OSEP Finding #1: Provide appropriate EI services to all infants and toddlers with disabilities and their families that are eligible for those services 

consistent with IDEA Section 635(a)(2) and 34 C.F.R. § 303.112, including, failing to: 

a. Ensure its local ECI programs are appropriately maintaining records as required by IDEA Section 637(b)(4), as well as 34 C.F.R. § 303.224(b), 

2 C.F.R. § 200.333, and 2 C.F.R. § 200.303, in order to provide EI services to infants and toddlers with disabilities in a timely manner; 

b. Ensure that it has a comprehensive child find system in place that is able to appropriately identify infants and toddlers with disabilities for 

IDEA Part C services consistent with IDEA Section 635(a)(5) and 34 C.F.R. § 303.302(b)(1); and 

c. Ensure that IDEA Part C resources are available for all geographic areas in the State consistent with IDEA Section 637(a)(7) and

34 C.F.R. § 303.207.

Required Corrective Action 1a 

Develop, and submit for OSEP approval, a corrective action plan (CAP) that addresses service provision and identifies the steps that the State will 

take to ensure that appropriate EI services are available to all infants and toddlers with disabilities and their families as required by IDEA Section 

635(a)(2) and 34 C.F.R. § 303.112. This CAP must include a description of how the State will ensure continuity of EI services when a provider exits 

ECI prior to a new provider being secured for a region. The CAP must also include a description of how it will monitor EIS providers to ensure that 

IFSP teams review, on an individualized basis, whether and what compensatory services may be needed for eligible children for whom there has been 

a disruption in service provision.

TX-C Response to Required 

Action TX-C Timeline OSEP Analysis & Discussion Required Action /Next Steps

1.a.1:

In 2018, HHSC added language to 

the base ECI contract that allows 

contractors to provide services to 

clients outside of their designated 

service area if the children reside 

in counties or zip codes not 

covered by an existing ECI 

contractor. This language provides 

a mechanism for other ECI 

contractors to temporarily provide 

services to families in another area 

should there ever be a future gap.

As a result of the COVID-19 

pandemic, all 41 providers are 

utilizing telehealth for some 

aspects of service delivery. This 

1.a.1:

Completed

1.a.1:

OSEP accepts the HHSC 

corrective action to add language 

to the base ECI contract that 

allows contractors to provide 

services to clients outside of their 

designated service area if the 

children reside in counties or zip 

codes not covered by an existing 

ECI contractor. However, OSEP 

is unclear how this correction 

action completed in 2018 before 

the issuance of OSEPs finding of 

noncompliance that HHSC failed 

to provide appropriate EI services 

to all infants and toddlers with 

disabilities and their families that 

1.a.1: 

HHSC must provide OSEP the 

final language added to the base 

ECI base ECI contract that allows 

contractors to provide services to 

clients outside of their designated 

service area if the children reside 

in counties or zip codes not 

covered by an existing ECI 

contractor. In, addition, HHSC 

must identify the steps it will take, 

or has taken, to ensure effective 

implementation of this practice to 

ensure continuity of EI services 

when a provider exists ECI prior 

to a new provider being secured 

for a region.
TX-C Response to Required 

Action TX-C Timeline OSEP Analysis & Discussion Required Action /Next Steps

modality can help provide 

coverage across the provider 

network should another contractor 

exit the program.

are eligible for those services 

consistent with IDEA Section 

635(a)(2) and 34 C.F.R. § 303.112 

will assist in preventing future 

instances of noncompliance. OSEP 

was unable to identify specific 

steps or a description of 

implementation policies practices 

or procedures that may prevent 

future noncompliance concerning 

this specific practice HHSC had in 

place at the time of OSEP’s onsite 

monitoring completed in August 

of 2019 and OSEP October 5, 

2020 monitoring letter. 

The Texas Administrative Code -

Title 40, Part 2, Chapter 108, 

Subchapter K, Section 108.1104 

(3) notes that a parent must 

consent to service delivery via 

telehealth. OSEP is unclear what 

impact this provision of the Texas 

Administrative Code may have on 

HHSC’s ability to provide services 

if an ECI provider leaves a service 

network. 
TX-C Response to Required 

Action TX-C Timeline OSEP Analysis & Discussion Required Action /Next Steps

1.a.2:

HHSC will revise its contractor 

transition checklists to include 

prompts to assess if the incoming 

contractor is able and interested in 

processing new referrals prior to 

its contract effective date or 

delivering and billing for specific 

services prior to its contract 

effective date if there are staffing 

challenges with the outgoing 

contractor.

