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: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
CASE-CASE-NON-TCM CASE MANAGEMENT 3 0.750000 27.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 43 126.750000 4643.5000 36.6351
Subtotal (Total Children Is Unduplicated) 44 127.500000 4671.2500 36.6373
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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 31 50.000000 3750.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 11.500000 862.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 5.000000 375.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 24 44.000000 3665.3600 83.3036
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 28 48.000000 2664.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 435 785.882999 58321.0650 74.2109
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.500000 862.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 138 237.000000 17519.6800 73.9227
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 124 190.133333 14195.0000 74.6581
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 2.500000 187.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 422 738.500000 40800.7500 55.2481
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.500000 360.7500 48.1000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 206 327.299200 28208.1700 86.1847
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 15 15.000000 750.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 17 17.000000 867.8500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 885 2508.815532 174615.1150 69.6006
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EI Services,Class #03
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 3 4.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 6.000000 150.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 116 586.750000 29277.5000 49.8977
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 34 42.250000 2112.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 10.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 66 301.250000 21467.8600 71.2626
OCCT-97530GT-OT SESSION BY LICENSED OT 23 38.500000 2750.4400 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 57.2000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 1 2.000000 114.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 60 304.500000 21753.4800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 26 37.000000 2629.0000 71.0541
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 150 693.000000 49282.9200 71.1153
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 47 65.750000 4697.1800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.000000 27.7600 13.8800
Subtotal (Total Children Is Unduplicated) 391 2089.750000 134505.2400 64.3643
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Total 4726.065532 313791.6050 66.3959
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Number of Children (Unduplicated) With at Least One Service 1242
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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 1 1.500000 83.2500 0.0000
S 3 3.000000 171.4400 0.0000
H 461 509.250000 34380.4800 0.0000
T 0 0.000000 0.0000 0.0000
277 297.000000 18253.0100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 742 810.750000 52888.1800 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
88 108.500000 7228.8900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 88 108.500000 7228.8900 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 35 33.500000 6457.1300 6457.1300
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 41.750000 2927.4600 81.4600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 76 75.250000 9384.5900 6538.5900
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
272 417.500000 28476.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 272 417.500000 28476.2500 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 2 0.500000 18.5000 0.0000
P 6 5.087400 381.5550 381.5300
D 16 31.000000 2301.0500 0.0000
S 3 2.250000 96.2500 0.0000
H 18 35.000000 2601.0500 0.0000
T 0 0.000000 0.0000 0.0000
19 20.750000 1181.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 64 94.587400 6579.6550 381.5300
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 3.000000 225.0000 0.0000
P 252 323.500000 21914.8900 21982.6500
D 6 6.000000 428.6400 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
15 15.500000 1116.2200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 275 348.000000 23684.7500 21982.6500
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
315 718.000000 48614.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 315 718.000000 48614.2500 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 2 2.000000 100.0000 0.0000
P 31 41.000000 2889.5000 2095.5000
D 4 4.000000 200.0000 200.0000
S 4 6.000000 311.0000 122.5000
H 110 146.500000 9739.4800 0.0000
T 326 345.500000 21092.6000 14625.7700
85 93.750000 5343.6300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 562 638.750000 39676.2100 17043.7700
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 0 0.000000 0.0000 0.0000
D 120 122.000000 7261.3200 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
439 463.500000 28808.7100 0.0000
Other 79 81.500000 5438.4600 0.0000
---------------------------------------------------------
Total 638 667.000000 41508.4900 0.0000
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 4 1.105924 78.7200 69.8200
D 121 119.394076 8412.0400 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
290 302.500000 20170.8500 0.0000
Other 41 40.250000 2875.4600 0.0000
---------------------------------------------------------
Total 456 463.250000 31537.0700 69.8200
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 14.000000 1042.8800 0.0000
T 0 0.000000 0.0000 0.0000
36 54.478132 3971.3400 0.0000
Other 1 1.000000 51.0500 0.0000
---------------------------------------------------------
Total 45 69.478132 5065.2700 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 31 29.500000 1091.5000 1082.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 11 10.750000 397.7500 0.0000
T 0 0.000000 0.0000 0.0000
229 274.750000 17658.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 271 315.000000 19148.0000 1082.2500