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Final Regulations Implementing the Ticket to Work and Self-Sufficiency Program

ICI Policy Brief

03/01/2002

Please note: The information in this publication is based on a "Substantial Gainful Activity" ( SGA) amount for non-blind individuals of $780 for 2002. The SGA for calendar year 2001 was $740. In reviewing the information in this publication, readers should keep in mind that the SGA amount of $780, which is presented for illustrating the impact of regulations, may be adjusted each year, consistent with changes in the cost of living.

INTRODUCTION

On December 17, 1999, President Clinton signed into law the historic Ticket to Work and Work Incentives Improvement Act of 1999 [Public Law 106-170; hereinafter referred to as "TWWIIA"].

TWWIIA has four purposes [Section 2(b)]:

On December 28, 2000, the Commissioner of the Social Security Administration (SSA) published in the Federal Register a Notice of Proposed Rulemaking regarding the new Ticket to Work and Self-Sufficiency program ("Ticket to Work" program) authorized under TWWIIA. [65 Federal Register 82844-82912] The Commissioner provided the public 60 days to submit comments. The Commissioner received comments from over 400 commenters.

On December 28, 2001, the Commissioner published in the Federal Register final regulations implementing the Ticket to Work program [66 FR 67370-67442]. These final regulations are effective January 28, 2002. The regulations can be downloaded by linking with The Social Security Administration's web site--www.ssa.gov/work/ResourcesToolkit/regulation2.html. In addition to containing the text of the final regulation, the December 28, 2001 Federal Register also includes an explanation of the major differences between the proposed and final regulations and a description of the major comments received by SSA and SSA's responses.

The purpose of the policy brief is to describe the major provisions in the final regulation implementing the new Ticket to Work program. The policy brief serves as a resource for stakeholders interested in implementing the new program. The policy brief quotes or paraphrases actual language contained in the final regulations, SSA's explanations and interpretations accompanying the publication of the final regulations, and technical assistance documents relating to the final regulations. The Appendix to the policy brief describes in outline form the major policy differences between the proposed and the final regulations.

BACKGROUND ABOUT SSA WORK-RELATED PROGRAMS

SSA Work-Related Programs in Existence Prior to TWWIIA

Under the Social Security Act (prior to the enactment of TWWIIA) two programs assisted specified individuals to obtain and retain employment. These specified individuals are individuals applying for or determined eligible for Social Security disability benefits on the basis of disability under Title II of the Social Security Act (The Federal Old-Age, Survivors, and Disability Insurance Benefits program, hereinafter in this policy brief, the acronym "SSDI" refers to all benefit payments made to individuals on the basis of disability under Title II of the Social Security Act) and under Title XVI of the Social Security Act (The Supplemental Security Income, (SSI) program).

Prior to the enactment of TWWIIA, under the first program, the Commissioner of the Social Security Administration (Commissioner) was required to promptly refer to state vocational rehabilitation agencies (State VR agencies) specified individuals applying for SSDI or SSI benefits for necessary vocational rehabilitation services. These State VR agencies are established in each state under Title I of the Rehabilitation Act of 1973, as most recently amended by Title IV of the Workforce Investment Act of 1998 (P.L. 105-220). A State VR agency is reimbursed for the costs of vocational rehabilitation services provided to SSDI and SSI beneficiaries with a single payment after the beneficiary performs "substantial gainful activity" (i.e., for calendar year 2002 has earnings of $780 per month for non-blind disabled beneficiaries and $1300 per month for blind beneficiaries) for a continuous period of at least nine months. [Sections 222(a) and (d) and sections 1615(d) and (e) of the Social Security Act]

The Social Security Administration (SSA) also established an "alternate participant program" (commonly referred to as the "alternate provider" program) under which private and other public agencies are eligible to receive reimbursement from SSA for providing VR and related services to SSDI and SSI beneficiaries. To participate in the alternate participant program, a beneficiary first must have been referred to, and declined by, a State VR agency. These private and public agencies were reimbursed according to the same procedures as State VR agencies. [20 CFR 404.2104; 404.2106]

The Commissioner was authorized to impose sanctions (i.e., deduct or terminate SSDI or SSI benefits) with respect to an individual who refuses without good cause to accept rehabilitation services available under Title I of the Rehabilitation Act.

Section 1631(a)(6) of the Social Security Act authorized the SSA to continue disability payments to individuals who recover medically while participating in a program of vocational rehabilitation services approved by the Commissioner if the Commissioner determines that continuation in or completion of the program will increase the likelihood that the individual will be permanently removed from the disability rolls.

Changes to Programs Made By the Ticket to Work and Work Incentives Improvement Act of 1999

TWWIIA makes several changes to programs in existence prior to its passage. First, the provision sanctioning SSDI and SSI beneficiaries for failure to accept rehabilitation services is repealed. [Section 101(b)(1)(B) and Section 101(b)(2)(B) of the Act]

Second, the provision requiring prompt referral of specified disabled individuals under the SSDI and SSI programs to State VR agencies is repealed. [Section 101(b)(1)(C) and Section 101(b)(2)(A) of the Act].

Third, the provision authorizing the continuation of benefits while a beneficiary is receiving vocational rehabilitation services is revised to include a reference to the Ticket to Work program. [Section 101(b) of the Act]

In addition, effective January 1, 2002, continuing disability reviews for long-term SSDI beneficiaries (i.e., individuals receiving disability benefits for at least 24 months) may not be scheduled for individuals solely as a result of the individuals' work activity.

Regulations implementing these statutory changes will be published in the Federal Register at a later date.

OVERVIEW OF THE NEW TICKET TO WORK PROGRAM

Title I of TWWIIA creates a new program called the Ticket to Work and Self-Sufficiency Program. (The "Ticket to Work" program).

The purpose of the Ticket to Work program is to expand the universe of service providers and therefore enhance the range of choices available to SSDI and SSI disabled beneficiaries to assist them in finding, entering, and retaining self-supporting employment. Expanded opportunities for these individuals will also increase the likelihood that they will reduce or eliminate their dependency on SSDI and SSI cash benefits.

