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OFFICE FOR CIVIL RIGHTS

GOVERNMENT PERFORMANCE AND RESULTS ACT (GPRA)

FY 2002 FINAL GPRA ANNUAL PERFORMANCE PLAN,

FY 2001 FINAL REVISED GPRA ANNUAL PERFORMANCE PLAN, AND

FY 2000 GPRA PERFORMANCE REPORT

INTRODUCTION

The Office for Civil Rights (OCR) has combined all of the above into a single document.

I. AGENCY CONTEXT FOR PERFORMANCE MEASUREMENT

1.1 Mission and Long-Term Goals

The Office for Civil Rights promotes and ensures that people have equal access to and opportunity to participate in and receive services in all HHS programs without facing unlawful discrimination. Through prevention and correction of unlawful discrimination, the Office for Civil Rights helps HHS carry out its overall mission of improving the health and well-being of all people affected by its many programs.

In January 1995, OCR issued a Civil Rights Plan (revised for minor non-substantive changes in 1999) that established three broad goals. These goals are to: 1) provide leadership in the creation and evolution of a Department-wide civil rights program, 2) increase nondiscriminatory access to and participation in HHS programs, and, 3) redevelop OCR's infrastructure and invest in its staff. OCR's seven GPRA performance objectives flow directly from the plan's goals and objectives. Specifically, they address the plan's objectives of reducing discrimination in high incidence and high priority areas, using joint projects to assist OCR in carrying out its mission, and enhancing OCR's operational efficiency.

OCR's first six GPRA performance objectives deal with high priority issues identified during the planning process for the Civil Rights Plan -- adoption, managed care, services for limited-English proficient persons, welfare reform, nondiscriminatory quality health care, and services in the most-integrated setting for individuals with disabilities. OCR's seventh performance objective deals with increasing operational efficiency by focusing resources on high priority areas. The six high priority areas were identified during OCR's planning process through public forums with community-based and other organizations, state and local agencies, service providers, and other Departmental components. In addition, the passage of new legislation, Presidential and Secretarial priorities, continuing changes in health care delivery systems, recent research findings, media reporting, information from community-based organizations, and ongoing OCR compliance activities confirm that these are key issues on which OCR should focus its resources.

OCR's GPRA plan is directly linked to the HHS Strategic Plan as evidenced by the number of OCR goals/objectives that support the HHS strategic objectives. OCR's objectives and cooperative activities within the Department play a crucial role in helping the Department to realize its Strategic Plan's goal of increasing nondiscriminatory access to and participation in HHS programs. OCR's performance measures under the adoption objective support the HHS strategic objective of improving the safety and security of children and youth (Strategic Objective 2.4). Measures under OCR's managed care, limited-English proficiency (LEP), quality health care (health disparities), and disability objectives support the HHS strategic objectives of increasing the percentage of the nation's children and adults who have health insurance coverage (Strategic Objective 3.1), protecting and improving the health and satisfaction of beneficiaries in Medicare and Medicaid (Strategic Objective 3.4), and improving consumer and patient protection (Strategic Objective 4.3). The managed care, LEP, and quality health care objectives also support eliminating disparities in health access and outcomes (Strategic Objective 3.2). In addition, the OCR LEP and welfare reform (Temporary Assistance to Needy Families - TANF) objectives support the HHS strategic objective of improving the economic independence of low income families, including those receiving welfare (Strategic Objective 2.1), and the LEP and disability objectives support the Departmental strategic objective of increasing independence and quality of life of persons with long-term care needs (Strategic Objective 2.6). OCR's LEP objective also supports the HHS strategic objective of increasing consumer and patient use of health care quality information (Strategic Objective 4.2). For a quick reference showing how OCR's objectives cross-cut and support HHS strategic objectives, see the last chart in the Appendix.

1.2 Organization, Programs, Operations, Strategies and Resources

OCR assesses compliance with nondiscrimination requirements by processing and resolving discrimination complaints, conducting pre-grant reviews and post-grant reviews and investigations, monitoring corrective action plans, and carrying out voluntary compliance, outreach, public education, training, technical assistance, consultation and joint project activities. The public expects to receive high quality services without regard to race, color, national origin, disability, age, sex, and religion. As the primary defender of the public's right to nondiscriminatory access to and receipt of health and human services from hospitals and nursing homes to Head Start centers and senior centers, OCR works to ensure equal opportunity for all to access such services. In addition, OCR has responsibility for the health information privacy requirements of the Health Insurance Portability and Accountability Act (HIPAA).

OCR is comprised of a compliance and support staff, a legal counsel staff, and a program management component. The FY 2002 budget request would support 275 FTEs on an annualized basis. This includes annualization of salaries and benefits and FTEs for staff hired during FY 2001 to support privacy protection under HIPAA. The majority of OCR's staff works on frontline compliance activities, largely in OCR's regional offices with expert program and policy coordination and support from a cadre of headquarters experts.

OCR allocates staff to complaints, pre-grant reviews, and OCR-initiated compliance activities (e.g., compliance reviews, post-grant investigations, voluntary compliance and outreach, technical assistance, and public education). The issues raised in complaints and pre-grants often raise routine civil rights concerns that are not focused on high priority activities. In contrast, staff time allocated to OCR-initiated compliance activities focuses on high priority issues identified by OCR and addresses systemic problems that will benefit the largest number of people.

Investigative, compliance review, outreach, technical assistance, public education, training, consultation, and joint project activities are each co-equal methods by which OCR achieves correction and prevention of unlawful discrimination. OCR uses these methods interchangeably and with flexibility to address the unique compliance circumstances facing individual HHS grantees and service providers. In some cases, outreach and public education may better serve the purpose of achieving compliance than a review/audit activity. In other cases, where cooperation may be limited, an investigation or review may be deemed to be the best means for achieving a positive compliance outcome. Each of the activities that are identified as results/indicators in this report are planned, substantive, and part of an overall compliance strategy that requires significant staff time and other resources.

1.3 Coordination and Education

Through consultations, technical assistance and other outreach activities, OCR will continue to educate HHS agencies, state and local agencies, service providers and other organizations to ensure adherence to civil rights requirements. OCR will work with such entities, including regionally-based task forces that have been established as part of OCR's discrimination and racial and ethnic health disparities activities, to identify possible compliance problems, and where appropriate, conduct joint activities to ensure nondiscriminatory access to services.

Under the GPRA adoption and welfare reform priority areas, OCR is working with the Administration for Children and Families (ACF) to ensure that the provisions of the Small Business Job Protection Act of 1996 and TANF are implemented in a nondiscriminatory manner. OCR will also coordinate with the Health Care Financing Administration (HCFA) in the areas of data needs, provision of technical assistance and conducting joint compliance activities, including activities under the nondiscriminatory quality health care priority area.

Under the LEP priority area, OCR coordinates with HHS agencies (notably HCFA and ACF), other government agencies such as the Department of Justice (DOJ) and the White House, and other organizations. These efforts facilitated the development of policy guidance to ensure that health and social services providers who receive HHS funding provide language assistance, as appropriate, to persons with limited English proficiency (LEP). Examples include working with: 1) ACF, HCFA and state Medicaid directors to reiterate that federal matching of funds are available to cover the costs of providing language assistance; 2) hospital associations to help their membership understand and implement the LEP policy guidance; 3) state agencies and community groups to conduct LEP outreach and training events to showcase promising practices with regard to providing interpreter services; and, 4) the Department of Agriculture to develop procedures for communicating with LEP persons seeking TANF, Medicaid, Food Stamps and other public benefit programs.

In addition, in the area of TANF, OCR has been providing technical assistance to covered entities such as states, providers and vendors involved in administering TANF programs to help them recognize potential civil rights issues and prevent problems from occurring as they carry out welfare-to-work programs.

Under the disability (most-integrated setting) priority, OCR will work jointly with DOJ, the Department of Housing and Urban Development (HUD), HCFA, Substance Abuse and Mental Health Services Administration (SAMHSA), and states to help them carry out the requirements of the Supreme court's Olmstead decision. OCR has been working with states and other interested parties in the development of Olmstead planning coalitions to develop state comprehensive working plans to serve people with disabilities in the most-integrated setting appropriate for them.

Under the GPRA managed care priority area, OCR has been working with HCFA, the HHS Office of Minority Health, state and local governments, and leaders of medical and provider organizations. These collaborative efforts have focused on working with states and managed care organizations to address the unique needs of vulnerable populations and the issue of racial and ethnic disparities in the health care delivery system.

