DMS

REPORT

DIFFERENTIATED MONITORING AND SUPPORT

OFFICE OF SPECIAL EDUCATION PROGRAMS

U.S. DEPARTMENT OF EDUCATION

 

STATE FLORIDA

DATE JANUARY 19, 2021 

IDEA PART C 

CONTENTS

LETTER .............................................................................................................................................. 1

ENCLOSURE ....................................................................................................................................... 4

DMS NOTICE ................................................................................................................................... 13

STOP THE CLOCK MEMORANDUM................................................................................................... 15
LETTER

UNITED STATES DEPARTMENT OF EDUCATION

OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES

400 MARYLAND AVE., S.W. WASHINGTON, D.C. 20202-2600

www.ed.gov

The Department of Education’s mission is to promote student achievement and preparedness for global competitiveness 

by fostering educational excellence and ensuring equal access.

Letter

January 19, 2021

Honorable Scott Rivkees, M.D. 

Surgeon General 

Florida Department of Health

Children’s Medical Services

4052 Bald Cypress Way, Bin A00 

Tallahassee, Florida 32339 

Scott.Rivkees@flhealth.gov 

Dear Surgeon General Rivkees:

The purpose of this letter is to provide a summary of the results of the differentiated monitoring 

and support (DMS) activities conducted by the U.S. Department of Education’s (Department),

Office of Special Education Programs (OSEP) during an on-site monitoring visit to the Florida 

Department of Health’s (FDOH), Early Steps program on December 11–13, 2019 and post-visit

monitoring interviews with select Local Early Steps (LES) programs in Florida during December 

2019 and January 2020. 

As part of the DMS process, OSEP conducts an organizational assessment (OA) of factors to 

identify States’ progress in meeting performance standards and compliance with applicable 

requirements. These requirements are reflected in Part C of the Individuals with Disabilities 

Education Act (IDEA) and its implementing regulations, the Education Department General 

Administrative Regulations and the Office of Management and Budget’s (OMB), Uniform 

Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards 

(Uniform Guidance). OSEP uses the information from the OA and an Engagement Decision Tree

to make decisions about how it will engage with States over the course of the Federal fiscal year 

(FFY). The FFY 2018 DMS areas were: 1) Results; 2) Compliance; 3) State Systemic 

Improvement Plan (SSIP); and 4) Fiscal Accountability. 

On August 26, 2019, OSEP sent Florida’s IDEA Part C DMS Notice to Renee Jenkins, FDOH’s

Early Steps Part C Coordinator. The DMS Notice indicated that FDOH was designated as 

needing “intensive” engagement under Part C of IDEA for results and “targeted” for Compliance 

and Fiscal Accountability. OSEP did not engage the Early Steps program regarding its SSIP, for

which the level of engagement was determined to be “universal.” For this area OSEP will 

continue to provide the State ongoing technical assistance. We have attached a copy of the DMS 

Notice for your convenience. 

The results of OSEP’s monitoring were gathered from:

• Interviews with representatives from FDOH (including staff from its Quality Assurance 

Accountability and Monitoring Unit, Policy and Professional Development Unit, its 

Special Projects Coordinator, State Parent Consultant and Early Steps State Office staff 
Page 2—Honorable Scott Rivkees, M.D.

including, the Early Steps Part C Coordinator, Contract Manager, Data Manager, Fiscal, 

Policy and SSIP personnel).

• Interviews with local LES program representatives. 

• Review of publicly available information, policies and procedures and other related 

documents submitted to OSEP from FDOH, which is the State lead agency responsible 

for implementing IDEA Part C requirements in Florida. 

• Review of the State’s systems for collecting and reporting its IDEA Part C data the State 

submitted for selected indicators in the State’s State Performance Plan/Annual 

Performance Report. 

As a result of the monitoring activities, OSEP identified one concern in the results area of early 

childhood outcomes and three findings of noncompliance with FDOH’s implementation of its 

Early Steps IDEA Part C program. OSEP attributes the root causes of its concern and findings to

FDOH’s structure of the Early Steps program which has delegated its authority of various IDEA 

Part C requirements to its LES, early intervention service (EIS) programs, providers and other 

agencies, and organizations without maintaining its general supervisory responsibilities over the 

implementation of those requirements as the designated State lead agency. 

Specifically, OSEP finds that FDOH has failed to:

1. Provide all early intervention services identified on the individualized family services 

plan (IFSP) of infants and toddlers with disabilities in a timely manner and ensure early 

intervention services are individualized to meet the needs of the child and family as 

determined by the IFSP team as required by IDEA Sections 635 and 636, as well as 34 

C.F.R. §§ 303.12, 303.342, 303.343, and 303.344(d); 

2. Monitor its LES/EIS programs for compliance as required by IDEA Section 635(a)(10) 

and 34 C.F.R. § 303.120(a) for fiscal requirements including the statewide system of 

payments policy and payor of last resort requirements in IDEA Section 640 and 34 

C.F.R. §§ 303.510(b), 303.520, and 303.521; and

3. Ensure that the State has a methodology, including policies and procedures, to track all 

State and local funding sources to enable it to ensure compliance with the IDEA Part C 

Maintenance of Effort (MOE) requirements in 34 C.F.R. § 303.225(b). 

The following enclosure provides a detailed description of the results of OSEP’s monitoring, a 

detailed analysis of the findings of noncompliance and the required corrective actions FDOH

will be required to implement as a result of the findings of noncompliance identified above. 
Page 3—Honorable Scott Rivkees, M.D.

We appreciate your efforts to improve results for infants and toddlers with disabilities. If you 

have any questions, please contact Susan Kauffman, your OSEP State Lead, at 202-245-6432. 

