[Federal Register Volume 65, Number 250 (Thursday, December 28, 2000)]
[Proposed Rules]
[Pages 82844-82874]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-32924]
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Part IV
Social Security Administration
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20 CFR Part 411
The Ticket to Work and Self-Sufficiency Program; Proposed Rule
Federal Register / Vol. 65, No. 250 / Thursday, December 28, 2000 /
Proposed Rules
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SOCIAL SECURITY ADMINISTRATION
20 CFR Part 411
RIN 0960-AF-11
The Ticket to Work and Self-Sufficiency Program
AGENCY: Social Security Administration.
ACTION: Notice of proposed rulemaking.
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SUMMARY: We are proposing rules to implement the new ``Ticket to Work
and Self-Sufficiency Program'' (Ticket to Work program) authorized by
the Ticket to Work and Work Incentives Improvement Act of 1999. The
Ticket to Work program will provide disabled beneficiaries with
expanded access to employment services, vocational rehabilitation
services, or other support services. We will pay the providers of those
services after the beneficiaries achieve certain levels of work.
DATES: To be sure that your comments are considered, we must receive
them no later than February 26, 2001.
ADDRESSES: Comments should be submitted:
In writing, to the Commissioner of Social Security, P.O.
Box 17703, Baltimore, MD 21235-7703;
By telefax to (410) 966-2830;
By E-mail to [email protected]; or
Delivered to the Office of Process and Innovation
Management, Social Security Administration, 2109 West Low Rise
Building, 6401 Security Boulevard, Baltimore, Maryland 21235-6401,
between 8 a.m. and 4:30 p.m. on regular business days. You may also
inspect comments during these same hours by making arrangements with
the contact person shown below.
FOR FURTHER INFORMATION CONTACT: Geoffrey Funk, Team Leader,
Legislative Implementation Team, Office of Employment Support Programs,
Social Security Administration, 6401 Security Boulevard, Baltimore,
Maryland 21235-6401. Call (410) 965-9010 or TTY 1-(800) 988-5906 for
information about these proposed rules. For information on eligibility
or filing for benefits, call our national toll-free number, 1-(800)
772-1213 or TTY 1-(800) 325-0778. You may also contact SSA Online at
www.ssa.gov.
SUPPLEMENTARY INFORMATION:
Background
The National Organization on Disability/Harris Survey of 1998 found
that only 29 percent of individuals with disabilities were working
full- or part-time. From 1986 to 1999, the number of individuals
receiving disability benefits rose 80 percent, with about half
receiving Social Security disability benefits and half Supplemental
Security Income (SSI) benefits. Among the factors contributing to this
increase were expanded eligibility for benefits, SSA's outreach
efforts, the recession of the late 1980's and early 1990's, greater
demand for benefits due to the lack of adequate, affordable health care
insurance, and the aging of the work force. The Federal government
spent $51.3 billion on Social Security disability benefits in 1999, and
$22.9 billion in SSI. Many States use State funds to supplement the
benefits of SSI beneficiaries.
According to the U.S. General Accounting Office, less than 1
percent of Social Security disability and SSI beneficiaries leave the
Social Security and SSI rolls each year as a result of paid employment.
Of those who leave, about one-third return within 3 years. If just one-
half of one percent of the current Social Security disability and SSI
recipients were to cease receiving benefits as a result of engaging in
self-supporting employment, savings in cash assistance would total $3.5
billion over the work-life of those individuals.
These proposed rules are intended to expand the options available
for Social Security disability beneficiaries and disabled or blind SSI
beneficiaries to access vocational rehabilitation services, employment
services, and other support services that are necessary for such
beneficiaries to obtain, regain or maintain employment that reduces
their dependency on cash assistance. We expect that the expansion of
these options and the creation of new work incentives in the Ticket to
Work and Work Incentives Improvement Act of 1999 (TWWIIA) will remove
some of the disincentives that many beneficiaries with disabilities
face when they attempt to work or, if already working, continue working
or increase their work effort. If more beneficiaries with disabilities
engage in self-supporting employment, the net result will be a
reduction in the Social Security and SSI disability rolls and savings
to the Social Security Trust Fund and general revenues.
Ticket to Work and Work Incentives Improvement Act of 1999
On December 17, 1999, President Clinton signed into law the Ticket
to Work and Work Incentives Improvement Act of 1999 (Public Law 106-
170).
In section 2(b) of TWWIIA, the Congress states that TWWIIA has four
basic purposes. In general, these are:
--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.
--To encourage States to adopt the option of allowing individuals with
disabilities to purchase Medicaid coverage that is necessary to enable
such individuals to maintain employment.
--To provide individuals with disabilities the option of maintaining
Medicare coverage while working.
--To establish a ``Ticket to Work and Self-Sufficiency Program''
that allows Social Security disability and disabled or blind SSI
recipients to seek the employment services, vocational rehabilitation
services, and other support services needed to obtain, regain, or
maintain employment and reduce their dependence on cash benefit
programs.
Section 101(a) of TWWIIA amends part A of title XI of the Social
Security Act (the Act) by adding a new section 1148, The Ticket to Work
and Self-Sufficiency Program (Ticket to Work program). The purpose of
the Ticket to Work program is to expand the universe of service
providers available to beneficiaries with disabilities who are seeking
employment services, vocational rehabilitation services, and other
support services to assist them in obtaining, regaining and maintaining
self-supporting employment.
The Social Security Administration is required to develop the
regulations necessary to implement TWWIIA and to provide details
regarding the Ticket to Work program. Section 1148(l) of the Act
requires the Commissioner to prescribe such regulations as are
necessary to carry out the provisions of section 1148 of the Act. In
addition, section 101(e) of TWWIIA requires the Commissioner of Social
Security to prescribe such regulations as are necessary to implement
the amendments made by section 101. We are proposing these regulations
to address a number of areas where specific policy decisions were left
to the discretion of the Commissioner.
Under the Ticket to Work program, the Commissioner may issue
tickets to Social Security disability beneficiaries and disabled and
blind SSI beneficiaries. Each beneficiary will have the option of using
his or her ticket to obtain services from a provider known as an
employment network (EN). The beneficiary will choose the EN, and the EN
will provide employment services, vocational rehabilitation services,
and other support services to assist the beneficiary in obtaining,
regaining and maintaining self-supporting
[[Page 82845]]
employment. ENs will also be able to choose who they serve.
The Commissioner's intent in developing the proposed rules for the
Ticket to Work program is to allow service providers that have
traditionally provided employment services, vocational rehabilitation
services and other support services, as well as other types of
entities, to qualify as ENs and serve beneficiaries with disabilities
under the program. The expansion of options available to obtain these
services will provide beneficiaries with real choices in getting the
services they need to obtain, regain, or maintain employment.
Public Education Forums and Conferences
Immediately following passage of TWWIIA, we began working with the
U.S. Departments of Health and Human Services, Education, and Labor, as
well as the Presidential Task Force on the Employment of Adults with
Disabilities, the President's Committee on Employment of People with
Disabilities, and the National Council on Disability. These Federal
partners joined together to plan and conduct a series of public
education forums. The purpose of the forums was to increase the
awareness of public disability programs among individuals with
disabilities, their families and representatives, and service
providers. The forums focused on Federal and State employment-related
policies and programs for people with disabilities.
Forums were scheduled in eleven major cities across the country.
Those cities were Baltimore, MD (December 12, 1999); Kansas City, MO
(February 2, 2000); Durham, NC (March 9, 2000); Phoenix, AZ (March 30,
2000); New York, NY (April 6, 2000); Austin, TX (May 17, 2000);
Seattle, WA (June 13, 2000), Worcester, MA (June 26, 2000); Chicago, IL
(August 1, 2000); Harrisburg, PA (August 15, 2000); and Denver, CO
(September 13-14, 2000).
Representatives from many national and community-based
organizations (e.g., the SSI Coalition, Virginia Commonwealth
University, Disability Rights Education and Defense Fund, the National
Brain Injury Association, Consortium for Citizens with Disabilities,
Robert Wood Johnson Foundation, National Council on Independent Living,
Capstone Group, and State representatives from the Developmental
Disabilities Councils, the State Independent Living Councils, and the
Governors' Committees on Employment of People with Disabilities)
participated in these forums.
The forums provided participants with both information and an
opportunity for discussion. Topics included: SSA customer services and
work incentives; State health care systems and models; and employment
initiatives of the Departments of Education, Labor, and Health and
Human Services.
The forums were also used as an opportunity to share information
about TWWIIA and conduct exploratory discussions about policy issues
relating to the implementation of the provisions in TWWIIA that were
left to the Commissioner to interpret. New models where State and local
systems are working together to serve their common customers with
disabilities were highlighted.
SSA representatives have also been involved in meetings and
conferences on the national, regional, State, and local levels. These
included SSA-sponsored forums in Chicago, San Francisco, Dallas,
Denver, and Philadelphia conducted in January and February 2000, which
focused on the Ticket to Work program. At these meetings and
conferences, SSA representatives made presentations on TWWIIA,
facilitating discussion and obtaining recommendations that were
considered in developing the provisions of the Ticket to Work program
that are being addressed in these proposed rules.
SSA's Programs for Rehabilitation Services Prior to Implementation
of the Ticket to Work Program
In titles II and XVI of the Social Security Act, Congress provided
that we promptly refer individuals applying for or determined eligible
for Social Security disability benefits or SSI benefits based on
disability or blindness to State vocational rehabilitation (VR)
agencies for necessary rehabilitation services. Under the statute and
by regulations, if a State VR agency does not serve a beneficiary whom
we referred, we may use other public or private agencies,
organizations, institutions or individuals to provide services. Under
our regulations, these other providers of services are known as
alternate participants. We are authorized under the Act to pay State VR
agencies and alternate participants for the reasonable and necessary
costs of services provided to Social Security disability beneficiaries
and disabled and blind SSI beneficiaries under specific circumstances.
The most frequent circumstance permitting payment under the Act is when
the services provided result in the beneficiary performing substantial
gainful activity (SGA) for a period of at least 9 continuous months.
These programs for referral and reimbursement for VR services are
provided for in sections 222(a) and (d), and sections 1615(a), (d), and
(e) of the Act.
Section 101(b) of TWWIIA makes a number of conforming amendments to
the Act, which require amendments to existing regulations that
implement these statutory provisions. As we gradually implement the
Ticket to Work program in States selected by the Commissioner, the
provisions of the Act for referring beneficiaries to State VR agencies
will cease to be in effect in those States as provided in sections
101(b), (c) and (d) of TWWIIA. Additionally, the use of alternate
participants under the title II and title XVI vocational rehabilitation
reimbursement programs will be phased out in the States as the Ticket
to Work program is implemented, as authorized under section 101(d)(5)
of TWWIIA.
Under sections 222 and 1615 of the Act, the Commissioner is
authorized to impose sanctions (i.e., make deductions from Social
Security disability benefits or suspend SSI benefits) with respect to
any beneficiary who refused, without good cause, to accept
rehabilitation services made available by a State VR agency or an
alternate participant.
The proposed rules to implement these statutory changes will be
published in the Federal Register at a later date.
Section 101(b) of TWWIIA also amends sections 225(b)(1) and
1631(a)(6)(A) of the Act by striking ``a program of vocational
rehabilitation services'' and inserting ``a program consisting of the
Ticket to Work and Self-Sufficiency Program under section 1148 or
another program of vocational rehabilitation services, employment
services, or other support services''. Under existing law, SSA
continues to pay disability benefits to individuals who recover
medically while participating in an approved program of vocational
rehabilitation services 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. The proposed rules to implement the expanded
definition discussed above will be published in the Federal Register at
a later date.
We will also publish at a later date in the Federal Register the
rules for implementing section 112 of the TWWIIA, Expedited
Reinstatement of Disability Benefits.
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General Goals of the Ticket to Work Program
The Ticket to Work program will enhance the range of choices
available to Social Security disability and disabled and blind SSI
beneficiaries when they are seeking employment services, VR services
and other support services to obtain, regain or maintain self-
supporting employment. The coordinated and interrelated public policy
embodied in various provisions of TWWIIA will remove several
disincentives to employment faced by beneficiaries with disabilities.
The Ticket to Work program will increase beneficiaries' access to
public and private providers to obtain employment services, VR
services, and other support services. As a result, the Ticket to Work
program, together with other provisions of TWWIIA, should substantially
increase the number of beneficiaries who increase their work effort and
leave the Social Security or SSI disability rolls due to income from
employment.
In addition to providing the increased opportunity for these
beneficiaries to obtain services when they seek employment, TWWIIA may
result in substantial savings for the Federal government and State
governments. Not only should there be an increase in the number of
beneficiaries leaving the Social Security and SSI disability rolls due
to work or earnings, some individuals will secure work with employers
who offer group health coverage, thereby reducing Medicaid and Medicare
expenses. Earned income should also yield tax receipts while reducing
expenses in Social Security disability and disabled and blind SSI
benefits, food stamps, HUD rent subsidies, and veterans benefits.
Improved employment rates of individuals with disabilities should
increase the independence of such individuals and strengthen our
communities and workforce.
Ticket to Work Program
Section 1148 of the Act, which was added by section 101(a) of
TWWIIA, directs the Commissioner of Social Security (the Commissioner)
to establish a Ticket to Work and Self-Sufficiency Program. Section
1148(b) of the Act authorizes the Commissioner to issue tickets to
disabled beneficiaries. Beneficiaries may choose among public or
private service providers that have been approved by SSA to function as
ENs under the program to obtain employment services, vocational
rehabilitation services, or other support services to assist them in
obtaining, regaining or maintaining employment that will reduce their
dependence on cash benefits. Beneficiaries will also have the option of
choosing to obtain services from their State VR agency. The overall
purpose of the Ticket to Work program is to expand the universe of
options available to beneficiaries with disabilities for obtaining such
services.