Further, in its nondiscrimination and racial and ethnic disparities work, OCR will coordinate with other agencies including the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, HUD, DOJ, state agencies, and local task forces. These local task forces are composed of medical providers, representatives of academia including medical and other health care professional school faculty, government agencies, the faith community, professional associations, hospital societies, and others in each region. OCR will involve them directly in education, technical assistance and other outreach activities and to use their expertise as OCR implements a variety of compliance activities.

1.4 Summary FY 2000 Performance Report: Accountability Through Performance Measurement

As of the end of FY 1999, OCR had established baselines for 15 output measures in the four priority areas of adoption, managed care, LEP, and TANF under Goal I and for four output measures on operational efficiency under Goal II. In FY 2000, looking at each of the individual program and operational efficiency goals, OCR met or exceeded the individual targets for eight of 15 program output measures and one of four operational efficiency measures. In total, OCR met or exceeded nine output measures while falling short of the targets for the remaining ten.

However, most of these output measures did not include OCR's technical assistance or consultation activities which are increasingly used to achieve compliance in the civil rights arena. At a composite level for program activities that includes technical assistance or consultation activities, OCR completed 770 priority program compliance activities compared with a combined target of 715. This is nearly eight percent higher than projected. Further, OCR also completed another 246 compliance activities in the developmental areas of racial and ethnic health disparities and Olmstead (most-integrated setting) compliance work. In total, when looking at all six program priority areas, OCR completed 42 percent more activities than had been targeted in the initial four priority program areas. Based on this experience, OCR is modifying the output indicators in the FY 2001 plan by combining multiple output indicators into a single indicator including outreach, technical assistance, consultation and joint project activities, in addition to case investigations and reviews (see Appendix A.1., page 79 for further discussion of these terms).

As the summary of changes table later in this report notes, the combined indicator more accurately reflects OCR's flexible approach to increasing compliance (preventing and correcting unlawful discrimination), by tailoring its activities to address the unique circumstances of HHS grantees/providers rather than adhering to a strictly prescribed set of activities. The fact that OCR far exceeded the sum of its individual targets in the FY 2000 plan while missing several of the individual targets also reflects OCR's focus: (1) on areas in which there was increased public interest (e.g., the program areas of racial and ethnic health disparities and Olmstead); (2) on the issuance of policy guidance and subsequent public education, and (3) a continuing shift toward greater use of outreach, public education, training, consultation and joint projects. Based on the results and assessment of the most effective means of achieving changes in specific programmatic areas, FY 2001 and FY 2002 sub-objectives, measures and targets have been modified. Discussion of the revised sub-objectives, measures and targets and reasons for changes are included under each of the individual objectives and on the summary of changes chart at the end of this document.

OCR has made a strong effort to build a performance management approach into the way it conducts its business. As discussed above, the priority issues flow from its strategic plan, and its program planning reflects these priorities.

A detailed description of OCR's approach to measuring outputs and outcomes associated with its compliance program is included in Section A.1 in the Appendix. In summary, OCR established initial FY 1998 baseline data for its case-related output measures in the first four priority areas. In FY 2000, OCR has data for all output measures under those four areas. OCR has assessed its accomplishments against the projected goals based on analysis of data from its Compliance Activity Tracking System (CATS) and verification of those data with its regional offices. (See Section 2.1.1., "Data Issues".)

Also, in FY 1998, OCR began the process of identifying the type of outcome data that would be needed in order to establish baselines for its outcome measures. When OCR developed its outcome measures, it projected that the process of collecting data and establishing outcome measure baselines would take two to three years. This time frame was due to the nature of the programs under review, the specific designated performance measures, and the fact that facilities may have from several months to a year or more to complete corrective actions under monitoring plans. OCR needs to have sufficient numbers of comparable reviews and investigations and attendant monitoring data to serve as a base for comparisons. In FY 1999, very few activities were completed for which outcome data were available as of the end of the fiscal year. FY 2000 is the first year in which any outcome data became available, and OCR will need two to three years to collect a sufficient amount of data to be able to set measures based on its compliance experience.

OCR has reviewed the data associated with the eleven outcome measures for which OCR had projected developing baselines in FY 2000 in the initial four program priority areas. These baselines rely extensively on data collected from grantees/providers, states and others following completion of investigations and reviews. OCR has had greater difficulty than initially anticipated in collecting data in the context of reviews and investigations. The data received to date provide an insufficient base from which to set targets for FY 2001 and FY 2002. OCR has determined that it needs to collect data during FY 2001 and FY 2002 before setting a baseline. The earliest year in which OCR now plans to set the baseline is FY 2002. During FY 2001 and FY 2002, OCR will carefully assess, with input from OCR's senior civil rights experts, the efficacy of the outcome measures associated with the adoption, managed care, LEP, and welfare reform priority areas. By the end of FY 2002, OCR will have determined if these measures are appropriate and will establish baselines, or if, necessary, will modify outcome measures to ensure that they will correctly assess the result of OCR's work.

OCR has provided technical assistance to its regional staff on the collection and input of performance data. OCR will continue to work with staff to enhance their ability to collect data that will enable assesment of whether performance targets have been met. This year, based on preliminary results from an Inspector General's audit and OCR staff experience in reviewing data, OCR included an additional data verification process prior to generating final FY 2000 data. In FY 2001 and beyond, OCR will identify and implement approaches to effectively coordinate program management, incorporate a results orientation into ongoing operations, and improve data collection and reporting.

External factors may affect OCR's proposed outcomes. The factors include:

• Legislation, Administrative Action, and Court Decisions

Federal or state administrative action, court actions, or changes in laws may affect OCR's ability to achieve its outcomes. For example, changes in professional school admissions policies could affect the number of minority practitioners providing services in individual managed care plans and in turn affect the number of minorities being served by such plans.

Fiscal Availability

Significant cuts in funding for state and local programs' budgets would have a deleterious effect on proposed outcomes. Cuts in services in state and local programs would result in fewer minorities and disabled people being served. Additionally, if community-based groups and other organizations experience cuts in foundation, government, and private funding, OCR may not be able to work as effectively with these groups as envisioned by the plan.

Economy and Demographics

Changes in the economy may have an affect on OCR's meeting its outcomes. For example, if unemployment increases significantly, there may be a smaller pool of available adoptive parents. If that were the case, there would probably be an increase in the time all children, including minority children, would have to wait to be adopted.

Changes in the demographics of program participants due to a variety of factors could cause OCR to modify program objectives related to minority access to services. An example of circumstances in which an objective may have to be changed would be if the number of minority participants in a welfare-to-work program decreases due to successful job placements.

II. PROGRAM PLANNING AND ASSESSMENT

Introduction

The specific performance goals for OCR's six program objectives and one operational efficiency (management) objective delineate what have been judged to be the most important output and outcome measures for assessing the success of OCR's programmatic activities. This section discusses these performance goals in the context of OCR's overall compliance activities.

2.1 Compliance Activity

2.1.1 Program Description, Context and Summary of Performance

The Office for Civil Rights' single program activity is to ensure compliance with civil rights laws. The program is accomplished through several compliance methods (i.e., complaint investigations, post-grant reviews and investigations, pre-grant reviews, monitoring, and voluntary compliance, outreach and public education). As noted previously, OCR's GPRA plan identifies six key program areas and issues for priority civil rights attention and seeks to develop customer-focused outcome measures that will supplement output measures.

OCR's FY 2002 budget request reflects a commitment to strengthen the HHS civil rights compliance program and related compliance activities. OCR's FY 2002 compliance program builds on FY 2001 high priority activities including joint projects with states in implementing the Olmstead decision, and reviews and outreach focused on nondiscriminatory health care, welfare-to-work, immigrant access, LEP, and children's access to health insurance and care.

During FY 2001 and FY 2002, OCR will continue to collect data that will enable development and refinement of outcome baselines. These baselines will enable assessment of OCR's success in meeting its goal of increasing access to and participation in HHS programs through the prevention or correction of unlawful discriminatory barriers and practices. The GPRA Annual Performance Plan also incorporates output measures that serve both as measures of operational efficiency and as intermediate and interim measures until OCR has been able to collect, monitor and validate two to three years of facility or other provider data to develop baselines for population-based outcome measures for the first four of its program priority areas.

The determination of what performance measures will be developed for the HIPAA privacy activity will require several years of experience with the new program. It is likely that OCR will need at least two to three years of experience with privacy of health information activities before establishing any performance measures.

Data Issues

The data to measure its compliance activities is derived from OCR's management information system. Currently OCR collects data on case processing and other compliance projects through its Compliance Activity Tracking System (CATS). This database system has been designed using commercial off-the-shelf software (Microsoft Access) and is currently operating as a flat file system with each region entering data into a regional file that can be combined with other regional files into a national data resource. During the next two years, resources permitting, OCR plans to convert the database to a relational format in which an underlying table structure will enable greater ease of data generation and analysis.

