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Social Security issued new regulations effective June 21, 2008 that significantly improve the Ticket to Work Program. These changes expand the choices available to Social Security beneficiaries with disabilities who want to enter or reenter the workforce, and facilitate a wider array and better coordination of the services and supports available to beneficiaries. With increased support, a better payment plan, and incentives for partnering with State Vocational Rehabilitation (VR) agencies, the new regulations could provide service providers and employers with opportunities to become Employment Networks (ENs) and start incorporating the Ticket into their business practices.
You may read this topic's sections sequentially or jump to any specific section using the links below:
· Improvements Associated with Beneficiary Participation
· Improvements Targeted for Employment Networks
· Social Security believes these improvements in the regulations will:
· Key Changes to June 2008 Ticket to Work Regulations
· Questions and Answers on the New Regulations
o EN Payment and Contract Questions
o EN/VR Relationship Questions
· Eligibility for the Ticket has been expanded to all adult beneficiaries ages 18 through 64. Prior to this, certain beneficiaries were not eligible to receive a Ticket prior to completion of their first Continuing Disability Review (CDR) because medical improvement was expected to occur.
· 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."
· 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.
· Encourage more organizations to become ENs and increase the range and number of ENs available to serve beneficiaries.
· Promote more partnering between organizations and expand the range of services offered to beneficiaries, as well as improve the coordination of services provided to beneficiaries.
· Promote better coordination of a variety of services available to beneficiaries at the Federal, State and local levels, including coordination of VR and EN services and better coordination of SSA Work Incentives.
The new regulations substantially revise the amount and manner of payments to Employment Networks.
See the Ticket Payment Systems and Employment Networks and Employment Network Outcome Milestone Payment Amounts topics for comprehensive information about the new payment systems.
The new Ticket regulations create opportunities for new EN-VR partnerships. Now SSA will pay a State VR agency and an EN for providing sequential services for the same beneficiary. A Ticket Holder may receive VR services to meet his/her intensive up front service needs and, after the VR case is closed with the beneficiary in employment, the beneficiary may assign his/her Ticket to an EN and receive job retention or other support services. While the EN has the opportunity to earn both Phase 2 Milestones and Outcome payments, the Phase 1 Milestones would not be available to the EN because VR provided those up-front, intensive services leading to employment.
SSA has determined that Phase 1 Ticket payments should be awarded based on work that an EN helps a beneficiary achieve. This means that one or more of the Phase 1 Milestones may not be available to an EN if the beneficiary worked during the 18 months prior to assigning his/her Ticket to that EN.
Transition to the New EN Payment System: The payment rate in effect at the time the Milestone or Outcome is attained is the rate that will be paid for that particular payment month.
The table below shows the regulatory improvements made to the specific Ticket program items along with a comparison to prior regulations related to those items.
NOTE: Section numbers in the questions and answers below (enclosed in brackets "[" and "]") refer to 20 CFR Part 411.
|
Item |
Prior Regulation |
New Ticket Regulation effective July 21, 2008 |
|
Return to Work Concept |
Does not address the reality that entering the workforce or returning to work for SSA beneficiaries is an incremental and often episodic process. Payments are only available once the beneficiary's earnings reach the Substantial Gainful Activity (SGA) level. |
Creates a three phase return to work process: 1) Starts with Phase 1 Milestone payments based on work at the 2009 Trial Work level of $700 ($670 a month in 2008). [411.525(a)(2)] 2) Progresses to Phase 2 Milestones based on earnings at gross SGA levels (does not require deductions for Work Incentives). SGA levels in 2009 are $980 for disabilities other than blindness and $1,640 for beneficiaries who are blind (was $940 and $1,570 in 2008). [411.525(a)(2)(ii)] 3) Moves to standard in prior rules where Outcome payments are triggered by net SGA earnings (i.e. after deductions for Work Incentives) and a zero cash benefit status. The payment system and the way SSA measures timely progress are designed to facilitate this gradual return to self-sufficiency. |
|
Who is eligible for a ticket? |
