CRPCRPCRPCRPCRPBRIEF Your Source for Issues and Trends in Community Rehabilitation This project is in part supported under a grant from the Department of Education. However, the contents do not necessarily represent the policy of the Department of Education and endorsement by the Federal Government should not be assumed. HIGHLIGHTS The Ticket to Work and Work Incentives Improvement Act (PL 106-170) was signed into law on December 17, 1999. Its purpose is fourfold: 1. To provide health care and employment preparation and placement services to individuals with disabilities that will enable those individuals to reduce their dependence on cash benefit programs; 2. To encourage states to adopt the option of a Medicaid Buy-In, allowing individuals with disabilities to purchase Medicaid coverage that is necessary to enable them to maintain employment; 3. To provide enhanced options to individuals with disabilities for maintaining Medicare coverage while working; and 4. To establish a “Ticket to Work and Self-Suffi- ciency Program” that allows SSDI and SSI beneficiaries to seek employment services, VR services, and other support needed to obtain, retain, or maintain employment and reduce their dependence on cash benefit programs. IMPLICATIONS FOR CONSUMERS Over the next few years, as SSA rolls out and implements the Ticket to Work Program in selected states, the requirement for SSA to refer beneficiaries to state VR agencies first will cease to be in effect. That is, a beneficiary will have the option of deciding when and whether to use his or her Ticket to obtain services from an EN (Employment Network), or from the State VR agency. A beneficiary with a Ticket may assign it to any EN they choose, or the State VR agency, as long as that EN or State VR agency is willing to accept their Ticket. Beneficiaries may discuss their employment and rehabilitation plan with as many ENs in their areas as they wish, or with the State VR agency. However, a beneficiary cannot assign his or her Ticket to more than one EN at a time, or an EN and the State VR agency at the same time. A list of available providers can be obtained from the Program Manager, MAXIMUS, Inc. (866-968- 7842, TDD 866-833-2967). The EN or State VR agency will only receive payment for its services if the beneficiary achieves certain work-related outcomes. At any time, a beneficiary can retrieve his or her Ticket from an EN or State VR agency and reassign it to another, as long as Ticket eligibility requirements continue to be met. The Ticket to Work and the Self-Sufficiency Program Vol. 1, No. 2 August 2002 The following contains excerpts from “The Ticket To Work and Self-Sufficiency Program” Policy and Practice Series, Thomas P. Golden, Director, Northeast Work Incentives Support Center at Cornell University; and, James R. Sheldon, Jr., Attorney, Neighborhood Legal Services of Buffalo, New York. A full copy of this series can be viewed at www.ilr.cornell.edu/ped/dep/pp_6.pdf Who is eligible for a ticket? To be eligible to receive a Ticket, an SSDI and/or SSI beneficiary must reside in a Ticket state. In addition to residing in a Ticket State, an individual who is entitled to title II disability benefits or title XVI (SSI) disability or blindness benefits must also meet several criteria to be eligible for a Ticket: • be 18 through 64 years of age; • if an SSI recipient, be eligible for benefits under the adult disability standard; • be receiving a Federal cash benefit from Social Security; • have a disabling impairment which is classified by SSA as either medical improvement not expected or medical improvement possible, or, if the impairment is classified as medical improvement expected, have undergone at least one Continuing Disability Review (CDR) and been found to have a continuing disability. (See Cornell University’s Full Policy and Practice Brief for restrictions.) RELEVANCE TO CRPS The role of employment networks An EN can be Any Public or Private Entity An EN is any qualified entity that has entered into an agreement with the SSA to function as an EN under the Ticket to Work program. To serve as an EN, an entity must meet and maintain compliance with both general and specific selection criteria. General criteria include: • having systems in place to protect the confidentiality of personal information about beneficiaries seeking or receiving services; • being both physically and programmatically accessible; • not discriminating in the provision of services based on a beneficiary’s age, gender, race, color, creed, or national origin; • having adequate resources to perform the activities required under the agreement with SSA or the ability to obtain them; and, • implementing accounting procedures and control operations necessary to carry out the Ticket program. The specific criteria that an entity must meet to qualify as an EN 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; • using