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
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 11327 14996.75000 554741.0000 36.9907
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 522 483.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7842 23513.50000 869925.5000 36.9969
Subtotal (Total Children Is Unduplicated) 15415 38993.75000 1424666.5000 36.5358
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 19 21.000000 1018.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 21 28.750000 1437.5000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 2 4.000000 200.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 209 357.000000 17850.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 9.000000 675.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 10 18.000000 1350.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 6.500000 487.5000 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 2 3.500000 262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.500000 562.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 2.500000 187.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 12.000000 666.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 17 24.000000 1332.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 105 193.938966 14545.4225 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 173 315.377066 23614.2800 74.8763
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 26 45.336800 3400.2600 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 113 175.000000 13085.0000 74.7714
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 55 102.500000 7687.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 23 42.000000 3150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 153 290.000000 16095.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 442 722.500000 40098.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 53 98.954100 7421.5575 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 112 182.500000 13687.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 26 26.000000 1868.8800 71.8800
SCREEN-T1023-SCREENING 6 6.000000 300.0000 50.0000
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 3.000000 153.1500 51.0500
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 52.5700 52.5700
Subtotal (Total Children Is Unduplicated) 1104 2702.856932 171563.8700 63.4750
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 8 19.000000 1325.8200 69.7800
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 131 138.000000 6900.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 202 212.750000 10637.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 36 37.750000 943.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 136 143.500000 7162.5000 49.9129
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 455 297.500000 14875.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 8 6.000000 150.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 48 50.750000 2537.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 353 196.250000 9800.0000 49.9363
CONOP-CONOP-CONSULT, OT, PHONE 4 2.500000 62.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 70 92.250000 4612.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 373 167.000000 8350.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 145 160.500000 8025.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 419 225.250000 11262.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 18 12.750000 318.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1107 2625.000000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 105 410.000000 20500.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 93 153.750000 7687.5000 50.0000
INTR-T1013-INTERPRETER 93 265.250000 13262.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 817 3430.000000 34300.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 26 86.500000 6179.5600 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 14 37.500000 2679.0000 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 15 65.250000 4661.4600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 7 11.000000 785.8400 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 1 3.000000 214.3200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 43 119.000000 8501.3600 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 30 70.250000 5018.6600 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 76 81.250000 3006.2500 37.0000
TRAV-TRAVS-Travel by mile 324 21650.00000 9632.9000 0.4449
Subtotal (Total Children Is Unduplicated) 2270 30771.50000 203514.1100 6.6137
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Total 72468.106932 1799744.4800 24.8350
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Number of Children (Unduplicated) With at Least One Service 16157
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 14 7.000000 259.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 0.250000 9.2500 0.0000
2283 1377.000000 53866.8100 0.0000
Other 16 4.750000 175.7500 0.0000
---------------------------------------------------------
Total 2314 1389.000000 54310.8100 0.0000
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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 3419 5962.500000 61308.4200 0.0000
---------------------------------------------------------
Total 3419 5962.500000 61308.4200 0.0000
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 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
4566 3080.250000 114607.2800 0.0000
Other 9 12.000000 839.4400 0.0000
---------------------------------------------------------
Total 4575 3092.250000 115446.7200 0.0000
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 1 0.500000 18.5000 37.0000
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
2830 2886.500000 120332.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2831 2887.000000 120351.3800 37.0000
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 21 442.500000 481.4100 481.4100
D 1 0.500000 18.5000 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
2547 1361.750000 47406.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2569 1804.750000 47906.1600 481.4100
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
4898 3013.000000 113358.7500 0.0000
Other 194 124.250000 4597.2500 0.0000
---------------------------------------------------------
Total 5092 3137.250000 117956.0000 0.0000
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 0 0.000000 0.0000 0.0000
D 11 15.000000 707.0000 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
6635 3503.823600 127425.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6648 3522.823600 128432.7700 0.0000
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 10283 9675.250000 369742.0500 369742.0500
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
126 119.250000 4490.2500 0.0000
Other 3 5.500000 334.5000 0.0000
---------------------------------------------------------
Total 10412 9800.000000 374566.8000 369742.0500
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
5533 4628.250000 187001.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5533 4628.250000 187001.0000 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 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
3 2.500000 138.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3 2.500000 138.7500 0.0000
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 2 2.250000 120.2500 0.0000
S 10 5.250000 194.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 1171 18056.750000 24707.0800 23602.5700
2014 1217.750000 37192.5000 40.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3197 19282.000000 62214.0800 23642.5700
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 10 7.000000 317.0000 0.0000
S 310 149.000000 5503.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7658 4989.250000 130303.7400 0.0000
Other 33 29.750000 1100.7500 0.0000
---------------------------------------------------------
Total 8011 5175.000000 137225.2400 0.0000
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 25 15.500000 649.5000 0.0000
S 223 175.250000 3116.9000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
8167 5641.250000 161000.6500 0.0000
Other 78 55.750000 2062.7500 0.0000
---------------------------------------------------------
Total 8493 5887.750000 166829.8000 0.0000
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 1 1.000000 39.9000 39.9000
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
4232 2708.283332 105492.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4233 2709.283332 105532.8000 39.9000
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 1 2.000000 150.0000 150.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3123 3184.000000 120309.0000 0.0000
Other 1 1.750000 64.7500 0.0000
---------------------------------------------------------
Total 3125 3187.750000 120523.7500 150.0000