1.a.2:

04/01/2021

1.a.2:

OSEP accepts the HHSC proposed 

corrective action to revise the ECI 

contractor transition checklist. 

However, OSEP is not able 

analyze the implementation of this 

corrective action until HHSC is 

able to provide a copy of the final 

revised checklist. In addition, 

HHSC does not describe what will 

be done if the checklist indicates 

that an incoming contractor 

declines to process new referrals, 

or delivery of services when there 

has been a disruption in service 

provision contractors.

1.a.2:

HHS must provide OSEP a copy 

of the final revised ECI contractor 

transition checklist. In addition, 

HHSC must identify and describe 

the continuity of services plan 

HHSC has in place in the event an 

incoming contractor is not 

interested in processing new 

referrals prior to their contract 

effective date. 

1.a.3:

HHSC will explore, with its Legal 

Services staff, adding additional 

enforcement options to the ECI 

contract to encourage exiting 

contractors to continue service

delivery with full compliance. 

These additional enforcement 

options could include withholding 

payments or assessing damages if 

an exiting contractor does not 

successfully perform transition 

responsibilities before the effective 

termination date of the contract.

1.a.3:

Effective 09/01/2021

1.a.3:

OSEP accepts the HHSC proposed 

corrective action to consider 

including additional enforcement 

actions in ECI contract language. 

However, OSEP is not able to 

review the implementation of this 

corrective action until HHSC is 

able to provide the final approved 

enforcement actions that will be 

added to existing ECI contractors. 

1.a.3:

HHSC must provide OSEP an 

explanation of the outcomes of 

exploring additional contract 

language, including, if applicable a 

list and description of the final 

approved enforcement actions to 

address how the agency will 

intercede in the event an outgoing 

contractor cannot continue service 

delivery with full compliance with 

IDEA Section 635(a)(2) and

34 C.F.R. § 303.112
TX-C Response to Required 

Action TX-C Timeline OSEP Analysis & Discussion Required Action /Next Steps

1.a.4:

HHSC will add language to an 

incoming contractor’s contract to 

require the incoming contractor to 

have IFSP teams review whether 

and what services, compensatory 

or otherwise, may be needed.

1.a.4:

“going forward”

1.a.4:

OSEP is not able to review this 

corrective action until HHSC is 

able to provide the final approved 

language that will be added to new 

ECI contractors.

As noted in OSEP’s monitoring 

report, the CAP must include a 

description of how HHSC will 

monitor providers to ensure that

IFSP are completing these 

reviews. An appropriate 

description of monitoring language 

could appear in contract language 

or in other documentation.

1.a.4:

HHSC must provide OSEP the 

final approved language that 

describes the requirements for 

incoming contracts to have IFSP 

teams review whether and what 

services, compensatory or 

otherwise may be needed for 

eligible children who may be 

impacted by the change in 

contractors or a disruption in 

services. 
Required Corrective Action 1b

Develop a CAP that addresses service provision and identifies the steps that the State will take to ensure that HHSC and EIS providers implement a 

system of internal controls for data entry into TKIDS to ensure its local ECI programs are maintaining records consistent with 34 C.F.R. § 303.224(b) 

and 2 C.F.R. § 200.303. This CAP must identify how the LA will demonstrate to OSEP that any revised policies and/or procedures are reasonably 

designed to ensure compliance with IDEA requirements including, evidence of implementation by its EIS providers.

TX-C Response to Required 

Action TX-C Timeline OSEP Analysis & Discussion Required Action /Next Steps

1.b.1:

HHSC already monitors the 

accuracy of data entry compliance 

during on-site, comprehensive 

monitoring visits by comparing the

service entry and demographic 

information in TKIDS for the 

sample period to the service entry 

documentation in the contractor’s 

system. HHSC will also begin to 

provide additional quality 

assurance oversight of and 

technical assistance on record 

keeping by local programs during 

fiscal year 2022, prioritizing those 

programs with the greatest 

percentage of noncompliance with 

records accuracy for on-site 

quality assurance reviews.

1.b.1:

Throughout FY22, beginning 

09/2021

1.b.1:

OSEP is unclear whether the 

HHSC monitoring of accuracy of 

data entry compliance during onsite comprehensive monitoring 

visits as described in HHSC’s 

corrective actions is a practice 

implemented before OSEP’s 

finding that local ECI programs did 

not maintain records consistent 

with 34 C.F.R. § 303.224(b) and 2 

C.F.R. § 200.303, or is a newly 

implemented practice. The 

indication that HHSC will provide 

additional quality assurance 

oversight and technical assistance 

lacks sufficient detail for OSEP to 

conclude that the CAP identifies or 

describes the steps the State will 

take to ensure that HHSC and EIS 

providers implement a system of 

internal controls for data entry into 

TKIDS to ensure its local ECI 

programs are maintaining records 

consistent with 

34 C.F.R. § 303.224(b) and 2 

C.F.R. § 200.303. HHSC also did 

not provided evidence of 

implementation of this requirement 

by EIS providers.

