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
Agency Filter:EXT
Payclass Filters:OTHER
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 19 34.000000 1700.0000 50.0000
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 1 1.500000 83.2500 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) 41 94.500000 4888.5000 51.7302
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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 300 1420.000000 70355.7400 49.5463
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12 24.000000 240.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 49 265.500000 18853.0000 71.0094
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 184 897.500000 64117.4000 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 13.000000 743.6000 57.2000
TRAV-TRAVS-Travel by mile 917 54021.00000 23828.9400 0.4411
Subtotal (Total Children Is Unduplicated) 1036 57065.50000 205647.7900 3.6037
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Total 57160.000000 210536.2900 3.6833
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Number of Children (Unduplicated) With at Least One Service 1057
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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
62 68.000000 3828.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 62 68.000000 3828.8000 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 2645 56648.250000 190484.9500 190484.9500
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
36 124.000000 7593.6000 6372.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2681 56772.250000 198078.5500 196856.9500
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 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
25 39.000000 1117.9300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 25 39.000000 1117.9300 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
94 81.250000 5291.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 94 81.250000 5291.7500 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