Section 1148(d)(1) of the Act authorizes the Commissioner to
conduct a competitive bidding process and enter into an agreement with
one or more organizations to serve as a Program Manager (PM) to assist
SSA in administering the Ticket to Work program.
The PM will recruit and recommend for selection by the Commissioner
ENs for service under the program; monitor all ENs serving in the
geographic areas covered under the PM's agreement to ensure that
adequate choices of services are made available to beneficiaries;
assure that payment by the Commissioner to ENs is warranted; facilitate
access by beneficiaries to ENs; ensure the availability of adequate
services; and ensure that sufficient ENs are available and that each
beneficiary receiving services under the program has reasonable access
to employment services, vocational rehabilitation services, and other
support services. Section 1148(d)(4) of the Act directs the
Commissioner to select and enter into agreements with service providers
that are willing to function as ENs and assume responsibility for the
coordination and delivery of employment services, vocational
rehabilitation services, and other support services to beneficiaries
with disabilities under the Ticket to Work program. A beneficiary with
a ticket may assign his or her ticket to any provider that is serving
as an EN under the Ticket to Work program and is willing to take the
assignment.
Section 1148(l) of the Act requires the Commissioner to prescribe
such regulations as are necessary to carry out the provisions of
section 1148. In addition, section 101(e) of TWWIIA requires the
Commissioner to prescribe such regulations as are necessary to
implement the amendments made by section 101 of TWWIIA. The regulations
proposed in this notice address those areas which must be regulated in
order to begin implementing the Ticket to Work program. Additional
regulations necessary for the ongoing implementation of the program
will be issued in the Federal Register at a later date. For example,
proposed performance measures to be used in conducting periodic reviews
as necessary to provide for effective quality assurance in the
provision of services by ENs will need to be developed and published in
the Federal Register for comment. Refer to the section near the end of
this Supplementary Information, titled ``Additional Matters for
Comment,'' for more information on provisions that will be addressed in
future regulations.
Proposed Regulations
We are proposing to add a new part 411 to chapter III of title 20
of the Code of Federal Regulations to provide the rules for the Ticket
to Work program. The new part 411 is divided into the following
subparts.
Subpart A--Introduction
Subpart A of these proposed rules provides an introduction to the
rules in the new part 411. Proposed Sec. 411.100 provides an overview
of the proposed rules in part 411. Proposed Sec. 411.105 describes the
purpose of the Ticket to Work program. Proposed Sec. 411.110 explains
that the Ticket to Work program will be implemented in graduated phases
in sites around the country as required by section 101(d) of TWWIIA.
Proposed Sec. 411.115 provides definitions of terms used in part 411.
Subpart B--Tickets Under the Ticket to Work Program
Subpart B of these proposed rules describes what a ticket is and
explains who is eligible to receive a ticket.
Proposed Sec. 411.120 explains that a ticket is a document that
provides evidence of the Commissioner's agreement to pay an EN
milestone or outcome payments for services to beneficiaries under the
Ticket to Work program. Proposed Sec. 411.125 states the following
requirements, among others, for eligibility to receive a ticket: a
title II beneficiary must be age 18 to 64, and a title XVI beneficiary
must be age 18 to 64 and be eligible for disability payments under the
disability standard for adults; a beneficiary must be in current pay
status for monthly cash benefits based on disability under title II of
the Act or monthly Federal cash benefits based on disability or
blindness under title XVI of the Act; and a 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.
In developing requirements for ticket eligibility under the
proposed rules, we considered, but decided not to propose,
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extending eligibility for a ticket to two additional groups of
individuals.
The first group consists of beneficiaries who have impairments that
are expected to improve and for whom we have not yet conducted at least
one continuing disability review. Because these beneficiaries have
conditions that are expected to medically improve in a relatively short
period of time, they could be expected to return to work without the
need for services under the Ticket to Work program. Continuing
disability reviews for this category of beneficiaries are scheduled for
six to eighteen months after the initial disability determination.
Under the proposed rules, if we determine in the first continuing
disability review that the beneficiary remains disabled, we would then
issue a ticket, provided that the beneficiary met the other ticket
eligibility criteria. This approach would ensure that beneficiaries
whose conditions do not improve as anticipated have the opportunity to
benefit from services under the Ticket to Work program within a
relatively short period of time after the initial determination.
The second group consists of those who received title XVI payments
prior to attaining age 18 (i.e., under the disability standard for
children) and have since attained age 18, but for whom we have not yet
conducted a redetermination of their eligibility under the disability
standard for adults. Because ongoing eligibility has not yet been
determined for these beneficiaries, we believe that it is premature to
issue a ticket to them immediately. Under the proposed rules, if we
establish in the redetermination that a beneficiary in this group is
eligible for disability payments under the disability standard for
adults, we would then issue a ticket, provided that the beneficiary met
the other ticket eligibility criteria. We plan to review periodically
our policy regarding ticket eligibility, including whether it would be
prudent to extend eligibility to the groups discussed above.
Proposed Sec. 411.130 explains that SSA will distribute tickets in
graduated phases. Proposed Sec. 411.135 explains that participation in
the Ticket to Work program is voluntary. This proposed section explains
that if beneficiaries want to participate in the program they can take
their tickets to any entity serving under the program. Proposed
Sec. 411.140 explains that a beneficiary may assign his or her ticket
to any EN or State VR agency that is willing to provide services, and
that the beneficiary may discuss his or her rehabilitation and
employment plans with as many entities as he or she wishes. This
proposed section explains that the beneficiary can obtain a list of the
approved ENs in his or her area. This section also explains certain
requirements a beneficiary must meet in order to assign a ticket. This
section provides that beneficiaries and ENs must agree to and sign an
individual work plan (IWP) (or, in the case of a State VR agency, an
individualized plan for employment (IPE)) before a ticket can be
assigned. This provision requires that a copy of the plan be submitted
to the PM to facilitate the assignment of the ticket. Proposed
Sec. 411.145 describes the conditions under which a beneficiary may
take a ticket back after it has been assigned to an EN or State VR
agency. It also describes other conditions under which a ticket that is
assigned can be taken out of assignment. Proposed Sec. 411.150 explains
the beneficiary's right to reassign a ticket, if the beneficiary
chooses.
Proposed Sec. 411.155 explains when a beneficiary's ticket
terminates and eligibility for participation in the Ticket to Work
program ends. Once a ticket terminates, a beneficiary may not assign or
reassign it to an EN or State VR agency. Under the proposed rules, a
ticket will terminate when entitlement to Social Security disability
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; when a Social Security disabled
widow(er) beneficiary attains age 65; when a disabled or blind SSI
beneficiary reaches age 65 and may qualify for SSI benefits based on
age; or after the 60th month for which an outcome payment is made based
on that ticket.
Subpart C--Suspension of Continuing Disability Reviews for
Beneficiaries Who Are Using a Ticket
Under section 221(i) of the Act and under the authority granted by
sections 1631 and 1633 of the Act, we conduct periodic reviews to
ensure that beneficiaries continue to meet the definition of disability
under sections 223(d) and 1614(a) of the Act. These reviews are called
continuing disability reviews. TWWIIA amends the Act to add section
1148(i), which states that SSA may not initiate a continuing disability
review during any period in which a beneficiary is using a ticket.
The statute states:
``During any period for which an individual is using, as defined by
the Commissioner, a ticket to work and self-sufficiency issued under
this section, the Commissioner (and any applicable State agency) may
not initiate a continuing disability review or other review under
section 221 of whether the individual is or is not under a disability
or a review under title XVI similar to any such review under section
221.''
The definition of using a ticket is to be determined by the
Commissioner of Social Security. Subpart C outlines our proposed
definition of using a ticket.
In developing our proposed definition of using a ticket, we
considered two key factors. First, the intent of the Ticket to Work
program is to allow beneficiaries with disabilities to seek the
services they need to work and to reduce or eliminate dependence on
Social Security disability and SSI benefits. However, anecdotal
evidence suggests that some beneficiaries are afraid that working, or
even receiving vocational rehabilitation services, may increase the
likelihood that their benefits will be terminated in a continuing
disability review. Therefore, using a ticket should be defined in a way
that minimizes this employment disincentive for beneficiaries
participating in the Ticket to Work program. However, in order to
maintain the integrity of the disability programs, it is also important
that beneficiaries who have medically improved and who no longer meet
the definition of disability under sections 223(d) and 1614(a)(3) of
the Act do not continue to receive disability benefits for an undue
length of time.
Our proposed definition seeks to balance these concerns by ensuring
that continuing disability reviews are suspended only during the period
in which beneficiaries are making meaningful progress toward reducing
or eliminating dependence on Social Security disability or SSI
benefits, while at the same time recognizing that such progress may not
always be rapid or continuous.
Under our proposed definition of using a ticket, a beneficiary
would be considered to be using a ticket during the period in which he
or she was making progress toward the goal of reducing or eliminating
dependence on disability benefits within reasonable timeframes. Under
this approach, beneficiaries would be allowed a limited period to
prepare for work. At the end of this period, they would need to show
that they were progressing toward self-sufficiency by demonstrating
increasing levels of employment.
An important advantage of this definition of using a ticket is that
it increases employment incentives by ``rewarding'' beneficiaries who
work and progress toward self-sufficiency with continued deferral of
continuing
[[Page 82848]]
disability reviews. However, requiring beneficiaries to demonstrate
increasing levels of employment within a defined timeframe results in a
fairly complex regulation. The complexity arises from our attempt to
balance the concerns discussed above and, to the extent possible, to
accommodate the diverse employment needs of a wide range of
beneficiaries. While some level of complexity is unavoidable, we have
attempted wherever possible to simplify the regulation and to make it
straightforward to implement.
The following analysis discusses the major provisions of subpart C.
Proposed Secs. 411.170 and 411.171 describe when the period of
using a ticket begins and ends. We propose that the period of using a
ticket begin when the ticket is first assigned to an EN or State VR
agency. The primary purpose of the suspension of continuing disability
reviews is to ensure that Ticket to Work program participants 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. Prior to the
assignment of the ticket, a beneficiary is not participating in these
activities under the Ticket to Work program.
Under our proposed definition, the period of using a ticket ends
with the earliest of the following:
(1) The completion of the 60-month outcome payment period;
(2) When the beneficiary is no longer making timely progress toward
self-supporting employment according to our guidelines (see
Secs. 411.180 through 411.225);
(3) Three months after the ticket is no longer assigned, if the
beneficiary fails to reassign the ticket during this 3-month period; or
(4) When the beneficiary's entitlement to or eligibility for
disability benefits terminates.
Proposed Secs. 411.180, 411.185, and 411.220 describe our
guidelines for timely progress toward self-supporting employment. We
propose that after assigning a ticket, beneficiaries be allowed up to
two years to prepare for employment. Under the current VR system, the
average time to attain employment with substantial earnings is
approximately 2 years.
After 2 years, beneficiaries would be required to meet
progressively higher levels of employment to continue to be considered
to be using a ticket in order to receive the protection in 1148(i) of
the Act regarding non-initiation of continuing disability reviews. Such
a progression would allow beneficiaries time to improve their
employment capacities. Under our proposed definition, in the third year
of Ticket to Work program participation, beneficiaries would be
required to work at least 3 months at the SGA level. In the fourth year
of the program, they would be required to work at least 6 months at the
SGA level. In the fifth and succeeding years, in order to be considered
to be using a ticket they would be 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 Social Security disability benefits and
Federal SSI benefits.
In developing these guidelines, we recognized 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. In addition, some beneficiaries
may need to try more than one job before finding a situation that suits
their abilities and needs. The requirement that beneficiaries need only
work 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.
In addition, since beneficiaries would be required to work for only
3 months in the third year of their participation in the program,
beneficiaries would actually have a total of 2 years and 9 months to
prepare for employment. This should allow beneficiaries sufficient
preparation time even if they are incapacitated for some portion of
that time due to the disabling impairment.
Beneficiaries would also have the option of placing their ticket in
inactive status during the initial 24-month period following assignment
of a ticket if they expected to be unable to participate in their
employment plan for a significant period of time due to a relapse, or
if they simply chose to stop participating in the plan temporarily. Any
period in which the ticket was 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 should one become due.
In Sec. 411.185, we propose levels of earnings that an individual
must have in order to be considered to be using a ticket. Under the
proposed definition, the required earnings level would increase over
time. In the third and fourth years, both Social Security disability
beneficiaries and disabled and blind SSI beneficiaries would be
required to work at the SGA level applicable to non-blind beneficiaries
for the specified number of months. This level is set by regulation
under 20 CFR 404.1574 and is currently $700 a month for non-blind
beneficiaries. SSI disability and blindness beneficiaries, Social
Security disability beneficiaries who are in a trial work period, and
Social Security disability beneficiaries who are statutorily blind
would be deemed to have met the requirement to work at the SGA level
applicable to non-blind beneficiaries if their gross earnings from
employment, before any exclusions, were at or above the dollar amount
of the non-blind SGA level, or if their net earnings from self-
employment, before any exclusions, were at the SGA level applicable to
non-blind beneficiaries.