staff that are otherwise qualified based on education or experience, such as by using staff with experience or a college degree in a field related to the services the EN wants to provide such as vocational counseling, human relations, teaching, or psychology; and • taking reasonable steps to assure that if any medical and related health services are provided, such medical and health-related services are provided under the formal supervision of persons licensed to prescribe or supervise the provision of these services in the State in which the services are performed. Any entity must have applicable certificates, licenses, or other credentials if such documentation is required by State law to provide VR services, employment services or other support services. How to become an EN An entity, other than a State VR agency, applies to SSA to become an EN by responding to SSA’s request for proposals (RFP). This RFP is available through SSA’s website at: www.ssa.gov/ work. The applicant must certify that it is qualified to provide employment services, VR services, or other support services to beneficiaries either directly or through contract or other arrangement. MAXIMUS has scheduled the following recruitment forums to provide more information to agencies interested in becoming an employment network. • September 10, Shreveport • September 12, New Orleans • September 19, Little Rock EN Responsibilities The EN assumes responsibility for the coordination and delivery of employment services, VR services, or other support services to beneficiaries payable because of work or earnings. An EN can be paid for an outcome month only if it is attained after a beneficiary has assigned his or her Ticket to the EN and before the individual’s Ticket terminates. An outcome payment under this payment system will be equal to 40 percent of the Payment Calculation Base for the calendar year in which the outcome payment month occurs, rounded to the nearest whole dollar. Payments under the “outcome milestone payment system” SSA can pay the EN for up to four milestones achieved by the beneficiary after the Ticket is first assigned and the beneficiary begins to work. In addition, SSA can pay the EN for up to 60 outcome payment months that the beneficiary attains for each month that no SSDI or disability cash payments were made. The Four Milestones are based on the earnings levels that SSA uses when it considers whether a beneficiary’s work activity is substantially gainful activity (currently over $780.00 per month for a household). Scheduled phases of implementation In Region VI, SSI/SSDI beneficiaries will receive Tickets in the following manner: Phase I: Oklahoma - already distributed Phase II: Arkansas, Louisiana, New Mexico - 2002 Phase III: Texas - 2003 SUMMARY The intent of the ticket legislation is to provide consumers with more choices and options for employment providers. To date, potential “ticket” customers have not “flooded” the system. In Oklahoma, there were fewer than 70 calls to the DRS hotline after the first wave of Tickets were released. However, as with any new programs, it will be some time before we know the full effect. who have assigned their Ticket to that EN. An EN may consist of either a single provider of such services or a group of providers organized to combine their resources into a single entity. An EN provides services either directly or by entering into agreements with other providers. An EN must develop and implement IWPs in partnership with each beneficiary whom they agree to serve in a manner that affords the beneficiary the opportunity to exercise informed choice in selecting an employment goal and specific services needed to achieve that goal. An employment network cannot change a beneficiary for services. The two EN payment systems ENs may elect to be paid under one of two EN payment systems - the Outcome Payment System or the Outcome-Milestone Payment System. Payments under the new EN payment systems differ, depending on the option chosen and the types of benefits received by the beneficiary. The pace of payments to an EN will also depend on how quickly the beneficiary achieves the required work outcomes. An EN elects one of the two payment systems when it enters into an agreement with SSA to serve as an EN. After first electing a payment system, the EN can then make one change in its chosen payment system at any time during the first 12 months after the month it becomes an EN, or within 12 months after the month the Ticket program starts in its State, whichever occurs later. Additionally, at least every 18 months SSA will offer each EN the opportunity to change its elected payment system. Payments under the “outcome payment system” SSA can pay the EN for up to 60 outcome payment months that a beneficiary attains during his or her outcome payment period. 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