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
Payclass Filters:GR
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 783 813.750000 30108.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 652 660.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 553 2057.750000 75850.0000 36.8606
Subtotal (Total Children Is Unduplicated) 1234 3532.250000 105958.7500 29.9975
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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 7 12.000000 900.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 9.000000 675.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 15.000000 832.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 88 141.833333 10600.0000 74.7356
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 47 71.025600 5287.9200 74.4509
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 24 38.500000 2887.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 138 201.500000 11100.0000 55.0868
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 53 80.000000 6000.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 9 9.000000 530.1900 58.9100
Subtotal (Total Children Is Unduplicated) 235 603.858933 40288.1100 66.7178
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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 1 3.000000 150.0000 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
TRAV-TRAVS-Travel by mile 199 6529.000000 2896.9800 0.4437
Subtotal (Total Children Is Unduplicated) 367 7226.000000 10196.9800 1.4112
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Total 11362.108933 156443.8400 13.7689
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Number of Children (Unduplicated) With at Least One Service 1295
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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 45 554.250000 1957.6900 1957.6900
D 5 9.500000 107.1400 0.0000
S 3 38.000000 15.6400 0.0000
H 0 0.000000 0.0000 0.0000
T 2 3.750000 195.7500 183.2500
248 189.000000 5560.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 303 794.500000 7836.9700 2140.9400
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 32 668.500000 1755.5700 1755.5700
0 0.000000 0.0000 0.0000
Other 212 1604.500000 3781.2300 0.0000
---------------------------------------------------------
Total 244 2273.000000 5536.8000 1755.5700
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 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
445 402.500000 16638.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 450 411.500000 16993.2500 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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
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
286 320.000000 13146.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 287 325.000000 13331.1900 0.0000
Center 05
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 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 245 372.750000 5333.6600 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 4 4.000000 40.0000 40.0000
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
336 252.000000 8309.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 340 256.000000 8349.7500 40.0000
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 16 16.500000 233.2500 233.2500
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
361 300.500000 9835.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 378 319.500000 10161.5000 233.2500
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 370 545.000000 16028.8400 16028.8400
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
3 3.000000 111.0000 0.0000
Other 1 1.500000 83.2500 0.0000
---------------------------------------------------------
Total 374 549.500000 16223.0900 16028.8400
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
198 217.750000 8447.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 198 217.750000 8447.7500 0.0000
Center 51
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 29 60.000000 723.8500 723.8500
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
140 124.500000 4277.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 169 184.500000 5001.3500 723.8500
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 70 1068.000000 883.7400 842.7400
257 199.500000 6641.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 327 1267.500000 7525.2400 842.7400
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 16 111.250000 138.3500 138.3500
T 35 273.500000 512.7200 512.7200
619 604.750000 8915.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 670 989.500000 9566.8500 651.0700
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 4 8.250000 362.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 87 719.250000 1072.8800 1072.8800
T 41 424.000000 489.9300 489.9300
821 1378.750000 13386.1800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 953 2530.250000 15311.2400 1562.8100
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 17 33.025600 2053.9200 2053.9200
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
545 412.833333 14920.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 562 445.858933 16974.4200 2053.9200
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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 6 154.000000 154.5300 154.5300
194 271.000000 9696.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 200 425.000000 9850.7800 154.5300