At the end of the second quarter of FY 1998, OCR added data fields to capture GPRA outcome measures related to conducting specific types of reviews and investigations and GPRA output data for the initial four identified high priority issues. Fields were added in FY 2000 for the two new priority objectives: increasing nondiscriminatory quality health care for minorities; and, increasing the provision of health and human services in the most-integrated settings appropriate for individuals with disabilities. Data on populations served by providers and data on types and numbers of services are collected during reviews and investigations by the investigator(s) handling a given case.

OCR established initial FY 1998 baseline data for the majority of its case-related output measures. Because FY 1998 data on outreach activities, joint projects, consultations, and technical assistance provided were inadequate to establish baselines, OCR used FY 1999 data to establish baselines for these latter activities. In FY 2000, OCR established a baseline for the one remaining case-related output measure (managed care reviews) for which a baseline had not been set under the first four priority areas.

OCR uses a number of techniques in order to validate data collected. These include conducting additional on-site reviews/investigations, examining files and other records, and analyzing data from independent sources such as other HHS components, state or local governmental agencies, or other organizations. Data on the number of reviews, corrective actions and no violation findings, outreach activities, and other joint projects, the number of consultations/technical assistance provided and other counts of OCR contacts/projects are reported by each region to OCR headquarters. Where there are variances from what is expected, OCR program operations staff contact the regions to verify such differences. Where data reported for comparable activities across several regions appear to be skewed in a given region or two, program staff follows up to identify reasons for such variances. In addition, OCR will continue to validate all data as it has in the past through periodic management reviews or evaluations of civil rights program implementation. In addition, there is close monitoring of data reported in its tracking system. When data appear to be inconsistent, headquarters staff notifies regional staff to check the data, verify accuracy, and make changes as necessary. In an effort to ensure that data input into the system are accurate, in FY 2000 and FY 2001 headquarters staff provided on-site training to all staff in six regional offices, while working with the remaining four regions on a monthly basis to assist them in collecting and entering valid data.

HHS' Office of the Inspector General (OIG) is conducting an audit of OCR's FY 1999 Performance Report. Based on preliminary discussions, OCR has taken several steps to make sure that the data OCR collects are accurate and effectively verified and that its explanations of what is collected and reported are consistent with OCR operations. Specifically, OCR is making sure that all activities reported in its data system as high priority activities are in fact incorporated as high priority activities in letters of findings or other documentation issued by OCR. As a result of the OIG audit, OCR clarified the definition of "corrective action" to include investigations or reviews closed during the year for which the data are reported and in which a recipient either has already made changes or has agreed to make further changes to come into compliance. OCR is sending out instructions to strengthen its management controls and will continue to conduct regional training to provide further guidance to staff on how to collect and enter data to ensure their validity.

One factor that may affect OCR's reporting on performance involves limitations of data. OCR has adapted its compliance activity management information system in order to be able to capture and analyze pre- and post-review/complaint investigation data. As OCR implements its GPRA objectives, OCR will work with recipients to determine if they have any problems in collecting requested data. In addition, there may be variations in the definitions of certain terms used by states. OCR will be examining these definitions to determine if these variations are significant. If OCR finds that the data in different states are not comparable, OCR may need to do one or more of the following: (1) be more specific in its definition of data terms; (2) change its measures; or, (3) determine if its compliance activity system adequately generates the data that OCR needs to measure performance. With respect to the new priority objective on nondiscriminatory quality health care, limitations on the availability of racial and ethnic health data ultimately may impede OCR's ability to measure the outcome effect of its efforts.

Where baselines were developed in FY 1998 and FY 1999, OCR has evaluated accomplishment of program output goals as of the end of FY 2000 based on analysis of data available through its Compliance Activity Tracking System (CATS). Section 2.1.2 on the following page discusses OCR's accomplishments.

2.1.2 Goal-by-Goal Presentation of Performance

Goal I: TO INCREASE NONDISCRIMINATORY ACCESS AND PARTICIPATION IN HHS PROGRAMS

Objective A: Increase number of HHS adoption service providers who provide nondiscriminatory placements for minority children.

In establishing performance measures for the adoption area, OCR focused on activities that would eliminate discriminatory policies and practices in state and local adoption agencies to ensure nondiscriminatory placement of children in permanent adoptive homes.

I.A.1: Increase number of state agencies and adoption agencies (local) found to be in compliance with the nondiscrimination provisions of the Small Business Job Protection Act.

I.A.1.a: Increased number of corrective actions and no violation findings

Performance: OCR has used this measure because it is important to show that as a result of OCR action there has been an increase in the number of adoption services providers that are in compliance with the nondiscrimination provisions of the Small Business Job Protection Act (SBJPA). This measure indicates the number of recipients that are in compliance with the nondiscrimination provisions either because they made or agreed to make changes in their policies and practices in order to bring them into compliance or because OCR found that there were no violations.

OCR's baseline for FY 1998 was 20. In FY 1999, OCR's target was 30, and OCR achieved corrective action and no violation findings in 20 cases. In FY 2000, OCR's target was 22, and OCR achieved corrective action and no violation findings in eight cases. The continued decrease in corrective action and no violation findings is not related to a decrease in successfully obtaining corrective action or to providers' lack of compliance, but instead directly relates to a shift in focus during the past two to three years from investigations and reviews to outreach and technical assistance. (See the detailed discussion below on the revised output measure.)

I.A.1.b: Increased number of reviews

Performance: OCR has used this as a performance measure because reviews are activities that OCR initiates and is thereby able to focus its resources on recipients for which OCR has information indicating potential compliance problems.

OCR's baseline for FY 1998 was 14. In FY 1999, the target was 28, and OCR completed 13. In FY 2000, the target was 15 and OCR did not complete any such reviews. (See the detailed discussion below on the revised output measure that reflects OCR's increasing emphasis on outreach and technical assistance, and its commitment to using a flexible approach to improving compliance.)

Modification of Adoption Output Measures

The indicators (i.e., increased number of corrective actions/no violation findings and reviews) and related outputs noted above include only two of many types of activities that OCR employs to ensure nondiscrimination in adoption services. During the past two to three years, OCR has shifted its focus to outreach activities, joint projects and technical assistance/consultations -- activities for which no output measure was included in the plan. For example, during FY 2000, although OCR began investigations and reviews, it found that outreach, technical assistance, joint efforts, and consultation were the more effective means of achieving compliance. During FY 2000, OCR completed 15 outreach activities, used joint project techniques in six activities, and provided technical assistance and consultation in 11 activities.

Based on the trends over the past two years, OCR is modifying the output indicators in the FY 2001 plan by combining multiple output indicators into a single indicator that includes these other activities. The combined indicator more accurately reflects OCR's flexible approach to increasing compliance (preventing and correcting unlawful discrimination), by tailoring its activities to address the unique circumstances of HHS grantees/providers, rather than adhering to a strictly prescribed set of activities.

In FY 2000, the combined target for the two output measures under this objective was 37 (22 corrective action/no violation findings and 15 reviews). Using the revised consolidated measure described above, OCR completed 40 activities (+3 and +8.1%). While the combined targets and revised consolidated measure are not exactly comparable, the data from the revised measure indicates that OCR-initiated work in the area of adoption nondiscrimination is greater than the initial output targets set for this objective in FY 2000.

The following table provides data on the individual output categories that now constitute the single output indicator:

I.A.1.c: Decreased number or proportion of minority children waiting adoptive placement

I.A.1.d: Decreased waiting times for minority children

Developmental Measures: OCR is using the outcome measures above because data have shown that, when compared to non-minority children, a disproportionate percentage of minority children in the adoption/foster care system were waiting permanent adoptive placement and that the waiting time for minority children was longer than that experienced by non-minority children. These two outcome measures are developmental because it will take two to three years to establish baselines. With respect to outcome measures, OCR developed a system for collecting pre- and post-review/complaint investigation data over a two- to three-year period to show the effect of OCR's involvement on protected beneficiaries of actions taken by HHS service providers.

OCR has begun to collect data for the two measures above prior to the initiation of a review or complaint investigation of an adoption service provider (or during the review/investigation if pre-existing data are unavailable). OCR will collect data through subsequent monitoring after a sufficient period of time has elapsed to evaluate if there has been a change in the number or proportion of minority children waiting adoptive placement and in their waiting time in the system. The collection of such pre-OCR and post-OCR involvement data is the means by which OCR will be able to validate if the work it is carrying out is having the expected effect on HHS beneficiaries.