The new Ticket to Work program is being phased into operation on a gradual basis at sites selected by the Commissioner of SSA beginning on January 28, 2002, the effective date of the final regulations. The new Ticket to Work program must be fully implemented as soon as practicable, but no later than January 1, 2004. (Note: The timetable for the phase-in for specific states is listed in the policy brief below under "Provisions in Final Regulations."

The new Ticket to Work program establishes an entitlement to a ticket for every individual who meets eligibility criteria established by the Commissioner. A ticket is a document that the Commissioner issues to SSDI and SSI beneficiaries for participation in the Ticket to Work program. The entitlement to a ticket goes into effect once the program is fully implemented in a state.

In general, all SSI and SSDI disability cash beneficiaries age 18 to 64 are eligible for a ticket except beneficiaries whose conditions are expected to improve (and who have not had at least one continuing disability review), beneficiaries who have not attained age 18, and childhood SSI beneficiaries who have attained age 18 but who have not had a redetermination under the adult disability standard.

Participation in the Ticket to Work program is voluntary. The ticket may be used to obtain vocational rehabilitation, employment, and other support services. The disabled beneficiary holding a ticket may assign the ticket to any employment network (i.e., service provider) of their choice that is willing to accept the assignment or to the State vocational rehabilitation agency (State VR agency) if the disabled beneficiary is eligible to receive State VR services. A beneficiary can retrieve the ticket from the employment network or the State VR agency and reassign the Ticket to another employment network or the State VR agency.

During the period for which an individual is using a ticket (i.e., making "timely progress toward self-sufficiency"), the Commissioner (and the applicable state agency) may not initiate a continuing disability review of whether an individual is or is not under a disability under the SSDI or SSI program. More specifically, SSA will suspend medical reviews to determine whether an individual's medical condition has improved. The regulatory definition of "using a ticket" provides the beneficiary with a limited period of time to prepare for work and subsequent periods during which the beneficiary must demonstrate increasing levels of employment.

The Commissioner of SSA has entered into a contract with a Program Manager who will be responsible for assisting the Commissioner in administering the Ticket to Work program. SSA has selected MAXIMUS, Inc. to serve as the Program Manager for the entire country. The Program Manager's responsibilities include: recruiting and monitoring employment networks, facilitating beneficiary access to employment networks, facilitating payments to employment networks, and resolving disputes among stakeholders.

Employment networks may include qualified state agencies (including State VR agencies, Medicaid agencies, and agencies serving persons with mental retardation, developmental disabilities, and mental illness), local agencies (including One-stop service delivery systems under the Workforce Investment Act), public schools, public and private colleges and universities, and private entities (including community rehabilitation providers, employers and nontraditional providers).

The employment network can be a single entity or an association of entities. The employment network can provide services directly or through contract or other arrangement with other entities.

All employment networks must meet minimum qualifications based on general criteria (e.g., physical and program accessibility) and specific criteria (e.g., licensure or accreditation, if applicable or education or experience). Any entity must have applicable certificates, licenses, or other credentials if state law requires such documentation.

The employment network is responsible for coordination and delivery of employment services, vocational rehabilitation services, and other support services. The employment network must report, among other things, information to assist the program manager in determining whether an individual is making "timely progress" and information about a beneficiaries work activity and earnings.

The employment network must ensure that services provided under the Ticket to Work program are provided under an appropriate individual work plan developed and implemented in partnership with each beneficiary receiving services. The State VR agency must ensure that services provided under the Ticket to Work program are provided under an appropriate individualized plan for employment developed and implemented in partnership with each beneficiary receiving services.

An employment network receives payment from the Commissioner in accordance with either the outcome payment system or the outcome-milestone payment system. An employment network may not request or receive compensation for such services from the beneficiary.

Under the outcome payment system, an employment network is paid over a period not to exceed 60 months at 40% of the average monthly SSDI or SSI benefit for every month the beneficiary does not receive benefits due to work/earnings.

Using calendar year 2002 figures, under the outcome payment system, an employment network could be paid the following amounts for SSDI beneficiaries: $317 per month, $3,804 per year, and $19,020 for the 60-month period. The employment network could be paid the following amounts for SSI recipients: $191 per month; $2,292 per year; and $11,460 for the 60-month period.

Under the outcome-milestone payment system, the total amount payable to an employment network is about 85 percent of the total potentially payable under the outcome payment system over the 60-month period for the same beneficiaries. This total payment consists of two parts-payments for milestones and payments for outcomes. An employment network can receive payment for up to four milestones after a beneficiary starts work (i.e., Milestone 1-worked for 1 calendar month where earnings exceed SGA; Milestone 2-worked for 3 calendar months out of 12 where earnings exceed SGA; Milestone 3-worked for 7 calendar months out of 12 where earnings exceed SGA; and Milestone 4-worked for 12 calendar months out of 15 where earnings exceed SGA). The term "earnings means gross earnings from employment or net earnings from self-employment. In addition, the employment network receives outcome payments for every month the beneficiary does not receive benefits due to work/earnings. The outcome payments are reduced proportionally over the 60-month period by the amount of the payments received for milestones.

Using calendar year 2002 figures, an employment network could receive the following milestone payments for SSDI beneficiaries: 1-$269; 2-$538; 3-$1,077; and 4-$1,346 or a total of $3,230. If the employment network received all four milestones, the maximum amount an employment network can receive in the form of outcome payments for a SSDI beneficiary is $215.17 a month; $2,582.04 per year and $12,910.20 for the 60-month period. The total payment (up to four milestones plus outcome payments) could be $16,140 for the entire 60-month period.

An employment network could receive the following milestones for SSI beneficiaries: 1-$162; 2-$324; 3-$648; 4-$811 or a total of $1,945. If the employment network received all four milestones, the maximum amount an employment network can receive in the form of outcome payments for a SSI beneficiary is $129.58 a month; $1,554.96 per year and $7,774.80 for the 60-month period. The total payment (four milestones plus outcome payments) could be approximately $9,720 for the entire 60-month period.

