CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2017 ending 06/30/2017 Date of Report:08/05/2017 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 858 876.500000 32430.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 835 1214.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1603 6271.750000 231832.7500 36.9646
Subtotal (Total Children Is Unduplicated) 1627 8362.500000 264263.2500 31.6010
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 7 16.000000 800.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 23 40.000000 3000.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 13.500000 1012.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 10.000000 750.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 13 23.500000 1762.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 33 54.000000 2957.0000 54.7593
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 497 746.000000 55643.9000 74.5897
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 218 314.000030 23161.1200 73.7615
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 207 291.000100 21686.3475 74.5235
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 690 1038.000000 57355.0200 55.2553
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 378 569.500000 43423.2100 76.2480
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 15 15.000000 1633.8200 108.9213
SCREEN-T1023-SCREENING 7 7.000000 350.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1076 3139.500130 213635.4175 68.0476
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 3.500000 175.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 1.500000 75.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 24.750000 1237.5000 50.0000
INTR-T1013-INTERPRETER 32 69.750000 3289.5000 47.1613
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 294 582.000000 5830.0000 10.0172
TRAV-TRAVS-Travel by mile 240 6959.000000 3087.4200 0.4437
Subtotal (Total Children Is Unduplicated) 413 7641.500000 13744.4200 1.7987
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Total 19143.500130 491643.0875 25.6820
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Number of Children (Unduplicated) With at Least One Service 1646
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.250000 83.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 344 286.750000 11914.7500 0.0000
P 92 681.500000 4567.0400 4567.0400
D 8 9.500000 519.5000 0.0000
S 8 11.000000 407.0000 0.0000
H 12 18.500000 1319.2500 0.0000
T 5 5.000000 220.0000 201.5000
583 468.750000 15738.0000 0.0000
Other 13 19.000000 1278.7500 0.0000
---------------------------------------------------------
Total 1067 1502.250000 36047.5400 4768.5400
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 62 1106.500000 2872.0100 2872.0100
0 0.000000 0.0000 0.0000
Other 306 826.500000 7069.4100 0.0000
---------------------------------------------------------
Total 368 1933.000000 9941.4200 2872.0100
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 165 145.000000 5365.0000 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
501 371.500000 11781.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 666 516.500000 17146.9500 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 162 347.250000 13413.2500 0.0000
P 129 199.000000 10190.2100 10190.2100
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
313 321.000000 15919.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 604 867.250000 39523.2600 10190.2100
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 218 203.250000 8812.2500 0.0000
P 112 1020.250000 4455.9600 4455.9600
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
296 184.500000 5133.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 626 1408.000000 18401.9600 4455.9600
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 1 2.000000 117.0000 117.0000
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
819 699.250000 29431.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 820 701.250000 29548.0000 117.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 2.000000 74.0000 0.0000
P 524 654.250000 26414.7100 26414.7100
D 6 6.500000 277.5000 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
648 519.250000 16494.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1180 1182.000000 43260.4600 26414.7100
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 7 10.750000 662.7500 0.0000
P 707 908.000000 38480.4800 38479.9800
D 4 5.000000 316.5000 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
47 60.750000 3782.7700 0.0000
Other 77 105.000000 7826.2500 0.0000
---------------------------------------------------------
Total 842 1089.500000 51068.7500 38479.9800
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 486 513.250000 24260.7500 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
359 465.250000 17730.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 845 978.500000 41991.2500 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 132 98.000000 3985.7500 0.0000
P 10 10.000000 500.0000 500.0000
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
265 212.000000 7475.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 407 320.000000 11961.5000 500.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 39 62.000000 3505.5000 27.7500
P 224 278.250000 13293.5000 13293.5000
D 3 5.500000 305.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 12 23.500000 1616.2500 0.0000
T 92 1235.500000 2643.0000 2469.0000
192 146.000000 5841.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 562 1750.750000 27205.2500 15790.2500
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 33 37.000000 1989.0000 83.2500
P 271 319.000000 14699.2500 14699.2500
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 56 264.000000 877.5100 877.5100
700 608.750000 14988.2500 0.0000
Other 2 3.000000 233.2500 0.0000
---------------------------------------------------------
Total 1064 1232.750000 32824.2600 15660.0100
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 353 388.500000 17709.7500 0.0000
P 4 5.500000 329.0000 329.0000
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 223 1936.500000 3440.1400 3421.6400
1492 1462.500000 46229.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2072 3793.000000 67708.1400 3750.6400
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 522 637.239433 28656.9550 28656.9600
D 0 0.000000 0.0000 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
494 438.260697 20405.0525 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1017 1077.500130 49212.0075 28656.9600
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 28 36.750000 1416.2500 0.0000
P 98 120.250000 5764.5000 5764.5000
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 29 477.000000 1617.5900 1617.5900
115 146.500000 6680.2500 972.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 271 781.000000 15497.0900 8354.0900