Modification of Adoption Outcome Measures

In its FY 1999 and FY 2000 plans, OCR projected that it would have the baseline data for the two adoption outcome measures by the end of FY 2001. However, as noted earlier in this document with respect to each of the 11 outcome measures for which OCR had projected developing baselines in FY 2000 in the initial four program priority areas, OCR has had greater difficulty than initially anticipated in collecting data. These outcome baselines rely extensively on data collected from grantees/providers, states and others following completion of investigations and reviews. The data received to date provide an insufficient base from which to set targets for FY 2001 and FY 2002. OCR has determined that it needs to collect data during FY 2001 and FY 2002 before setting a baseline.

The earliest year in which OCR now plans to set the baseline is FY 2002. During FY 2001 and FY 2002, OCR will carefully assess, with input from OCR's senior civil rights experts, the efficacy of the outcome measures associated with the adoption priority area. By the end of FY 2002, OCR will have determined if these measures are appropriate and will establish baselines, or if, necessary, will modify outcome measures to ensure that they will correctly assess the result of OCR's work. Continued use of outreach, voluntary compliance, technical assistance, public education, joint projects, and consultations as the major methods for achieving adoption nondiscrimination compliance is likely to result in less data from which OCR could establish case-related outcome baselines.

Objective B: Increase access for minorities and persons with disabilities to nondiscriminatory services in managed care settings.

OCR activities support this objective by focusing resources on correcting discriminatory barriers preventing equal access to managed care services for minorities and persons with disabilities.

I.B.1: Increased number of managed care plans found to be in compliance with Title VI, Section 504 and the Americans with Disabilities Act.

I.B.1.a: Increased number of corrective actions and no violation findings

Performance: OCR has used this measure because it is important to show that as a result of OCR action there has been an increase in the number of managed care providers that are in compliance Title VI, Section 504 and the Americans with Disabilities Act. This measure indicates the number of recipients that are in compliance because they either made changes in their policies and practices in order to bring them into compliance or because OCR found that there were no violations.

OCR's baseline for FY 1998 was ten. In FY 1999, the target was 40, and OCR completed 27. In FY 2000, the target was 30, and OCR completed eight. The continued decrease in corrective action and no violation findings is not related to a decrease in successfully obtaining corrective action or to providers' lack of compliance, but instead directly relates to both the complexity of managed care reviews, investigations and analysis and a shift in focus during the past two years from investigations and reviews to outreach and technical assistance. (See the detailed discussion below on the revised output measure.)

I.B.1.b: Increased number of minority practitioners providing services to managed care plans

Developmental Measure: According to OCR's stakeholders, because managed care plans may not hire a sufficient number of minority practitioners, the minority patients of these practitioners effectively would not have access to these plans because patients most often want to stay with their physician. In addition, minority patients may feel uncomfortable going to a practitioner who does not have a similar cultural background. The lack of minority practitioners may result in managed care plans not marketing to minority patients. OCR selected this outcome measure because OCR wanted to show if, as a result of OCR's involvement, managed care plans hired more minority practitioners, resulting in more minorities having access to these plans.

I.B.1.c: Increase number of interpreter/bilingual contacts/hours for LEP enrollees

I.B.1.d: Increased number of interpreter contacts/hours for hearing/speech impaired individuals

Developmental Measures: OCR has used the two outcome measures above because OCR's initial reviews of managed care plans have shown that they do not have an adequate number of LEP, hearing and speech interpreters. This results in barriers for LEP persons and persons with hearing and speech disabilities in enrollment and receipt of services within the plans.

The three outcome measures under this sub-objective (I.B.1.b., c. and d.) are developmental because it will take several years to establish baselines. With respect to outcome measures, OCR developed a system for collecting pre- and post-review/complaint investigation data over a two- to three-year period to show the effect of OCR's involvement on protected beneficiaries of actions taken by HHS service providers. OCR has begun to collect data for the measure above prior to the initiation of a review or complaint investigation of a managed care provider (or during the review/investigation if pre-existing data are unavailable). OCR will collect data through subsequent monitoring after a sufficient period of time has elapsed to evaluate if there has been an increase as a result of OCR's involvement. The collection of such pre-OCR and post-OCR involvement data is the means by which OCR will be able to validate if the work it is carrying out is having the expected effect on HHS beneficiaries.

Modification of Managed Care Outcome Measures

In its FY 1999 and FY 2000 plans, OCR projected that it would have the baseline data for the two adoption outcome measures by the end of FY 2001. However, as noted earlier in this document with respect to each of the 11 outcome measures for which OCR had projected developing baselines in FY 2000 in the initial four program priority areas, OCR has had greater difficulty than initially anticipated in collecting data. These outcome baselines rely extensively on data collected from grantees/providers, states and others following completion of investigations and reviews. The data received to date provide an insufficient base from which to set targets for FY 2001 and FY 2002. OCR has determined that it needs to collect data during FY 2001 and FY 2002 before setting a baseline.

The earliest year in which OCR now plans to set the baseline is FY 2002. During FY 2001 and FY 2002, OCR will carefully assess, with input from OCR's senior civil rights experts, the efficacy of the outcome measures associated with the adoption priority area. By the end of FY 2002, OCR will have determined if these measures are appropriate and will establish baselines, or if, necessary, will modify outcome measures to ensure that they will correctly assess the result of OCR's work. Continued use of outreach, voluntary compliance, technical assistance, public education, joint projects, and consultations in addition to investigations and reviews as major methods for achieving managed care nondiscrimination compliance is likely to result in less data from which OCR could establish case-related outcome baselines.

I.B.1.e: Increased number of reviews

Performance: OCR has used this as a performance measure because reviews are activities that OCR initiates and is thereby able to focus its resources on recipients for which OCR has information indicating potential compliance problems. By increasing the number of reviews of managed care plans, OCR will be focusing more of its resources in priority areas where OCR expects to achieve change from OCR's involvement. In FY 2000, OCR completed six such reviews. Using this number as the baseline, the target for FY 2001 is eight managed care reviews.

I.B.2: Increase managed care plans' awareness and understanding of civil rights requirements

I.B.2.a.: Increased number of joint projects

I.B.2.b: Increased number of outreach activities

Performance: OCR has used these two performance measures because they are indicators of the extent to which managed care organizations, and other groups have gained knowledge about civil rights requirements and responsibilities that will increase managed care plans' compliance with OCR's laws and regulations, thereby enhancing nondiscriminatory access to services for minorities and persons with disabilities. In FY 2000, the targets were 18 joint projects and 21 outreach activities and OCR engaged in 14 joint projects and 31 outreach activities. Although OCR missed its joint effort goal by four, OCR exceeded the outreach goal by ten, thereby exceeding the composite goal of 39 joint projects and outreach activities by six. In addition, OCR provided technical assistance and consultation in 26 activities. (See the detailed discussion below on the revised output measure that reflects OCR's commitment to using a flexible approach to improving compliance.)

Modification of Managed Care Output Measures

Based on the trends over the past two years, OCR is modifying the output indicators in the FY 2001 plan by combining multiple output indicators into a single indicator that includes all case-related and voluntary compliance and outreach, joint project, consultation, and public education activities. The combined indicator more accurately reflects OCR's flexible approach to increasing compliance (preventing and correcting unlawful discrimination), by tailoring its activities to address the unique circumstances of HHS grantees/providers, rather than adhering to a strictly prescribed set of activities.

In FY 2000, the combined target for the three output measures under this objective was 69 (30 corrective action/no violation findings, 21 outreach activities and 18 joint projects). Using the revised consolidated measure described above, OCR completed 85 activities (+16 and +23.2%). While the combined targets and revised consolidated measure are not exactly comparable, the data from the revised measure indicates that OCR work in the area of managed care nondiscrimination is greater than the initial output targets set for this objective in FY 2000. The table on the following page provides data on the individual output categories that now constitute the single output indicator:

Objective C: Increase access to HHS services for limited English proficient (LEP) persons.

During FY 2001 and FY 2002 OCR will continue to work with health care and social services providers, state and local agencies and HHS agencies, to ensure that persons of limited English proficiency (LEP) are not discriminated against on the basis of national origin.

I.C.1: Increase HHS OPDIV staffs', grantees' and program providers' knowledge and understanding of limited English proficiency (LEP) guidance.

