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:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 14390 47704.50000 1764655.7500 36.9914
Subtotal (Total Children Is Unduplicated) 14390 47704.50000 1764655.7500 36.9914
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 15.500000 1162.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 48 72.500000 5437.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 26 34.000000 2550.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 14 22.000000 1650.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 6.000000 450.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 29 48.500000 3637.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 9.000000 499.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 59 86.500000 4800.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 44 86.000000 6450.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 692 1191.170133 89154.0100 74.8457
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 13.000000 975.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 253 409.000000 30675.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 16.500000 1237.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 247 411.000000 30786.0000 74.9051
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 35 67.000000 3718.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 824 1360.500000 75447.9000 55.4560
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 53.500000 4012.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 349 642.500000 48187.5000 75.0000
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167TLGT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 34 36.000000 1800.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 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 5 5.000000 255.2500 51.0500
Subtotal (Total Children Is Unduplicated) 1595 4598.670133 313683.8600 68.2119
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 85 174.250000 8712.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 363 1679.750000 83987.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 2.000000 142.8800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 72 285.750000 20413.9800 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 2 2.000000 142.8800 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 85 334.500000 23896.6800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 4 3.750000 267.9000 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 53 170.250000 12162.6600 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 11 18.250000 1303.7800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 70 294.250000 20960.3800 71.2332
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 12.000000 857.2800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 70 164.250000 11734.0200 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 38 132.000000 9430.0800 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 115 410.500000 29326.1200 71.4400
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 8 9.500000 131.8600 13.8800
Subtotal (Total Children Is Unduplicated) 765 3693.000000 223470.5000 60.5119
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Total 55996.170133 2301810.1100 41.1066
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Number of Children (Unduplicated) With at Least One Service 14491
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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 1 0.750000 27.7500 0.0000
P 0 0.000000 0.0000 0.0000
D 3 2.500000 161.3800 0.0000
S 4210 2758.750000 112641.6600 0.0000
H 6686 4464.000000 185874.3100 185874.3100
T 0 0.000000 0.0000 0.0000
19 15.250000 564.2500 0.0000
Other 3 4.500000 299.5000 0.0000
---------------------------------------------------------
Total 10922 7245.750000 299568.8500 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 1548 955.000000 42135.5000 0.0000
---------------------------------------------------------
Total 1548 955.000000 42135.5000 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
62 64.750000 4273.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3381 2282.250000 90379.2400 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 0 0.000000 0.0000 0.0000
S 1 2.000000 74.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
270 307.000000 20121.0000 0.0000
Other 1 1.500000 55.5000 0.0000
---------------------------------------------------------
Total 4036 5744.750000 221302.7500 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 0 0.000000 0.0000 0.0000
D 1 1.500000 112.5000 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
5 3.250000 120.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3086 1966.500000 74721.9700 41748.7500
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
6138 4174.500000 167700.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6138 4174.500000 167700.0000 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 2587 1901.500000 76833.5000 76829.8000
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
17 16.000000 592.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3676 2687.750000 107890.2500 76829.8000
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 3737 3761.500000 147262.0000 147262.0000
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 3 13.000000 481.0000 425.5000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4372 4463.000000 174765.7500 147687.5000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 463 351.750000 13336.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2640 1921.000000 77683.7500 0.0000
P 6946 4856.750000 197742.7500 197103.8450
D 84 52.000000 2074.0000 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
0 0.000000 0.0000 0.0000
Other 2 1.750000 64.7500 0.0000
---------------------------------------------------------
Total 10223 7344.250000 301963.0000 197103.8450
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
10 7.000000 259.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 949 720.750000 28648.9200 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 270 242.000000 9200.1900 9255.6900
D 0 0.000000 0.0000 0.0000
S 321 352.000000 13702.7400 46.7500
H 0 0.000000 0.0000 0.0000
T 1 1.000000 37.0000 0.0000
20 21.250000 1202.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1948 1982.750000 85190.8800 9302.4400
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 19 8.000000 399.3200 0.0000
U 0 0.000000 0.0000 0.0000
B 2373 1993.250000 95478.9600 0.0000
P 924 803.250000 38574.4200 38498.6300
D 130 106.000000 4812.1800 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
714 627.500000 30199.2700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4160 3538.000000 169464.1500 38498.6300
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 1537 1245.000000 53956.1600 53819.0900
D 56 35.000000 1320.8300 9.2500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1915 1684.000000 76868.7800 0.0000
Other 1 1.000000 37.0000 0.0000
---------------------------------------------------------
Total 5863 4897.750000 219593.6900 53837.5900
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 2078 1263.250000 49031.3100 49883.4100
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
12 5.750000 212.7500 0.0000
Other 1 0.836800 62.7600 0.0000
---------------------------------------------------------
Total 4361 3059.920133 126523.6600 49975.9100
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 4193 4158.750000 161782.7500 159206.0500
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4863 4933.250000 191961.5000 159363.3000