CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 784 814.000000 30118.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 711 700.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1496 5702.500000 210604.0000 36.9319
Subtotal (Total Children Is Unduplicated) 1529 7217.000000 240722.0000 33.3549
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 5 16.000000 800.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 2 3.000000 150.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 39 62.500000 4602.1700 73.6347
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 19 27.000000 2025.0000 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 15 22.500000 1687.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 45 75.500000 4190.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 643 1024.000000 75801.0000 74.0244
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 306 481.000000 35941.0000 74.7214
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 152 249.000000 18470.6600 74.1794
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 818 1269.500000 70199.4000 55.2969
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 284 413.500000 31555.0500 76.3121
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 14 14.000000 1152.9100 82.3507
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1168 3663.000000 246937.4400 67.4140
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 3 3.750000 187.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.250000 12.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.750000 37.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 192 207.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 22.000000 1100.0000 50.0000
INTR-T1013-INTERPRETER 25 56.250000 2612.5000 46.4444
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 219 425.000000 4250.0000 10.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 4.000000 285.7600 71.4400
TRAV-TRAVS-Travel by mile 199 6529.000000 2896.9800 0.4437
Subtotal (Total Children Is Unduplicated) 367 7249.000000 11432.7400 1.5771
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Total 18129.000000 499092.1800 27.5300
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Number of Children (Unduplicated) With at Least One Service 1574
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 8.500000 314.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 44 53.250000 3800.0000 0.0000
P 310 790.250000 11661.3600 11661.3600
D 5 9.500000 107.1400 0.0000
S 3 38.000000 15.6400 0.0000
H 6 8.000000 600.0000 0.0000
T 5 9.750000 513.9000 501.4000
257 200.500000 6258.0000 0.0000
Other 33 45.000000 2692.5000 0.0000
---------------------------------------------------------
Total 678 1162.750000 25963.0400 12162.7600
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 35 674.000000 2168.0700 2018.0700
0 0.000000 0.0000 0.0000
Other 339 1718.000000 9182.2300 0.0000
---------------------------------------------------------
Total 374 2392.000000 11350.3000 2018.0700
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 5.000000 185.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 415 464.000000 22007.7500 0.0000
P 5 9.000000 355.0000 355.0000
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
457 424.000000 18114.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 882 902.000000 40662.0000 355.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 61 103.000000 4404.2500 0.0000
P 214 390.750000 16645.6700 16645.6700
D 1 5.000000 185.0000 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
409 428.250000 20512.4200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 685 927.000000 41747.3400 16645.6700
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 135 118.750000 4792.7500 0.0000
P 27 229.000000 1393.1600 1393.1600
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
218 143.750000 3940.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 380 491.500000 10126.4100 1393.1600
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 6 7.000000 235.7500 235.7500
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
572 538.750000 23758.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 578 545.750000 23994.0000 235.7500
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.500000 18.5000 0.0000
P 289 344.000000 15748.7500 15748.7500
D 1 2.500000 92.5000 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
365 303.250000 9937.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 656 650.250000 25797.2500 15748.7500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 13 18.500000 684.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 76 135.000000 6259.0000 0.0000
P 778 1132.250000 44810.2600 44810.3200
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
49 75.500000 4926.1200 0.0000
Other 74 111.000000 8208.0000 0.0000
---------------------------------------------------------
Total 990 1472.250000 64887.8800 44810.3200
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 18 19.250000 712.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 301 379.750000 19006.5000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 10 20.750000 1200.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
260 332.750000 16107.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 589 752.500000 37027.0000 0.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 1.750000 64.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 55 48.500000 1998.0000 0.0000
P 32 64.000000 1009.6100 1009.6100
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
167 151.750000 6234.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 258 266.000000 9307.1100 1009.6100
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 78 112.250000 6386.2500 0.0000
P 195 234.250000 10221.7500 9814.0300
D 1 2.000000 111.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 23 43.500000 2862.7500 0.0000
T 100 1127.000000 4576.5600 4495.5600
321 317.500000 14631.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 718 1836.500000 38790.2300 14309.5900
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 64 73.500000 3176.7500 27.7500
P 202 242.000000 11417.7500 11417.7500
D 0 0.000000 0.0000 0.0000
S 2 1.500000 55.5000 0.0000
H 16 111.250000 138.3500 138.3500
T 35 273.500000 512.7200 512.7200
671 672.250000 12748.7800 0.0000
Other 23 36.000000 2338.0000 0.0000
---------------------------------------------------------
Total 1013 1410.000000 30387.8500 12096.5700
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 183 185.000000 7642.5000 0.0000
P 320 341.000000 15437.0000 15437.0000
D 4 8.250000 362.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 88 720.250000 1147.8800 1147.8800
T 42 425.500000 573.1800 573.1800
975 1588.750000 25522.9300 0.0000
Other 2 2.500000 92.5000 0.0000
---------------------------------------------------------
Total 1614 3271.250000 50778.2400 17158.0600
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 502 590.025600 27867.9200 27867.9200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 9 18.000000 1350.0000 0.0000
T 0 0.000000 0.0000 0.0000
665 648.474400 31735.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1176 1256.500000 60953.5000 27867.9200
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 131 188.000000 7539.0000 0.0000
P 47 48.500000 3105.2500 3105.2500
D 1 1.000000 75.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 11 165.000000 790.5300 790.5300
295 390.250000 15810.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 485 792.750000 27320.0300 3895.7800