Indicator 9 - General supervision system (including monitoring, complaints, hearings, etc.) identifies and corrects noncompliance as soon as possible but in no case later than one year from...

Helping Families. Supporting Communities. Empowering Individuals.

Overview of the Annual Performance Report Development: See Indicator 1

Monitoring Priority Effective General Supervision Part C / General Supervision
Indicator 9 General supervision system (including monitoring, complaints, hearings, etc.) identifies and corrects noncompliance as soon as possible but in no case later than one year from identification.
(20 U.S.C. 1416 (a)(3)(B) and 1442)
Measurement

Percent of noncompliance corrected within one year of identification:

  • # of findings of noncompliance.
  • # of corrections completed as soon as possible but in no case later than one year from identification.

    Percent = [(b) divided by (a)] times 100.

    States are required to use the "Indicator C 9 Worksheet" to report data for this indicator (see Attachment A).

FFY Measurable and Rigorous Target

FFY  Measurable and Rigorous Target
FFY09/SFY10 100 percent of noncompliance will be corrected within one year of identification.

Actual Target Data for FFY 2009

Indicator 9 (Target data for FFY 2008 - the percent shown in the last row of the Indicator C 9 Worksheet [(column (b) sum divided by column (a)) times 100])
FFY09/SFY10  (42/71) x 100 = 59.2%
FFY09/SFY10 Target 100%

This Indicator documents the correction of noncompliance within one year for findings identified in FFY08/SFY09 (i.e., those sent to CFC offices on December 18, 2008, and then revised on March 5, 2009) and on site monitoring visits conducted in FFY08/SFY09. There were no complaints or hearing requests that resulted in a finding of noncompliance. Of the findings identified in FFY08/SFY09, 59.2% were corrected within one year. The target for this indicator is 100%. For finding identified in FFY07/SFY08, 98.2% were corrected within one year. The two remaining uncorrected findings (under 8C) identified in FFY07/SFY08 have been corrected.

Discussion of Improvement Activities Completed and Explanation of Progress or Slippage that Occurred for FFY 2009:

The drop in this measure from 98.2% in FFY08/SFY09 to 59.2% can be attributed to the addition of "prong 2" to findings identified for Indicators 1, 7 and 8, ensuring that CFC offices have correctly implemented the specific regulatory requirement, as defined in OSEP Timely Correction Memo 09-02. When a finding has been identified, the CFC office develops a corrective action plan and implementation is documented. Child-specific data are accessed through the data systems (i.e., the Service Delay Reporting and Cornerstone systems) and file reviews to ensure that correction for that child has occurred. Prong 2 involves the documentation that a CFC office has implemented the regulatory requirement using monthly statistical reports that show three consecutive months during which the CFC office shows (100%) compliance.

In FFY09/SFY10, the greatest challenge for correction of noncompliance was for Indicator 1, service delays, in which 20 of the 21 identified findings remain uncorrected. Challenges for timely services are discussed under Indicator 1. Several factors related to compliance with this indicator, including provider payment delays, are not under the control of the CFC office or the Bureau. For other indicators (7 and 8C) the issue involves documenting three consecutive months with 100% compliance. Several CFC offices fall in and out of 100% compliance with one or two consecutive months of compliance, but not 3 consecutive months. Non-compliance usually involves a very small number of children, as demonstrated by CFC-specific date for these indicators. Lack of correction of two findings for 8A involved noncompliance with1file in each of two CFC offices with an uncorrected finding.

Improvement Activities Completed: Illinois has a process in place to document the identification and correction of noncompliance as soon as possible but in no case later than one year from identification, which builds on Illinois' extensive use of its data system. The process of notifying CFC offices of findings has been combined with the determination process, allowing CFC offices to fully address areas of concern into a comprehensive correction action plan. As part of efforts to address noncompliance, all new service coordinators complete on-line training modules. The Illinois Early Intervention Training Program continues to update and modify the modules as needed and upon the request and approval of the Department.

Improvement Activity Status/Timeline/Resource

?Improvement Activity Status/Timeline/Resource
In the FFY09 APR (to be submitted on 2/1/11), correction of noncompliance will also include "prong 2," ensuring that CFC offices have correctly implemented the specific regulatory requirement. The attached document provides sample compliance documentation using actual data for Indicators 7 and 8A.

For Indicator 1, 7 and 8C, correction within 12 months of the notification of a finding is now identified when data demonstrate that a CFC office has 100 percent compliance during three consecutive months.

For Indicator 8A, correction will be documented when no files at the subsequent annual monitoring review indicate a finding, based upon identified transition elements in the monitoring review tool.

