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
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 10817 14545.50000 540582.2000 37.1649
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 649 622.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7860 22982.08410 854468.4785 37.1798
Subtotal (Total Children Is Unduplicated) 14827 38150.08410 1395050.6785 36.5674
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 27 29.000000 1406.5000 48.5000
BEHV-BEHV-BEHAVIORAL ASSESSMENT 1 2.000000 250.0000 125.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 15 25.000000 1250.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 10 19.500000 975.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 253 444.750000 22237.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 9.500000 712.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 9 17.000000 1275.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 10.000000 750.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 15.000000 832.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 15 29.000000 1609.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 132 217.979866 15259.8900 70.0060
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 97 176.035700 13202.6775 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 49.170133 3650.2600 74.2373
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 67 126.000000 9450.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 27 47.500000 3562.5000 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 253 454.500000 25224.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 192 369.000000 20479.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 74 112.834100 8462.5575 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 20.500000 1537.5000 75.0000
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
SCREEN-T1023-SCREENING 4 4.000000 200.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
Subtotal (Total Children Is Unduplicated) 913 2232.269799 136260.1850 61.0411
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 20.000000 1511.1600 75.5580
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 95 90.250000 4512.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 162 170.500000 8525.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 37 36.250000 906.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 125 145.500000 7275.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 407 260.500000 13025.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 4 2.250000 56.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 52 60.750000 3037.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 420 247.250000 12287.5000 49.6967
CONOP-CONOP-CONSULT, OT, PHONE 2 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 84 96.500000 4825.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 379 183.000000 9112.5000 49.7951
CONPP-CONPP-CONSULT, PT, PHONE 3 1.250000 31.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 170 198.500000 9925.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 346 194.500000 9712.5000 49.9357
CONSP-CONSP-CONSULT, SLP, PHONE 9 4.250000 106.2500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1132 3127.749700 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 11 59.500000 2975.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 84 362.250000 17970.3000 49.6075
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 34 98.750000 4937.5000 50.0000
INTR-T1013-INTERPRETER 126 515.750000 25787.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1066 5114.000000 51140.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 24 76.000000 5468.9600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 12 40.750000 2932.3700 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 1 3.000000 172.8000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 3 2.500000 179.9000 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 3 2.500000 179.9000 71.9600
PHY-97110-PT SESSION BY LICENSED PT 17 59.000000 4245.6400 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 3 7.000000 503.7200 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 2 3.000000 215.8800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 37 120.000000 8405.1600 70.0430
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 17 66.250000 4767.3500 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 5 8.000000 575.6800 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 3 4.000000 287.8400 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 50 73.000000 2701.0000 37.0000
TRAV-TRAVS-Travel by mile 397 28684.00000 12762.5900 0.4449
Subtotal (Total Children Is Unduplicated) 2108 40139.24970 231082.7500 5.7570
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Total 80521.603599 1762393.6135 21.8872
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Number of Children (Unduplicated) With at Least One Service 15444
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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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.000000 10.0000 10.0000
117 30.000000 1128.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 118 31.000000 1138.8000 10.0000
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 1 0.500000 18.6000 0.0000
0 0.000000 0.0000 0.0000
Other 2631 8807.250000 50928.7900 0.0000
---------------------------------------------------------
Total 2632 8807.750000 50947.3900 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
2159 1524.750000 57740.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2159 1524.750000 57740.9000 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 1.000000 37.2000 93.0000
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
2623 3001.000000 119673.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2624 3002.000000 119711.1000 93.0000
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 16 12.250000 455.7000 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
2847 1485.750000 50629.2000 0.0000
Other 1 0.250000 9.3000 0.0000
---------------------------------------------------------
Total 2864 1498.250000 51094.2000 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 2 4.000000 261.0000 0.0000
4131 2420.750000 92526.6700 0.0000
Other 315 183.000000 6807.6000 0.0000
---------------------------------------------------------
Total 4448 2607.750000 99595.2700 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 6 7.000000 411.6000 0.0000
S 1 0.250000 9.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6642 3436.917200 125194.1835 0.0000
Other 1 2.000000 74.4000 0.0000
---------------------------------------------------------
Total 6650 3446.167200 125689.4835 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 7478 7176.000000 277160.1500 277160.1500
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 3059 3107.500000 119957.0300 119957.0300
66 65.750000 2687.8600 0.0000
Other 2 3.000000 200.0000 0.0000
---------------------------------------------------------
Total 10605 10352.250000 400005.0400 397117.1800
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 1 0.750000 37.5000 37.5000
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
5300 4478.250000 176977.9000 0.0000
Other 3 2.250000 83.7000 0.0000
---------------------------------------------------------
Total 5304 4481.250000 177099.1000 37.5000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 6 8.750000 424.3000 0.0000
S 3 4.250000 270.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 1753 22898.750000 34390.8300 32116.5900
2262 1322.250000 42128.0500 0.0000
Other 2 2.000000 74.4000 0.0000
---------------------------------------------------------
Total 4026 24236.000000 77287.8800 32116.5900
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 269 177.750000 7545.4200 0.0000
S 8 7.000000 40.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
9516 6316.750000 152224.8600 0.0000
Other 24 19.000000 706.8000 0.0000
---------------------------------------------------------
Total 9817 6520.500000 160517.0800 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 260 196.500000 8581.2400 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
9359 6940.750000 169575.6800 0.0000
Other 80 52.750000 1962.3000 0.0000
---------------------------------------------------------
Total 9699 7190.000000 180119.2200 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 0.500000 18.6000 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
4932 3617.186399 136560.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4933 3617.686399 136578.8500 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 2 2.500000 93.0000 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
3244 3203.000000 124748.4000 0.0000
Other 1 0.750000 27.9000 0.0000
---------------------------------------------------------
Total 3247 3206.250000 124869.3000 0.0000