A State VR agency must participate in the Ticket to Work program if it wants to receive payment from SSA for serving disabled beneficiaries issued a ticket. For each ticket holder, the State VR agency may elect to receive payment either as an employment network (i.e., receive payment under the outcome payment system or the outcome-milestone payment system) or receive payment under the cost reimbursement payment system in effect prior to the enactment of TWWIIA. The services provided under the VR program are governed by Title I of the Rehabilitation Act of 1973, as amended.

The Commissioner is expected to evaluate the cost-effectiveness and outcomes of the new Ticket to Work Program.

PROVISIONS IN THE FINAL REGULATIONS

Purpose and Phase-in of the new Ticket To Work Program and Phase-out of the Alternate Participant Program.

What is the purpose of the new Ticket to Work Program?

The purpose of the new Ticket to Work program is to expand the universe of service providers and therefore enhance the range of choices available to SSDI and SSI disabled beneficiaries who are seeking employment services, vocational rehabilitation services, and other support services to assist them in finding, entering, and retaining self-supporting employment. The expansion of options available to obtain these services will provide beneficiaries with "real choices" in getting the services they need to obtain, regain, and maintain employment. Expanded employment opportunities for these individuals will also increase the likelihood that these individuals will reduce or eliminate their dependency on SSDI and SSI cash benefits. [20 CFR 411.105, .180(a); See also 66 FR at page 67371-67372 (December 28, 2001)]

Will the new Ticket to Work program be implemented on a gradual basis? What will happen to the alternate participant program in effect prior to the enactment of TWWIIA?

Yes. The new Ticket to Work program will be implemented in graduated phases in selected states around the country. [20 CFR 411.110, .130]

The first group of states (Phase I) began implementation in February 2002. These states include Arizona, Colorado, Delaware, Florida, Illinois, Iowa, Massachusetts, New York, Oklahoma, Oregon, South Carolina, Vermont, and Wisconsin.

Phase II will be implemented later in calendar year 2002. Phase II states include Alaska, Arkansas, Connecticut, Georgia, Indiana, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Dakota, South Dakota, Tennessee, Virginia, and the District of Columbia.

Phase III will be implemented in calendar year 2003. Phase III states include: Alabama, California, Hawaii, Idaho, Maine, Maryland, Minnesota, Nebraska, North Carolina, Ohio, Pennsylvania, Rhode Island, Texas, Utah, Washington, West Virginia, and Wyoming. Phase III also includes Puerto Rico and the Trust Territories of American Samoa, Guam, The Northern Mariana Islands, and the Virgin Islands.

Phase-in of the new Ticket to Work program must be completed on or before January 1, 2004.

Once the new Ticket to Work program has been implemented in a state, the alternate participant program for payment of VR services will begin to be phased-out in that state. SSA will not pay any alternate participant under the alternate participant program for any services that are provided under an employment plan that is signed on or after the date of implementation of the Ticket to Work program in that state. If an employment plan was signed before implementation of the Ticket to Work Program in the state, the alternate participant will continue to receive payments for services provided prior to January 1, 2004 under the alternate participant program. Under no circumstances will SSA pay an alternate participant under the alternate participant program for any services provided on or after January 1, 2004. [20 CFR 411.715, .720, .725, .730]

Significance of and Eligibility for a Ticket

What is a ticket?

A ticket is a document that provides evidence of the Commissioner's commitment under the Ticket to Work program to make payments of a specified amount to an employment network or a State VR agency to which a disabled beneficiary's ticket has been assigned for employment services, vocational rehabilitation, and other support services provided to a disabled beneficiary. The final regulations include a complete description of the format and the wording of the ticket. [20 CFR 411.120]

Who is eligible to participate in the new Ticket to Work program?

An SSDI disabled beneficiary must be age 18 to 64, and an SSI disabled beneficiary must be age 18 to 64 and be eligible for disability payments under the disability standards for adults.

In addition, a disabled beneficiary must be in "current pay status" for monthly cash benefits based on disability under the SSDI program or monthly federal cash benefits based on disability or blindness under the SSI program. Further, the disabled beneficiary must either (1) have a permanent impairment or a nonpermanent impairment (i.e., an impairment for which medical improvement is possible but cannot be predicted) or (2) have an impairment that is expected to improve and have undergone at least one continuing disability review. [66 FR 67373; 20 CFR 411.125(a)] SSA has decided not to extend eligibility for a ticket to the following three groups of beneficiaries: (1) beneficiaries who have impairments that are expected to improve and for whom SSA has not yet conducted at least one continuing disability review; (2) beneficiaries (under the disability standard for children) who have not attained age 18; and (3) those who received SSI payments prior to attaining age 18 (i.e., under the disability standard for children) and have since attained age 18, but for whom SSA has not yet conducted a redetermination of their eligibility using the standard for adults. On December 28, 2001, the Commissioner published a Notice in the Federal Register seeking suggestions from the public to assist the SSA in designing an approach for beneficiaries in the second and third groups that could complement the Ticket to Work program. [66 FR 67443]

Is an individual eligible for more than one ticket? What about DACs (disabled adult children)?

An individual will not be eligible to receive more than one ticket during any period during which he or she is either entitled to SSDI benefits based on disability or eligible for SSI benefits based on disability or blindness and his or her eligibility has not terminated. [20 CFR 411.125(b)] However, if an individual's entitlement under SSDI ends or eligibility under SSI has terminates, an individual will be entitled to a second ticket if his or her entitlement to SSDI cash benefits or eligibility for SSI cash assistance has been reinstated. [20 CFR 411.125(c)] TWWIIA provides that an individual who is an adult child (18 years old or older) of an insured person who is entitled to old-age or disability benefits or who has died, is eligible for benefits if the individual is unmarried and has a disability that began before the individual is 22 years old. Under TWWIIA, an individual whose entitlement to child's insurance benefits based on disability has terminated may again become entitled to such benefits if he or she has not married and he or she is under a disability which began before the end of the 84th month following the month in which his or her most recent entitlement to child's insurance benefits terminated because he or she ceased to be under a disability. Therefore, according to the Preamble accompanying the final regulations [66 FR at page 67388 (December 28, 2001)], DACs are eligible to receive another ticket in the first month they again become entitled to benefits, as long as they meet all other requirements for eligibility for a ticket.

