Significant Provisions in the Final Regulations Implementing the Ticket to Work and Self-Sufficiency Program.

Significant Provisions in theFinal RegulationsImplementing the

Ticket to Workand Self-

Sufficiency Program

Ticket to Work Program--Purpose

• To expand the universe of service providers available to serve individuals entitled to SSI and SSDI benefits based on disability in obtaining services necessary to find, enter, and retain employment

Ticket to Work Program--Implementation

• To allow thorough evaluation and ensure full implementation of the Ticket program on a timely basis, the Program will be implemented in three phases.

Ticket to Work Program--Implementation--Phase 1

• The Ticket program was launched February 2002 in the 13 States: Arizona, Colorado, Delaware Florida, Illinois, Iowa Massachusetts, New York, Oklahoma Oregon, South Carolina, Vermont Wisconsin

Ticket to Work Program--Implementation--Phase 2

• The Ticket program was phased into additional States and the District of Columbia in November 2002:

Alaska, Arkansas, Connecticut, District of Columbia, Georgia, Indiana, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Dakota, South Dakota, Tennessee, Virginia

Ticket to Work Program--Implementation--Phase 3

• The Ticket program will be phased into the remaining States and territories in 2003 for complete National implementation by 2004:

Alabama, American Samoa, California, Guam, Hawaii, Idaho, Maine, Maryland, Minnesota, Nebraska, North Carolina, Northern Mariana Islands, Ohio, Pennsylvania, Puerto Rico, Rhode Island, Texas, Utah, Virgin Islands, Washington, West Virginia, Wyoming

Eligibility to a Ticket

All SSI and SSDI disability cash beneficiaries, except:

• Beneficiaries whose conditions are expected to improve, and who have not had at least one continuing disability review;

• Beneficiaries who have not attained age 18; • Childhood SSI beneficiaries who have attained

age 18, but who have not had a redetermination under the adult disability standard.

Receipt of a Ticket A beneficiary receiving a Ticket:

• can choose whether or not to use the Ticket

• can use the Ticket to obtain services from employment network of his or her choice, or from a State VR agency if he or she qualifies for services

• can retrieve the Ticket from the EN or the VR Agency and reassign it to another EN or the VR Agency

Suspension of CDRs--“Using a Ticket”

• SSA may not initiate a CDR while a beneficiary is “using a ticket” (making “timely progress toward self-sufficiency”)

• A CDR is suspended while the beneficiary is using a ticket. The regulatory definition of “using a ticket” provides the beneficiary with a limited period to prepare for work, and subsequent periods during which the beneficiary must demonstrate increasing levels of employment.

Use of aProgram Manager

• SSA has contracted with a Program Manager (PM):

– MAXIMUS, Inc., 09/30/00– PM responsibilities: Recruit/monitor/recommend ENs Facilitate beneficiary access to ENs Facilitate payments to ENs Resolve EN-State VR agency disputes Other administrative duties for SSA

Employment Networks

• Employment Network (EN)

– Any qualified State, local, or private entity

– Assumes responsibility for coordination and delivery of employment services, vocational rehabilitation services, or other support services under the Ticket to Work program

Employment Networks--Eligibility

• Employment Network

– Can be a single entity or an association of entities combining resources

– Can provide services directly or by entering into agreements with other organizations or individuals to provide the needed services to a beneficiary

Employment Networks--Qualifications

• All ENs must meet minimum qualifications– Licensure or accreditation, if applicable; or

– Education, or experience

• Non-traditional service providers (such as employers, and religious and charitable organizations) may be approved as ENs.

Employment Networks--Agreements with SSA

• An Open Request for Proposals was published April 13, 2001:

– FedBizOpps: http://www.eps.gov

– WorkSite: http://www.ssa.gov/work

Employment Networks--Must Report

• Information to assist the Program Manager in determining whether a beneficiary is making timely progress toward self-sufficiency (for CDR suspension); and

• Information about a beneficiary’s work activity and earnings so SSA can determine their effect on entitlement to benefits and benefit amounts

State VR Agency Participationin the Ticket to Work Program

• State VR agencies must participate in the Ticket program to receive payment for serving a beneficiary with a ticket

• A VRA can choose for each beneficiary it serves, on a beneficiary-by-beneficiary basis, to be paid under the cost reimbursement system or under one of the EN payment systems

• A VRA must provide reports on beneficiary outcomes when choosing to be paid as an EN.

