Part C State Annual Performance Report (APR) for FFY 06/SFY 07

Overview of the Annual Performance Report Development:

During FFY 06/SFY 07 the program carefully reviewed secondary factors that seemed to point to higher levels of service delay than were being reported. This was followed by an extensive discussion with CFC Managers about the issue. It was pointed out that while service delays are bad, if they are underreported neither the CFCs nor the Bureau of Early Intervention have documentation of the problem and that makes it difficult to recruit providers to fill the gaps. Attention focused on the existing paper service delay reporting system that had been used for many years. This is a paper system submitted by CFCs to the Bureau of Early Intervention once a month. These data are entered into a database that maintains the history of delays for the full year. The monthly totals are accumulated and compared to the number of IFSPs for the same periods.

Discussions led to the decision to upgrade the delay reporting system effective January 2007, although it took until April 2007 to work out the problems. These discussions and the new system have led to more accurate and uniform reporting and will improve the program's ability to identify and respond to service delays. The new system allows the program to sort off family delays and treat them differently. Although for state oversight purposes CFCs are expected to do everything they can to limit family delays, the new system also allows the program to include shortages of service and instances where service is being delivered in a non-natural service because no provider is available to provide service in a natural setting. This allows the program to compile a total shortfall calculation that can be translated into FTEs from the statewide level down to the Zip code level.

The month of April is being used for making local determinations and for this report. The program has decided that it will not use service delay reporting in performance contracting, although it will utilized it in determination scorecards if an agency fails to submit a credible corrective action plan or fails to make good faith efforts to complete corrective action steps. Experience shows that service delay is highly seasonal. It is low in the first seven or eight months of the state fiscal year then grows in sync with the annual spring jump in the caseload. April is near the annual peak in delays.

Indicator 1: Percent of infants and toddlers with IFSPs who receive the early intervention services on their IFSPs in a timely manner.

Measurement: Percent = [(# of infants and toddlers with IFSPs who receive the early intervention services on their IFSPs in a timely manner) divided by the (total # of infants and toddlers with IFSPs)] times 100.Account for untimely receipt of services.

FFY: 2006 (2006-2007)

Measurable and Rigorous Target: 100 percent of infants and toddlers with IFSPs will receive the early intervention services on their IFSP within 30 days.

Actual Target Data for FFY 06/SFY 07:

The table below shows performance for the state and for each of the state's 25 service coordination agencies in April 2007, followed by statewide performance for April 2006. It calculates performance both including and excluding delays for family reasons. Statewide, 3.5% of children were experiencing delays in receipt of one or more services due to system reasons. As noted previously, normal seasonality indicates that the number of service delays will be higher than average in April. Seven agencies had no delays for system reasons and two others with mid-sized caseloads had just one each. The following five agencies had system delays of more than 5%:

  • #3 - Freeport/Northwest Illinois - This area has had significant problems identifying enough providers to deliver services in natural settings and in identifying enough providers in general. Problems have been greatest in particular rural areas where the availability or lack of availability of one provider makes a big difference.
  • #4 - Kane & Kendall Counties/Outer Western Chicago Suburbs - This is a rapidly growing area with great competition for qualified professionals.
  • #10 - Southeast Chicago - This area is the poorest in the state. In SFY 07, an average of 88.2% of kids were on Medicaid and only 4.5% had enough income for the families to owe fees, 185% of poverty. This compares to 60% Medicaid statewide and 30.4% that paid fees for the year. Fewer qualified professionals live in the area and it is difficult to recruit providers from outside to work in the area when there are many work opportunities in the Chicago area.
  • #15 - Joliet/Southwest Chicago Suburbs - This is a rapidly growing area with great competition for qualified professionals.
  • #18 - Springfield/Central Illinois - Springfield is a medical center for downstate Illinois. This creates competition for qualified providers. April also seems to have represented a short-term problem. This area usually runs at or below average for delays with occasional spikes like this one.

Almost all service delays for system reasons are due to problems identifying a qualified and willing provider within 30 days of an initial IFSP or within 30 days of a disruption in services during an IFSP. The lowest rate of problems is downstate, where growth is slower and where the EI provider community is more stable, with fewer alternative employment opportunities. Most downstate areas report few problems. Four of the 13 downstate agencies (1, 3, 16 & 18) account for all but two of the 88 system delays. Suburban problems are most related to rapid growth and competition for qualified professionals. Within Chicago, there also is competition for qualified providers and that is complicated by economic factors. CFC 10 is the poorest Chicago area and had a16.4% rate of service delay, although there has been a significant improvement since April. CFC 11 is the wealthiest area of Chicago and it had just a 1.1% problem.

