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
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 119 179.500000 6641.5000 37.0000
Subtotal (Total Children Is Unduplicated) 119 179.500000 6641.5000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 18.000000 1350.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 26.000000 1875.0000 72.1154
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 15.000000 1125.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 18 27.500000 2062.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 49 88.500000 4813.2500 54.3870
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 188 295.500000 22162.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 78 140.000000 10500.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 107 187.000000 14025.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 333 568.500000 31496.2500 55.4024
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 153 231.500000 17323.5000 74.8315
OCTF-97168-OT RE-EVAL EST PLAN CARE 14 14.000000 714.7000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 24 24.000000 1225.2000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 59 66.000000 3369.3000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 10 10.000000 510.5000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 6 6.000000 306.3000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 64 64.000000 3267.2000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 66 66.000000 3369.3000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 3 3.000000 153.1500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 986 1851.500000 119693.2000 64.6466
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EI Services,Class #03
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 7.000000 513.2400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 14.000000 350.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4654 37898.25000 1894465.5000 49.9882
OCCT-97530-OT SESSION BY LICENSED OT 295 1606.250000 114244.7400 71.1251
OCCT-97530HM-OT SESSION BY OT ASST 166 991.750000 56728.1000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 255 1628.000000 116304.3200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 105 770.500000 44041.7800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 504 3406.500000 242625.5200 71.2243
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 10 34.500000 1973.4000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 10 31.000000 430.2800 13.8800
Subtotal (Total Children Is Unduplicated) 5402 46387.75000 2471676.8800 53.2830
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Total 48418.750000 2598011.5800 53.6571
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Number of Children (Unduplicated) With at Least One Service 6019
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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 1 1.000000 50.0000 50.0000
D 103 100.000000 5552.5500 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
2 3.000000 166.5000 0.0000
Other 233 307.500000 18781.2000 0.0000
---------------------------------------------------------
Total 339 411.500000 24550.2500 50.0000
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
1 1.000000 50.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 1.000000 50.0000 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 17 15.000000 555.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 30 30.250000 1119.2500 0.0000
P 181 134.250000 4967.2500 4967.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2281 9420.000000 483194.8300 0.0000
T 0 0.000000 0.0000 0.0000
142 394.250000 27900.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2651 9993.750000 517736.4800 4967.2500
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
51 88.000000 5739.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 51 88.000000 5739.1300 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 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 9.000000 450.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 9.000000 450.0000 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 1 1.500000 112.5000 112.5000
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
2061 6479.500000 354237.7100 0.0000
Other 150 242.000000 17750.2500 0.0000
---------------------------------------------------------
Total 2212 6723.000000 372100.4600 112.5000
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
3289 11599.500000 594533.6200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3289 11599.500000 594533.6200 0.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 25.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 4 17.000000 226.5700 171.0500
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
1081 3111.000000 186546.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1086 3128.500000 186798.0100 171.0500
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 0 0.000000 0.0000 0.0000
599 1392.750000 81528.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 599 1392.750000 81528.1900 0.0000
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
1717 1806.750000 93204.4300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1717 1806.750000 93204.4300 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
3652 3774.000000 195426.3500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3652 3774.000000 195426.3500 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
4138 3915.500000 239664.6500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4138 3915.500000 239664.6500 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 1 1.000000 71.4400 71.4400
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 200.0000
1690 5570.500000 285958.5700 285901.4500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1692 5575.500000 286230.0100 286172.8900