1.b.1:

HHSC must provide OSEP a 

description of the steps the State 

will take to ensure that HHSC and 

EIS providers implement a system 

of internal controls for data entry 

into TKIDS to ensure its local ECI 

programs are maintaining records 

consistent with

34 C.F.R. § 303.224(b) and 2 

C.F.R. § 200.303. If HHSC 

currently has monitoring and 

procedures in place that address 

this finding, HHSC must indicate 

what specific steps are being taken 

to prevent future noncompliance in 

this area, as well as how the 

current noncompliance identified 

by OSEP has been corrected.
TX-C Response to Required 

Action TX-C Timeline OSEP Analysis & Discussion Required Action /Next Steps

1.b.2:

HHSC will develop 

comprehensive procedures for 

virtual or on-site inspection of 

records, including HHSC 

oversight for the transfer of 

records to the incoming provider, 

during contractor transitions. This 

will include an agreed upon 

process and timelines for exiting 

contractors to provide relevant 

records to the incoming contractor 

in advance of their exit to allow an 

opportunity for the incoming 

agency to review the records 

provided and request any 

additional information needed to 

support timely and effective 

service delivery.

1.b.2:

09/01/2021

1.b.2:

OSEP accepts the HHSC proposed 

corrective action to develop 

comprehensive procedures for 

virtual or on-site inspection of 

records, including HHSC 

oversight for the transfer of 

records to the incoming provider, 

during contractor transitions.

OSEP is not able to review 

implementation of this corrective 

action until HHSC is able to 

provide the final approved 

language that describes procedures 

for virtual or on-site inspection of 

records.

1.b.2:

HHSC must provide OSEP a copy 

of the finalized comprehensive 

procedures for virtual or on-site 

inspection of records, including 

HHSC oversight for the transfer of 

records to the incoming provider, 

during contractor transitions.
Required Corrective Action 1c

Addresses service provision and identifies the steps that the State will take to ensure that it is meeting the requirements under IDEA Section 

635(a)(5) and 34 C.F.R. § 303.302(b)(1) to meet its child find responsibilities including identifying, evaluating, and locating all infants and toddlers 

with disabilities.

TX-C Response to Required 

Action TX-C Timeline OSEP Analysis & Discussion Required Action /Next Steps

1.c.1:

HHSC will continue using the 

voluntary child find selfassessment tool newly developed 

by OSEP to analyze Texas 

outreach efforts and identify areas 

of strength, as well as areas for 

improvement, and develop a plan 

of action for implementation. To 

date, this has included surveys of 

contractors and 

stakeholders/referral sources that 

have generated over 1,100 

responses, with plans for family 

and community focus groups in 

the coming months.

1.c.1:

09/01/2021

1.c.1:

OSEP accepts the State corrective 

action to use the voluntary child 

find self-assessment tool. OSEP is 

not able to review implementation 

of this corrective action until 

HHSC identifies the specific steps 

or the plan HHSC has developed 

based upon the data collected from 

the self-assessment tool. 

1.c.1:

HHSC must provide to OSEP 

evidence of the specific steps and 

plans developed from the use of 

the voluntary child find selfassessment tool as of the 

completion date of 9/01/2021 for 

the corrective action item. 

1.c.2:

HHSC will host child find forums 

twice a year for contractor staff 

who are involved in child find 

activities. These forums will be 

topic specific. They will also 

provide an opportunity for 

contractors to share best practices 

and exchange program ideas.

1.c.2:

By 07/01/2021, every six months 

thereafter

1.c.2:

OSEP accepts the proposed 

corrective action of HHSC to host 

child find forums twice a year for 

contractor staff who are involved 

in child find activities. OSEP 

acknowledges that State and 

Federal guidelines regarding 

COVID19 may impact the 

implementation of this corrective 

action. 

1.c.2:

HHSC to must provide to OSEP 

evidence of implementation of the 

child find forums. 
TX-C Response to Required 

Action TX-C Timeline OSEP Analysis & Discussion Required Action /Next Steps

1.c.3:

HHSC will provide each 

contractor with a breakdown of 

key referral data and how it 

compares to statewide referral 

data. HHSC will require 

contractors with significant 

variances from the statewide data 

to develop plans for how they will 

target referrals that are underrepresented in their community.

