CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2019 ending 03/31/2019 Date of Report:05/04/2019 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 87 54.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 100 166.250000 6095.7500 36.6662
Subtotal (Total Children Is Unduplicated) 100 220.750000 6095.7500 27.6138
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 19 34.000000 1700.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 14.000000 777.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 47 77.000000 5775.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 38 69.000000 5175.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 85 146.000000 8103.0000 55.5000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 3 14.000000 700.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 8 32.000000 1600.0000 50.0000
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 133 409.500000 25422.7500 62.0824
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 29 40.750000 2037.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 18 17.000000 425.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 5 3.500000 175.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 5.000000 250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 7.000000 350.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.250000 31.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 16 17.000000 850.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 306 1438.000000 71255.7400 49.5520
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 13 25.000000 250.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 50 267.500000 18995.8800 71.0126
OCCT-97530HM-OT SESSION BY OT ASST 7 17.750000 1015.3000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 73 307.250000 21949.9400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 3 7.000000 400.1200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 194 915.750000 65421.1800 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 13.000000 743.6000 57.2000
TRAV-TRAVS-Travel by mile 918 54033.00000 23834.2800 0.4411
Subtotal (Total Children Is Unduplicated) 1050 57116.75000 208009.7900 3.6418
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Total 57747.000000 239528.2900 4.1479
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Number of Children (Unduplicated) With at Least One Service 1145
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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 2 4.500000 233.2500 233.2500
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
1 2.000000 100.0000 100.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3 6.500000 333.2500 333.2500
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
64 69.000000 3865.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 64 69.000000 3865.8000 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 3015 57182.250000 217357.6000 217357.6000
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
43 130.750000 7843.3500 6372.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3058 57313.000000 225200.9500 223729.6000
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 9 7.250000 517.9400 80.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
32 57.000000 1404.7100 15.3400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 41 64.250000 1922.6500 95.3400
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
17 18.000000 953.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17 18.000000 953.8800 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
98 83.250000 5365.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 98 83.250000 5365.7500 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 1 7.000000 400.4000 445.4000
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
2 11.000000 629.2000 629.2000
Other 17 175.000000 856.4100 856.4100
---------------------------------------------------------
Total 20 193.000000 1886.0100 1931.0100