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: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
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 73 54.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 474 1070.250000 39599.2500 37.0000
Subtotal (Total Children Is Unduplicated) 474 1125.000000 39599.2500 35.1993
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 12 22.000000 1100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 43 75.000000 5625.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 43 76.500000 5737.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 17.500000 1312.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 87 154.500000 8574.7500 55.5000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 4.000000 200.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 4 15.000000 750.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 118 371.000000 23695.9000 63.8704
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 32 44.750000 2237.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 13 12.500000 312.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 6 9.000000 450.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 9 8.500000 425.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 9.500000 475.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 12.000000 600.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 266 1184.500000 56895.5600 48.0334
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 20 59.000000 590.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 46 205.000000 14645.2000 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 3 9.250000 529.1000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 63 269.000000 19217.3600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 197 1275.250000 90500.6800 70.9670
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 3.000000 171.6000 57.2000
TRAV-TRAVS-Travel by mile 775 44263.00000 19491.8800 0.4404
Subtotal (Total Children Is Unduplicated) 893 47364.25000 206541.3800 4.3607
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Total 48860.250000 269836.5300 5.5226
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Number of Children (Unduplicated) With at Least One Service 1371
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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
58 68.000000 4208.0800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 58 68.000000 4208.0800 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 2546 47543.500000 214541.3900 214541.3900
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
16 37.250000 2189.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2562 47580.750000 216730.6800 214541.3900
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 3 2.250000 160.7400 90.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
39 38.500000 2096.5200 71.4400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 42 40.750000 2257.2600 161.4400
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
121 104.750000 7138.2700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 121 104.750000 7138.2700 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 7 6.500000 298.6000 298.6000
H 0 0.000000 0.0000 0.0000
T 1 4.000000 200.0000 200.0000
835 939.500000 35119.0000 0.0000
Other 50 116.000000 3884.6400 3884.6400
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Total 893 1066.000000 39502.2400 4383.2400