May 21, 2004
The Honorable Clay Shaw
Chairman
Social Security Subcommittee
House Ways and Means Committee
Washington, DC 20515
Dear Mr. Chairman
We, the undersigned members of the Consortium for Citizens with Disabilities (CCD) Task Force on Work Incentives Implementation, are writing this letter to ask you, as Chair of the House Social Security Subcommittee, to send a letter to the Commissioner of the Social Security Administration (SSA) reinforcing Congressional intent that Title I of the Ticket to Work and Work Incentives Improvement Act (P.L. 106-170) gives SSA the authority to revisit and revise existing policies (both regulatory and sub-regulatory) promulgated to implement the Ticket to Work and Self-Sufficiency program (the Ticket program). To date, the Ticket program has experienced limited success and we believe there are two things that could be done in the very near future that would significantly increase the success rate of the Ticket program. Neither of these things would require legislative action and we believe both are within SSA’s current authority to revisit some of its early policy interpretations. The first would be to permit payments under both the traditional cost reimbursement system and the new employment network payment system for the same ticket-eligible beneficiary. The second would be to permit partial outcome payments for partial reductions in cash disability benefits.
Attached to this letter you will find two position papers outlining the reasoning (including legislative citations) behind our belief that SSA can and should revisit these issues as quickly as possible, prior to full implementation of the Ticket program in November 2004. We believe that a letter from the Chair of the House Social Security Subcommittee, indicating Congressional interest in SSA's revisiting policies such as these, would help tremendously in moving SSA to act expeditiously on these recommendations.
The Ticket program was intended to create additional options for Social Security beneficiaries with disabilities who are interested in seeking services to enter or re-enter employment. Among other things, these options include access to an expanded pool of service providers, access to extended health coverage under Medicare and Medicaid, access to accurate information to make informed decisions about going to work, and access to advocacy services. However, attempts to expand the pool of service providers available to beneficiaries with disabilities who want to work has seen very limited success to date due to some of the policy interpretations made by SSA at the onset of program implementation.
The Ticket program is a new program that uses a different approach to service delivery. Unfortunately, SSA had to make many, if not most, of the policy interpretations related to the Ticket program prior to having any actual experience with the program. With full implementation of the program only a few months away, SSA now has significant information with which to revisit some of these policy interpretations. As you are aware, Congress was astute enough to realize that the Ticket program’s implementing regulations might need to be revisited once some initial experience with the program provided factual information regarding program implementation was available. Thus, Section 101(d)(1 & 2) of P.L. 106-170 calls for the graduated implementation of the program carried out at phase-in sites “on a wide enough scale to permit a thorough evaluation of the alternative methods under consideration, so as to ensure that the most efficacious methods are determined and in place for full implementation of the Program on a timely basis.” In addition, Section 101(d)(4)(D) calls for periodic evaluation reports, requiring that “each such report shall set forth the Commissioner’s evaluation of the extent to which the Program has been successful and the Commissioner’s conclusions on whether or how the Program should be modified.”
We believe these and other legislative citations provide ample evidence that Congress meant to give SSA the authority to revisit some of its policy interpretations once actual experience with program implementation provides evidence that these policies do not contribute to or are hindering the success of the program. As of April 2004, only 47,000 of the 7 million tickets that had been mailed had been assigned. With only 439 of the approximately 1,100 employment networks (ENs) under contract with SSA accepting ticket assignments, most of the ticket assignments are still going to State VR agencies. There has been extensive testimony before Congress and SSA indicating that the participation by ENs will continue to be severely limited as long as the incentives for EN participation are almost non-existent.
We believe that time is of the essence with regard to changes that must be made to make the Ticket program work. We are hoping that a Congressional letter to Commissioner Barnhart in the near future would set the stage to get these changes made prior to full implementation in November 2004.
Sincerely,
American Association on Mental Retardation
American Association of People with Disabilities
American Network of Community Options and Resources
American Occupational Therapy Association
Council of State Agencies for Vocational Rehabilitation
Easter Seals
International Association of Business, Industry and Rehabilitation
National Alliance for the Mentally Ill
National Association of Protection and Advocacy Systems
National Organization of Social Security Claimants' Representatives
NISH
Paralyzed Veterans of America
United Spinal Association
U. S. Psychiatric Rehabilitation Association [formerly IAPSRS]
May 21, 2004
The Honorable Robert Matsui
Ranking Member
Social Security Subcommittee
House Ways and Means Committee
Washington, DC 20515
Dear Representative Matsui:
We, the undersigned members of the Consortium for Citizens with Disabilities (CCD) Task Force on Work Incentives Implementation, are writing this letter to ask you, as Ranking Member of the House Social Security Subcommittee, to send a letter to the Commissioner of the Social Security Administration (SSA) reinforcing Congressional intent that Title I of the Ticket to Work and Work Incentives Improvement Act (P.L. 106-170) gives SSA the authority to revisit and revise existing policies (both regulatory and sub-regulatory) promulgated to implement the Ticket to Work and Self-Sufficiency program (the Ticket program). To date, the Ticket program has experienced limited success and we believe there are two things that could be done in the very near future that would significantly increase the success rate of the Ticket program. Neither of these things would require legislative action and we believe both are within SSA’s current authority to revisit some of its early policy interpretations. The first would be to permit payments under both the traditional cost reimbursement system and the new employment network payment system for the same ticket-eligible beneficiary. The second would be to permit partial outcome payments for partial reductions in cash disability benefits.