I.C.1.a: Increased number of consultations and technical assistance provided

Performance: OCR has used this performance measure because it is an indicator of the extent to which OPDIV staff, grantees and program providers have gained knowledge about civil rights requirements and responsibilities that will increase their ability to recognize whether programs and services funded by the Department may have civil rights compliance issues. OCR expects that this increased knowledge will help ensure that recipients of HHS funds are in compliance with OCR's laws and regulations, thereby enhancing nondiscriminatory access to services for LEP persons. The baseline for this measure in FY 1999 was 54 and the target for FY 2000 was 60. OCR provided LEP-related consultation and technical assistance in 102 instances, exceeding the target by 70 percent. (See the detailed discussion below on the revised output measure that reflects OCR's commitment to using a flexible approach to improving compliance.)

I.C.2: Increase number of joint projects at the community level.

I.C.2.a: Increased number of joint efforts

I.C.2.b: Increased number of outreach activities

Performance: OCR has used these two performance measures because they are indicators of the extent to which service providers and other parties have gained knowledge about civil rights requirements and responsibilities that will increase programs' compliance with OCR's laws and regulations, thereby enhancing nondiscriminatory access to services for LEP persons. The FY 1999 baselines for these measures were 51 joint projects and 76 outreach activities and the targets in FY 2000 were 56 joint projects and 84 outreach activities. OCR used joint projects in 29 activities and completed 114 outreach activities for a total of 143. Although OCR missed the goal by 27, OCR exceeded the outreach goal by 30, thereby exceeding the composite goal of 140 joint projects and outreach activities by three. (See the detailed discussion below on the revised output measure that reflects OCR's commitment to using a flexible approach to improving compliance.)

I.C.3: Increase number of HHS grantees and providers found to be in compliance with Title VI in LEP reviews/investigations

I C.3.a: Increased number of corrective actions and no violation findings

Performance: OCR has used this measure because it is important to show that as a result of OCR action there has been an increase in the number of service providers that are in compliance with Title VI. This measure indicates the number of recipients that are in compliance with Title VI either because they made or agreed to make changes in their policies and practices in order to bring them into compliance or because OCR found that there were no violations.

OCR's baseline for FY 1998 was 98 and in FY 1999 OCR completed 146. The target for FY 2000 was 151 with OCR completing 81 such reviews. The decrease in corrective action and no violation findings in FY 2000 is directly related to OCR's significant investment of resources in LEP policy guidance development, review and subsequent major public education activities, thereby shifting its focus to outreach, consultation and technical assistance. OCR was the first federal civil rights agency to issue policy guidance with respect to language access and Title VI and served as the model for other agencies government-wide. OCR anticipates a continuing increase in outreach activities associated with language access and expects the number of corrective actions and no violation findings to increase in FY 2001. (See the detailed discussion below on the revised output measure that reflects OCR's commitment to using a flexible approach to improving compliance.)

I.C.3.b: Increased number of reviews

Performance: OCR has used this as a performance measure because reviews are activities that OCR initiates and is thereby able to focus its resources on recipients for which OCR has information indicating potential compliance problems. By increasing the number of limited English proficiency reviews, OCR will be focusing more of its resources on priority areas where OCR expects to achieve change from OCR's involvement.

OCR's baseline for FY 1998 was 92. In FY 1999, OCR completed 132. In FY 2000, the target was 136 and OCR completed 77. As was the case with the decrease in corrective action and no violation findings, the reduction in reviews completed in FY 2000 is directly related to OCR's significant investment of resources in LEP policy guidance development, review and subsequent major public education activities and the consequent shifting of its focus to outreach, consultation and technical assistance. OCR anticipates a continuing increase in outreach activities associated with language access and expects the number of reviews to increase in FY 2001. (See the detailed discussion below on the revised output measure that reflects OCR's commitment to using a flexible approach to improving compliance.)

Modification of LEP Output Measures

Based on its experience during the past two years, OCR is modifying the output indicators in the FY 2001 plan by combining multiple output indicators into a single indicator that includes all case-related and voluntary compliance and outreach, joint project, consultation, and public education activities. The combined indicator more accurately reflects OCR's flexible approach to increasing compliance (preventing and correcting unlawful discrimination), by tailoring its activities to address the unique circumstances of HHS grantees/providers, rather than adhering to a strictly prescribed set of activities.

In FY 2000, the combined target for the five output measures under this objective was 487 (151 corrective action/no violation findings, 136 reviews, 84 outreach activities, 60 consultations and technical assistance and 56 joint projects). Using the revised consolidated measure described above, OCR completed 403 activities (or 82.8% of the combined target of 487). Given the resources applied to developing the policy guidance, the complexity of several of the cases in process, and the magnitude of many of the outreach activities in late FY 2000 following the issuance of the LEP policy guidance, OCR's commitment of resources and achievements were greater than the sum of the individual categories of activity. While the combined targets and revised consolidated measure are not exactly comparable, the data from the revised measure indicates that OCR work in the area of limited English proficiency (LEP) nondiscrimination, despite shortfalls in individual targets, still reflected considerable activity under this objective in FY 2000. The table on the following page provides data on the individual output categories that now constitute the single output indicator:

I C.3.c: Increased number of LEP persons served

I.C.3.d: Increased number of interpreter/bilingual contacts/hours for LEP persons

I.C.3.e: Increased number of services for LEP persons

I.C.3.f. Increased number of translated documents available

Developmental Measures: These performance measures were established because OCR reviews and investigations have shown that providers frequently do not have an adequate number of interpreters, documents, and other aids that can assist limited English proficient individuals to access and benefit from services. In addition, stakeholders, and interest groups in particular, consistently have identified that LEP individuals have serious difficulties in accessing services and in receiving quality services due to language and cultural barriers. These measures will indicate whether OCR's reviews and investigations have resulted in increased access for this population. These four outcome measures are developmental because it will take two to three years to establish baselines. With respect to outcome measures, OCR developed a system for collecting pre- and post-review/complaint investigation data over a two- to three-year period to show the effect of OCR's involvement on protected beneficiaries of actions taken by HHS service providers.

OCR has begun to collect data for the four measures above prior to the initiation of a review or complaint investigation of providers (or during the review/investigation if pre-existing data are unavailable). OCR will collect data through subsequent monitoring after a sufficient period of time has elapsed to evaluate if there has been a change in access to services for LEP beneficiaries. The collection of such pre-OCR and post-OCR involvement data is the means by which OCR will be able to validate if the work it is carrying out is having the expected effect on HHS beneficiaries.

Modification of Limited English Proficiency (LEP) Outcome Measures

In its FY 1999 and FY 2000 plans, OCR projected that it would have the baseline data for the two adoption outcome measures by the end of FY 2001. However, as noted earlier in this document with respect to each of the 11 outcome measures for which OCR had projected developing baselines in FY 2000 in the initial four program priority areas, OCR has had greater difficulty than initially anticipated in collecting data. These outcome baselines rely extensively on data collected from grantees/providers, states and others following completion of investigations and reviews. The data received to date provide an insufficient base from which to set targets for FY 2001 and FY 2002. OCR has determined that it needs to collect data during FY 2001 and FY 2002 before setting a baseline.

The earliest year in which OCR now plans to set the baseline is FY 2002. During FY 2001 and FY 2002, OCR will carefully assess, with input from OCR's senior civil rights experts, the efficacy of the outcome measures associated with the adoption priority area. By the end of FY 2002, OCR will have determined if these measures are appropriate and will establish baselines, or if, necessary, will modify outcome measures to ensure that they will correctly assess the result of OCR's work. Continued use of outreach, voluntary compliance, technical assistance, public education, joint projects, and consultations in addition to investigations and reviews as major methods for achieving limited English proficiency (LEP) nondiscrimination compliance is likely to result in less data from which OCR could establish case-related outcome baselines.

Objective D: Increase number of state and local welfare agencies and service providers administering TANF that are in compliance with Title VI, Section 504 and the ADA.

As states and local governments continue implementation of the TANF welfare reform program, some groups have expressed concerns that racial and language minorities and persons with disabilities may be subjected to disparate treatment in assignment to work, training and education programs. Working with ACF and others, OCR will ensure that programs are implemented in a nondiscriminatory manner.

I.D.1: Increase state and local welfare agencies' and service providers' knowledge and understanding of Title VI, Section 504 and ADA requirements in the administration of TANF.

I.D.1.a: Increased number of consultations and technical assistance provided

Performance: OCR has used this performance measure because it is an indicator of the extent to which state and local welfare agencies and service providers have gained knowledge about civil rights requirements and responsibilities that will increase their ability to recognize whether their programs and services funded by the Department may have civil rights compliance issues. OCR expects that this increased knowledge will help ensure that TANF programs are in compliance with OCR's laws and regulations, thereby enhancing nondiscriminatory access to services for minorities and persons with disabilities. In FY 1999, the baseline for this measure was 16. In FY 2000, the target was 18 and OCR provided TANF consultation and technical assistance in 41 instances exceeding the target by 128 percent. (See the detailed discussion below on the revised output measure that reflects OCR's commitment to using a flexible approach to improving compliance.)