1.c.3:

Local data to be sent by 

03/01/2021; Underperforming 

contractors to send improvement 

plans by 09/01/2021

1.c.3:

OSEP accepts HHSC’s proposed 

correction action to provide data to 

each contractor and require 

contractors with significant 

variances from Statewide data to 

develop plans to target referral that 

are under-represented in their 

community. OSEP is not able to 

review implementation of this 

corrective action until evidence of 

completed improvement plans is 

received.

1.c.3:

HHSC must provide to OSEP a 

summary of the key referral data 

provided to ECI contractors, and a 

sample of at least 5% of the 

submitted improvement plans for 

underperforming ECI contractors.

1.c.4:

HHSC ECI will consult with the 

ECI Advisory Committee and 

coordinate with the HHSC Office 

of Disability Prevention for 

Children to plan and participate in 

a media campaign that will 

increase public awareness about 

ECI.

1.c.4:

Planning to begin in Spring 2021; 

launch in Fall 2021 or Spring 2022

1.c.4:

OSEP accepts HHSC’s proposed 

corrective action to plan and 

participate in a media campaign to 

increase public awareness of ECI. 

OSEP is not able to review 

implementation of this corrective 

action until the media campaign is 

launched.

1.c.4:

HHSC must provide to OSEP a 

description of the media campaign 

including the launch date of the 

campaign. 

1.c.5:

HHSC will increase the weight of 

federal Indicator 6 related to the 

percent of the birth to three 

population each contractor is 

serving in its local performance 

determinations formula.

1.c.5:

Beginning with state fiscal year 

2021 local performance 

determinations.

1.c.5:

OSEP accepts HHSC’s proposed 

corrective action to increase the 

weight of federal Indicator 6 

related to the percent of the birth 

to three population each contractor 

is serving in its local performance 

determinations formula and 

HHSC’s proposed action to 

provide key partners with contact 

information for new ECI 

providers.

1.c.5:

No further action required.
TX-C Response to Required 

Action TX-C Timeline OSEP Analysis & Discussion Required Action /Next Steps

1.c.6:

In the event of a contractor 

transition, incoming contractors 

conduct outreach to local referral 

sources and HHSC reaches out to 

state referral sources to notify 

them of the change in service 

providers. HHSC will also begin 

coordinating with its statewide 

partners, such as the Special

Supplemental Nutrition Program 

for Women, Infants and Children 

(WIC) program, Child Care 

Regulation, Texas Health Steps, 

MCOs, and other key partners to 

obtain a list of local 

programs/referral sources specific 

to the area of transition and will 

complete targeted outreach to 

ensure those referral sources have 

the new ECI provider’s contact 

information to make the required 

updates in their referral systems.

1.c.6:

Beginning with its next contractor 

transition following a termination 

notice.

1.c.6:

OSEP accepts HHSC’s proposed 

corrective action to increase 

outreach to local referral sources 

and notify referral sources of 

changes in ECI providers. 

1.c.6:

No further action required. 
Required Corrective Action 1d

Addresses service provision and identifies the steps that the State will take to ensure that resources are made available to all geographic areas within 

the State as required under 34 C.F.R. § 303.207

TX-C Response to Required 

Action TX-C Timeline OSEP Analysis & Discussion Required Action /Next Steps

1.d.1:

The $1.5 million in supplemental 

funding for fiscal year 2019 was 

distributed in August 2019 to 11 

contractors that were serving 

significantly over their contractual 

target of enrolled children and 

meeting the performance target for 

delivered hours. The fiscal year 

2020 exceptional item funding 

provided an increase for all 41 

providers, and HHSC utilized a 

standard, metrics-based 

methodology to allocate funding to 

every geographic area of the state. 

The additional dollars went 

directly to providers to fund their 

caseload. The fiscal year 2021 

exceptional item funding was 

allocated across the provider base 

through a competitive procurement 

resulting in statewide coverage.

1.d.1:

Completed

1.d.1:

OSEP appreciates the State’s 

efforts to increase funding to 

address the provision of Part C 

services and to ensure that 

resources are made available to all 

geographic areas within the State 

as required under

34 C.F.R. § 303.207.

1.d.1:

No Further Action Required
TX-C Response to Required 

Action TX-C Timeline OSEP Analysis & Discussion Required Action /Next Steps

1.d.2:

HHSC will begin development of 

training on evidence-based 

personnel retention strategies that 

will be made available to all 

contractors and planning for select 

retention strategies and financial 

assistance targeted toward 

contractors with the highest 

turnover rates as part of its

personnel retention grant from 

OSEP.