Adult beneficiaries with disabilities, ages 18 through 64: · All Medical Improvement Not Expected (MINEs) and Medical Improvement Possible (MIPs) · Medical Improvement Expected (MIEs) eligible only after having had a Continuing Disability Review (CDR) |
Effective July 21, 2008 all adult beneficiaries with disabilities will be eligible to receive Tickets. Tickets will not be mailed to MIEs until around Nov. 1, 2008 due to computer system delays. [411.125] |
|
Outcome Only EN Payment System |
40% of payment calculation base (PCB—based on average benefit paid in prior year for SSDI and SSI-only) for up to 60 months of no cash benefit due to work activity |
67% of the payment calculation base · For up to 36 months for SSDI beneficiaries ($657 a month). Total potential payments equal $23,652. · For up to 60 months for SSI beneficiaries ($377 a month). Total potential payments equal $22,620. [411.525(a)(1)(i); 411.550] |
|
Outcome-Milestone EN Payment System |
Up to 4 Milestone payments after 1,3,7, and 12 months of SGA 1. 1st month SGA ® 34% of PCB 2. 3 months SGA ® 68% of PCB 3. 7 months SGA ® 136% of PCB 4. 12 months SGA ® 170% of PCB (No equivalent to Phase 2)
Outcome payments = 36% of PCB reduced for Milestone recovery |
Four Phase 1 Milestone Payments (based on months of work at Trial Work level, i.e., $700 a month in 2009, was $670 in 2008) are available to compensate for initial efforts at self-supporting employment. [411.500(f)(1)] 1. 50% of TW in a month ® 120% SSDI PCB($1177) 2. 3 months (out of last 6) TW ® 120% SSDI PCB 3. 6 months (out of last 12) TW ® 120% SSDI PCB 4. 9 months (out of last 18) TW ® 120% SSDI PCB *In Phase 1, all payments based on 120% of SSDI PCB, for 2008 = $1177. Payment of Milestone 4 requires substantial completion of services outlined in the beneficiaries Individualized Work Plan (IWP). [411.525(a)(2)(i)]
Phase 2 Milestone Payments (per month of work at gross earnings equal to SGA level, i.e., $940 non-blind and $1,570 blind in 2009, was $940 non-blind and $1,570 blind in 2008) · Up to 11 payments of $353 for SSDI or up to 18 payments of $203 for SSI Each payment equal to 36% of respective PCB. [411.525(a)(2)(ii)] *Milestone payments are made on gross wages before deductions for Work Incentives. [411.525(a)(2)(i) & (ii)] Milestones are consecutive and cumulative
Outcome Phase Monthly Payments Up to 36 payments of $353 for SSDI and up to 60 payments of $203 for SSI. Amount is 36% of respective PCB without Milestone recovery. [411.525(a)(2)(iv); 411.545] |
|
Transition to New Payment System *Transition payment cases are those where some, but not all, of the EN payments have been made under the prior regulations. |
N/A |
A case will be transitioned at the time SSA makes the first payment under the new rules for work attained in July 2008 or later. Once a payment is made under the new rules for July 2008 or later, SSA will no longer make a payment under the old rules. [411.500(g); 411.551] 1. SSA will equate prior four Milestones with new Phase 1 Milestones and pay the next unpaid Milestone. [411.551(a)] 2. If all four prior Milestones were attained then the beneficiary enters the new system at the beginning of Phase 2 Milestones. [411.551(b)] 3. If Outcome payments started then Outcome payments will continue at the new rates based on a formula. Payments made will be totaled and subtracted from the new "total" value of the Ticket, and then the remainder will be divided by the applicable monthly Outcome payment amount under the new rules to determine the number of Outcome payments available (must be 60 or less). Total payments cannot exceed total value of the Ticket at the time of transition. [411.551(c)(1), (2) & (3)] 4. All payment requests for all Milestones and Outcomes earned under the prior rules must be submitted by March 31, 2009. [411.551] |
|
Milestone Reconciliation – when Outcome payment period starts before all Milestones are paid |
N/A |
Final rule adds a "Milestone reconciliation" payment that includes all Milestones available at time of 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. [411.500(h); 411.525(c); 411.536] |
|
Total Payments: |
· Total of Outcome-Milestone payments equals 85% of Outcome only payments · SSDI total payments about 70% higher than SSI |
· Outcome-Milestone payments increased to 90% of Outcome only payments [411.525(b)] · SSDI and SSI total potential payments about equal ($21,299 for SSDI and $20,542 for SSI). |
|
Milestone Recovery |
Uniformly over the 60 months of Outcome payments (i.e. 1/60 of total Milestones paid will be recovered from each monthly Outcome payment). |
No recovery from Outcome payments will be required. |
|
"Timely Progress" Definition of Using a Ticket for Purposes of Continuing Disability Review (CDR) Protection |
1. 24 month review – "active" participation required. No work requirement. 2. 36 month review - 3 months work at SGA level 3. 48 month review - 6 months work at SGA level 4. 60 month review - 6 months work above SGA and $0 cash benefit level · Successive 12 month reviews - 6 months work above SGA and $0 cash benefit level |
