CSAVR Response to TWWIA Panel Annual Report May 03
October 28, 2003
Sarah Wiggins Mitchell, Chair
Ticket to Work and Work Incentives Advisory Panel
Social
Security Administration
400 Virginia Avenue, SW, Suite 700
Washington, DC 20024
Dear Chairwoman Mitchell,
In May 2003, the Ticket to Work and Work Incentives Advisory (TWWIA) Panel released its Third Annual Report to the President and Congress. The purpose of this report is to issue findings, conclusions and recommendations regarding the implementation of the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA). The report specifically focused on the Ticket Program implementation.
The Council of State Administrators of Vocational Rehabilitation (CSAVR) is composed of the chief administrators of the State Vocational Rehabilitation (VR) agencies. CSAVR applauds many of the recommendations issued in this Report, but we are concerned about some of the comments regarding the role of the State VR agencies in the Ticket to Work implementation.
CSAVR wholeheartedly supports the Report’s recommendations to:
· Expand work incentive specialists within SSA.
· Create an immediate, coordinated national marketing and public education campaign aimed at beneficiaries.
· Require SSA to work with other Federal and State systems to develop and implement a national training plan for service providers.
· Remove the restrictions on the use of Protection and Advocacy grant funds regarding supporting beneficiaries with overpayments.
· Urge Congress to fully evaluate the Rehabilitation Act, the Social Security Act and the TWWIIA legislation to ensure that the programs authorized by these laws operate in a positive and complementary fashion, in an effort to minimize conflicts and eliminate adverse outcomes for people with disabilities who are seeking employment.
· Urge the Social Security Administration (SSA) to look at benefits reductions that result in other than zero benefits not only as a successful outcome but as a reasonable way of accruing additional savings to the Federal Trust Fund.
· Increase milestone payments for Employment Networks (EN) under the Ticket Program.
· Improve the appeals process for beneficiaries under the Ticket Program.
· Fully implement a $1 for $2 Demonstration project for SSDI beneficiaries.
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The Ticket Program and State VR Agencies
We are pleased about the Panel’s recognition of the leading role State VR agencies are taking in the implementation of the Ticket Program, and acknowledgement that the policies and practices around the Ticket Program are still emerging. However, several comments in the section on “Relationship between State VR Agencies and the Ticket Program” concern us.
The Report specifically states that:
· It is unclear if beneficiaries who deposit their Tickets with State VR agencies are being offered real choice on where they can use their Tickets. (The report acknowledges that 86% of Tickets assigned to date have been to VR agencies, and of those, 57% are new consumers previously not served by State VR agencies.)
· The Panel is concerned over SSA’s guidance to State VR agencies that a Ticket is “automatically” assigned to VR when a consumer signs his/her IPE.
· State VR agencies are encouraging all potential ENs to contract with the VR agency. Some VR agencies are encouraging ENs to partner with VR in a manner that is more coercive than cooperative, and VR is often the controller of the Ticket in these partnerships.
· State VR agencies are telling consumers that they cannot receive services through the VR agency if they deposit their Ticket elsewhere.
· State VR agencies are not truly implementing the Ticket Program by choosing traditional reimbursement on the large majority of VR’s Ticket cases.
· The Panel is concerned that some Medicaid, VR, or developmental disability agencies are planning to use Ticket Program payments as substitutes for their other public funds—reserving their own funds for other programs, even though SSI and SSDI beneficiaries are clearly eligible for their programs.
The Report does state that some State VR agencies appear to be very open to cooperative approaches that encourage choice, that the relationship between ENs and State VR agencies are very complex, and that State VR agencies must serve all beneficiaries (whereas ENs have a choice on who to serve).
CSAVR Response
1) Beneficiaries having no choices on where to deposit their Tickets
We agree that the lack of non-traditional and alternative Employment Networks is contrary to the legislation’s intent and is a potential problem affecting consumer choice in using a Ticket. Recognizing the lack of choices in many parts of the country, several State VR agencies have engaged in agreements with both traditional and non-traditional providers to help ameliorate this problem. In many cases, these partnerships have
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encouraged providers to work with Ticket holders who would not have otherwise done so, and have created greater choice for Ticket holders.
Unlike other ENs, State VR agencies do not have a choice as to whether or not they will serve as an EN, nor do they have a choice as to whether or not to serve an individual on SSI or SSDI who is interested in employment. Because of this, VR has a unique and important role to play in the implementation and the success of the Ticket Program, and in ensuring broad access to vocational rehabilitation services for beneficiaries, regardless of disability or age.
