CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/20/2020 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 538 819.250000 30284.5000 36.9661
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 22 16.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 940 4277.250000 158092.7500 36.9613
Subtotal (Total Children Is Unduplicated) 966 5112.500000 188377.2500 36.8464
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 2 2.500000 125.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.500000 337.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 19 35.000000 2625.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 8 13.500000 1012.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 5 9.500000 712.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 9.500000 527.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 18 32.500000 1803.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 29 46.829867 3512.2400 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 388 664.336800 49042.7000 73.8220
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 15.500000 1162.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 180 297.500001 21963.9700 73.8285
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 17 26.500000 1987.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 177 313.500000 23172.5000 73.9155
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 40 65.000000 3607.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 512 835.500000 46305.0000 55.4219
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 17.833333 1337.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 142 253.500000 19012.5000 75.0000
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 803 2656.000001 179172.4100 67.4595
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 3 4.750000 237.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 1 0.250000 12.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1 2.000000 100.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2 1.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 4 26.000000 1300.0000 50.0000
INTR-T1013-INTERPRETER 12 39.000000 1970.0000 50.5128
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 3.000000 30.0000 10.0000
OCCT-97530HMGT-OT SESSION BY OT ASST 1 2.000000 114.4000 57.2000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 0.500000 18.5000 37.0000
TRAV-TRAVS-Travel by mile 11 307.000000 136.5700 0.4449
Subtotal (Total Children Is Unduplicated) 31 386.500000 3969.4700 10.2703
-----------------------------------------------------------------------------------------------------------------------
Total 8155.000001 371519.1300 45.5572
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 978
-----------------------------------------------------------------------------------------------------------------------
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 3 4.500000 287.5000 287.5000
D 0 0.000000 0.0000 0.0000
S 169 156.250000 6744.7500 0.0000
H 357 356.500000 16733.2500 14727.0000
T 9 15.500000 1066.4000 1066.4000
358 281.250000 11540.2500 0.0000
Other 20 30.500000 2180.2500 0.0000
---------------------------------------------------------
Total 916 844.500000 38552.4000 16080.9000
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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 199 141.000000 6750.5000 0.0000
---------------------------------------------------------
Total 199 141.000000 6750.5000 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 9.750000 473.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 66 62.500000 2521.0000 0.0000
P 1 1.000000 50.0000 50.0000
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
106 96.500000 4591.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 180 169.750000 7635.7500 50.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 9.750000 360.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 55 84.500000 3126.5000 0.0000
P 4 6.250000 231.2500 231.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 114.4000 0.0000
T 0 0.000000 0.0000 0.0000
56 71.500000 3426.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 122 174.000000 7259.6500 231.2500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.500000 187.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 83 81.500000 3072.5000 2397.2500
P 15 40.000000 1317.1400 1317.1400
D 1 0.500000 18.5000 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
80 62.000000 2294.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 181 186.500000 6889.6400 3714.3900
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
641 555.250000 25493.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 641 555.250000 25493.2500 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 5.500000 203.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 57 48.750000 2038.5000 0.0000
P 100 115.750000 5843.5400 5843.5400
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
288 232.250000 9768.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 451 404.250000 18004.0400 5843.5400
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 33 63.250000 2601.7500 0.0000
P 448 703.000000 32595.9700 33158.5800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 228 290.500000 16155.5000 0.0000
T 0 0.000000 0.0000 0.0000
142 203.250000 9377.5000 0.0000
Other 60 117.000000 8589.7500 0.0000
---------------------------------------------------------
Total 912 1378.000000 69357.4700 33158.5800
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 27 23.750000 878.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 110 109.750000 4931.7500 0.0000
P 281 299.750000 13917.5000 13917.5200
D 1 2.250000 83.2500 0.0000
S 45 78.000000 5313.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
243 310.750000 15876.7500 0.0000
Other 14 23.500000 1626.0000 0.0000
---------------------------------------------------------
Total 721 847.750000 42627.7500 13917.5200
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 26 29.000000 1325.2500 0.0000
P 5 5.000000 375.0000 375.0000
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
64 57.000000 2466.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 95 91.000000 4166.7500 375.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 40 57.000000 2716.0000 0.0000
P 14 22.250000 944.3100 938.2700
D 0 0.000000 0.0000 0.0000
S 3 3.500000 129.5000 0.0000
H 4 8.000000 561.0000 0.0000
T 31 301.000000 2197.9400 2157.9400
124 156.000000 7573.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 216 547.750000 14121.7500 3096.2100
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 9.000000 360.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 173 184.250000 8469.5000 0.0000
P 39 49.750000 2520.2500 2409.2500
D 14 12.250000 547.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2 3.000000 166.5000 166.5000
327 261.250000 11874.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 563 519.500000 23938.5000 2575.7500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 114 126.500000 5791.2500 0.0000
P 71 77.750000 3457.0000 3457.0000
D 5 3.750000 138.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 16 38.000000 822.6800 822.6800
366 364.000000 17013.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 572 610.000000 27222.9300 4279.6800
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 361 464.500000 22516.2500 0.0000
P 140 137.250000 6784.2500 6784.2500
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
494 504.000001 24151.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1003 1121.750001 54651.7500 6784.2500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 19 25.000000 1236.2500 0.0000
P 138 211.500000 9230.7500 9155.7500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.000000 75.0000 0.0000
T 0 0.000000 0.0000 0.0000
238 326.500000 14305.0000 800.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 396 564.000000 24847.0000 9955.7500