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
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 12268 13619.25000 503718.5000 36.9858
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6820 6390.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 8033 23544.50000 870624.7500 36.9778
Subtotal (Total Children Is Unduplicated) 18404 43554.50000 1374343.2500 31.5546
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 9 12.000000 582.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 73 78.750000 3937.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 626 873.000000 43650.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 29 44.000000 3300.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 16.500000 1237.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 13 20.500000 1537.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 20 28.500000 2137.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 43 56.000000 3108.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 331 552.739333 41455.4500 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 155 224.500000 16837.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 96 149.000000 11175.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 569 790.500000 43872.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 208 332.670133 24950.2600 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 4 4.000000 204.2000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 53 59.000000 2950.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 13 13.000000 663.6500 51.0500
Subtotal (Total Children Is Unduplicated) 1706 3257.659466 201751.9600 61.9316
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 275 322.000000 16100.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 27 17.500000 437.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 763 691.750000 34500.0000 49.8735
CONIP-CONIP-CONSULT, ITDS PHONE 43 26.000000 650.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 497 307.500000 15375.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 55 25.000000 625.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 400 268.500000 13425.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 15 7.250000 181.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 422 400.500000 20025.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 35 21.250000 531.2500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2023 4749.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 10.000000 250.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 187 757.000000 37850.0000 50.0000
INTR-T1013-INTERPRETER 340 532.250000 26563.7500 49.9084
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1666 7891.000000 78880.0000 9.9962
OCCT-97530-OT SESSION BY LICENSED OT 28 130.000000 9287.2000 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 1 2.000000 114.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 28 163.000000 11644.7200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 65 264.750000 18827.4000 71.1139
SPL-92508-GROUP SPL SESSION PER CHILD 4 11.000000 152.6800 13.8800
TRAV-TRAVS-Travel by mile 588 36094.00000 16058.6200 0.4449
Subtotal (Total Children Is Unduplicated) 3266 52691.50000 301478.7700 5.7216
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Total 99503.659466 1877573.9800 18.8694
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Number of Children (Unduplicated) With at Least One Service 19407
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 52 25.250000 937.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6408 4278.000000 149300.3600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6460 4303.250000 150237.8600 0.0000
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 3679 15565.500000 63520.3200 0.0000
---------------------------------------------------------
Total 3679 15565.500000 63520.3200 0.0000
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
5204 3991.000000 121289.9100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5204 3991.000000 121289.9100 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 1 1.500000 55.5000 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
3665 3258.250000 130123.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3666 3259.750000 130178.5000 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 92 405.000000 6546.2300 6546.2300
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
2865 1705.750000 49721.3200 214.3200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2957 2110.750000 56267.5500 6760.5500
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
6076 3260.250000 109740.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6076 3260.250000 109740.7500 0.0000
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 0 0.000000 0.0000 0.0000
D 31 28.500000 1091.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 47 94.000000 7050.0000 0.0000
T 0 0.000000 0.0000 0.0000
7189 4232.250000 126767.7500 0.0000
Other 1 2.000000 111.0000 0.0000
---------------------------------------------------------
Total 7268 4356.750000 135020.2500 0.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 10541 9057.000000 313133.4900 313133.4900
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
18 14.750000 602.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10559 9071.750000 313735.9900 313133.4900
Center 10
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 2 1.250000 46.2500 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
5811 4598.500000 151610.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5814 4600.250000 151675.2500 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 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
2700 1683.000000 55883.6100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2700 1683.000000 55883.6100 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 57 44.000000 1544.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 1713 22450.750000 41019.5400 35949.3900
1827 1229.500000 35207.6700 36.6700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3597 23724.250000 77771.9600 35986.0600
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 1 0.250000 9.2500 9.2500
D 20 26.250000 1249.2500 0.0000
S 1 1.000000 37.0000 0.0000
H 1 1.000000 71.4400 0.0000
T 0 0.000000 0.0000 0.0000
10692 8611.750000 137301.9100 37.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10715 8640.250000 138668.8500 46.2500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 1.250000 46.2500 0.0000
P 0 0.000000 0.0000 0.0000
D 39 36.750000 2520.6100 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 0.750000 0.0000 0.0000
12243 8991.750000 158613.6100 46.2500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12285 9030.500000 161180.4700 46.2500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.250000 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
4096 2441.409466 86654.2100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4097 2441.659466 86654.2100 0.0000
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 0 0.000000 0.0000 0.0000
3369 3464.750000 125748.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3369 3464.750000 125748.5000 0.0000