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
Payclass Filters:GR
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 667 745.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 609 2446.000000 90354.0000 36.9395
Subtotal (Total Children Is Unduplicated) 1289 4039.000000 121702.2500 30.1318
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 5 16.000000 800.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 16.538134 1240.3600 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.492666 336.9500 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 7.500000 562.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 16.000000 888.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 120 179.674001 13475.5500 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 58 82.515466 6188.6600 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 50 73.000000 5475.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 187 263.000000 14568.7500 55.3945
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 75 104.269467 7820.2100 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 6 6.000000 353.4600 58.9100
SCREEN-T1023-SCREENING 5 7.000000 350.0000 50.0000
Subtotal (Total Children Is Unduplicated) 318 779.989734 52334.4400 67.0963
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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 1 4.000000 200.0000 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
TRAV-TRAVS-Travel by mile 260 8452.000000 3750.6000 0.4438
Subtotal (Total Children Is Unduplicated) 437 9258.750000 12965.6000 1.4004
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Total 14077.739734 187002.2900 13.2835
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Number of Children (Unduplicated) With at Least One Service 1356
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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 0 0.000000 0.0000 0.0000
P 62 428.500000 1219.7000 1219.7000
D 0 0.000000 0.0000 0.0000
S 25 14.500000 481.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.500000 75.0000 75.0000
387 281.500000 10249.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 475 726.000000 12024.9500 1294.7000
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 55 1827.500000 2046.6900 2046.6900
0 0.000000 0.0000 0.0000
Other 326 2079.250000 4664.5100 0.0000
---------------------------------------------------------
Total 381 3906.750000 6711.2000 2046.6900
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
383 336.250000 15065.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 383 336.250000 15065.0000 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 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
376 409.750000 17444.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 376 409.750000 17444.4600 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 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
331 364.250000 7330.5800 383.8300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 435 1271.750000 12165.5300 5218.7800
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
307 220.000000 7298.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 309 222.000000 7318.0000 20.0000
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 35 63.000000 729.3200 729.3200
D 6 8.500000 427.5000 0.0000
S 4 4.500000 138.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
296 224.950000 8015.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 341 300.950000 9311.0700 729.3200
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 418 862.250000 19672.2200 19672.2200
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 418 862.250000 19672.2200 19672.2200
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 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
429 433.000000 16178.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 429 433.000000 16178.0000 0.0000
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 16 16.000000 465.5000 465.5000
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
36 33.750000 1325.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 52 49.750000 1791.2500 465.5000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 27 23.000000 703.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 84 1041.000000 1096.9900 1036.9900
109 115.750000 3857.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 220 1179.750000 5657.2400 1036.9900
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 1 0.500000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 36 366.500000 623.5100 623.5100
799 781.500000 13270.8900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 836 1148.500000 13894.4000 623.5100
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 130 1040.000000 1563.3600 1563.3600
954 1199.000000 16021.9700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1084 2239.000000 17585.3300 1563.3600
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 29 45.969067 2510.6800 2510.6800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.500000 92.5000 0.0000
T 0 0.000000 0.0000 0.0000
540 449.320667 17030.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 570 497.789734 19633.9800 2510.6800
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 7 158.000000 175.4100 175.4100
246 336.250000 12374.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 253 494.250000 12549.6600 175.4100