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
Payclass Filters:GR
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 563 2088.500000 77145.0000 36.9380
Subtotal (Total Children Is Unduplicated) 1347 4179.250000 109575.5000 26.2189
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 6 9.592600 479.6300 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.500000 337.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.500000 187.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 11.500000 598.2500 52.0217
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 84 119.552667 8899.9900 74.4441
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 48.638433 3647.8800 74.9999
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 49 67.101000 5032.5750 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 166 211.500000 11665.7700 55.1573
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 76 117.500000 8740.0200 74.3831
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 7 7.000000 374.8500 53.5500
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 280 603.384700 40188.9650 66.6059
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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 2 6.750000 337.5000 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 7623.500000 12844.4200 1.6848
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Total 12406.134700 162608.8850 13.1071
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Number of Children (Unduplicated) With at Least One Service 1405
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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 69 646.500000 2468.9300 2468.9300
D 2 3.000000 110.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3 3.000000 118.2500 118.2500
577 459.250000 15111.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 651 1111.750000 17808.9300 2587.1800
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 189 727.500000 2736.6600 0.0000
---------------------------------------------------------
Total 251 1834.000000 5608.6700 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 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
365 252.750000 7388.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 365 252.750000 7388.2000 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 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
246 261.250000 11292.8500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 246 261.250000 11292.8500 0.0000
Center 05
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 111 1018.750000 4343.4600 4343.4600
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 407 1203.250000 9477.2100 4343.4600
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
473 330.250000 10459.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 474 332.250000 10576.0000 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 0 0.000000 0.0000 0.0000
P 44 117.500000 1196.4600 1196.4600
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
638 507.500000 15813.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 688 631.500000 17287.4600 1196.4600
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 399 448.250000 16051.0200 16051.0200
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
1 2.000000 38.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 400 450.250000 16089.5400 16051.0200
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
303 373.500000 11652.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 303 373.500000 11652.2500 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 0 0.000000 0.0000 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
259 206.000000 7045.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 269 216.000000 7545.2500 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 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 81 1214.500000 1224.0000 1204.0000
172 113.000000 3424.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 253 1327.500000 4648.7500 1204.0000
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 54 261.500000 690.0100 690.0100
639 528.500000 9991.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 693 790.000000 10681.2600 690.0100
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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 214 1927.500000 2958.1400 2958.1400
934 787.750000 11770.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1148 2715.250000 14728.1400 2958.1400
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 13 22.739433 1512.4550 1512.4600
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
405 279.645267 9360.0800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 418 302.384700 10872.5350 1512.4600
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 25 469.000000 1095.5900 1095.5900
109 129.500000 5708.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 134 598.500000 6803.8400 1095.5900