CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 824 847.250000 31348.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 736 781.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1572 6339.750000 234284.0000 36.9548
Subtotal (Total Children Is Unduplicated) 1594 7968.500000 265632.2500 33.3353
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 5 18.000000 900.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 34 55.500000 4162.4999 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 16 27.000532 2025.0400 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 13 21.000000 1429.0000 68.0476
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 21 35.500000 2625.0000 73.9437
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 41 71.000000 3940.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 623 952.930534 71072.2900 74.5829
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 297 459.499999 34278.1500 74.5988
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 212 307.500000 23017.9600 74.8552
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 869 1335.000000 74064.7500 55.4792
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 320 478.069467 35902.0200 75.0979
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 8 8.000000 961.4600 120.1825
SCREEN-T1023-SCREENING 6 9.000000 450.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 1254 3780.000532 254929.7199 67.4417
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.750000 87.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.750000 37.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 0.500000 25.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 219 199.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 19.000000 950.0000 50.0000
INTR-T1013-INTERPRETER 33 70.500000 3525.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 277 529.000000 5290.0000 10.0000
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 8.000000 571.5200 71.4400
TRAV-TRAVS-Travel by mile 260 8452.000000 3750.6000 0.4438
Subtotal (Total Children Is Unduplicated) 437 9282.750000 14358.5600 1.5468
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Total 21031.250532 534920.5299 25.4346
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Number of Children (Unduplicated) With at Least One Service 1616
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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 14 18.000000 1206.7500 0.0000
P 87 461.500000 3082.5200 3082.5200
D 0 0.000000 0.0000 0.0000
S 170 161.500000 7344.7500 0.0000
H 316 280.500000 12484.2500 11223.5000
T 1 1.500000 75.0000 75.0000
391 285.250000 10501.5000 0.0000
Other 43 63.500000 4070.2500 0.0000
---------------------------------------------------------
Total 1022 1271.750000 38765.0200 14381.0200
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 59 1835.000000 2609.1900 2609.1900
0 0.000000 0.0000 0.0000
Other 559 2271.000000 13302.0100 0.0000
---------------------------------------------------------
Total 618 4106.000000 15911.2000 2609.1900
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 6.250000 231.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 297 296.750000 13597.7500 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
383 336.250000 15065.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 687 639.250000 28894.0000 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 36 72.000000 2664.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 61 105.750000 4590.7500 0.0000
P 243 385.000000 16645.4900 16851.4900
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
441 464.250000 21707.2100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 781 1027.000000 45607.4500 16851.4900
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 85 69.250000 2695.2500 1803.7500
P 104 907.500000 4834.9500 4834.9500
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
332 365.000000 7358.3300 383.8300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 521 1341.750000 14888.5300 7022.5300
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 2 2.000000 20.0000 20.0000
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
538 462.750000 20704.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 540 464.750000 20724.7500 20.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 76 101.000000 4858.7500 0.0000
P 98 152.300000 5042.8200 5042.8200
D 6 8.500000 427.5000 0.0000
S 4 4.500000 138.7500 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
317 248.200000 8932.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 503 517.500000 19587.5700 5042.8200
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 13 20.000000 1025.0000 0.0000
P 790 1429.250000 48034.6800 48034.6800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 197 250.500000 12525.5000 0.0000
T 2 3.000000 195.7500 187.5000
19 27.250000 1897.7500 0.0000
Other 76 123.500000 9067.5000 0.0000
---------------------------------------------------------
Total 1097 1853.500000 72746.1800 48222.1800
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 7.500000 277.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 100 115.000000 5087.0000 0.0000
P 324 394.250000 19021.2500 19021.2500
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
519 608.000000 28045.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 953 1124.750000 52431.0000 19021.2500
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 10 9.250000 379.2500 0.0000
P 23 26.000000 947.5000 947.5000
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
52 50.000000 2187.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 85 85.250000 3514.3000 947.5000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 29 42.000000 2065.0000 0.0000
P 153 212.250000 10438.5000 10000.9800
D 1 2.000000 150.0000 0.0000
S 27 23.000000 703.0000 0.0000
H 16 29.500000 2085.7500 0.0000
T 107 1085.000000 3568.9100 3378.9100
170 231.250000 11279.4800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 503 1625.000000 30290.6400 13379.8900
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 3.500000 129.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 205 229.250000 10325.0000 150.0000
P 158 195.000000 8980.7500 8980.7500
D 0 0.000000 0.0000 0.0000
S 1 0.500000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 36 366.500000 623.5100 623.5100
861 871.500000 18836.3300 0.0000
Other 13 13.250000 565.2500 0.0000
---------------------------------------------------------
Total 1278 1679.500000 39460.3400 9754.2600
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 6.750000 249.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 313 327.250000 15200.7500 37.0000
P 293 297.000000 13229.5000 13229.5000
D 4 5.500000 383.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 139 1056.500000 2557.1100 2557.1100
1054 1348.750000 25481.4700 0.0000
Other 26 25.000000 962.0000 0.0000
---------------------------------------------------------
Total 1833 3066.750000 58063.8300 15823.6100
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 176 195.250000 8212.2500 18.5000
P 296 364.969067 17277.6800 22232.4800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 6 12.500000 842.5000 0.0000
T 0 0.000000 0.0000 0.0000
663 662.031465 31739.6299 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1141 1234.750532 58072.0599 22250.9800
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 23 28.750000 1282.0000 18.5000
P 256 386.750000 16718.7500 16481.6000
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 12 169.000000 886.4100 886.4100
311 409.250000 17076.5000 200.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 602 993.750000 35963.6600 17586.5100