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
Payclass Filters:GR
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 15752.50000 582585.5000 36.9837
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 247 231.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7562 25410.00000 939874.0000 36.9884
Subtotal (Total Children Is Unduplicated) 16191 41394.00000 1522459.5000 36.7797
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 12 12.000000 582.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 45 70.250000 3512.5000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 5 7.000000 350.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 97 139.000000 6950.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 8.000000 600.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 11 18.000000 1350.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 10 15.500000 1162.5000 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 5 8.000000 600.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 5.500000 412.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 6 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 7.000000 388.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 38 57.000000 3163.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 19.000000 1425.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 131 241.336800 18100.2600 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 77 121.500000 9112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 40 70.000000 5250.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 14 19.000000 1054.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 271 457.000000 25363.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 97 167.500000 12562.5000 75.0000
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 14 14.000000 700.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 2.118511 108.1500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.0500 51.0500
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 674 1497.205311 95485.2100 63.7756
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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 16 26.750000 1337.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 84 383.500000 19175.0000 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 1 1.000000 71.4400 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 26 103.000000 7358.3200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 4 8.500000 607.2400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 22 131.000000 9358.6400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 10.750000 698.2900 64.9572
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 44 183.750000 13091.8800 71.2483
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
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) 1914 8865.250000 229151.3700 25.8483
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Total 51756.455311 1847096.0800 35.6882
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Number of Children (Unduplicated) With at Least One Service 16675
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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 12 12.000000 650.7000 0.0000
S 17 8.000000 296.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6975 4204.750000 164024.2600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7004 4224.750000 164970.9600 0.0000
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 3090 1413.000000 57164.0000 0.0000
---------------------------------------------------------
Total 3090 1413.000000 57164.0000 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
3830 2281.500000 96610.3700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3830 2281.500000 96610.3700 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 0 0.000000 0.0000 0.0000
D 3 5.500000 203.5000 0.0000
S 1 0.500000 18.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3271 3116.250000 121407.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3275 3122.250000 121629.7500 0.0000
Center 05
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 34 50.000000 3446.9000 3446.9000
D 34 23.250000 917.2500 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
2505 1414.000000 52220.0000 50.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2573 1487.250000 56584.1500 3496.9000
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
6732 3499.250000 130316.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6732 3499.250000 130316.9200 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 0 0.000000 0.0000 0.0000
P 1 0.250000 9.2500 9.2500
D 35 16.750000 619.7500 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
6842 3368.000000 127059.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6879 3387.000000 127838.5000 9.2500
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 6583 5475.000000 207441.3900 207441.3900
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
3653 3151.750000 119104.3800 9.2500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10236 8626.750000 326545.7700 207450.6400
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4 2.000000 74.0000 0.0000
P 2 1.250000 46.2500 162.0000
D 19 17.250000 638.2500 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
4900 3338.000000 126753.2500 0.0000
Other 21 33.000000 2260.5000 0.0000
---------------------------------------------------------
Total 4946 3391.500000 129772.2500 162.0000
Center 51
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
1338 898.000000 33849.7100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1338 898.000000 33849.7100 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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 9 7.500000 314.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 534 4376.000000 14614.5300 12615.8100
1903 1308.500000 47157.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2446 5692.000000 62086.5300 12615.8100
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 19 13.750000 543.1900 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
5915 3313.250000 134869.4900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5934 3327.000000 135412.6800 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 3 0.750000 27.7500 27.7500
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 0.750000 27.7500 0.0000
7157 3953.500000 165980.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7161 3955.000000 166036.1600 27.7500
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 5 2.000000 74.0000 91.2200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 3.250000 209.2500 0.0000
T 0 0.000000 0.0000 0.0000
4778 2818.205311 105981.3300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4786 2823.455311 106264.5800 91.2200
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 4 1.000000 37.0000 37.0000
D 2 1.750000 64.7500 64.7500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4519 3625.000000 131912.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4525 3627.750000 132013.7500 101.7500