I.D.2: Increase number of joint projects/outreach activities focused on nondiscrimination in administering TANF.

I.D.2.a: Increased number of joint projects

I.D.2.b: Increase number of outreach activities

Performance: OCR has used these two performance measures because they are indicators of the extent to which affected groups, service providers, and other organizations have gained knowledge about civil rights requirements and responsibilities that will increase programs' compliance with OCR's laws and regulations, thereby enhancing nondiscriminatory access to services for minorities and persons with disabilities. The baselines for these measures in FY 1999 were 20 joint projects and 26 outreach activities. In FY 2000, the targets for these measures were 22 joint projects and 29 outreach activities, with OCR using joint projects in 65 instances and completing 40 outreach activities. This means that OCR exceeded the individual targets by 196 percent and 38 percent respectively. (See the detailed discussion below on the revised output measure that reflects OCR's commitment to using a flexible approach to improving compliance.)

I.D.3: Increase number of state and local TANF agencies and service providers found to be in compliance with Title VI, Section 504 and ADA.

I.D.3.a: Increased number of corrective actions and no violation findings

Performance: OCR is using this measure because it is important to show that as a result of OCR action there has been an increase in the number of state and local welfare agencies and service providers in compliance with Title VI, Section 504 and the ADA. This measure indicates the number of recipients that are in compliance with these statutes either because they made or agreed to make changes in their policies and practices in order to bring them into compliance or because OCR found that there were no violations.

OCR's baseline for FY 1998 was eight. In FY 1999, OCR completed 23. In FY 2000, the target was 29, and OCR completed 49, exceeding the target by 20 corrective actions and no violation findings (+69%). This level of achievement was due to a targeted set of joint Medicaid/TANF reviews that OCR engaged in with HCFA. (See the detailed discussion below on the revised output measure that reflects OCR's commitment to using a flexible approach to improving compliance.)

I.D.3.b: Increased number of reviews

Performance: OCR established this as a performance measure because reviews are activities that OCR initiates and is thereby able to focus its resources on recipients for which OCR has information indicating potential compliance problems. By increasing the number of TANF reviews, OCR will be focusing more of its resources on priority areas where OCR expects to achieve change from OCR's involvement.

OCR's baseline for FY 1998 was seven. In FY 1999, OCR completed 19. In FY 2000, the target was 24, and OCR completed 47, exceeding the target by 23 reviews (+96%) due to the joint Medicaid/TANF reviews that OCR engaged in with HCFA. (See the detailed discussion below on the revised output measure that reflects OCR's commitment to using a flexible approach to improving compliance.)

Modification of TANF Output Measures

Based on its experience in other program areas, OCR is modifying the output indicators in the FY 2001 plan by combining multiple output indicators into a single indicator that includes all case-related and voluntary compliance and outreach, joint project, consultation, and public education activities. The combined indicator more accurately reflects OCR's flexible approach to increasing compliance (preventing and correcting unlawful discrimination), by tailoring its activities to address the unique circumstances of HHS grantees/providers, rather than adhering to a strictly prescribed set of activities.

In FY 2000, the combined target for the five output measures under this objective was 122 (29 corrective action/no violation findings, 24 reviews, 29 outreach activities, 18 consultation and technical assistance activities, and 22 joint project activities). Using the revised consolidated measure described above, OCR completed 242 activities (+120 and +98.4%). While the combined targets and revised consolidated measure are not exactly comparable, the data from the revised measure indicates that OCR work in the area of TANF nondiscrimination far exceeded the individual output targets set for this objective in FY 2000. In FY 2000, the actual performance included the one-time targeted set of joint reviews with HCFA noted above. Because OCR presently does not expect to repeat this joint effort in FY 2001 and FY 2002, the consolidated targets for these years are lower than the FY 2000 achievement. The table below provides data on the individual output categories that now constitute the single output indicator:

I.D.3.c: Increased number of minority (including national origin/LEP) persons served

I.D.3.d: Increased number of disabled persons served

Developmental Measures: These measures will indicate whether OCR's reviews and investigations have resulted in increased access for these populations. Stakeholders, including community-based organizations, have indicated concerns that both minorities and persons with disabilities are being steered to lower end jobs and training opportunities under TANF. These two outcome measures are developmental because it will take two to three years to establish baselines. With respect to outcome measures, OCR developed a system for collecting pre- and post-review/complaint investigation data over a two- to three-year period to show the effect of OCR's involvement on protected beneficiaries of actions taken by HHS service providers.

OCR has begun to collect data for the two measures above prior to the initiation of a review or complaint investigation of providers (or during the review/investigation if pre-existing data are unavailable). OCR will collect data through subsequent monitoring after a sufficient period of time has elapsed to evaluate if there has been a change in access to services for minority and disabled beneficiaries. The collection of such pre-OCR and post-OCR involvement data is the means by which OCR will be able to validate if the work it is carrying out is having the expected effect on HHS beneficiaries.

Modification of TANF Outcome Measures

In its FY 1999 and FY 2000 plans, OCR projected that it would have the baseline data for the two adoption outcome measures by the end of FY 2001. However, as noted earlier in this document with respect to each of the 11 outcome measures for which OCR had projected developing baselines in FY 2000 in the initial four program priority areas, OCR has had greater difficulty than initially anticipated in collecting data. These outcome baselines rely extensively on data collected from grantees/providers, states and others following completion of investigations and reviews. The data received to date provide an insufficient base from which to set targets for FY 2001 and FY 2002. OCR has determined that it needs to collect data during FY 2001 and FY 2002 before setting a baseline.

The earliest year in which OCR now plans to set the baseline is FY 2002. During FY 2001 and FY 2002, OCR will carefully assess, with input from OCR's senior civil rights experts, the efficacy of the outcome measures associated with the adoption priority area. By the end of FY 2002, OCR will have determined if these measures are appropriate and will establish baselines, or if, necessary, will modify outcome measures to ensure that they will correctly assess the result of OCR's work. Continued use of outreach, voluntary compliance, technical assistance, public education, joint projects, and consultations in addition to investigations and reviews as major methods for achieving TANF nondiscrimination compliance is likely to result in less data from which OCR could establish case-related outcome baselines.

Objective E: Increase nondiscriminatory quality health care for minorities.

This priority is a new program area to which OCR has begun to allocate resources on a pilot basis during FY 1999 and FY 2000. Recent research, a report by the media in a major metropolitan area, and the HHS goal of eliminating health disparities have noted areas in which potential discrimination in practitioners' and institutions' referral and treatment patterns may affect the quality of health care provided to minorities.

I.E.1: Increase number of health care providers medical schools, community-based organizations, professional organizations, HHS agencies, state and local agencies and other groups to improve nondiscriminatory quality health care for minorities.

I.E.1.a: Increased number of joint projects/task forces

I.E.1.b: Increased number of outreach activities

I.E.1.c: Increased number of consultations and technical assistance provided

Developmental Measures: OCR established these three performance measures because they are indicators of the extent to which service providers, and other organizations have gained knowledge about civil rights requirements and responsibilities that will increase programs' compliance with OCR's laws and regulations, thereby enhancing nondiscriminatory access to services for minorities. These measures also may indicate the extent to which various stakeholders are working together with OCR to enhance minorities' access to and receipt of nondiscriminatory quality health care. During FY 2000 OCR engaged in 17 joint projects, completed 46 outreach activities, and provided consultation and technical assistance in 41 instances. (See the discussion below on the revised output measure that reflects OCR's commitment to using a flexible approach to improving compliance.)

I.E.2: Increased number of HHS providers found to be in compliance with Title VI.

I.E.2.a: Increased number of corrective actions and no violation findings

Developmental Measure: OCR is using this measure because it is important to show that as a result of OCR action there has been an increase in the number of health care providers in compliance with Title VI. This measure indicates the number of recipients that are in compliance either because they made or agreed to make changes in their policies and practices in order to bring them into compliance or because OCR found that there were no violations. During FY 2000 OCR achieved 12 corrective actions and no violation findings in the health disparities arena. (See the detailed discussion below on the revised output measure that reflects OCR's commitment to using a flexible approach to improving compliance.)

I.E.2.b: Increased number of reviews

Developmental Measure: OCR established this as a performance measure because reviews are activities that OCR initiates and is thereby able to focus its resources on recipients for which OCR has information indicating potential compliance problems. By increasing the number of reviews, OCR will be focusing more of its resources where OCR expects to achieve change from OCR's involvement. During FY 2000, OCR completed 12 reviews in the health disparities arena. (See the discussion below on the revised output measure that reflects OCR's commitment to using a flexible approach to improving compliance.)