Is participation in the new Ticket to Work Program voluntary or mandatory?

Participation in the new Ticket to Work program is voluntary. The individual beneficiary is free to choose when and whether to assign the ticket to an employment network or to a State VR agency. [20 CFR 411.135]

If a disabled beneficiary wants to participate in the new Ticket to Work program, what must he or she do with the ticket?

A disabled beneficiary must take and then assign his or her ticket to an employment network that is willing to provide services or to a State VR agency if he or she is eligible to receive VR services. In order to assign a ticket, the disabled beneficiary and the employment network or State VR agency (vocational rehabilitation counselor) must agree to and sign an individual work plan (or in the case of the State VR agency an individualized plan for employment). This will be the effective date of the assignment of the disabled beneficiary's ticket [20 CFR 411.135, .140]

Can a disabled beneficiary assign a ticket to more than one provider of services at a time?

No. A disabled beneficiary may not assign his or her ticket to more than one provider of services (i.e., an employment network or State VR agency) at a time. [20 CFR 411.140(a)]

Once a ticket has been assigned to an EN or a State VR agency, can it be taken out of assignment?

Yes. A disabled beneficiary can take his or her ticket out of assignment for any reason. The disabled beneficiary must notify the Program Manager of his or her wish to retrieve the ticket. The ticket will no longer be assigned to that entity effective on the first day of the month following the month in which the disabled beneficiary notified the Program Manager of his or her desire to retrieve the ticket. [20 CFR 411.140, .145, .150]

If a disabled beneficiary's employment network goes out of business or is no longer approved to participate as an employment network, the Program Manager will take the ticket out of assignment. [20 CFR 411.140, .145, .150]

In addition, if the disabled beneficiary's employment network is no longer willing or able to provide services or if the State VR agency stops providing services because the individual is no longer eligible for VR services, the employment network or State VR agency may ask the Program Manager to take the ticket out of assignment. [20 CFR 411.140, .145, .150]

Can a disabled beneficiary reassign his or her ticket to another EN or the State VR agency?

Yes. A disabled beneficiary may reassign a ticket unless he or she is receiving cash benefit payments under either of two special rules. First, a ticket may not be reassigned by a disabled beneficiary who is continuing to receive benefits because he or she is recovering medically while participating in a program of vocational rehabilitation services approved by the Commissioner if the Commissioner determines that continuation in or completion of the program will increase the likelihood that the individual will be permanently removed from the disability rolls. Second, an individual who is continuing to receive cash benefits pending the appeal of a medical cessation determination may not reassign a ticket.

In order to reassign a ticket to an employment network or State VR agency, all of the following requirements must be met [411.150]:

(1) The ticket must be unassigned.

(2) The disabled beneficiary and the appropriate representative of the new employment network or State VR agency, must agree to and sign the Individual Work Plan (EN) or Individualized Plan for Employment (used by the State VR agency).

(3) The disabled beneficiary must meet the general eligibility requirements for a ticket (including appropriate age and in current pay status) on or after the day the new IWP or IPE is signed.

NOTE: There are two exceptions to this general rule. For an individual who is considered "not using a ticket," the disabled beneficiary does not have to meet the age and current pay status eligibility requirements if the disabled beneficiary and the appropriate representative sign an IWP (EN) or IPE (State VR agency) within 30 days from the date the ticket was no longer assigned. For a disabled beneficiary who is considered "using a ticket," the disabled beneficiary does not have to meet the age and current pay status eligibility requirements if the disabled beneficiary and the appropriate representative sign an IWP (EN) or IPE (State VR agency) within 3 months from the date the ticket was no longer assigned. [The criteria for a ticket being considered "in use" is described under the section "Suspension of Continuing Disability Reviews."]

(4) The employment network must submit a copy of the signed IWP to the Program Manager or a representative of the State VR agency must submit a specified form to the Program Manager.

(5) The Program Manager must receive the copy of the IWP or the required form.

If all of these conditions are satisfied, the ticket will be considered reassigned to the new employment network or State VR agency on the first day conditions (1), (2) and (3) above are satisfied.

When does a disabled beneficiary's entitlement to a ticket terminate?

A ticket terminates when (1) entitlement to SSDI benefits ends (e.g., a beneficiary attains 65) or eligibility for SSI benefits based on disability or blindness terminates (whichever is later) for reasons other than the individual's work activity or earnings; (2) a Social Security disabled widow (er) beneficiary attains 65; or (3) a disabled or blind SSI beneficiary reaches age 65 and may qualify for SSI benefits based on age.

Once a disabled beneficiary's ticket terminates, he or she may not assign or reassign it to an employment network or State VR agency. SSA will not pay an employment network or State VR agency for milestones or outcomes achieved after the month in which a ticket terminates. [20 CFR 411.155]

Suspension of Continuing Disability Reviews (CDRs)

What is a continuing disability review?

The Social Security Act authorizes SSA to conduct periodic reviews of SSDI and SSI disabled beneficiaries to ensure that they continue to meet the definition of disability and therefore remain entitled/eligible for cash benefits. These reviews are called continuing disability reviews (CDRs). [20 CFR 411.160; 66 FR at page 67375 (December 28, 2001)]

The definition of "disability" for purposes of determining initial eligibility is identical under the SSDI and SSI programs. "Disability" is defined as the inability to engage in any substantial gainful activity (SGA) by reason of a medically determinable physical or mental impairment that is expected to last for a continuous period of not less than 12 months, or to result in death. For calendar year 2002, SGA is defined for non-blind disabled beneficiaries as earnings of $780 per month and $1300 per month for blind disabled beneficiaries.

