CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2017 ending 03/31/2017 Date of Report:05/05/2017 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 770 750.750000 27777.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 771 1091.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1526 5973.750000 220880.7500 36.9752
Subtotal (Total Children Is Unduplicated) 1552 7816.250000 248658.5000 31.8130
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 43 96.000000 4616.4000 48.0875
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 24 37.500000 2712.5000 72.3333
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 13.500000 957.5000 70.9259
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 10.500000 787.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 21 32.500000 2407.6200 74.0806
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 37 63.000000 3496.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 533 823.000099 61008.3599 74.1292
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 212 310.000200 23185.0000 74.7903
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 189 259.500100 19393.3500 74.7335
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 654 969.000000 53686.2500 55.4038
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 371 549.000000 41188.1300 75.0239
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 13 13.000000 1382.2500 106.3269
SCREEN-T1023-SCREENING 4 4.000000 200.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1115 3181.500399 215071.3599 67.6006
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 0.500000 25.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 29.500000 1475.0000 50.0000
INTR-T1013-INTERPRETER 28 49.250000 2434.0000 49.4213
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 252 486.000000 4583.6100 9.4313
PHY-97110-PT SESSION BY LICENSED PT 2 3.250000 232.1800 71.4400
TRAV-TRAVS-Travel by mile 199 6292.000000 2738.4400 0.4352
Subtotal (Total Children Is Unduplicated) 359 6862.500000 11588.2300 1.6886
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Total 17860.250399 475318.0899 26.6132
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Number of Children (Unduplicated) With at Least One Service 1564
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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 452 372.000000 14238.0000 0.0000
P 73 864.250000 3014.3500 3014.3500
D 10 68.000000 787.7700 0.0000
S 41 56.250000 3719.5000 0.0000
H 10 14.000000 1050.0000 0.0000
T 6 42.000000 336.0100 336.0100
422 330.000000 9853.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1014 1746.500000 32998.6300 3350.3600
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 35 412.000000 1238.0400 1241.0400
4 68.500000 300.9800 0.0000
Other 439 1601.750000 11968.2000 0.0000
---------------------------------------------------------
Total 478 2082.250000 13507.2200 1241.0400
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 86 83.500000 3202.5000 0.0000
P 174 178.750000 8034.7500 6573.2500
D 0 0.000000 0.0000 0.0000
S 1 1.000000 37.0000 0.0000
H 6 6.000000 116.4000 0.0000
T 0 0.000000 0.0000 0.0000
551 467.250000 20827.7700 0.0000
Other 11 7.500000 277.5000 0.0000
---------------------------------------------------------
Total 829 744.000000 32495.9200 6573.2500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 54 68.000000 3185.7500 0.0000
P 182 325.750000 12942.4500 12942.4500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 13.000000 650.0000 0.0000
T 0 0.000000 0.0000 0.0000
390 430.250000 20620.0000 0.0000
Other 1 1.500000 107.1600 0.0000
---------------------------------------------------------
Total 630 838.500000 37505.3600 12942.4500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 252 228.250000 10136.2500 0.0000
P 112 1019.000000 4511.6200 4511.6200
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
276 182.000000 4810.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 640 1429.250000 19457.8700 4511.6200
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 234.0000 234.0000
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
685 551.750000 23401.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 687 555.750000 23635.7500 234.0000
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 519 637.500000 26240.9800 26240.9800
D 1 2.250000 83.2500 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
735 682.000000 18894.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1255 1321.750000 45218.2300 26240.9800
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9 17.500000 818.5000 0.0000
P 582 761.750000 31967.8800 31967.8800
D 1 1.000000 55.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 0.750000 27.7500 27.7500
84 110.250000 7059.3300 112.5000
Other 47 59.000000 4376.2500 0.0000
---------------------------------------------------------
Total 724 950.250000 44305.2100 32108.1300
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 19 15.500000 573.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 431 473.000000 22521.5000 0.0000
P 155 179.500000 9596.7500 9596.7500
D 0 0.000000 0.0000 0.0000
S 9 7.500000 277.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
366 423.750000 18531.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 980 1099.250000 51500.2500 9596.7500
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 115 83.250000 3429.5000 0.0000
P 16 16.000000 726.0000 726.0000
D 1 0.750000 27.7500 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
209 164.000000 5931.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 341 264.000000 10114.2500 726.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 22 18.750000 921.7500 0.0000
P 262 299.250000 14290.4600 14116.0400
D 4 7.500000 455.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 3 6.000000 450.0000 0.0000
T 78 1101.500000 1425.4600 1374.4600
181 185.000000 6806.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 550 1618.000000 24349.6700 15490.5000
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 293 308.250000 14113.5000 14113.5000
D 0 0.000000 0.0000 0.0000
S 29 28.750000 1063.7500 1008.2500
H 0 0.000000 0.0000 0.0000
T 17 217.000000 182.5900 182.5900
604 700.250000 12476.6600 1230.2500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 943 1254.250000 27836.5000 16534.5900
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 394 389.750000 16324.5000 0.0000
P 193 218.750000 10915.0000 10915.0000
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 100 747.500000 1497.7200 1497.7200
775 859.000000 16975.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1462 2215.000000 45713.1700 12412.7200
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 392 529.401967 24517.2100 24263.6600
D 7 14.000000 1050.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 15 29.637500 2105.8100 2105.8100
475 475.460932 21136.2299 4178.3000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 890 1050.500399 48959.2499 30547.7700
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 102 133.500000 5430.0000 0.0000
P 48 52.250000 2508.5000 2508.5000
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 8 296.000000 189.0600 189.0600
174 209.250000 9593.2500 727.5000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 332 691.000000 17720.8100 3425.0600