Individual Work Plan

• Required written document:

– Developed, signed, and implemented in partnership by the EN and the beneficiary

– Outlines specific employment services, VR services, or other support services the EN and beneficiary have determined are necessary to achieve the beneficiary’s employment goal

Individual Work Plan, continued

• Must include at least statements of:– of the beneficiary’s vocational goal– of services and supports necessary to achieve

the beneficiary’s vocational goal– of any terms and conditions– that EN may not request or receive any

compensation for cost of services and supports

Individual Work Plan, continued

• Included statements, continued– of conditions under which EN can amend the

IWP or terminate the relationship– of the beneficiary’s rights, including the right

to retrieve the ticket– of remedies available to the beneficiary,

including the availability of advocacy services and assistance through P&A Services

Individual Work Plan, continued

• Included statements, continued:

– of the beneficiary’s rights to privacy and confidentiality

– of the beneficiary’s right to seek to amend the IWP

– of the beneficiary’s right to have a copy of the IWP made available to the beneficiary in an accessible format

EN Payment Systems-- Outcome Payment System

Outcome payments to an EN(over 60 months):

– at 40 % of average monthly SSDI or SSI benefit

– for every month beneficiary does not receive benefits due to work/earnings

EN Payment Systems--Outcome-Milestone System

Payment for four milestones--after work starts:

1 -worked for 1 calendar month at SGA2 -worked for 3 calendar months out of 12 at

SGA3 -worked for 7 calendar months out of 12 at

SGA4 -worked for 12 calendar months out of 15 at

SGA

EN Payment Systems-- Outcome-Milestone System

Outcome-Milestone payments, continued:

– Reduced Outcome payments--about 85% of total potentially payable under the Outcome payment system over 60 months for the same beneficiary

EN Payment Systems-- Increased Incentives for ENs

Final regulations:• Added 2 new milestones (doubled the number of

possible milestone payments)• Moved one new milestone to follow 1st month of

work;• Doubled the value of milestone payments;• Extended period of recoupment (reduction in

outcome payments due to milestone payments) from 12 months to 60 months

Dispute Resolution in theTicket to Work Program--

Beneficiary and EN• The dispute resolution process describes the

responsibilities of an EN that is not a State VR agency to:

– have grievance procedures that a beneficiary can use to seek resolution of a dispute

– inform each beneficiary of the right to refer a dispute first to the PM, and then to SSA for resolution

– inform each beneficiary of the availability of assistance from the State P&A system.

Dispute Resolution in theTicket to Work Program--

EN and PM• The PM is required to have procedures to

resolve disputes with ENs that do not involve an EN’s payment request.

• An EN can seek a solution through the PM’s internal grievance procedures.

• If the PM’s internal grievance procedures do not result in a mutually agreeable solution, the PM must refer the dispute to SSA for a decision.

Dispute Resolution in theTicket to Work Program--

Beneficiary and State VR Agency• The dispute resolution procedures in the

Rehabilitation Act of 1973, as amended, apply to any beneficiary who has assigned his or her ticket to a State VR agency.

• The Rehabilitation Act requires the State VR agency to provide a description of services authorized through the CAP program, and to provide an opportunity to resolve disputes using formal mediation or an informal hearing process.

Resolution of Payment Dispute--EN and SSA

• If an EN other than a State VR agency has a payment dispute with SSA, the dispute will be resolved under the dispute resolution procedures contained in the EN’s agreement with SSA.

Ticket to Work Programand Alternate Participants

• The AP process will end in each State as the Ticket program is phased-in

• APs providing VR services will be asked if they choose to become ENs

• If an AP chooses to become an EN, services to current clients will continue to be covered under the current cost reimbursement system for a limited time

Ticket to Work Programand Alternate Participants

• If an AP chooses not to become an EN, payment will not be made for services to new clients after the Ticket program is phased-in the State

• If an AP chooses not to become an EN, payment will not be made for any services after January 1, 2004

The Work Site

• SSA Office of Employment Support Programs’ Web Site:

• http://www.ssa.gov/work