CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 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 815 1011.000000 37407.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 66 67.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1361 6071.500000 224528.9500 36.9808
Subtotal (Total Children Is Unduplicated) 1383 7150.250000 261935.9500 36.6331
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 3 10.000000 500.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 23 43.000000 3225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 13 25.500000 1912.5000 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 13 22.500000 1687.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 12.000000 666.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 30 50.000000 2775.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 115 197.000000 14775.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 514 855.000000 64016.5000 74.8731
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 33 57.500000 4312.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 246 400.499998 29959.5000 74.8052
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 48 85.500000 6242.5000 73.0117
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 194 317.500000 23754.0000 74.8157
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 180 321.500000 17843.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 664 1117.500000 61996.2500 55.4776
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 64 118.000000 8850.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 163 292.500000 21937.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 14 14.000000 3095.4000 221.1000
Subtotal (Total Children Is Unduplicated) 1219 3967.499998 269548.4000 67.9391
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EI Services,Class #03
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 1 2.000000 100.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 17 22.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 2.000000 100.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
INTR-T1013-INTERPRETER 26 48.250000 2162.5000 44.8187
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 51 73.000000 730.0000 10.0000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 0.500000 18.5000 37.0000
TRAV-TRAVS-Travel by mile 45 1263.000000 561.9200 0.4449
Subtotal (Total Children Is Unduplicated) 127 1412.500000 3722.9200 2.6357
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Total 12530.249998 535207.2700 42.7132
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Number of Children (Unduplicated) With at Least One Service 1492
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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 23 34.250000 2122.7500 2122.7500
D 10 16.500000 1056.5000 0.0000
S 59 74.500000 3888.5000 0.0000
H 5 6.000000 391.5000 0.0000
T 24 37.000000 2228.5000 2228.5000
34 47.250000 2874.5000 0.0000
Other 23 31.500000 2063.2500 0.0000
---------------------------------------------------------
Total 178 247.000000 14625.5000 4351.2500
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 33 522.000000 1967.3600 1967.3600
3 20.000000 28.0100 0.0000
Other 536 387.500000 15721.8700 0.0000
---------------------------------------------------------
Total 572 929.500000 17717.2400 1967.3600
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.750000 27.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 86 128.500000 7071.7500 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
157 198.750000 11137.7500 0.0000
Other 4 6.500000 240.5000 0.0000
---------------------------------------------------------
Total 248 334.500000 18477.7500 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 75.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 129 226.750000 9611.6300 0.0000
P 18 31.500000 1165.5000 1165.5000
D 2 3.750000 138.7500 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
241 296.750000 16887.0200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 391 559.750000 27877.9000 1165.5000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 5.750000 212.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 187 164.250000 6077.2500 1951.7500
P 124 447.000000 8319.2000 8319.2000
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
476 495.500000 12997.4500 195.4500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 792 1112.500000 27606.6500 10466.4000
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 6 8.000000 431.0000 431.0000
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
985 1015.500000 51012.0000 0.0000
Other 52 51.000000 1887.0000 0.0000
---------------------------------------------------------
Total 1043 1074.500000 53330.0000 431.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 6.250000 231.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 87 126.500000 6219.5000 0.0000
P 105 145.750000 6615.7500 6588.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 6.000000 450.0000 0.0000
T 0 0.000000 0.0000 0.0000
454 342.500000 13173.5000 0.0000
Other 10 8.000000 333.0000 0.0000
---------------------------------------------------------
Total 662 635.000000 27023.0000 6588.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 40 63.250000 2983.5000 0.0000
P 530 747.000000 33828.0000 33869.3600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 132 185.000000 10688.0000 0.0000
T 1 2.000000 111.0000 0.0000
196 280.250000 13343.5000 0.0000
Other 72 130.750000 9350.7500 0.0000
---------------------------------------------------------
Total 971 1408.250000 70304.7500 33869.3600
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 274 334.250000 15793.5000 0.0000
P 1 2.250000 83.2500 16.6500
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
331 474.000000 23909.7500 0.0000
Other 62 64.000000 2707.0000 0.0000
---------------------------------------------------------
Total 668 874.500000 42493.5000 16.6500
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 21 22.000000 590.5000 590.5000
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 5.500000 373.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 26 27.500000 964.0000 590.5000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 13 18.750000 1110.7500 0.0000
P 66 107.500000 5054.5000 5002.1500
D 6 12.000000 666.0000 0.0000
S 4 4.500000 166.5000 0.0000
H 4 8.000000 600.0000 37.5000
T 29 324.000000 1113.3300 1013.3300
135 179.500000 8604.2500 520.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 257 654.250000 17315.3300 6572.9800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 163 192.750000 9204.5000 0.0000
P 85 107.000000 4683.7500 4683.7500
D 0 0.000000 0.0000 0.0000
S 23 12.750000 528.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 2 3.000000 166.5000 166.5000
422 370.250000 17332.2500 0.0000
Other 26 20.000000 777.0000 0.0000
---------------------------------------------------------
Total 721 705.750000 32692.7500 4850.2500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 13 26.000000 1738.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 227 249.750000 10398.7500 0.0000
P 76 111.750000 5651.7500 5651.7500
D 11 11.000000 483.0000 0.0000
S 1 1.000000 75.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 8 16.000000 800.0000 800.0000
423 499.750000 23484.7000 0.0000
Other 7 9.500000 388.5000 0.0000
---------------------------------------------------------
Total 766 924.750000 43019.7000 6451.7500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 396 563.500000 27639.0000 0.0000
P 13 24.602533 1717.1900 1717.1900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 21 42.000000 3150.0000 0.0000
T 0 0.000000 0.0000 0.0000
804 720.397465 33971.8100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1234 1350.499998 66478.0000 1717.1900
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 112 214.250000 9352.5000 0.0000
P 197 356.750000 17383.2500 17383.2500
D 0 0.000000 0.0000 0.0000
S 1 1.500000 83.2500 83.2500
H 0 0.000000 0.0000 0.0000
T 3 5.250000 260.0000 20.3500
502 1112.750000 48118.9500 0.0000
Other 1 1.500000 83.2500 0.0000
---------------------------------------------------------
Total 816 1692.000000 75281.2000 17486.8500