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: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 10723 11578.50000 428321.2500 36.9928
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7582 7526.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 20703 61665.25000 2279972.2400 36.9734
Subtotal (Total Children Is Unduplicated) 21860 80769.75000 2708293.4900 33.5310
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 7 7.000000 339.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 63 71.500000 3575.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 467 727.250000 36362.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 139 224.000000 16690.0000 74.5089
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 70 102.000000 7605.0000 74.5588
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 23 34.000000 2550.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 83 131.000000 9755.5000 74.4695
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 120 179.000000 9823.7700 54.8814
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1623 2563.000000 190846.9700 74.4623
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 736 1141.500000 84560.5100 74.0784
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 390 590.000000 44170.2900 74.8649
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2003 3063.000000 169388.5700 55.3015
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 921 1405.500000 105347.8000 74.9540
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 96 96.000000 8684.7700 90.4664
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 4 4.000000 302.8800 75.7200
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 13 13.000000 345.9300 26.6100
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.000000 41.4600 41.4600
OCTH-97165-OT EVAL LOW COMPLEXITY 5 5.000000 255.2500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 64 66.000000 3300.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 25 25.000000 1276.2500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 4122 10455.75000 695579.3000 66.5260
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 256 272.000000 13600.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 12 9.500000 237.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 872 1082.000000 53962.5000 49.8729
CONIP-CONIP-CONSULT, ITDS PHONE 50 22.750000 568.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 42 41.500000 2075.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 62 68.000000 3400.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.250000 31.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 123 156.250000 7812.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 2.250000 56.2500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 7 14.000000 1026.4800 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1597 4849.000000 35.7200 0.0074
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 12 83.000000 2075.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1121 5671.250000 283260.0000 49.9467
INTR-T1013-INTERPRETER 231 470.250000 23512.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1625 7968.000000 79660.0000 9.9975
OCCT-97530-OT SESSION BY LICENSED OT 53 221.250000 15739.7400 71.1401
OCCT-97530HM-OT SESSION BY OT ASST 2 8.000000 457.6000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 67 222.250000 15720.3800 70.7329
PHY-97110HM-PT SESSION BY PT ASST 5 26.000000 1486.1600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 218 1055.750000 75142.9000 71.1749
SPL-92508-GROUP SPL SESSION PER CHILD 6 23.000000 315.3600 13.7113
TRAV-TRAVS-Travel by mile 558 37209.00000 16561.8500 0.4451
Subtotal (Total Children Is Unduplicated) 2938 59476.25000 596737.4400 10.0332
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Total 150701.750000 4000610.2300 26.5465
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Number of Children (Unduplicated) With at Least One Service 22148
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 0.750000 27.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 7275 4870.250000 192545.4600 0.0000
P 102 104.500000 5357.8000 5357.8000
D 62 64.000000 4324.2700 0.0000
S 164 139.250000 7080.9300 0.0000
H 259 279.000000 19122.5600 0.0000
T 0 0.000000 0.0000 0.0000
5816 3970.750000 125731.3100 0.0000
Other 1 1.500000 112.5000 0.0000
---------------------------------------------------------
Total 13682 9430.000000 354302.5800 5357.8000
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 4484 13325.250000 100394.4800 0.0000
---------------------------------------------------------
Total 4484 13325.250000 100394.4800 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 22 27.750000 1377.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2770 1725.250000 69056.2500 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 1 1.750000 64.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3930 1961.500000 60558.9300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6723 3716.250000 131057.4300 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 39 45.500000 1683.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 492 813.000000 31478.0000 0.0000
P 2583 4083.250000 160148.5600 160261.5600
D 42 64.250000 2377.2500 0.0000
S 1 3.000000 111.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2998 2767.750000 122320.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6155 7776.750000 318118.7500 160261.5600
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2573 1603.250000 64004.5000 0.0000
P 139 621.500000 9227.7900 9227.7900
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
2467 1485.500000 42106.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5179 3710.250000 115338.2900 9227.7900
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
11826 7674.500000 281777.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11826 7674.500000 281777.4400 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 19 12.500000 538.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 8 7.250000 496.2500 0.0000
P 4687 3652.500000 149323.0000 149323.0000
D 189 144.250000 5898.0000 0.0000
S 5 9.500000 364.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 0.500000 18.5000 0.0000
5892 3800.250000 116880.5000 0.0000
Other 2 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 10803 7627.250000 273537.7500 149323.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 56 61.750000 3084.7500 0.0000
P 13526 12080.250000 447694.3100 447867.7770
D 16 20.000000 1399.7100 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
135 174.000000 9627.8400 0.0000
Other 1 2.000000 111.0000 0.0000
---------------------------------------------------------
Total 13734 12338.000000 461917.6100 447867.7770
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 31 15.000000 555.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 8880 7014.750000 295890.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 43 25.250000 934.2500 0.0000
S 10 17.750000 1204.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6367 5346.250000 194418.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15331 12419.000000 493002.2500 0.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1338 866.250000 33763.5000 0.0000
P 0 0.000000 0.0000 0.0000
D 9 5.500000 203.5000 0.0000
S 1 0.500000 18.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2773 2623.500000 68308.0300 0.0000
Other 1 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 4125 3498.250000 102386.0300 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 71 77.750000 4126.2500 37.0000
P 2910 2655.250000 127227.4300 124562.7300
D 141 155.250000 8247.9600 0.0000
S 33 27.000000 1221.0000 0.0000
H 122 156.250000 10507.5900 0.0000
T 3365 28464.500000 73508.1100 62118.8500
3173 2000.500000 57603.4600 140.8900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9815 33536.500000 282441.8000 186859.4700
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 947 870.500000 38154.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 214 153.250000 6103.0000 0.0000
P 1573 1571.673380 71166.2998 70261.3700
D 4 5.000000 295.7500 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
11711 9386.076620 201145.8402 0.0000
Other 17 20.500000 1139.6300 0.0000
---------------------------------------------------------
Total 14466 12007.000000 318005.0200 70261.3700
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1385 1119.750000 47042.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 3048 2463.750000 108226.8500 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
12111 9288.000000 194513.7400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16544 12871.500000 349782.8400 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 0.750000 27.7500 0.0000
P 3499 2960.500000 118787.7500 118787.7500
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 0 0.000000 0.0000 0.0000
4403 2644.250000 90750.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7904 5605.500000 209565.5500 118787.7500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2431 2486.750000 99109.7500 0.0000
P 242 207.750000 9475.2500 9475.3000
D 15 20.250000 805.7500 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
2506 2451.000000 99591.6600 2253.6600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5194 5165.750000 208982.4100 11728.9600