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
Agency Filter:EXT
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 134 184.500000 6826.5000 37.0000
Subtotal (Total Children Is Unduplicated) 134 184.500000 6826.5000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 19.000000 1425.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 7.500000 562.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 12.500000 937.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 44 77.000000 4273.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 125 194.000000 14550.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 55 97.000000 7275.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 118 201.500000 15112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 260 430.000000 23865.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 126 190.500000 14287.5000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 10 10.000000 510.5000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 33 33.000000 1684.6500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 8 8.000000 408.4000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 42 42.000000 2144.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 48 48.000000 2449.3500 51.0281
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 783 1387.000000 90473.1000 65.2293
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EI Services,Class #03
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 2 2.000000 146.6400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 18.000000 450.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4660 38294.75000 1914420.0000 49.9917
OCCT-97530-OT SESSION BY LICENSED OT 261 1557.568300 111194.7400 71.3900
OCCT-97530HM-OT SESSION BY OT ASST 121 679.000000 38838.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 252 1467.000000 104586.7200 71.2929
PHY-97110HM-PT SESSION BY PT ASST 85 596.750000 34110.2300 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 487 3017.250000 215304.7800 71.3580
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 7.000000 400.4000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 12 29.500000 409.4600 13.8800
Subtotal (Total Children Is Unduplicated) 5379 45668.81830 2419861.7700 52.9872
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Total 47240.318300 2517161.3700 53.2842
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Number of Children (Unduplicated) With at Least One Service 5866
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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 123 125.750000 7954.4700 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 192 234.000000 14008.4700 0.0000
---------------------------------------------------------
Total 315 359.750000 21962.9400 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 9.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 87 75.000000 2775.0000 0.0000
P 84 60.750000 2247.7500 2247.7500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2546 10404.500000 529409.0700 0.0000
T 0 0.000000 0.0000 0.0000
227 506.000000 33927.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2945 11046.500000 568368.8400 2247.7500
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
27 52.000000 3399.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 27 52.000000 3399.1900 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 2 2.500000 187.5000 187.5000
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
2037 6435.500000 355949.2700 0.0000
Other 140 223.000000 16315.5000 0.0000
---------------------------------------------------------
Total 2179 6661.000000 372452.2700 187.5000
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
3296 11793.000000 603268.9100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3296 11793.000000 603268.9100 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 3 8.000000 464.3200 364.3200
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
688 1976.750000 116952.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 691 1984.750000 117416.5700 364.3200
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 1 2.000000 150.0000 150.0000
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 4.000000 200.0000 0.0000
609 1408.250000 82875.8300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 611 1414.250000 83225.8300 150.0000
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
1963 2043.500000 105151.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1963 2043.500000 105151.1300 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
3451 3520.750000 179852.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3451 3520.750000 179852.2000 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
3790 3527.500000 216970.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3790 3527.500000 216970.2000 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 2 6.000000 428.6400 428.6400
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 2 6.000000 300.0000 300.0000
1353 4825.318300 244364.6500 244364.6500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1357 4837.318300 245093.2900 245093.2900