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
Payclass Filters:GR
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 3443.750000 127363.2500 36.9839
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1715 1838.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1812 8869.250000 327857.0000 36.9656
Subtotal (Total Children Is Unduplicated) 3766 14151.50000 455220.2500 32.1676
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 11 29.000000 1450.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 4 4.500000 225.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 22 33.038134 2477.8600 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 9.000000 675.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 10.492666 786.9500 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 9.000000 675.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 11 16.000000 1200.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 25 41.000000 2275.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 5.500000 305.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 370 557.057733 41532.1300 74.5562
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 54 88.670133 6542.3000 73.7825
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 174 258.376665 19378.2500 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 28 45.955335 3446.6500 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 150 226.657600 16999.3200 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 38 67.000000 5025.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 581 825.500000 45759.7500 55.4328
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 90 153.000000 8491.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 183 262.319466 19673.9600 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 32.000000 2400.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 6 6.000000 353.4600 58.9100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 13 21.000000 1050.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 1071 2711.067732 181424.9800 66.9201
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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 10 21.500000 1075.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 3 4.750000 237.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 3.000000 75.0000 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 7 7.000000 350.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1 2.000000 100.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 539 566.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 86.000000 4300.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 7.000000 350.0000 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
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 71.4400 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 27434.75000 53123.5800 1.9364
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Total 44297.317732 689768.8100 15.5713
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Number of Children (Unduplicated) With at Least One Service 3936
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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 196 1733.000000 5376.9300 5376.9300
D 6 24.000000 352.4800 0.0000
S 1 0.500000 18.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 2 3.000000 225.0000 225.0000
1592 1190.250000 43544.0000 0.0000
Other 3 4.500000 337.5000 0.0000
---------------------------------------------------------
Total 1800 2955.250000 49854.4100 5601.9300
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 167 5176.750000 7326.5700 7326.5700
0 0.000000 0.0000 0.0000
Other 1101 4712.000000 20391.5000 0.0000
---------------------------------------------------------
Total 1268 9888.750000 27718.0700 7326.5700
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 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
1133 1234.250000 46954.3100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1147 1321.750000 47417.8300 463.5200
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 4 3.500000 98.8000 98.8000
D 2 4.250000 157.2500 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
939 997.250000 41981.2600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 945 1005.000000 42237.3100 98.8000
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 342 3217.500000 16228.9600 16228.9600
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
863 611.250000 18305.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1205 3828.750000 34534.7100 16228.9600
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 32 40.000000 1260.0000 1260.0000
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
1633 1107.000000 39796.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1665 1147.000000 41056.0000 1260.0000
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 143 231.500000 4558.6100 4558.6100
D 11 15.500000 723.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 8 16.000000 1200.0000 0.0000
T 0 0.000000 0.0000 0.0000
1191 867.402800 30137.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1353 1130.402800 36619.5700 4558.6100
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 1518 2912.750000 77606.6000 77606.6000
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
128 177.750000 7669.7500 0.0000
Other 6 10.000000 711.0000 0.0000
---------------------------------------------------------
Total 1652 3100.500000 85987.3500 77606.6000
Center 10
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 65 224.000000 8979.2000 8979.2000
D 1 1.000000 37.0000 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
1454 1399.250000 47115.0000 0.0000
Other 114 198.500000 13181.2500 0.0000
---------------------------------------------------------
Total 1634 1822.750000 69312.4500 8979.2000
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 99 201.000000 4120.0900 4120.0900
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
747 606.750000 21037.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 846 807.750000 25157.8400 4120.0900
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 39 36.000000 1221.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 208 2711.500000 3334.9100 3159.9100
411 426.000000 14726.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 658 3173.500000 19281.9100 3159.9100
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 23 26.000000 1189.0000 0.0000
S 1 0.500000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 213 2030.000000 3556.4200 3556.4200
2347 1816.500000 41336.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2584 3873.000000 46081.8600 3556.4200
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 1 0.750000 0.0000 55.5000
D 1 0.250000 9.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 750 4887.250000 9699.3400 9503.5900
2590 2113.500000 46048.3600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3342 7001.750000 55756.9500 9559.0900
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 110 181.536398 10873.4800 10873.4800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.500000 92.5000 0.0000
T 0 0.000000 0.0000 0.0000
1785 1443.628534 54061.1400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1896 1627.664932 65027.1200 10873.4800
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 1 0.500000 18.5000 18.5000
D 1 1.000000 55.5000 55.5000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 52 465.500000 1932.4300 1932.4300
896 1146.500000 41719.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 950 1613.500000 43725.4300 2006.4300