Modification of Health Disparities Output Measures

Based on OCR's experience in other program priority areas, OCR also is modifying the developmental output indicators for this objective in the FY 2001 plan by combining multiple output indicators into a single indicator that includes all case-related and voluntary compliance and outreach, joint project, consultation, and public education activities. The combined indicator more accurately reflects OCR's flexible approach to increasing compliance (preventing and correcting unlawful discrimination), by tailoring its activities to address the unique circumstances of HHS grantees/providers, rather than adhering to a strictly prescribed set of activities.

Objective F: Increase provision of health and human services in most-integrated settings for persons with disabilities.

This priority is a program area requiring the allocation of resources in FY 2002. The June 1999 decision in the Olmstead case by the Supreme Court, requirements for states to develop state-level comprehensive, effectively working plans to integrate persons with disabilities into communities, and increased attention within the disability community have led OCR to request an increase in resources to address issues related to ensuring that persons with disabilities are provided services in the most-integrated settings, as appropriate.

I.F.1: Increase HHS OPDIV staffs', grantees' and program providers' knowledge of requirements to provide health and human services in most-integrated settings to persons with disabilities.

I.F.1.a: Increased number of consultations and technical assistance provided

Developmental Measure: OCR established this performance measure because it is an indicator of the extent to which OPDIV staff, grantees and program providers have gained knowledge about civil rights requirements and responsibilities that will increase their ability to recognize whether programs and services funded by the Department may have civil rights compliance issues. OCR expects that this increased knowledge will help ensure that recipients of HHS funds are in compliance with OCR's laws and regulations, thereby enhancing nondiscriminatory access to community-based services for persons with disabilities. During FY 2000, OCR provided consultation and technical assistance in 34 instances. (See the discussion below on the revised output measure that reflects OCR's commitment to using a flexible approach to improving compliance.)

I.F.2: Increase joint efforts/outreach activities.

I.F.2.a: Increased number of joint projects

I.F.2.b: Increased number of outreach activities

Developmental Measures: OCR established these two performance measures because they are indicators of the extent to which service providers and other groups have gained knowledge about civil rights requirements and responsibilities that will increase programs' compliance with OCR's laws and regulations, thereby enhancing nondiscriminatory access to community-based services for persons with disabilities. During FY 2000, OCR engaged in 31 joint projects and completed 36 outreach activities. (See the discussion below on the revised output measure that reflects OCR's commitment to using a flexible approach to improving compliance.)

I.F.3: Increase number of state and local agencies and service providers found in compliance with Section 504 and ADA.

I.F.3.a: Increased number of corrective actions and no violation findings

Developmental Measure: OCR is using this measure because it is important to show that as a result of OCR action there has been an increase in the number of providers in compliance with Section 504 and the ADA. This measure indicates the number of recipients that are in compliance either because they made or agreed to make changes in their policies and practices in order to bring them into compliance or because OCR found that there were no violations. During FY 2000, OCR achieved 17 corrective actions and no violation findings in the Olmstead (most-integrated setting) arena. (See the detailed discussion below on the revised output measure that reflects OCR's commitment to using a flexible approach to improving compliance.)

I.F.3.b: Increased number of reviews

Developmental Measure: OCR established this as a performance measure because reviews are activities that OCR initiates and is thereby able to focus its resources on recipients for which OCR has information indicating potential compliance problems. By increasing the number of most-integrated setting and disability reviews, OCR will be focusing more of its resources on priority areas where OCR expects to achieve change from OCR's involvement. (See the discussion below on the revised output measure that reflects OCR's commitment to using a flexible approach to improving compliance.)

Modification of Most-Integrated Setting/Disability Output Measures

Based on OCR's experience in other program priority areas, OCR also is modifying the developmental output indicators for this objective in the FY 2001 plan by combining multiple output indicators into a single indicator that includes all case-related and voluntary compliance and outreach, joint project, consultation, and public education activities. The combined indicator more accurately reflects OCR's flexible approach to increasing compliance (preventing and correcting unlawful discrimination), by tailoring its activities to address the unique circumstances of HHS grantees/providers, rather than adhering to a strictly prescribed set of activities.

I.F.3.c: Increased number of people with disabilities receiving services in the most-integrated setting

Developmental Measure: This measure will indicate whether OCR's reviews and investigations have resulted in increased nondiscriminatory access to community-based services for persons with disabilities. Stakeholders, particularly interested or affected groups, have indicated concerns that persons with disabilities are being inappropriately provided services in institutional settings and are being denied placements in the most-integrated setting appropriate to their needs. This outcome measure is developmental because it will take two to three years to establish baselines. With respect to outcome measures, OCR developed a system for collecting pre- and post-review/complaint investigation data over a two- to three-year period to show the effect of OCR's involvement on protected beneficiaries of actions taken by HHS service providers.

OCR will begin to collect data for this measure above prior to the initiation of a review or complaint investigation of providers (or during the review/investigation if pre-existing data are unavailable). OCR will collect data through subsequent monitoring after a sufficient period of time has elapsed to evaluate if there has been a change in access to services for disabled beneficiaries. The collection of such pre-OCR and post-OCR involvement data is the means by which OCR will be able to validate if the work it is carrying out is having the expected effect on HHS beneficiaries. OCR currently projects that it will have the baseline data for the Olmstead Most-Integrated Setting outcome measure by the end of FY 2002, although the complexity of this issue may result in some slippage. During FY 2001 and FY 2002, OCR will carefully assess, with input from OCR's senior civil rights experts, the efficacy of the outcome measures associated with the Olmstead priority area and if necessary, will modify outcome measures to ensure that they will correctly assess the result of OCR's work.

Goal II: TO ENHANCE OPERATIONAL EFFICIENCY

Objective A: Increase percentage of resources focused on high priority issues.

OCR's GPRA performance plan is predicated on allocating staff and other resources to the highest priority civil rights issues. (The process OCR used to determine it six priority civil rights issues -- adoption, managed care, LEP, welfare reform, health disparities (nondiscriminatory quality health care), and services in the most-integrated setting to individuals with disabilities (Olmstead) -- is described on page 39.) OCR has committed considerable energies during the past few years to streamlining case processing, re-inventing its Case Resolution Manual, and developing guidance and training for investigators. All of these activities are aimed at increasing OCR's ability to focus on key priorities. Consistent with this thrust, OCR will increase compliance activities focused on high priority issues and will decrease the average age of priority case closures.

II.A.1: Increase percent and/or number of OCR compliance activities focused on high priority issues.

II.A.1.a: Increased percent and/or number of closures that are focused on high priority issues

Performance: OCR's baseline for FY 1998 was 23% and/or 150. In FY 1999, the percentage of closures focusing on high priority issues was 32.6% and the number of such closures was 209. In FY 2000, the target was 33% and/or 233. The actual proportion of investigated closures that focused on all high priority issues (including the four initial and two developmental program categories) was 30.9% missing the proportional target marginally. Due to OCR's emphasis during the year on outreach, public education, training, consultation, technical assistance and joint projects, the total number of investigations and reviews of all kinds decreased. Consistent with this across-the-board decrease, the number of such case closures that focused on high priority issues (188) also was lower than had been projected. In this context, the more important measure of the extent of OCR-initiated case work focusing on high priorities is the proportion of all such work rather than the number. With an increase in total complaint receipts in FY 2000 that continued increases begun in FY 1999, the overall proportion of case closures focusing on high priority issues will likely continue to be affected by the increased caseload of allegations that cut across many more areas than the high priority issues alone.

II.A.1.b: Increased percent and/or number of corrective actions or no violation findings that are focused on high priority issues

Performance: OCR's baseline for FY 1998 was 21% and/or 123. In FY 1999, the percentage of corrective actions and no violation findings focusing on high priority issues was 31.8% and the number of such corrective actions and no violation findings was 204. In FY 2000, the targets were 33% and 290. The actual proportion of investigated closures that focused on all high priority issues (including the four initial and two developmental program categories) was 32.4% just missing the proportional target. Due to OCR's emphasis during the year on outreach, public education, training, consultation, technical assistance and joint projects, the total number of investigations and reviews of all kinds with corrective actions and no violation findings decreased. Consistent with this across-the-board decrease, the number of such case closures that focused on high priority issues (175) also was lower than had been projected. In this context, the more important measure of the extent of self-initiated case work focusing on high priorities is the proportion of all such work rather than the number. With an increase in total complaint receipts in FY 2000 that continued increases begun in FY 1999, the overall proportion of case closures focusing on high priority issues will likely continue to be affected by the increased caseload of allegations that cut across many more areas than the high priority issues alone.