For purposes of the Ticket to Work program, the term "continuing disability review" refers to "medical" reviews to determine whether an individual's impairment continues to exist. For purposes of the Ticket to Work program, the term "continuing disability review does not refer to determinations of whether an individual meets the work or earnings requirements to receive cash benefits. In other words, SSA will continue to conduct work reviews to determine whether an SSDI beneficiary is still eligible for cash benefits.

If an SSDI beneficiary's earnings are at the SGA level after the trial work period, the beneficiary will not be paid cash benefits for any month during the extended period of eligibility in which his or her earnings are at the SGA level, and the beneficiary will be paid cash benefits for any month during this period for which his or her earnings are below the SGA level. If the SSDI beneficiary's earnings are at the SGA level after the extended period of eligibility, SSA will terminate his or her cash benefit payments. If SSDI cash benefits are terminated, the individual may immediately qualify for continued Medicare for an extended period. In addition, if the individual's work is reduced below the SGA level within 5 years, he or she may qualify for reinstatement of cash benefits and Medicare under the expedited reinstatement provision.

If an SSI recipient's cash benefits and Medicaid have terminated for any reason other than medical recovery, he or she may qualify for reinstatement of cash benefits and/or Medicaid under the expedited reinstatement provision.

How does being in the Ticket to Work program affect a decision by SSA to conduct a CDR? What is the significance of suspending a continuing disability review?

If a disabled beneficiary is "using a ticket" under the Ticket to Work program, SSA will not begin a CDR. [20 CFR 411.165] This provision requiring the suspension of CDRs is designed to address the fear experienced by some beneficiaries that working or even receiving vocational rehabilitation services may increase the likelihood that their benefits will be terminated in a continuing disability review. In other words, the primary purpose of the suspension of continuing disability reviews is to ensure that participants in the Ticket to Work program are not inhibited in their attempts to work or pursue an employment plan by the fear that such activities will increase the likelihood that their benefits will be terminated in a medical review. At the same time, SSA was concerned with the need to maintain the integrity of the disability programs i.e., persons who are medically improved and no longer meet the definition of disability should not continue to receive disability benefits for an undue length of time. [66 FR at pages 67375-67376 (December 28, 2001)]

NOTE: Effective January 1, 2002, CDRs for a long-term SSDI beneficiary (i.e., a beneficiary receiving disability benefits for at least 24 months) may not be scheduled for such individual solely as a result of his or her work activity. SSA would continue to evaluate work activity to determine whether eligibility for cash benefits continued (e.g., the individual has earnings that exceed the established level) but a return to work would not trigger a medical review of the beneficiary's impairment to determine whether it continued to be disabling. An individual not using a ticket would still be subject to a regularly scheduled periodic review. Regulations implementing this new provision will be published in the Federal Register at a later date. [Section 111 of TWWIIA adds Section 221(m) to the Social Security Act; 66 FR at page 67390 (December 28, 2001)]

For purposes of determining whether a continuing disability review must be suspended, when does the period of "using a ticket" begin and end?

The period of "using a ticket" begins on the effective date of the assignment of a ticket to an employment network or State VR agency. [20 CFR 411.170]

The period of "using a ticket" ends with the earliest of the following [20 CFR 411.171]:

  1. The month before the month in which the ticket terminates e.g., entitlement to SSDI benefits ends or eligibility for SSI benefits based on disability or blindness terminates (whichever is later) for reasons other than the individual's work activity or earnings or a disabled or blind SSI beneficiary reaches age 65 and may qualify for SSI benefits based on age.
  2. The day before the effective date of a decision that a disabled beneficiary is no longer making "timely progress" toward self-supporting employment.
  3. The close of the 3-month extension period that begins with the first month in which the ticket is no longer assigned unless the ticket is reassigned within the 3-month extension period.
  4. The 60th month for which an outcome payment is made.
  5. For a State VR agency that selects the cost reimbursement method, the 60th month for which an outcome payment would have been made had the State VR agency chosen to serve the disabled beneficiary as an employment network.

If SSA begins a CDR before the ticket is assigned, what are the consequences for the individual?

If SSA "begins" a CDR before the date a ticket is assigned, the beneficiary may still assign the ticket and receive employment-related services. However, SSA will complete the CDR. If SSA determines that the individual is no longer disabled, in most cases the individual will no longer be eligible to receive benefits.

The date on which SSA "begins" the CDR is the date SSA sends the notice to the individual specifying that SSA is beginning to review the individual's disability case.

If the individual assigns the ticket before SSA determines that he or she is no longer eligible, in certain circumstances, the individual may continue to receive benefits. If the decision by SSA that the individual is no longer eligible is appealed, the individual may choose to have the benefits continued pending the appeal. [20 CFR 411.175]

What are the guidelines for determining if a beneficiary is making "timely progress" toward self-supporting employment?

SSA considers that a disabled beneficiary is making "timely progress" toward self-supporting employment when the individual shows an increasing ability to work at levels that will reduce or eliminate dependence on benefits. [20 CFR 411.180(a)]

After assigning a ticket, a beneficiary is allowed up to 2 years to prepare for employment (initial 24-month period). The disabled beneficiary must show that he or she is "actively participating" in their individual work plan or individual plan for employment i.e., engaging in activities outlined in the individual's plan on a regular basis and in the approximate time frames specified in the employment plan. [20 CFR 411.180(c)(1)] Active participation will be presumed unless the disabled beneficiary or the employment network or State VR agency informs the Program Manager that the disabled beneficiary is not actively participating. [20 CFR 411. 190(a)(1)]

At the end of the initial 24-month period, the disabled beneficiary must successfully complete the 24-month progress review conducted by the Program Manager. [20 CFR 411.190(b)(2)] In conducting the review, the Program Manager will consider whether the disabled beneficiary is "actively participating" in his or her employment plan and whether the plan includes a goal of at least three months of work by the time of the first 12-month progress review and whether it is reasonable that the goal will be achieved at the time of the first 12-month progress review. [20 CFR 411.195]

After the end of the initial 24-month period, beneficiaries would be required to meet progressively higher levels of employment to continue to be considered "using a ticket" in order to receive protection regarding non-initiation of continuing disability reviews.

