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
Payclass Filters:GR
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 11332 12630.50000 467183.5000 36.9885
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8853 13601.75000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7122 22068.25000 815526.0000 36.9547
Subtotal (Total Children Is Unduplicated) 17684 48300.50000 1282709.5000 26.5569
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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 79 89.250000 4462.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 489 767.750000 38387.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 32 38.500000 2887.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 12.500000 937.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 24 50.000000 3750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 28 37.000000 2053.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 276 346.474799 25898.1100 74.7475
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 83 111.500000 8322.5000 74.6413
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 45 55.500000 4162.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 459 544.500000 30169.7500 55.4082
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 224 337.000000 25235.0000 74.8813
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 24 24.000000 1285.2000 53.5500
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 6 6.000000 159.6600 26.6100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 9 9.000000 450.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 23 24.000000 1225.2000 51.0500
Subtotal (Total Children Is Unduplicated) 1369 2467.974799 150275.4700 60.8902
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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 247 311.500000 15575.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 3.250000 81.2500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 9 17.000000 1246.4400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 12 19.000000 475.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 203 900.250000 45012.5000 50.0000
INTR-T1013-INTERPRETER 269 563.500000 28164.5000 49.9814
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1852 9691.000000 96860.0000 9.9948
OCCT-97530-OT SESSION BY LICENSED OT 5 15.000000 1071.6000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 9 20.000000 1383.8000 69.1900
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 49 214.750000 15297.7400 71.2351
TRAV-TRAVS-Travel by mile 587 39026.00000 17370.5200 0.4451
Subtotal (Total Children Is Unduplicated) 2829 52652.75000 316376.2000 6.0087
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Total 103421.224799 1749361.1700 16.9149
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Number of Children (Unduplicated) With at Least One Service 18174
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 18 11.000000 379.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 1 0.750000 27.7500 0.0000
6408 4329.500000 128829.6200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6427 4341.250000 129236.6200 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 3426 14773.500000 56822.8400 0.0000
---------------------------------------------------------
Total 3428 14774.250000 56850.5900 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 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
4581 2829.000000 87782.4700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4581 2829.000000 87782.4700 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 10 10.750000 397.7500 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
3260 2898.500000 117700.8100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3270 2909.250000 118098.5600 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 164 584.750000 10670.1800 10660.9300
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
2650 1533.750000 43234.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2814 2118.500000 53904.6800 10660.9300
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
7572 4060.750000 124348.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7572 4060.750000 124348.7500 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 164 91.750000 3526.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 0.500000 18.5000 0.0000
7100 4491.250000 127128.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7265 4583.500000 130673.1400 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 9607 7550.500000 255995.3900 255995.3900
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
22 20.500000 624.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9629 7571.000000 256619.8900 255995.3900
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
6116 4536.250000 136532.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6116 4536.250000 136532.5000 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 1 1.000000 10.0000 10.0000
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
3430 2427.500000 84059.3500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3431 2428.500000 84069.3500 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 0 0.000000 0.0000 0.0000
P 2 1.750000 87.5000 87.5000
D 19 15.250000 679.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3238 27807.500000 59128.8300 52614.9500
2973 2034.750000 40974.4900 130.1400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6232 29859.250000 100870.0700 52832.5900
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 2 1.250000 59.2500 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
11954 9046.250000 144775.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11956 9047.500000 144834.4400 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
12130 9205.750000 133303.0000 0.0000
Other 1 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 12131 9206.250000 133321.5000 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
3992 2538.474799 87199.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3992 2538.474799 87199.1100 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 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
2798 2489.750000 100699.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2825 2511.750000 101513.7500 0.0000