CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2019 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 2602 3444.250000 127381.7500 36.9839
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1894 1947.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 4535 22787.00000 842361.5000 36.9668
Subtotal (Total Children Is Unduplicated) 4565 28179.00000 969743.2500 34.4137
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 13 37.000000 1850.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 4 4.500000 225.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 102 160.000000 11999.9999 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 51 82.000532 6150.0400 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 8.000000 600.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 37 61.500000 4466.5000 72.6260
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 8 13.500000 1012.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 39 63.500000 5255.7900 82.7683
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 7 13.500000 1012.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 127 216.000000 11988.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 19 34.000000 1887.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1796 2799.996534 208567.9400 74.4886
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 400 681.336800 50317.7000 73.8514
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 905 1436.999998 106986.8200 74.4515
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 192 313.500001 23163.9700 73.8883
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 616 945.157600 70366.6800 74.4497
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 178 315.000000 23285.0000 73.9206
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2438 3748.000000 207887.3000 55.4662
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 531 867.000000 48053.2500 55.4247
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 852 1301.009066 102318.0000 78.6451
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 148 263.000000 19725.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 8 8.000000 961.4600 120.1825
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 22 31.000000 1550.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 4240 13442.50053 912459.6499 67.8787
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 102.9300 102.9300
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 6 10.000000 500.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 11 22.500000 1125.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 3 4.750000 237.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 3.500000 87.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 9 6.000000 300.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 1 0.250000 12.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.500000 125.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 8 8.000000 400.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1 2.000000 100.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 539 566.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 24 375.000000 18750.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 5 36.750000 1837.5000 50.0000
INTR-T1013-INTERPRETER 112 238.750000 12185.0000 51.0366
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 758 1839.000000 18390.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 25.000000 1786.0000 71.4400
OCCT-97530HMGT-OT SESSION BY OT ASST 1 2.000000 114.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 4 31.500000 2250.3600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 30.000000 2143.2000 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 2 3.000000 111.0000 37.0000
TRAV-TRAVS-Travel by mile 686 24580.00000 10896.5100 0.4433
Subtotal (Total Children Is Unduplicated) 1208 27789.00000 71479.4000 2.5722
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Total 69410.500531 1953682.2999 28.1468
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Number of Children (Unduplicated) With at Least One Service 4603
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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 559 2077.000000 20813.0000 20805.5000
D 15 33.000000 763.6300 0.0000
S 170 156.750000 6763.2500 0.0000
H 1403 1351.500000 62367.5000 56795.7500
T 10 17.000000 1178.9000 1178.9000
1629 1237.750000 46853.0000 0.0000
Other 164 240.250000 15631.2500 46.2500
---------------------------------------------------------
Total 3950 5113.250000 154370.5300 78826.4000
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 185 5211.250000 9839.0700 9839.0700
0 0.000000 0.0000 0.0000
Other 1687 5186.250000 41952.5000 0.0000
---------------------------------------------------------
Total 1872 10397.500000 51791.5700 9839.0700
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 9.750000 473.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 893 899.000000 41006.0000 0.0000
P 14 87.500000 463.5200 463.5200
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
1149 1256.250000 48413.8100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2063 2252.500000 90357.0800 463.5200
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 9.750000 360.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 173 267.250000 10999.2500 0.0000
P 856 1439.500000 66879.7400 66988.8800
D 2 4.250000 157.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 2 3.000000 164.4000 0.0000
T 0 0.000000 0.0000 0.0000
1088 1118.250000 50568.5100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2127 2842.000000 129129.9000 66988.8800
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.500000 187.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 496 443.250000 17169.0000 15131.0000
P 343 3219.000000 16341.4600 16341.4600
D 2 1.500000 55.5000 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
863 611.250000 18305.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1706 4277.500000 52059.2100 31472.4600
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 39 51.500000 1995.7500 1995.7500
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 0 0.000000 0.0000 0.0000
2903 2425.750000 109533.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2942 2477.250000 111528.7500 1995.7500
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 11 14.500000 612.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 129 113.000000 4643.7500 0.0000
P 706 937.597200 39054.1500 39204.1500
D 15 23.500000 1323.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 9 18.000000 1350.0000 0.0000
T 0 0.000000 0.0000 0.0000
1211 896.152800 31790.2100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2081 2002.750000 78774.1100 39204.1500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 34 65.250000 2675.7500 0.0000
P 2598 4651.000000 164696.6700 165512.1000
D 3 2.250000 83.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 903 1173.000000 59874.5000 0.0000
T 0 0.000000 0.0000 0.0000
160 230.250000 11344.0000 0.0000
Other 254 432.500000 31755.0000 0.0000
---------------------------------------------------------
Total 3953 6555.250000 270466.1700 165512.1000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 28 24.750000 915.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 165 174.750000 7697.7500 0.0000
P 1757 2114.500000 95875.7000 95772.7200
D 7 11.000000 445.0000 0.0000
S 47 82.000000 5613.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1790 2050.750000 90796.6900 0.0000
Other 124 218.500000 14603.2500 0.0000
---------------------------------------------------------
Total 3918 4676.250000 215947.8900 95772.7200
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 167 136.750000 5511.0000 0.0000
P 204 295.250000 8080.3900 8080.3900
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
787 646.750000 23955.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1158 1078.750000 37546.6900 8080.3900
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 49 68.250000 3321.2500 150.0000
P 384 572.000000 29295.3100 27912.1300
D 0 0.000000 0.0000 0.0000
S 64 68.750000 2810.7500 0.0000
H 13 26.000000 1911.0000 0.0000
T 338 2967.000000 18256.0600 17291.0600
559 709.000000 32657.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1407 4411.000000 88252.1400 45353.1900
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 9.000000 360.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 224 242.250000 11133.7500 0.0000
P 943 999.170000 45664.0000 47366.0000
D 68 73.080000 3902.5700 0.0000
S 1 0.500000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 215 2033.500000 3818.9200 3818.9200
2574 2153.000000 62035.1900 0.0000
Other 22 26.750000 1727.2500 0.0000
---------------------------------------------------------
Total 4055 5537.250000 128642.4300 51184.9200
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 246 251.250000 11545.0000 0.0000
P 1782 1787.980000 80057.8900 79887.9900
D 38 46.520000 2956.1100 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 813 4971.250000 14632.3400 14436.5900
2995 2667.500000 78665.8600 0.0000
Other 18 16.000000 858.0000 0.0000
---------------------------------------------------------
Total 5892 9740.500000 188715.2000 94324.5800
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 469 616.750000 30049.5000 64.7500
P 1480 1767.536398 83421.4800 88139.5300
D 0 0.000000 0.0000 0.0000
S 1 2.000000 150.0000 0.0000
H 9 18.500000 1292.5000 0.0000
T 0 0.000000 0.0000 0.0000
2244 2297.214133 114073.0599 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4203 4702.000531 228986.5399 88204.2800
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 57 79.500000 3508.0000 0.0000
P 798 1169.750000 50627.9500 50446.1500
D 1 1.000000 55.5000 55.5000
S 0 0.000000 0.0000 0.0000
H 2 2.000000 150.0000 0.0000
T 70 513.500000 4615.4300 4615.4300
1191 1581.000000 68157.2100 9939.7100
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2119 3346.750000 127114.0900 65056.7900