Sincerely,

/s/

Laurie VanderPloeg

Director

Office of Special Education Programs 

cc: Renee Jenkins, Part C Coordinator

Renee.Jenkins@flhealth.gov

Attachments:

Enclosure 

DMS Notice

OSEP’s June 23, 2020, Stop the Clock Memorandum 
ENCLOSURE

The Office of Special Education Programs’ (OSEP) differentiated monitoring and support 

(DMS) system is a component of Results Driven Accountability (RDA) to improve results for 

children with disabilities under the Individuals with Disabilities Education Act (IDEA). DMS is 

designed to help the U.S. Department of Education (Department) identify potential grantee risk 

and to assist OSEP, in effectively using its resources to monitor State grantees as they implement 

the IDEA. DMS addresses State-specific and Entity-specific needs in the areas of results, 

compliance, State Systemic Improvement Plan (SSIP), and fiscal accountability by 

differentiating levels and types of monitoring and support based on each State’s and Entity’s 

unique strengths, progress, and challenges in each area. 

This enclosure provides a detailed description of OSEP’s results from the DMS activities it

conducted to review the Florida Department of Health’s (FDOH’s), Early Steps program 

implementation of IDEA Part C, during December 11–13, 2019, and monitoring interviews with 

select Local Early Steps (LES) programs in Florida. This enclosure also describes the one 

concern in the area of results and the three findings of noncompliance with IDEA Part C 

requirements and the corrective actions that FDOH must take to address those findings of

noncompliance. 

Background 

FDOH is the State lead agency (LA) designated under IDEA Section 635(a)(10) that administers 

Florida’s IDEA Part C program, Early Steps, in the State of Florida through its Children’s 

Medical Services, Early Steps State Office. According to its December 1, 2020, Early Steps 

Program Annual Report,1 FDOH is “responsible for program oversight, which includes, but is 

not limited to: administrative functions, Federal reporting, Federal grant management, fiscal 

accountability and the monitoring of contract compliance.” Early Steps State staff consist of a 

Program Administrator (Part C Coordinator), two-unit supervisors, and a data analyst, 

programmatic, budgetary and contract management staff. 

FDOH contracts with 14 LES programs that are the State’s early intervention service (EIS) 

programs and which provide early intervention services directly or through subcontracts with 

other community EIS providers in 15 geographic regions throughout the State. The 14 LES/EIS

programs consist of hospitals, universities, non-profit, private, and for-profit organizations. 

FDOH’s EIS program contracts are structured around programmatic and fiscal deliverables such 

as:

• Child Find Plans; 

• Business Continuation Response Plans; 

• Funding Resource Plans; and

• Performance Improvement Plans.

1 The December 1, 2020 Early Steps Program Annual Report, can be accessed at: http://www.cmskids.com/providers/early_steps/reports/Earlystepsannualreport.pdf
OSEP DMS LETTER FLORIDA | 2020 PAGE 5 

According to FDOH’s Early Steps Policy Handbook2 “LES programs may hire direct staff or 

contract with enrolled individuals or agencies that employ enrolled individuals in each service 

area.” LES programs are held responsible by the LA for: 

• Providing professional development to staff; 

• Making timely payments to community service providers for early intervention service 

claims;

• Developing policies and procedures for timely data collection, and database entry; and

• Providing oversight of its contracted staff and the agencies that employ its service 

providers.

The State indicated in its FFY 2020 IDEA Part C grant application that FDOH provides 

approximately $20 million of its IDEA Part C funds to its LES programs for the provision of 

direct early intervention services.3

 Through its statewide System of Payments (SoP) policy,4

FDOH utilizes public insurance, private insurance, State General Revenue (GR), and IDEA Part 

C funds to support its LES/EIS programs in funding the provision of early intervention services. 

The Early Steps State appropriation (including Medicaid match dollars) is approximately $43 

million5 and FDOH reported that approximately 70% of funding for the IDEA Part C Early Steps 

program is supported by Medicaid dollars. 

Additionally, in 2014–2015 some early intervention services provided by Early Steps began to 

transition from a “fee-for service” model to Medicaid Managed Care.

6 In December 2018, as part 

of Florida’s Statewide Medicaid Managed Care (SMMC) expansion plan, additional early 

intervention services7 previously provided by Early Steps transitioned into Medicaid Managed 

Care, “to facilitate an integrated health care delivery system wherein the health plan is 

responsible for coordinating and paying for all of the services that the child needs.”8 Although 

FDOH made efforts to support its LES/EIS programs, the impact of this transition on Early Steps 

EIS programs has been a contributing factor to FDOH’s noncompliance with IDEA Part C 

requirements. The three areas of noncompliance are discussed in greater detail in subsequent 

sections of this enclosure. 

2 All references, including section numbers and quotations, to the Early Steps Policy Handbook in this memorandum refer to the 

document, dated January 1, 2018, unless otherwise noted because that is the version that FDOH provided to OSEP in 

November 2019, for this monitoring activity.

3 In FFY 2020, Florida’s IDEA Part C grant was $26,088,064. 

4 Under IDEA Part C, a State may adopt SoP policies to fund early intervention services consistent with 34 C.F.R. 

§§ 303.13(a)(3) and 303.203(b) and meet the requirements under 34 C.F.R. §§ 303.520. and 303.521.

5 The 2019-2020 State appropriation was $43,145,063. See pg. 9, http://www.cmskids.com/providers/early_steps/reports/Earlystepsannualreport.pdf . 

6 The Agency for Health Care Administration (AHCA) is the State agency responsible for administering Medicaid in Florida. 

