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
Agency Filter:EXT
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 101 140.500000 5198.5000 37.0000
Subtotal (Total Children Is Unduplicated) 101 140.500000 5198.5000 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 15.500000 1162.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 21.000000 1575.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 11 18.000000 1350.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 10 13.000000 975.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 39 70.500000 3912.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 111 175.000000 13125.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 63 108.500000 8137.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 134 231.500000 17362.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 178 306.000000 16983.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 150 229.000000 17137.5000 74.8362
OCTF-97168-OT RE-EVAL EST PLAN CARE 6 6.000000 306.3000 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 4 4.000000 204.2000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 6 6.000000 306.3000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 28 32.000000 1633.6000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 7 7.000000 357.3500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 33 34.000000 1735.7000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 32 32.000000 1633.6000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 10 10.000000 510.5000 51.0500
Subtotal (Total Children Is Unduplicated) 746 1321.000000 88510.4000 67.0026
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 782.0400 782.0400
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 11 66.500000 1662.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4915 39904.75000 1995014.5000 49.9944
OCCT-97530-OT SESSION BY LICENSED OT 287 1627.750000 116229.5000 71.4050
OCCT-97530HM-OT SESSION BY OT ASST 144 749.250000 42803.9000 57.1290
PHY-97110-PT SESSION BY LICENSED PT 269 1457.750000 104042.4800 71.3720
PHY-97110HM-PT SESSION BY PT ASST 68 370.250000 21163.4900 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 542 3306.250000 236157.7200 71.4277
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 8.000000 457.6000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 6 20.750000 288.0100 13.8800
Subtotal (Total Children Is Unduplicated) 5692 47512.25000 2518601.7400 53.0095
-----------------------------------------------------------------------------------------------------------------------
Total 48973.750000 2612310.6400 53.3410
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 6150
-----------------------------------------------------------------------------------------------------------------------
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 17 17.000000 1860.7600 1860.7600
D 73 72.000000 4011.2400 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 8 8.000000 421.4400 421.4400
1 1.500000 112.5000 0.0000
Other 61 94.000000 6300.7500 0.0000
---------------------------------------------------------
Total 160 192.500000 12706.6900 2282.2000
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
7 7.000000 371.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7 7.000000 371.4400 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 48 37.500000 1387.5000 0.0000
P 124 99.500000 3681.5000 3681.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2729 11079.500000 560999.0700 387.8600
T 0 0.000000 0.0000 0.0000
147 318.000000 22251.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3048 11534.500000 588319.8700 4069.3600
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 1 1.000000 25.0000 25.0000
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 1.000000 25.0000 25.0000
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
406 413.000000 22141.5300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 406 413.000000 22141.5300 0.0000
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 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
12 33.000000 1650.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12 33.000000 1650.0000 0.0000
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 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
2151 6821.000000 379237.8800 0.0000
Other 142 211.000000 15542.2500 0.0000
---------------------------------------------------------
Total 2293 7032.000000 394780.1300 0.0000
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
3283 11540.250000 591447.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3283 11540.250000 591447.9200 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 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
846 2603.000000 153286.4100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 846 2603.000000 153286.4100 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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 1 1.000000 50.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
643 1433.250000 85212.0100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 644 1434.250000 85262.0100 0.0000
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 0 0.000000 0.0000 0.0000
1953 2033.750000 104763.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1953 2033.750000 104763.0000 0.0000
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 0 0.000000 0.0000 0.0000
3160 3212.000000 163825.3300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3160 3212.000000 163825.3300 0.0000
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 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
3956 3726.750000 229096.5700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3956 3726.750000 229096.5700 0.0000
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 0 0.000000 0.0000 0.0000
1497 5210.750000 264634.7400 264454.7400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1497 5210.750000 264634.7400 264454.7400