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
Payclass Filters:GR
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 11897 13117.50000 485208.7500 36.9894
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6782 6561.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7630 21190.25000 783092.5000 36.9553
Subtotal (Total Children Is Unduplicated) 17474 40869.50000 1268301.2500 31.0330
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 3 3.000000 145.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 80 90.250000 4512.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 562 863.000000 43150.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 23 33.500000 2512.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 14 21.500000 1612.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 14 20.500000 1537.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 31 37.500000 2081.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 288 487.858799 36589.4100 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 108 168.000000 12600.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 42 63.000000 4725.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 408 584.000000 32412.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 194 324.000000 24300.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 44 44.000000 2592.0400 58.9100
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 3 3.000000 249.8700 83.2900
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 5 5.000000 117.1000 23.4200
SCREEN-T1023-SCREENING 22 23.000000 1150.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 13 13.000000 663.6500 51.0500
Subtotal (Total Children Is Unduplicated) 1414 2788.608799 171288.3200 61.4243
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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 325 427.500000 21375.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 18 10.750000 268.7500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 10 21.000000 1539.7200 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2106 4801.000000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 8.000000 200.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 174 747.100000 37353.1000 49.9975
INTR-T1013-INTERPRETER 81 158.750000 7937.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1723 8297.000000 82960.0000 9.9988
OCCT-97530-OT SESSION BY LICENSED OT 10 37.750000 2696.8600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 5 8.000000 571.5200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 19 96.500000 6786.8000 70.3295
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) 3008 53920.85000 262407.6700 4.8665
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Total 97578.958799 1701997.2400 17.4423
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Number of Children (Unduplicated) With at Least One Service 18290
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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 1 0.250000 9.2500 0.0000
P 5 4.750000 30.0000 104.0000
D 1 0.500000 18.5000 0.0000
S 1 0.250000 9.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.000000 50.0000 50.0000
4081 2560.500000 71475.7600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4090 2567.250000 71592.7600 154.0000
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 3017 15489.250000 52583.4600 0.0000
---------------------------------------------------------
Total 3017 15489.250000 52583.4600 0.0000
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 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
4731 2947.500000 96920.5700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4731 2947.500000 96920.5700 0.0000
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 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
3867 3582.500000 140872.0200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3895 3620.000000 142259.5200 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 72 429.750000 4578.9300 4578.9300
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
2430 1417.750000 41615.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2502 1847.500000 46194.6800 4578.9300
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
7186 3805.500000 118117.5400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7186 3805.500000 118117.5400 0.0000
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 0 0.000000 0.0000 0.0000
D 179 143.250000 5982.2500 0.0000
S 1 60.000000 2220.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6507 4181.000000 128038.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6687 4384.250000 136240.5000 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 10983 8779.500000 296827.5900 296827.5900
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
74 67.250000 2582.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11057 8846.750000 299409.5900 296827.5900
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 1 5.000000 50.0000 50.0000
D 48 34.250000 1267.2500 0.0000
S 2 3.250000 120.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3966 3276.750000 111149.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4017 3319.250000 112586.5000 50.0000
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 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
1857 1359.250000 48017.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1857 1359.250000 48017.7500 0.0000
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 2 4.000000 222.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2697 24964.000000 41273.3500 37721.6300
2926 1585.250000 43362.8400 49.5900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5625 26553.250000 84858.1900 37771.2200
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 1 1.000000 73.3200 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
11154 8501.500000 139622.6900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11155 8502.500000 139696.0100 0.0000
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 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
11081 8241.350000 131436.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11292 8423.100000 139527.8400 0.0000
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
4570 2737.608799 94590.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4570 2737.608799 94590.6600 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
3137 3176.000000 119401.6700 2030.9800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3137 3176.000000 119401.6700 2030.9800