

			Get Latest WorkWORLD

	www.workworld.org	workworld@vcu.edu

Ticket Payment Systems and Employment Networks

The information contained in this topic primarily describes how service providers are paid for the services that they provide under the Ticket to Work and Self-Sufficiency Program, or "Ticket" system. It is presented so that individual consumers and their advocates and consultants may better understand the role of Employment Networks (EN), and how their financial interests may affect the nature of the services they provide. Additionally, it may help individuals to understand the expectations and outcomes that Employment Networks hope to achieve.

NOTE: After proposing changes for several years, in May 2008 SSA published new regulations for the Ticket program, which became effective on July 21, 2008. To see the new Ticket to Work regulations, go to:
http://edocket.access.gpo.gov/2008/E8-10879.htm

You can also read a summary of the 2008 regulation changes in the Ticket to Work Regulation Changes - 2008 topic.

Information is presented below for two time periods, as the Ticket to Work Regulation Changes of 2008 significantly changed the payment systems. Select the time period of interest:

· Payment System after Regulation Changes effective June 21, 2008

· Payment System before Regulation Changes effective June 21, 2008

Click here to read the note at the end of this page for toll-free telephone numbers to get more information about the Ticket Program.

NOTE: The following section describes the Payment System after the Regulation Changes effective June 21, 2008.

Payment Systems Improvements

SSA has issued new regulations that significantly alter the payment systems of the Ticket to Work Program.

Improvements Associated with Beneficiary Participation

· Phase 1 Milestones based on part-time work and increases in self-sufficiency permit beneficiaries to receive a mix of benefit payments and earnings, recognizing that the road to self-sufficiency is often an incremental, multi-step process.

· Phase 2 Milestones based on gross earnings of Substantial Gainful Activity (SGA) encourage the use of SSA and other work incentives.

· Several improvements have been made to the "timely progress" requirements associated with a Ticket being "in-use."

Improvements Targeted for Employment Networks

· ENs earn milestones earlier in the process, more often, and at a higher rate.

· Some Milestones are available based on part-time work.

· Payments for SSI and SSDI beneficiaries are approximately the same.

· SSA can now pay a State VR agency and an EN for providing sequential services to the same beneficiary when VR serves the beneficiary under Cost Reimbursement and the beneficiary subsequently assigns his/her Ticket to the EN for job retention or ongoing support services.

Payment Calculation Base

The Payment Calculation Base (PCB) is the national average disability benefit payable under each of the Social Security Administration's two disability programs (SSI and SSDI) based on Social Security formulas. Each December the SSA calculates the two PCBs. See the Employment Network Outcome/Milestone Payment Amounts - TWWIIA topic for current PCB figures.

Payment Options

Under the new regulations, there are still two basic payment systems. ENs must choose one of the two systems:

· Outcome payment method, under which ENs will receive payment for outcomes months only; or

· Milestone-outcome payment method, under which ENs will receive reduced payments for outcome months in exchange for milestone payments in advance of the first outcome payments. Total possible payments for this method are approximately 90% of the Outcome only payments.

An outcome month is a month in which a beneficiary has earnings sufficient for "zero cash benefit" status and SSA pays no disability benefits to the beneficiary because of his/her work and earnings.

A milestone generally occurs after a beneficiary starts working and before Federal cash benefits stop because of work and earnings.

Outcome Payment Method

Under the Outcome Payment Method, a monthly payment equal to 67% of the applicable Payment Calculation Base is made to the EN for each outcome month in which a beneficiary has earnings sufficient for "zero cash benefit" status and SSA pays no disability benefits to the beneficiary because of his/her work and earnings.

For SSI ticket holders, there may be up to 60 of these payments. For SSDI ticket holders, there may be up to 36 of these payments.

The maximum total of outcome payments available to an EN is approximately the same for ticket holders of either disability program.

See the Employment Network Outcome/Milestone Payment Amounts - TWWIIA topic for current payment figures.

Milestone-Outcome Payment Method

Under the Milestone-Outcome Payment method, there are three distinct time periods of interest: Phase 1, Phase 2, and Outcome. There also can be a Milestone Reconciliation.

Phase 1 has four potential milestones, each of which yields a payment to ENs equal to 120% of the SSDI Payment Calculation Base for both SSI and SSDI beneficiaries. Milestone 1 occurs after one month's work at earnings equal to 50% of a Trial Work Period Month level. Milestone 2 occurs after three months (cumulative) work (out of last six) with monthly earnings equal to a Trial Work Period Month level. Milestone 3 occurs after six months (cumulative) work (out of last 12) with monthly earnings equal to a Trial Work Period Month level. Milestone 4 occurs after nine months (cumulative) work (out of last 18) with monthly earnings equal to a Trial Work Period Month level.

Milestone payments are made on gross wages before deductions for Work Incentives.

Payment of Milestone 4 requires substantial completion of services outlined in the beneficiary's Individualized Work Plan (IWP).

The maximum total of Phase 1 Milestone-Outcome payments available to an EN is identical for ticket holders of either disability program.

See the Trial Work Period topic for the current Trial Work Period Monthly Services amount.

Phase 2 milestones occur when the beneficiary has monthly gross earnings that exceed the Substantial Gainful Activity (SGA) amount. For each of these months, an EN receives a payment equal to 36% of the applicable Payment Calculation Base. For SSI recipients, the EN may receive up to 18 of these monthly payments. For SSDI beneficiaries, the EN may receive up to 11 of the payments.

Milestone payments are made on gross wages before deductions for Work Incentives.

All Milestones are consecutive and cumulative.

The maximum total of Phase 2 Milestone-Outcome payments available to an EN is approximately the same for ticket holders of either disability program.

See the Substantial Gainful Activity topic for the current Substantial Gainful Activity amount.

Outcome payments occur for each month in which a beneficiary has earnings sufficient for "zero cash benefit" status and SSA pays no disability benefits to the beneficiary because of his/her work and earnings. For each of these months, an EN receives a payment equal to 36% of the applicable Payment Calculation Base. For SSI recipients, the EN may receive up to 60 of these monthly payments. For SSDI beneficiaries, the EN may receive up to 36 of the payments.

The maximum total of Outcome payments available to an EN is approximately the same for ticket holders of either disability program.

Milestone Reconciliation is a payment that includes all Milestones available at the time of the first Ticket assignment that remain unpaid due to the start of the Outcome payment period. The reconciliation payment is made when the 12th Outcome payment is achieved.

NOTE: The following section describes the Payment System before the Regulation Changes effective June 21, 2008.

How many payment options are available to Employment Networks (ENs)?

Two. At the time an EN becomes an approved provider it can elect either the:

· Outcome payment system, under which it will receive payment for outcomes months only; or

· Outcome-milestone payment system, under which it will receive reduced payments for outcome months in exchange for milestone payments in advance of the first outcome payments.

What's the basic difference between outcome months and milestones?

Generally speaking, an outcome month is a month in which SSA pays no Federal cash disability benefits to a beneficiary because of his/her work and earnings. Under both EN payment systems, the maximum number of outcome payment months for each ticket is 60. These 60 outcome payment months do not have to be consecutive.

A milestone occurs after a beneficiary starts working and before Federal cash benefits stop because of work and earnings. There are four milestones for which an EN can be paid. A beneficiary attains a milestone when he/she has gross earnings from employment (or net earnings from self-employment) that exceed SSA's Substantial Gainful Activity (SGA) threshold amount for the number of months specified in the following table.

MILESTONE	NUMBER OF MONTHS EARNINGS MUST BE MORE THAN THE SGA THRESHOLD AMOUNT
1	1 month
2	3 months within a 12-month period
3	7 months within a 12-month period
4	12 months within a 15-month period

Don't benefits stop automatically when a beneficiary earns the SGA dollar amount?

No, and that's why one of the two EN payment options provides for milestone payments.

SSA has two disability programs and some individuals receive benefits under both programs.

· The Title II (Social Security) disability program is an insurance program for workers, their adult children, and their widow(er)s.

· The Title XVI (Supplemental Security Income (SSI)) disability program is a needs-based program for individuals with limited income and resources.

See SGA - SSI or SGA - SSDI for information on how earning over the SGA amount affects each benefit.

In terms of total payments, what is the difference between the two EN payment systems?

If an EN were eligible to receive all 60 outcome payments with respect to a ticket, then the payments under the outcome-milestone payment system would be about 85 % of what would be payable under the outcome payment system.

The difference in total payments lies in the fact that under the outcome-milestone payment system:

· the outcome payment rate is lower; and

· each outcome payment is reduced by an amount equal to 1/60th of the milestone payments received by an EN with respect to an individual.

Are the payments under the two EN payment systems based on the individual's benefit rate or on the costs an EN incurs?

Neither. The payments are based on the Payment Calculation Base (PCB) for the calendar year in which the beneficiary attains the outcome payment month or milestone. The PCB is the national average disability benefit payable under each of SSA's two disability programs. In December of each year, SSA will calculate, and post to its web page, an SSDI and an SSI PCB for milestones and outcome months achieved in the following calendar year. SSA will use the:

· SSDI PCB when computing the payment due an EN for serving an SSDI or a concurrent SSDI/SSI beneficiary; and

· SSI PCB when computing the payment due an EN for serving an SSI beneficiary, who is not concurrently an SSDI beneficiary.

As the national average disability benefit payable tends to rise every year due, in part, to cost-of-living adjustments, the annual computation of the PCB should increase.

