CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2021 ending 03/31/2021 Date of Report:05/04/2021 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 790 922.250000 34123.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 43 31.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1530 6952.250000 257233.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1551 7906.250000 291356.5000 36.8514
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 5 9.000000 450.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 10 20.500000 1025.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 15.500000 1162.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 23 40.000000 3000.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 16 28.000000 2100.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 11 18.500000 1387.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.500000 787.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 8 14.000000 1050.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 13 25.500000 1415.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 31 55.000000 3052.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 45 74.500000 5568.0000 74.7383
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 605 1010.000000 75686.8100 74.9374
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 17 27.000000 2025.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 303 485.500000 36412.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 17 29.000000 2175.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 266 441.000000 32905.0000 74.6145
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 73 123.500000 6854.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 742 1219.500000 67497.9700 55.3489
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 28 53.500000 4012.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 222 368.500000 27637.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 11 11.000000 2363.6400 214.8764
SCREEN-T1023-SCREENING 3 3.000000 150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1231 4083.500000 278768.4200 68.2670
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EI Services,Class #03
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 11 11.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
INTR-T1013-INTERPRETER 30 50.750000 2537.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 32 45.000000 450.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 1.750000 125.0200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 2 4.500000 321.4800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 1 2.000000 142.8800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 285.7600 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
TRAV-TRAVS-Travel by mile 29 888.000000 395.1100 0.4449
Subtotal (Total Children Is Unduplicated) 98 1011.500000 4500.6300 4.4495
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Total 13001.250000 574625.5500 44.1977
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Number of Children (Unduplicated) With at Least One Service 1591
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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 40 56.750000 3126.2500 3043.0000
D 4 5.500000 243.5600 0.0000
S 399 373.500000 17700.2500 0.0000
H 267 210.000000 9010.7500 8560.7500
T 1 1.500000 112.5000 112.5000
393 324.500000 14791.2500 0.0000
Other 78 90.500000 5771.7500 972.0000
---------------------------------------------------------
Total 1182 1062.250000 50756.3100 12688.2500
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 24 670.500000 1564.0800 1564.0800
1 2.000000 150.0000 0.0000
Other 392 305.000000 13945.5000 0.0000
---------------------------------------------------------
Total 417 977.500000 15659.5800 1564.0800
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.750000 27.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 121 134.750000 5884.5000 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
232 270.750000 14327.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 354 406.250000 20239.7500 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 4.750000 288.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 62 107.750000 4373.0000 0.0000
P 85 149.250000 5616.7500 5513.7400
D 2 1.500000 341.5000 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
247 280.500000 15432.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 401 543.750000 26052.3900 5513.7400
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 255 250.250000 9715.2500 6581.2500
P 95 188.500000 6560.3000 6560.3000
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
302 251.250000 9316.2500 112.5000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 652 690.000000 25591.8000 13254.0500
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 5 5.500000 123.2500 123.2500
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
929 847.500000 40087.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 934 853.000000 40211.0000 123.2500
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.500000 92.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 24 18.500000 684.5000 0.0000
P 224 280.000000 12630.0000 12630.0000
D 1 2.000000 150.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 4.000000 300.0000 0.0000
T 0 0.000000 0.0000 0.0000
421 293.000000 11173.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 674 600.000000 25030.5000 12630.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9 13.500000 621.2500 0.0000
P 592 907.000000 41222.7500 41274.7500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 153 216.000000 12097.5000 0.0000
T 0 0.000000 0.0000 0.0000
69 129.500000 8303.2500 0.0000
Other 55 109.500000 7832.2500 0.0000
---------------------------------------------------------
Total 878 1375.500000 70077.0000 41274.7500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 13 12.750000 585.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 149 168.000000 7095.7500 0.0000
P 473 549.000000 26191.0000 26191.0000
D 1 2.000000 111.0000 0.0000
S 30 56.500000 3837.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
491 625.250000 31297.0100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1157 1413.500000 69118.2600 26191.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 23 22.500000 1356.0000 0.0000
P 7 8.000000 527.8800 527.8800
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
119 108.000000 4714.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 149 138.500000 6598.0700 527.8800
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9 13.500000 887.7500 0.0000
P 68 112.750000 5336.2200 5336.2200
D 6 12.000000 666.0000 0.0000
S 11 12.000000 481.0000 0.0000
H 12 24.000000 1683.0000 0.0000
T 24 183.000000 1726.7300 1526.7300
96 128.500000 5671.7500 130.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 226 485.750000 16452.4500 6992.9500
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 9.500000 351.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 128 145.000000 7653.5000 0.0000
P 85 92.750000 4263.2500 4263.2500
D 44 40.000000 1480.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.500000 83.2500 83.2500
298 249.500000 11712.1900 0.0000
Other 1 0.250000 9.2500 9.2500
---------------------------------------------------------
Total 564 538.500000 25552.9400 4355.7500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 346 395.250000 18903.7500 0.0000
P 169 193.750000 8573.7500 8573.7500
D 18 23.750000 954.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 1 0.250000 9.2500 9.2500
T 8 13.000000 848.2500 848.2500
235 248.750000 12253.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 777 874.750000 41543.0000 9431.2500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 599 695.250000 31802.2500 0.0000
P 50 74.300000 3953.5000 3916.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 13 26.000000 1950.0000 0.0000
T 0 0.000000 0.0000 0.0000
751 655.700000 33798.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1413 1451.250000 71504.0000 3916.5000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 14 22.750000 1164.7500 0.0000
P 436 703.500000 30434.7500 29721.6600
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
599 864.000000 38620.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1050 1590.750000 70238.5000 29721.6600