CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 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 894 1082.500000 40222.5000 37.1570
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 127 120.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 848 3450.750000 128358.6000 37.1973
Subtotal (Total Children Is Unduplicated) 1285 4653.750000 168581.1000 36.2248
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 1.500000 75.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 8.000000 600.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 7.500000 562.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 9 15.500000 860.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 37 61.974400 4648.0800 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 62 105.500000 7873.5000 74.6303
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 21.500000 1562.5000 72.6744
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 41 74.000000 5550.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 17.500000 1312.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 33 53.000000 3975.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 116 208.500000 11571.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 124 212.000000 11766.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 38 64.000000 4800.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 32 57.000000 4275.0000 75.0000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 332 932.974400 61113.5800 65.5040
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1 0.750000 37.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 1 0.250000 12.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 0.250000 12.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 58 53.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
INTR-T1013-INTERPRETER 33 86.000000 3832.0000 44.5581
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 80 121.000000 1210.0000 10.0000
TRAV-TRAVS-Travel by mile 104 3235.000000 1439.3300 0.4449
Subtotal (Total Children Is Unduplicated) 194 3499.000000 6643.8300 1.8988
-----------------------------------------------------------------------------------------------------------------------
Total 9085.724400 236338.5100 26.0121
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1358
-----------------------------------------------------------------------------------------------------------------------
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 30 62.500000 2085.2300 2085.2300
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 2 2.500000 102.7500 102.7500
208 182.500000 8238.3500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 240 247.500000 10426.3300 2187.9800
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 52 933.500000 3163.2400 3163.2400
4 46.000000 20.4600 0.0000
Other 415 1132.250000 8744.4400 0.0000
---------------------------------------------------------
Total 471 2111.750000 11928.1400 3163.2400
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
235 359.000000 12121.4200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 235 359.000000 12121.4200 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 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
232 315.750000 13572.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 232 315.750000 13572.1500 0.0000
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 135 837.000000 9194.4200 9194.4200
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
440 326.500000 11318.1000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 575 1163.500000 20512.5200 9194.4200
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
297 232.000000 8857.2000 0.0000
Other 8 8.000000 297.6000 0.0000
---------------------------------------------------------
Total 305 240.000000 9154.8000 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 28 33.000000 785.0000 785.0000
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
481 338.000000 12728.7000 0.0000
Other 2 3.000000 111.6000 0.0000
---------------------------------------------------------
Total 511 374.000000 13625.3000 785.0000
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 250 317.750000 13464.1500 13464.1500
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
163 202.250000 8327.3500 0.0000
Other 6 12.000000 900.0000 0.0000
---------------------------------------------------------
Total 419 532.000000 22691.5000 13464.1500
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
432 527.000000 22451.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 432 527.000000 22451.4000 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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 31 380.000000 268.1500 268.1500
153 144.750000 5142.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 184 524.750000 5411.0500 268.1500
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 6 4.500000 224.1000 0.0000
H 0 0.000000 0.0000 0.0000
T 6 138.000000 90.0700 90.0700
541 393.250000 14170.8000 0.0000
Other 1 1.500000 112.5000 0.0000
---------------------------------------------------------
Total 554 537.250000 14597.4700 90.0700
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 1 0.750000 27.9000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 17 72.500000 930.5200 930.5200
545 609.750000 20351.8300 0.0000
Other 2 2.500000 168.6000 0.0000
---------------------------------------------------------
Total 565 685.500000 21478.8500 930.5200
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 13 25.000000 1498.0000 1498.0000
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
880 768.224400 30230.0800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 893 793.224400 31728.0800 1498.0000
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 2 7.000000 70.0000 70.0000
457 667.500000 26569.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 459 674.500000 26639.5000 70.0000