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
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 11046 14098.00000 524242.9000 37.1856
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 664 678.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 8172 23797.75000 885025.2000 37.1894
Subtotal (Total Children Is Unduplicated) 15338 38574.00000 1409268.1000 36.5341
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 16 18.000000 873.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 39 57.000000 2850.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 4 8.000000 400.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 235 340.250000 17012.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 9.500000 712.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 9 15.500000 1162.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 0.500000 37.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 9 16.000000 1200.0000 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 2 3.000000 225.0000 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 5 7.500000 562.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 6.500000 360.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 18 31.500000 1748.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 102 170.767731 12677.5800 74.2387
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 109 184.270133 13820.2600 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 28 42.500000 3187.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 56 100.000000 7500.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 21 38.000000 2850.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 20 39.000000 2925.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 222 416.500000 23088.0000 55.4334
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 205 371.000000 20590.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 95 148.000000 11100.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 30 58.450600 4383.7950 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 1 1.000000 76.1500 76.1500
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 12 12.000000 600.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 154.2300 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 205.6400 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 205.6400 51.4100
Subtotal (Total Children Is Unduplicated) 923 2123.238464 131774.1150 62.0628
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 12 26.000000 1870.9600 71.9600
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 117 119.500000 5975.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 179 197.250000 9862.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 52 46.750000 1168.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 119 139.500000 6975.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 450 290.000000 14487.5000 49.9569
CONIP-CONIP-CONSULT, ITDS PHONE 9 7.500000 187.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 95 106.250000 5312.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 382 203.750000 10175.0000 49.9387
CONOP-CONOP-CONSULT, OT, PHONE 5 2.750000 68.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 90 111.250000 5562.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 376 169.750000 8487.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.250000 31.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 167 184.750000 9237.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 382 229.500000 11475.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 16 13.750000 343.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1114 3123.250000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 3 14.000000 700.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 69 280.750000 14037.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 27 89.250000 4462.5000 50.0000
INTR-T1013-INTERPRETER 105 433.500000 21675.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1045 4618.000000 46180.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 26 95.250000 6854.1900 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 12 38.000000 2734.4800 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 57.6000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 2 3.000000 215.8800 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 2 2.000000 143.9200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 19 79.000000 5684.8400 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 3 4.500000 323.8200 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 4 9.000000 647.6400 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 0.500000 35.9800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 37 151.750000 10919.9300 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 21 47.500000 3418.1000 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 6 16.000000 1151.3600 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 4 6.000000 431.7600 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 42 55.000000 2035.0000 37.0000
TRAV-TRAVS-Travel by mile 367 26442.00000 11764.9100 0.4449
Subtotal (Total Children Is Unduplicated) 2089 37358.75000 224695.3700 6.0145
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CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 Page: 2
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
Total 78055.988464 1765737.5850 22.6214
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 15985
-----------------------------------------------------------------------------------------------------------------------
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 17 7.750000 288.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1810 1174.500000 48619.9200 0.0000
Other 3 0.750000 27.9000 0.0000
---------------------------------------------------------
Total 1830 1183.000000 48936.1200 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 2995 11006.500000 52883.2700 0.0000
---------------------------------------------------------
Total 2995 11006.500000 52883.2700 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
2607 1660.000000 63689.4500 0.0000
Other 2 2.000000 87.2000 0.0000
---------------------------------------------------------
Total 2609 1662.000000 63776.6500 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
2936 3376.000000 134457.3500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2936 3376.000000 134457.3500 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 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
3091 1624.500000 55688.4000 0.0000
Other 6 1.750000 65.1000 0.0000
---------------------------------------------------------
Total 3097 1626.250000 55753.5000 0.0000
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
4726 2847.000000 108184.6800 0.0000
Other 261 168.000000 7140.8200 0.0000
---------------------------------------------------------
Total 4987 3015.000000 115325.5000 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 2 1.500000 55.8000 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
5979 3060.950600 111647.0950 0.0000
Other 12 5.000000 186.0000 0.0000
---------------------------------------------------------
Total 5993 3067.450600 111888.8950 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 6498 6287.250000 241403.6400 241403.6400
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 32 34.750000 1395.1000 1395.1000
3902 3816.500000 146543.0800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10432 10138.500000 389341.8200 242798.7400
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
5261 4144.500000 161748.1000 0.0000
Other 7 4.000000 148.8000 0.0000
---------------------------------------------------------
Total 5268 4148.500000 161896.9000 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 7.500000 416.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3 7.500000 416.2500 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 1 0.250000 9.3000 9.3000
D 17 19.500000 1008.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1496 18279.500000 28387.7200 27134.6800
2187 1274.500000 39217.6100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3701 19573.750000 68622.6300 27143.9800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 201 137.000000 6204.1400 0.0000
S 71 55.500000 1309.7000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
8512 5882.250000 141414.7700 0.0000
Other 19 17.750000 772.5000 0.0000
---------------------------------------------------------
Total 8803 6092.500000 149701.1100 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 148 104.750000 4910.8200 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
8992 6378.250000 153757.2800 0.0000
Other 54 37.000000 1376.4000 0.0000
---------------------------------------------------------
Total 9194 6520.000000 160044.5000 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 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
5531 3647.537864 136933.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5531 3647.537864 136933.2900 0.0000
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 0 0.000000 0.0000 0.0000
3041 2990.250000 115713.3000 0.0000
Other 2 1.250000 46.5000 0.0000
---------------------------------------------------------
Total 3043 2991.500000 115759.8000 0.0000