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
Payclass Filters:MED
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 521 2561.500000 94684.0000 36.9643
Subtotal (Total Children Is Unduplicated) 521 2561.500000 94684.0000 36.9643
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 10 19.000000 1425.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 7.000000 525.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 9 16.500000 915.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 201 347.500000 26062.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 83 142.000000 10650.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 7.500000 562.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 104 180.500000 13537.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 18.500000 1026.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 262 437.500000 24281.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 8.000000 600.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 96 172.000000 12900.0000 75.0000
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 420 1382.500000 94365.2500 68.2570
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EI Services,Class #03
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 24.500000 1225.0000 50.0000
OCCT-97530HMGT-OT SESSION BY OT ASST 1 2.000000 114.4000 57.2000
Subtotal (Total Children Is Unduplicated) 4 26.500000 1339.4000 50.5434
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Total 3970.500000 190388.6500 47.9508
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Number of Children (Unduplicated) With at Least One Service 529
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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 0 0.000000 0.0000 0.0000
S 169 156.250000 6744.7500 0.0000
H 337 326.500000 14727.0000 14727.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 20 30.500000 2180.2500 0.0000
---------------------------------------------------------
Total 526 513.250000 23652.0000 14727.0000
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 65 57.250000 2888.0000 0.0000
---------------------------------------------------------
Total 65 57.250000 2888.0000 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 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
5 4.500000 225.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 78 76.750000 3219.7500 0.0000
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
13 15.000000 978.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 79 117.500000 4811.6500 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 0 0.000000 0.0000 0.0000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 86 84.500000 3278.5000 2397.2500
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
233 223.000000 10156.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 233 223.000000 10156.5000 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 93 101.750000 4979.5000 4979.5000
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 155 156.000000 7221.5000 4979.5000
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 177 321.250000 14904.2500 14904.2500
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 56 109.500000 8066.2500 0.0000
---------------------------------------------------------
Total 267 495.000000 25609.2500 14904.2500
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 464 513.500000 25125.0000 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 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
5 5.000000 355.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 31 34.000000 1680.7500 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 40 57.000000 2716.0000 0.0000
P 7 8.250000 305.2500 305.2500
D 0 0.000000 0.0000 0.0000
S 3 3.500000 129.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
9 16.000000 1014.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 59 84.750000 4165.5000 305.2500
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 0 0.000000 0.0000 0.0000
53 63.500000 3130.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 287 318.750000 15028.5000 2409.2500
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 4 3.500000 129.5000 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
122 151.500000 7766.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 311 359.250000 17144.5000 3457.0000
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 132 123.000000 5725.0000 5725.0000
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
49 96.000000 6824.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 542 683.500000 35065.2500 5725.0000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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
2 16.000000 800.0000 800.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 160 253.500000 11342.0000 9955.7500