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: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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 75.0000 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 41 71.000000 5325.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 43 76.500000 5737.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 85 150.500000 8352.7500 55.5000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 86 301.000000 19596.8000 65.1056
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EI Services,Class #03
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 12 24.500000 1225.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 2.750000 196.4600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 2.250000 160.7400 71.4400
Subtotal (Total Children Is Unduplicated) 17 30.500000 1632.2000 53.5148
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Total 1456.500000 60828.2500 41.7633
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Number of Children (Unduplicated) With at Least One Service 492
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Center 09
Flag Claims Units Chgs Paid
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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 317 487.250000 24173.6800 24173.6800
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 1.250000 46.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 320 488.500000 24219.9300 24173.6800
Center 52
Flag Claims Units Chgs Paid
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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
28 26.250000 1328.5800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 31 28.500000 1489.3200 90.0000
Center 57
Flag Claims Units Chgs Paid
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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
835 939.500000 35119.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 835 939.500000 35119.0000 0.0000