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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 44 94.250000 3413.2500 36.2149
Subtotal (Total Children Is Unduplicated) 44 95.000000 3413.2500 35.9289
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 2 3.000000 150.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 19 32.000000 2310.0000 72.1875
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 14.000000 980.0000 70.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 30 39.000000 2925.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 14 20.000000 1500.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 18 29.500000 1637.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 383 692.620400 50176.0300 72.4438
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 142 277.663200 19833.4000 71.4297
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 98 163.000000 12225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 429 752.500000 41703.7500 55.4203
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 186 290.000000 22743.9900 78.4276
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 10 10.000000 500.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 14 14.000000 714.7000 51.0500
Subtotal (Total Children Is Unduplicated) 808 2343.283600 157705.4200 67.3010
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 3 3.000000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 5.000000 125.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 136 673.750000 33682.5000 49.9926
OCCT-97530-OT SESSION BY LICENSED OT 65 364.250000 26007.7800 71.4009
OCCT-97530HM-OT SESSION BY OT ASST 4 109.000000 6234.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 68 362.750000 25843.4600 71.2432
PHY-97110HM-PT SESSION BY PT ASST 1 2.000000 114.3200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 159 918.300000 62570.8800 68.1377
SPL-92508-GROUP SPL SESSION PER CHILD 5 13.000000 180.4400 13.8800
Subtotal (Total Children Is Unduplicated) 405 2451.050000 154759.1800 63.1400
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Total 4889.333600 315877.8500 64.6055
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Number of Children (Unduplicated) With at Least One Service 1182
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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 0 0.000000 0.0000 0.0000
H 322 330.750000 22706.6100 0.0000
T 0 0.000000 0.0000 0.0000
224 228.000000 13293.7100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 546 558.750000 36000.3200 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 10 9.500000 1973.6900 1973.6900
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
55 54.000000 4030.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 65 63.500000 6004.1900 1973.6900
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 1 2.000000 142.8800 142.8800
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 1 2.000000 142.8800 142.8800
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
247 379.000000 25763.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 247 379.000000 25763.2500 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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
26 16.250000 601.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 27 18.250000 751.2500 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 4 4.000000 185.7600 0.0000
P 359 453.250000 29593.3900 30169.4300
D 9 9.000000 642.9600 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
50 62.500000 3901.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 422 528.750000 34323.3600 30169.4300
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 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
359 782.000000 52527.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 359 782.000000 52527.0000 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 76 104.000000 7089.6000 4690.6600
D 0 0.000000 0.0000 0.0000
S 5 5.000000 185.0000 0.0000
H 67 97.000000 6871.9200 0.0000
T 352 373.500000 20740.2500 14339.7100
176 186.000000 10174.9900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 676 765.500000 45061.7600 19030.3700
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 14 13.750000 940.8700 1754.0300
D 87 105.550000 4415.0500 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
579 728.000000 45878.5100 0.0000
Other 47 45.750000 2678.6100 0.0000
---------------------------------------------------------
Total 727 893.050000 53913.0400 1754.0300
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 14 7.710000 552.5700 934.5700
D 50 48.000000 3406.5600 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
449 482.290000 33711.4600 0.0000
Other 34 33.000000 2168.4400 0.0000
---------------------------------------------------------
Total 547 571.000000 39839.0300 934.5700
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 8 16.000000 1200.0000 0.0000
T 0 0.000000 0.0000 0.0000
21 33.783600 2508.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 29 49.783600 3708.7700 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
230 277.750000 17843.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 230 277.750000 17843.0000 0.0000