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
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 964 1134.500000 42184.8000 37.1836
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 155 162.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 827 3307.500000 123039.0000 37.2000
Subtotal (Total Children Is Unduplicated) 1302 4604.500000 165223.8000 35.8831
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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 6 10.000000 750.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 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 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 16.000000 888.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 85 142.407199 10196.1400 71.5985
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 77 128.000000 9500.0000 74.2188
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 21.000000 1575.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 53 93.500000 7012.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 30.242000 2268.1500 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 46 77.500000 5812.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 133 236.500000 13098.0000 55.3827
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 121 216.500000 12004.7500 55.4492
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 40 60.500000 4537.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 32.000000 2400.0000 75.0000
Subtotal (Total Children Is Unduplicated) 405 1103.649199 72347.7900 65.5532
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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 1 0.500000 25.0000 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
TRAV-TRAVS-Travel by mile 161 6472.000000 2859.5900 0.4418
Subtotal (Total Children Is Unduplicated) 285 6845.250000 10038.3400 1.4665
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Total 12553.399199 247609.9300 19.7245
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Number of Children (Unduplicated) With at Least One Service 1435
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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 29 151.000000 981.7500 981.7500
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 41 186.000000 2293.9600 2293.9600
0 0.000000 0.0000 0.0000
Other 1 0.250000 9.3000 0.0000
---------------------------------------------------------
Total 71 337.250000 3285.0100 3275.7100
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 68 2432.500000 3939.8400 3904.2400
9 179.000000 189.7600 0.0000
Other 427 1563.500000 7448.9300 0.0000
---------------------------------------------------------
Total 504 4175.000000 11578.5300 3904.2400
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 2 3.500000 262.5000 262.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 5 9.500000 644.2500 644.2500
T 0 0.000000 0.0000 0.0000
192 259.750000 11287.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 199 272.750000 12193.9500 906.7500
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
248 347.250000 15006.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 248 347.250000 15006.7500 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 206 1619.000000 11331.1600 11331.1600
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 703 2011.250000 23880.0500 12189.9500
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
314 242.000000 9284.6000 0.0000
Other 3 4.250000 158.1000 0.0000
---------------------------------------------------------
Total 337 265.500000 9718.9500 276.2500
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 48 60.000000 1843.0000 1843.0000
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
484 363.000000 14308.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 532 423.000000 16151.8000 1843.0000
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 321 420.500000 19381.4500 19381.4500
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 168 199.750000 8218.9500 8218.9500
10 14.250000 530.1000 0.0000
Other 12 23.000000 1725.0000 0.0000
---------------------------------------------------------
Total 511 657.500000 29855.5000 27600.4000
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 1 2.000000 111.0000 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
387 474.000000 20017.3500 0.0000
Other 2 2.250000 83.7000 0.0000
---------------------------------------------------------
Total 390 478.250000 20212.0500 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 20 21.500000 994.5000 994.5000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 2.000000 111.0000 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 41 469.000000 529.3500 239.7500
158 157.250000 5958.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 200 628.250000 6598.6500 239.7500
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 1 0.500000 18.6000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2 2.000000 20.0000 20.0000
493 473.000000 12906.7300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 496 475.500000 12945.3300 20.0000
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 10 10.500000 390.6000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 28 106.500000 1357.4900 1357.4900
514 777.000000 19917.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 552 894.000000 21665.2200 1357.4900
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 16 31.742000 2224.6500 2224.6500
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
934 888.407199 35323.0400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 950 920.149199 37547.6900 2224.6500
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
457 646.250000 25975.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 457 646.250000 25975.9500 0.0000