CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 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 739 746.750000 27629.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 615 575.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1499 5680.000000 209854.7500 36.9463
Subtotal (Total Children Is Unduplicated) 1529 7002.500000 237484.5000 33.9142
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 6 17.000000 850.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 3 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 32 48.500000 3637.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 17 26.000000 1950.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 19 26.000000 1950.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 13.500000 1012.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 46 75.500000 4190.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 569 895.666667 66830.0000 74.6148
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 316 516.500000 38559.8200 74.6560
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 193 309.500000 23138.5000 74.7609
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 829 1281.000000 70829.0000 55.2920
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 289 446.333333 33480.8900 75.0132
SCREEN-T1023-SCREENING 8 13.000000 650.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1187 3672.500000 247278.4600 67.3325
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.000000 100.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 2.000000 100.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 172 183.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 21.000000 1050.0000 50.0000
INTR-T1013-INTERPRETER 33 60.750000 3072.5000 50.5761
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 226 418.000000 4180.0000 10.0000
TRAV-TRAVS-Travel by mile 199 6308.000000 2789.5800 0.4422
Subtotal (Total Children Is Unduplicated) 363 6999.500000 11492.0800 1.6418
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Total 17674.500000 496255.0400 28.0775
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Number of Children (Unduplicated) With at Least One Service 1558
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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 1 0.500000 18.5000 0.0000
P 81 631.000000 3908.3000 3908.3000
D 1 1.500000 112.5000 0.0000
S 102 132.500000 5204.9800 0.0000
H 260 242.500000 11022.2500 9835.0000
T 2 2.500000 187.5000 187.5000
455 382.750000 14762.2500 0.0000
Other 43 65.500000 4210.5000 0.0000
---------------------------------------------------------
Total 945 1458.750000 39426.7800 13930.8000
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 43 1047.000000 2446.2100 2446.2100
0 0.000000 0.0000 0.0000
Other 405 1235.500000 9084.0700 0.0000
---------------------------------------------------------
Total 448 2282.500000 11530.2800 2446.2100
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 267 299.500000 14160.0000 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
332 322.000000 15396.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 601 622.000000 29574.5000 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 18 39.250000 1452.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 68 112.750000 4962.7500 0.0000
P 210 353.000000 15024.7400 14913.7400
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
267 262.750000 11830.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 563 767.750000 33269.9900 14913.7400
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 137 131.500000 5197.2500 2571.5000
P 111 1114.000000 5173.7300 5173.7300
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
290 261.500000 6257.0800 494.3300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 538 1507.000000 16628.0600 8239.5600
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 7 8.000000 220.0000 220.0000
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
575 481.250000 22506.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 582 489.250000 22726.5000 220.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 5.000000 185.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 24 28.250000 1310.2500 0.0000
P 137 175.000000 8134.0000 8184.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 5 10.000000 750.0000 0.0000
T 0 0.000000 0.0000 0.0000
276 211.750000 6717.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 450 430.000000 17096.7500 8184.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 11 17.250000 713.2500 0.0000
P 618 1245.750000 38329.4500 38528.1700
D 1 2.000000 150.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 303 401.500000 19634.5000 0.0000
T 1 2.000000 111.0000 166.5000
28 113.750000 2489.8800 0.0000
Other 77 124.500000 9162.0000 0.0000
---------------------------------------------------------
Total 1039 1906.750000 70590.0800 38694.6700
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 9 12.750000 471.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 172 191.250000 8244.7500 0.0000
P 279 326.250000 15926.0000 15926.0000
D 2 3.500000 129.5000 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
503 593.250000 26649.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 965 1127.000000 51421.7500 15926.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 43 34.250000 1498.7500 0.0000
P 19 19.000000 892.0000 892.0000
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
294 221.750000 8070.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 358 277.000000 10572.0000 892.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 13 14.500000 612.5000 0.0000
P 110 173.500000 8638.5000 8437.8500
D 0 0.000000 0.0000 0.0000
S 22 24.500000 1058.5000 0.0000
H 19 38.000000 2850.0000 0.0000
T 86 855.500000 3954.8300 3759.8300
197 243.000000 11211.6700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 447 1349.000000 28326.0000 12197.6800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 9 6.750000 363.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 105 125.750000 6024.2500 0.0000
P 134 143.000000 6555.0000 6528.7500
D 2 2.250000 83.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 51 251.000000 738.9400 738.9400
650 580.250000 15126.8900 0.0000
Other 2 2.000000 101.7500 0.0000
---------------------------------------------------------
Total 953 1111.000000 28993.8300 7267.6900
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 5.000000 185.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 191 192.000000 8784.7500 0.0000
P 281 279.250000 12503.5000 12396.2700
D 3 2.750000 196.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 86 643.500000 1480.1900 1480.1900
826 1273.500000 20437.0800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1390 2396.000000 43587.2700 13876.4600
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 94 132.000000 6100.0000 0.0000
P 325 414.116667 19287.2500 19248.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 5 10.000000 750.0000 0.0000
T 0 0.000000 0.0000 0.0000
596 660.633333 35015.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1020 1216.750000 61152.7500 19248.0000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 17 28.250000 1073.0000 0.0000
P 229 333.500000 14691.0000 14661.7500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 3.000000 225.0000 0.0000
T 12 16.000000 602.0000 602.0000
272 353.000000 14767.5000 456.7500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 533 733.750000 31358.5000 15720.5000