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: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 859 3323.500000 122766.0000 36.9388
Subtotal (Total Children Is Unduplicated) 859 3323.500000 122766.0000 36.9388
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 19 29.500000 2212.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 16.500000 1237.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 17.500000 1312.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 6.500000 487.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 29 48.000000 2664.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 262 407.000000 30525.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 174 272.500000 20437.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 106 174.000000 13011.0000 74.7759
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 423 623.000000 34548.7500 55.4555
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 156 237.500000 17812.5000 75.0000
SCREEN-T1023-SCREENING 4 4.000000 200.0000 50.0000
Subtotal (Total Children Is Unduplicated) 623 1836.000000 124448.7500 67.7825
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 19.000000 950.0000 50.0000
Subtotal (Total Children Is Unduplicated) 5 19.000000 950.0000 50.0000
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Total 5178.500000 248164.7500 47.9221
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Number of Children (Unduplicated) With at Least One Service 884
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 99 112.500000 5087.5000 0.0000
H 248 225.500000 9835.0000 9835.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 39 61.000000 3873.0000 0.0000
---------------------------------------------------------
Total 387 399.500000 18814.0000 9835.0000
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 142 105.000000 4586.7500 0.0000
---------------------------------------------------------
Total 142 105.000000 4586.7500 0.0000
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
1 2.000000 111.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 270 302.000000 14289.5000 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 209 352.000000 14757.0000 14646.0000
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
25 18.500000 1212.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 320 522.500000 22384.0000 14646.0000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 137 131.500000 5197.2500 2571.5000
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 137 131.500000 5197.2500 2571.5000
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
205 211.000000 10418.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 205 211.000000 10418.2500 0.0000
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 111 144.000000 7207.5000 7257.5000
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
6 5.250000 194.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 149 182.500000 8897.0000 7257.5000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 11 17.250000 713.2500 0.0000
P 204 348.750000 16508.5000 16508.5000
D 1 2.000000 150.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 2.000000 111.0000 166.5000
4 7.000000 525.0000 0.0000
Other 54 89.500000 6537.0000 0.0000
---------------------------------------------------------
Total 275 466.500000 24544.7500 16675.0000
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 275 322.250000 15806.0000 15806.0000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 458 529.750000 24652.0000 15806.0000
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 3 3.000000 166.5000 166.5000
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
64 47.000000 1968.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 112 86.250000 3744.2500 166.5000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 13 14.500000 612.5000 0.0000
P 106 165.500000 8038.5000 8038.5000
D 0 0.000000 0.0000 0.0000
S 10 10.250000 531.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
30 57.750000 3475.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 159 248.000000 12657.7500 8038.5000
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 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
24 37.000000 2347.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 272 312.500000 15290.5000 6528.7500
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 0 0.000000 0.0000 0.0000
71 96.500000 5742.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 549 575.500000 27412.7500 12396.2700
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 301 368.250000 16361.2500 16322.0000
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
118 234.000000 16369.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 513 734.250000 38830.2500 16322.0000
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 0 0.000000 0.0000 0.0000
4 7.000000 456.7500 456.7500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 253 371.750000 16445.7500 15118.5000