7 These services include developmental screening, evaluation, early intervention sessions, and Targeted Case Management.

8 See pg. 3, https://ahca.myflorida.com/Medicaid/statewide_mc/pdf/EIS_FAQs_Final.pdf .
OSEP DMS LETTER FLORIDA | 2020 PAGE 6

Results from OSEP’s Monitoring

As a result of OSEP’s visit, OSEP identified one concern in the results area of early childhood 

outcomes and the following three findings of noncompliance that are discussed in further detail 

below. Specifically, OSEP finds that FDOH failed to:

1. Provide all early intervention services as identified on the individualized family service 

plan (IFSP) of infants and toddlers with disabilities in a timely manner and ensure early 

intervention services are individualized to meet the needs of the child and family as 

determined by the IFSP team as required by IDEA Sections 635 and 636, as well as 34 

C.F.R. §§ 303.12, 303.342, 303.343, and 303.344(d); 

2. Monitor its LES/EIS programs for compliance as required by IDEA Section 635(a)(10) 

and 34 C.F.R. § 303.120(a) for the fiscal requirements including the statewide system of 

payments policy and payor of last resort requirements in IDEA Section 640 and 34 

C.F.R. §§ 303.510(b), 303.520, and 303.521; and 

3. Ensure that the State has a methodology, including policies and procedures, to track all 

State and local public funding sources to enable the State to ensure compliance with the 

IDEA Part C Maintenance of Effort (MOE) requirements in 34 C.F.R. § 303.225(b). 

Area of Concern: Results – Child Outcomes Measurement System

Based on the State’s FFY 2017 State Performance Plan (SPP)/Annual Performance Report 

(APR) Indicator 3 (child outcomes) data, Florida’s results score was 60.10% as reported in 

OSEP’s FFY 2019 IDEA Part C RDA Matrix.9 Under IDEA Sections 616, 635(a)(14), and 642 

and 34 C.F.R. §§ 303.124 and 303.701(c), FDOH must have a have a system for compiling and 

reporting timely and accurate data that are valid and reliable and reflect its performance. 

For child outcomes, FDOH reported that the quality of its data reported under SPP/APR 

Indicator 3 has been impacted by challenges with: 

• inconsistent implementation of the Battelle Developmental Inventory, Second Edition, 

(BDI-2)

10 throughout the State; 

• its ability to collect and analyze accurate child outcomes data; 

• State rules around the child outcomes progress categories, which are conservative and 

rigorous; 

• limited access to coaches with expertise in evidence-based practices; 

• inadequate screening and assessment tools; and 

• limited resources and professional development. 

FDOH staff indicated it has delegated the responsibility of training and effective implementation 

of its child outcomes measurement tools to its EIS programs. Additionally, to improve data and 

program performance, FDOH shared that it was piloting the Child Outcomes Summary (COS) 

9 The State’s FFY 2018 SPP/APR data demonstrated an approximate 10% decrease (49.42%) in the results of its child outcomes 

data. 

10 The BDI-2 is a standardized, individually administered assessment battery of key developmental skills in children from birth 

through seven years of age.
OSEP DMS LETTER FLORIDA | 2020 PAGE 7

tool with three of its LES programs. In its 2020-2021 State Plan,11 FDOH also reported that it

plans to implement use of the COS statewide through a three year “phased approach” in 

conjunction with the BDI-2 and “support local programs to provide effective professional 

development to support fidelity of implementation of the COS process” and “develop policies 

and procedures for implementation of the COS to ensure clear and consistent statewide 

practices.” 

OSEP acknowledges that the State has begun to address the significant barriers that it has 

identified in collecting and reporting its child outcomes data. We expect that the State will 

continue its efforts towards both improving its early outcome data and improving results for 

infants and toddlers with disabilities and their families. OSEP looks forward to reviewing (in the 

State’s FFY 2019 SPP/APR, due February 1, 2021) updated information around the State’s 

implementation of the COS, technical assistance and professional development, and FFY 2019 

early childhood outcome data reflecting improved results for Florida’s infants and toddlers with 

disabilities and their families.

Findings

Finding 1: Provide timely and individualized early intervention services.

Under IDEA Section 635(a) and 34 C.F.R. § 303.342(a) and (e), each State must ensure that Part 

C services are provided to all eligible infants and toddlers with disabilities and their families in a 

timely manner. Additionally, States must also ensure that each eligible infant and toddler with a 

disability has available early intervention services that are designed to meet his or her unique 

individual needs as identified by the IFSP team as required by IDEA Sections 635 and 636, as 

well as 34 C.F.R. §§ 303.12, 303.342, 303.343, and 303.344(d).

OSEP notes that the State’s data for SPP/APR Indicator 1 (timely service provision) for FFY 

2017 was 88.67% and for FFY 2018 was 89.39% and while these data appear to indicate that 

services are timely initiated, during OSEP’s visit, OSEP learned that the Part C services needed 

may not be identified on the IFSP at the initial meeting and that there are other concerns with the 

provision of appropriate services despite relatively strong data reported under SPP/APR 

Indicator 1.

During interviews with LES staff, OSEP consistently heard that the State’s transition to a

Medicaid Managed Care model, in which Managed Medical Assistance (MMA) programs 

provide early intervention service delivery and billing, has negatively impacted Part C service 

provision due to: 

1. provider shortages; 

2. untimely payments to providers for Part C service delivery; and 

3. long wait times for EIS providers to get credentialed which has resulted in service delays, 

staff leaving, and providers not being credentialed in the system while sometimes 

providing services. 

11 See http://www.cms-kids.com/providers/early_steps/reports/20_21StatePlam.2020.pdf .
OSEP DMS LETTER FLORIDA | 2020 PAGE 8

This information was also consistent with information from the State’s FFY 2018 APR in which 

FDOH reported that the following factors impacted its SPP/APR Indicator 1 data:

• Provider availability in rural counties; 

• Provider shortages of discipline-specific therapists to provide Part C services;

• Shortages of staff available to schedule initial evaluations with a multidisciplinary team; 

• Limited access to high-quality, real-time data; and

• Local program processes that caused late eligibility and IFSP development.

During monitoring interviews LES staff reported that Part C EIS provider shortages and high 

caseloads have not only impacted the ability to provide Part C services in a timely manner but 

have also influenced individualized early intervention service decisions for the type, time, 

frequency, and duration of Part C services for eligible infants and toddlers with disabilities and 

their families. Program staff also shared examples of children and families experiencing long 

wait times in between service sessions and second IFSP meetings being held after the initial 

IFSP meeting to amend the Part C services on the IFSP based on provider availability and case 

load capacity. During monitoring FDOH staff also discussed the use of a second IFSP meeting as 

a mechanism to identify and provide early intervention services for which the State had limited 

providers. 

