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
Payclass Filters:OTHER
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 80 56.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 91 158.750000 5873.7500 37.0000
Subtotal (Total Children Is Unduplicated) 91 215.250000 5873.7500 27.2880
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 8 17.500000 875.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 9.500000 712.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 9.500000 527.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 39 65.000000 4875.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 48 88.000000 6600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 82 144.000000 7936.5000 55.1146
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 104 339.500000 21873.0500 64.4272
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 13 18.000000 900.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 2.500000 62.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 5 5.000000 250.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 5.000000 250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 9 9.000000 450.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 3.750000 93.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 219 1018.000000 50900.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 42 59.000000 2950.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 27 59.000000 590.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 37 199.000000 14216.5600 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 8 11.000000 785.8400 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 6 17.000000 972.4000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 1 1.000000 57.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 58 341.500000 24396.7600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 4 13.000000 928.7200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 2 5.000000 285.8000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 184 1073.500000 76664.5700 71.4155
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 34 79.750000 5697.3400 71.4400
TRAV-TRAVS-Travel by mile 793 42128.00000 18310.0600 0.4346
Subtotal (Total Children Is Unduplicated) 903 45049.00000 198811.5000 4.4132
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Total 45603.750000 226558.3000 4.9680
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Number of Children (Unduplicated) With at Least One Service 989
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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
90 97.000000 5400.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 90 97.000000 5400.5200 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 2280 43870.000000 177599.0600 177599.0600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 343 512.500000 25462.0000 0.0000
T 0 0.000000 0.0000 0.0000
41 573.000000 4808.3200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2664 44955.500000 207869.3800 177599.0600
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.000000 71.4400 71.4400
38 309.000000 1459.9200 408.1300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 39 310.000000 1531.3600 479.5700
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 59 62.000000 4211.7600 4211.7600
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
107 106.500000 6157.5300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 166 168.500000 10369.2900 4211.7600
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
0 0.000000 0.0000 0.0000
Other 44 72.750000 1387.7500 1387.7500
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Total 44 72.750000 1387.7500 1387.7500