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
Payclass Filters:GR
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 927 3379.500000 125023.0000 36.9945
Subtotal (Total Children Is Unduplicated) 1443 4680.250000 168710.7500 36.0474
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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 3 4.000000 300.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.500000 112.5000 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 2 3.500000 262.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.000000 525.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 18 22.500000 1248.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 8.500000 471.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 52 86.500000 6487.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 111 190.366933 14180.0500 74.4880
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 20.500000 1537.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 41 64.500000 4837.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 27 45.500000 3412.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 40 65.932133 4944.9100 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 98 173.500000 9629.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 192 332.000000 18426.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 36 56.064500 4204.8375 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 41 60.500000 4500.0000 74.3802
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 7 7.000000 503.1600 71.8800
SCREEN-T1023-SCREENING 2 3.000000 150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 416 1182.863566 77583.7075 65.5897
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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 1 8.000000 400.0000 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
TRAV-TRAVS-Travel by mile 120 4068.000000 1807.0000 0.4442
Subtotal (Total Children Is Unduplicated) 234 4415.000000 9712.0000 2.1998
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Total 10278.113566 256006.4575 24.9079
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Number of Children (Unduplicated) With at Least One Service 1541
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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 37 144.500000 2514.4100 2514.4100
D 2 2.000000 100.0000 0.0000
S 4 4.000000 148.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
240 190.250000 7719.2500 0.0000
Other 5 2.000000 74.0000 0.0000
---------------------------------------------------------
Total 288 342.750000 10555.6600 2514.4100
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 57 1083.250000 3347.7000 3236.7000
13 600.500000 714.3100 0.0000
Other 558 983.500000 11620.7800 0.0000
---------------------------------------------------------
Total 628 2667.250000 15682.7900 3236.7000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 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
386 455.000000 22073.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 388 459.500000 22298.0000 225.0000
Center 04
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 3 12.000000 120.0000 120.0000
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
240 308.250000 14040.4100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 243 320.250000 14160.4100 120.0000
Center 05
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 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 619 1391.000000 20247.0700 9230.3200
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 4 8.000000 400.0000 400.0000
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
490 401.750000 15149.7500 0.0000
Other 20 14.750000 545.7500 0.0000
---------------------------------------------------------
Total 514 424.500000 16095.5000 400.0000
Center 07
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 34 59.000000 1876.0000 1876.0000
D 2 1.750000 64.7500 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
464 322.064500 12948.0875 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 500 382.814500 14888.8375 1876.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 501 650.750000 27061.5000 27061.5000
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 7.000000 392.0000 0.0000
Other 5 8.500000 637.5000 0.0000
---------------------------------------------------------
Total 511 666.250000 28091.0000 27061.5000
Center 10
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
371 442.250000 19598.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 371 442.250000 19598.0000 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
2 2.000000 150.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 67 84.500000 2466.0000 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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 2 4.000000 148.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 44 589.000000 559.4300 539.4300
119 122.000000 4347.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 165 715.000000 5054.9300 539.4300
Center 53
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 57 26.000000 962.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 5 91.500000 142.4100 142.4100
409 262.250000 10021.2500 0.0000
Other 1 1.500000 55.5000 0.0000
---------------------------------------------------------
Total 472 381.250000 11181.1600 142.4100
Center 54
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 13 69.500000 897.0300 897.0300
499 533.000000 16609.3900 0.0000
Other 5 4.500000 166.5000 0.0000
---------------------------------------------------------
Total 517 607.000000 17672.9200 897.0300
Center 55
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 14 27.932133 1888.9100 1888.9100
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
820 699.616933 29335.2700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 834 727.549066 31224.1800 1888.9100
Center 57
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
481 666.250000 26790.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 481 666.250000 26790.0000 0.0000