Additionally, as part of Florida’s SMMC expansion plan, Early Steps required its local programs 

to implement new billing systems and have agreements in place with local MMA programs12 and 

third-party payor sources that are responsible for coordinating and paying for early intervention 

services. Although FDOH requires that its LES programs have agreements in place with 

managed care organizations, during monitoring interviews LES/EIS program staff reported that 

untimely payments and time spent on financial disputes has directly impacted the timing of early 

intervention service delivery and that the burden of resolving financial disputes for payment of 

early intervention services has been assigned as the responsibility of LES/EIS programs.

LES/EIS program staff shared examples of EIS providers selecting infants and toddlers for early 

intervention service provision based on the child’s or family’s insurance plan in order to receive 

timely payments and satisfactory reimbursement rates from insurance. Finally, LES/EIS program 

staff shared that because the credentialing process for EIS providers enrolling in MMA plans is 

lengthy, it can result in staff leaving or in some cases, providing Part C services without being 

fully credentialed in order for the LES/EIS programs to avoid service disruptions or untimely 

service delivery.

The above information indicates that in many cases, although infants and toddler with disabilities 

and their families may have an initial IFSP in place and receive services within the State’s 30-

day timeline under SPP/APR Indicator 1, the services identified on the initial IFSP do not reflect 

the services necessary to meet the unique needs of the child and family as required under 34 

C.F.R. § 303.344(d). Rather the initial IFSP identifies only the services with providers readily 

available to the LES/EIS program or for which timely reimbursement is likely.

In its June 1, 2019 State Plan,13 FDOH reported that it depends on its LES/EIS programs to 

ensure compliance with State and Federal policies but acknowledged that some LES/EIS 

programs are not in compliance with those policies. FDOH also discussed that its Early Steps 

12 MMA programs are one of three programs that make up Florida’s Statewide Medicaid Managed Care.

13 See pg. 5, http://www.cms-kids.com/providers/early_steps/reports/2019StatePlanFinal.pdf .
OSEP DMS LETTER FLORIDA | 2020 PAGE 9

data system is outdated and does not allow access to high-quality, real-time data and prevents the 

State from aggregating its data to conduct a root cause analysis of factors that have caused 

programmatic noncompliance. In the June 1, 2019 State Plan, FDOH also reported that “an 

assessment of the existing number of providers and provider types is needed to ensure an 

adequate network of providers in the Early Steps Program for timely service provision” and, 

overall, the demand for services is greater than the number of qualified and credentialed 

providers.

In response to its transition to SMMC, FDOH reported that it has encouraged its local LES/EIS 

programs to reach out to the MMA programs to collaborate in assigning providers and has

encouraged managed care plan providers that are not credentialed by Early Steps to complete 

Early Steps training and enroll with Early Steps, to expand the Early Steps provider network. 

The State reported that it also works with Agency for Health Care Administration (AHCA), to 

assist with provider shortages. Further, FDOH’s 2019 State Plan reported that “new contracts 

and billing processes are being developed” and “establishing these expanded relationships during 

this transition period creates a potential barrier to meeting performance measures related to 

timely service provision.”

Although the State has apparently identified some factors contributing to the finding, FDOH has 

not provided OSEP with sufficient information to establish that the issues have been corrected 

and that IFSPs and the service made available to infants and toddlers with disabilities and their 

families are in compliance with the IDEA Part C requirements. 

Finding 2: Monitor its LES/EIS programs to ensure fiscal compliance with its system of 

payment policy and Part C payor of last resort requirements.

Under IDEA Section 635(a)(10) and 34 C.F.R. § 303.120(a)(2), the State LA must monitor and 

enforce the implementation of Part C of the IDEA by its local LES/EIS programs and providers, 

to ensure statewide compliance. This includes ensuring that its LES/EIS programs are 

implementing and complying with fiscal requirements including the State’s SoP policies and 

procedures and IDEA Part C’s payor of last resort requirements. If the State LA identifies 

noncompliance, it must ensure that the noncompliance is corrected as soon as possible and in no 

case later than one year after the LA’s identification of the noncompliance consistent with 34 

C.F.R. § 303.120(a)(2)(iv). Additionally, under 34 C.F.R. §§ 303.520 and 300.521, of the IDEA 

Part C regulations, a State must adopt a written SoP policy if the State uses public insurance or 

benefits, private insurance, or family fees, such as a sliding scale, to pay for IDEA Part C 

services. Lastly, under IDEA Section 640(a) and 34 C.F.R. § 303.510(a), Federal funds under 

IDEA Part C may be used only to pay for early intervention services that an infant or toddler 

with a disability needs but is not currently entitled to receive or have payment made from any 

other Federal, State, local, or private source. 

During monitoring discussions, FDOH staff described its fiscal monitoring process which is 

conducted through Contract Monitoring. Although FDOH was able to demonstrate that it has a 

process in place to oversee its contracts, it was unable to provide OSEP with any examples of 

IDEA fiscal noncompliance that had been identified or evidence of fiscal monitoring that had 

occurred prior to 2017. Additionally, in OSEP’s review of the Monitoring Tool that is used by 

FDOH Contract Monitoring staff for fiscal monitoring, OSEP noted various SoP requirements 

were not included as part of the monitoring criteria and FDOH was unable to provide evidence of 
OSEP DMS LETTER FLORIDA | 2020 PAGE 10

another mechanism or tool that would oversee the implementation of those requirements by its 

LES/EIS programs. 

Additionally, during monitoring, FDOH reported that LES/EIS programs are required to use 

IDEA Part C funds as the payor of last resort, and that providers are responsible for documenting 

payor sources on IFSPs. FDOH reported that it verifies payor of last resort through its Contract 

Monitoring and that the process involves the review of billing records, Medicaid denials, and 

IFSPs. Information from document reviews is tracked with criteria on the fiscal monitoring tool.