In the 3rd year of participation in the Ticket to Work program, the beneficiary is required to work at least 3 months in a 12-month period (not necessarily consecutive) at the Substantial Gainful Activity (SGA) level (for calendar year 2002 set at $780 for non-blind beneficiaries). This period is referred to as the "first 12-month review period." The disabled beneficiary may "bank" work performed in the initial 24-month period and apply it to the first 12-month review period. In other words, if the disabled beneficiary worked in one or more months during the initial period at the applicable level, each month of work may be used to reduce by one month the number of months of work required for the first 12-month progress review period that occurs in the third year. [20 CFR 411.180(c)(1) and (2)]

In the 4th year of participation in the program, the beneficiary is required to work at least 6 months during a 12-month period (not necessarily consecutive) at the SGA level. This period is referred to as the "second 12-month review period." [20 CFR 411.180(c)(3)]

In the 5th and succeeding years, in order to be considered to be using a ticket, the beneficiary is required to work at least 6 months in each year and have earnings in each such month that were sufficient to eliminate the payment of SSDI benefits and Federal SSI benefits. [20 CFR 411.180(c)(3)]

The Program Manager must conduct 12-month progress reviews at the end of each 12-month progress review period. [20 CFR 411.190(b)(3)] The 12-month progress review entails a two-step process. Step One entails a retrospective review--did you complete the work requirements in the just completed 12-month progress review period? Step Two entails a review of anticipated work level--is it expected that the disabled beneficiary will work at the prescribed level required during the next 12-month progress review period? [20 CFR 411. 200]

In crafting these guidelines, SSA explains that progress toward self-sufficiency is not always continuous and that for some, full self-sufficiency may not be attained. Many beneficiaries have disabilities with cycles of relapse and remission. The requirements for only 3 months out of 12 in the third year and 6 months out of 12 in succeeding years recognizes that some beneficiaries may not be able to work on a continuous basis. [66 FR at page 67376 (December 28, 2001)]

What are the guidelines for determining whether SSDI and SSI beneficiaries have sufficient "earnings" to indicate that the "timely progress" requirement is satisfied?

SSDI BENEFICIARIES

During the first and second 12-month work review periods SSA will consider an SSDI beneficiary to be working in any month in which earnings from employment or self-employment are at the SGA level.

For individuals in the trial work period, SSA will consider the following as fulfilling this requirement:

During the third 12-month work review period and later 12-month review periods, SSA will consider an SSDI beneficiary to be working in a month for which benefits are not payable because of work or earnings. [20 CFR 411.185(a)]

SSI BENEFICIARIES

During the first and second 12-month work review periods, SSA will consider an SSI beneficiary to be working in a month in which the individual has:

During the third 12-month work review period and later 12-month review periods, SSA will consider SSI beneficiaries to be working in a month for which the individual has earnings from employment or self-employment that are sufficient to preclude the payment of Federal SSI cash benefits for a month. [20 CFR 411.185(b)]

CONCURRENT SSDI AND SSI BENEFICIARIES

During the first and second 12-month work review periods SSA will consider a concurrent SSDI and SSI beneficiary to be working in a month in which earnings from employment or self-employment are at the SGA level. For a month in which such an individual is in the trial work period, SSA will consider the following as satisfying this requirement:

During the third 12-month work review period and later 12-month work review periods, SSA will consider a SSDI, SSI concurrent beneficiary to be working in a month in which the individual has earnings from employment or self-employment sufficient to preclude the payment of SSDI benefits and Federal SSI cash benefits for a month. [20 CFR 411.185 (c)]

If a beneficiary expects that he or she will be unable to participate in the employment plan for a significant period of time due to a relapse or if he or she simply chooses to stop participating in the plan, what options are available?

Beneficiaries have the option of placing their ticket in inactive status during the initial twenty-four month period following assignment of a ticket. Any period in which the ticket is inactive would not count toward the time limitations under the timely progress guidelines. However, since the ticket would not be in use during this period, the beneficiary would be subject to a continuing disability review. [20 CFR 411.190(a)(2), .220]

If a beneficiary chooses to resume active participation in an employment plan, SSA will allow 3 months to demonstrate this active participation to the Program Manager. During this 3-month period, the individual will be considered to be making timely progress toward self-supporting employment. The Program Manager will send a written notice of its decision. The decision will become effective 30 days after the date on which the Program Manager sends the notice, unless a review is requested. [20 CFR 411.190(a)(2)]

What happens if a disabled beneficiary fails to make timely progress toward self-supporting employment?

The timely progress guidelines described above are only used to determine whether a disabled beneficiary is "using a ticket" for purposes of protection against initiation of a CDR. If it is determined that a disabled beneficiary is not making timely progress toward self-supporting employment, SSA will find that the individual is no longer "using a ticket." If this happens, the disabled beneficiary will once again be subject to continuing disability reviews. Disabled beneficiaries who do not meet the timely progress guidelines may still participate in the Ticket to Work program, receive services, and generate outcome and milestone payments to employment networks and State VR agencies. [20 CFR 411.210(a); 66 FR 67391 (December 28, 2001)]

If a beneficiary who fails to make timely progress or chooses to be placed in inactive status decides to re-enter the "in-use" status, what guidelines are used to determine whether the individual is once again "using the ticket"?

In a disabled beneficiary decides to re-enter the "in use" status, he or she would need to work for a specified number of months. The number of months and earnings levels required would vary depending on how far the beneficiary had progressed when he or she failed to meet the guidelines. [20 CFR 411.180, .185, .210(b)] This policy is included in recognition of the reality that many beneficiaries may make unsuccessful attempts before eventually reaching their employment goals, and these unsuccessful attempts should not deprive them of the supports that they need to make renewed efforts.

Is a determination by the Program Manager that a beneficiary is not making timely progress subject to review by SSA?

Yes. A beneficiary may request a review by SSA. [20 CFR 411. 205]

What happens if an individual's ticket is no longer assigned to an employment network or State VR agency? Is there an extension period during which the ticket may be reassigned without subjecting the individual to CDRs?

