CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2021 ending 06/30/2021 Date of Report:07/15/2021 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 857 1077.250000 39858.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 57 38.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1477 6119.250000 226199.5000 36.9652
Subtotal (Total Children Is Unduplicated) 1509 7235.000000 266057.7500 36.7737
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 3 6.000000 300.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 8 14.500000 725.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.500000 383.2500 69.6818
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 33 59.000000 4425.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 8 15.000000 1125.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 10 16.500000 1208.2500 73.2273
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 7 11.500000 862.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 10.500000 582.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 31 52.500000 2913.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 81 139.500000 10462.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 637 1056.500000 78948.5000 74.7265
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 43 72.000000 5400.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 261 416.000000 31104.9000 74.7714
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 47 84.000000 6300.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 246 400.000000 30000.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 116 208.000000 11544.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 759 1227.500000 67954.0000 55.3597
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 47 90.000000 6750.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 187 303.000000 22725.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 14 14.000000 2295.2800 163.9486
SCREEN-T1023-SCREENING 2 3.000000 150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1297 4210.000000 286572.1800 68.0694
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 17 24.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 15.000000 750.0000 50.0000
INTR-T1013-INTERPRETER 25 51.500000 2575.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 27 52.000000 520.0000 10.0000
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 2.500000 178.6000 71.4400
TRAV-TRAVS-Travel by mile 36 813.000000 359.4300 0.4421
Subtotal (Total Children Is Unduplicated) 90 958.500000 4383.0300 4.5728
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Total 12403.500000 557012.9600 44.9077
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Number of Children (Unduplicated) With at Least One Service 1570
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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 37 76.250000 3329.0400 3329.0400
D 1 15.000000 6.6700 0.0000
S 273 231.250000 10662.0000 0.0000
H 6 8.500000 569.2500 0.0000
T 13 40.500000 1035.5400 1035.5400
199 180.000000 8475.0000 0.0000
Other 45 52.500000 3264.0000 0.0000
---------------------------------------------------------
Total 574 604.000000 27341.5000 4364.5800
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 16 196.750000 1410.5100 1410.5100
5 19.500000 400.1100 0.0000
Other 371 305.750000 14338.7500 0.0000
---------------------------------------------------------
Total 392 522.000000 16149.3700 1410.5100
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 10.750000 510.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 87 109.500000 5861.2500 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
152 168.750000 9839.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 246 289.000000 16211.5000 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 17 18.000000 1118.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 29 35.750000 1925.7500 0.0000
P 46 71.750000 2879.7500 2879.7500
D 1 1.000000 75.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 7.000000 350.0000 0.0000
T 0 0.000000 0.0000 0.0000
397 555.750000 26293.2800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 492 689.250000 32642.2800 2879.7500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 12 14.250000 527.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 183 183.750000 7045.7500 4121.7500
P 74 260.000000 5688.1100 5688.1100
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
335 319.250000 10730.1500 1248.9000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 604 777.250000 23991.2600 11058.7600
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
1084 1056.750000 51194.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1084 1056.750000 51194.0000 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 14.750000 545.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 31 44.250000 2165.2500 0.0000
P 143 192.677900 9328.8425 9328.8400
D 5 10.000000 750.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 4 8.000000 600.0000 0.0000
T 0 0.000000 0.0000 0.0000
365 297.822100 11170.4075 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 556 567.500000 24560.2500 9328.8400
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 13 23.000000 888.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 70 115.250000 4723.0000 0.0000
P 651 951.500000 42847.0000 42946.5400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 204 293.500000 16387.2500 0.0000
T 4 7.000000 390.9000 0.0000
264 369.000000 16912.2500 0.0000
Other 134 254.000000 17899.5000 0.0000
---------------------------------------------------------
Total 1340 2013.250000 100047.9000 42946.5400
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 8.250000 342.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 346 421.500000 19707.7500 0.0000
P 3 6.000000 411.0000 102.7500
D 1 0.500000 18.5000 0.0000
S 40 71.500000 4992.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
274 377.500000 19442.1000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 669 885.250000 44913.6000 102.7500
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 23.000000 1471.5000 0.0000
P 5 5.000000 375.0000 375.0000
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
25 24.000000 1188.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 53 52.000000 3034.5000 375.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 10.000000 711.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 66 88.750000 3783.5000 0.0000
P 57 81.250000 3562.0000 3509.2200
D 3 6.000000 333.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 16 31.000000 2149.5000 0.0000
T 42 383.000000 1891.8000 1629.8000
92 116.500000 5235.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 281 716.500000 17665.8000 5139.0200
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 150 153.500000 7110.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 194 196.000000 9153.2500 0.0000
P 110 127.250000 6250.5000 6250.5000
D 0 0.000000 0.0000 0.0000
S 7 10.000000 750.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
390 324.750000 15264.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 851 811.500000 38528.5000 6250.5000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 130 136.000000 6113.0000 0.0000
P 141 191.750000 9027.7500 9166.9000
D 0 0.000000 0.0000 0.0000
S 5 7.500000 562.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 3 5.500000 383.2500 383.2500
407 454.750000 21438.2500 0.0000
Other 3 6.000000 355.0000 145.0000
---------------------------------------------------------
Total 689 801.500000 37879.7500 9695.1500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 589 728.000000 34339.0000 0.0000
P 13 24.859733 1553.4800 1553.4800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 20 39.226267 2891.9700 0.0000
T 0 0.000000 0.0000 0.0000
730 654.414000 32409.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1352 1446.500000 71193.5000 1553.4800
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 63 108.250000 4306.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 88 139.000000 6530.2500 0.0000
P 175 280.500000 12520.2500 12411.7500
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 4 16.000000 480.0000 480.0000
445 608.250000 27110.2500 0.0000
Other 8 17.750000 656.7500 499.5000
---------------------------------------------------------
Total 785 1171.250000 51659.2500 13391.2500