However, OSEP did not locate specific criteria or evidence supporting FDOH’s oversight of the

IDEA Part C payor of last resort requirements. Additionally, as part of the monitoring activity, 

OSEP reviewed three Funding Resource Plans submitted by FDOH. During that review OSEP 

identified various funding sources and the State was unable to demonstrate oversight of those 

sources. From discussions with FDOH about these funding sources, OSEP learned that not only 

does the State not have access to the data from payor sources being accessed at the local level but

some LES/EIS programs may not have access to that information when it involves contracts 

between LES/EIS programs and certain community programs. In fact, FDOH staff indicated that 

there is limited documentation of any kind related to provision, frequency, intensity, or cost of 

any early intervention services being provided by these outside community programs. Since 

FDOH is unable to access information on all eligible children receiving early intervention

services, it is unable to determine that all available payor sources were accessed prior to LES 

programs accessing IDEA Part C dollars. This information is consistent with information 

included in its 2020-2021 State Plan in which FDOH acknowledged that the Early Steps Program 

relies on multiple funding streams at the Federal, State, and local level and “the current data 

system does not permit tracking of local resources and funding streams to ensure that Part C of 

the IDEA is the payor of last resort.”14

OSEP also identified policies and procedures within the Early Steps SoP policy that were 

inconsistent with the IDEA requirements for obtaining parental consent for the use of public 

benefits or insurance as required by 34 C.F.R. § 303.520(a)(2)(i). The State was notified of this 

noncompliance in response to its FFY 2020 IDEA Part C grant application through OSEP’s June 

23, 2020, Stop the Clock Memorandum (Memo).

15 FDOH is addressing the noncompliance 

identified in OSEP’s June 23, 2020 Stop the Clock Memo through a separate corrective action 

process from the noncompliance identified within this enclosure and OSEP will respond to 

FDOH’s SoP revised policies through the FFY 2020 and 2021 IDEA Part C grant applications.

Finding 3: Methodology, including policies and procedures to ensure the tracking of all

funding sources to determine compliance with IDEA Part C’s Maintenance of Effort

requirements. 

Under 34 C.F.R. § 303.225(b), each State lead agency must have a methodology to calculate the 

total amount of State and local funds budgeted for expenditures, and actually expended, for early 

intervention services for eligible children and their families. The State lead agency must have 

this methodology to ensure that “the total amount of State and local funds budgeted for 

expenditures in the current fiscal year for early intervention services for children eligible under 

this part and their families must be at least equal to the total amount of State and local funds 

14 See pg. 12, http://www.cms-kids.com/providers/early_steps/reports/20_21StatePlam.2020.pdf .

15 See Attachment 1.
OSEP DMS LETTER FLORIDA | 2020 PAGE 11

actually expended for early intervention services for these children and their families in the most 

recent preceding fiscal year for which the information is available.”

From monitoring discussions with FDOH and LES staff, OSEP learned of local level public 

funding sources that are utilized for early intervention services including the State contributions

made under the Children’s Health Insurance Program (CHIP) and county and local educational

agency (LEA) funds. FDOH staff reported to OSEP that the Early Steps Program relies on 

multiple funding streams at the Federal, State, and local level and “the current data system does 

not permit tracking of local resources and funding streams...”16 During discussions with OSEP 

staff about these funding dollars, FDOH staff reported that local level funding sources vary 

across its regions and although its LES/EIS programs depend on local funding to sustain early 

intervention services, the State cannot account for all local level funding sources including 

county and public State level funds for CHIP; and that its Early Steps data system does not 

provide information that is sufficient in detail to allow FDOH to determine the total amounts of 

State and local funds budgeted and expended specifically for the purposes of providing Part C 

early intervention services. 

Additionally, although OSEP did not review the total amount of expenditures for the Early Steps 

program from State fiscal years (SFY) 2016 through 2020, according to the Early Steps budget 

that was presented to OSEP during monitoring and which is presented in its December 1, 2020 

Annual Report, IDEA Part C funds and State General Revenue funds are listed as the payor 

sources for the Early Steps program and the budgeted amounts of State General Revenue funds

from SFYs 2016 through 2020 demonstrates a slight decrease.

17

Based on the information provided by FDOH, OSEP has determined that the State does not have 

a system in place to track and be able to calculate the total amount of State and local funds 

budgeted for expenditures, and actually expended, for early intervention services for children 

eligible under Part C of IDEA and their families. Further, the State is unable to ensure that the 

level of State and local funding for the provision of early interventions services complies with 

the IDEA Part C MOE requirements in 34 C.F.R. § 303.225(b).

Required Actions/Next Steps

OSEP finds that FDOH has failed to:

1. Provide all early intervention services identified on the IFSPs of infants and toddlers with 

disabilities in a timely manner as required by IDEA Sections 635 and 34 C.F.R. 

§ 303.342(a) and (e) and ensure early intervention services are individualized to meet the 

needs of the child and family as determined by the IFSP team as required by IDEA 

Sections 635 and 636 and 34 C.F.R. §§ 303.12, 303.342, 303.343, and 303.344(d); 

2. Monitor its EIS/LES programs for compliance as required by IDEA Section 635(a)(10) 

and 34 C.F.R. § 303.120(a) for two fiscal requirements: (1) the statewide system of 

payments policy; and (2) payor of last resort requirements in IDEA Section 640 and 34 

C.F.R. §§ 303.510(b), 303.520, and 303.521; and

16 See pg. 12, http://www.cms-kids.com/providers/early_steps/reports/20_21StatePlam.2020.pdf .

17 See pg. 9, http://www.cms-kids.com/providers/early_steps/reports/Earlystepsannualreport.pdf .
OSEP DMS LETTER FLORIDA | 2020 PAGE 12

3. Ensure that the State has a methodology, including any policies and procedures, to track 

all state and local public funding sources to enable it to ensure compliance with the IDEA 

Part C Maintenance of Effort (MOE) requirements in 34 C.F.R. § 303.225(b). 

As a result, the State will be required to implement the following corrective actions to address

the three findings of noncompliance identified above. 

