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:MED
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 2592 13509.25000 499408.5000 36.9679
Subtotal (Total Children Is Unduplicated) 2592 13509.25000 499408.5000 36.9679
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 58 93.500000 7012.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 10 19.000000 1425.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 32 54.500000 4087.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 24 39.500000 2962.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 7.000000 525.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 19 30.500000 2250.0000 73.7705
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 7.500000 562.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 71 122.000000 6771.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 10 18.000000 999.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 824 1253.500000 93930.4000 74.9345
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 204 351.500000 26362.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 487 741.000000 55575.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 91 152.000000 11400.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 307 479.000000 35886.0000 74.9186
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 104 180.500000 13537.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1249 1836.500000 101898.0000 55.4849
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 271 452.500000 25113.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 473 712.500000 53400.0000 74.9474
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 101 179.500000 13462.5000 75.0000
SCREEN-T1023-SCREENING 9 10.000000 500.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 2238 6744.000000 457936.7000 67.9028
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 211.500000 10575.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 28.250000 1412.5000 50.0000
OCCT-97530HMGT-OT SESSION BY OT ASST 1 2.000000 114.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 2 4.000000 285.7600 71.4400
Subtotal (Total Children Is Unduplicated) 16 245.750000 12387.6600 50.4076
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Total 20499.000000 969732.8600 47.3063
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Number of Children (Unduplicated) With at Least One Service 2629
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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 306 258.000000 10019.0000 10011.5000
D 7 7.000000 280.6500 0.0000
S 169 156.250000 6744.7500 0.0000
H 1345 1268.500000 56795.7500 56795.7500
T 0 0.000000 0.0000 0.0000
14 17.000000 1099.5000 0.0000
Other 151 221.250000 14274.5000 46.2500
---------------------------------------------------------
Total 1992 1928.000000 89214.1500 66853.5000
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 586 474.250000 21561.0000 0.0000
---------------------------------------------------------
Total 586 474.250000 21561.0000 0.0000
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 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
6 6.500000 336.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 906 915.250000 41815.7500 0.0000
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 797 1384.000000 57249.7500 57358.8900
D 0 0.000000 0.0000 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
121 94.500000 6200.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1099 1758.500000 74974.4000 57358.8900
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 0 0.000000 0.0000 0.0000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 500 447.250000 17412.0000 15131.0000
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
1002 979.250000 46224.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1002 979.250000 46224.0000 0.0000
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 536 656.750000 30819.5000 30969.5000
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
5 2.750000 101.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 681 787.000000 36177.5000 30969.5000
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 820 1351.250000 64173.5000 64173.5000
D 3 2.250000 83.2500 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
7 12.500000 898.5000 0.0000
Other 204 356.000000 26085.7500 0.0000
---------------------------------------------------------
Total 1069 1788.250000 93953.7500 64173.5000
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 1692 1890.500000 86896.5000 86793.5200
D 6 10.000000 408.0000 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
1 1.000000 71.4400 0.0000
Other 10 20.000000 1422.0000 0.0000
---------------------------------------------------------
Total 1949 2203.000000 103025.1900 86793.5200
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 104 93.250000 3909.2500 3909.2500
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
40 40.000000 2917.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 311 270.000000 12337.8000 3909.2500
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 344 495.500000 24001.0000 24080.0500
D 0 0.000000 0.0000 0.0000
S 25 32.750000 1589.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
74 143.500000 8822.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 492 740.000000 37734.2500 24230.0500
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 9.000000 360.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 221 239.500000 11032.0000 0.0000
P 940 995.250000 45416.5000 47096.0000
D 28 26.000000 1349.3200 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
138 196.500000 11388.2500 0.0000
Other 8 8.250000 437.2500 0.0000
---------------------------------------------------------
Total 1343 1474.500000 69984.0700 47096.0000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 246 251.250000 11545.0000 0.0000
P 1778 1783.750000 79796.5000 79504.9000
D 26 27.250000 1559.7500 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
333 440.000000 24766.2500 0.0000
Other 14 9.000000 333.0000 0.0000
---------------------------------------------------------
Total 2397 2511.250000 118000.5000 79504.9000
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 1326 1498.000000 65948.0000 70666.0500
D 0 0.000000 0.0000 0.0000
S 1 2.000000 150.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
356 700.000000 48857.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2152 2816.750000 145004.5000 70730.8000
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 787 1164.250000 50252.2500 50070.4500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
34 160.000000 8403.7500 8403.7500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 880 1405.750000 62314.0000 58474.2000