What is the payment rate for the outcome payment system?

The outcome payment system has a flat payment rate. It is 40% of the applicable Payment Calculation Base (PCB) for the calendar year in which the beneficiary achieves the outcome month. This is the maximum amount that the law allows.

What are the payment rates for the outcome-milestone payment system?

The following chart summarizes the payment rates for the outcome-milestone payment system. They represent a percentage of the applicable PCB for the calendar year in which the beneficiary attains the milestone or outcome payment month.

TYPE OF PAYMENT	PAYMENT RATE (AS % OF THE APPLICABLE PCB)
Milestone 1	34%
Milestone 2	68%
Milestone 3	136%
Milestone 4	170%
Outcome payment month	34%

What are the actual payment amounts?

See the actual payment amounts by going to Employment Network Outcome/Milestone Payment Amounts.

Are there any other criteria for a milestone or outcome payment month?

Yes. There are three additional criteria.

1. The milestones for which payment may be made must occur before the first outcome payment month. Thus, an EN may actually receive fewer than four milestone payments for a particular beneficiary it serves.

2. A month after disability-based benefits terminate for work or earnings can be an outcome payment month only if the individual:

· earns more than the SGA threshold amount in the month; and

· is not entitled to or eligible for any type of monthly cash benefits from SSA for that month.

3. An EN may be paid only for milestones or outcome payment months that a beneficiary attains:

· after assigning the ticket to the EN; and

· before the ticket terminates.

When does a ticket terminate?

Generally, a ticket terminates with the earliest of the following:

· the month in which disability benefits terminate for reasons other than work and earnings;

· the month an individual entitled to Social Security widow(er)'s benefits based on disability attains age 65; or

· the month following the month an individual receiving SSI benefits on account of disability or blindness attains age 65.

However, should disability-based benefits terminate for work or earnings, then different rules apply. Under these rules, a ticket terminates with the earliest of the following:

· the month the individual attains full retirement age (beginning in 2003 SSA's full retirement age will increase gradually from age 65 to age 67);

· the month the individual dies;

· the month the individual becomes entitled to or eligible for a non-disability-based benefit from Social Security;

· the month SSA makes a subsequent unfavorable disability determination (i.e., the month SSA denies a subsequent application for disability benefits, or the month SSA decides not to approve a request to reinstate disability-based benefits); or

· the month the SSA makes a favorable disability determination (i.e., the month the individual again becomes entitled to or eligible for disability-based benefits based on a new application, or the month the individual is eligible to receive another ticket because SSA approves a request to reinstate disability-based benefits).

Can an EN change its elected payment system?

Yes. SSA will periodically give an EN the opportunity to change its elected payment system. The change will apply to prospective clients only. It will not apply to clients who have already assigned their ticket to the EN under the EN's earlier elected payment system.

Must a State vocational rehabilitation (VR) agency elect an EN payment system?

Yes. However, when a State VR agency is serving a person with a ticket, a State VR agency can elect, on a case-by-case basis, to be paid as an EN under its chosen EN payment system or to be paid under the traditional VR cost reimbursement payment system.

Is it possible to pay more than one EN?

Yes. It is possible for more than one EN to receive payment for serving the same beneficiary at different times. However, special rules may apply. For example:

· When two ENs request payment for the same milestone or same outcome payment month, the payment will be allocated based upon the services each EN provided.

· If SSA pays a State VR agency under the traditional cost reimbursement payment system with respect to a ticket, such payment precludes any subsequent payment based on the same ticket to an EN (or another State VR agency) under one of the two EN payment systems.

· Conversely, if SSA pays an EN (or State VR agency) under one of the two EN payment systems with respect to a ticket, such payment precludes any subsequent payment based on the same ticket to a State VR agency under the traditional cost reimbursement payment system.

How are payment requests processed?

ENs send requests for payment, evidence of a beneficiary's work or earnings, and other information to SSA's Ticket Program Manager (PM), MAXIMUS, Inc. MAXIMUS, Inc. reviews the information and makes a recommendation for payment to SSA. SSA then determines all final approvals for payment.

For More Information About the Ticket Program

Social Security has contracted with MAXIMUS, Inc., which will serve as the Program Manager for the Ticket Program. MAXIMUS is a private organization that will help Social Security manage the program. One of their main duties will be to provide information to beneficiaries and the general public about the Ticket Program.

MAXIMUS has toll-free telephone numbers for the Ticket Program. These numbers are:

1-866-968-7842 (1-866-YOURTICKET)
TTY (1-866-833-2967) (1-866-TDD 2 WORK)

MAXIMUS has trained staff at these phone numbers that can answer all questions related to the Ticket Program.

Additional information is also available on MAXIMUS' web site, http://www.yourtickettowork.com.