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:MED
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 916 3759.500000 139009.0000 36.9754
Subtotal (Total Children Is Unduplicated) 916 3759.500000 139009.0000 36.9754
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 27.500000 2062.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 18.500000 1387.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 12.000000 900.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 20.500000 1500.0000 73.1707
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 23 41.000000 2275.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 292 433.800000 32535.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 154 228.000000 17100.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 113 166.000000 12450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 469 703.500000 39044.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 182 266.500000 19987.5000 75.0000
SCREEN-T1023-SCREENING 1 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) 675 1920.300000 129393.3000 67.3818
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 4.000000 200.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 8.000000 571.5200 71.4400
Subtotal (Total Children Is Unduplicated) 2 12.000000 771.5200 64.2933
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Total 5691.800000 269173.8200 47.2915
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Number of Children (Unduplicated) With at Least One Service 937
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 145 147.000000 6863.7500 0.0000
H 300 262.000000 11223.5000 11223.5000
T 0 0.000000 0.0000 0.0000
1 0.250000 9.2500 0.0000
Other 35 51.000000 3210.7500 0.0000
---------------------------------------------------------
Total 495 478.250000 22514.0000 11223.5000
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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 233 191.750000 8637.5000 0.0000
---------------------------------------------------------
Total 233 191.750000 8637.5000 0.0000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 304 303.000000 13829.0000 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 242 384.500000 16442.7500 16648.7500
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
33 23.500000 1518.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 372 585.750000 25216.2500 16648.7500
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 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
1 0.750000 27.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 86 70.000000 2723.0000 1803.7500
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
175 173.750000 8553.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 175 173.750000 8553.5000 0.0000
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 61 86.500000 4103.5000 4103.5000
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
10 11.000000 407.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 148 199.500000 9406.2500 4103.5000
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 235 381.000000 17980.2500 17980.2500
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 2 3.000000 195.7500 187.5000
3 5.500000 373.5000 0.0000
Other 61 102.500000 7492.5000 0.0000
---------------------------------------------------------
Total 314 512.000000 27067.0000 18167.7500
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 434 516.750000 24385.7500 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 7 10.000000 482.0000 482.0000
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
16 16.250000 861.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 33 35.500000 1723.0500 482.0000
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 144 195.250000 9231.7500 9349.1700
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
33 62.000000 3879.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 206 299.250000 15176.5000 9349.1700
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
22 36.500000 2308.5000 0.0000
Other 13 13.250000 565.2500 0.0000
---------------------------------------------------------
Total 402 477.500000 22309.0000 9130.7500
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 0 0.000000 0.0000 0.0000
72 101.550000 6144.2500 0.0000
Other 25 23.000000 851.0000 0.0000
---------------------------------------------------------
Total 711 761.050000 36058.5000 13266.5000
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 257 299.000000 13267.0000 18221.8000
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
94 174.000000 11894.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 527 668.250000 33373.7700 18240.3000
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 0 0.000000 0.0000 0.0000
1 4.000000 200.0000 200.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 280 419.500000 18200.7500 16700.1000