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: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 11333 12630.75000 467192.7500 36.9885
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8896 13758.75000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 21675 68128.25000 2518723.5000 36.9703
Subtotal (Total Children Is Unduplicated) 22762 94517.75000 2985916.2500 31.5911
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 8 8.000000 388.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 80 91.250000 4562.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 490 768.750000 38437.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 134 227.500000 16832.5000 73.9890
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 63 119.000000 8755.0000 73.5714
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 19 26.500000 1987.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 116 201.500000 15118.7700 75.0311
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 143 227.500000 12626.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1602 2415.262003 180677.2603 74.8065
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 720 1063.500000 79517.5000 74.7696
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 368 543.000000 40647.5000 74.8573
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2056 3198.000000 176914.5200 55.3204
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1060 1615.000000 122157.6800 75.6394
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 61 61.000000 6271.9500 102.8189
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.000000 75.7200 75.7200
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 9 9.000000 405.8800 45.0978
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 96 97.000000 4850.0000 50.0000
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 32 33.000000 1684.6500 51.0500
Subtotal (Total Children Is Unduplicated) 4250 10718.76200 712574.3303 66.4792
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 1256.8500 1256.8500
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 290 344.000000 17162.5000 49.8910
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 18 10.250000 256.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 994 1263.500000 63081.0000 49.9256
CONIP-CONIP-CONSULT, ITDS PHONE 45 21.500000 537.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 81 91.250000 4562.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 121 139.250000 6962.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 0.750000 18.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 249 314.500000 15725.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 3.250000 81.2500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 12 32.000000 2346.2400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 21 58.000000 1450.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1399 7068.750000 353412.5000 49.9965
INTR-T1013-INTERPRETER 269 563.500000 28164.5000 49.9814
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1853 9692.000000 96870.0000 9.9948
OCCT-97530-OT SESSION BY LICENSED OT 45 188.250000 13448.5800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 51 132.000000 9235.0800 69.9627
PHY-97110HM-PT SESSION BY PT ASST 4 35.000000 2000.6000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 136 718.000000 50289.2200 70.0407
SPL-92508-GROUP SPL SESSION PER CHILD 2 4.000000 55.5200 13.8800
TRAV-TRAVS-Travel by mile 588 39038.00000 17375.8600 0.4451
Subtotal (Total Children Is Unduplicated) 3071 59718.75000 684292.2000 11.4586
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Total 164955.262003 4382782.7803 26.5695
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Number of Children (Unduplicated) With at Least One Service 22893
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 87 77.500000 3487.4200 0.0000
U 0 0.000000 0.0000 0.0000
B 8195 5565.000000 220160.8000 0.0000
P 0 0.000000 0.0000 0.0000
D 9 14.500000 834.0000 0.0000
S 557 436.500000 16122.7500 0.0000
H 76 95.000000 6667.3500 0.0000
T 6 5.500000 203.5000 0.0000
6463 4374.000000 131162.1600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15393 10568.000000 378637.9800 0.0000
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 1 0.500000 18.5000 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
1 0.250000 9.2500 0.0000
Other 5256 16137.250000 116512.0900 0.0000
---------------------------------------------------------
Total 5258 16138.000000 116539.8400 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 1441 853.500000 32863.2500 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
5759 3527.250000 113664.2200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7200 4380.750000 146527.4700 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.750000 101.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2995 4548.500000 171260.7500 0.0000
P 1048 1406.250000 64009.4700 64027.0400
D 10 10.750000 397.7500 0.0000
S 2 1.750000 64.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3592 3215.750000 140864.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7648 9185.750000 376699.4100 64027.0400
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 6.000000 222.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2598 1706.250000 67848.7500 0.0000
P 165 587.750000 10884.5000 10875.2500
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 0 0.000000 0.0000 0.0000
2651 1534.000000 43243.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5424 3834.000000 122199.0000 10875.2500
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
12872 8038.000000 295475.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12872 8038.000000 295475.2500 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 22 18.250000 675.2500 0.0000
P 5356 4080.500000 165935.7500 165926.5000
D 164 91.750000 3526.2500 0.0000
S 2 0.750000 27.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 3 1.500000 55.5000 0.0000
7183 4558.250000 130275.3900 0.0000
Other 3 3.000000 111.0000 0.0000
---------------------------------------------------------
Total 12733 8754.000000 300606.8900 165926.5000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 3.000000 225.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 54 59.000000 2992.7500 0.0000
P 14607 12338.250000 452130.6500 454691.2590
D 7 10.000000 633.0000 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
244 249.000000 12278.1700 0.0000
Other 1 2.000000 150.0000 0.0000
---------------------------------------------------------
Total 14915 12661.250000 468409.5700 454691.2590
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 4.500000 166.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 10031 7731.750000 323570.2500 0.0000
P 1 0.250000 9.2500 0.0000
D 0 0.000000 0.0000 0.0000
S 3 3.500000 224.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6514 5356.250000 191993.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16559 13096.250000 515963.7500 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 2341 1454.000000 56921.7500 0.0000
P 1 1.000000 10.0000 10.0000
D 32 15.000000 573.5000 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
3455 2474.750000 87288.9100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5829 3944.750000 144794.1600 10.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 353 361.500000 17895.2500 114.7500
P 2913 2551.750000 116589.3400 116242.1800
D 94 111.750000 5894.0300 0.0000
S 4 6.000000 400.0000 0.0000
H 339 363.000000 24502.8900 0.0000
T 3463 28069.750000 76132.6300 64366.2000
3270 2326.500000 57056.7100 130.1400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10436 33790.250000 298470.8500 180853.2700
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 427 347.500000 14617.5000 1387.5000
P 3909 3733.950000 168488.0000 167638.2500
D 10 12.000000 661.0000 0.0000
S 3 2.500000 118.5000 18.5000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
12752 9827.050000 183776.9900 0.0000
Other 31 26.750000 1272.7500 0.0000
---------------------------------------------------------
Total 17133 13950.250000 368953.2400 169044.2500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2843 2283.750000 98674.0000 0.0000
P 26 23.500000 1176.5000 1158.0000
D 0 0.000000 0.0000 0.0000
S 2 2.250000 83.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 11 9.000000 333.0000 333.0000
16156 12671.250000 292385.5000 0.0000
Other 4 1.250000 46.2500 0.0000
---------------------------------------------------------
Total 19042 14991.000000 392698.5000 1491.0000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4 6.000000 374.0000 0.0000
P 3563 3076.250000 124650.7500 124539.9300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 7 14.000000 1000.0000 0.0000
T 0 0.000000 0.0000 0.0000
4022 2584.762003 90721.3703 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7596 5681.012003 216746.1203 124539.9300
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.500000 92.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1301 1268.750000 48950.0000 0.0000
P 2029 1962.500000 82281.0000 82281.0000
D 27 22.000000 814.0000 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
2845 2537.000000 102808.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6203 5792.750000 234945.5000 82281.0000