CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2018 ending 06/30/2018 Date of Report:08/10/2018 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
CASE-CASE-NON-TCM CASE MANAGEMENT 11 7.500000 277.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 91 54.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 495 1420.750000 52586.2500 37.0130
Subtotal (Total Children Is Unduplicated) 496 1483.000000 52863.7500 35.6465
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 9.500000 712.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 125 183.500000 13676.8700 74.5334
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 51 96.500000 7275.0000 75.3886
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 163 255.000000 14180.2500 55.6088
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 171 551.500000 36228.6700 65.6912
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EI Services,Class #03
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 1.500000 75.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 10 32.500000 1625.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 10.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 3.000000 214.3200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 11 35.750000 2553.9800 71.4400
TRAV-TRAVS-Travel by mile 1 19.000000 8.4600 0.4453
Subtotal (Total Children Is Unduplicated) 23 92.750000 4486.7600 48.3748
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Total 2127.250000 93579.1800 43.9907
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Number of Children (Unduplicated) With at Least One Service 541
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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 40 41.500000 2860.8300 2860.8300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 393 613.750000 32198.0000 0.0000
T 0 0.000000 0.0000 0.0000
91 73.500000 2719.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 524 728.750000 37778.3300 2860.8300
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 10 11.000000 561.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.000000 71.4400 40.0000
T 3 6.000000 287.8700 266.8700
30 45.750000 1322.0400 138.4600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 44 63.750000 2242.3500 445.3300
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
1 2.000000 150.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 2.000000 150.0000 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
1155 1332.750000 53408.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1155 1332.750000 53408.5000 0.0000