With its FFY 2021 IDEA Part C application, the State must submit for OSEP approval its revised 

SoP policies identified in OSEP’s June 23, 2020 Stop the Clock Memo.

Within 90 days from the issuance of this letter, the State must submit for OSEP approval a 

corrective action plan (including timelines and evidence of implementation) that: 

1. Includes revised monitoring procedures to review whether early intervention services on 

the initial IFSP are individualized and meet the unique needs of the child and family as 

determined by the IFSP team; 

2. Includes revised monitoring procedures to reflect the IDEA Part C fiscal requirements for 

(a) payor of last resort and (b) system of payments; and 

3. Includes revised policies and procedures to ensure that the State has a methodology to 

track all State and local public funding sources to enable it to ensure compliance with the 

IDEA Part C MOE requirements.
DMS NOTICE

Differentiated Monitoring and Support Engagement Decisions:

Florida

2018-2019

This year we have selected four States for on-site visits as part of OSEP’s Differentiated Monitoring and 

Support (DMS) system. These selections were based on the relative number of intensive and targeted 

Levels of Engagement (LOEs) across all states. Your State has been selected for an on-site visit. 

OSEP’s Differentiated Monitoring and Support (DMS) system is a component of Results Driven 

Accountability. DMS is designed to identify potential grantee risk to the Department and to assist OSEP 

in effectively using its resources to monitor grantees. DMS addresses State-specific needs in the areas of 

results, compliance, State Systemic Improvement Plan (SSIP), and fiscal by differentiating levels and 

types of monitoring and support based on each State’s unique strengths, progress, and challenges in each 

area.

DMS is a multi-tiered model for monitoring and providing support based on the principle that supports 

are first provided at a core or universal level to effectively address the needs of all States. Targeted 

monitoring and support is generally based on OSEP’s identification of common needs among multiple 

States. Intensive monitoring and support is reserved for those States with the most intense or complex 

challenges to implementation. 

OSEP has assessed States’ and Entities’ progress in meeting performance standards and compliance with 

the legal requirements of the Individuals with Disabilities Education Act, the Education Department 

General Administrative Regulations and the Uniform Administrative Requirements, Cost Principles, and 

Audit Requirements for Federal Awards. This information was used to help OSEP make decisions about 

a State’s or Entities’ levels of engagement for monitoring and support. 

The charts below specify your State’s level of engagement in each area – results, compliance, fiscal and 

SSIP.
OSEP DMS LETTER FLORIDA | 2020 PAGE 14

Results | Level of Engagement: Intensive

Factors Existing/Current Engagement

• Child Performance - Comparing your State’s 

2017 Outcomes Data to other State’s 2017 

Outcomes Data

• Child Performance - Comparing your State’s 

FFY 2017 data to your State’s FFY 2016 data

OSEP continues to make information and 

technical assistance (TA) resources available and 

provide universal support to all States. 

New Engagement

OSEP will offer to provide the State, in collaboration with OSEP’s technical assistance providers, 

intensive technical assistance and support in its work to improve the State’s data quality and child 

performance outcomes related to positive social relationships, skills, and knowledge. OSEP’s support 

may include establishing a schedule of regular contact, engaging in conversations to explore improvement 

activities, and discussing the progress and effectiveness of activities currently underway in the State to 

improve outcomes for students with disabilities. OSEP may also work with the State to conduct a root 

cause analysis of the factors that contribute to low results outcomes for infants, toddlers, and their 

families.

Fiscal | Level of Engagement: Targeted

Factors Existing/Current Engagement

• The State's IDEA Part C award exceeds 

$10,000,000.

• The State has between 15-29 EIS programs.

OSEP continues to make information and TA 

resources available and provide universal support 

to all States. 

New Engagement

OSEP has previously provided targeted TA to the State based on the same factors. As a result, no further 

engagement is necessary.

Compliance | Level of Engagement: Targeted

Factors Existing/Current Engagement

• Indicator 1: Timely service provision 88.67%

• Indicator 7: 45-day timeline 84.33

OSEP continues to make information and TA 

resources available and provide universal support 

to all States. 

New Engagement

OSEP will gather additional information to determine the scope of engagement necessary to assist the 

State in improving IDEA compliance. This may include discussions with the State to determine the 

factors impacting the State’s specific area of low compliance and collaboratively working with the State 

to develop a plan to bring the State into IDEA compliance as soon as possible.

SSIP | Level of Engagement: Universal

Factors Existing/Current Engagement

• Factors are only listed when the level of 

engagement is targeted or intensive.

OSEP continues to make information and TA 

resources available and provide universal support 

to all States. 

New Engagement

OSEP will provide universal support related to the State’s SSIP.
UNITED STATES DEPARTMENT OF EDUCATION

OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES

Stop The Clock Memorandum

June 23, 2020

MEMORANDUM

TO: Renee Jenkins, Part C Coordinator

Florida Department of Health (FDOH)

THROUGH: Angela Tanner-Dean, Associate Division Director

Division of Monitoring and State Improvement Planning (MSIP), 

Office of Special Education Programs (OSEP)

FROM: Susan Kauffman, State Lead, Florida Part C / Fiscal Implementation Team

Kathleen Heck, State Lead, Florida Part C

SUBJECT: Stop the Clock for Florida IDEA Part C Grant Application for 

Federal Fiscal Year (FFY) 2020 

The Office of Special Education Programs (OSEP) has reviewed Florida’s FFY 2020 application 

submitted on April 24, 2020, under Part C of the Individuals with Disabilities Education Act 

(IDEA Part C). Based on its review of the application and other available information, OSEP has 

determined that the application is not substantially approvable under IDEA Part C and the 

Education Department General Administrative Regulations (EDGAR) in 34 CFR §76.703. The 

State will need to take additional actions, including revising its application and providing a 

specific, written assurance to make its FFY 2020 application substantially approvable. 

