CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2017 ending 09/30/2017 Date of Report:11/05/2017 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 10971 11273.75000 416936.5000 36.9829
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7495 8619.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 20778 60635.75000 2242181.5000 36.9779
Subtotal (Total Children Is Unduplicated) 22052 80529.00000 2659118.0000 33.0206
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 8 13.000000 630.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 91 106.250000 5312.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 481 728.000000 36400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 94 159.000000 11925.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 43 59.000000 4425.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 15.500000 1162.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 61 98.500000 7556.4400 76.7151
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 117 187.500000 10283.7700 54.8468
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1385 2103.000000 157048.5600 74.6783
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 693 1019.500000 76046.1900 74.5917
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 322 503.000000 37382.5200 74.3191
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1860 2820.500000 155771.4500 55.2283
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 843 1223.499970 91415.0178 74.7160
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 23 23.000000 3235.2500 140.6630
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 4 4.000000 439.2200 109.8050
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 123.1500 41.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 6 6.000000 306.3000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 154.2000 38.5500
SCREEN-T1023-SCREENING 72 74.000000 3700.0000 50.0000
SPCH-92522-EVAL OF SPCH SOUND PROD 3 3.000000 153.1500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 19 19.000000 969.9500 51.0500
Subtotal (Total Children Is Unduplicated) 3771 9174.249970 604542.7678 65.8956
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 255 314.500000 15725.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 9 6.500000 162.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 791 949.250000 47371.7500 49.9044
CONIP-CONIP-CONSULT, ITDS PHONE 15 7.750000 193.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 43 46.500000 2325.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.250000 31.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 65 63.750000 3187.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 210 231.000000 11550.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 4.000000 100.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 15 32.000000 2346.2400 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1231 2437.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 15.000000 375.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1205 5337.250000 266702.5000 49.9700
INTR-T1013-INTERPRETER 242 463.000000 23150.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1629 7522.000000 75211.0000 9.9988
OCCT-97530-OT SESSION BY LICENSED OT 59 262.750000 18680.8600 71.0975
OCCT-97530HM-OT SESSION BY OT ASST 3 3.000000 171.6000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 57 165.750000 11649.0200 70.2807
PHY-97110HM-PT SESSION BY PT ASST 5 29.000000 1657.6400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 183 819.250000 57775.6800 70.5226
SPL-92508-GROUP SPL SESSION PER CHILD 3 9.000000 124.9200 13.8800
TRAV-TRAVS-Travel by mile 566 37254.00000 16581.7200 0.4451
Subtotal (Total Children Is Unduplicated) 2902 55974.25000 555072.9300 9.9166
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Total 145677.499970 3818733.6978 26.2136
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Number of Children (Unduplicated) With at Least One Service 22280
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 3.500000 168.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 6718 4475.500000 177575.7600 0.0000
P 1 1.500000 112.5000 112.5000
D 2 0.500000 18.5000 0.0000
S 1050 789.750000 29749.1900 0.0000
H 150 173.000000 12021.6900 0.0000
T 2 12.500000 23.8000 5.3000
6053 3917.750000 119595.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13981 9374.000000 339265.0500 117.8000
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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 4787 15006.500000 102881.9300 0.0000
---------------------------------------------------------
Total 4787 15006.500000 102881.9300 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 53 45.750000 1705.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2586 1508.000000 57187.5000 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
5075 2868.750000 82777.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7714 4422.500000 141670.2500 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 12 11.250000 416.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 212 311.500000 11771.5000 0.0000
P 3000 4642.750000 179997.6900 179766.4400
D 43 63.750000 2358.7500 0.0000
S 1 0.250000 9.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3233 2977.750000 128559.8200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6501 8007.250000 323113.2600 179766.4400
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2954 1803.500000 70895.7500 0.0000
P 143 646.500000 8089.5700 8089.5700
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 1 0.500000 18.5000 0.0000
2763 1515.750000 43142.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5861 3966.250000 122145.8200 8089.5700
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
11344 7334.750000 276769.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11344 7334.750000 276769.7500 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 6.500000 240.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 18 14.750000 621.7500 0.0000
P 4637 3365.750000 134265.0000 134265.0000
D 154 96.000000 3776.0000 0.0000
S 3 4.000000 281.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 0.500000 18.5000 0.0000
6108 3796.000000 110666.7500 0.0000
Other 1 1.250000 46.2500 0.0000
---------------------------------------------------------
Total 10929 7284.750000 249915.7500 134265.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 9 6.000000 222.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 193 163.750000 6548.0700 375.0000
P 12686 10863.000000 403376.6700 403457.1500
D 16 21.000000 1441.9800 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
166 181.250000 9500.5800 0.0000
Other 1 0.250000 0.0000 0.0000
---------------------------------------------------------
Total 13071 11235.250000 421089.3000 403832.1500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 6.000000 222.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9061 6778.500000 282622.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 120 60.000000 2220.0000 0.0000
S 44 70.250000 4993.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5906 4695.500000 170235.5000 0.0000
Other 4 1.250000 46.2500 0.0000
---------------------------------------------------------
Total 15141 11611.500000 460339.0000 0.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 45 22.250000 823.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1763 1047.750000 40710.5000 0.0000
P 0 0.000000 0.0000 0.0000
D 22 11.750000 460.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.000000 50.0000 0.0000
T 0 0.000000 0.0000 0.0000
2512 1755.250000 63569.6100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4343 2838.000000 105614.1100 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 752 727.750000 39102.7500 9.2500
P 2064 1747.500000 76675.5200 75984.5600
D 81 85.250000 4731.7600 130.0000
S 2 2.000000 100.0000 0.0000
H 228 252.250000 16552.1300 0.0000
T 3108 26549.000000 69301.1200 57787.9700
3020 1860.750000 49219.7500 78.6900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9255 31224.500000 255683.0300 133990.4700
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 9 7.500000 342.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 348 244.500000 9046.5000 0.0000
P 2631 2497.156640 113461.1602 113250.1600
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
10865 8413.343330 164907.1376 0.0000
Other 35 37.000000 1848.6400 0.0000
---------------------------------------------------------
Total 13888 11199.499970 289605.9378 113250.1600
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 9.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 4877 3892.500000 168941.0800 0.0000
P 1 1.000000 50.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 2 1.250000 46.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.000000 37.0000 0.0000
9549 7238.750000 130867.8600 0.0000
Other 2 3.000000 168.0000 0.0000
---------------------------------------------------------
Total 14433 11137.750000 300119.4400 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 2 1.250000 46.2500 0.0000
P 3690 3207.750000 129252.5000 129252.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 5 10.000000 750.0000 0.0000
T 0 0.000000 0.0000 0.0000
4403 2645.750000 90948.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8100 5864.750000 220997.0000 129252.5000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 55 40.250000 1526.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1834 1748.750000 69778.2500 0.0000
P 988 968.500000 40158.7500 40121.7500
D 10 7.750000 286.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2 2.000000 130.5000 0.0000
2703 2403.000000 97643.0700 214.3200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5592 5170.250000 209524.0700 40336.0700