II.A.1.c: Increased percent and/or number of outreach and joint projects activities that are focused on high priority issues

Performance: OCR selected this performance measure because it and the closure and corrective action/no violation findings measures all indicate a greater concentration of OCR resources on issues that have been identified as civil rights priority areas. The FY 1999 baselines for the percentage and/or number of all outreach and joint efforts that are focused on high priority issues are 50% and 121 and the targets for FY 2000 were 53% and 137 respectively. OCR exceeded both of these targets by focusing 65% of its considerably increased outreach and joint efforts on high priorities (including the four initial and two developmental program categories). OCR also exceeded the numerical target by completing 282 outreach and joint project activities focusing on the high priority program areas.

Modification of Measures of OCR's Focus on High Priority Issues

As in the case of all of the program objectives in this plan, OCR will modify the output indicators for the proportion and numbers of its compliance workload that focuses on high priority issues by combining multiple output indicators. OCR will include the closure, corrective action/no violation findings, and the outreach and joint project activities indicators into a single indicator. Using this single indicator in FY 2000, just under 50 percent (47% and 462 activities) of OCR's key indicators of programmatic achievement focused on high priority issues. In FY 2001, the target will be set at 48% and 425. The number has been reduced consistent with the one-time Medicaid/TANF joint OCR-HCFA reviews of states nationwide conducted during FY 2000. Although there will be outreach, technical assistance and potentially further investigative work following up on these reviews, OCR has adjusted future targets to reflect that such follow-up activity will not be on a one-for-one basis covering all of the states that were reviewed in FY 2000.

II.A.2: Decrease average age of priority case closures.

II.A.2.a: Decrease average age of all priority case closures

Performance: OCR selected this performance measure because it indicates how efficiently staff are processing high priority cases and the extent to which staff are becoming increasingly familiar with the complex issues raised in each of these priority areas. OCR's baseline for FY 1998 was 244 days. In FY 1999, the average age of priority case closures increased by just over one percent to 247 days. In FY 2000, the target was 241 days and the actual average was 309 days. This was due in part to a concerted effort nationwide to close older cases as well as to the increasing complexity of cases raising the priority issues. It also reflects additional scrutiny of which cases should be included in the average age computations based on preliminary findings of the Inspector General's audit of OCR's FY 1999 GPRA achievements and report. This year, OCR removed any cases which were closed administratively (without a finding) after a request for data had been sent to a grantee/provider.

Based on the FY 2000 data, OCR will continue to aim for 2.5% reductions per year in the average age of priority case closures. However, the target for FY 2000 has been adjusted to be based on the actual performance in FY 2000.

APPENDIX TO THE PERFORMANCE PLAN

A.1 Approach to Performance Measurement

OCR will use both outputs and outcomes to measure performance during FY 2002 (see charts with goals, objectives, and measures). Starting in FY 1998, OCR has focused its compliance and outreach/education activities on the six high priority performance objectives. During FY 1998, OCR developed GPRA data fields for the collection of case and outreach-related data within its existing Compliance Activity Tracking System (CATS). OCR has collected data to establish baselines against which the FY 2002 outputs will be measured. Based on its experience over the past two years, OCR is modifying the output indicators in the FY 2001 plan by combining multiple output indicators into a single indicator that includes each of the compliance activities listed below:

increased number of reviews conducted,

increased number of corrective actions and no violation findings from review and complaint investigation activities,

increased number of consultations/technical assistance provided (e.g., either case-related or responses to requests for specific assistance in avoiding or resolving potential civil rights problems),

increased number of joint efforts (e.g., coordinated projects planned with other HHS agencies, states, local governments, providers, and community-based and other organizations in which shared objectives are set and implemented) and,

increased number of outreach activities conducted (e.g., special projects or significant planned activities focused on the compliance needs of states, local governments, providers, and community-based and other organizations).

The combined indicator more accurately reflects OCR's flexible approach to increasing compliance (preventing and correcting unlawful discrimination), by tailoring its activities to address the unique circumstances of HHS grantees/providers, rather than adhering to a strictly prescribed set of activities. Although the activities noted above are not exactly comparable, each can be equally effective in reaching compliance. Each requires a considerable level of effort in working with recipients of federal financial assistance and others to prevent or correct discriminatory policies or practices. On average, these activities are estimated to take similar amounts of staff time. The consultation/technical assistance, joint efforts, and outreach activities all involve planned and coordinated efforts that are part of an overall strategic approach to resolving potential civil rights problems.

OCR has determined that the consolidated output measure is an important indicator of its success in educating providers, community-based and other organizations, and program beneficiaries about civil rights requirements and responsibilities. Public knowledge of these requirements and responsibilities is a major factor in ensuring compliance. Elements of the consolidated indicator, such as the number of joint projects, consultations, technical assistance, and outreach activities reflect the extent of OCR's coverage of the extensive network of providers and users of HHS-funded services. The number of reviews and the number of corrective actions or "no violation" findings in OCR's casework are measures both of the scope of OCR's coverage of the universe of HHS grantees and of OCR's success in achieving civil rights compliance through outreach, joint projects, technical assistance, and investigative activities. The inter-related set of compliance activities is integral to OCR's flexible approach to working with and responding to the diverse needs of OCR's stakeholders.

With respect to outcome-oriented measures, OCR developed a system for collecting pre- and post-review/complaint investigation data over a two- to three-year period to show the effect of OCR's involvement on protected beneficiaries of actions taken by HHS service providers. OCR has begun to collect data regarding access to service and services received prior to the initiation of a review or complaint investigation (or during the review/investigation if pre-existing data are unavailable). OCR will collect data through subsequent monitoring after a sufficient period of time has elapsed to evaluate if there has been a change in protected beneficiaries' access to or receipt of services. The collection of such pre-OCR and post-OCR involvement data is the means by which OCR will be able to validate if the work it is carrying out is having the expected effect on HHS beneficiaries. For example, if OCR has reason to believe that, in an area with a large population of limited English proficient persons, a hospital does not provide adequate interpreter services to enable access to its medical services, OCR will conduct a review and capture data over a specified period of time on the number of hours of interpreter services provided (either retrospectively or during the review). Subsequent to the review or investigation, OCR will monitor and collect data from the hospital on interpreter hours provided during a comparable time period. The period for which OCR will require a provider to submit data will, in part, be dependent on the size of the facility and/or the type and number of services for which the facility will be collecting data.

A.2 Changes and Improvements Over Previous Year

Because HHS' Office of the Inspector General raised questions regarding the output measure under all of OCR's priority areas that is based on "corrective action", OCR clarified the definition for "corrective action" to include closed cases in which recipients either have made changes and have agreed to make further changes to bring them into compliance.

A.3 Linkage to HHS and OPDIV Strategic Plans

(See linkage information in Part I Section 1.1 and the last chart in this Appendix)

A.4. Performance Measurement Linkage with Budget, Human Resources and Information Technology Planning

All of the performance objectives are directly linked to OCR's FY 2002 budget request. As noted in Part II, Section 2.1.1 above, OCR's FY 2002 budget request of $32,005,000 reflects both an ongoing commitment to strengthen HHS' civil rights compliance program and continuing its role under HIPAA. OCR resources will support development of comprehensive, effectively working plans for provision of services to persons with disabilities in the most-integrated setting possible (Olmstead), maximizing participation in the State Children's Health Insurance program (SCHIP) and Medicaid by eliminating discriminatory barriers to participation; outreach and other compliance activities related to welfare reform and civil rights, nondiscriminatory quality health care focused on racial and ethnic disparities in health care and health status, language access, including immigrant access to benefits for which they are eligible. The effect of FY 2002 funding increments will be reflected in the increased outputs, and eventually outcomes, measured under the GPRA Plan. If there are significant reductions in OCR's funding in FY 2002, several of the objectives are unlikely to be met.

With respect to human resources planning, OCR is assessing the various staffing and skill needs associated with the civil rights and privacy rights issues. Further, OCR in FY 2000 reorganized its headquarters operation to increase the span of control while reducing management layers in an effort to ensure that expert consultation on civil rights authorities is readily available to frontline staff. In FY 2002, OCR will build on this refocusing of staff expertise and on continuing training and capacity-building activities.

* This GPRA objective is focused on improving operational efficiency and therefore increasing the proportion of resources being devoted to high priority issues (i.e., the six GPRA high priority areas A-F under the access goal above). Therefore, in some sense, the operational efficiency goal supports all of the HHS Strategic Plan objectives noted above because success under OCR's efficiency goal will result in increased resources focused on priority issues that address the HHS goals.

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