If a ticket was once assigned to an employment network or State VR agency and is no longer assigned, a disabled beneficiary is eligible for an extension of up to 3 months (the "extension period") to reassign the ticket if the ticket is "in use" and no longer assigned for the following reasons: (1) the disabled beneficiary was dissatisfied with the services being provided; (2) the disabled beneficiary relocated to an area not served by the previous employment network; (3) the disabled beneficiary's employment network went out of business or is not longer approved or is no longer willing or able to provide services; or (4) the disabled beneficiary's State VR agency stopped providing services to him or her. 20 CFR 411.220(a)]

During the "extension period," the ticket will still be considered "in use" and thus the individual will not be subject to a CDR during this period. 20 CFR 411.220(b)] Time spent in the extension period will not count toward the time limitations for the timely progress guidelines. [20 CFR 411.220 (c)]

The "extension period" begins on the first day on which the ticket is no longer assigned and ends three months after it begins or when the ticket is assigned to a new employment network or State VR agency, whichever is sooner. [20 CFR 411.220(d)]

If the "extension period" began during the initial 24-month period, the disabled beneficiary who reassigns his or her ticket during this period will have a new initial 24-month period. [20 CFR 411.220(e)]

If the ticket is not reassigned during the "extension period," the ticket is no longer "in use" and therefore the disabled beneficiary will once again be subject to a continuing disability review. [20 CFR 411.220(f)]

A ticket may be "reassigned" after the end of the "extension period" under specified conditions described in 20 CFR 411.150 (see Question and Answer "Can a disabled beneficiary reassign his or her ticket to another EN or the State VR agency?") [20 CFR 411.225] If the "extension period" began during the initial 24-month period, the disabled beneficiary will have a new initial 24-month period because the beneficiary may have to reassign the ticket due to no fault of his or her own. [20 CFR 411.225(c); 66 FR at page 67378 (December 28, 2001)]. If the extension period began during any 12-month progress review period and the ticket is assigned after the end of the "extension period," the period comprising the remaining months in that review period will begin with the first month beginning after the day on which reassignment of the ticket is effective. [20 CFR 411.225(d)]

PROGRAM MANAGER

What is a Program Manager?

A Program Manager is an organization in the private or public sector that has entered into an agreement to assist SSA in administering the Ticket to Work program. MAXIMUS, Inc. was initially selected to serve as the Program Manager for the entire country based on a competitive bidding process. [20 CFR 411.230; 66 FR at page 67395 (December 28, 2001)]

What are the Program Manager's primary responsibilities?

The Program Manager's primary responsibilities include recruiting, recommending and monitoring employment networks; facilitating access by beneficiaries to employment networks (e.g., ensure that all information provided to beneficiaries is in accessible formats); facilitating payment to employment networks; and performing specified administrative requirements such as reviewing individual work plans, reviewing amendments to individual work plans, and resolving disputes between employment networks. (Note: The Program Manager will not review individualized plans for employment developed by State VR agencies and beneficiaries) [20 CFR 411.245] top of page

EMPLOYMENT NETWORKS

What is an employment network?

An employment network is any qualified entity that has entered into an agreement with SSA under the Ticket to Work program and has agreed to assume responsibility for the coordination and delivery of employment services, vocational rehabilitation services, and other support services to beneficiaries who have assigned their tickets to that entity. [20 CFR 411.300]

Who is eligible to be an employment network?

Any qualified agency or instrumentality of a state or political subdivision or a private entity willing to assume specified responsibilities may be considered an employment network. Employment networks may include (but are not limited to) charitable and religious organizations, State VR agencies, community rehabilitation providers and other alternate participants, One-stop Centers under the Workforce Investment Act, State Mental Retardation/Developmental Disabilities and Mental Health agencies, employers that offer job training or other supports or services, public and private secondary schools (including transition programs), community colleges, institutions of higher education, and organizations administering vocational rehabilitation services to Indians with disabilities. [20 CFR 411.305]

The policies embedded in the final regulations are intended to permit both traditional as well as other types of entities to qualify, including non-traditional service providers (including family and friends) while still requiring evidence that all employment networks meet certain minimum qualifications such as licensure, accreditation, academic qualifications or experience. [66 FR at page 67379 and 67397 (December 28, 2001)]

The disabled beneficiary may not serve as his or her own employment network. In addition, federal agencies e.g., Department of Veterans Affairs, may not serve as employment networks. [66 FR at page 67397 (December 28, 2001)]

Must an employment network consist of a single entity or may it consist of a consortium or association of entities?

A single entity or an association or consortium of entities combining their resources is eligible to be an employment network. The entity may provide services directly or by entering into a contract, agreement or other arrangement with other organizations or individuals to provide appropriate services. [20 CFR 411.305]

How does an entity apply to be an employment network?

An entity (other than a State VR agency) applies to the Commissioner by responding to a request for proposals (RFP) by SSA. This RFP is available through the SSA website www.ssa.gov/work. The entity must assure that it is qualified to provide employment services, vocational rehabilitation services, or other support services to disabled beneficiaries either directly or through contract or other arrangement. [20 CFR 411.310] State VR agencies do not apply to the Commissioner to become employment networks. [66 FR at page 67379 (December 28, 2001)]

What are the minimum qualifications necessary to become an employment network?

To serve as an employment network, an entity must meet and maintain compliance with both general and specific selection criteria.

General selection criteria include having systems in place to ensure confidentiality of personal information, physical and program accessibility, the existence of nondiscriminatory policies, practices, and procedures (based on beneficiaries age, gender, race, color, creed, or national origin), having adequate resources to perform activities, and implementing fiscal control and fund accounting procedures. [20 CFR 411.315(a)] Examples of "program accessibility" include making documents and literature available in alternate media and ensuring that data systems available to clients are fully accessible for independent use by persons with disabilities. [20 CFR 411.315(a)(2)]

Specific criteria include using staff who are qualified under applicable certification, licensing, or registration standards that apply to their profession, including certification or accreditation by national accrediting or certifying organizations or using staff that are otherwise qualified based on education or experience. If (and only if) any medical and related health services are provided, "specific criteria" also include taking reasonable steps to ensure that such services are provided under the formal supervision of persons licensed to provide or supervise the provision of these services. [20 CFR 411.315(b)]

Any entity must have applicable certificates, licenses, or other credentials if state law requires such documentation. [20 CFR 411.315(c)]

What are the employment network's primary responsibilities?