OSEP has reviewed Section II.A.3a of the State’s FFY 2020 IDEA Part C grant application, 

which indicates that the State’s System of Payments (SoP) policies and procedures are “on file” 

and thus were previously approved by OSEP. OSEP last approved the State’s SoP polices under 

Section II.A.3a as part of the State’s FFY 2012 grant application. However, OSEP learned 

through its December 2019 Part C fiscal monitoring process and visit to the State,18 that the State 

has implemented policies that were neither submitted to nor approved by OSEP; and 

furthermore, are inconsistent with the IDEA Part C SoP requirements. Therefore, the State must 

revise Section II.A.3a of its application to indicate “No” and a date by which the State will 

submit its revised SoP policies and provide a specific written assurance as explained further 

below. During the monitoring process, FDOH presented its SoP policies to OSEP in a document 

entitled, Early Steps Policy Handbook, dated January 1, 201819. This version of the State’s SoP 

and the one on FDOH’s public facing website, both differ from the SoP policy approved by 

OSEP in 2012. OSEP did not approve either SoP for implementation under, 

18 The results of OSEP’s Differentiated Monitoring and Support visit, including fiscal monitoring will be addressed 

under separate cover. This memorandum addresses only the information generated during the visit that effect 

whether the State’s FFY 2020 IDEA Part-C grant application is substantially approvable.

19 Although the State has posted an Early Steps Policy Handbook dated, January 1, 2020 to its website, all 

references, including section numbers and quotations, to the Early Steps Policy Handbook in this memorandum 

refer to the document, dated January 1, 2018, unless otherwise noted because that is the version that ESSO 

provided to OSEP.
OSEP DMS LETTER FLORIDA | 2020 PAGE 16

34 C.F.R. § 303101(c), and both contain new provisions that conflict with IDEA Part C 

requirements in 34 C.F.R. §§ 303.520 and 303.521.20

OSEP has identified noncompliance with the following three IDEA Part C requirements:

1. Consent is obtained for the use of private insurance when private insurance is a 

prerequisite for the use of public benefits or insurance.

2. Consent is obtained prior to using a child’s or parent’s public benefits or insurance 

when that child or parent is not already enrolled in the public benefits or insurance 

programs. 

3. Consent is obtained prior to disclosing a child’s personally identifiable information 

to the State public agency responsible for the administration of the State’s public 

benefits or insurance program for billing.

The IDEA Part C final regulations establish protections for parents of infants and toddlers with 

disabilities around the State’s use of public benefits or public insurance to pay for Part C services 

while also taking into account the privacy of parents and the need for States to have access to 

public benefits to finance Part C programs.21

Under 34 C.F.R. § 303.520(b)(1)(i), the LA must obtain consent for the use of private insurance 

when private insurance is a prerequisite for the use of public benefits. The State’s 2012 SoP, 

approved by OSEP, included the correct requirements for this provision under section 1.7.0 (Use

of Private Insurance) at 1.7.1(B). However, the revised Early Steps Policy Handbook at Section 

1.7.1(C), states that “parental consent to use private insurance is not required when both 

Medicaid and private insurance coverage are available since existing private insurance is a 

prerequisite for the use of Medicaid.” This policy change conflicts with the IDEA requirements 

under 34 C.F.R. § 303.520(b)(1)(i) and is inconsistent with the State’s SoP policies approved in 

2012.22

Under 34 C.F.R. § 303.520(a), when accessing public benefits or insurance Florida must: 

1. Obtain parental consent prior to using a child’s or parent’s public benefits or 

insurance when that child or parent is not already enrolled in the public benefits or 

insurance program consistent with 34 C.F.R. § 303.520(a)(2)(i); and 

2. Must provide written notice that parental consent must be obtained consistent with 34 

C.F.R.§ 303.520(a)(3) and 34 C.F.R. § 303.414 before the lead agency or EIS 

provider discloses a child’s personally identifiable information (PII) to the State 

20 The public participation requirements in 34 CFR § 303.208 apply to all new or revised policies and not just those 

required to be submitted under Section II.A. of the IDEA Part C grant application. Under 34 C.F.R. § 303.208(b), 

FDOH must: (1) provide an opportunity for the general public, including individuals with disabilities, parents of 

infants and toddlers with disabilities, early intervention service providers, and members of the State Interagency 

Coordinating Council, to comment on the new or revised policy for at least 30 days; and (2) hold public hearings 

on the new or revised policy (with a 30- day notice of the hearings to enable public participation). OSEP has no 

information on whether the State completed require public participation procedures before implementing revisions 

to its SoP.

21 Federal Register, 34 Part 303, Vol. 76, No. 188. Subpart F—Use of Funds and Payor of Last Resort, 

https://sites.ed.gov/idea/files/20110925-Final_Regulations-Part_C.pdf

22 The language that OSEP approved for Section 1.7.1 (C) in 2012 was moved to 1.7.1(D) in the revised handbook, a 

section that did not previously exist.
OSEP DMS LETTER FLORIDA | 2020 PAGE 17

public agency responsible for the administration of the State’s public benefits or 

insurance program for billing purposes.23

The Early Steps Policy Handbook indicates at Section 1.8.2 that “the Florida Agency for 

Healthcare Administration has given the Florida Department of Health, Early Steps and 

Medicaid providers authority via the Florida Medicaid Provider General Handbook and the 

Florida Medicaid Early Intervention Services Coverage and Limitations Handbook to: 

1. Exchange information that is necessary for Medicaid applicants and recipients to 

receive services or benefits;

2. Release information to authorized representative of the Medicaid program;

3. Bill another insurance carrier;

4. Release information to the billing agent; and

5. Provide information to the Department of Health, Division of Children’s Medical 

Services, Early Steps office or targeted case manager.

Further, at Section 1.8.3(2) of the Early Steps Policy Handbook, it states that IDEA Part C 

requirements related to parental consent to use Medicaid are met via the provisions of policy 

1.8.2 and “no additional consent is required: 

1. Prior to use of Medicaid benefits whether enrollment in Medicaid occurs before or 

after referral to Early Steps; and 

2. Before a child’s PII information is disclosed to the Medicaid fiscal agent for 

billing purposes.” 