Attached to this letter you will find two position papers outlining the reasoning (including legislative citations) behind our belief that SSA can and should revisit these issues as quickly as possible, prior to full implementation of the Ticket program in November 2004. We believe that a letter from the Chair of the House Social Security Subcommittee, indicating Congressional interest in SSA's revisiting policies such as these, would help tremendously in moving SSA to act expeditiously on these recommendations.
The Ticket program was intended to create additional options for Social Security beneficiaries with disabilities who are interested in seeking services to enter or re-enter employment. Among other things, these options include access to an expanded pool of service providers, access to extended health coverage under Medicare and Medicaid, access to accurate information to make informed decisions about going to work, and access to advocacy services. However, attempts to expand the pool of service providers available to beneficiaries with disabilities who want to work has seen very limited success to date due to some of the policy interpretations made by SSA at the onset of program implementation.
The Ticket program is a new program that uses a different approach to service delivery. Unfortunately, SSA had to make many, if not most, of the policy interpretations related to the Ticket program prior to having any actual experience with the program. With full implementation of the program only a few months away, SSA now has significant information with which to revisit some of these policy interpretations. As you are aware, Congress was astute enough to realize that the Ticket program’s implementing regulations might need to be revisited once some initial experience with the program provided factual information regarding program implementation was available. Thus, Section 101(d)(1 & 2) of P.L. 106-170 calls for the graduated implementation of the program carried out at phase-in sites “on a wide enough scale to permit a thorough evaluation of the alternative methods under consideration, so as to ensure that the most efficacious methods are determined and in place for full implementation of the Program on a timely basis.” In addition, Section 101(d)(4)(D) calls for periodic evaluation reports, requiring that “each such report shall set forth the Commissioner’s evaluation of the extent to which the Program has been successful and the Commissioner’s conclusions on whether or how the Program should be modified.”
We believe these and other legislative citations provide ample evidence that Congress meant to give SSA the authority to revisit some of its policy interpretations once actual experience with program implementation provides evidence that these policies do not contribute to or are hindering the success of the program. As of April 2004, only 47,000 of the 7 million tickets that had been mailed had been assigned. With only 439 of the approximately 1,100 employment networks (ENs) under contract with SSA accepting ticket assignments, most of the ticket assignments are still going to State VR agencies. There has been extensive testimony before Congress and SSA indicating that the participation by ENs will continue to be severely limited as long as the incentives for EN participation are almost non-existent.
We believe that time is of the essence with regard to changes that must be made to make the Ticket program work. We are hoping that a Congressional letter to Commissioner Barnhart in the near future would set the stage to get these changes made prior to full implementation in November 2004.
Sincerely,
American Association on Mental Retardation
American Association of People with Disabilities
American Network of Community Options and Resources
American Occupational Therapy Association
Council of State Agencies for Vocational Rehabilitation
Easter Seals
International Association of Business, Industry and Rehabilitation
National Alliance for the Mentally Ill
National Association of Protection and Advocacy Systems
National Organization of Social Security Claimants' Representatives
NISH
Paralyzed Veterans of America
United Spinal Association
U. S. Psychiatric Rehabilitation Association [formerly IAPSRS]
May 21, 2004
The Honorable Jim Bunning
United States Senate
Washington, DC 20510
Dear Senator Bunning
We, the undersigned members of the Consortium for Citizens with Disabilities (CCD) Task Force on Work Incentives Implementation, are writing this letter to ask you, as author of the legislation creating the Ticket to Work and Self-Sufficiency Act, to send a letter to the Commissioner of the Social Security Administration (SSA) reinforcing Congressional intent that Title I of the Ticket to Work and Work Incentives Improvement Act (P.L. 106-170) gives SSA the authority to revisit and revise existing policies (both regulatory and sub-regulatory) promulgated to implement the Ticket to Work and Self-Sufficiency program (the Ticket program). To date, the Ticket program has experienced limited success and we believe there are two things that could be done in the very near future that would significantly increase the success rate of the Ticket program. Neither of these things would require legislative action and we believe both are within SSA’s current authority to revisit some of its early policy interpretations. The first would be to permit payments under both the traditional cost reimbursement system and the new employment network payment system for the same ticket-eligible beneficiary. The second would be to permit partial outcome payments for partial reductions in cash disability benefits.