Changes to Timely Progress Review requirements [411.180]: 1. 12 month review - 3 months work at Trial Work level ($700 in 2009, was $670 in 2008) or 60% of full time college credits for 1 year earned. 2. 24 month - 6 months work at TW level or 75% of full time college credits for 1 year earned. 3. 36 month - 9 months work > SGA or completed 2 year program or an additional 1year of full-time college credit earned. 4. 48 Month - 9 months work > SGA or an additional 1 year of full-time college credit earned. 5. 60 months - 6 months @ $0 payment level or an additional 1 year of full-time college credit earned. 6. 72 months - 6 months @ $0 cash payment level or completed 4 year college program. · Successive 12 month periods 6 months @ $0 payment level. *10% variance tolerance applies. [411.166(h)] |
|
Transition to Timely Progress Rules |
N/A |
At time of first review after July 21, 2008, the beneficiary will receive a letter notifying him/her of the new requirements that will be applied one year later at the time of the next scheduled review. [411.226(b)] |
|
Vocational Rehabilitation (VR) Agency Rules |
A State VR agency can elect to be paid under Cost Reimbursement rules, BUT Ticket must be assigned to the VR agency to be eligible to submit for Cost Reimbursement. No payments allowed under either EN payment system if VR had ticket assigned under Cost Reimbursement. |
1. If VR agency provides services under Cost Reimbursement method, then a new "in use-SVR" status provides CDR protection for beneficiary. Beneficiary cannot assign the Ticket to an EN while VR has an open case. CDR protection is extended for 90 days after VR case closure. VR agencies will be asked to submit information on beneficiary cases being opened to be served under Cost Reimbursement electronically every month. [411.166(a)] 2. VR and EN can both receive payment sequentially, VR under Cost Reimbursement and EN under the elected EN payment system after VR case closure and assignment of Ticket to the EN. EN who accepts a ticket after VR achieves an employment outcome and closes the case is only eligible for Phase 2 Milestone and Outcome payments. Phase 1 Milestone payments will not be available. [411.135; 411.140; 411.535(a)(iii); 411.585] |
|
Effect of Recent Work and Earnings. |
N/A |
Final regulations contain a "recent work" rule which will be applied when the Ticket is first assigned. Under the new rules, some Phase 1 Milestone payments may not be available if the beneficiary worked above the Trial Work level during the 18 months prior to Ticket assignment. [411.535(a)(1)(ii)] · Milestone 1 not available if earnings > TWP level in the month prior to Ticket assignment · Milestone 2 not available if earnings in 3 of last 6 months > TWP · Milestone 3 not available if earnings in 6 of last 12 months > TWP · Milestone 4 not available if earnings in 9 of last 18 months > TWP * does not apply to transition cases |
|
EN Overpayments Due to Benefits Eligibility Errors |
ENs must repay if Ticket payments were made and SSA retroactively determined that the beneficiary was not eligible for disability benefits. |
SSA will not seek an adjustment if a retroactive determination or decision about a beneficiary's right to benefits causes an overpayment to the EN. [411.555(c)] |
|
EN Reporting |
No requirement that EN report when they want Ticket taken out of assignment. |
Clarifies that ENs must also report to the Maximus (the OSM) when they want a Ticket taken out of assignment. [411.145(a)] |
|
EN Payments to Beneficiary |
N/A |
States that payments to beneficiaries are allowed. [411.566] *Payments to beneficiaries currently treated as unearned income. |
|
DOL Workforce One-Stop Centers & American Indian Vocational Rehabilitation (VR) Service Projects |
N/A |
States that SSA recognizes Workforce Investment Boards and One-Stop Career Centers [411.310(d)], and American Indian VR Service Projects [411.310(e)] as qualified to be ENs with streamlined contract requirements. These entities are still required to enter into a contract with SSA and comply with both general and specific requirements associated with being an EN; however, they are now considered to be automatically "qualified" to be ENs and have been deemed to have met the liability insurance requirements in the EN Request for Proposal. To become an EN, such entities need only complete and submit to SSA a 12-page portion of the RFP found in Part III--EN Proposal Documentation Requirements. This completed documentation constitutes their EN contract proposal. |
NOTE: Section numbers in the questions and answers below (shown with a "§" symbol) refer to 20 CFR Part 411.
1. What are the transition rules for payments to an EN who is already working with a Ticket Holder under the existing payment system? Will the new Milestones and Outcomes supersede the old ones? Any retroactivity?
The payment rate in effect at the time the Milestone or Outcome is attained is the rate that will be paid for that particular payment month. The new rates are not retroactive. See response to question 2 (below) and §411.551 for the transition rules.
2. Can an EN receive Milestone and Outcome payments under both the old and the new systems for a case in process at the time the new regulations go in to effect?
A transition case is defined as a case on which payments were attained prior to the effective date of the new regulations.
An EN will receive payments under the new EN payment system for Milestones and Outcomes attained beginning with the effective date of the new regulations. An EN has until March 31, 2009 to request payments for work attained prior to July 2008. See §411.551.
3. What can be expected by an EN who takes a Ticket from a beneficiary who is already working?
If this is the first time the Ticket is being assigned and the beneficiary has not been working with the State Vocational Rehabilitation agency prior to Ticket assignment, the EN may expect to receive all payments available on the Ticket once the required level of work is achieved.
However, if the beneficiary has trial work level of earnings in the 18 months prior to Ticket assignment, some or all Phase 1 Milestones may not be paid to the EN. .
If the EN accepts a Ticket that has been previously assigned, the EN may receive any available but previously unpaid payments under its chosen EN payment system. If the beneficiary was previously working with a State VR agency and VR closed the case with the beneficiary in employment, the Phase 1 Milestones are not available to the EN because VR provided the service that resulted in the beneficiary’s initial employment.
4. Will existing EN contracts be automatically transferred or "grandfathered" into the new system?
Existing ENs will have an opportunity to accept or reject a contract adjustment reflecting the changes in the new regulations. If an EN accepts the contract adjustment, they will continue to participate in the Ticket Program.
1. Under the new regulations, how are ENs and VR agencies encouraged to work together on behalf of Ticket Holders?
After the State VR agency closes a case under the Cost Reimbursement payment option, the beneficiary may assign his/her Ticket to an EN for job retention or other support services. As the beneficiary continues work at the required level, the EN subsequently becomes eligible for Ticket payments. At the same time, the State VR agency may become eligible for Cost Reimbursement. This new policy encourages partnerships between ENs and State VR agencies since both organizations can receive payment on the same Ticket. See §411.135 and §411.140.
2. What happens to EN payments if a Ticket is assigned after a person has already worked with VR -- a) under the Cost Reimbursement system, or b) under the VR-as-EN system?
(a) See response to question 4 of this section.
(b) If a person works with a State VR agency that chose to be paid under an EN payment system and later assigns his or her Ticket to another EN, the second EN will be entitled to any payments for work attained beginning with the month that the second EN held the Ticket assignment. This is current policy. The new regulations do not change this.
3. What happens to VR payments if a Ticket was previously assigned to an EN and payments made?
If payments were previously made to an EN and then the Ticket is unassigned, a State VR agency can still be paid under the Cost Reimbursement option. In addition, a State VR agency that chooses to be paid under one of the EN payment systems could receive any available unpaid payments on that same Ticket. See §411.585.
4. Can an EN and a VR agency work with a Ticket Holder simultaneously? Or, if handled sequentially, what are the effects on payments to the EN and VR agency?
An EN and a State VR agency cannot work with a Ticket Holder simultaneously and receive payments under the new Partnership Plus option. This option applies when an EN and a VR agency provide services sequentially to the same beneficiary. When an EN receives a Ticket from a beneficiary who was working when the State VR agency closed his or her case, the EN may receive Phase 2 Milestone payments and Outcome payments once the beneficiary achieves the required level of work. Phase 1 payments are not available to the EN under these circumstances. See §411.535(a)(1)(iii).
It is important to note that nothing precludes a VR agency from paying a service provider that has been approved to function as an EN for services provided under a "fee for service" contract while the beneficiary’s case is still an open VR case or during the period of time during which a VR agency may provide post-employment services after case closure. Such arrangements do not impact the opportunities for payments under the Ticket Program's Partnership Plus provisions.
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
The Ticket to Work Regulations (20 CFR Part 411) are available online at:
http://www.socialsecurity.gov/OP_Home/cfr20/411/411-0000.htm
Ticket to Work and Self-Sufficiency Program
Ticket Payment Systems and Employment Networks
Employment Network Outcome/Milestone Payment Amounts - TWWIIA
Partnership Plus - Ticket to Work Program
http://www.socialsecurity.gov/work/documents/SSA-63-024%20Overview%20of%20Final%20Regs1.pdf
http://www.socialsecurity.gov/work/documents/SSA-63-035%20Q%20and%20A%20Regs.pdf
http://www.socialsecurity.gov/work/newregs.html
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