Earnings at the SGA level applicable to non-blind beneficiaries may
not be sufficient to eliminate the payment of all disability benefits,
since the amount of earnings needed to eliminate the payment of
disability benefits depends on a variety of factors, including whether
the beneficiary receives Social Security or SSI benefits, or both,
whether the beneficiary is blind, and whether the beneficiary has
impairment related work expenses or is eligible for other income
exclusions. We are proposing that the earnings requirement for the
third and fourth years be at the SGA level for non-blind beneficiaries
to establish an initial earnings level that:
(1) Is consistent across different categories of beneficiaries,
increasing simplicity; and
(2) Allows beneficiaries time to work toward the higher levels of
earnings that may be required to eliminate the payment of disability
benefits for the required months.
In the fifth and subsequent years, both Social Security and SSI
beneficiaries would be required to work for at least 6 months with
earnings in each such month that were sufficient to eliminate payment
of Social Security disability and Federal SSI cash benefits in a month.
The requirement that individuals using a ticket eventually attain this
level of earnings is consistent with the payment structure of the
Ticket to Work program, in which ENs receive outcome payments only when
Federal disability benefit payments are eliminated. It also reflects
that one of the purposes of the Ticket to Work program is to produce
savings in benefit payments. Since the suspension of continuing
disability reviews for individuals using a ticket means that it is
possible that some beneficiaries who no longer meet the definition of
disability will continue to be eligible for
[[Page 82849]]
benefits, it is important that the suspension of continuing disability
reviews not continue for an undue length of time without a significant
reduction in benefit payments due to earnings.
In proposed Sec. 411.210, we discuss beneficiaries who do not meet
the timely progress guidelines. Beneficiaries who do not make timely
progress toward employment in order to be considered using a ticket
would be allowed to continue in the Ticket to Work program, and the
beneficiary's EN or State VR agency would still be eligible for any
payments that became due. However, these beneficiaries would no longer
be considered to be using a ticket as defined by the Commissioner, and
therefore would once again be subject to continuing disability reviews.
We also propose that beneficiaries who fail to meet the timely
progress guidelines to be considered to be using a ticket have the
opportunity to be considered to be using a ticket later. In order to be
considered to be using a ticket later, a beneficiary would need to work
for a specified number of months. The number of months, and earnings
level required, would vary depending on how far the beneficiary had
progressed when he or she failed to meet the guidelines.
We propose this method of allowing a beneficiary to once again be
considered to be using a ticket because we recognize, as mentioned
above, that due to the nature of disability, progress toward increased
self-sufficiency is not always direct. 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.
In proposed Secs. 411.190, 411.195, 411.200, and 411.205, we
discuss how it will be determined if a beneficiary is meeting the
timely progress guidelines. We are proposing that the PM conduct
periodic reviews to ensure that beneficiaries are meeting the timely
progress guidelines. The first review would be a progress review 24
months after the assignment of the ticket. This would be followed by
annual work reviews. After each successful review, the beneficiary
would be considered to be meeting the timely progress guidelines until
the next review was completed. If a beneficiary disagreed with the PM's
decision in any review, the beneficiary would have the right to ask SSA
to review the PM's decision.
The criteria for the 24-month progress review and the annual work
reviews are designed to be as clear cut as possible. This feature,
combined with the PM's responsibility for conducting the reviews should
allow for rapid processing of reviews and decrease the administrative
burden on both the beneficiary and SSA.
Subpart D--Use of One or More Program Managers To Assist in the
Administration of the Ticket to Work Program
Section 1148(d)(1) of the Act requires the Commissioner to enter
into an agreement with one or more organizations to serve as a PM to
assist the Commissioner in administering the Ticket to Work program.
Section 101(e)(2)(E) of TWWIIA identifies specific regulations that SSA
must promulgate regarding the terms of the agreements to be entered
into with a PM. Three items are specifically required:
(1) The terms by which a PM would be precluded from direct
participation in the delivery of services;
(2) Standards which must be met by quality assurance measures and
methods of recruitment of ENs; and
(3) The format under which dispute resolution will operate under
section 1148(d)(7) of the Act.
Among other things, section 1148(d)(7) requires the Commissioner to
provide a mechanism for resolving disputes between PMs and ENs, and
between PMs and providers of services.
Subpart D of these proposed rules explains that SSA will contract
with one or more organizations to serve as a PM and assist SSA in
administering the Ticket to Work program. Proposed Sec. 411.230
explains that SSA will conduct a competitive bidding process to select
one or more private organizations to perform the PM's functions.
Proposed Sec. 411.235 describes the minimum qualifications required of
a PM. Proposed Sec. 411.240 describes certain limitations that are
placed on a PM regarding the provision of services under the Ticket to
Work program. Proposed Sec. 411.245 identifies key responsibilities
that a PM must assume to assist SSA in administering the program and
proposed Sec. 411.250 explains how SSA will evaluate a PM.
Subpart E--Employment Networks
Section 1148(d)(4)(A) of the Act requires the Commissioner to
select and enter into agreements with ENs to provide services as
outlined under the Ticket to Work program. Section 1148(f)(1) states
that each EN serving under the Ticket to Work program shall consist of
an agency or instrumentality of a State (or a political subdivision
thereof) or a private entity that assumes responsibility for the
coordination and delivery of services under the program to
beneficiaries assigning tickets to it.
These ENs are in addition to State agencies administering or
supervising the administration of the State plan approved under title I
of the Rehabilitation Act of 1973, as amended (29 U.S.C. 720 et seq.),
known as State VR agencies, that will also be serving beneficiaries
with disabilities under the Ticket to Work program. State VR agencies
will have the option of serving beneficiaries with tickets either as an
EN (that is, to be paid under one of the EN payment systems described
in subpart H of the proposed rules) or under the existing cost
reimbursement payment system authorized in sections 222(d) and 1615(d)
of the Act. The Commissioner is also directed to enter into an
agreement with any alternate participant operating under the authority
of section 222(d)(2) of the Act in any State where the Ticket to Work
program is being implemented if the alternate participant chooses to
serve as an EN. An EN may consist of a one-stop delivery system
established under subtitle B of title I of the Workforce Investment Act
of 1998 (29 U.S.C. 2811 et seq.).
Section 1148(f) of the Act requires that entities seeking to
participate in the Ticket to Work program as ENs meet certain
qualifications. The Commissioner has discretion in determining the
qualifications that an entity must meet to be approved to serve as an
EN. We are proposing requirements for ENs that are not unduly
burdensome and that are intended to permit both traditional as well as
other types of entities to qualify. The Commissioner's intent is to
ensure that non-traditional service providers are not prohibited from
being approved as ENs, while still requiring evidence that all ENs meet
certain minimum qualifications such as licensure, accreditation,
academic qualifications, or experience. This inclusive approach is
critically important to ensure that beneficiaries with disabilities
have a real choice in services necessary to obtain, regain and maintain
employment.
Section 1148(f) of the Act also addresses requirements for ENs
under the Ticket to Work program. It requires each EN to serve a
prescribed service area and ensure that employment services, VR
services, and other support services are provided under appropriate
IWPs.
Proposed Secs. 411.300 and 411.305 explain what an EN is and what
entities are eligible to apply to serve as ENs. Proposed Sec. 411.310
explains how public or private entities will apply to us to be
[[Page 82850]]
approved as ENs and how we will determine whether an entity qualifies
to be an EN. Proposed Sec. 411.315 describes the minimum qualifications
for an EN under the Ticket to Work program. Proposed Sec. 411.320
describes the major responsibilities of an entity serving as an EN.
Proposed Sec. 411.321 explains the conditions under which we will
terminate an EN for inadequate performance. Proposed Sec. 411.325 lists
the reporting requirements placed on an entity serving as an EN and
proposed Sec. 411.330 explains how we will evaluate an EN's
performance.
Subpart F--State Vocational Rehabilitation Agencies' Participation
Section 1148(c) of the Act addresses participation by State VR
agencies in the Ticket to Work program. Among other things, this
section gives each State VR agency the opportunity to determine, on a
case-by-case basis, whether it will participate in the Ticket to Work
program as an EN or under the cost reimbursement payment system
authorized under sections 222(d) and 1615(d) of the Act (see 20 CFR
404.2101 et seq. and 416.2201 et seq.). The State VR agency must elect
either the outcome payment system or the outcome-milestone payment
system to be used when it chooses to function as an EN when serving a
beneficiary with a ticket. The Commissioner is directed to provide for
periodic opportunities to exercise this election. When the State VR
agency serves as an EN under the Ticket to Work program, it means that
the State VR agency has chosen, with respect to a particular
beneficiary, the option of being paid under the EN payment system it
has elected for this purpose. Generally under the Ticket to Work
program, however, State VR agencies will continue to operate as they do
today. For example, when a State VR agency functions as an EN, it will
provide services in accordance with the requirements of the State plan
approved under title I of the Rehabilitation Act of 1973, as amended,
and a client will complete an individualized plan for employment (IPE)
with the State VR agency. If a State VR agency has a dispute over a
payment under the cost reimbursement payment system, the State VR
agency will use the dispute resolution procedures already in place
under 20 CFR 404.2127 and 416.2227. The new responsibilities for State
VR agencies under the Ticket to Work program include checking if State
VR agency clients have a ticket ready for assignment, routing EN
payment dispute questions through the PM, and providing reports
regarding the outcomes achieved by its clients who have a ticket.
Subpart F of the proposed rules establishes that the cost
reimbursement payment system is a payment option under the Ticket to
Work program for State VR agencies. Proposed Sec. 411.360 explains what
a State VR agency must do to function as an EN under the Ticket to Work
program with respect to a beneficiary and explains that a State VR
agency may choose, on a case-by-case basis, to seek payment from SSA
under the cost reimbursement payment system or its elected EN payment
system. Proposed Sec. 411.365 describes how a State VR agency will
select an EN payment system for use when functioning as an EN. Proposed
Sec. 411.370 explains that a State VR agency may choose to serve all
beneficiaries with tickets under the cost reimbursement payment system.
Proposed Sec. 411.375 explains that State VR agencies must continue to
provide services to beneficiaries with tickets under the requirements
of the State plan approved under title I of the Rehabilitation Act of
1973, as amended (29 U.S.C. 720 et seq.).
Proposed Sec. 411.380 describes how a State VR agency will
determine if a person seeking services is a disabled beneficiary with a
ticket. Proposed Sec. 411.385 explains what the State VR agency must do
when it determines that a person is a beneficiary with a ticket
available for assignment and how it will work with the PM to facilitate
the assignment of a beneficiary's ticket to the State VR agency when
the beneficiary chooses to make such assignment. It also explains how
the State VR agency will notify the PM regarding the method of payment
it is selecting for a particular beneficiary.
Proposed Sec. 411.390 describes what a State VR agency should do
when it determines that a beneficiary already receiving services under
an approved IPE is a beneficiary with a ticket available for
assignment. Proposed Sec. 411.395 explains that each State VR agency
will be required to provide periodic reports to SSA on the specific
outcomes achieved with respect to the services provided to
beneficiaries under the Ticket to Work program.
Section 1148(c)(3) of the Act requires State VR agencies and ENs to
enter into agreements regarding the conditions under which services
will be provided when an EN that has been assigned the beneficiary's
ticket refers the beneficiary to a State VR agency for services.
Proposed Sec. 411.400 explains that an EN may refer a beneficiary that
it is serving under the Ticket to Work program to a State VR agency for
services only if such an agreement is in place prior to the EN making
the referral. Proposed Sec. 411.410 explains that these agreements are
broad-based and apply to all beneficiaries who may be referred by an EN
to a particular State VR agency. Proposed Sec. 411.415 explains that
the PM will verify the establishment of such agreements based on the
EN's submission of a copy of the agreement to the PM. Proposed
Sec. 411.420 provides guidance on what should be included in these
agreements and proposed Sec. 411.425 explains what a State VR agency
should do if an EN attempts to refer a beneficiary being served under
the Ticket to Work program to the State VR agency without having
established such an agreement. Proposed Sec. 411.430 explains what the
PM should do when notified that a referral has been attempted in the
absence of an agreement. Proposed Sec. 411.435 establishes procedures
for resolving disputes arising under these agreements.
Subpart G--Requirements for Individual Work Plans
Section 1148(g) of the Act requires each EN to ensure that
employment services, vocational rehabilitation services, and other
support services provided under the Ticket to Work program are provided
under IWPs. The minimum requirements for an IWP are spelled out in this
section.
Subpart G of these proposed rules establishes the requirements for
the IWP that must be developed when an EN and a beneficiary with a
ticket come to a mutual understanding to work in partnership under the
Ticket to Work program to assist the beneficiary in achieving
employment that is self-supporting and that reduces dependence on cash
assistance. Beneficiaries who are clients of the State VR agencies will
continue to use the individualized plan for employment rather than an
IWP. Proposed Sec. 411.455 explains the purpose of the IWP and explains
that the EN must develop and implement the plan in a manner that gives
the beneficiary the opportunity to exercise informed choice in
selecting an employment goal. Proposed Sec. 411.460 explains that the
beneficiary and the EN share the responsibility for determining the
content of the IWP.
Proposed Sec. 411.465 describes the specific information that must
be included in each IWP and proposed Sec. 411.470 explains that an IWP
becomes effective on the date it was signed by a beneficiary, or the
beneficiary's representative, and by the EN, provided that the program
manager verifies that a beneficiary has a ticket eligible for
assignment and records the assignment.
[[Page 82851]]
Subpart H--Employment Network Payment Systems
Section 1148(h) of the Act provides that the Ticket to Work program
shall provide for payments authorized by the Commissioner to ENs. These
payments shall occur under either an outcome payment system or an
outcome-milestone payment system. The two systems are defined in
Sec. 411.500. This section also defines two other terms we use related
to the payment systems.