Attached to this letter you will find two position papers outlining the reasoning (including legislative citations) behind our belief that SSA can and should revisit these issues as quickly as possible, prior to full implementation of the Ticket program in November 2004. We believe that a letter from the Chair of the House Social Security Subcommittee, indicating Congressional interest in SSA's revisiting policies such as these, would help tremendously in moving SSA to act expeditiously on these recommendations.
The Ticket program was intended to create additional options for Social Security beneficiaries with disabilities who are interested in seeking services to enter or re-enter employment. Among other things, these options include access to an expanded pool of service providers, access to extended health coverage under Medicare and Medicaid, access to accurate information to make informed decisions about going to work, and access to advocacy services. However, attempts to expand the pool of service providers available to beneficiaries with disabilities who want to work has seen very limited success to date due to some of the policy interpretations made by SSA at the onset of program implementation.
The Ticket program is a new program that uses a different approach to service delivery. Unfortunately, SSA had to make many, if not most, of the policy interpretations related to the Ticket program prior to having any actual experience with the program. With full implementation of the program only a few months away, SSA now has significant information with which to revisit some of these policy interpretations. As you are aware, Congress was astute enough to realize that the Ticket program’s implementing regulations might need to be revisited once some initial experience with the program provided factual information regarding program implementation was available. Thus, Section 101(d)(1 & 2) of P.L. 106-170 calls for the graduated implementation of the program carried out at phase-in sites “on a wide enough scale to permit a thorough evaluation of the alternative methods under consideration, so as to ensure that the most efficacious methods are determined and in place for full implementation of the Program on a timely basis.” In addition, Section 101(d)(4)(D) calls for periodic evaluation reports, requiring that “each such report shall set forth the Commissioner’s evaluation of the extent to which the Program has been successful and the Commissioner’s conclusions on whether or how the Program should be modified.”
We believe these and other legislative citations provide ample evidence that Congress meant to give SSA the authority to revisit some of its policy interpretations once actual experience with program implementation provides evidence that these policies do not contribute to or are hindering the success of the program. As of April 2004, only 47,000 of the 7 million tickets that had been mailed had been assigned. With only 439 of the approximately 1,100 employment networks (ENs) under contract with SSA accepting ticket assignments, most of the ticket assignments are still going to State VR agencies. There has been extensive testimony before Congress and SSA indicating that the participation by ENs will continue to be severely limited as long as the incentives for EN participation are almost non-existent.
We believe that time is of the essence with regard to changes that must be made to make the Ticket program work. We are hoping that a Congressional letter to Commissioner Barnhart in the near future would set the stage to get these changes made prior to full implementation in November 2004.
Sincerely,
American Association on Mental Retardation
American Association of People with Disabilities
American Network of Community Options and Resources
American Occupational Therapy Association
Council of State Agencies for Vocational Rehabilitation
Easter Seals
International Association of Business, Industry and Rehabilitation
National Alliance for the Mentally Ill
National Association of Protection and Advocacy Systems
National Organization of Social Security Claimants' Representatives
NISH
Paralyzed Veterans of America
United Spinal Association
U. S. Psychiatric Rehabilitation Association [formerly IAPSRS]
May 21, 2004
The Honorable Charles Grassley
Chairman
Senate Finance Committee
United States Senate
Washington, DC 20510
Dear Mr. Chairman:
We, the undersigned members of the Consortium for Citizens with Disabilities (CCD) Task Force on Work Incentives Implementation, are writing this letter to ask you, as chairman of the Senate Finance Committee, to send a letter to the Commissioner of the Social Security Administration (SSA) reinforcing Congressional intent that Title I of the Ticket to Work and Work Incentives Improvement Act (P.L. 106-170) gives SSA the authority to revisit and revise existing policies (both regulatory and sub-regulatory) promulgated to implement the Ticket to Work and Self-Sufficiency program (the Ticket program). To date, the Ticket program has experienced limited success and we believe there are two things that could be done in the very near future that would significantly increase the success rate of the Ticket program. Neither of these things would require legislative action and we believe both are within SSA’s current authority to revisit some of its early policy interpretations. The first would be to permit payments under both the traditional cost reimbursement system and the new employment network payment system for the same ticket-eligible beneficiary. The second would be to permit partial outcome payments for partial reductions in cash disability benefits.
Attached to this letter you will find two position papers outlining the reasoning (including legislative citations) behind our belief that SSA can and should revisit these issues as quickly as possible, prior to full implementation of the Ticket program in November 2004. We believe that a letter from the Chair of the House Social Security Subcommittee, indicating Congressional interest in SSA's revisiting policies such as these, would help tremendously in moving SSA to act expeditiously on these recommendations.
The Ticket program was intended to create additional options for Social Security beneficiaries with disabilities who are interested in seeking services to enter or re-enter employment. Among other things, these options include access to an expanded pool of service providers, access to extended health coverage under Medicare and Medicaid, access to accurate information to make informed decisions about going to work, and access to advocacy services. However, attempts to expand the pool of service providers available to beneficiaries with disabilities who want to work has seen very limited success to date due to some of the policy interpretations made by SSA at the onset of program implementation.
The Ticket program is a new program that uses a different approach to service delivery. Unfortunately, SSA had to make many, if not most, of the policy interpretations related to the Ticket program prior to having any actual experience with the program. With full implementation of the program only a few months away, SSA now has significant information with which to revisit some of these policy interpretations. As you are aware, Congress was astute enough to realize that the Ticket program’s implementing regulations might need to be revisited once some initial experience with the program provided factual information regarding program implementation was available. Thus, Section 101(d)(1 & 2) of P.L. 106-170 calls for the graduated implementation of the program carried out at phase-in sites “on a wide enough scale to permit a thorough evaluation of the alternative methods under consideration, so as to ensure that the most efficacious methods are determined and in place for full implementation of the Program on a timely basis.” In addition, Section 101(d)(4)(D) calls for periodic evaluation reports, requiring that “each such report shall set forth the Commissioner’s evaluation of the extent to which the Program has been successful and the Commissioner’s conclusions on whether or how the Program should be modified.”
We believe these and other legislative citations provide ample evidence that Congress meant to give SSA the authority to revisit some of its policy interpretations once actual experience with program implementation provides evidence that these policies do not contribute to or are hindering the success of the program. As of April 2004, only 47,000 of the 7 million tickets that had been mailed had been assigned. With only 439 of the approximately 1,100 employment networks (ENs) under contract with SSA accepting ticket assignments, most of the ticket assignments are still going to State VR agencies. There has been extensive testimony before Congress and SSA indicating that the participation by ENs will continue to be severely limited as long as the incentives for EN participation are almost non-existent.
We believe that time is of the essence with regard to changes that must be made to make the Ticket program work. We are hoping that a Congressional letter to Commissioner Barnhart in the near future would set the stage to get these changes made prior to full implementation in November 2004.
Sincerely,
American Association on Mental Retardation
American Association of People with Disabilities
American Network of Community Options and Resources
American Occupational Therapy Association
Council of State Agencies for Vocational Rehabilitation
Easter Seals
International Association of Business, Industry and Rehabilitation
National Alliance for the Mentally Ill
National Association of Protection and Advocacy Systems
National Organization of Social Security Claimants' Representatives
NISH
Paralyzed Veterans of America
United Spinal Association
U. S. Psychiatric Rehabilitation Association [formerly IAPSRS]
May 21, 2004
The Honorable Max Baucus
Ranking Member
Senate Finance Committee
United States Senate
Washington, DC 20510
Dear Senator Baucus:
We, the undersigned members of the Consortium for Citizens with Disabilities (CCD) Task Force on Work Incentives Implementation, are writing this letter to ask you, as Ranking Member of the Senate Finance Committee, to send a letter to the Commissioner of the Social Security Administration (SSA) reinforcing Congressional intent that Title I of the Ticket to Work and Work Incentives Improvement Act (P.L. 106-170) gives SSA the authority to revisit and revise existing policies (both regulatory and sub-regulatory) promulgated to implement the Ticket to Work and Self-Sufficiency program (the Ticket program). To date, the Ticket program has experienced limited success and we believe there are two things that could be done in the very near future that would significantly increase the success rate of the Ticket program. Neither of these things would require legislative action and we believe both are within SSA’s current authority to revisit some of its early policy interpretations. The first would be to permit payments under both the traditional cost reimbursement system and the new employment network payment system for the same ticket-eligible beneficiary. The second would be to permit partial outcome payments for partial reductions in cash disability benefits.
Attached to this letter you will find two position papers outlining the reasoning (including legislative citations) behind our belief that SSA can and should revisit these issues as quickly as possible, prior to full implementation of the Ticket program in November 2004. We believe that a letter from the Chair of the House Social Security Subcommittee, indicating Congressional interest in SSA's revisiting policies such as these, would help tremendously in moving SSA to act expeditiously on these recommendations.
The Ticket program was intended to create additional options for Social Security beneficiaries with disabilities who are interested in seeking services to enter or re-enter employment. Among other things, these options include access to an expanded pool of service providers, access to extended health coverage under Medicare and Medicaid, access to accurate information to make informed decisions about going to work, and access to advocacy services. However, attempts to expand the pool of service providers available to beneficiaries with disabilities who want to work has seen very limited success to date due to some of the policy interpretations made by SSA at the onset of program implementation.
The Ticket program is a new program that uses a different approach to service delivery. Unfortunately, SSA had to make many, if not most, of the policy interpretations related to the Ticket program prior to having any actual experience with the program. With full implementation of the program only a few months away, SSA now has significant information with which to revisit some of these policy interpretations. As you are aware, Congress was astute enough to realize that the Ticket program’s implementing regulations might need to be revisited once some initial experience with the program provided factual information regarding program implementation was available. Thus, Section 101(d)(1 & 2) of P.L. 106-170 calls for the graduated implementation of the program carried out at phase-in sites “on a wide enough scale to permit a thorough evaluation of the alternative methods under consideration, so as to ensure that the most efficacious methods are determined and in place for full implementation of the Program on a timely basis.” In addition, Section 101(d)(4)(D) calls for periodic evaluation reports, requiring that “each such report shall set forth the Commissioner’s evaluation of the extent to which the Program has been successful and the Commissioner’s conclusions on whether or how the Program should be modified.”
We believe these and other legislative citations provide ample evidence that Congress meant to give SSA the authority to revisit some of its policy interpretations once actual experience with program implementation provides evidence that these policies do not contribute to or are hindering the success of the program. As of April 2004, only 47,000 of the 7 million tickets that had been mailed had been assigned. With only 439 of the approximately 1,100 employment networks (ENs) under contract with SSA accepting ticket assignments, most of the ticket assignments are still going to State VR agencies. There has been extensive testimony before Congress and SSA indicating that the participation by ENs will continue to be severely limited as long as the incentives for EN participation are almost non-existent.
We believe that time is of the essence with regard to changes that must be made to make the Ticket program work. We are hoping that a Congressional letter to Commissioner Barnhart in the near future would set the stage to get these changes made prior to full implementation in November 2004.
Sincerely,
American Association on Mental Retardation
American Association of People with Disabilities
American Network of Community Options and Resources
American Occupational Therapy Association
Council of State Agencies for Vocational Rehabilitation
Easter Seals
International Association of Business, Industry and Rehabilitation
National Alliance for the Mentally Ill
National Association of Protection and Advocacy Systems
National Organization of Social Security Claimants' Representatives
NISH
Paralyzed Veterans of America
United Spinal Association
U. S. Psychiatric Rehabilitation Association [formerly IAPSRS]
May 21, 2004
The Honorable Edward Kennedy
Ranking Member
Senate HELP Committee
United States Senate
Washington, DC 20510
Dear Senator Kennedy:
We, the undersigned members of the Consortium for Citizens with Disabilities (CCD) Task Force on Work Incentives Implementation, are writing this letter to ask you, as Ranking Member of the Senate HELP Committee, to send a letter to the Commissioner of the Social Security Administration (SSA) reinforcing Congressional intent that Title I of the Ticket to Work and Work Incentives Improvement Act (P.L. 106-170) gives SSA the authority to revisit and revise existing policies (both regulatory and sub-regulatory) promulgated to implement the Ticket to Work and Self-Sufficiency program (the Ticket program). To date, the Ticket program has experienced limited success and we believe there are two things that could be done in the very near future that would significantly increase the success rate of the Ticket program. Neither of these things would require legislative action and we believe both are within SSA’s current authority to revisit some of its early policy interpretations. The first would be to permit payments under both the traditional cost reimbursement system and the new employment network payment system for the same ticket-eligible beneficiary. The second would be to permit partial outcome payments for partial reductions in cash disability benefits.
Attached to this letter you will find two position papers outlining the reasoning (including legislative citations) behind our belief that SSA can and should revisit these issues as quickly as possible, prior to full implementation of the Ticket program in November 2004. We believe that a letter from the Chair of the House Social Security Subcommittee, indicating Congressional interest in SSA's revisiting policies such as these, would help tremendously in moving SSA to act expeditiously on these recommendations.
The Ticket program was intended to create additional options for Social Security beneficiaries with disabilities who are interested in seeking services to enter or re-enter employment. Among other things, these options include access to an expanded pool of service providers, access to extended health coverage under Medicare and Medicaid, access to accurate information to make informed decisions about going to work, and access to advocacy services. However, attempts to expand the pool of service providers available to beneficiaries with disabilities who want to work has seen very limited success to date due to some of the policy interpretations made by SSA at the onset of program implementation.
The Ticket program is a new program that uses a different approach to service delivery. Unfortunately, SSA had to make many, if not most, of the policy interpretations related to the Ticket program prior to having any actual experience with the program. With full implementation of the program only a few months away, SSA now has significant information with which to revisit some of these policy interpretations. As you are aware, Congress was astute enough to realize that the Ticket program’s implementing regulations might need to be revisited once some initial experience with the program provided factual information regarding program implementation was available. Thus, Section 101(d)(1 & 2) of P.L. 106-170 calls for the graduated implementation of the program carried out at phase-in sites “on a wide enough scale to permit a thorough evaluation of the alternative methods under consideration, so as to ensure that the most efficacious methods are determined and in place for full implementation of the Program on a timely basis.” In addition, Section 101(d)(4)(D) calls for periodic evaluation reports, requiring that “each such report shall set forth the Commissioner’s evaluation of the extent to which the Program has been successful and the Commissioner’s conclusions on whether or how the Program should be modified.”
We believe these and other legislative citations provide ample evidence that Congress meant to give SSA the authority to revisit some of its policy interpretations once actual experience with program implementation provides evidence that these policies do not contribute to or are hindering the success of the program. As of April 2004, only 47,000 of the 7 million tickets that had been mailed had been assigned. With only 439 of the approximately 1,100 employment networks (ENs) under contract with SSA accepting ticket assignments, most of the ticket assignments are still going to State VR agencies. There has been extensive testimony before Congress and SSA indicating that the participation by ENs will continue to be severely limited as long as the incentives for EN participation are almost non-existent.
We believe that time is of the essence with regard to changes that must be made to make the Ticket program work. We are hoping that a Congressional letter to Commissioner Barnhart in the near future would set the stage to get these changes made prior to full implementation in November 2004.
Sincerely,
American Association on Mental Retardation
American Association of People with Disabilities
American Network of Community Options and Resources
American Occupational Therapy Association
Council of State Agencies for Vocational Rehabilitation
Easter Seals
International Association of Business, Industry and Rehabilitation
National Alliance for the Mentally Ill
National Association of Protection and Advocacy Systems
National Organization of Social Security Claimants' Representatives
NISH
Paralyzed Veterans of America
United Spinal Association
U. S. Psychiatric Rehabilitation Association [formerly
IAPSRS]
Attachment I
Providing Sequential Funding to Meet the Needs of
Beneficiaries with Disabilities Who Want to Work
Actual experience with implementation of the Ticket program to date has demonstrated that State VR agencies continue to be the primary provider of employment, training and support services to get beneficiaries with disabilities to engage in employment. The program is half way through the third and final phase of implementation and State VR agencies have 90 percent of the ticket assignments. Unfortunately, State VR agencies are being criticized for this fact, while in reality the problem is the lack of incentives for employment networks (ENs) to participate in the program.
While the Ticket program was intended to create additional options for providing and funding services and supports for beneficiaries who want to work, some of SSA’s regulatory and policy interpretations have had just the opposite effect. Of particular concern is SSA’s interpretation in the final rule for the Ticket program (20 CFR Part 411) regarding the traditional cost reimbursement program being subsumed under the Ticket program. Based on this regulatory interpretation, the traditional cost reimbursement program is no longer available to VR agencies that serve beneficiaries who are ticket-eligible and who choose not to use their tickets when seeking assistance from the Public VR program. Under the Social Security Act, SSA reimburses State VR agencies for reasonable and necessary service costs incurred in assisting individuals with disabilities who receive benefits under the SSDI and SSI programs to engage in employment with earnings equal to or above SSA’s standard for substantial gainful activities (SGA). This “cost reimbursement” system is afforded to, according to sections 222 and 1615 of The Social Security Act, “State agencies” that administer a State plan under section 101 of the Rehabilitation Act of 1973, as amended. This reference refers to the designated state unit (DSU) responsible for administering the State’ public VR program authorized under Title I of the Rehab Act.
SSA’s Operations Manuals, known as POMS, indicates that SSA changed its method for reimbursing State VR agencies back in 1981:
“The Omnibus Budget Reconciliation Act of 1981 (P.L. 97-35), changed the methods by which funds are paid to State VR agencies for rehabilitation services. Effective October 1, 1981, SSA MUST (emphasis added) reimburse State VR agencies each time their services result in a title II or title XVI beneficiary/recipient performing substantial gainful activity (SGA) for a continuous period of 9 months and certain other reimbursement conditions are met. Reimbursement will be on a case-by-case basis.”
The Ticket program opened up new options for all parties involved in assisting beneficiaries with disabilities to engage in employment and receive earnings that result in the discontinuation of cash benefits (SSI and SSDI). Beneficiaries have additional options in terms of places that they can seek services and assistance to enter or re-enter the workforce. Community Rehabilitation Programs (CRPs) and other service providers have, for the first time, the option of seeking compensation for SSA for providing services to beneficiaries who engage in employment that results in the discontinuation of SSA cash benefits. In addition, State VR agencies have a new option for seeking compensation from SSA for successfully serving beneficiaries who go to work and earn at or above SGA for nine (9) months. However, TWWIIA did not amend the traditional cost reimbursement system authorized under sections 222 and 1615 of The Social Security Act and referenced in Omnibus Budget Reconciliation Act of 1981 (P.L. 97-35). Rather, TWWIIA created a new Section 1148(c)(1), STATE PARTICIPATION, that states:
“Each State agency administering or supervising the administration of the State plan approved under title I of the Rehabilitation Act of 1973 (29 U.S.C. 720 et seq.) may elect to participate in the Program as an employment network with respect to a disabled beneficiary. If the State agency does elect to participate in the Program, the State agency also shall elect to be paid under the outcome payment system or the outcome-milestone payment system in accordance with subsection (h)(1).”
This provision of law appears to give VR the choice of participating in the Ticket program and seeking compensation under one of the EN payment systems, or of not participating in the Ticket program and seeking compensation under the traditional cost reimbursement program. The regulations governing the Ticket program appear to change this “voluntary participation” into “mandatory participation,” requiring VR to participate in the Ticket program if it wishes to receive any type of payment from SSA, i.e., either through one of the EN payment systems or through the traditional cost reimbursement program. We believe SSA’s interpretation of Section 1148(c)(1) is flawed as spelled out in Subpart F, Section 411.350 of the governing regulations which states:
“411.350 Must a State VR agency participate in the Ticket to Work program?
Yes. Each State agency administering or supervising the administration of the State plan approved under title I of the Rehabilitation Act of 1973, as amended (29 U.S.C. 720 et seq.), must participate in the Ticket to Work program if it wishes to receive payments from SSA for serving disabled beneficiaries who are issued a ticket.”
VR is the only service provider that has the additional option of being able to choose on a “case-by-case” basis whether to seek compensation for successfully serving a beneficiary with a ticket under the traditional “cost reimbursement” program or under one of the new EN payment systems created by the Ticket program. Title I, Subtitle A, Section 101(c)(1) of TWWIIA establishes a new Sec. 1148(c) of the Social Security Act and sets forth a special status for State VR agencies.
“With respect to disabled beneficiaries that the State agency does not elect to have participate in the Program, the State shall be paid for services provided to that beneficiary under the system of payment applicable under Sec. 222(d) and subsection (d) and (e) of Sec. 1615.”
This provision clearly acknowledges that VR may serve ticket-eligible beneficiaries outside the Ticket program and seek compensation under the traditional cost reimbursement system. In addition, Section 411.355(c) of the ticket regulations stipulates that VR may only seek compensation under the traditional cost reimbursement system when serving beneficiaries who are not “ticket eligible.”
“411.355 What payment options does a State VR agency have under the Ticket to Work program?
(c) The State VR agency may seek payment only under its elected EN payment system whenever it serves as an EN. When serving a beneficiary who was not issued a ticket, the State VR agency may seek payment only under the cost reimbursement payment system.”
Nevertheless, Section 411.585 of the Ticket regulations severely limits VR’s ability to seek cost reimbursement.
“411.585 Can a State VR agency and an EN both receive payment for serving the same beneficiary?
Yes. It is possible if the State VR agency serves the beneficiary as an EN. In this case, both the State VR agency serving as an EN and the other EN may be eligible for payment based on the same ticket (see Section 411.560).
(a) If a State VR agency is paid by us under the cost reimbursement payment system with respect to a ticket, such payment precludes any subsequent payment by us based on the same ticket to an EN or to a State VR agency serving as an EN under either the outcome payment system or the outcome-milestone payment system.
(b) If an EN or a State VR agency serving a beneficiary as an EN is paid by us under one of the EN payment systems with respect to a ticket, such payment precludes subsequent payment to a State VR agency under the cost reimbursement payment system based on the same ticket.”
According to these regulatory interpretations regarding beneficiaries who are served by both VR and an EN, once a payment is made under either cost reimbursement or an EN payment system, no payment can be made under the other payment system. On the other hand, if VR is paid under an EN payment system, the regulations do allow for shared payments when both an EN and a State VR agency serve the same ticket-eligible beneficiary. Based on these regulations, SSA has interpreted that the creation of the EN payment systems in the Ticket legislation has caused the traditional cost reimbursement program to be subsumed under the Ticket program. We maintain that nothing in the Ticket legislation amended or changed the traditional cost reimbursement program.
These interpretations will, and have, put VR agencies and ENs in a position of “competing” to get the first payment. If an EN has chosen the milestone/outcome payment system, and the beneficiary works for one month with earnings above the SGA amount, the EN is eligible for the first milestone payment, thereby trumping VR from any payment under the cost reimbursement system, regardless of the amount VR has invested in that beneficiary. On the other hand, if an EN chooses the outcome payment system, and VR has served the same individual under the cost reimbursement system, VR can be reimbursed after 9 months of SGA, while the consumer would have to go completely off benefits for the EN to be paid under the outcome payment system. This interpretation creates a significant disincentive for ENs to participate in the Ticket program. It also creates a situation where VR could loose a significant amount of program income that would be used to assist additional individuals with disabilities, including beneficiaries with disabilities, to engage in employment.
Attachment II
Providing Partial Outcome Payments for Partial Reduction in Cash Benefits
According to the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA), the Commissioner of the Social Security Administration (SSA) has the authority to revise existing policy promulgated under the Ticket to Work and Self-Sufficiency program (The Ticket program) once actual experience with the program provides factual information that demonstrates a need for such change. One policy change that would provide a significant incentive for employment networks (ENs) to participate in the Ticket program and accept ticket assignments from individuals with the most significant disabilities would be to allow outcome payments to employment networks (ENs) when beneficiaries reduce but do not necessarily eliminate their dependency on cash benefits under the SSI and SSDI programs. Currently, ENs are only eligible for outcome payments if beneficiaries’ dependency on cash benefits is eliminated i.e., they receive zero cash benefits.
As you know, the Ticket program, created under the Ticket to Work and Work Incentives Improvement Act of 1999 (P.L. 106-170), was intended by Congress to be a key component of an initiative to encourage beneficiaries to increase their earnings and at the same time reduce or eliminate their dependency on cash benefits. Unfortunately, reviews and evaluations of the Ticket program by SSA contractors, the Ticket to Work and Work Incentives Advisory Panel, the Adequacy of Incentives Advisory Group, and testimony by witnesses at a recent Congressional hearing all lead to the same conclusion--the Ticket program, as currently constituted, is not working. Reasons for the failure of the program to date, include, but are not limited to: the current payment system fails to recognize the capitalization and cash flow needs of most service providers, the level of risk is too great for most ENs, and making outcome payments only when earnings fully eliminate cash benefits ensures that ENs will not knowingly provide services to beneficiaries whose earnings are unlikely to fully eliminate their benefits and ignores two important realities (a considerable percentage of beneficiaries who are potential clients may be able to work only part-time due to their disability and even part-time work generates SSI cost savings).
On a more positive note, the Ticket to Work and Work Incentives Advisory Panel (the Ticket Panel), the AOI Advisory Group, and many stakeholders (including groups representing beneficiaries, employment networks and State Vocational Rehabilitation agencies) believe that the basic premise of the program remains sound but that the Commissioner must make significant policy changes before full implementation in November 2004. Among policy changes that have been recommended by The Ticket Panel, the AOI Advisory Group, and all the key stakeholders is to allow outcome payments to ENs where beneficiaries reduce but do not eliminate their dependency on cash benefits. This policy change recognizes the heterogeneity of the population by allowing a beneficiary to progress in reasonable steps to full self-sufficiency, encourages ENs participation by providing greater shared risk, and by allowing for payment at a lower work standard for persons with the most significant disabilities who are only capable of working part-time.
Although there is disagreement as to whether the Commissioner had authority to pursue such a policy in the initial regulations, there is broad based consensus that such authority now exists and should be exercised through the issuance of revised interim final regulations (with an opportunity to comment) before full implementation is set to occur in November 2004. Our understanding of Congressional intent is based on the following sections in P.L. 106-170:
· Section 2(b)(1) of P.L. 106-170, which specifies that the purpose of the legislation is to provide health care and employment preparation and placement services to individuals with disabilities that will enable those individuals to reduce their dependency on cash benefit programs.
· Section 2(b)(4) of P.L. 106-170, which further specifies that the purpose of the legislation is to establish a return to work ticket program that will allow individuals with disabilities to seek the services necessary to obtain and retain employment and reduce their dependency on cash benefit programs. [emphasis added]
· Section 1148(h)(5)(C) of the Social Security Act, as added by P.L. 106-170, which directs the Commissioner of SSA to submit a report on the Adequacy of Incentives to Congress by December 17, 2002, consult with the Ticket Panel, and “implement” the necessary adjusted payment rates prior to full implementation of the Ticket program. The target population of the AOI study includes “individuals who work and receive partial cash benefits.” [emphasis added]
· Section 101(d) of P.L. 106-170, which specifies that the Commissioner shall determine “the most efficacious” payment methods and ensure that they are in place for full implementation of the program on a timely basis (i.e., before November 2004).
