CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/21/2020 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
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 12421 15757.00000 582752.0000 36.9837
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 247 231.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 21695 73263.25000 2710033.5000 36.9904
Subtotal (Total Children Is Unduplicated) 22903 89251.75000 3292785.5000 36.8932
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 12 12.000000 582.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 47 74.000000 3700.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 5 7.000000 350.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 107 151.000000 7550.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 25 39.500000 2962.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 64 99.000000 7425.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 6.000000 450.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 39 55.500000 4162.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 8.500000 637.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 21 34.000000 2550.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 11 11.500000 862.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 43 75.000000 5625.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 24 34.000000 1887.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 86 155.500000 8630.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 105 185.000000 13875.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1106 1978.000000 147877.0000 74.7609
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 31.000000 2325.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 427 701.000000 52525.0000 74.9287
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 29 45.500000 3412.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 372 636.000000 47611.0000 74.8601
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 98 159.500000 8852.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1311 2307.000000 127668.5200 55.3396
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 46 80.000000 6000.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 545 1007.500000 75562.5000 75.0000
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
OCTH-97167TLGT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161GT-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 52 54.000000 2700.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 10.000000 510.5000 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 357.3500 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 6 6.000000 306.3000 51.0500
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 2758 7987.000000 537818.5200 67.3367
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 65 54.750000 2737.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 241 281.750000 14087.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 112 117.750000 2943.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 189 151.000000 7550.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 840 827.000000 41337.5000 49.9849
CONIP-CONIP-CONSULT, ITDS PHONE 39 55.250000 1381.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 132 63.750000 3187.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 637 418.500000 20925.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 21 14.750000 368.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 128 74.250000 3712.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 374 246.500000 12325.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 48 24.000000 593.7500 24.7396
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 191 141.750000 7075.0000 49.9118
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 624 599.750000 29975.0000 49.9792
CONSP-CONSP-CONSULT, SLP, PHONE 56 59.500000 1487.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 53 56.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 118 273.750000 13687.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 523 2581.750000 129087.5000 50.0000
INTR-T1013-INTERPRETER 52 146.750000 7337.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 92 253.000000 2530.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 9 8.500000 607.2400 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 149 662.750000 47382.5800 71.4939
OCCT-97530TL-OT SESSION BY LICENSED OT 2 2.000000 142.8800 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 93 364.500000 26039.8800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 13 29.000000 2071.7600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 126 589.340000 42139.0000 71.5020
PHY-97110TL-PT SESSION BY LICENSED PT 11 18.250000 1303.7800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 70 297.000000 21156.8400 71.2352
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 36 114.500000 8110.1900 70.8314
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 258 1211.500000 86169.9800 71.1267
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 38 132.000000 9430.0800 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 120 437.500000 31255.0000 71.4400
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 8 9.500000 131.8600 13.8800
CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/21/2020 Page: 2
List order: No List
Agency Filter:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 241 433.750000 16048.7500 37.0000
TRAV-TRAVS-Travel by mile 105 3996.000000 1777.8700 0.4449
Subtotal (Total Children Is Unduplicated) 2280 14747.84000 596097.6900 40.4193
-----------------------------------------------------------------------------------------------------------------------
Total 111986.590000 4426701.7100 39.5289
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 23077
