CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2022 ending 06/30/2022 Date of Report:08/08/2022 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 1037 1180.750000 43687.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 124 120.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1837 7362.000000 272218.2500 36.9761
Subtotal (Total Children Is Unduplicated) 1879 8662.750000 315906.0000 36.4672
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 4 13.500000 675.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 24.500000 1837.5000 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 11 18.500000 1387.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 10.500000 787.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 16 29.500000 2212.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 13.500000 1012.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 7 14.000000 1050.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 26 36.000000 1998.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 36 63.500000 3524.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 240 435.500000 32322.5000 74.2193
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 520 892.000000 66752.5300 74.8347
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 82 138.000000 10350.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 254 408.000000 30600.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 104 177.000000 13155.0000 74.3220
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 185 304.500000 22808.2500 74.9039
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 273 473.500000 26279.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 718 1220.500000 67487.7500 55.2952
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 104 170.000000 12750.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 145 241.000000 18037.5000 74.8444
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 23 23.000000 3278.0800 142.5252
SCREEN-T1023-SCREENING 4 5.000000 250.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1410 4760.500000 322130.6100 67.6674
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 1 0.750000 37.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 3.000000 150.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 4.000000 200.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 36 36.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 34.000000 1700.0000 50.0000
INTR-T1013-INTERPRETER 46 107.500000 5337.5000 49.6512
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 106 187.000000 1780.0000 9.5187
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
TRAV-TRAVS-Travel by mile 120 4068.000000 1807.0000 0.4442
Subtotal (Total Children Is Unduplicated) 234 4442.000000 11083.4400 2.4951
-----------------------------------------------------------------------------------------------------------------------
Total 17865.250000 649120.0500 36.3342
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1930
-----------------------------------------------------------------------------------------------------------------------
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 69 193.000000 5800.9100 5800.9100
D 2 2.000000 100.0000 0.0000
S 81 80.250000 4387.2500 0.0000
H 223 214.500000 9729.5000 8618.7500
T 0 0.000000 0.0000 0.0000
278 234.250000 10403.7500 0.0000
Other 57 65.750000 4276.0000 0.0000
---------------------------------------------------------
Total 710 789.750000 34697.4100 14419.6600
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 64 1094.250000 4172.7000 4061.7000
16 606.000000 1126.8100 0.0000
Other 755 1159.000000 18984.0300 0.0000
---------------------------------------------------------
Total 835 2859.250000 24283.5400 4061.7000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 152 198.500000 9533.7500 0.0000
P 2 4.500000 225.0000 225.0000
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
444 552.500000 29381.9400 0.0000
Other 84 100.750000 4751.2500 0.0000
---------------------------------------------------------
Total 682 856.250000 43891.9400 225.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 3.000000 205.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 75 94.750000 4432.1500 0.0000
P 97 165.750000 6432.7500 6429.7900
D 14 23.500000 1009.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 3 12.000000 600.0000 0.0000
T 0 0.000000 0.0000 0.0000
283 353.500000 18716.4300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 475 652.500000 31396.5800 6429.7900
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 227 205.750000 7612.7500 5272.5000
P 165 1059.000000 9105.1500 9105.1500
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
454 332.000000 11141.9200 125.1700
Other 2 0.750000 27.7500 0.0000
---------------------------------------------------------
Total 848 1597.500000 27887.5700 14502.8200
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 11.000000 595.7500 595.7500
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
888 889.750000 41406.7500 0.0000
Other 20 14.750000 545.7500 0.0000
---------------------------------------------------------
Total 914 915.500000 42548.2500 595.7500
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 48 71.250000 3773.2500 0.0000
P 208 244.685500 11103.9125 11103.9100
D 3 3.750000 214.7500 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
471 336.064500 13998.0875 0.0000
Other 35 17.500000 647.5000 0.0000
---------------------------------------------------------
Total 768 679.250000 30111.5000 11103.9100
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 65 99.750000 5110.5000 0.0000
P 664 914.250000 40138.2500 40154.9600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 170 229.500000 12926.7500 0.0000
T 0 0.000000 0.0000 0.0000
57 100.500000 6722.0000 0.0000
Other 55 100.500000 7098.7500 0.0000
---------------------------------------------------------
Total 1011 1444.500000 71996.2500 40154.9600
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 26 25.750000 1254.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 466 518.250000 24089.0000 0.0000
P 2 3.000000 195.7500 0.0000
D 1 2.000000 150.0000 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
444 576.750000 28759.2500 0.0000
Other 45 59.750000 2816.2500 0.0000
---------------------------------------------------------
Total 984 1185.500000 57265.0000 0.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 65 82.500000 2316.0000 2316.0000
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
4 12.000000 650.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 69 94.500000 2966.0000 2316.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 23 30.000000 1677.0000 0.0000
P 96 144.250000 6911.6400 6583.6000
D 5 10.000000 633.0000 0.0000
S 35 44.750000 2050.2500 177.7300
H 13 25.000000 1680.0000 0.0000
T 60 621.000000 2535.2900 2355.2900
155 186.000000 8795.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 387 1061.000000 24282.6800 9116.6200
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 6 11.000000 786.0000 0.0000
P 47 55.750000 3215.2500 3215.2500
D 2 1.000000 37.0000 0.0000
S 89 48.750000 1803.7500 0.0000
H 6 7.000000 316.0000 0.0000
T 5 91.500000 142.4100 142.4100
814 750.000000 33484.2500 0.0000
Other 5 6.500000 323.7500 0.0000
---------------------------------------------------------
Total 974 971.500000 40108.4100 3357.6600
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 2.000000 150.0000 0.0000
P 85 114.500000 6817.5000 6817.5000
D 2 1.750000 121.7500 0.0000
S 7 11.000000 825.0000 0.0000
H 1 1.500000 112.5000 0.0000
T 17 77.000000 1391.2800 1391.2800
1189 1364.750000 56059.8900 0.0000
Other 19 17.500000 647.5000 0.0000
---------------------------------------------------------
Total 1321 1590.000000 66125.4200 8208.7800
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 140 259.500000 14326.5000 0.0000
P 214 324.182133 16110.1600 15030.9900
D 0 0.000000 0.0000 0.0000
S 1 0.627467 47.0600 0.0000
H 6 12.000000 900.0000 0.0000
T 0 0.000000 0.0000 0.0000
937 916.190400 44648.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1298 1512.500000 76032.5000 15030.9900
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 201 359.750000 17214.7500 0.0000
P 237 448.250000 19830.0000 19829.6300
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 6 11.250000 511.2500 425.5000
578 832.750000 37794.2500 0.0000
Other 1 2.750000 101.7500 0.0000
---------------------------------------------------------
Total 1023 1654.750000 75452.0000 20255.1300