
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 309 425.500000 31912.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1780 2691.500000 148110.8600 55.0291
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 846 1337.000000 100990.2800 75.5350
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 55 55.000000 5653.0000 102.7818
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.000000 57.2700 57.2700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 15 15.000000 673.8200 44.9213
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 3 3.000000 153.1500 51.0500
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 51.0500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 13 14.000000 4907.3500 350.5250
SCREEN-T1023-SCREENING 115 170.000000 8475.0000 49.8529
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 40 41.000000 2093.0500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 3787 9653.750000 643012.0803 66.6075
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 19.6000 19.6000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 282 304.250000 15212.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 20 13.750000 343.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 985 1386.500000 69287.5000 49.9730
CONIP-CONIP-CONSULT, ITDS PHONE 67 41.250000 1031.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 76 97.000000 4850.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 139 226.250000 11312.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 241 368.500000 18425.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 7 4.500000 112.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 18 51.000000 3739.3200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 16.000000 400.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1366 6782.500000 339112.5000 49.9982
INTR-T1013-INTERPRETER 245 486.250000 24312.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1757 9014.000000 90110.0000 9.9967
OCCT-97530-OT SESSION BY LICENSED OT 52 192.500000 14837.8600 77.0798
PHY-97110-PT SESSION BY LICENSED PT 92 325.750000 34277.0500 105.2250
PHY-97110HM-PT SESSION BY PT ASST 11 80.500000 4824.2200 59.9282
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 225 1044.750000 152399.2200 145.8715
TRAV-TRAVS-Travel by mile 482 30850.00000 13731.8700 0.4451
Subtotal (Total Children Is Unduplicated) 2999 51288.75000 798401.6400 15.5668
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Total 143397.250000 4043423.4703 28.1974
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Number of Children (Unduplicated) With at Least One Service 21133
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 44 20.750000 767.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 6794 4406.000000 163235.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 191 252.000000 17339.0500 0.0000
S 947 951.500000 52169.0900 0.0000
H 22 28.500000 2119.7000 0.0000
T 5 5.000000 271.4400 271.4400
5429 3527.000000 104210.0100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13432 9190.750000 340112.0400 271.4400
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
0 0.000000 0.0000 0.0000
Other 3824 7817.000000 84803.0200 0.0000
---------------------------------------------------------
Total 3824 7817.000000 84803.0200 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 129 83.250000 3603.5000 0.0000
P 2879 1725.000000 70680.0500 25762.0500
D 45 32.500000 1278.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 173 169.250000 63485.2300 0.0000
T 0 0.000000 0.0000 0.0000
5723 3745.250000 173718.1700 0.0000
Other 43 39.250000 1556.2500 0.0000
---------------------------------------------------------
Total 8992 5794.500000 314321.7000 25762.0500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 7.500000 277.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 61 93.500000 3459.5000 0.0000
P 2975 4227.750000 168842.6500 169168.8200
D 46 71.250000 2692.7500 0.0000
S 2 4.250000 157.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.500000 55.5000 0.0000
2962 2615.750000 114727.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6050 7021.500000 290212.4000 169168.8200
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2346 1548.500000 63232.2500 0.0000
P 72 1153.250000 4431.4100 4431.4100
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
2453 1407.750000 42427.0600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4871 4109.500000 110090.7200 4431.4100
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
11136 6861.250000 257812.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11136 6861.250000 257812.7500 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 4.750000 175.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 213 141.500000 5387.2500 0.0000
P 4892 3594.750000 144988.5000 144951.5000
D 76 55.250000 2309.2500 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
6015 3605.000000 108666.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11202 7401.250000 261527.5000 144951.5000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 106 102.250000 4699.7500 101.7500
P 13085 11293.250000 423050.6800 422581.5900
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
600 634.000000 30638.3300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13791 12029.500000 458388.7600 422683.3400
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 73 44.000000 1628.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 8713 6034.500000 251044.5000 0.0000
P 0 0.000000 0.0000 0.0000
D 71 38.250000 1415.2500 0.0000
S 177 138.500000 5124.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5633 4267.250000 152130.7500 0.0000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 14668 10522.750000 411352.2500 0.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 50 32.750000 1211.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2404 1514.250000 59054.7500 0.0000
P 1 0.500000 18.5000 0.0000
D 8 6.750000 306.2500 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
4649 2840.000000 95876.0200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7112 4394.250000 156467.2700 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 9 12.000000 750.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 893 912.500000 46314.7500 175.7500
P 1726 1495.250000 66101.3800 63496.1200
D 163 167.250000 10096.9400 40.0000
S 42 48.000000 2664.3200 0.0000
H 145 145.000000 9736.2800 0.0000
T 2850 26255.250000 51876.6800 47109.7300
3364 2382.500000 74381.3300 20.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9192 31417.750000 261921.6800 110841.6000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 4.250000 157.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 550 529.750000 25699.5000 0.0000
P 2814 2660.500000 119138.5000 119138.5000
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
11664 9185.500000 181318.1700 0.0000
Other 17 15.500000 771.7500 0.0000
---------------------------------------------------------
Total 15051 12395.500000 327085.1700 119138.5000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4712 3815.000000 163983.5000 50.0000
P 672 682.750000 35758.7500 35774.5000
D 0 0.000000 0.0000 0.0000
S 1 0.250000 9.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
12429 9477.500000 160837.9600 0.0000
Other 4 2.750000 101.7500 0.0000
---------------------------------------------------------
Total 17821 13980.250000 360765.2100 35824.5000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 21 15.000000 555.0000 0.0000
P 2861 2580.000000 105127.2500 105127.2500
D 14 26.750000 1977.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 9 16.990400 1274.2800 0.0000
T 0 0.000000 0.0000 0.0000
3206 1987.259600 68548.2203 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6111 4626.000000 177482.5003 105127.2500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 3.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2550 2410.500000 98379.2500 0.0000
P 914 929.750000 34513.7500 34169.5000
D 11 16.000000 592.0000 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
2767 2475.500000 97456.7500 0.0000
Other 1 0.750000 27.7500 0.0000
---------------------------------------------------------
Total 6246 5835.500000 231080.5000 34169.5000