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
Agency Filter:EXT
Payclass Filters:OTHER
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 8 17.500000 875.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 14 31.500000 1798.0500 57.0810
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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 3 3.000000 150.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 5.000000 250.0000 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 218 1017.000000 50850.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 42 59.000000 2950.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 25 57.000000 570.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 36 198.000000 14145.1200 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 179 1065.500000 76093.0500 71.4153
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 31 76.000000 5429.4400 71.4400
TRAV-TRAVS-Travel by mile 783 41875.00000 18197.5100 0.4346
Subtotal (Total Children Is Unduplicated) 883 44777.25000 197568.0900 4.4122
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Total 44808.750000 199366.1400 4.4493
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Number of Children (Unduplicated) With at Least One Service 896
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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 0 0.000000 0.0000 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 2321 44443.000000 182407.3800 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
16 46.000000 863.0500 352.4500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17 47.000000 934.4900 423.8900
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
89 87.750000 5051.9900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 148 149.750000 9263.7500 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 43 72.000000 1360.0000 1360.0000
---------------------------------------------------------
Total 43 72.000000 1360.0000 1360.0000