Florida’s Agency for Health Care Administration (AHCA) administers Medicaid for the State 

while FDOH is the designated State LA for implementation of IDEA Part C and has 

responsibility for ensuring compliance with IDEA Part C requirements under 34 CFR § §

303.120 and 303.201. The State’s revised policies at Sections 1.8.2 and 1.8.3 do not provide for 

appropriate written consent prior to using a child’s or parent’s public benefits or insurance when 

that child or parent is not already enrolled in the public benefits or insurance program, or before 

the LA (FDOH) or EIS provider discloses a child’s personally identifiable information (PII) to 

the State public agency responsible for the administration of the State’s public benefits or 

insurance program for billing purposes (AHCA). 

23 Under 34 C.F.R. § 303.414, the lead agency and other participating agencies are prohibited from disclosing PII to 

any party except participating agencies (including the lead agency and EIS providers) that are part of the State's 

part C system without parental consent, except under specifically defined circumstances. The term “participating 

agency” is defined at 34 C.F.R. § 303.403 and includes “any individual, agency, entity, or institution that collects, 

maintains, or uses personally identifiable information to implement the requirements in part C of the Act and the 

regulations in this part with respect to a particular child.” Public agencies (such as the State Medicaid or CHIP 

program) or private insurance companies that act solely as funding sources for Part C services are expressly 

excluded from the definition of a participating agency.
OSEP DMS LETTER FLORIDA | 2020 PAGE 18

In addition to the provisions described above, OSEP also identified additional SoP changes to the 

Early Steps Policy Handbook since OSEP’s FFY 2012 approval.24 Before implementing any 

revisions to its SOP or other policies, procedures, methods or descriptions required under Section 

II.A. of the IDEA Part C grant application, then the State must submit revisions to OSEP for 

review and approval under 34 C.F.R. § 303.101(c). Furthermore, any revision to an existing 

policy or procedure needed to comply with Part-C must be subjected to the public participation 

requirements described under 34 C.F.R. § 303.208(b).

OSEP has determined that FDOH’s SoP policies are not consistent with the following IDEA Part 

C requirements to ensure that:

1. Consent is obtained prior to the use of private insurance when private insurance is a 

prerequisite for the use of public benefits consistent with 34 C.F.R. § 303.520(b)(1)(i); 

2. Consent is obtained prior to using a child’s or parent’s public benefits or insurance when 

that child or parent is not already enrolled consistent with 34 C.F.R. § 303. 520(a)(2)(i); 

and 

3. Consent is obtained prior to disclosing a child’s PII to the State public agency (AHCA) 

responsible for the administration of the State’s public benefits or insurance program for 

billing consistent with 34 C.F.R. § 303.520(a)(3) and 34 C.F.R. § 303.414. 

Required Actions/Next Steps:

In order to receive its FFY 2020 IDEA Part C grant award, FDOH must submit:

1. A revised Section II.A of its application, with a response under Section II.A.3a 

indicating “No” and a date not later than June 30, 2021 for completion. FDOH must resubmit its FFY 2020 IDEA Part C grant application, dated and signed with the signature 

of an official who has authority to ensure compliance with the assurance, as soon 

possible. Please note that the State will also need to submit a revised Section I and 

indicate in Section I.A that the State is requesting a conditional approval of its FFY 2020 

IDEA Part C grant award; and 

• 2. A specific written assurance to OSEP as part of its FFY 2020 IDEA Part C grant 

application that the State will:

a) Use its SoP policies that are on file with OSEP as approved in FFY 2012 until 

those policies are amended, subject to public participation and approved by 

OSEP.

b) Submit to OSEP, by October 1, 2020, a copy of the draft revisions to its Early 

Steps Policy Handbook, prior to the public comment period, and submit to OSEP 

promptly after the public comment period and any subsequent revised drafts of 

the States SoP policy that are publicly circulated. 

24 Changes included portions of the following Sections: 1.4.0 (Financial Policies and procedures), 1.6.0 (Public and 

Private Insurance), and 1.8.0 (Use of Public Insurance/Medicaid); specifically, policies under Sections: 1.4.4, 

1.4.14, 1.6.4, 1.6.6, 1.8.4, and 1.8.10. None of these revisions were submitted to OSEP for approval prior to 

implementation. Additionally, the State did not provide OSEP with the version of the handbook posted on the 

State’s website, dated January 1, 2020. As a result, OSEP has not conducted a review of that document.
OSEP DMS LETTER FLORIDA | 2020 PAGE 19

c) Make all changes necessary to the SoP policies in the Early Steps Policy 

Handbook to comply with 34 C.F.R. §§ 303.510, 303.520 and 303.521 as required 

under 34 C.F.R. § 303.203(b)(1)), and submit to OSEP the revised Handbook as 

soon as it is finalized, but no later than June 30, 2021;

d) Ensure that, throughout the period that the State uses its IDEA Part C FFY 2020 

grant funds, all early intervention service (EIS) providers in the State will comply 

with all requirements of IDEA Part C, 34 C.F.R. §§ 303.510, 303.520 and 

303.521 and specifically the requirements for consent to access public and private 

insurance and to disclose a child’s personally identifiable information for 

insurance billing; and 

e) Provide OSEP, by August 31, 2020, a copy of a memorandum notifying all EIS 

providers that are part of the State’s IDEA Part C early intervention system of the 

changes described in (a) and (d) above that affect the use of the SoP under 34 

CFR §§ 303.510, 303.520 and 303.521.

The above assurance must be dated and include the signature of an official who has authority to 

ensure compliance with the assurance.

Please contact Susan Kauffman, at 202-245-6432 or Susan.kauffman@ed.gov if you have any 

questions or concerns. We look forward to receiving the requested documentation so that we 

may complete our review of Florida’s FFY 2020 IDEA Part C application.

cc: Gregg Corr, Division Director

Kathleen Heck