The amount we can pay to an EN (including a State VR agency
choosing to be paid as an EN) under either payment system is based upon
the prior calendar year's national average disability benefits payable
under title II or title XVI, not upon the specific benefit payable to a
beneficiary with a ticket. The amount payable to an EN will depend upon
whether the individual who assigned his or her ticket to the EN is
entitled to benefits under title II or is eligible for benefits under
title XVI. If the beneficiary is concurrently entitled under title II
and eligible under title XVI, we will use the title II payment
calculation base.
Payments to ENs are for specific milestones or outcomes achieved by
a beneficiary who assigns a ticket to the EN. Such payments are not
based upon the costs of specific services provided by the EN.
The outcome payments under either EN payment system are payable for
a maximum of 60 months. These months do not have to be consecutive.
Section 1148(h)(3)(C) of the Act provides that the schedule of payments
to the EN under the outcome-milestone payment system shall be designed
so that the total of the payments is less than, on a net present value
basis, the total payments the EN would be limited to if the EN were
paid under the outcome payment system.
Section 1148(c) of the Act permits each State VR agency to
participate in the program as an EN with respect to a disabled
beneficiary. When the State VR agency elects to participate in the
Ticket to Work program as an EN with respect to a disabled beneficiary,
the State VR agency shall be paid in accordance with its elected EN
payment system. If the State VR agency chooses not to participate as an
EN with respect to a disabled beneficiary, the State VR agency shall be
paid for services provided to that beneficiary in accordance with the
cost reimbursement payment system under sections 222(d) and 1615(d) and
(e) of the Act. Our regulations concerning this cost reimbursement
payment system are at 20 CFR Secs. 404.2101 through 404.2127 and
Secs. 416.2201 through 416.2227. Payments to State VR agencies are
discussed in Sec. 411.510.
Each EN will elect the EN payment system it will be paid under when
it agrees to become an EN. We periodically will offer each EN
(including a State VR agency) the opportunity to change its elected
payment system. If the EN does change its elected payment system, the
change will apply only to tickets assigned to the EN after the change
in the elected payment system is made known to SSA. These provisions,
including the frequency of opportunity for an EN to change its payment
system, are discussed in Secs. 411.505 through 411.520.
Sections 411.525 through 411.565 provide our proposed rules for
computing payments to ENs under the two EN payment systems and for
allocating payments to multiple ENs to whom the ticket was assigned at
different times.
Section 1148(h)(2) of the Act provides that the outcome payment
system shall provide for a schedule of payments to an EN, in connection
with a beneficiary who assigns a ticket to the EN, for each month,
during the individual's outcome payment period, for which Social
Security disability benefits and Federal SSI benefits based on
disability or blindness are not payable to the individual because of
work or earnings. There can be a maximum of sixty outcome payment
months and, therefore, a maximum of sixty monthly outcome payments. In
proposed Sec. 411.525, we explain that an outcome payment month is a
month for which Social Security disability benefits and Federal SSI
benefits based on disability or blindness are not payable to the
individual because of work or earnings. The proposed rules also provide
criteria for determining whether a month occurring after the month in
which a beneficiary's entitlement to Social Security disability
benefits ends or eligibility for SSI benefits based on disability or
blindness terminates due to work activity or earnings will be
considered to be an outcome payment month. Under the proposed rules, we
will consider any month after the month in which such entitlement ends
or eligibility terminates because of work or earnings to be an outcome
payment month if the individual has gross earnings from employment (or
net earnings from self-employment) in that month that are at or above
the SGA dollar amount in 20 CFR 404.1574(b)(2) (for an individual who
is not statutorily blind) or in 20 CFR 404.1584(d) (for an individual
who is statutorily blind), and the individual is not entitled to any
monthly benefits under title II or eligible for any benefits under
title XVI for that month.
In Sec. 411.525, we propose that monthly payments under the outcome
payment system will be 40 percent of the payment calculation base,
which is defined in Sec. 411.500. This percentage is the maximum the
law allows at the beginning of the program. Under the outcome payment
system, each monthly outcome payment is the same during a calendar
year. At the end of each calendar year, the payment calculation base
will be re-figured for the next year.
For example, at the end of calendar year 2000 the national average
disability benefits payable per month for 2000 will be calculated for
title II and for title XVI. Forty percent will be multiplied by each of
these two amounts to determine the monthly outcome payment amounts for
calendar year 2001 under the outcome payment system. At the end of
2001, the computation will be repeated using the 2001 national average
disability benefits payable per month to determine the monthly payment
under the outcome payment system for 2002.
To illustrate with sample data, if outcome payment months occurred
in calendar year 2, the following maximum monthly outcome payments
would be based upon the calendar year 1 payment calculation base as
follows--
For title II and concurrent title II/XVI beneficiaries:
Average national disability benefit for year 1 = $693 per month
$693 x 40% = $277
$277 is the monthly payment amount to the EN for an outcome payment
month in calendar year 2
For title XVI recipients:
Average national disability payment for year 1 = $440 per month
$440 x 40% = $176
$176 is the monthly payment amount to the EN for an outcome payment
month in calendar year 2
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 payment calculation base should increase the monthly
outcome payment amount for each succeeding year.
The outcome-milestone payment system provides payments to the EN
when the beneficiary achieves milestones directed toward the goal of
permanent employment. Payments for the milestones achieved come before,
and are in addition to, payments made during the outcome payment
period.
Proposed Sec. 411.525 explains that we will pay an EN to whom a
ticket has
[[Page 82852]]
been assigned only for milestones or outcomes that are achieved prior
to the month in which an individual's ticket terminates. We will not
pay milestone or outcome payments based on an individual's work
activity or earnings in or after the month a ticket terminates.
Section 411.535 describes the two milestones we are proposing. Both
milestones occur after work begins and are based upon an earnings level
and duration of work. Both milestones can be attained even if there are
interruptions in the work pattern. The amount of the second milestone
payment is more than the first, but the beneficiary must work longer in
order for the EN to receive the second milestone payment. Both
milestones are based upon the dollar amount we use when we evaluate
monthly earnings to determine if work activity is SGA. For calendar
year 2000, these dollar amounts are $700 per month for beneficiaries
who are not statutorily blind and $1,170 per month for beneficiaries
who are statutorily blind. Section 411.535 proposes the milestone
requirements. Section 411.540 proposes how we will calculate the
payment for each milestone. For milestone one, we propose using a
percentage of the payment calculation base defined in Sec. 411.500 that
approximately equals two outcome payment months under the outcome-
milestone payment system. For milestone two, we propose to double the
percentage used for milestone one.
Section 411.545 proposes how, under the outcome-milestone payment
system, we will calculate the amount payable for outcome payment period
months following the payment of milestones. Monthly outcome payments
during the first 12 outcome payment period months (months 1-12) will be
the lowest and also will be reduced each month by an amount equal to
\1/12\th of the total milestone payments made with respect to a ticket.
Monthly outcome payments during the fifth interval of 12 outcome
payment period months (months 49-60) will pay the highest amount per
month. The outcome month payments under the outcome-milestone payment
system will be a percentage of the payment calculation base applicable
to the year in which the outcome payment month occurs. Under the
outcome-milestone payment system we propose to use, the total potential
payment will be about 85 percent of the total potential payment that
could be made under the outcome payment system. As stated previously,
the outcome payment months do not have to be consecutive months under
either EN payment system.
Section 411.555 proposes that an EN may generally keep its
milestone and outcome payments received under the elected payment
system, even if the beneficiary does not sustain work for 60 outcome
payment period months. This section also states that retroactive
adjustments to payments already received by ENs may occur for reasons
related to our modifying our previous determination about a
beneficiary's right to benefits, or due to allocating a prior payment
with another EN.
Sections 411.560 and 411.565 explain that it is possible to pay
more than one EN for the same milestone or outcome payment month. In
this situation, the payment would be allocated among the ENs that
qualify for payment. Section 1148(e)(3) of the Act provides that the PM
will determine the allocation based on the services provided by each
EN. We propose it also will be possible to pay more than one EN for
different milestones or outcome payment months on the same ticket. When
more than one EN is eligible for payment with respect to a ticket, we
propose paying each EN in accordance with its elected payment system at
the time the ticket was assigned to each EN.
Section 411.570 provides that the Act prohibits an EN from
requesting or accepting compensation from a beneficiary for the EN's
services.
Proposed Sec. 411.575 describes how an EN will request payment for
either a milestone payment, or an outcome payment month. The EN will
make a written request to the PM for payment for each milestone. The
request will be accompanied by evidence showing that the milestone was
achieved. We do not have to stop a beneficiary's monthly cash payment
in order to pay a milestone payment to an EN.
For outcome payments under either EN payment system, an EN must
submit a written request for payment to the PM. The request and
evidence of work or earnings that is sufficient to reduce monthly
Federal cash benefits to zero are required in order to begin outcome
payments to the EN. We will make the determination that the work or
earnings are sufficient to stop the beneficiary's monthly cash payment
by using the same criteria we already use to make this determination.
For outcome payments for months after a beneficiary's entitlement to
Social Security disability benefits ends or eligibility for SSI
benefits based on disability or blindness terminates due to work
activity or earnings, an EN must submit evidence that the individual
has monthly gross earnings from employment or net earnings from self-
employment that are at or above the applicable SGA dollar amount. In
order to continue receiving monthly outcome payments, the EN must
provide ongoing evidence of work and earnings to demonstrate that it is
entitled to each monthly outcome payment.
Proposed Sec. 411.580 explains that an EN must first have had the
ticket assigned to it before it can be eligible to receive milestone or
outcome payments.
As a beneficiary is free to choose where to assign a ticket,
proposed Sec. 411.585 explains that a State VR agency and an EN can
both be eligible for payment on a ticket if the State VR agency elects
to be paid as an EN. Therefore, each entity can be paid as an EN under
its respective EN payment system. However, if the State VR agency
chooses to serve a beneficiary with a ticket and to be paid under the
cost reimbursement payment system, then we will pay either the State VR
agency under the cost reimbursement payment system or we will pay an EN
under its elected payment system. We propose that, for each ticket, a
payment either under the cost reimbursement payment system or under an
elected EN payment system will exclude any payment under the other
payment system. We propose this restriction to comply with the payment
limitations that exist in the Act for the cost reimbursement payment
system and for the EN payment systems. Absent this restriction, it
would be possible to pay separately under both the cost reimbursement
payment system and under the EN payment systems such amounts as, when
combined, would exceed the statutory limitation of one or both of these
payment systems for serving the same beneficiary under the same ticket.
Following is a chart showing an example of payments under each of
the two EN payment systems. This chart illustrates how we propose to
calculate payments under the outcome payment system and under the
outcome-milestone payment system. The payment calculation base was
determined as discussed above in the preamble. Actual data, based upon
calendar year 2000, should be available at the end of the calendar year
for implementing the EN payment systems in calendar year 2001.
BILLING CODE 4191-02-P
[[Page 82853]]
[GRAPHIC] [TIFF OMITTED] TP28DE00.015
BILLING CODE 4191-02-C
[[Page 82854]]
Proposed Sec. 411.590 describes what an EN or State VR agency can
do if either disagrees with our decision on a payment request which is
submitted. This section also explains that an EN cannot appeal our
determination about a beneficiary's right to benefits even when that
determination affects the payment to an EN.
Proposed Sec. 411.595 identifies various methods we will use to
monitor the EN payment systems for financial integrity. Section 411.597
proposes that we periodically review the conditions affecting payment
under the two EN payment systems to determine if these payment systems
are providing adequate incentives and appropriate economies for ENs to
assist beneficiaries to enter the workforce.
Subpart I--Ticket to Work Program Dispute Resolution
Program managers and employment networks may have disputes with us
under the Ticket to Work program. In addition, section 1148(d)(7) of
the Act requires us to provide for a mechanism for resolving disputes
between beneficiaries and ENs, between ENs and PMs, and between PMs and
service providers. As part of this process, SSA is required to provide
a party to a dispute a reasonable opportunity for a full and fair
review of the matter in dispute. Finally, beneficiaries and State VR
agencies may have disputes. The various dispute resolution mechanisms
are discussed below.
PM and EN Disputes With SSA
Since PMs will operate under contracts with SSA and since ENs,
other than State VR agencies functioning as ENs, will operate under
agreements with SSA, disputes between SSA and PMs and between SSA and
ENs will be subject to the dispute resolution procedures contained in
the contracts and agreements with SSA.
Disputes Between Beneficiaries and ENs
There is a three-step process for resolving disputes between
beneficiaries and ENs. This three-step process will ensure that both
beneficiaries and ENs have the opportunity to resolve disputes using
informal means.
As a first step in the dispute resolution process, each EN is
required to have an internal grievance procedure whereby beneficiaries
have the opportunity to work with representatives of the EN to try to
resolve any disputes arising during the implementation or amending of
an IWP. If the dispute is not resolved using the EN's internal
grievance procedures, both the beneficiary and the EN will have the
option of contacting the PM for assistance in resolving the dispute.
Upon request, the PM will conduct a full review of the matter in
dispute and make a recommendation to the beneficiary and the EN as to
how the dispute might be resolved (see proposed Sec. 411.615). This
second step is intended to provide the parties to the dispute the
opportunity to present their case before an impartial third party, the
PM. The third step involves bringing the dispute to SSA.
Proposed Sec. 411.605 explains the EN's responsibilities regarding
this dispute resolution process, including informing beneficiaries of
the availability of assistance from the State Protection and Advocacy
(P&A) system at every step in the dispute resolution process. Proposed
Sec. 411.610 identifies specific points in the rehabilitation process
when beneficiaries must be informed about the procedures for resolving
disputes.
