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
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 11277 12218.00000 451924.0000 36.9884
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8570 13056.25000 521.4400 0.0399
TCM-T1017TL-TARGETED CASE MANAGEMENT 21136 66279.50000 2450942.0900 36.9789
Subtotal (Total Children Is Unduplicated) 22123 91553.75000 2903387.5300 31.7124
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 15 15.000000 727.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 134 201.500000 9010.1200 44.7152
EXIT-EXIT-EXIT ASSESSMENT 502 757.250000 37862.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 132 207.000000 15403.1000 74.4111
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 58 100.000000 7467.3400 74.6734
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 28 29.000000 2175.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 111 175.000000 12972.5200 74.1287
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 157 250.500000 13837.7500 55.2405
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1723 2659.499997 198296.3997 74.5615
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 694 989.500000 73302.9000 74.0807
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 384 526.000000 39147.5200 74.4249
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2065 3118.000000 172447.0200 55.3069
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1130 1687.500000 126884.1700 75.1906
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 81 81.000000 7012.8800 86.5788
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.000000 75.7200 75.7200
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 15 15.000000 880.4400 58.6960
OCTH-97165-OT EVAL LOW COMPLEXITY 3 4.000000 204.2000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 700.0000 700.0000
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 107 116.000000 5800.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 37 37.000000 1888.8500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 4385 10974.75000 726300.1297 66.1792
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 362 416.000000 20800.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 17 12.250000 306.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1040 1369.250000 68362.5000 49.9270
CONIP-CONIP-CONSULT, ITDS PHONE 42 24.250000 606.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 133 191.750000 9587.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 0.750000 18.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 161 254.250000 12712.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 271 437.000000 21850.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 15 49.000000 3592.6800 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 15 33.500000 837.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1400 7167.250000 358380.0000 50.0024
INTR-T1013-INTERPRETER 286 576.500000 28712.5000 49.8049
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1830 9402.000000 94020.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 53 232.750000 16955.4800 72.8485
PHY-97110-PT SESSION BY LICENSED PT 89 743.250000 44977.5200 60.5147
PHY-97110HM-PT SESSION BY PT ASST 6 35.000000 1964.4200 56.1263
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 168 896.500000 100768.7200 112.4024
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 600.0000 600.0000
TRAV-TRAVS-Travel by mile 557 37320.00000 16611.4700 0.4451
Subtotal (Total Children Is Unduplicated) 3174 59163.25000 801689.0400 13.5505
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Total 161691.749997 4431376.6997 27.4063
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Number of Children (Unduplicated) With at Least One Service 22245
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 86 73.000000 4689.9400 0.0000
U 0 0.000000 0.0000 0.0000
B 8307 5391.250000 205731.0200 0.0000
P 5 7.000000 500.0000 500.0000
D 84 83.750000 5773.6900 0.0000
S 417 457.250000 31587.5600 0.0000
H 114 139.750000 10008.1000 0.0000
T 0 0.000000 0.0000 0.0000
6469 4149.250000 129370.9600 0.0000
Other 1 1.000000 71.4400 0.0000
---------------------------------------------------------
Total 15483 10302.250000 387732.7100 500.0000
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 5197 14065.250000 113844.4700 0.0000
---------------------------------------------------------
Total 5197 14065.250000 113844.4700 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 983 608.750000 23915.0000 100.0000
P 2155 1341.250000 55341.7500 39978.0250
D 18 10.500000 388.5000 0.0000
S 5 4.250000 157.2500 0.0000
H 207 198.750000 48774.0900 0.0000
T 0 0.000000 0.0000 0.0000
6640 4483.000000 153912.2700 0.0000
Other 60 48.500000 1937.5000 0.0000
---------------------------------------------------------
Total 10068 6695.000000 284426.3600 40078.0250
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 55.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 695 897.750000 39948.0000 0.0000
P 3141 4728.750000 187329.0900 187493.6000
D 81 106.250000 3968.7500 0.0000
S 2 2.000000 74.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4006 3838.000000 165429.8700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7926 9573.750000 396805.2100 187493.6000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2834 1909.250000 77157.7500 0.0000
P 193 851.750000 10652.4900 10652.4900
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
2734 1619.500000 44603.7500 250.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5762 4381.500000 132450.9900 10902.4900
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
12412 7698.000000 282898.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12412 7698.000000 282898.2500 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 0.750000 27.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 13 9.250000 342.2500 0.0000
P 5535 3973.250000 160114.2500 160058.7500
D 131 89.000000 3584.0000 0.0000
S 3 1.250000 46.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6941 4175.250000 126355.2500 0.0000
Other 1 1.000000 37.0000 0.0000
---------------------------------------------------------
Total 12626 8249.750000 290506.7500 160058.7500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 3.500000 129.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 220 191.750000 7419.7500 27.7500
P 12833 10861.250000 410872.9500 411031.3500
D 7 10.000000 671.0700 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
447 517.500000 27729.4700 163.9600
Other 2 3.500000 223.5000 0.0000
---------------------------------------------------------
Total 13511 11587.500000 447046.2400 411223.0600
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 529 368.000000 13616.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 7035 5144.750000 217016.5000 0.0000
P 1709 1224.250000 54837.0000 54837.0000
D 102 66.500000 2460.5000 0.0000
S 61 33.500000 1391.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6079 4723.250000 169685.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15515 11560.250000 459007.0000 54837.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 5.500000 203.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2315 1476.250000 57329.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 8 3.250000 120.2500 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
3808 2533.750000 88260.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6136 4018.750000 145913.5300 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 265 188.750000 7672.0000 37.0000
P 2946 2668.750000 124907.0000 121355.5600
D 83 95.750000 6128.9900 0.0000
S 6 6.000000 222.0000 0.0000
H 91 90.500000 5878.6200 46.9000
T 3371 28105.000000 73144.6600 62206.0100
3517 2490.750000 73885.0000 36.5100
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10279 33645.500000 291838.2700 183681.9800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 133 137.250000 6642.2500 0.0000
P 3810 3549.425000 159377.6400 158416.0000
D 3 3.000000 150.0000 0.0000
S 447 315.750000 11615.6900 11615.6900
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
12402 9300.075000 175000.2900 17884.2500
Other 18 17.250000 859.2500 0.0000
---------------------------------------------------------
Total 16813 13322.750000 353645.1200 187915.9400
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.500000 68.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 3797 3006.000000 124176.2500 0.0000
P 2549 2236.000000 104403.0000 104408.2500
D 1 0.250000 9.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 16 10.000000 370.0000 370.0000
12793 9832.000000 167953.2500 0.0000
Other 1 0.750000 27.7500 0.0000
---------------------------------------------------------
Total 19159 15086.500000 397008.0000 104778.2500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 3.750000 138.7500 0.0000
P 3607 3150.595000 128231.9500 127746.2500
D 14 28.000000 2100.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
4208 2612.154997 89236.5997 29899.1000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7832 5796.499997 219857.2997 157645.3500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 32 29.750000 1100.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2286 2188.500000 85959.0000 0.0000
P 818 788.750000 32460.2500 32460.2500
D 21 12.500000 462.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 0.500000 18.5000 0.0000
T 0 0.000000 0.0000 0.0000
2976 2688.500000 108395.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6135 5708.500000 228396.5000 32460.2500