  By March 31, 2010, a quarterly data report will be established to provide child-specific information to CFC offices so that they can follow-up on correction of noncompliance for Indicators 1 and 8C.  CFC offices receive monthly reports that identify children that remain on the service delay list. A monthly status update is required. In addition children that have been removed from the list without a known resolution are identified and CFC offices are required to provide the required documentation. Bureau of Performance Support Services staff are currently modifying the monthly statistical report to facilitate the identification of correction of noncompliance and to provide child-specific information regarding 8C.

Timely Correction of FFY 2008 Findings of Noncompliance (corrected within one year from identification of the noncompliance):

  1. Number of findings of noncompliance the State made during FFY 2008 (the period from July 1, 2008, through June 30, 2009) (Sum of Column a on the Indicator C 9 Worksheet) 71
  2. Number of findings the State verified as timely corrected (corrected within one year from the date of notification to the EIS programs of the finding) (Sum of Column b on the Indicator C 9 Worksheet) 42
  3. Number of findings not verified as corrected within one year [(1) minus (2)] 29

Correction of FFY 2008 Findings of Noncompliance Not Timely Corrected (corrected more than one year from identification of the noncompliance) and/or Not Corrected:

  1. Number of FFY 2008 findings not timely corrected (same as the number from (3) above) 29
  2. Number of FFY 2008 findings the State has verified as corrected beyond the one-year timeline ("subsequent correction") 1
  3. Number of FFY 2008 findings not yet verified as corrected [(4) minus (5)] 28

Actions Taken if Noncompliance Not Corrected: Corrective action plans to address noncompliance policies, procedures, and practices are required to be written and implemented for any finding of non-compliance. Compliance is considered in setting determination scorecards if an agency fails to submit a credible corrective action plan, fails to make adequate progress, or fails to implement major features of the plan. Determination scores are negatively impacted by poor performance in performance measures.

Verification of Correction of FFY 2008 findings (either timely or subsequent): See steps outlined below.

Describe the specific actions that the State took to verify the correction in FFY 2009 of findings of noncompliance identified in FFY 2008: When a finding has been identified, the CFC office develops a corrective action plan and implementation is documented. In addition, the following steps are taken.

  • Indicator 1: CFC offices submit a monthly Service Delay Report. This report includes a status code and date the delay was resolved. Child-specific information was used to determine the status of all instances of noncompliance. Child specific data were accessed through the Service Delay Reporting system, the Cornerstone system, and file reviews. All instances of noncompliance were resolved for reasons that include the following: data entry error, service provided, family declined service, and child no longer in system. The status of findings will be monitored quarterly to verify that a CFC office had implemented the regulatory requirement using monthly statistical reports that show three consecutive months during which the CFC office shows (100%) compliance.
  • Indicator 2: Illinois uses its data system and a formal system of notification, to identify findings and document correction of noncompliance. In SFY08/FFY09, 5 findings of noncompliance were identified for Indicator 2, with all findings of noncompliance corrected within one year.
  • Indicator 7: The data system continues to track a child for whom an evaluation/assessment and an initial IFSP meeting were not conducted within Part C's 45-day timeline. No cases from the findings identified in this report were left unresolved, as indicated in 75-day reports and case-by-case follow-up with CFC offices. The status of findings will be monitored quarterly to verify that a CFC office had implemented the regulatory requirement using monthly statistical reports that show three consecutive months during which the CFC office shows (100%) compliance.
  • Indicator 8A: File reviews completed as part of CFC office onsite monitoring visits utilize randomly selected files to determine if IFSPs document transition steps and services. As part of a contractual agreement with the lead agency, the Illinois EI Monitoring Program conducts annual on-site monitoring visits to the 25 CFC offices. The number of files to be reviewed in a CFC office is based upon the number of active cases, varying from 20 files in a CFC office with a caseload of less than 200 to 56 files for a caseload between 1,800 and 2,000. The number of files is divided by the number of service coordinators and then files are randomly selected to be representative of each service coordinator's caseload. In addition to the development and implementation of corrective action plans, child specific correction is documented and correction documented when no files at the subsequent annual monitoring review indicate a finding.

    There are several elements of the CFC monitoring file review tool that relate to documentation of the transition process. Transition elements from the CFC monitoring file review tool that reflect compliance with Indicator 8(a) include the following:

    • There is evidence that six months prior to the child's third birthday communication began with the family about transition.
    • With informed parental consent, service coordinator notified the child's local educational agency that the child will shortly reach the age of eligibility for preschool services under Part B.
    • Early Intervention to Early Childhood Tracking Form was completed (PA34).
    • Transition Efforts are documented in case notes (CMO4).
  • Indicator 8B: No findings of noncompliance have been identified for 8B. Electronic transfer of data to the Illinois State Board of Education/Part B, on the state-level, ensures full compliance.
  • Indicator 8C: CFC offices conducted case file reviews for all children that did not have a transition meeting entered in the Cornerstone system. CFC offices either confirmed through case notes that a transition meeting had been held/transition appropriate completed or that the child was no longer in the jurisdiction of the Early Intervention program. Transition information from the IL State Board of Education was also reviewed to determine the child's transition outcome. The status of findings will be monitored quarterly to verify that a CFC office had implemented the regulatory requirement using monthly statistical reports that show three consecutive months during which the CFC office shows (100%) compliance.

