CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 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 684 757.750000 28179.0000 37.1877
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 112 108.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 671 2756.500000 102552.1000 37.2037
Subtotal (Total Children Is Unduplicated) 999 3623.000000 130731.1000 36.0837
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 20.400000 1530.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 300.0000 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 3 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.000000 300.0000 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 11 17.500000 971.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 70 119.240266 8943.0200 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 50 85.836800 6437.7600 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 32.927467 2469.5600 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 44 81.000000 6075.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 25 38.000000 2850.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 23 41.500000 3112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 120 218.000000 12154.5000 55.7546
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 101 180.000000 10029.0000 55.7167
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 41.000000 3075.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 28 55.000000 4125.0000 75.0000
Subtotal (Total Children Is Unduplicated) 355 957.404533 63641.5900 66.4730
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EI Services,Class #03
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1 0.500000 25.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.500000 25.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 39 34.500000 0.0000 0.0000
EPIC-99601-Early Steps Professional Development Fee 44 50.000000 750.0000 15.0000
INTR-T1013-INTERPRETER 30 71.000000 3594.0000 50.6197
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 81 124.000000 1488.0000 12.0000
PHY-97110-PT SESSION BY LICENSED PT 1 3.000000 215.8800 71.9600
TRAV-TRAVS-Travel by mile 134 4533.000000 2011.6200 0.4438
Subtotal (Total Children Is Unduplicated) 215 4816.500000 8109.5000 1.6837
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Total 9396.904533 202482.1900 21.5478
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Number of Children (Unduplicated) With at Least One Service 1117
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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 25 188.500000 1138.6900 1138.6900
D 4 30.000000 34.7600 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 9 36.000000 749.1500 749.1500
19 22.750000 1438.3500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 57 277.250000 3360.9500 1887.8400
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 51 1453.500000 2594.1900 2594.1900
0 0.000000 0.0000 0.0000
Other 125 181.000000 2121.5100 0.0000
---------------------------------------------------------
Total 176 1634.500000 4715.7000 2594.1900
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 4 140.000000 85.4100 85.4100
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
91 128.750000 6113.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 95 268.750000 6198.6600 85.4100
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
119 170.250000 7233.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 119 170.250000 7233.9000 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 243 2305.500000 12269.3700 12269.3700
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
491 374.250000 12071.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 734 2679.750000 24340.7700 12269.3700
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 3 6.000000 344.0000 344.0000
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 2.250000 83.7000 0.0000
231 213.000000 8232.1500 0.0000
Other 7 8.250000 306.9000 0.0000
---------------------------------------------------------
Total 242 229.500000 8966.7500 344.0000
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 40 97.000000 1618.6900 1606.6900
D 2 4.000000 185.4000 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
413 334.250000 12911.2000 0.0000
Other 1 -1.000000 -12.0000 -12.0000
---------------------------------------------------------
Total 456 434.250000 14703.2900 1594.6900
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 345 654.500000 20815.9400 20815.9400
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
26 38.250000 2097.3000 0.0000
Other 3 5.000000 345.7500 0.0000
---------------------------------------------------------
Total 374 697.750000 23258.9900 20815.9400
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 2 12.000000 144.0000 144.0000
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
420 487.250000 20169.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 422 499.250000 20313.6000 144.0000
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 15 27.000000 687.0000 687.0000
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15 27.000000 687.0000 687.0000
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 5 4.750000 176.7000 0.0000
H 0 0.000000 0.0000 0.0000
T 27 226.000000 731.6700 696.8700
175 186.250000 7430.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 207 417.000000 8338.7700 696.8700
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 9 7.250000 269.7000 0.0000
S 2 1.000000 37.2000 0.0000
H 0 0.000000 0.0000 0.0000
T 6 9.500000 585.7500 585.7500
364 240.750000 9034.3500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 381 258.500000 9927.0000 585.7500
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 13 23.250000 1185.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 32 122.500000 2285.4300 2285.4300
390 443.500000 16825.3600 0.0000
Other 1 0.750000 27.9000 0.0000
---------------------------------------------------------
Total 436 590.000000 20323.6900 2285.4300
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 20 33.927467 2190.4400 2190.4400
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
756 796.727066 32029.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 776 830.654533 34220.0200 2190.4400
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
290 382.500000 15893.1000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 290 382.500000 15893.1000 0.0000