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
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 739 746.750000 27629.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 543 526.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 580 2225.750000 82251.0000 36.9543
Subtotal (Total Children Is Unduplicated) 1191 3498.750000 109880.7500 31.4057
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 5 14.000000 700.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 3 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 9.000000 675.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 10.500000 582.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 123 189.323466 14159.2600 74.7887
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 52 80.798533 6059.8900 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 48 75.000000 5625.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 196 279.000000 15456.7500 55.4005
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 72 105.833333 7937.5000 75.0000
SCREEN-T1023-SCREENING 4 9.000000 450.0000 50.0000
Subtotal (Total Children Is Unduplicated) 308 788.455332 52746.1500 66.8981
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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 1 2.000000 100.0000 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 6980.500000 10542.0800 1.5102
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Total 11267.705332 173168.9800 15.3686
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Number of Children (Unduplicated) With at Least One Service 1278
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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 65 605.500000 2241.0500 2241.0500
D 1 1.500000 112.5000 0.0000
S 3 20.000000 117.4800 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.000000 75.0000 75.0000
449 374.750000 14191.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 519 1002.750000 16737.5300 2316.0500
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 39 1039.000000 1846.2100 1846.2100
0 0.000000 0.0000 0.0000
Other 263 1130.500000 4497.3200 0.0000
---------------------------------------------------------
Total 302 2169.500000 6343.5300 1846.2100
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
331 320.000000 15285.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 331 320.000000 15285.0000 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
230 231.750000 9700.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 230 231.750000 9700.2500 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 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 401 1375.500000 11430.8100 5668.0600
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
306 194.750000 6884.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 313 202.750000 7104.0000 220.0000
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 24 27.000000 626.5000 626.5000
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
270 206.500000 6523.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 299 243.500000 7899.7500 626.5000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 381 846.000000 18917.3800 18917.3800
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
19 100.750000 1633.1300 0.0000
Other 3 4.500000 337.5000 0.0000
---------------------------------------------------------
Total 403 951.250000 20888.0100 18917.3800
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 4 4.000000 120.0000 120.0000
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
410 426.250000 15558.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 414 430.250000 15678.0000 120.0000
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 725.5000 725.5000
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
230 174.750000 6102.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 246 190.750000 6827.7500 725.5000
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 12 14.250000 527.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 64 812.500000 1400.1000 1345.1000
139 131.250000 4430.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 215 958.000000 6358.1000 1345.1000
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 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
575 470.750000 8163.6400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 628 724.000000 8985.8300 738.9400
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 81 635.500000 997.1900 997.1900
724 1128.750000 11475.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 805 1764.250000 12472.7700 997.1900
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 18 33.866667 2026.0000 2026.0000
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
449 376.588665 14982.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 467 410.455332 17008.1500 2026.0000
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 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 8 8.000000 80.0000 80.0000
216 285.000000 10369.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 224 293.000000 10449.5000 80.0000