While delays for this report are reported in with family delays removed from the calculations, the program generally treats all delays as problems that need to be looked into and addressed. Many family delays are for obvious and unavoidable issues, such as child or parent health issues. Others are due to problems it is difficult for the CFC to address.

Service Delays - All Cases Open in April Calculated Including & Excluding Family Delays
CFC # & Name IFSPs Family
Delays
Net
IFSPs
System
Delays
% System
Delays
Family &
System
Delays
#1 - ROCKFORD 556 11 545 23 4.2% 6.1%
#2 - LAKE COUNTY 803 12 791 17 2.1% 3.6%
#3 - FREEPORT 364 1 363 24 6.6% 6.9%
#4 - KANE-KENDALL 868 16 852 43 5.0% 6.8%
#5 - DUPAGE COUNTY 1,233 10 1,223 28 2.3% 3.1%
#6 - N. SUBURBS 1,384 20 1,364 62 4.5% 5.9%
#7 - W. SUBURBS 962 3 959 19 2.0% 2.3%
#8 - S.W. CHICAGO 752 27 725 35 4.8% 8.2%
#9 - CENTRAL CHICAGO 1,110 - 1,110 46 4.1% 4.1%
#10 - S.E. CHICAGO 821 - 821 135 16.4% 16.4%
#11 - N. CHICAGO 1,850 12 1,838 20 1.1% 1.7%
#12 - S. SUBURBS 1,089 54 1,035 29 2.8% 7.6%
#13 - MACOMB 379 - 379 - 0.0% 0.0%
#14 - PEORIA 498 2 496 1 0.2% 0.6%
#15 - JOLIET 1,273 4 1,269 70 5.5% 5.8%
#16 - BLOOMINGTON 587 3 584 20 3.4% 3.9%
#17 - QUINCY 225 - 225 - 0.0% 0.0%
#18 - SPRINGFIELD 318 - 318 19 6.0% 6.0%
#19 - DECATUR 406 - 406 - 0.0% 0.0%
#20 - EFFINGHAM 409 - 409 - 0.0% 0.0%
#21 - METRO E. ST. LOUIS 588 - 588 1 0.2% 0.2%
#22 - CENTRALIA 340 - 340 - 0.0% 0.0%
#23 - NORRIS CITY 226 - 226 - 0.0% 0.0%
#24 - CARBONDALE 165 1 164 - 0.0% 0.6%
#25 - MCHENRY 382 6 376 14 3.7% 5.2%
Service Delays among Electronic Reporting - All Cases Open in April Calculated Including & Excluding Family Delays
CFC # & Name IFSPs Family
Delays
Net
IFSPs
System
Delays
% System
Delays
Family &
System
Delays
State: Electronic Reporting 17,588 182 17,406 606 3.5% 4.5%
Cook County 7,968 116 7,852 346 4.4% 5.8%
Collar Counties 4,559 48 4,511 172 3.8% 4.8%
Downstate 5,061 18 5,043 88 1.7% 2.1%

[ 606/(17,588-182) ] x100= 3.48% Service Delays

Service Delays among Paper Reporting - All Cases Open in April Calculated Including & Excluding Family Delays
CFC # & Name IFSPs Family
Delays
Net
IFSPs
System
Delays
% System
Delays
Family &
System
Delays
State: Paper Reporting 16,744 181 16,563 285 1.7% 2.8%
Cook County 7,374 83 7,291 156 2.1% 3.2%
Collar Counties 4,537 31 4,506 64 1.4% 2.1%
Downstate 4,833 67 4,766 65 1.4% 2.7%

Discussion of Improvement Activities Completed and Explanation of Progress or Slippage that occurred for FFY 06/SFY 07:

Technically, the reporting system in place through December 2006 and the system now in use called for the reporting of almost the same information. However, the change in the reporting process and the programs improved guidance created a very different environment. As was speculated in the FFY05/SFY 06 APR, there was an increase in the proportion of cases experiencing service delays. Some of the reasons for the increase are outlined below but some may be due to improved reporting. We cannot confirm that the data reported for April 2007 is more accurate than what was reported for April 2006, but that probably is the case.

