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
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 10971 11273.75000 416936.5000 36.9829
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7494 8618.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 6966 20153.75000 745192.2500 36.9754
Subtotal (Total Children Is Unduplicated) 16865 40046.25000 1162128.7500 29.0197
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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 14 13.000000 975.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 23 28.000000 1554.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 246 313.865998 23539.9500 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 88 107.000000 8025.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 60 84.000000 6300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 492 576.500000 31995.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 142 192.000000 14362.5000 74.8047
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 8 8.000000 428.4000 53.5500
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 26.6100 26.6100
PSTH-97161-PT EVAL LOW 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 13 13.000000 663.6500 51.0500
Subtotal (Total Children Is Unduplicated) 1273 2211.115998 132027.4100 59.7108
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 254 313.500000 15675.0000 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 64 62.750000 3137.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 209 230.750000 11537.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 4.000000 100.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 2 5.000000 366.6000 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1089 2237.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 143 543.500000 27175.0000 50.0000
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 6 8.250000 589.3800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 2 2.000000 114.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 6 15.750000 1125.1800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 44 137.000000 9787.2800 71.4400
TRAV-TRAVS-Travel by mile 566 37254.00000 16581.7200 0.4451
Subtotal (Total Children Is Unduplicated) 2603 49812.50000 234684.8100 4.7114
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Total 92069.865998 1528840.9700 16.6052
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Number of Children (Unduplicated) With at Least One Service 17473
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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 2 0.500000 18.5000 0.0000
S 3 2.500000 92.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 12.000000 5.3000 5.3000
5999 3864.000000 116616.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6005 3879.000000 116732.6000 5.3000
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 3156 13801.500000 49536.1800 0.0000
---------------------------------------------------------
Total 3156 13801.500000 49536.1800 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
4788 2665.500000 75175.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4788 2665.500000 75175.0000 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 1 1.000000 50.0000 50.0000
D 43 63.750000 2358.7500 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
2951 2725.750000 109681.8600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2995 2790.500000 112090.6100 50.0000
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 142 643.500000 7875.2500 7875.2500
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
2762 1515.500000 43132.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2904 2159.000000 51008.0000 7875.2500
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
6746 3744.250000 116522.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6746 3744.250000 116522.0000 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 154 96.000000 3776.0000 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
6024 3737.250000 108374.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6178 3833.250000 112150.7500 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 8146 6469.000000 222377.7700 222377.7700
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
71 57.750000 2061.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8217 6526.750000 224438.7700 222377.7700
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 120 60.000000 2220.0000 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
5608 4069.250000 127664.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5728 4129.250000 129884.2500 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 0 0.000000 0.0000 0.0000
D 4 2.750000 127.7500 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
2483 1714.250000 60902.0400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2487 1717.000000 61029.7900 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 4 3.000000 214.3200 90.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2724 26147.000000 43412.1700 40745.1800
2822 1666.500000 37539.4400 68.6900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5550 27816.500000 81165.9300 40903.8700
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
9835 7479.000000 117142.1000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9835 7479.000000 117142.1000 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 1 1.000000 37.0000 0.0000
8871 6591.500000 99728.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8872 6592.500000 99765.2900 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
4371 2596.115998 87225.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4371 2596.115998 87225.7000 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 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
2642 2330.000000 94556.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2654 2339.750000 94974.0000 0.0000