CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 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 675 744.250000 27537.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 552 548.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1296 5334.500000 197348.7500 36.9948
Subtotal (Total Children Is Unduplicated) 1318 6626.750000 224886.0000 33.9361
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 4 8.000000 400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 33 49.000000 3675.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 16 26.000000 1950.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 13 21.000000 1575.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 10 16.000000 1688.1000 105.5063
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 40 67.500000 3746.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 558 875.499999 65220.4000 74.4950
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 12 17.000000 1275.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 274 417.499999 31090.2200 74.4676
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 12 16.000000 1200.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 177 276.157600 20654.9700 74.7941
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 720 1101.000000 61105.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 17 28.000000 1554.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 251 384.842400 30359.2400 78.8875
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 9.500000 712.5000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1071 3323.999998 226927.9800 68.2695
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 2.000000 100.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.250000 62.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.250000 12.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 187 203.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 37.000000 1850.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 7.000000 350.0000 50.0000
INTR-T1013-INTERPRETER 32 45.500000 2275.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 246 476.000000 4760.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 8.000000 571.5200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 10.000000 714.4000 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 2.500000 92.5000 37.0000
TRAV-TRAVS-Travel by mile 209 6370.000000 2821.3700 0.4429
Subtotal (Total Children Is Unduplicated) 375 7162.500000 13609.7900 1.9001
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Total 17113.249998 465423.7700 27.1967
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Number of Children (Unduplicated) With at Least One Service 1334
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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 67 677.000000 2729.8400 2729.8400
D 2 3.000000 123.4000 0.0000
S 0 0.000000 0.0000 0.0000
H 464 428.250000 19045.7500 17403.2500
T 1 12.000000 4.9400 4.9400
336 250.000000 8784.7500 0.0000
Other 61 85.500000 5476.5000 0.0000
---------------------------------------------------------
Total 931 1455.750000 36165.1800 20138.0300
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 68 2137.000000 3844.0300 3844.0300
0 0.000000 0.0000 0.0000
Other 273 806.250000 6795.6400 0.0000
---------------------------------------------------------
Total 341 2943.250000 10639.6700 3844.0300
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 5.500000 203.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 196 216.250000 9809.7500 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
246 244.750000 11014.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 448 466.500000 21027.7500 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 72 130.000000 5384.7500 0.0000
P 171 304.750000 15195.6600 15199.1800
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
337 343.750000 15794.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 580 778.500000 36374.9100 15199.1800
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 116 107.250000 4215.2500 2998.5000
P 60 511.000000 2756.0500 2756.0500
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
175 113.750000 3350.5000 150.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 351 732.000000 10321.8000 5904.5500
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 16 18.500000 499.0000 499.0000
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
531 510.750000 24442.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 547 529.250000 24941.5000 499.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 20 22.750000 993.7500 0.0000
P 113 169.750000 7906.0000 7956.0000
D 1 2.000000 150.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 4.000000 300.0000 0.0000
T 0 0.000000 0.0000 0.0000
180 170.500000 5786.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 316 369.000000 15136.0000 7956.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 7 8.500000 371.5000 0.0000
P 676 1124.000000 41584.8700 41638.9700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 207 274.000000 13690.2500 0.0000
T 0 0.000000 0.0000 0.0000
7 11.000000 786.0000 0.0000
Other 55 87.000000 6369.0000 0.0000
---------------------------------------------------------
Total 952 1504.500000 62801.6200 41638.9700
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.250000 46.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 34 37.750000 1481.5000 0.0000
P 401 509.500000 23097.9200 23097.6700
D 1 1.500000 83.2500 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
444 570.250000 27018.5000 0.0000
Other 17 33.500000 2239.5000 0.0000
---------------------------------------------------------
Total 898 1153.750000 53966.9200 23097.6700
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 52 45.500000 1794.5000 0.0000
P 43 95.500000 1712.8400 1712.8400
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
234 195.000000 6992.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 329 336.000000 10499.8400 1712.8400
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9 16.500000 1066.5000 150.0000
P 73 110.500000 5641.5000 5438.9800
D 0 0.000000 0.0000 0.0000
S 21 20.750000 841.7500 0.0000
H 11 21.500000 1612.5000 0.0000
T 86 772.500000 4034.8700 3839.8700
115 165.750000 7752.8400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 315 1107.500000 20949.9600 9428.8500
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 73 85.000000 4013.5000 325.7500
P 275 268.750000 12190.7500 14031.0000
D 4 5.250000 384.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 47 257.500000 825.0100 825.0100
729 774.250000 17096.2900 0.0000
Other 2 3.000000 225.0000 0.0000
---------------------------------------------------------
Total 1130 1393.750000 34734.8000 15181.7600
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 166 168.250000 7982.0000 0.0000
P 537 551.000000 24376.2500 24275.0000
D 16 16.250000 866.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 153 1046.500000 1953.1600 1953.1600
913 1008.750000 20493.9100 0.0000
Other 3 1.750000 64.7500 0.0000
---------------------------------------------------------
Total 1788 2792.500000 55736.8200 26228.1600
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 85 121.750000 5720.7500 0.0000
P 316 381.842799 17605.2100 17444.2100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 4.000000 300.0000 0.0000
T 0 0.000000 0.0000 0.0000
455 493.657199 25864.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 858 1001.249998 49490.7500 17444.2100
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 14 26.250000 1046.2500 0.0000
P 103 139.500000 5990.0000 5901.2000
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 14 28.500000 573.5000 573.5000
281 355.500000 15026.5000 1322.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 412 549.750000 22636.2500 7796.7000