Proposed Sec. 411.615 describes how a disputed issue will be
referred to the PM, including what information should be submitted.
Proposed Sec. 411.620 tells how long the PM has to provide a written
recommendation on how to resolve the dispute. Proposed Sec. 411.625
explains that if the parties to the dispute do not agree with the PM's
recommendation and the dispute continues to be unresolved, either the
beneficiary or the EN has the option of bringing the dispute to the
attention of a Dispute Resolution Board that will be created within SSA
to resolve such disputes and issue administrative decisions.
The Dispute Resolution Board will consist of five members. The
members will be SSA staff from the Office of Employment Support
Programs who are knowledgeable regarding the Ticket to Work program. As
appropriate, the membership will be supplemented with SSA staff with
specialized knowledge in other areas.
Proposed Sec. 411.625 also describes the information that must be
submitted to SSA to facilitate the Dispute Resolution Board's review of
the dispute. Proposed Sec. 411.630 explains that SSA's decision is
final.
Proposed Sec. 411.635 explains that a beneficiary has the right to
be represented in the dispute resolution process under the Ticket to
Work program and that the State P&A system is available to provide
assistance and advocacy services to beneficiaries seeking or receiving
services from ENs operating under the Ticket to Work program.
Disputes Between ENs and PMs
Proposed Sec. 411.650 explains that a dispute between an EN and the
PM, that does not involve an EN's payment request, will be resolved
using the procedures for resolving disputes developed by the PM. If the
matter cannot be resolved using these procedures, it will be forwarded
to SSA for resolution. Proposed Sec. 411.655 explains how a PM will
refer disputes to us. Proposed Sec. 411.660 explains that SSA's
decision on a dispute between an EN and a PM is final.
A dispute over a payment request submitted by an EN, including a
State VR agency serving as an EN, will be resolved using the dispute
resolution procedures contained in Sec. 411.590.
Disputes Between Service Providers and PMs
We are required to provide a mechanism for resolving disputes
between service providers and program managers. Most service providers
approved to serve beneficiaries under the Ticket to Work program will
be serving as ENs. Disputes between ENs and PMs over payments are
discussed in subpart H. Other disputes between ENs and PMs are
discussed above, and in Secs. 411.650, 411.655, and 411.660. State VR
agencies that choose not to serve beneficiaries with tickets as ENs
will be the only other service providers having a relationship with a
PM under the Ticket to Work program. Disputes between a State VR agency
that is not functioning as an EN and a PM, that involve issues related
to ticket assignment and do not involve a request for payment or other
reimbursement issue, will be handled in accordance with the PM's
dispute resolution procedures. A dispute over a payment request
submitted by a State VR agency which is serving a beneficiary with a
ticket under the vocational rehabilitation cost reimbursement system
(see sections 222(d) and 1615(d) of the Act) will be resolved under
existing regulations governing the resolution of disputes regarding a
payment request (see 20 CFR 404.2127(a) and 416.2227(a)).
Disputes Between Beneficiaries and State VR Agencies
Proposed Sec. 411.640 explains that the dispute resolution
procedures in the Rehabilitation Act of 1973, as amended (29 U.S.C. 720
et seq.) apply to any dispute arising between a disabled beneficiary
and a State VR agency, regardless of whether the services are being
provided under one of the EN payment systems or under the cost
[[Page 82855]]
reimbursement payment system authorized under sections 222(d) and
1615(d) of the Act.
Subpart J--The Ticket to Work Program and Alternate Participants Under
the Programs for Payments for Vocational Rehabilitation Services
Section 101(d) of TWWIIA requires graduated implementation of the
Ticket to Work program. The program will be phased in nationally over a
three-year period, with the first tickets being issued early in 2001.
SSA will announce the States selected for participation in the Ticket
to Work program in the Federal Register, until the program has been
implemented nationwide. By January 1, 2004, the program will be
operating in all States and U.S. Territories.
Section 1148(d)(4)(B) of the Act requires the Commissioner, in any
State where the Ticket to Work program is implemented, to enter into
agreements with any alternate participant that is operating under the
authority of section 222(d)(2) of the Act in the State as of the date
of enactment of TWWIIA if the alternate participant chooses to serve as
an EN under the program.
Subpart J of these proposed rules describes how implementation of
the Ticket to Work program affects the current alternate participant
payment programs under 20 CFR 404.2101 et seq. and 416.2201 et seq.
Proposed Sec. 411.700 explains what an alternate participant is.
Proposed Sec. 411.705 and Sec. 411.710 explain that an approved
alternate participant has the option of becoming an EN when the Ticket
to Work program is implemented in a State and tells an alternate
participant what it must do to become an EN. Sections 411.715 through
411.730 describe how the transition process will occur for alternate
participants who choose to become ENs. These sections explain how SSA
will handle payments related to beneficiaries who were being served by
alternate participants under existing employment plans prior to the
Ticket to Work program being implemented in the State and the alternate
participant becoming an EN. These sections also provide that SSA will
not provide reimbursement for any services provided to a beneficiary
under the alternate participant payment system after December 31, 2003.
Clarity of These Proposed Rules
Executive Order 12866 and the President's memorandum of June 1,
1998 (63 FR 31885) require each agency to write all rules in plain
language. In addition to your substantive comments on these proposed
rules, we invite your comments on how to make these proposed rules
easier to understand.
For example:
Have we organized the material to suit your needs?
Are the requirements in the rules clearly stated?
Do the rules contain technical language or jargon that
isn't clear?
Would a different format (grouping and order of sections,
use of headings, paragraphing) make the rules easier to understand?
Would more (but shorter) sections be better?
Could we improve clarity by adding tables, lists, or
diagrams?
What else could we do to make the rules easier to
understand?
Additional Matters for Comment
While we are proposing rules to implement the new Ticket to Work
program authorized in section 101 of TWWIIA, we will at a future time
address the following matters:
1. Section 1148(f)(4) of the Social Security Act, as added by
section 101 of TWWIIA, requires that ``Each employment network shall
prepare periodic reports, on at least an annual basis, itemizing for
the covered period specific outcomes achieved with respect to specific
services provided by the employment network. Such reports shall conform
to a national model prescribed under this section.'' We invite public
comments on what this national model for periodic reports should
include.
2. Section 1148(d)(6) of the Social Security Act, as added by
section 101 of TWWIIA, requires that ``The Commissioner shall provide
for such periodic reviews as are necessary to provide for effective
quality assurance in the provision of services by employment networks.
The Commissioner shall solicit and consider the views of consumers and
the program manager under which the employment networks serve and shall
consult with providers of services to develop performance
measurements.'' We invite comments from consumers, service providers,
and other members of the public on the performance standards we should
use to provide for effective quality assurance of the Ticket to Work
program.
Eligibility for a Ticket for SSI Childhood Disability Beneficiaries Age
16 and Older
Proposed 411.125 states that an individual will be eligible to
receive a ticket in a month in which he or she is age 18 or older and
has not attained age 65, provided the individual has qualified for
title II benefits based on disability or qualified for title XVI
benefits based on disability under the adult standard or based on
blindness. As we gain experience with the Ticket to Work program, we
plan, at a later time, to explore the possibility of expanding the age
criteria for receiving a ticket to include those SSI beneficiaries age
16 and older who are eligible for disability benefit payments based on
the childhood disability standard. We plan to seek comments on this
possible age expansion at a later time, but if you wish to comment on
the issue of providing tickets to this group of beneficiaries now,
please do so. We will consider carefully any comments we receive.
Electronic Version
The electronic version of this document is available on the
Internet at http://www.access.gpo.gov/su_docs/aces/aces140.html. It is
also available on the Internet site for SSA at http://www.ssa.gov.
Regulatory Procedures
Executive Order 12866
We have consulted with the Office of Management and Budget (OMB)
and determined that these proposed rules meet the criteria for a
significant regulatory action under Executive Order 12866. Thus, they
will be subject to OMB review. For the five-year period from fiscal
year 2001 through 2005, the effects on the Old Age, Survivors and
Disability benefit payments range from minimal in fiscal year 2001 to
savings of $10 million in fiscal year 2005. For the same period, the
effects on Federal Supplemental Security Income payments range from
minimal in fiscal year 2001 to savings of $22 million in fiscal year
2005. As the costs and savings from fiscal year 2001 through 2005 are
not expected to exceed $100 million in any one year, these proposed
rules are not ``major'' under the provisions of 5 U.S.C. 801 et seq.
Regulatory Flexibility Act
We certify that these proposed rules would not have a significant
economic impact on a substantial number of small entities because they
would primarily affect only individuals, and those entities that
voluntarily enter into a contractual agreement with us. Thus, an
initial regulatory flexibility analysis as provided in the Regulatory
Flexibility Act, as amended, is not required.
Paperwork Reduction Act
The proposed regulations contain new reporting, recordkeeping and
disclosure requirements in the sections listed
[[Page 82856]]
below. As required by the Paperwork Reduction Act of 1995, we have
submitted the information requirements to OMB for its review.
Organizations and individuals desiring to submit comments on these
requirements should direct them to the Office of Information and
Regulatory Affairs, OMB, ATTN: OMB Desk Officer for SSA, New Executive
Office Building, Room 10235, Washington, D.C. 20503; and to the Social
Security Administration, ATTN: Reports Clearance Officer, 1-A-21
Operations Building, Baltimore, MD 21235-6401. OMB is required to make
a decision concerning the collections of information contained in these
proposed regulations between 30 and 60 days after publication of this
document in the Federal Register. Therefore, a comment to OMB will be
most useful if received by OMB within 30 days of publication.
The public burden includes the time it will take to understand what
is needed, gather the necessary facts and provide the information or
maintain the specified records.
SSA is soliciting comments in order to:
Evaluate whether the proposed collection of information is
necessary for the proper performance of the functions of the Agency
including whether the information will have practical utility;
Evaluate the accuracy of the Agency's estimate of the
burden of the proposed collection of information, including the
validity of the methodology and assumptions used;
Enhance the quality, utility, and clarity of the
information to be collected; and
Minimize the burden of the collection of information on
those who are to respond, including through the use of appropriate
automated, electronic, mechanical, or other technological collection
techniques, or other forms of information technology (e.g., permitting
electronic submission of responses).
Following is a table of the reporting (Rpt), recordkeeping (Rec)
and disclosure (Dis) burdens imposed on the public (beneficiaries, ENs,
PMs, State vocational rehabilitation agencies):
----------------------------------------------------------------------------------------------------------------
Estimated
Number of Average burden per annual
Section number & requirement respondents Frequency of response response burden
(hours)
----------------------------------------------------------------------------------------------------------------
Sec. 411.140(c)--Rpt............... 31,450 One time.............. 4\1/2\ hours.......... 141,525
Sec. 411.325(e)--Rpt............... \1\ 2,582 Quarterly............. 2 hours............... 20,656
Sec. 411.325(f)--Dis............... 45,000 Occasional............ 5 min................. 3,750
Sec. 411.190(a)--Rpt............... 1,000 One time.............. .5 hours.............. 500
Sec. 411.220(b)(1)--Rpt............ 1,000 One time.............. .5 hours each......... 500
Sec. 411.220(c)(1)--Rpt............ 500 One time.............. 5 min................. 42
Sec. 411.245(b)(1)--Rec............ \2\ 1,000 One time.............. 1 min................. 200
Sec. 411.325(d)--Rpt............... 1,800 One time.............. 8 hours............... 14,400
Sec. 411.365....................... 82 One time.............. 4 hours............... 328
Sec. 411.575--Rpt.................. 13,000 Daily................. .5 hours.............. 6,500
Sec. 411.605(b)--Dis............... 45,000 Occasional............ 5 min................. 3,750
Sec. 411.435(c)--Rpt............... 2,582 One time.............. 1 hour................ 2,582
Sec. 411.615--Rpt.................. 3,000 One time.............. 1 hour................ 3,000
Sec. 411.625--Rpt.................. 1,500 One time.............. 1 hour................ 1,500
----------------------------------------------------------------------------------------------------------------
\1\ Per quarter.
\2\ Per month.
Below is a brief description of each requirement subject to OMB
clearance under the Paperwork Reduction Act. We have used the following
abbreviations in the description:
EN--Employment Network
IWP--Individual Work Plan (between a beneficiary and an EN)
IPE--Individualized Plan for Employment (between a beneficiary and a
State VR agency)
PM--Program Manager
SSA--Social Security Administration
SVRA--State Vocational Rehabilitation Agency
------------------------------------------------------------------------
Reporting, recordkeeping or disclosure
CFR section requirement
------------------------------------------------------------------------
Sec. 411.140(c)............. Information collected from beneficiary to
prepare an IWP/IPE.
Sec. 411.325(e)-(f)......... General reporting and disclosure from EN
Sec. 411.190(a)............. Beneficiary/EN/SVRA/PM reporting
beneficiaries' non-participation.
Sec. 411.220(b)(1).......... Reporting--Beneficiary requests inactive
status from PM.
Sec. 411.220(c)(1).......... Reporting--Beneficiary requests
reactivation of ticket from PM.
Sec. 411.245(b)(1).......... Beneficiary requests/receives current EN
roster from PM.
Sec. 411.325(d)............. EN reports referral agreement with SVRA.
Sec. 411.365................ SVRA reporting payment option to PM.
Sec. 411.575................ ENs and SVRAs request payment under EN
payment election and provides wage/
earnings evidence.
Sec. 411.605(b)............. Disclosure--Provide internal grievance
procedures from EN to beneficiary.
Sec. 411.435(c)............. Reporting--Request to PM from EN or SVRA
on dispute resolution.
Sec. 411.615................ Reporting--beneficiary or EN request to
PM to review disputed issue.
Sec. 411.625................ Reporting--beneficiary or EN request for
SSA review of PM's recommendation on
resolution of dispute.
------------------------------------------------------------------------
(Catalog of Federal Domestic Program Nos. 96.001, Social Security-
Disability Insurance; 96.002, Social Security-Retirement Insurance;
96.004, Social Security-Survivors Insurance; and 96.006,
Supplemental Security Income)
List of Subjects in 20 CFR Part 411
Administrative practice and procedure, Blind, Disability benefits,
[[Page 82857]]
Old-age, survivors, and Disability Insurance, Reporting and
recordkeeping requirements, Social Security, Supplemental Security
Income, Public assistance programs, Vocational rehabilitation.
Dated: August 28, 2000.
Kenneth S. Apfel,
Commissioner of Social Security.
For the reasons set forth in the preamble, we propose to add a new
part 411 to chapter III of title 20 of the Code of Federal Regulations
to read as follows:
PART 411--THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM
Sec.
Subpart A--Introduction
411.100 Scope.
411.105 What is the purpose of the Ticket to Work program?
411.110 How is the Ticket to Work program implemented?
411.115 Definitions of terms used in this part.
Subpart B--Tickets Under the Ticket to Work Program
411.120 What is a ticket under the Ticket to Work program?
411.125 Who is eligible to receive a ticket under the Ticket to
Work program?
411.130 How will SSA distribute tickets under the Ticket to Work
program?
411.135 What do I do when I receive a ticket?
411.140 When can I assign my ticket and how?
411.145 Once my ticket has been assigned to an EN or State VR
agency, can it be taken out of assignment?
411.150 Can I reassign my ticket to a different EN or the State VR
agency?
411.155 When does my ticket terminate?
Subpart C--Suspension of Continuing Disability Reviews for
Beneficiaries Who Are Using a Ticket
Introduction
411.160 What does this subpart do?
411.165 How does being in the Ticket to Work program affect my
continuing disability reviews?
Definition of Using a Ticket
411.170 When does the period of using a ticket begin?
411.171 When does the period of using a ticket end?
411.175 What if I assign my ticket after a continuing disability
review has begun?
Guidelines for Timely Progress Toward Self-Supporting Employment
411.180 What is timely progress toward self-supporting employment?
411.185 How much do I need to earn to be considered to be working?
411.190 How is it determined if I am meeting the timely progress
guidelines?
411.191 Table summarizing the guidelines for timely progress
toward self-supporting employment.
411.192 What if my EN, the State VR agency, or I report that I am
not actively participating in my employment plan?
411.195 How will the PM conduct my 24-month progress review?
411.200 How will the PM conduct my annual work review?
411.205 What if I disagree with the PM's decision about whether I
am making timely progress toward self-supporting employment?
411.210 What happens if I do not make timely progress toward self-
supporting employment?
Exceptions to the Timely Progress Guidelines
411.220 What if I am temporarily unable to participate in my
employment plan?
411.225 What if my ticket is no longer assigned to an EN or State
VR agency?
Subpart D--Use of One or More Program Managers to Assist in
Administration of the Ticket to Work Program
411.230 What is a PM?
411.235 What qualifications are required of a PM?
411.240 What limitations are placed on a PM?
411.245 What are a PM's responsibilities under the Ticket to Work
program?
Evaluation of Program Manager Performance
411.250 How will SSA evaluate a PM?
Subpart E--Employment Networks
411.300 What is an EN?
411.305 Who is eligible to be an EN?
411.310 How does an entity apply to be an EN and who will
determine whether an entity qualifies as an EN?
411.315 What are the minimum qualifications necessary to be an EN?
411.320 What are an EN's responsibilities as a participant in the
Ticket to Work program?
411.321 Under what conditions will SSA terminate an agreement with
an EN due to inadequate performance?
411.325 What reporting requirements are placed on an EN as a
participant in the Ticket to Work program?
411.330 How will SSA evaluate an EN's performance?
Subpart F--State Vocational Rehabilitation Agencies' Participation
Participation in the Ticket to Work Program
411.350 Must a State VR agency participate in the Ticket to Work
program?
411.355 What payment options does a State VR agency have under the
Ticket to Work program?
411.360 How does a State VR agency become an EN?
411.365 How does a State VR agency notify SSA about its choice of
a payment system for use when functioning as an EN?
411.370 Does a State VR agency ever have to function as an EN?
411.375 Does a State VR agency continue to provide services under
the requirements of the State plan approved under title I of the
Rehabilitation Act of 1973, as amended, when functioning as an EN?
Ticket Status
411.380 How does a State VR agency determine whether a person
seeking services has a ticket?
411.385 What does a State VR agency do if a beneficiary who is
applying for services has a ticket that is available for assignment?
411.390 What does a State VR agency do if a beneficiary to whom it
is already providing services has a ticket that is available for
assignment?
411.395 Is a State VR agency required to provide periodic reports?
Referrals by Employment Networks to State VR Agencies
411.400 Can an EN to which a beneficiary's ticket is assigned
refer the beneficiary to a State VR agency for services?
Agreements Between Employment Networks and State VR Agencies
411.405 When does an agreement between an EN and the State VR
agency have to be in place?
411.410 Does each referral from an EN to a State VR agency require
its own agreement?
411.415 Who will verify the establishment of agreements between
ENs and State VR agencies?
411.420 What information should be included in an agreement
between an EN and a State VR agency?
411.425 What should a State VR agency do if it gets an attempted
referral from an EN and no agreement has been established between
the EN and the State VR agency?
411.430 What should the PM do when it is informed that an EN has
attempted to make a referral to a State VR agency without an
agreement being in place?
Resolving Disputes Arising under Agreements Between Employment Networks
and State VR Agencies
411.435 How will disputes arising under the agreements between ENs
and State VR agencies be resolved?
Subpart G--Requirements for Individual Work Plans
411.450 What is an IWP?
411.455 What is the purpose of an IWP?
411.460 Who is responsible for determining what information is
contained in the IWP?
411.465 What are the minimum requirements for an IWP?
411.470 When does an IWP become effective?
Subpart H--Employment Network Payment Systems
411.500 Definitions of terms used in this part.
411.505 How is an EN paid by SSA?
411.510 How is the State VR agency paid under the Ticket to Work
program?
[[Page 82858]]
411.515 Can the EN change its elected payment system?
411.520 How are beneficiaries whose ticket is assigned to an EN
affected by an EN's change in elected payment system?
411.525 How are the EN payments calculated under each of the two
EN payment systems?
411.530 How will the outcome period payments be reduced when paid
under the outcome-milestone payment system?
411.535 What are the milestones for which an EN can be paid?
411.540 What are the payment amounts for each of the milestones?
411.545 What are the payment amounts for outcome payment months
under the outcome-milestone payment system?
411.550 What are the payment amounts for outcome payment months
under the outcome payment system?
411.555 Can the EN keep the milestone and outcome payments even if
the beneficiary does not achieve all 60 outcome months?
411.560 Is it possible to pay a milestone or outcome payment to
more than one EN?
411.565 What happens if two or more ENs qualify for payment on the
same ticket but have elected a different EN payment system?
411.570 Can an EN request payment from the beneficiary who
assigned a ticket to the EN?
411.575 How does the EN request payment for milestones or outcome
payment months achieved by a beneficiary who assigned a ticket to
the EN?
411.580 Can an EN receive payments for milestones or outcome
payment months that occur before the beneficiary assigns a ticket to
the EN?
411.585 Can a State VR agency and an EN both receive payment for
serving the same beneficiary?
411.590 What can an EN do if the EN disagrees with our decision on
a payment request?
411.595 What oversight procedures are planned for the EN payment
systems?
411.597 Will SSA periodically review the outcome payment system
and the outcome-milestone payment system for possible modifications?
Subpart I--Ticket to Work Program Dispute Resolution
Disputes Between Beneficiaries and Employment Networks
411.600 Is there a process for resolving disputes between
beneficiaries and ENs?
411.605 What are the responsibilities of the EN regarding the
dispute resolution process?
411.610 When should a beneficiary receive information on the
procedures for resolving disputes?
411.615 How will a disputed issue be referred to the PM?
411.620 How long does the PM have to recommend a resolution to the
dispute?
411.625 Can the beneficiary or the EN request a review of the PM's
recommendation?
411.630 Is SSA's decision final?
411.635 Can a beneficiary be represented in the dispute resolution
process under the Ticket to Work program?
Disputes Between Beneficiaries and State VR Agencies
411.610 Do the dispute resolution procedures of the Rehabilitation
Act of 1973, as amended, apply to beneficiaries seeking services
from the State VR agency?
Disputes Between Employment Networks and Program Managers
411.650 Is there a process for resolving disputes between ENs and
PMs, other than disputes on a payment request?
411.655 How will the PM refer the dispute to us?
411.660 Is SSA's decision final?
Subpart J--The Ticket to Work Program and Alternate Participants Under
the Programs of Payments for Vocational Rehabilitation Services
411.700 What is an alternate participant?
411.705 Can an alternate participant become an EN?
411.710 How will an alternate participant choose to participate as
an EN in the Ticket to Work program?
411.715 If an alternate participant becomes an EN, will
beneficiaries for whom an employment plan was signed prior to
implementation be covered under the Ticket to Work program payment
provisions?
411.720 If an alternate participant chooses not to become an EN,
can it continue to function under the programs for payments for VR
services?
411.725 If an alternate participant becomes an EN and it has
signed employment plans, both as an alternate participant and an EN,
how will SSA pay for services provided under each employment plan?
411.730 What happens if an alternate participant signed an
employment plan with a beneficiary before Ticket to Work program
implementation in the State and the required period of substantial
gainful activity is not completed by January 1, 2004?
Authority: Sec. 1148 of the Social Security Act (42 U.S.C.
1320b-19); sec. 101(b)-(e), Pub. L. 106-170, 113 Stat. 1860, 1873
(42 U.S.C. 1320b-19 note).
Subpart A--Introduction
Sec. 411.100 Scope.
The regulations in this part 411 relate to the provisions of
section 1148 of the Social Security Act which establishes the Ticket to
Work and Self-Sufficiency Program (hereafter referred to as the
``Ticket to Work program''). The regulations in this part are divided
into ten subparts:
(a) Subpart A explains the scope of this part, explains the purpose
and manner of implementation of the Ticket to Work program, and
provides definitions of terms used in this part.
(b) Subpart B contains provisions relating to the ticket under the
Ticket to Work program.
(c) Subpart C contains provisions relating to the suspension of
continuing disability reviews for disabled beneficiaries who are
considered to be using a ticket.
(d) Subpart D contains provisions relating to the use of one or
more program managers to assist us in the administration of the Ticket
to Work program.
(e) Subpart E contains provisions relating to employment networks
in the Ticket to Work program.
(f) Subpart F contains provisions relating to State vocational
rehabilitation agencies' participation in the Ticket to Work program.
(g) Subpart G contains provisions relating to individual work plans
in the Ticket to Work program.
(h) Subpart H contains provisions establishing employment network
payment systems.
(i) Subpart I contains provisions that establish a procedure for
resolving disputes under the Ticket to Work program.
(j) Subpart J contains provisions explaining how the implementation
of the Ticket to Work program affects alternate participants under the
programs for payments for vocational rehabilitation services under
subpart V of part 404 and subpart V of part 416 of this chapter.
Sec. 411.105 What is the purpose of the Ticket to Work program?
The purpose of the Ticket to Work program is to expand the universe
of service providers available to individuals who are entitled to
Social Security benefits based on disability or eligible for
Supplemental Security Income (SSI) benefits based on disability or
blindness in obtaining the services necessary to find, enter and retain
employment. Expanded employment opportunities for these individuals
also will increase the likelihood that these individuals will reduce
their dependency on Social Security and SSI cash benefits.
Sec. 411.110 How is the Ticket to Work program implemented?
We are implementing the Ticket to Work program in graduated phases
at phase-in sites around the country. We are implementing the program
at sites on a wide enough scale to allow for a thorough evaluation and
ensure full implementation of the program on a timely basis.
[[Page 82859]]
Sec. 411.115 Definitions of terms used in this part.
As used in this part:
(a) The Act means the Social Security Act, as amended.
(b) Commissioner means the Commissioner of Social Security.
(c) I, my, you, or your means the disabled beneficiary.
(d) We or us means the Social Security Administration.
(e) Ticket to Work program or program means the Ticket to Work and
Self-Sufficiency Program under section 1148 of the Act.
(f) Disabled beneficiary means a title II disability beneficiary or
a title XVI disability beneficiary.
(1) Title II disability beneficiary means an individual entitled to
disability insurance benefits under section 223 or to monthly insurance
benefits under section 202 of the Act based on such individual's
disability as defined in section 223(d) of the Act. (See Sec. 404.1505
of this chapter.) An individual is a title II disability beneficiary
for each month for which such individual is entitled to such benefits.
(2) Title XVI disability beneficiary means an individual eligible
for Supplemental Security Income benefits under title XVI on the basis
of blindness (within the meaning of section 1614(a)(2) of the Act) (see
Sec. Sec. 416.981 and 416.982 of this chapter) or disability (within
the meaning of section 1614(a)(3) of the Act) (see Sec. 416.905 of this
chapter). An individual is a title XVI disability beneficiary for each
month for which such individual is eligible for such benefits.
(3) Supplemental Security Income benefit under title XVI means a
cash benefit under section 1611 or 1619(a) of the Act, and does not
include a State supplementary payment, administered Federally or
otherwise.
(g) Social Security disability benefits means the benefits
described in paragraph (f)(1) of this section.
(h) Federal SSI cash benefits means a Supplemental Security Income
benefit under title XVI based on blindness or disability as described
in paragraphs (f)(2) and (f)(3) of this section.
(i) State vocational rehabilitation agency or State VR agency means
a State agency administering or supervising the administration of the
State plan approved under title I of the Rehabilitation Act of 1973, as
amended.
(j) Cost reimbursement payment system means the provisions for
payment for vocational rehabilitation services under subpart V of part
404 and subpart V of part 416 of this chapter.
(k) Employment plan means an individual work plan under which an
employment network (other than a State VR agency) provides services to
a disabled beneficiary under the Ticket to Work program or an
individualized plan for employment under which a State VR agency
provides services. When used in subpart J of this part, ``employment
plan'' also means a ``similar document'' referred to in
Sec. Sec. 404.2114(a)(2) and 416.2214(a)(2) of this chapter under which
an alternate participant under the programs for payments for vocational
rehabilitation services (described in subpart V of part 404 and subpart
V of part 416 of this chapter) provides services to a disabled
beneficiary under those programs.
Subpart B--Tickets Under the Ticket to Work Program
Sec. 411.120 What is a ticket under the Ticket to Work program?
A ticket under the Ticket to Work program is a document which
provides evidence of the Commissioner's agreement to pay, under the
rules in subpart H of this part, an employment network (EN) or a State
VR agency to which a disabled beneficiary's ticket is assigned, for
providing employment services, vocational rehabilitation services, and
other support services to the beneficiary.
Sec. 411.125 Who is eligible to receive a ticket under the Ticket to
Work program?
(a) You will be eligible to receive a Ticket to Work in a month in
which--(1) You are age 18 or older and have not attained age 65;
(2)(i)(A) You are a title II disability beneficiary (other than a
beneficiary receiving benefit payments under Sec. 404.316(c),
Sec. 404.337(c), Sec. 404.352(d), or Sec. 404.1597a of this chapter);
and
(B) You are in current pay status for monthly title II cash
benefits based on disability (see subpart E of part 404 of this chapter
for our rules on nonpayment of title II benefits); or
(ii)(A) You are a title XVI disability beneficiary (other than a
beneficiary receiving disability or blindness benefit payments under
Sec. 416.996 or Sec. 416.1338 of this chapter);
(B) If you are an individual described in Sec. 416.987(b)(1) of
this chapter, you are eligible for benefits under title XVI based on
disability under the standard for evaluating disability for adults
following a redetermination of your eligibility under Sec. 416.987 of
this chapter; and
(C) Your monthly Federal cash benefits based on disability or
blindness under title XVI are not suspended (see subpart M of part 416
of this chapter for our rules on suspension of title XVI benefit
payments); and
(3) Our records show that--
(i) Your case is not designated as a medical improvement expected
diary review case (see Secs. 404.1590 and 416.990 of this chapter for
what we mean by a medical improvement expected diary review); or
(ii) Your case is designated as a medical improvement expected
diary review case, and we have conducted at least one continuing
disability review in your case and made a final determination or
decision that your disability continues (see subpart J of part 404 or
subpart N of part 416 of this chapter for when a determination or
decision becomes final).
(b) You will not be eligible to receive more than one ticket during
any period during which you are either--
(1) Entitled to title II benefits based on disability (see
Secs. 404.316(b), 404.337(b) and 404.352(b) of this chapter for when
entitlement to title II disability benefits ends); or
(2) Eligible for title XVI benefits based on disability or
blindness and your eligibility has not terminated (see subpart M of
part 416 of this chapter for our rules on when eligibility for title
XVI benefits terminates).
Sec. 411.130 How will SSA distribute tickets under the Ticket to Work
program?
(a) We will distribute tickets in graduated phases at phase-in
sites selected by the Commissioner, beginning in 2001, to permit a
thorough evaluation of the Ticket to Work program and ensure that the
most effective methods are in place for full implementation of the
program. (See Sec. 411.110.)
(b) We will distribute a ticket to you when we distribute tickets
in your State, if you are eligible to receive a ticket under
Sec. 411.125.
Sec. 411.135 What do I do when I receive a ticket?
Your participation in the Ticket to Work program is voluntary. When
you receive your ticket, you are free to choose when and whether to
assign it (see Sec. 411.140 for information on assigning your ticket).
If you want to participate in the program, you can take your ticket to
any EN you choose or to your State VR agency.
Sec. 411.140 When can I assign my ticket and how?
(a) You may assign your ticket only during a month in which you
meet the requirements of Sec. 411.125(a)(1) and (a)(2). You may assign
your ticket to any EN which is serving under the program
[[Page 82860]]
and is willing to provide you with services, or you may assign your
ticket to a State VR agency that is willing to provide you with
services. You may not assign your ticket to more than one provider of
services (i.e., an EN or a State VR agency) at a time. However, if you
have assigned your ticket to an EN or State VR agency and you are
dissatisfied with the services being provided, you may retrieve your
ticket under the rules in Sec. 411.145. Also, you may reassign your
ticket under the rules in Sec. 411.150.
(b)(1) In determining which EN you want to work with, you may
discuss your rehabilitation and employment plans with as many ENs in
your area as you wish. You also may discuss your rehabilitation and
employment plans with the State VR agency.
(2) You can obtain a list of the approved ENs in your area from the
program manager (PM) we have enlisted to assist in the administration
of the Ticket to Work program.
(c) Both you and the EN of your choice need to agree upon an
individual work plan (IWP). If you are working with a State VR agency,
both you and the State VR agency need to agree upon an individualized
plan for employment (IPE). The IWP or IPE outlines the services
necessary to assist you in achieving your chosen employment goal.
(d) In order to assign your ticket, you and the EN must agree to
and sign an IWP, or you and the State VR agency must agree to and sign
an IPE. In addition, you must be eligible to assign your ticket under
the rules in paragraph (a) of this section. If these requirements are
met, we will consider your ticket assigned to the EN or the State VR
agency. The effective date of the assignment of your ticket will be the
date on which you and the EN or State VR agency sign your employment
plan. See subpart C (Sec. 411.160 through Sec. 411.225) for an
explanation of how assigning your ticket may affect medical reviews
that we conduct to determine if you are still disabled under our rules.
(e) The EN will submit a copy of your IWP to the PM to facilitate
the assignment of your ticket to that EN. If you are working with a
State VR agency, your VR counselor will submit a form to the PM to
facilitate the assignment of your ticket to that agency.
Sec. 411.145 Once my ticket has been assigned to an EN or State VR
agency, can it be taken out of assignment?
(a) If you assigned your ticket to an EN or a State VR agency and
you are dissatisfied with the services being provided, you may retrieve
your ticket from the EN or State VR agency. You must notify the PM that
you wish to retrieve your ticket. The ticket will be no longer assigned
to that EN or State VR agency effective with the first day of the month
following the month in which you notify the PM that you wish to
retrieve your ticket. You may reassign your ticket under the rules in
Sec. 411.150.
(b) If your EN goes out of business or is no longer approved to
participate as an EN in the Ticket to Work program, the PM will take
your ticket out of assignment with that EN. The ticket will be no
longer assigned to that EN effective on the first day of the month
following the month in which the EN goes out of business or is no
longer approved to participate in the Ticket to Work program. You will
be sent a notice informing you that your ticket is no longer assigned
to that EN or State VR agency. In addition, if your EN or the State VR
agency (in accordance with title I of the Rehabilitation Act of 1973,
as amended) is no longer willing or able to provide services to you,
the EN or State VR agency may ask the PM to take your ticket out of
assignment with that EN or State VR agency. The ticket will be no
longer assigned to that EN or State VR agency effective on the first
day of the month following the month in which the EN or State VR agency
makes a request to the PM that the ticket be taken out of assignment.
You will be sent a notice informing you that your ticket is no longer
assigned to that EN or State VR agency.
(c) For information about how taking a ticket out of assignment may
affect medical reviews that we conduct to determine if you are still
disabled under our rules, see Secs. 411.171(d) and 411.225.
Sec. 411.150 Can I reassign my ticket to a different EN or the State
VR agency?
(a) Yes. If you previously assigned your ticket and your ticket is
no longer assigned (see Sec. 411.145) or you wish to change the
assignment, you may reassign your ticket. If you previously assigned
your ticket to an EN, you may reassign your ticket to a different EN
which is serving under the program and is willing to provide you with
services, or you may reassign your ticket to the State VR agency. If
you previously assigned your ticket to the State VR agency, you may
reassign your ticket to an EN which is serving under the program and is
willing to provide you with services.
(b) In order for you to reassign your ticket--
(1) you and the new EN must agree to and sign a new IWP or, if you
wish to reassign your ticket to a State VR agency, you and the State VR
agency must agree to and sign an IPE;
(2) you must meet the requirements of Sec. 411.125(a)(1) and (a)(2)
in the month you and the new EN or State VR agency sign your employment
plan; and
(3) you must tell the PM that you want to reassign your ticket.
(c) If the requirements in paragraph (b) of this section are met,
we will consider your ticket reassigned to the new EN or State VR
agency. The reassignment of your ticket is effective on the first day
of the month following the month in which you and the new EN or State
VR agency sign your employment plan.
(d) The new EN will submit a copy of your new IWP to the PM to
facilitate the reassignment of your ticket to that EN. If you wish to
reassign your ticket to the State VR agency, your VR counselor will
submit a form to the PM to facilitate the reassignment of your ticket
to that agency.
Sec. 411.155 When does my ticket terminate?
Your ticket will terminate if and when you are no longer eligible
to participate in the Ticket to Work program. If your ticket
terminates, you may not assign or reassign it to an EN or State VR
agency. We will not pay an EN (including a State VR agency) for
milestones or outcomes achieved in or after the month in which your
ticket terminates (see Sec. 411.525(c)). Your eligibility to
participate in the Ticket to Work program will end, and your ticket
will terminate, in the earliest of the following months:
(a) The month in which your entitlement to Social Security
disability benefits ends, or the month in which your eligibility for
benefits under title XVI based on disability or blindness terminates,
whichever is later, for reasons other than your work activity or
earnings;
(b) If you are entitled to widow's or widower's insurance benefits
based on disability (see Secs. 404.335 and 404.336 of this chapter),
the month in which you attain age 65;
(c) If you are eligible for benefits under title XVI based on
disability or blindness, the month following the month in which you
attain age 65; or
(d) The month following the 60th month for which an outcome payment
is made to an EN (including a State VR agency) based on that ticket
under subpart H of this part.
[[Page 82861]]
Subpart C--Suspension of Continuing Disability Reviews for
Beneficiaries Who are Using a Ticket
Introduction
Sec. 411.160 What does this subpart do?
(a) This subpart explains our rules about continuing disability
reviews for disability beneficiaries who are participating in the
Ticket to Work program.
(b) Continuing disability reviews are reviews that we conduct to
determine if you are still disabled under our rules (see Secs. 404.1594
and 416.994 of this chapter). For the purposes of this subpart,
continuing disability reviews do not include any review to determine if
your disability has ended under Sec. 404.1594(d)(5) of this chapter
because you have demonstrated your ability to engage in substantial
gainful activity (SGA), as defined in Secs. 404.1571--404.1576 of this
chapter.
Sec. 411.165 How does being in the Ticket to Work program affect my
continuing disability reviews?
We periodically review your case to determine if you are still
disabled under our rules. (See Secs. 404.1594 and 416.994 of this
chapter.) However, if you are in the Ticket to Work program, we will
not begin a continuing disability review during the period in which you
are using a ticket. You must meet certain requirements for us to
consider you to be using a ticket.
Definition of Using a Ticket
Sec. 411.170 When does the period of using a ticket begin?
The period of using a ticket begins on the effective date of the
assignment of your ticket to an employment network (EN) or State VR
agency under Sec. 411.140.
Exception: If you have previously failed to meet the timely
progress guidelines under Secs. 411.180 through 411.190, the period of
using a ticket will not begin until you complete the requirements for
reentering in-use status. (See Sec. 411.210.)
Sec. 411.171 When does the period of using a ticket end?
The period of using a ticket ends with the earliest of the
following--
(a) The 60th month for which an outcome payment is made to your EN
(including a State VR agency) under subpart H of this part;
(b) If you have assigned your ticket to a State VR agency which
selects the cost reimbursement payment system, the 60th month for which
an outcome payment would have been made had the State VR agency chosen
to participate in the Ticket to Work program as an EN;
(c) The day before the effective date of a decision under
Sec. 411.192, Sec. 411.195, Sec. 411.200, or Sec. 411.205 that you are
no longer making timely progress toward self-supporting employment;
(d) The close of the 3-month period which begins with the first
month in which your ticket is no longer assigned to an EN or State VR
agency (see Sec. 411.145), unless you reassign your ticket within this
3-month period (see Sec. 411.225 for an explanation of the 3-month
extension period which begins when your ticket is no longer assigned);
or
(e) The month with which your entitlement to Social Security
disability benefits ends or your eligibility for Federal SSI cash
benefits terminates. If you are a concurrent title II and title XVI
beneficiary, the period of using a ticket will end with the month with
which your entitlement to Social Security disability benefits ends or
your eligibility for Federal SSI cash benefits terminates, whichever is
later. (See Secs. 404.316(b), 404.337(b), 404.352(b) and 416.1331-
416.1335 of this chapter.) Although you will no longer be considered to
be using a ticket after this month, your EN may still be eligible for
payments under the Ticket to Work program if your entitlement to or
eligibility for disability benefits terminated due to your work
activity or earnings.
Sec. 411.175 What if I assign my ticket after a continuing disability
review has begun?
(a) If we begin a continuing disability review before the date on
which you assign a ticket, you may still assign the ticket and receive
services under the Ticket to Work program. However, we will complete
the continuing disability review. If in this review we determine that
you are no longer disabled, in most cases you will no longer be
eligible to receive benefits. However, if you assigned your ticket
before we determined that you are no longer disabled, in certain
circumstances you may continue to receive benefits (see
Secs. 404.316(c), 404.337(c), 404.352(d), and 416.1338 of this
chapter). If you appeal the decision that you are no longer disabled,
you may also choose to have your benefits continued pending
reconsideration and/or a hearing before an administrative law judge on
the cessation determination (see Secs. 404.1597a and 416.996 of this
chapter).
(b) The date on which we begin the continuing disability review is
the date on the notice we send you that tells you that we are beginning
to review your disability case.
Guidelines for Timely Progress Toward Self-Supporting Employment
Sec. 411.180 What is timely progress toward self-supporting
employment?
(a) General. The purpose of the Ticket to Work program is to
provide you with the services and supports you need to work and reduce
or eliminate your dependence on Social Security disability benefits and
SSI benefits based on disability or blindness. We consider you to be
making timely progress toward self-supporting employment when you show
an increasing ability to work at levels which will reduce or eliminate
your dependence on these benefits.
(b) Guidelines. We will determine whether you are making timely
progress toward self-supporting employment by using the following
guidelines:
(1) During the initial 24-month period after you assign your
ticket, you must be actively participating in your employment plan.
``Actively participating in your employment plan'' means that you are
engaging in activities outlined in your employment plan on a regular
basis and in the approximate time frames specified in the employment
plan.
(2) During your first 12-month work review period, you must work
(as defined in Sec. 411.185) for at least 3 of these 12 months. The 3
months do not need to be consecutive.
(3) During your second 12-month work review period, and in later
12-month work review periods, you must work (as defined in
Sec. 411.185) for at least 6 of these 12 months. The 6 months do not
need to be consecutive.
(c) Definitions. As used in this subpart--
(1) The initial 24-month period means the 24-month period which
begins with the month following the month in which you first assigned
your ticket. When we count the 24 months, we will not include any month
during which your ticket is not assigned to an EN or State VR agency,
as described in Sec. 411.145, or any month in which your ticket is in
inactive status, as defined in Sec. 411.220.
(2) The 12-month work review period means the 12-month period that
begins either following the end of the initial 24-month period or
following the previous 12-month work review period. When we count the
12 months, we will not include any month during which your ticket is
not assigned to an EN or State VR agency, as described in Sec. 411.145.
[[Page 82862]]
Sec. 411.185 How much do I need to earn to be considered to be
working?
For the purpose of determining if you are meeting the timely
progress requirements for continued ticket use, we will consider you to
be working in each month in which you have earnings at the following
levels:
(a) For title II disability beneficiaries:
(1) During your first and second 12-month work review periods, we
will consider you to be working in a month in which you have earnings
from employment or self-employment at the SGA level for non-blind
beneficiaries, as defined in Secs. 404.1572 through 404.1576 of this
chapter. For a month in which you are in a trial work period (see
Sec. 404.1592 of this chapter), or if you are statutorily blind as
defined in Sec. 404.1581 of this chapter, we will consider the
following as fulfilling this requirement--
(i) Gross earnings from employment, before any deductions for
impairment related work expenses under Sec. 404.1576 of this chapter,
that are at or above the dollar amount of the SGA level for non-blind
beneficiaries in Sec. 404.1574 of this chapter; or
(ii) Net earnings from self-employment (as defined in
Sec. 416.1110(b) of this chapter), before any deductions for impairment
related work expenses under Sec. 404.1576 of this chapter, that are at
or above the dollar amount of the SGA level for non-blind beneficiaries
in Sec. 404.1574 of this chapter.
(2) During your third 12-month work review period, and during later
12-month work review periods, we will consider you to be working in a
month for which Social Security disability benefits are not payable to
you because of your work or earnings.
(b) For title XVI beneficiaries:
(1) During your first and second 12-month work review periods, we
will consider you to be working in a month in which you have--
(i) Gross earnings from employment, before any SSI income
exclusions, that are at or above the dollar amount of the SGA level for
non-blind beneficiaries in Sec. 404.1574 of this chapter; or
(ii) Net earnings from self-employment (as defined in
Sec. 416.1110(b) of this chapter), before any SSI income exclusions,
that are at or above the dollar amount of the SGA level for non-blind
beneficiaries in Sec. 404.1574 of this chapter.
Example: If you earn $750 in January 2001, but exclude $200 of this
income in a Plan for Achieving Self Support (see Sec. Sec. 416.1180-
416.1182 of this chapter), you would still be considered to be working
in that month.
(2) During your third 12-month work review period, and during any
later 12-month work review periods, we will consider you to be working
in a month in which you have earnings from employment or self-
employment that are sufficient to preclude the payment of Federal SSI
cash benefits for a month.
(c) For concurrent title II and title XVI beneficiaries:
(1) During your first and second 12-month work review periods, we
will consider you to be working in a month in which you have earnings
from employment or self-employment at the SGA level for non-blind
beneficiaries as defined in Sec. Sec. 404.1572 through 404.1576 of this
chapter. For a month in which you are in a trial work period (see
Sec. 404.1592 of this chapter), or if you are statutorily blind as
defined in Sec. 404.1581 of this chapter, we will consider the
following as fulfilling this requirement--
(i) Gross earnings from employment, before any SSI income
exclusions or deductions for impairment related work expenses under
Sec. 404.1576 of this chapter, that are at or above the dollar amount
of the SGA level for non-blind beneficiaries in Sec. 404.1574 of this
chapter; or
(ii) Net earnings from self-employment (as defined in
Sec. 416.1110(b) of this chapter), before any SSI income exclusions or
deductions for impairment related work expenses under Sec. 404.1576 of
this chapter, that are at or above the dollar amount of the SGA level
for non-blind beneficiaries in Sec. 404.1574 of this chapter.
(2) During your third 12-month work review period, and during later
12-month work review periods, we will consider you to be working in a
month in which you have earnings from employment or self-employment
sufficient to preclude the payment of Social Security disability
benefits and Federal SSI cash benefits for a month.
Sec. 411.190 How is it determined if I am meeting the timely progress
guidelines?
(a) During the initial 24-month period of using a ticket, you must
be actively participating in your employment plan, as defined in
Sec. 411.180(b)(1). Active participation in your employment plan will
be presumed unless you or your EN or State VR agency tell the program
manager (PM) that you are not actively participating. If you or your EN
or State VR agency tell the PM that you are not actively participating
in your employment plan, the PM will follow the procedures outlined in
Sec. 411.192.
(b) After the initial 24-month period, the PM will conduct reviews
to determine if you are meeting the timely progress guidelines for
continuing to be considered to be using a ticket.
(1) The PM will conduct a 24-month progress review at the end of
the initial 24-month period. (See Sec. 411.195.)
(2) If you successfully complete your 24-month progress review, the
PM will conduct annual work reviews at the end of each 12-month work
review period. (See Sec. 411.200.)
Sec. 411.191 Table summarizing the guidelines for timely progress
toward self-supporting employment.
You may use the following table to determine what you need to do to
meet the guidelines for timely progress toward self-supporting
employment. For more detail, refer to Secs. 411.180 through 411.190.
----------------------------------------------------------------------------------------------------------------
You are in this With this level At the end of the period we
If you-- period-- You must work-- of earnings-- will conduct your--
----------------------------------------------------------------------------------------------------------------
First assigned your ticket Initial 24-month No work Not applicable. 24-month progress review.
less than 24 months ago (not period. requirement.
counting any months in which Must be
your ticket was unassigned actively
or inactive). participating
in employment
plan.
First assigned your ticket 25 First 12-month 3 months out of SGA level for First work review.
to 36 months ago (not work review 12. non-blind
counting any months in which period. beneficiaries*.
your ticket was unassigned
or inactive).
First assigned your ticket 37 Second 12-month 6 months out of SGA level for Second work review.
to 48 months ago (not work review 12. non-blind
counting any months in which period. beneficiaries*.
your ticket was unassigned
or inactive).
[[Page 82863]]
First assigned your ticket 49 Third 12-month 6 months out of Earnings Third work review.
to 60 months ago (not work review 12. sufficient to
counting any months in which period. preclude
your ticket was unassigned Social
or inactive). Security
disability and
Federal SSI
cash benefits
for a month.
----------------------------------------------------------------------------------------------------------------
In later 12-month work review periods, the work and earnings requirements are the same as in the third 12-month
work review period.
----------------------------------------------------------------------------------------------------------------
*For an explanation of how we determine if you meet this requirement if you are in a trial work period, you are
blind, or you are a title XVI disability beneficiary, see Sec. 411.185.
Sec. 411.192 What if my EN, the State VR agency, or I report that I am
not actively participating in my employment plan?
(a) If you or your EN or State VR agency report to the PM that you
are not actively participating in your employment plan during the
initial 24-month period after you assign your ticket, the PM will give
you the choice of resuming participation in your employment plan or
placing your ticket in inactive status.
(b) If you choose to place the ticket in inactive status, your
ticket will be placed in inactive status beginning with the first day
of the month following the month in which you make your request. You
are not considered to be using a ticket during months in which your
ticket is in inactive status, and months in which your ticket is in
inactive status do not count toward the time limitations for making
timely progress toward self-supporting employment. For more information
about inactive status, see Sec. 411.220.
(c) If you choose to resume active participation in your employment
plan, you will be allowed 3 months to demonstrate this active
participation to the PM. During this period, you will be considered to
be making timely progress toward self-supporting employment. The PM
will contact your EN or State VR agency after the 3 months to determine
whether you have been actively participating in your employment plan
during these 3 months. If the EN or State VR agency report that you
have not been actively participating in your employment plan during
these 3 months, the PM will find that you are no longer making timely
progress toward self-supporting employment. The PM will send a written
notice of this decision to you at your last known address. The notice
will explain the reasons for the decision and inform you of the right
to ask us to review the decision. The decision will become effective 30
days after the date on which the PM sends the notice of the decision to
you, unless you request that we review the decision under Sec. 411.205.
Sec. 411.195 How will the PM conduct my 24-month progress review?
(a) In this review the PM will consider the following:
(1) Are you actively participating in your employment plan? By
``actively participating in your employment plan,'' we mean that you
are engaging in activities outlined in your employment plan on a
regular basis and in the approximate time frames specified in the plan.
(2) Does your employment plan have a goal of at least 3 months of
work (as defined in Sec. 411.185) during your next 12-month work review
period?
(3) Given your current progress in your employment plan, can you
reasonably be expected to reach this goal of at least 3 months of work
(as defined in Sec. 411.185) during your next 12-month work review
period?
(b) If the answer to all three of these questions is yes, the PM
will find that you are making timely progress toward self-supporting
employment. We will consider you to be making timely progress toward
self-supporting employment until your first annual work review.
(c) If the answer to any of these questions is no, the PM will find
that you are not making timely progress toward self-supporting
employment. The PM will send a written notice of the decision to you at
your last known address. The notice will explain the reasons for the
decision and inform you of the right to ask us to review the decision.
The decision will be effective 30 days after the date on which the PM
sends the notice of the decision to you, unless you request that we
review the decision under Sec. 411.205.
Sec. 411.200 How will the PM conduct my annual work review?
(a) The annual work review is a two step process:
(1) Step one--Retrospective Review. Did you complete the work
requirements (as specified in Sec. 411.180 and Sec. 411.185) in the
last 12-month work review period?
(i) If you have not completed the work requirements, the PM will
find that you are not making timely progress toward self-supporting
employment.
(ii) If you have completed the work requirements, the PM will go to
step two.
(2) Step two--Anticipated Work Level. Do both you and your EN or
State VR agency expect that you will work at the level required during
the next 12-month work review period?
(i) If not, the PM will find that you are not making timely
progress toward self-supporting employment.
(ii) If so, the PM will find that you are making timely progress
toward self-supporting employment. We will consider you to be making
timely progress toward self-supporting employment until your next
annual work review.
(b) If the PM finds that you are not making timely progress toward
self-supporting employment, the PM will send a written notice of the
decision to you at your last known address. The notice will explain the
reasons for the decision and inform you of the right to ask us to
review the decision. The decision will be effective 30 days after the
date on which the PM sends the notice of the decision to you, unless
you request that we review the decision under Sec. 411.205.
Sec. 411.205 What if I disagree with the PM's decision about whether I
am making timely progress toward self-supporting employment?
If you disagree with the PM's decision, you may request that we
review the decision. You must make the request before the 30th day
after the date on which the PM sends the notice of its decision to you.
We will consider you to be making timely progress toward self-
supporting employment until we make a decision. We will send a written
notice of our decision to you at your last known address. If we decide
that you are no longer making timely progress toward self-supporting
employment, our decision will be
[[Page 82864]]
effective on the date on which we send the notice of the decision to
you.
Sec. 411.210 What happens if I do not make timely progress toward
self-supporting employment?
(a) General. If it is determined that you are not making timely
progress toward self-supporting employment, we will find that you are
no longer using a ticket. If this happens, you will once again be
subject to continuing disability reviews. However, you may continue
participating in the Ticket to Work program. Your EN also may receive
any outcome payments for which it is eligible under Sec. 411.500 et
seq.
(b) