January 16, 2004
John Kregel, Ed.D. and W. Grant Revell, M.S., M.Ed., CRC
Virginia Commonwealth University
Rehabilitation Research
and Training Center on Workplace Support
1314 West Main
Street, Box 842011
Richmond, Virginia 23284-2011
Dear Mr. Kregel and Mr. Revell,
On behalf of the Council of State Administrators of Vocational Rehabilitation (CSAVR), I am writing to respond to some of the recommendations and misinformation contained in the issue paper that you were commissioned to write for the Ticket to Work and Work Incentives Advisory (TWWIA) Panel. Although the paper, “An Evolving Partnership: The Role of the State Vocational Rehabilitation Agencies in the Implementation of the Ticket to Work Program,” is portrayed as not being endorsed by the TWWIA Panel , the Social Security Administration (SSA), the Urban Institute, or Virginia Commonwealth University (VCU), the fact that it was developed with support from the SSA-funded TWWIA Panel and can be found on the Panel’s web site
(http://www.socialsecurity.gov/work/panel/index.html), and that it has been referenced in many of the deliberations of the TWWIA Panel, has led many to believe that it represents the opinions of SSA and the TWWIA Panel. Some of the misinformation in this paper is reflective of the misunderstanding of the public Vocational Rehabilitation (VR) program and of VR’s efforts to implement the Ticket to Work (TTW) program in a policy arena that has, to some extent, been a constantly moving target. For this reason, CSAVR feels it is necessary to respond to this paper and set the record straight on a number of issues.
CSAVR is appreciative of the positive and realistic statements contained in the paper about State Vocational Rehabilitation Agencies’ (SVRAs) ongoing efforts to implement the TTW program and of the recognition of the difficulties inherent in implementing a new and very complex program. These difficulties are further compounded by two factors. First, the public VR program is administered by the Rehabilitation Services Administration (RSA) in the Department of Education, while the TTW program is administered by SSA. Second, in some instances, the statutory and regulatory requirements governing the public VR program are not consistent with the statutory and regulatory requirements governing the TTW program. This has created difficulties for SVRAs as they try to implement policies governing the TTW program that seem to conflict with the underlying principles of the public VR program.
CSAVR is extremely disappointed in and concerned about the overall tone of the “Evolving Partnership” paper and the obvious slant towards favoring anything that will benefit and give additional advantages to Employment Networks (ENs).
SVRAs Have an Unfair Advantage
The paper refers to the unfair advantage that SVRAs have in implementing the TTW program and raises concerns about informed choice. It fails to acknowledge the underlying fact that, while the TTW program is built on the concept of choice, it actually limits the choices that beneficiaries can make by allowing ENs to decline service to a particular ticket-eligible beneficiary if the EN believes the services are too costly or that the beneficiary will not return to work. The opposite is true for SVRAs. Under the Rehabilitation Act, any Social Security disability beneficiary (whether ticket-eligible or not) who applies for services and is interested in going to work is presumed to be eligible for services from the SVRA. SVRAs cannot consider whether the beneficiary is assigning his/her ticket to VR or not, or whether the beneficiary is likely to work and earn enough to constitute Substantial Gainful Activity (SGA) and result in a discontinuation of cash benefits.
Admittedly, SVRAs receive public funds to serve eligible individuals with disabilities, while most ENs do not have access to such funds. However, the resources available to the public VR program are only adequate to serve approximately one in twenty individuals with disabilities who could potentially benefit from VR services. As a result, many SVRAs have been forced to implement an Order of Selection (OOS), a system whereby the provision of services must be prioritized for individuals with the most significant disabilities (i.e., based on a state definition developed within Federal guidelines). Thirty-seven (37) SVRAs developed an OOS for FY 2003, based on projections that the resources available to them would not be adequate to serve all of the eligible individuals projected to apply for and be determined eligible for services. Some of these SVRAs had to implement the OOS throughout the year, while others moved back and forth during the year between implementing the OOS and providing services to all individuals determined eligible. In at least three states, over 7,000 eligible individuals have been placed on a waiting list based on the state’s OOS.
The intent of the TTW program is to expand the availability of assistance and services to beneficiaries who want to engage in employment, and to expand the pool of service providers available to provide such assistance and services. Any payment from SSA to a SVRA, whether under the traditional cost reimbursement system or the EN payment system under the TTW program, is classified as program income. SVRAs must, under the requirements for program income, use all such payments to further the purposes of the public VR program. The only exception to this requirement is the authority, established in the 1992 amendments to the Rehab Act, for SVRAs to use program income to supplement the funds available to the state to provide assistance through the Client Assistance Program (CAP) or through Independent Living Centers (ILCs). These exceptions were granted because CAP assistance can have a direct impact on the ability of individuals with disabilities to access VR services and IL services are often needed to support individuals with disabilities in the community so that they will be able to seek VR services and engage in employment. Even when program income is used for automation improvements (as referenced in the “Evolving Partnerships” paper), the goal is to improve the effectiveness and efficiency of service provision. SVRAs collect data for a number of reasons, many of which are extremely important to the functioning of the program. Data is necessary to conduct strategic planning, to evaluate the effectiveness of different approaches to service provision, to measure outcomes, to identify unmet need and underserved populations, etc. Additionally reduced state financial resources and increased costs for technology and medical services have reduced the amount of funding available for hiring of VR counseling staff. Upgrading of office automation is the only way to offset the staffing reductions many states have had to make.
While SVRAs must use any payments for SSA to further the purposed of the program, ENs have no restrictions on how they can use payments from SSA. In addition, as mentioned earlier, an EN can refuse to serve any beneficiaries whose services may be costly or longer in duration, things that might reduce the EN’s potential profit margin. An EN could expend $2,000 on a ticket-eligible SSDI beneficiary and receive over $18,000 in total outcome payments. The EN can use the $16,000 in profit any way it sees fit.
Recommendation 1: Allow the SVRA Cost Reimbursement Program to carry on as a parallel program with the EN Outcome or Outcome-Milestone payment approaches.
CSAVR strongly supports the recommendation to allow the traditional cost reimbursement system to be operated as a complementary payment system to the new EN payment system. In fact, CSAVR’s Ad Hoc Ticket Work Group has met and deliberated on a pending recommendation by the Adequacy of Incentives (AOI) Advisory Group to permit VR agencies to obtain cost reimbursement for a particular beneficiary, deduct the amount of the cost reimbursement from the total potential outcome payments for that beneficiary, and make the remaining value of the outcome payments available to an EN to provide ongoing support services to keep that beneficiary employed and off cash assistance.
While supporting the idea of parallel payment systems, CSAVR is very concerned about a number of statements that follow this recommendation in the “Evolving Partnership” paper. Some of these statements contain misinformation about the public VR program. The statement about SVRAs continuing to provide “mandated” services to beneficiaries implies that beneficiaries are entitled to VR services. While beneficiaries who are interested in going to work are presumptively eligible for VR services, this presumption does not equate to an “entitlement” and it does not “entitle” any beneficiary to any specific service or services. VR services are individualized based on the vocational goal selected by an eligible individual and the services and supports the individual needs to accomplish that goal. Decisions about vocational goals and the services needed to achieve those goals must be consistent with the unique strengths, resources, priorities, concerns, abilities, capabilities, interests and informed choice of the eligible individual. In addition, eligible beneficiaries may end up on waiting lists if the SVRA is operating under a strict OOS.
Other statements highlight some of the mis-steps that SVRAs made during early implementation of the TTW program. This was a time when SVRAs were struggling with new responsibilities and dealing with new approaches to service provision and different ways of collecting data and measuring success with only minimal guidance from RSA and SSA. When made aware of proper interpretations of the law, these SVRAs adjusted their practices to be consistent with guidance provided by RSA and SSA. Additionally, CSAVR intervened directly with certain agencies when it was made aware of a problem in a particular state. The paper implies that these mis-steps are continuing and does not give any credit to SVRAs for correcting the problems and working more effectively with ENs.
CSAVR definitely agrees with the statement regarding the variety of tensions created within the SVRA/EN relationship. These tensions are the result of conflicting social policies and confusion over the interaction between existing requirements in Title I of the Rehab Act and new approaches to service delivery established under the TTW program. This confusion and the resultant tensions is not the responsibility of the SVRA, but belongs equally to the federal administering agencies, SVRAs and ENs, which at some points were working at cross purposes based on their unique interpretation of the TTW program and its implementing regulations.
CSAVR supports the recommendation to permit the two payment systems to function as complementary systems that provide “sequential funding” to meet the needs of beneficiaries who need vocational rehabilitation services to obtain employment and ongoing support services to maintain that employment. Among other things, this approach would encourage partnerships between SVRAs and ENs. However, CSAVR is very concerned about the statement in the “Evolving Partnership” paper that implies that this “sequential funding” approach should be permitted for a period of time and, once the EN base and EN payment systems are well established, the cost reimbursement system should be substantially reduced.
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 legislation 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). In addition, there is absolutely nothing in the accompanying Congressional reports that refer to doing away with or reducing the cost reimbursement system.
Rather than reducing the traditional cost reimbursement system, CSAVR would recommend expanding it to permit ENs to seek cost reimbursement under the same terms and conditions as SVRAs. When this was proposed during development of the Ticket legislation, advocates and representatives of ENs, who generally have unrealistic expectations of anything associated with the severely under-funded public VR program, fought against it. CSAVR believes extending cost reimbursement to ENs would solve many of the implementation problems that have been identified. ENs would be much more likely to participate and serve beneficiaries if they did not have to wait so long to receive compensation for their successes. It would give ENs the opportunity to serve beneficiaries with more costly service needs without requiring “monetary outlays beyond the risk tolerance of the EN” and threatening the fiscal viability of the EN. It would address the complaint that SVRAs have a different standard for success, i.e., a beneficiary working 9 consecutive months with earnings at or above SGA, as opposed to the discontinuation of cash benefits and waiting up to 60 months to receive all potential outcome payments.
With regard to extending cost reimbursement to One-Stop Centers, CSAVR would support this recommendation as long as SSA has approved the Centers to function as ENs, and as long as the Centers meet certain requirements to be approved as an EN. A One-Stop Center would have to be both physically and programmatically accessible. To receive cost reimbursement, the Center would have to provide (and pay for) the services that resulted in the beneficiary’s success under the Ticket program, not simply refer the beneficiary to VR for services. Under the pending bills to reauthorize the One-Stop Center system (H.R. 1261 and S. 1627), funds will be diverted from the public VR program to pay for the infrastructure of the One-Stop Centers and other related expenses associated with the operation of the One-Stop service delivery system. Currently, the diversion of these funds is in no way related to increased access to services for people with disabilities.
Recommendation 2: Regulations should be modified to ensure that an EN is able to accept Ticket assignment from a beneficiary, refer that individual to the SVRA for needed services, and not be required to reimburse the SVRA for those services.
This recommendation is the best example of the one-sided view demonstrated throughout this paper. If ENs were required to serve ticket-eligible beneficiaries as VR is, CSAVR might be able to see the logic in this recommendation. Since ENs can choose who they serve, they have the option of serving only those individuals who are most likely to succeed, who require minimal or cheaper services, and for whom the EN can be assured of a profit based on the total amount of the outcome payments over the 60 month payment period. VR, on the other hand, must serve all beneficiaries who apply for services and express an interest in going to work. VR cannot screen out beneficiaries based on the likelihood that they will go to work and earn enough to discontinue cash benefits, or based on the fact that the cost and duration of the services needed by the beneficiary will not result in a “profit” to the agency. As mentioned earlier, any payments from SSA to VR based on successfully serving beneficiaries with disabilities (whether they are ticket eligible or not) are considered to be program income and must be used to further the purposes of the VR program. VR does have access to cost reimbursement to cover the cost of services when a beneficiary has been employed for nine consecutive months with a salary at or above SGA. SVRAs contract with private providers for a significant amount of the services they provide. Although the amount varies from state to state, a significant amount of VR funds already go to private providers.
This section seems to confuse the issue of VR closures for purposes of federal reporting and the standard that is used to determine whether VR will get reimbursed for services provided to beneficiaries with disabilities. CSAVR questions the purpose of introducing the idea that VR does not lose money in the same sense that an EN would. VR is a publicly funded program, while most ENs do not receive public funding. The idea behind the ticket was to expand the choices available to beneficiaries who are seeking to enter or re-enter the workforce. The expansion of choices was accomplished by introducing the competitive market concept. Now, ENs and advocates seem to want to eliminate VR as a viable option or to have VR pay for services and let the ENs get the outcome payments.
If recommendation 2 is implemented, VR could potentially be asked to pay for the services that result in a beneficiary going off cash benefits while the EN gets the outcome payments. If this recommendation were implemented, SVRAs would have significantly less resources available to serve individuals with disabilities, including beneficiaries with disabilities, because of a significant reduction in VR’s program income. If VR is providing all of the services without any way of recouping the costs, it appears this recommendation is intended to subsidize private non-profit providers with public funds, without requiring them to meet specific standards for service delivery. Where is the beneficiary’s choice if a majority of them are referred to the VR agency for their actual services? What is the difference to the beneficiary between assigning their ticket initially to VR and assigning their ticket to an EN which immediately refers them to VR?
The end of this recommendation includes the following statement: “Just as SVRAs are not responsible for the successful implementation of the TTW, SSA and the TTW program are not responsible for solving the fiscal programs faced by SVRAs.” This statement is particularly noteworthy given that many statements and some recommendations in this paper seem to imply that it is the responsibility of SVRAs to solve the fiscal problems of ENs.
Recommendation #3: SSA should conduct a thorough outcome evaluation of the current SSA VR Reimbursement Program to (1) document the program’s long-term impact on beneficiaries’ earnings and employment status, and (2) analyze the net fiscal impact of the program on SSA.
The paper recommends studying a number of things related to the traditional cost reimbursement program. In FY 2002, the total annual reimbursements to SVRAs nationwide under this program amounted to approximately 5 percent of VR’s total Federal appropriation. The amount of reimbursement to SVRAs varies greatly from state to state and a number of SVRAs definitely do rely on these funds to continue providing the current level of services, to prevent the need to implement an OOS, or to expand the provision of services to additional eligible individuals. However, not many are aware that SVRAs receive reimbursement from SSA for only about 20 percent of the beneficiaries receiving assistance. Many beneficiaries that receive VR assistance never go to work, many choose to work part-time, and many others go to work with earnings less than SGA. In fact, even with the new work incentives created under TWWIIA, many beneficiaries continue to keep their earnings below SGA for fear of losing access to other critically needed services and benefits (i.e., often referred to as “parking”).
The “Evolving Partnership” paper recommends conducting a thorough outcome evaluation of the cost reimbursement program. It suggests determining whether individuals employed at SGA for nine consecutive months remain employed for extended periods of time and whether working reduces or eliminates their dependence on cash assistance. While CSAVR would like to see the result of such a study, the conclusion must be carefully presented to make sure other extenuating factors are taken in to account. For example, beneficiaries may decide they don’t want to work. They may keep their income low to maintain cash assistance and medical coverage. A beneficiary’s disability may get worse or additional functional limitations may develop in conjunction with the disability. Beneficiaries may be laid off or fired. Many factors come in to play when beneficiaries are deciding whether to continue in employment and when employers are deciding whether to retain individuals with disabilities as employees. The study must be careful not to blame VR for individual consequences that have nothing to do with VR actions.
CSAVR is very concerned about the statement regarding confusion over whether Congress and SSA intended to continue to operate both the cost reimbursement program and the EN payment systems under TWWIIA. First, it is important to remember that TWWIIA was passed by Congress, not SSA. Congressional intent is extremely clear in a number of provisions in the Ticket program. Section 148(c)(1) 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). With respect to a disabled beneficiary that the State agency does not elect to have participate in the Program, the State agency shall be paid for services provided to that beneficiary under the system for payment applicable under section 222(d) and subsections (d) and (e) of section 1615.”
The regulations are also very clear on the continuation of the cost reimbursement system, particularly with regard to beneficiaries who are not ticket-eligible. Section 411.355(c) states:
“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 system.”
Again, CSAVR feels the emphasis in the “Evolving Partnership” paper is placed on making ENs successful, not on ensuring that all beneficiaries with disabilities have access to needed services. For those beneficiaries who do not have tickets and, therefore, can only seek assistance from VR, eliminating the cost reimbursement system will negatively impact VR’s ability to serve greater numbers of individuals and beneficiaries with disabilities.
CSAVR would support the idea of modifying the stringent performance criteria in the Ticket program to realize the cost savings generated through the cost reimbursement program. Like SVRAs, ENs should have the option of seeking compensation for successfully serving beneficiaries under either cost reimbursement or the EN’s elected TTW payment system.
Recommendations 4 and 5: SSA, in collaboration with the RSA and the CSAVR, should examine how SVRAs use the funds they receive through the SSA VR Reimbursement Program; and SSA VR Reimbursement Program payments to SVRAs should be used exclusively to support direct employment services to beneficiaries.
Since any payments from SSA to SVRAs are classified as program income, SVRAs are already severely restricted in how they can use these funds. Such funds must be used to further the purposes of the VR program, i.e., to provide employment, training and related support services to assist individuals and beneficiaries with disabilities in obtaining, maintaining, regaining and advancing in employment. It is true that a few SVRAs have opted to use program income to improve management information systems and to subsidize the CAP program and Independent Living Centers. These uses of program income have been approved by the Department of Education because all of these activities can positively impact the overall purposes of the VR program. Program income cannot be used to further the purposes of “any” program in the Rehab Act, only the VR program and a few other programs that directly impact the ability of VR consumers to access services and engage in employment.
Recommendation 5 suggests that SVRAs should be further restricted in how they use program income received from SSA, i.e., limiting the use to assisting only beneficiaries with disabilities. Beneficiaries already get preferential treatment within the VR system, based on the presumption of their eligibility. Hundreds of thousands of individuals with disabilities who have not sought or have not been determined eligible for Social Security benefits still need assistance. In many cases such individuals do not have any source of income or access to medical assistance, while beneficiaries receive cash assistance and have access to medical assistance. CSAVR believes it would be unfair to further disadvantage individuals with significant disabilities who, for any number of reasons, are not receiving assistance from SSA. Rarely would reimbursement funds provide sufficient amounts to provide for all the service costs for SSDI and SSI consumers. Would this recommendation suggest that VR Title I funds only be used for consumers who are not SSDI or SSI consumers? It appears this funding proposal could be seen as discriminatory against non-SSDI and SSI consumers if Title I funds can be used for SSI and SSDI beneficiaries, but SSA reimbursement funds cannot be used for non-SSI or SSDI beneficiaries.
Recommendation 6: SSA should rescind current guidance to states regarding new cases contained in Transmittal 17. New policies should be implemented that protect beneficiaries’ rights to informed choice in the selection of an EN and Ticket assignment.
CSAVR has been and continues to be very concerned about some of the policies outlined in Transmittal 17 (TM 17). When TM 17 was initially released, CSAVR immediately raised concerns about a ticket being assigned to a SVRA without getting Form SSA-1365 completed and signed by the beneficiary. CSAVR does not support this option and about half the SVRAs implementing the TTW program to date have decided not to implement this option. Unfortunately, based on SSA’s interpretation of this option, these SVRAs stand to lose significant funds through the loss of cost reimbursement funds because SSA is requiring ticket assignment before VR can get cost reimbursement on new cases opened for ticket-eligible beneficiaries.
While CSAVR agrees that making informed choices and independent decisions about ticket assignment is critically important to the success of the TTW program, CSAVR does not agree with the statement that “Ticket assignment should be completely separate from the development of the IPE with a SVRA.” This is another example of the double standard evidenced throughout this paper as assignment of a ticket to an EN is directly connected to the development of the IWP.
CSAVR and SVRAs believe that “informed choice” is one of the most important underlying principles for the public VR program. To that end, CSAVR has been active in providing training and technical assistance to SVRAs as they implement the TTW program. During conference calls, training sessions and workshops, CSAVR staff has been very specific about the need for VR Counselors to talk to beneficiaries about their options for using a ticket. In addition, in response to concerns raised about TM 17 and SVRAs denying beneficiaries the opportunity to exercise informed choice with regard to the use of their tickets, CSAVR proposed amendments to the Rehabilitation Act that specify exactly what information VR counselors must provide to ticket-eligible beneficiaries who are seeking VR assistance. These proposed amendments, which were also supported by the Consortium for Citizens with Disabilities (CCD) Work Incentives Task Force, are a part of the bill to reauthorize the Workforce Investment Act (WIA) and the Rehabilitation Act contained in title IV of WIA (S. 1627), passed by the Senate in November 2003.
Recommendation 7: SSA should make every effort to reduce the administrative burdens placed on SVRAs that reduce program efficiency and increase program costs.
CSAVR would support any changes to the TTW program that would reduce the administrative burden placed on SVRAs and on ENs as they implement the program. The implementation of the TTW program has created a significant unfunded mandate for SVRAs. With no additional resources being allocated for these purposes, SVRAs have had to:
· send staff to training seminars and provide training in-house for counselors and intake workers;
· designate full time staff to functions as Ticket Coordinators and increase the number of intake workers;
· revise forms, letters, policies, etc.,
· identify and contact beneficiaries on VR’s existing caseload; and
· negotiate EN agreements.
Many SVRAs have also undertaken additional activities that they felt were necessary to the success of the TTW program. For example, some SVRAs have been active in recruiting ENs to participate in the TTW program. Some have held seminars for consumers and private providers to explain the TTW program. Some have modified their management information systems to accommodate the additional tracking necessary for outcome payments. Others are likely to do this once they get past the start-up activities and related costs necessary during initial implementation.
Many SVRAs have been criticized for opting to serve beneficiaries only under the traditional cost reimbursement system, an option clearly available to SVRAs under the TTW program. This decision is often made based on the administrative burden and cost associated with changing VR’s current tracking system that is based on requirements in the Rehab Act to accommodate the tracking needed to address the requirements for the EN payment system. Changes to a statewide management information system can take significant time to accomplish and can cost millions of dollars.
Recommendation 8: SSA should work collaboratively with RSA to provide coordinated guidance on implementation of both TWWIIA and the Rehabilitation Act.
CSAVR has been and will continue to encourage staff from SSA and RSA to work collaboratively as policies are developed that impact SVRAs and their implementation of the TTW program. We have also encouraged both Federal agencies to work together and seek input from SVRAs as they try to identify and deal with conflicting provisions in Title I of the Rehab Act and the TTW program. As mentioned earlier, CSAVR has gone so far as to propose amendments to Title I of the Rehab Act to clarify the comparable benefits issue and to address the role of the VR Counselor in providing information to beneficiaries seeking VR assistance.
CSAVR is concerned about the questions asked in connection with recommendation 8, i.e., regarding allowable activities related to TTW program and the public VR program. The answers to these questions are already evident in the law and regulations governing the public VR program and the practices of some SVRAs. The passage of the TTW has in no way changed the requirements applicable to the public VR program. VR cannot use the fact that a ticket has been assigned to an EN as a reason to deny eligibility to a beneficiary. However, VR must look at the issue of comparable benefits in determining what services will be provided for that beneficiary. In addition, a few SVRAs have authorized their VR counselors to provide funds directly to eligible consumers to purchase the services and supports needed to obtain employment, e.g., by way of vouchers, checks, cash, etc. While these may not be viewed as “stipends”, the overall result is the same.
CSAVR agrees that there remain a number of unanswered questions regarding the interplay between the TTW program and the requirements for SVRAs to seek comparable services and benefits before paying for specific services. CSAVR strongly recommends that the discussion that occur around this and other important policy issues include representatives from RSA, SSA, CSAVR, NORP, ENs, and some of the advocacy groups.
Recommendation 9: SSA should consider legislative and regulatory refinements to the TTW that will balance risks and opportunities among SVRAs, ENs and other public and private programs in a way that will expand beneficiary access to services.
While CSAVR agrees that Congress needs to revisit the authorizing provisions in the TTW program, CSAVR finds the questions posed in this section to be very troubling. After admitting that the number of ENs available to serve beneficiaries is severely inadequate and that only a small number of beneficiaries have assigned their tickets, the discussion goes on to ask whether SVRAs should play such a dominant role in accepting ticket assignments and in serving as a financial intermediary between SSA and the ENs. For most people, the TTW program appears to be a failure to date. As CSAVR expected, everyone is looking to blame VR for this perceived failure. If SVRAs were not a part of the TTW program, the program would be a complete failure. People should be applauding SVRAs for taking on this monstrous task without any new influx of funding, with little or no formal training or guidance, and with some policy decisions being moving targets.
The recommendation to eliminate or modify the SSA VR cost reimbursement program and treat SVRAs like all other ENs (i.e., by removing any special status given to SVRAs) would assure the total and complete failure of the TTW program. CSAVR maintains that the ultimate purpose of the TTW program is to expand the options available to get more beneficiaries with disabilities into employment and off cash benefits. The primary goal is not to subsidize ENs or to make ENs more viable. Clearly, CSAVR understands the importance of having a pool of viable ENs available to serve ticket-eligible beneficiaries. However, CSAVR does not think the efforts to build up the network of ENs should be financed by SVRAs, agencies that are already severely under-funded to address the employment and training needs of America’s youth and adults with disabilities.
If we really want the TTW program to work, we should be building on what is working, not trying to dismantle the public VR program. We know that between 80 and 90 percent of the ticket assignments are to SVRAs, We know that SVRAs do not have to consider the costs and duration of services because they have the option of seeking traditional cost reimbursement or compensation through one of the TTW payment systems. Rather than reducing or eliminating the cost reimbursement program, wouldn’t it make more sense to extend the option of seeking compensation under the traditional cost reimbursement system to ENs. If ENs could seek cost reimbursement, many of the problems associated with the low number of ENs participating in the TTW program would be resolved. ENs would not have to operate under a different standard of success than the SVRAs. ENs would not have to consider the cost and duration of services before agreeing to serve a ticket-eligible beneficiary.
In addition, extending cost reimbursement to ENs would eliminate some of the problems inherent in sharing outcome payments when the same beneficiary receives services from both a SVRA and an EN. Under the TTW regulations, payments can be shared between a SVRA and an EN only if the SVRA opts to serve the beneficiary as an EN and seek compensation under its elected TTW payment option. If a SVRA gets a payment under cost reimbursement, such payment precludes any subsequent payment to an EN. Similarly, if an EN gets a payment under its elected payment system (either outcome or milestone/outcome), the SVRA is precluded from seeking payment under cost reimbursement. The ability to “trump” payments under one payment system by getting a payment under the other payment system creates a great deal of tension between SVRAs and ENs. Changes to the ticket legislation to open up additional options to all parties and to eliminate the type of competition set up by some of SSA’s policy interpretations would go a long way in ensuring the success of the TTW program.
Recommendation 10: SVRAs should not be allowed to develop VR-EN agreements that allow them to be reimbursed over and above the costs of services provided to a beneficiary.
This recommendation represents another example of the double standard that so many have with regard to the TTW program. Everyone is so concerned that a SVRA might get a little more reimbursement than the actual cost of the services provided. If a SVRA were to get more than it spent, the money would still have to be used to further the purposes of the VR program. While no one wants VR to get these additional funds, everyone seems to think an ENs should get more than they invested in services. ENs can choose who they serve. ENs can use the money they receive from SSA for anything they want. Which method ultimately benefits the consumer more—clearly an investment in VR which is required to return any “profit” back to the VR program.
Summary
In summary, CSAVR would agree with the statement that the TWW program “sets up a program where VR is at risk for not being reimbursed by SSA for costs that it has traditionally collected under the cost reimbursement program.” While CSAVR and SVRAs do not “fear” competition from ENs, we do feel that some of SSA’s policy interpretations and some of the unrealistic expectations of many advocates and service providers have set SVRAs and ENs at odds with one another.
CSAVR recommends that SSA and the TWWIA Panel start looking at what is working and try to extend that throughout the TTW, rather than trying to change how VR operates. SVRAs nationwide serve over 1.2 million individuals with disabilities a year. Of those served each year, more than 220,000 are placed in competitive employment. The percentage of VR consumers that are beneficiaries with disabilities varies from state to state. While the TTW program focuses on reducing the number of individuals with disabilities who receive cash assistance under the SSI and SSDI programs, the value inherent in the ability of SVRAs to serve individuals with disabilities before they become Social Security beneficiaries and to prevent increasing numbers of individuals with disabilities from applying for cash benefits should not be ignored. Anything that is done to diminish the resources currently available to SVRAs will only have a negative impact on the unacceptably high unemployment rate for working-age adults with disabilities and could eventually impact the number of new applicants for Social Security disability benefits.
CSAVR supports SSA’s current efforts to simplify the documentation needed to initiate outcome payments. CSAVR would likely support any changes that would simplify the TTW program. Unfortunately, nothing in the TTW program or its governing regulations simplified anything about work incentives or continued access to cash assistance. The TTW program is so complicated that professionals in the field often get confused, yet we expect consumers to understand the program and feel comfortable placing their benefits in jeopardy to participate in the program.
CSAVR believes the attacks on VR are unjustified and unwarranted. We should all be focusing on how to better serve beneficiaries with disabilities. If we can all focus on this common goal, we should be able to make the TTW program a success.
Sincerely,
Carl Suter
Executive Director
CC: Commissioner Jo Anne B. Barnhart, Social Security Administration
Deputy Commissioner Martin Gerry, Disability & Income Security Programs, SSA
Commissioner Joanne Wilson, Rehabilitation Services Administration
Kim Hildred, Majority Staff Director, House Subcommittee on Social Security
Katheryn Olson, Minority Staff Director, House Subcommittee on Social Security
Connie Garner, Professional Staff to Senator Kennedy
Justin King, Professional Staff to Senator Jeffords
Holly Schmitt, Professional Staff to Senator Bunning
Sarah Wiggins Mitchell, Chair, TWWIA Panel
Marie Strahan, SSA