1.d.2:

10/04/2021

1.d.2:

OSEP accepts HHSC proposed 

plan to provide training on 

evidence-based personnel 

retention strategies. 

1.d.2:

HHSC must provide to OSEP 

documentation of training sessions 

to all ECI contractors on personnel 

retention strategies. 

1.d.3:

HHSC, along with a workgroup of 

contractor representatives, will 

review early intervention specialist 

credentialing requirements to 

determine if flexibilities should be 

added to support contractors’ 

ability to hire qualified staff.

1.d.3:

05/01/2021

1.d.3:

OSEP accepts HHSC proposed 

plan to review early intervention 

credentialing requirements. 

1.d.3:

No further action required. 

1.d.4:

HHSC will analyze the temporary 

flexibilities implemented during 

the COVID-19 pandemic to 

determine the viability of 

continuing those that helped 

facilitate statewide ECI service 

delivery via telehealth.

1.d.4:

06/01/2021

1.d.4:

OSEP accepts HHSC proposed 

plan to review temporary 

flexibilities permitted during 

COVID-19 to determine the 

viability of continuing some 

practices.

1.d.4:

No further action required. 
The State must submit a CAP that addresses the State’s single line of responsibility and identifies the steps that the State will take to ensure the 

general administration and supervision of programs and activities administered by agencies, institutions, organizations, and EIS providers, as 

required under 34 C.F.R. § 303.120, and to ensure the continuity of IDEA Part C service provision during financial disputes or untimely 

reimbursement for services. The CAP must include a process and any necessary implementing policies or intra-agency agreement(s) necessary to 

ensure that the LA is providing sufficient guidance and supervision to EIS providers for them to implement the State’s SoP. 

Required Corrective Action 2

The CAP must address the State’s single line of responsibility and identify the steps that the State will take to ensure the general administration and 

supervision of programs and activities administered by agencies, institutions, organizations, and EIS providers, as required under

34 C.F.R. § 303.120, and to ensure the continuity of IDEA Part C service provision during financial disputes or untimely reimbursement for services. 

The CAP must include a process and any necessary implementing policies or intra-agency agreement(s) necessary to ensure that the LA is providing 

sufficient guidance and supervision to EIS providers for them to implement the State’s SoP.

TX-C Response to Required 

Action TX-C Timeline OSEP Analysis & Discussion Required Action /Next Steps

2.1:

ECI and MCS will develop a 

survey to identify specific areas of 

concern regarding payments from 

MCOs and use the results to 

determine a more targeted 

approach to addressing problems 

and providing training to ECI 

contractors and/or MCOs.

2.1:

Survey: 03/01/2021

Next Steps: 08/01/2021

2.1:

OSEP accepts HHSC’s proposed 

corrective action pending evidence 

and receipt of completion of 

corrective action activities. 

2.1:

HHSC must provide OSEP 

documentation describing the 

results of the survey and 

identifying the follow up actions 

taken as a result of the survey, as 

well as the dates for completion 

those actions.

2.2:

HHSC will determine if any 

additional guidance on Medicaid 

dispute resolution needs to be 

added to the ECI Reimbursement 

Guide and will plan additional 

training to ECI providers on the 

policies and procedures to resolve 

Medicaid payment delays and 

disputes.

2.2:

10/04/2021

2.2:

OSEP accepts HHSC’s proposed 

corrective action pending evidence 

and receipt of completion of 

corrective action activities.

2.2:

HHSC must provide OSEP a 

summary of any additional 

guidance or training created as a 

result of its review. 
TX-C Response to Required 

Action TX-C Timeline OSEP Analysis & Discussion Required Action /Next Steps

2.3:

HHSC will assign a liaison for 

ECI contractors within the MCS 

Department to assist with 

resolution of ECI provider 

complaints related to Medicaid 

payments and routinely report 

metrics for resolution within the 

agency’s Agency Monthly Contact 

Report.

2.3:

10/04/2021

2.3:

OSEP accepts HHSC’s proposed 

corrective action pending evidence 

and receipt of completion of 

corrective action activities.

2.3:

No further action required.

2.4:

HHSC will review complaints data 

on a monthly basis to identify and 

track ECI complaints, including 

identification of any trends.

2.4:

Began 12/01/2020

2.4:

OSEP accepts HHSC’s proposed 

corrective action pending evidence 

and receipt of completion of 

corrective action activities.

2.4:

No further action required.