Significant Provisions in the Final Regulations Implementing the

Ticket to Work and SelfSufficiency Program

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

Eligibility to a Ticket
All SSI and SSDI disability cash beneficiaries, except:
• Beneficiaries whose conditions are expected to improve, and who have not had at least one continuing disability review; • Beneficiaries who have not attained age 18 or have attained age 65 (SSI) or Full Retirement Age (SSDI) • Childhood SSI beneficiaries who have attained age 18, but who have not had a redetermination under the adult disability standard.

Receipt of a Ticket
A beneficiary receiving a Ticket: • can choose whether or not to use the Ticket • can use the Ticket to obtain services from employment network of his or her choice, or from a State VR agency if he or she qualifies for services • can retrieve the Ticket from the EN or the VR Agency and reassign it to another EN or the VR Agency

Suspension of CDRs-“Using a Ticket”
• SSA may not initiate a Medical CDR while a beneficiary is “using a ticket” (making “timely progress toward self-sufficiency”) • A CDR is suspended while the beneficiary is using a ticket. The regulatory definition of “using a ticket” provides the beneficiary with a limited period to prepare for work, and subsequent periods during which the beneficiary must demonstrate increasing levels of employment.

Use of a Program Manager
• SSA has contracted with a Program Manager (PM): MAXIMUS, Inc., – PM responsibilities:
Recruit/monitor/recommend ENs Facilitate beneficiary access to ENs Facilitate payments to ENs Resolve EN-State VR agency disputes Other administrative duties for SSA

Employment Networks
• Employment Network (EN) – Any qualified State, local, or private entity – Assumes responsibility for coordination and delivery of employment services, vocational rehabilitation services, or other support services under the Ticket to Work program

Employment Networks-Eligibility
• Employment Network – Can be a single entity or an association of entities combining resources – Can provide services directly or by entering into agreements with other organizations or individuals to provide the needed services to a beneficiary

Employment Networks-Qualifications
• All ENs must meet minimum qualifications
– Licensed or accreditation, if applicable; or – Education that provides expertise, or experience in vocational rehabilitation

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

Employment Networks-Must Report
• Information to assist the Program Manager in determining whether a beneficiary is making timely progress toward self-sufficiency (for CDR suspension); and • Information about a beneficiary’s work activity and earnings so SSA can determine their effect on entitlement to benefits and benefit amounts

State VR Agency Participation in the Ticket to Work Program
• State VR agencies (VRA) must participate in the Ticket program to receive payment for serving a beneficiary with a ticket • A VRA can choose for each beneficiary it serves, on a beneficiary-by-beneficiary basis, to be paid under the cost reimbursement system or under one of the EN payment systems • A VRA must provide reports on beneficiary outcomes when choosing to be paid as an EN.

Individual Work Plan
• Required written document: – Developed, signed, and implemented in partnership by the EN and the beneficiary – Outlines specific employment services, VR services, or other support services the EN and beneficiary have determined are necessary to achieve the beneficiary’s employment goal

Individual Work Plan, continued
• Must include at least statements of: – of the beneficiary’s vocational goal – of services and supports necessary to achieve the beneficiary’s vocational goal – of any terms and conditions – that EN may not request or receive any compensation for cost of services and supports from the beneficiary

• Included statements, continued – of conditions under which EN can amend the IWP or terminate the relationship – of the beneficiary’s rights, including the right to retrieve the ticket – of remedies available to the beneficiary, including the availability of advocacy services and assistance through P&A Services

Individual Work Plan, continued

Individual Work Plan, continued
• Included statements, continued: – of the beneficiary’s rights to privacy and confidentiality – of the beneficiary’s right to seek to amend the IWP – of the beneficiary’s right to have a copy of the IWP made available to the beneficiary in an accessible format

EN Payment Systems-Outcome Payment System
Outcome payments to an EN(over 60 months): – at 40 % of average monthly SSDI or SSI benefit – for every month beneficiary does not receive benefits due to work/earnings

EN Payment Systems-Outcome-Milestone System
1 2 3 4 Payment for four milestones--after work starts: -worked for 1 calendar month at SGA -worked for 3 calendar months out of 12 at SGA -worked for 7 calendar months out of 12 at SGA -worked for 12 calendar months out of 15 at SGA

EN Payment Systems-Outcome-Milestone System
Outcome-Milestone payments, continued: – Reduced Outcome payments--about 85% of total potentially payable under the Outcome payment system over 60 months for the same beneficiary

EN Payment Systems-Increased Incentives for ENs
Final regulations:
• Added 2 new milestones (doubled the number of possible milestone payments) • Moved one new milestone to follow 1st month of work; • Doubled the value of milestone payments; • Extended period of recoupment (reduction in outcome payments due to milestone payments) from 12 months to 60 months

Dispute Resolution in the Ticket to Work Program-• The dispute resolution process describes the responsibilities of an EN that is not a State VR agency to: – have grievance procedures that a beneficiary can use to seek resolution of a dispute – inform each beneficiary of the right to refer a dispute first to the PM, and then to SSA for resolution – inform each beneficiary of the availability of assistance from the State P&A system.

Beneficiary and EN

Dispute Resolution in the Ticket to Work Program-• The PM is required to have procedures to resolve disputes with ENs that do not involve an EN’s payment request. • An EN can seek a solution through the PM’s internal grievance procedures. • If the PM’s internal grievance procedures do not result in a mutually agreeable solution, the PM must refer the dispute to SSA for a decision.

EN and PM

Dispute Resolution in the Ticket to Work Program-Beneficiary and State VR Agency
• The dispute resolution procedures in the Rehabilitation Act of 1973, as amended, apply to any beneficiary who has assigned his or her ticket to a State VR agency. • The Rehabilitation Act requires the State VR agency to provide a description of services authorized through the Client Assistance Program, and to provide an opportunity to resolve disputes using formal mediation or an informal hearing process.

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

Ticket to Work Program and Alternate Participants
• The Alternate Participant (AP) process will end in each State • APs providing VR services will be asked if they choose to become ENs • If an AP chooses to become an EN, services to current clients will continue to be covered under the current cost reimbursement system for a limited time

Ticket to Work Program and Alternate Participants
• If an AP chooses not to become an EN, payment will not be made for services to new clients after the Ticket program is phased-in the State • If an AP chooses not to become an EN, payment will not be made for any services after January 1, 2004

The Work Site
• SSA Office of Employment Support Programs’ Web Site: