CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 726 660.500000 24438.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 682 748.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1399 5544.250000 204908.0000 36.9587
Subtotal (Total Children Is Unduplicated) 1427 6952.750000 229346.5000 32.9864
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 29 45.500000 3412.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 14.500000 1087.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 7.000000 525.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 19 32.500000 2475.0000 76.1538
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 37 59.000000 3274.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 528 827.000000 61183.4300 73.9824
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 230 345.000000 25691.2500 74.4674
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 148 227.500000 16845.0200 74.0440
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 665 997.500000 55157.7500 55.2960
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 336 478.500000 36009.8400 75.2557
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 33 33.000000 3345.1900 101.3694
Subtotal (Total Children Is Unduplicated) 1006 3070.000000 209156.9800 68.1293
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 2.000000 100.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 4 7.000000 350.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 215 284.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 39.000000 1950.0000 50.0000
INTR-T1013-INTERPRETER 32 81.500000 3867.5000 47.4540
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 277 574.000000 5740.0000 10.0000
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 2 13.000000 743.0800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 214.3200 71.4400
TRAV-TRAVS-Travel by mile 248 7844.000000 3484.2800 0.4442
Subtotal (Total Children Is Unduplicated) 437 8850.000000 16545.6200 1.8696
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Total 18872.750000 455049.1000 24.1114
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Number of Children (Unduplicated) With at Least One Service 1453
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.000000 150.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 261 240.750000 9711.5000 0.0000
P 92 700.250000 3350.0400 3350.0400
D 2 1.250000 87.5000 0.0000
S 6 4.000000 262.0000 0.0000
H 4 6.000000 450.0000 0.0000
T 0 0.000000 0.0000 0.0000
279 228.750000 8387.0000 0.0000
Other 12 17.500000 1146.7500 0.0000
---------------------------------------------------------
Total 657 1200.500000 23544.7900 3350.0400
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 52 651.500000 3070.1800 3077.1800
0 0.000000 0.0000 0.0000
Other 321 901.500000 8434.4800 0.0000
---------------------------------------------------------
Total 373 1553.000000 11504.6600 3077.1800
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 3.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 283 275.000000 12300.0000 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
431 328.500000 10209.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 718 606.500000 22620.5000 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 15.500000 573.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 42 72.750000 3106.2500 0.0000
P 285 534.250000 22223.5200 22265.4000
D 4 10.000000 370.0000 0.0000
S 1 2.000000 74.0000 0.0000
H 3 13.000000 650.0000 0.0000
T 0 0.000000 0.0000 0.0000
438 463.250000 23421.3500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 777 1110.750000 50418.6200 22265.4000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 218 184.000000 8271.0000 0.0000
P 85 804.500000 2128.5100 2128.5100
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
136 90.000000 1970.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 439 1078.500000 12369.7600 2128.5100
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
475 401.000000 17101.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 475 401.000000 17101.7500 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 3 0.750000 27.7500 0.0000
P 407 488.000000 21174.5700 21174.5700
D 21 27.500000 1462.2500 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
525 445.500000 14290.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 957 962.000000 36964.3200 21174.5700
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 569 1161.000000 34538.0300 34538.0300
D 1 2.000000 111.0000 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
17 27.500000 1706.5000 0.0000
Other 50 73.500000 5405.2500 0.0000
---------------------------------------------------------
Total 637 1264.000000 41760.7800 34538.0300
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.750000 101.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 387 473.250000 22706.2500 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
338 421.250000 19146.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 726 897.250000 41954.0000 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 39 35.250000 1470.7500 0.0000
P 11 11.000000 415.5000 415.5000
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
104 91.250000 3687.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 154 137.500000 5573.5000 415.5000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9 14.500000 897.5000 0.0000
P 215 272.000000 13047.7500 12691.2400
D 8 14.250000 799.0000 0.0000
S 8 7.750000 286.7500 0.0000
H 26 49.500000 3225.0000 0.0000
T 111 1601.000000 3999.0300 3766.2800
339 312.500000 13054.7900 150.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 716 2271.500000 35309.8200 16607.5200
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 101 102.250000 4699.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 24 22.000000 898.7500 0.0000
P 129 161.160810 8226.5700 7867.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 81 586.750000 826.1500 826.1500
T 40 441.500000 571.0600 571.0600
912 865.839190 23517.1000 0.0000
Other 3 4.250000 270.2500 0.0000
---------------------------------------------------------
Total 1290 2183.750000 39008.8800 9264.4600
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 150 156.750000 6852.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 333 317.250000 15207.5000 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 78 779.500000 1052.0600 1052.0600
T 88 755.500000 1337.1700 1327.1700
1143 1750.250000 30942.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1792 3759.250000 55391.6100 2379.2300
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.500000 18.5000 0.0000
P 411 530.127600 24414.0700 24414.0700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 2.666667 200.0000 0.0000
T 9 18.000000 1272.0000 1272.0000
542 518.205733 24822.7600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 965 1069.500000 50727.3300 25686.0700
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 63 80.250000 3741.2500 0.0000
P 5 6.500000 381.7500 381.7500
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 15 163.000000 686.5300 686.5300
108 128.000000 5989.2500 783.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 191 377.750000 10798.7800 1851.2800