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:EIP DEI DEIP
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-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 19 35.000000 2567.8800 73.3680
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 35.500000 2662.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 30.000000 1656.7500 55.2250
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
Subtotal (Total Children Is Unduplicated) 37 132.500000 8673.1300 65.4576
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 2.000000 100.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.500000 25.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 52 46.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 19 53.500000 2675.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 4 4.000000 40.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 2.000000 92.8800 46.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 12 63.750000 4539.3000 71.2047
TRAV-TRAVS-Travel by mile 3 43.000000 19.1400 0.4451
Subtotal (Total Children Is Unduplicated) 73 218.250000 7641.3200 35.0118
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Total 793.250000 32686.9500 41.2064
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Number of Children (Unduplicated) With at Least One Service 226
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Center 09
Flag Claims Units Chgs Paid
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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 234 183.500000 8564.7200 8564.7200
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
455 442.500000 16372.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 736 714.500000 30981.3500 8564.7200
Center 52
Flag Claims Units Chgs Paid
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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 7 17.500000 221.7800 180.3400
24 52.250000 1033.8200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 31 69.750000 1255.6000 180.3400
Center 55
Flag Claims Units Chgs Paid
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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
9 9.000000 450.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9 9.000000 450.0000 0.0000