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
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 10721 11576.00000 428228.7500 36.9928
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7578 7517.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7071 20899.50000 772959.7500 36.9846
Subtotal (Total Children Is Unduplicated) 16815 39993.00000 1201188.5000 30.0350
-----------------------------------------------------------------------------------------------------------------------
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 452 700.000000 35000.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 32 38.000000 2850.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 9.000000 675.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 23 27.500000 2062.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 33 35.500000 1970.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 306 429.250531 32120.2900 74.8288
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 91 129.500000 9605.5800 74.1744
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 64 88.500000 6637.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 541 681.500000 37769.2500 55.4208
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 231 338.500000 25335.0200 74.8450
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 45 45.000000 2409.7500 53.5500
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 4 4.000000 302.8800 75.7200
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 5 5.000000 133.0500 26.6100
SCREEN-T1023-SCREENING 8 8.000000 400.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 10.000000 510.5000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 1387 2632.250531 162009.6200 61.5479
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 253 269.000000 13450.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 12 9.500000 237.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 869 1076.500000 53687.5000 49.8723
CONIP-CONIP-CONSULT, ITDS PHONE 49 21.750000 543.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 42 41.500000 2075.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 55 58.500000 2925.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.250000 31.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 123 154.250000 7712.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 1.750000 43.7500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 5 9.000000 659.8800 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1510 4658.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 4.000000 100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 151 615.250000 30750.0000 49.9797
INTR-T1013-INTERPRETER 231 470.250000 23512.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1622 7943.000000 79410.0000 9.9975
OCCT-97530-OT SESSION BY LICENSED OT 2 4.000000 285.7600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 9 25.500000 1821.7200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 37 144.500000 10323.0800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 9.000000 124.9200 13.8800
TRAV-TRAVS-Travel by mile 558 37187.00000 16552.0600 0.4451
Subtotal (Total Children Is Unduplicated) 2649 52704.75000 244303.3300 4.6353
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Total 95330.000531 1607501.4500 16.8625
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Number of Children (Unduplicated) With at Least One Service 17500
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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 3 3.500000 136.9400 0.0000
S 2 0.500000 18.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5604 3716.250000 109064.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5609 3720.250000 109220.3900 0.0000
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 2979 12177.500000 49372.4800 0.0000
---------------------------------------------------------
Total 2979 12177.500000 49372.4800 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
3893 1924.500000 58056.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3893 1924.500000 58056.1900 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 0 0.000000 0.0000 0.0000
D 42 64.250000 2377.2500 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
2713 2498.250000 101582.8900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2755 2562.500000 103960.1400 0.0000
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 134 613.500000 8763.4700 8763.4700
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
2465 1484.750000 42078.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2599 2098.250000 50841.7200 8763.4700
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
7153 4083.250000 124298.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7153 4083.250000 124298.9400 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 189 144.250000 5898.0000 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
5876 3792.750000 116577.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6065 3937.000000 122475.0000 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 8665 7246.750000 245924.7300 245924.7300
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 35.000000 1268.7500 0.0000
Other 1 2.000000 111.0000 0.0000
---------------------------------------------------------
Total 8693 7283.750000 247304.4800 245924.7300
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 43 25.250000 934.2500 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
6093 4781.750000 155976.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6136 4807.000000 156910.5000 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 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
2746 2568.250000 64782.8600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2746 2568.250000 64782.8600 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 11 10.250000 530.3500 0.0000
S 3 1.500000 55.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 2955 28008.500000 47347.1500 44487.6100
2881 1723.500000 41982.8900 120.8900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5850 29743.750000 89915.8900 44608.5000
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
10336 8008.500000 134554.3100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10336 8008.500000 134554.3100 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
10108 7457.500000 111651.2600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10108 7457.500000 111651.2600 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
4366 2601.000531 87749.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4366 2601.000531 87749.2900 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 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
2467 2336.750000 95602.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2482 2357.000000 96408.0000 0.0000