Given the many recent changes in work incentives, the creation of benefits counseling programs and other important systemic changes, larger numbers of beneficiaries are expected to attempt work than in the past. In most states, State VR agencies have been leading the way in helping to inform consumers, providers and advocates about the Ticket Program and associated changes in work incentives, and have been seeking creative local solutions that result in greater employment and choice for beneficiaries. Because of this leading role, expertise and strong historical presence, most beneficiaries have chosen to deposit their Tickets with State VR agencies. State VR agencies operate on the principle and regulatory statute of informed choice for their consumers, and in numerous cases the approach used by VR agencies in forming partnerships has encouraged the creation of more choices for beneficiaries.
2) “Automatic” assignment of Tickets
The “automatic” assignment of Tickets to State VR agencies when a consumer signs the Individualized Plan for Employment (IPE) is based on SSA’s guidance and interpretation of the legislation. Many VR agencies have expressed concern about this interpretation. In several states, State VR agencies have opted not to follow SSA’s interpretations, requiring the consumer’s explicit consent before assigning a Ticket. According to SSA’s interpretation, these VR agencies have given up the option of submitting for cost reimbursement because they do not have the ticket assignment. We believe in most of the other states, State VR agencies are providing information to beneficiaries about SSA’s interpretation of Ticket assignment when the consumer signs the IPE.
3) Employment Network Partnerships
State VR agencies agree that many potential providers are not becoming Employment Networks due to the considerable up-front costs inherent in serving this population. Most State VR agencies contract with providers on a fee-for-service basis, and in many cases these contracts provide some of the critical up-front funding necessary for providers to serve beneficiaries. In addition, some State VR agencies have signed agreements forming joint Employment Network Partnerships with providers. This approach is an allowable alternative within the Ticket legislation and it provides another method for VR to support providers who want to become ENs and participate in the Ticket Program. Such agreements create more choices for beneficiaries, and allow for improved collaboration and integration of services, potentially resulting in better employment outcomes for beneficiaries with disabilities.
4) State VR agencies are informing consumers they cannot be served if their Tickets are assigned elsewhere.
In CSAVR’s Ticket Principles Paper and in previous written testimony, CSAVR has stated that eligible consumers shall be served by the State VR agency regardless of where a beneficiary deposits his/her Ticket. Early on, missteps might have occurred in information communicated to VR consumers. These missteps, however, were remedied as quickly as possible, upon receipt and clarification of information from SSA and RSA.
5) State VR agencies are choosing traditional reimbursement instead of outcome payments and therefore not truly implementing the Ticket Program.
Most State VR agencies have chosen traditional reimbursement for all Tickets deposited with them, though in some states the percentage of outcome payments chosen approaches 40 percent of the total Ticket cases. The choice of traditional reimbursement is essential for State VR agencies, as they are required to serve eligible Ticket holders, and in many of these cases the costs will far exceed the potential outcome payments available under the Ticket Program. Furthermore, uncertainty over earnings tracking requirements and how outcome payments will work have discouraged State VR agencies from choosing outcome payments in large numbers.
State VR agencies remain committed to helping
beneficiaries find the best employment possible, and are
actively educating consumers about new work incentives that
encourage employment leading to self-sufficiency. In no
way is a State VR agency’s choice of traditional reimbursement
an indication of less than full commitment to full-time,
competitive employment for Ticket holders.
6) Some Medicaid, VR, or developmental disability agencies are planning to use Ticket Program payments as substitutes for their other public funds.
State VR agencies operate under the requirements of the Education Department General Administrative Regulations (EDGAR). EDGAR clearly defines what constitutes “program income” for State VR agencies and how such income can be used. When VR receives funds from SSA for getting beneficiaries with disabilities into employment and off cash benefits (i.e., whether cost reimbursement or milestone and outcome payments), these funds are classified as program income and can only be used to further the purposes of the VR program. Hence, these funds can only be used to provide services to individuals with disabilities who are seeking or receiving services under Title I of the Rehabilitation Act or other services under two other programs authorized under the Rehab Act, i.e., the Client Assistance Program (CAP) or independent living (IL) services. Program income can be used for CAP and IL services because they compliment the
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services provided by VR and enhance the likelihood that a VR consumer will enter competitive employment.
CSAVR applauds the TWWIA Panel for its continued examination of issues regarding the implementation of the Ticket Program. We appreciate this opportunity to provide feedback, and look forward to future collaboration in helping to make this program a success for beneficiaries with disabilities.
Sincerely,
Carl Suter
Executive Director
CSAVR
