CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 Page: 1
List order: No List
Payclass Filters:OTHER
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 126 442.500000 16372.5000 37.0000
Subtotal (Total Children Is Unduplicated) 126 442.500000 16372.5000 37.0000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 12 23.000000 1150.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 38.500000 2680.3800 69.6203
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 35.500000 2662.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 18 30.000000 1545.7500 51.5250
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 49 151.000000 9679.8800 64.1052
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 18 27.000000 1350.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 6 6.000000 300.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 5.000000 250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 4.500000 225.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 8 8.000000 400.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 52 46.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 121 475.750000 23787.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 35 110.000000 1100.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 19 65.250000 4611.4600 70.6737
OCCT-97530HM-OT SESSION BY OT ASST 6 32.750000 1873.3000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 23 67.250000 4804.3400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 4 16.000000 914.5600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 59 254.000000 18073.5600 71.1557
TRAV-TRAVS-Travel by mile 328 15644.00000 6929.8200 0.4430
Subtotal (Total Children Is Unduplicated) 468 16763.00000 64644.5400 3.8564
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Total 17356.500000 90696.9200 5.2255
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Number of Children (Unduplicated) With at Least One Service 609
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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 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
1 0.750000 53.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 0.750000 53.5800 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 2 0.000000 -261.0000 -261.0000
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2 0.000000 -261.0000 -261.0000
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 913 16007.000000 54463.4600 54463.4600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 47 88.500000 6044.1300 0.0000
T 0 0.000000 0.0000 0.0000
466 730.500000 17139.2100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1426 16826.000000 77646.8000 54463.4600
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 8 18.500000 271.7800 230.3400
48 117.250000 2624.9100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 56 135.750000 2896.6900 230.3400
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
128 113.750000 7181.9300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 128 113.750000 7181.9300 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 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 65 280.250000 3178.9200 3178.9200
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Total 65 280.250000 3178.9200 3178.9200