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.750000 27.7500 0.0000
P 0 0.000000 0.0000 0.0000
D 15 14.500000 812.0800 0.0000
S 4229 2768.750000 113080.5400 0.0000
H 7235 5023.250000 221323.0300 185874.3100
T 0 0.000000 0.0000 0.0000
7266 4509.000000 182609.5200 0.0000
Other 3 4.500000 299.5000 0.0000
---------------------------------------------------------
Total 18749 12320.750000 518152.4200 185874.3100
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 4638 2368.000000 99299.5000 0.0000
---------------------------------------------------------
Total 4638 2368.000000 99299.5000 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 172 137.750000 5481.2100 0.0000
U 0 0.000000 0.0000 0.0000
B 3147 2079.750000 80624.2500 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
3986 2451.000000 108068.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7305 4668.500000 194173.5900 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 330 497.000000 18389.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2906 4249.000000 157198.0000 0.0000
P 528 688.250000 25465.2500 25420.8500
D 3 5.500000 203.5000 0.0000
S 2 2.500000 92.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3574 3463.500000 144460.5000 0.0000
Other 1 1.500000 55.5000 0.0000
---------------------------------------------------------
Total 7344 8907.250000 345864.2500 25420.8500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 26 31.000000 1934.3200 0.0000
U 0 0.000000 0.0000 0.0000
B 3054 1930.750000 72554.9000 41748.7500
P 38 56.000000 3879.1000 3879.1000
D 35 24.750000 1029.7500 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
2510 1417.250000 52340.2500 50.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5663 3459.750000 131738.3200 45677.8500
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
13057 7958.750000 317660.4700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13057 7958.750000 317660.4700 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 13 12.000000 444.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1059 758.250000 30020.7500 0.0000
P 2588 1901.750000 76842.7500 76839.0500
D 35 16.750000 619.7500 0.0000
S 1 1.250000 46.2500 0.0000
H 5 10.000000 750.0000 0.0000
T 0 0.000000 0.0000 0.0000
6946 3486.250000 132802.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10647 6186.250000 241526.2500 76839.0500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 39 50.500000 2146.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 593 638.000000 24876.2500 0.0000
P 10435 9390.000000 364596.8500 364824.7500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 90 144.000000 8012.2500 0.0000
T 3 13.000000 481.0000 425.5000
3717 3250.250000 125391.3900 9.2500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14877 13485.750000 525504.2400 365259.5000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 463 351.750000 13336.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2644 1923.000000 77757.7500 0.0000
P 6948 4858.000000 197789.0000 197265.8450
D 103 69.250000 2712.2500 0.0000
S 88 161.000000 11061.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5138 3858.000000 162643.0000 0.0000
Other 23 34.750000 2325.2500 0.0000
---------------------------------------------------------
Total 15407 11255.750000 467625.0000 197265.8450
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 8.000000 296.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 906 690.250000 27513.9200 0.0000
P 3 2.500000 99.0000 74.0000
D 15 13.000000 481.0000 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
1349 906.500000 34164.2100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2288 1620.250000 62554.1300 74.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 6.000000 450.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1333 1360.500000 60598.7000 0.0000
P 287 269.500000 10895.7000 10765.3200
D 0 0.000000 0.0000 0.0000
S 334 363.500000 14303.0000 46.7500
H 46 51.750000 3544.0200 0.0000
T 732 4579.250000 27911.2300 20904.5600
2095 1533.750000 61667.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4830 8164.250000 179370.4500 31716.6300
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 19 8.000000 399.3200 0.0000
U 0 0.000000 0.0000 0.0000
B 2386 1999.000000 95691.7100 0.0000
P 935 813.590000 39313.9400 39680.9500
D 170 140.750000 6512.5700 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
7106 4456.500000 198285.7700 0.0000
Other 27 26.500000 1893.1600 0.0000
---------------------------------------------------------
Total 10643 7444.340000 342096.4700 39680.9500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 4.500000 261.2100 0.0000
U 0 0.000000 0.0000 0.0000
B 2347 1928.250000 87149.7100 9.2500
P 1540 1245.750000 53983.9100 53846.8400
D 84 63.250000 3339.0100 9.2500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 0.750000 27.7500 0.0000
9519 6099.750000 275375.2600 0.0000
Other 29 28.000000 1965.8800 0.0000
---------------------------------------------------------
Total 13527 9370.250000 422102.7300 53865.3400
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2270 1790.083333 77216.8400 92.5000
P 2088 1269.250000 49391.0700 50260.3900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 45 67.250000 4647.1900 0.0000
T 0 0.000000 0.0000 0.0000
4900 2918.329867 112887.7800 0.0000
Other 1 0.836800 62.7600 0.0000
---------------------------------------------------------
Total 9304 6045.750000 244205.6400 50352.8900
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 9.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 668 773.250000 30094.5000 157.2500
P 4204 4164.500000 161995.5000 159418.8000
D 2 1.750000 64.7500 64.7500
S 0 0.000000 0.0000 0.0000
H 1 1.000000 75.0000 0.0000
T 0 0.000000 0.0000 0.0000
4644 3790.250000 142589.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9520 8731.000000 334828.2500 159640.8000