An employment network's primary responsibilities include entering into an agreement with the SSA; serving a prescribed service area; providing necessary services (directly or through contract or other agreement) under an individual work plan to disabled beneficiaries with assigned tickets; electing a payment system at the time of signing an agreement with SSA; developing and implementing individual work plans in partnership with beneficiaries; and satisfying specified reporting requirements. [20 CFR 411.320]

What are the specific reporting requirements placed on employment networks?

The following reporting requirements are placed on entities that wish to participate in the Ticket to Work program as employment networks [20 CFR 411.325]:

  1. Report to the Program Manager each time it accepts a ticket for assignment.
  2. Submit to the Program Manager a copy of each signed individual work plan and copies of amendments thereto.
  3. Submit to the Program Manager a copy of any agreement the employment network has established with a State VR agency regarding the provision of VR services.
  4. Submit information to assist the Program Manager conducting the "progress reviews" to determine whether a disabled beneficiary is "using a ticket."
  5. Report to the Program Manager the specific outcomes achieved with respect to specific services the employment network provided or secured on behalf of disabled beneficiaries whose tickets it accepted, consistent with a national model to be prescribed by the SSA.
  6. Provide a copy of most recent annual report on outcomes to each beneficiary and ensure that copies are available to the public while ensuring confidentiality of personal information.
  7. Meet financial reporting requirements.
  8. Collect and record all data required by SSA.
  9. Adhere to all statutory and regulatory requirements.

Under what circumstances will SSA terminate an agreement with an employment network?

SSA will terminate an agreement with an employment network if the entity does not comply with the responsibilities and reporting requirements described above, including minimum performance standards relating to beneficiaries achieving self-supporting employment and leaving the benefit rolls. [20 CFR 411.321]

How will SSA evaluate an employment network's performance?

SSA will periodically review the results of the work of each employment network to ensure effective quality assurance in the provision of services to ticket holders. In conducting these reviews, SSA will solicit and consider the views of the consumers of the employment network and the Program Manager that monitors the employment network. Results of these reviews must be made available to the disabled beneficiaries. [20 CFR 411.330]

PARTICIPATION BY STATE VR AGENCIES

Must a State VR agency participate in the Ticket to Work program?

A State VR agency 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. [20 CFR 411.350]

Must a State VR agency function as an employment network? What payment options does a State VR agency have under the Ticket to Work program?

On a case-by-case basis, the State VR agency may participate either as an employment network (and thus be paid under the outcome payment system or the outcome-milestone payment system) or under the cost reimbursement payment system authorized under policy in effect prior to the enactment of TWWIIA. [20 CFR 411.355(a) and (b)]

A State VR agency can choose to function as an employment network or to receive payment under the cost reimbursement payment system each time that a ticket is assigned or reassigned to it so long as payment has not previously been made with respect to that ticket.

If payment has previously been made with respect to that ticket, the State VR agency can receive payment only under the payment system under which the earlier payment was made. [20 CFR 411. 355(d)] Thus, a State VR agency is precluded from being paid under the cost reimbursement payment system if an employment network or a State VR agency serving a disabled beneficiary as an employment network has been paid by SSA under one of the employment network payment systems with respect to that same ticket. [20 CFR 411.370]

When serving a disabled beneficiary who has not been issued a ticket, the State VR agency may seek payment only under the cost reimbursement payment system. [20 CFR 411.355(c)]

How does a State VR agency become an employment network?

State VR agencies do not apply to become employment networks i.e., they do not have to respond to SSA's Request for Proposals to function as employment networks. In other words, State VR agencies automatically qualify as employment networks. [66 FR at page 67379 (December 28, 2001)]

As the Ticket to Work program is implemented in a state, SSA will notify the State VR agency. The letter will ask the State VR agency to choose a payment system when it functions as an employment network. [20 CFR 411.360]

The State VR agency must respond to the letter from SSA by sending a reply letter informing the SSA which payment method it will use when functioning as an employment network. The director of the State VR agency or his or her designee must sign the letter. [20 CFR 411.365]

When a State VR agency functions as an employment network, must it still provide services in accordance with Title I of the Rehabilitation Act, including the state plan requirements?

Yes. The State VR agency must continue to provide services under the requirements of the state plan approved under Title I of the Rehabilitation Act. [20 CFR 411. 375]

How does a State VR agency determine whether a persons seeking services has a ticket?

A State VR agency can contact the Program Manager. [20 CFR 411.380]

What does a State VR agency do if a beneficiary who is eligible for VR services has a ticket available for assignment or reassignment?

In order to assign or reassign a ticket, the beneficiary and a representative of the State VR agency must agree to and sign the individualized plan for employment (IPE). The State VR agency must submit the following information to the Program Manager in order for the ticket to officially be assigned or reassigned: (1) A statement that the beneficiary has decided to assign or reassign the ticket to the State VR agency and that an IPE has been agreed to and signed by both the beneficiary and the representative of the State VR agency; (2) a statement of the vocational goal outlined in the IPE; and (3) a statement of the State VR agency's selection of the payment system under which the agency will seek payment. The information must be submitted in a format prescribed by SSA and include signatures of both parties [20 CFR 411.385]

For each beneficiary who is already a client of the State VR agency prior to receiving the ticket, the State VR agency must notify the Program Manager of the payment system election for each beneficiary at the time the beneficiary decides to assign the ticket to the State VR agency. [20 CFR 411.390; .510]

Is the State VR agency required to provide periodic reports to the Program Manager?

For cases where a State VR agency provided services functioning as an employment network, it must prepare an annual report on the specific outcomes achieved with respect to

Written by:

Robert Silverstein

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