Problem #1: There was a significant, and relatively sudden, increase in the caseload in the latter part of FFY 06/SFY 07. The caseload was lower in January 2007 than it had been at the end of June 2006 but it grew by 4.6% in the next three months. There was much less growth in spring of FFY 05/SFY 06. Illinois' system of any "able and willing" providers is more responsive than systems that centralize service delivery but it is still difficult for supply to meet demand when demand increases by 4.6% within a three-month period. This does not explain problems in areas with systemic problems that need to be addressed, such as Rockford, Freeport and Southeast Chicago, but it does explain why delay rates are higher in April-June than in the rest of the year. In areas without systemic problems, supply generally catches up with demand. The good news is that the new reporting system provides the program and local agencies with data that can better identify systematic problems and that can be used for recruitment. Also, the program is now building a history that will help us project the growth in demand.

Problem #2: Through FFY 06/FFY 07, provider rates presented a problem for recruitment. EI rates are based on Medicaid rates and they are much lower than the rates paid by insurance. In addition, those rates had not been increased in a number of years. This was causing some providers to leave the program or limit how much EI work they accepted. Low rates made others reluctant to enter the system. For SFY 08, law required a 3% provider increase. This will be of some help in recruitment and retention of providers.

Problem #3: When the state statute was amended to require the use of private health insurance for SFY 03, large providers pushed successfully to require providers to bill insurance first. They can only get paid if they have a valid denial from the insurance company. Large providers who are well versed in billing insurance, and who have staff dedicated to billing, like the system because they realize getting paid by insurance means higher rates. However, small and independent providers do not like this law. Some providers have left in frustration and others will not enter. The program is now in the process of considering revisions to its system to bill for providers by creating a central insurance billing unit.

Revisions, with Justification, to Proposed Targets / Improvement Activities / Timelines / Resources for FFY 07-10/SFY 08-11

As required, the targets for service delays will remain to have none. The improvement activities will be modified to read as follows:

  • Effective with FFY 06/SFY 07 CFCs will be required to submit a corrective action plan whenever service delays exceed 2.0% of children with IFSPs during April of the previous fiscal year. [This step reflects a modification more in line with the determination process. It has been implemented.]
  • With FFY 06/SFY07 CFCs with more than 5% of open cases in April experiencing service delays will be found in non-compliance. Agencies with more than 5% delays excluding family delays will be found in federal non-compliance. Agencies with more than 5% delays will be deemed in state non-compliance. [This is to be in line with the determination letter process and has been implemented.]
  • The corrective action plans of agencies found in either federal or state non-compliance will be forwarded to the Bureau of Early Intervention for incorporation into the state corrective action plan.
  • An Illinois Interagency Council on Early Intervention (IICEI) workgroup will be formed to address the following problems: 1) the systemic problems in areas found in non-compliance, 2) how to respond to demand in rural areas, 3) the expectations on both CFCs and the EI Bureau for addressing service delays, and 4) the potential use of incentives and penalties to improve compliance (example: 1% incentive payment for each quarter a CFC goes without needing more than 30 days to find a service authorized within an IFSP). An initial report will be issued by April 30, 2008 with action steps to be implemented during FFY 07/SFY 08. [This reflects minor adjustments in line with the determination letter process.]
  • Through regular meetings provider groups will be asked to assist in closing existing gaps in availability and in helping to quickly address new problems when they arise. These meetings will include the sharing of data on areas where the program is having difficulty meeting the demand and trends in the caseload and use of services. Meetings will start by July 2007. (These meetings have begun and are ongoing.)
  • The IICEI workgroup will recommend additional steps to eliminate service delays not covered previously, as deemed necessary after the April 30, 2008 report noted previously.
  • Starting no later than July 2007, a new item will be added to the programs monthly statistical reporting to highlight service delays by CFC. [This step has been completed.]
  • Starting no later than January 31, 2008, delays will be added to the statistics provided to the IICEI as part of each of their meetings. (This step has been completed.)
  • Starting no later than July 2007, delays by CFC will be added as part of the statistical report posted quarterly to the DHS website. The monthly CFC reports on delays will be adjusted to better reflect the requirements of the State Performance Plan. This will include more emphasis on service delays, compared to other kinds of delays that can be tracked in other ways.
  • The traditional service delay reporting system will be replaced with one that will provide much more actionable details for both CFCs and the EI Bureau, effective January 2007. [This step was completed.]
  • The program hopes that the steps outlined will result in the elimination of service delays. However, we will continue to utilize our monthly reporting system, monitoring, and meetings with provider groups to find additional ways to assure service availability through the period of the plan.
  • Before the end of FFY 07/SFY 08 the program will implement an option for providers to have insurance billing done by the program as a means of lessening the burden on small providers and encouraging more providers to work within the program.