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
Agency Filter:EIP DEI DEIP
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 11898 13118.50000 485245.7500 36.9894
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6855 6616.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 21413 61077.75000 2257496.7500 36.9610
Subtotal (Total Children Is Unduplicated) 22741 80813.00000 2742742.5000 33.9394
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 4.000000 194.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 81 92.250000 4612.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 562 863.000000 43150.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 134 224.500000 16837.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 62 102.000000 7650.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 18 30.500000 2287.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 69 121.000000 9281.4400 76.7061
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 126 202.000000 11211.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1865 3080.500000 229847.7300 74.6138
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 812 1270.500000 94825.4500 74.6363
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 276 463.000000 34610.2900 74.7522
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2265 3732.000000 206400.8800 55.3057
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1064 1790.500000 135147.4600 75.4803
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 76 76.000000 7348.6900 96.6933
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 12 12.000000 2003.5400 166.9617
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 16 16.000000 439.8500 27.4906
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.000000 36.4900 36.4900
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 78 84.000000 4200.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 32 32.000000 1563.6000 48.8625
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 97.8800 48.9400
Subtotal (Total Children Is Unduplicated) 4633 12202.75000 811950.0000 66.5383
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 225 241.750000 12087.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 25 15.000000 375.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 864 924.250000 46200.0000 49.9865
CONIP-CONIP-CONSULT, ITDS PHONE 37 23.750000 587.7500 24.7474
CONOF-CONOF-CONSULT, OT, FACE TO FACE 274 263.000000 13125.0000 49.9049
CONOP-CONOP-CONSULT, OT, PHONE 26 11.500000 287.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 225 225.500000 11262.5000 49.9446
CONPP-CONPP-CONSULT, PT, PHONE 2 1.750000 43.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 326 428.500000 21425.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 18 10.750000 268.7500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 11 25.000000 1833.0000 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2106 4801.000000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 21 32.000000 800.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1284 6415.000000 320612.0000 49.9785
INTR-T1013-INTERPRETER 81 158.750000 7937.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1723 8298.000000 82970.0000 9.9988
OCCT-97530-OT SESSION BY LICENSED OT 42 245.000000 17337.4300 70.7650
PHY-97110-PT SESSION BY LICENSED PT 34 91.500000 6536.7600 71.4400
PHY-97110HM-PT SESSION BY PT ASST 3 4.000000 228.6400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 148 770.750000 53742.3100 69.7273
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TRAV-TRAVS-Travel by mile 553 37600.00000 16735.5400 0.4451
Subtotal (Total Children Is Unduplicated) 3192 60587.75000 614409.8100 10.1408
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Total 153603.500000 4169102.3100 27.1420
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Number of Children (Unduplicated) With at Least One Service 23175
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 600 432.250000 17890.0900 0.0000
U 0 0.000000 0.0000 0.0000
B 701 770.000000 46457.8700 0.0000
P 6007 3810.750000 140696.2500 140560.7000
D 15 9.500000 385.9400 0.0000
S 8 8.250000 429.0000 0.0000
H 149 188.000000 13565.9100 37.0000
T 2 1.750000 77.7500 50.0000
4221 2714.250000 80058.1100 0.0000
Other 5 7.500000 543.0000 0.0000
---------------------------------------------------------
Total 11708 7942.250000 300103.9200 140647.7000
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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 4543 16606.750000 102683.7100 0.0000
---------------------------------------------------------
Total 4543 16606.750000 102683.7100 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 92 67.500000 3069.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 2657 1902.250000 82527.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 2 1.750000 64.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4753 2984.500000 99485.3200 0.0000
Other 1 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 7505 4956.500000 185164.8200 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 8.500000 314.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1102 1621.250000 62689.0000 0.0000
P 2462 3914.750000 156827.7900 156939.0300
D 28 37.500000 1387.5000 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
4265 3948.000000 166104.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7865 9530.000000 387323.3800 156939.0300
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 65 46.250000 1711.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 2137 1412.750000 55546.5000 0.0000
P 74 432.250000 4766.4300 4766.4300
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
2431 1418.500000 41643.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4707 3309.750000 103667.6800 4766.4300
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
12711 8059.750000 307485.0400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12711 8059.750000 307485.0400 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 13 9.500000 351.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 40 36.000000 1421.0000 0.0000
P 3564 3055.750000 129006.7500 128942.0000
D 179 143.250000 5982.2500 0.0000
S 9 68.000000 2620.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6538 4202.250000 128919.0000 0.0000
Other 2 1.000000 37.0000 0.0000
---------------------------------------------------------
Total 10345 7515.750000 268337.5000 128942.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 189 222.750000 8241.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1700 1599.250000 62514.0000 124.5000
P 14395 12439.250000 456566.2800 456578.1700
D 11 11.000000 785.8400 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
288 344.500000 20446.2600 0.0000
Other 1 1.000000 37.0000 0.0000
---------------------------------------------------------
Total 16584 14617.750000 548591.1300 456702.6700
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 384 297.750000 11016.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 5036 4589.250000 201863.2500 0.0000
P 1 5.000000 50.0000 50.0000
D 48 34.250000 1267.2500 0.0000
S 69 108.500000 6655.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4402 4223.250000 175180.5700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9940 9258.000000 396033.3200 50.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 225 163.250000 5938.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 571 392.500000 15111.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 1 0.750000 27.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 1 0.250000 9.2500 0.0000
T 0 0.000000 0.0000 0.0000
1870 1367.750000 48332.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2668 1924.500000 69418.7500 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 3.500000 142.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1012 990.250000 48275.2500 83.2500
P 2328 2153.250000 99537.4200 97206.2400
D 40 56.500000 3133.0900 150.0000
S 6 7.000000 259.0000 0.0000
H 161 233.500000 15771.3900 0.0000
T 3044 25295.250000 60435.1600 50071.3500
3202 1876.750000 59742.6900 49.5900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9800 30616.000000 287296.5000 147560.4300
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 21 18.500000 739.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 773 715.500000 29755.7500 2.0000
P 2700 2714.320600 127242.2800 127349.4200
D 1 1.000000 73.3200 0.0000
S 17 17.750000 720.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
11717 9051.929400 166717.4100 0.0000
Other 201 228.500000 12725.9700 0.0000
---------------------------------------------------------
Total 15430 12747.500000 337974.7300 127351.4200
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 3.000000 150.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1618 1251.500000 49967.0000 0.0000
P 3685 3188.650000 141403.9000 159786.4000
D 211 181.750000 8091.0700 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
11830 8962.850000 166166.7200 0.0000
Other 30 30.000000 1527.2500 0.0000
---------------------------------------------------------
Total 17377 13617.750000 367305.9400 159786.4000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 0.500000 18.5000 0.0000
P 3275 2663.500000 111179.5000 111179.5000
D 0 0.000000 0.0000 0.0000
S 5 3.500000 168.5000 0.0000
H 19 38.000000 2850.0000 0.0000
T 0 0.000000 0.0000 0.0000
4593 2776.250000 97362.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7894 5481.750000 211579.2500 111179.5000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2167 2631.500000 98693.2500 0.0000
P 318 333.250000 20399.7500 20210.5500
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
4235 4454.250000 177025.1400 8215.1500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6721 7419.500000 296136.6400 28425.7000