CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2023 ending 06/30/2023 Date of Report:07/25/2023 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 964 1134.500000 42184.8000 37.1836
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 155 162.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1662 7129.750000 265012.7000 37.1700
Subtotal (Total Children Is Unduplicated) 1706 8426.750000 307197.5000 36.4550
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 6 22.000000 1100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 31 57.000000 4237.5000 74.3421
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 25 39.000000 2925.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 11.500000 862.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 12 19.000000 1425.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 9 15.500000 1162.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 7 12.000000 900.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 12.500000 937.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 8 14.000000 1050.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 28 49.000000 2719.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 34 57.000000 3163.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 366 678.500000 49893.9000 73.5356
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 349 582.000000 43504.4900 74.7500
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 64 113.500000 8512.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 239 403.500000 30262.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 102 190.499999 14115.7500 74.0984
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 170 277.500000 20812.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 419 766.500000 42457.5000 55.3914
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 558 939.500000 52075.7500 55.4292
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 103 171.000000 12700.0000 74.2690
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 83 154.000000 11550.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 17 17.000000 2889.5000 169.9706
Subtotal (Total Children Is Unduplicated) 1382 4601.999999 309257.3900 67.2007
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.250000 6.2500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 56 53.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 21.500000 1075.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 2.000000 100.0000 50.0000
INTR-T1013-INTERPRETER 37 98.500000 4811.5000 48.8477
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 148 218.000000 2186.0000 10.0275
OCCT-97530TL-OT SESSION BY LICENSED OT 1 3.000000 215.8800 71.9600
TRAV-TRAVS-Travel by mile 162 6516.000000 2879.1700 0.4419
Subtotal (Total Children Is Unduplicated) 285 6913.250000 11323.8000 1.6380
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Total 19941.999999 627778.6900 31.4802
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Number of Children (Unduplicated) With at Least One Service 1799
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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 43 175.000000 2329.5000 2329.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 0.250000 9.3000 9.3000
T 57 209.500000 3908.7100 3908.7100
0 0.000000 0.0000 0.0000
Other 1 0.250000 9.3000 0.0000
---------------------------------------------------------
Total 102 385.000000 6256.8100 6247.5100
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 69 2434.000000 4052.3400 4016.7400
10 181.000000 339.7600 0.0000
Other 717 1805.500000 18381.8300 0.0000
---------------------------------------------------------
Total 796 4420.500000 22773.9300 4016.7400
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 7 11.500000 464.4000 0.0000
P 30 45.250000 2649.1500 2649.1500
D 1 0.500000 18.6000 0.0000
S 0 0.000000 0.0000 0.0000
H 9 16.500000 1071.7500 1071.7500
T 0 0.000000 0.0000 0.0000
317 433.750000 19762.8500 0.0000
Other 4 7.750000 288.3000 0.0000
---------------------------------------------------------
Total 368 515.250000 24255.0500 3720.9000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 10.000000 596.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 113 175.500000 7238.4000 0.0000
P 55 84.500000 3648.9000 3647.6000
D 9 13.250000 492.9000 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
348 462.250000 24110.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 532 745.500000 36087.5000 3647.6000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 8.500000 316.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 244 221.250000 8230.5000 3766.5400
P 208 1622.000000 11556.1600 11556.1600
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
497 392.250000 12548.8900 858.7900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 956 2244.000000 32651.7500 16181.4900
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 20 19.250000 276.2500 276.2500
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
751 815.500000 37042.9800 0.0000
Other 3 4.250000 158.1000 0.0000
---------------------------------------------------------
Total 774 839.000000 37477.3300 276.2500
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 2.500000 93.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 52 65.000000 3015.6000 0.0000
P 155 188.750000 8693.8000 8703.1000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 5 10.000000 750.0000 0.0000
T 0 0.000000 0.0000 0.0000
489 373.000000 15058.8000 0.0000
Other 11 8.000000 448.8000 0.0000
---------------------------------------------------------
Total 716 647.250000 28060.0000 8703.1000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 13.250000 492.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 151 239.250000 11199.1500 0.0000
P 330 437.000000 20618.9500 20618.9500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 102 122.000000 6848.8500 0.0000
T 186 234.750000 10775.7000 10775.7000
72 121.750000 7343.1000 0.0000
Other 56 105.500000 7629.7500 0.0000
---------------------------------------------------------
Total 907 1273.500000 64908.4000 31394.6500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 2.250000 83.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 558 714.000000 33119.8500 0.0000
P 0 0.000000 0.0000 0.0000
D 14 23.250000 1581.9000 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
523 714.000000 35959.9500 0.0000
Other 7 8.000000 297.6000 0.0000
---------------------------------------------------------
Total 1109 1461.500000 71043.0000 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 20 21.500000 994.5000 994.5000
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
3 4.500000 249.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 23 26.000000 1244.2500 994.5000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 4.250000 233.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 60 98.750000 5402.7000 74.4000
P 100 151.250000 7721.5000 7272.3000
D 6 12.000000 666.0000 0.0000
S 22 26.000000 1153.8000 122.7000
H 21 42.000000 3111.0000 0.0000
T 59 505.000000 2579.1500 2123.7500
190 212.000000 9594.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 460 1051.250000 30462.1500 9593.1500
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.500000 112.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 139 152.500000 7360.5000 0.0000
P 269 283.500000 13049.1500 13049.1500
D 5 5.500000 335.1000 0.0000
S 2 2.250000 159.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 3 4.000000 131.0000 131.0000
559 569.250000 18838.7300 0.0000
Other 8 4.500000 167.4000 0.0000
---------------------------------------------------------
Total 986 1023.000000 40153.6800 13180.1500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 218 282.750000 13833.2600 0.0000
P 355 451.000000 19864.8200 19864.8200
D 11 11.500000 465.6000 0.0000
S 1 3.000000 111.6000 0.0000
H 2 3.000000 225.0000 0.0000
T 40 127.000000 2563.4900 2563.4900
627 981.000000 33501.1300 0.0000
Other 4 4.750000 327.9000 37.5000
---------------------------------------------------------
Total 1258 1864.000000 70892.8000 22465.8100
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 271 482.500000 24360.3000 0.0000
P 158 283.992000 15261.7500 15172.9500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 25 50.000000 3750.0000 0.0000
T 0 0.000000 0.0000 0.0000
1019 1039.257999 45739.8500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1473 1855.749999 89111.9000 15172.9500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 8.750000 325.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 318 573.250000 25652.4000 0.0000
P 110 193.250000 9279.3000 9493.3000
D 8 13.500000 905.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 8 12.000000 773.2500 182.7000
543 789.750000 35464.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 991 1590.500000 72400.1400 9676.0000