Correction of Remaining FFY 2007 Findings of Noncompliance (if applicable)

If the State reported less than 100% for this indicator in its FFY 2007 APR and did not report that the remaining FFY 2007 findings were subsequently corrected, provide the information below:

  1. Number of remaining FFY 2007 findings noted in OSEP's June 2010 FFY 2008 APR response table for this indicator 2
  2. Number of remaining FFY 2007 findings the State has verified as corrected 2
  3. Number of remaining FFY 2007 findings the State has NOT verified as corrected [(1) minus (2)] 0

Correction of Any Remaining Findings of Noncompliance from FFY 2006 or Earlier - not applicable

Additional Information required by the OSEP APR Response Table for this Indicator (if applicable):

?Statement from the Response Table State's Response
If the State does not report 100% compliance for this indicator in the FFY09 APR, the State must review its improvement activities and review them, if necessary. See improvement activities listed below.
In addition, in reporting on Indicator 9 in the FFY 2009 APR, the State must use the Indicator 9 Worksheet. See Attachment A.
Further, in response to Indicators 1, 7, 8A and 8C in the FFy2009 APR, the State must report on correction of the noncompliance described in this table under those indicators. See description of correction of noncompliance, described above.

Revisions, with Justification, to Proposed Targets / Improvement Activities / Timelines / Resources for FFY10/SFY11: The State Performance Plan (SPP) has been revised to specify, for each indicator, annual targets and improvement activities for each year through FFY2012 (July1, 2012 through June 30, 2013).

FFY Measurable and Rigorous Target

?FFY Measurable and Rigorous Target
2011 (2011-2012) 100 percent of noncompliance will be corrected within one year of identification.
2012 (2012-2013) 100 percent of noncompliance will be corrected within one year of identification.

New Improvement Activity Timelines & Resources

?New Improvement Activity Timelines & Resources
Additional data will be provided to CFC offices so they can monitor compliance with transition requirements and address child-specific and system issues in a timely way. Beginning in January 2011 and on an ongoing basis, a system will be implemented that will provide a monthly list to each CFC office of all children that have not had transition meetings Resources include the Bureaus of Early Intervention and Performance Support Services. Beginning in July 2011and on an ongoing basis, "mini APR tables" will be provided to CFC offices on a quarterly basis, so that they can monitor performance on Indicators 1, 7, and 8C. Resources include the Bureaus of Early Intervention and Performance Support Services.
In addition to making findings to CFC offices based upon dispute resolution, complaints and hearings and reporting them in Indicator 9 of the APR, findings will also include those made to individual service providers. The provider will be notified of the finding and child -specific correction of the violation will be ensured. When broader non-compliance exists, the provider will be required to submit and implement a corrective action plan to ensure that the policy, procedure, or practice that led to the noncompliance has been corrected so that future provision of services to other children are compliant. This will be implemented in FFY10/SFY11 as part of the finding notification process and will continue as an ongoing strategy. Resources include the Bureaus of Early Intervention and the EI Monitoring Program.

Illinois Part C is implementing a coordinated system of finding notification and correction.

On a quarterly basis, data will be reviewed to ensure that implementation of corrective action plans have been documented, child specific correction has taken place, and CFC offices demonstrate three consecutive months with 100 percent compliance. When compliance with OSEP Timely Correction Memo 09-02 is

present, CFC offices will be notified that correction of a finding has taken place. The program will also communicate with the EI Monitoring Program to track and document correction of noncompliance for 8A that has been identified through file reviews as part of the  on-site CFC office review process. The system will also track correction of noncompliance identified based upon dispute resolution, complaints and hearings.

This will be implemented in FFY10/SFY11 as part of the finding notification process and will continue as an ongoing strategy.

Resources include the Bureaus of Early Intervention and Performance Support Services and the EI Monitoring Program.

Illinois will use a full 12 months of data for the identification of findings for Indicator 1.

This will be implemented in FFY10/SFY11 as part of the finding notification process and will continue as an ongoing strategy.

Resources include the Bureaus of Early Intervention and Performance Support Services.

Additional data will be provided to CFC offices so they can monitor service delays and address child-specific and system issues in a timely way.

Beginning in July 2011and on an ongoing basis, "mini APR tables" will be provided to CFC offices on a quarterly basis, so that they can monitor performance on Indicators 1, 7, and 8C.

Resources include the Bureaus of Early Intervention and Performance Support Services.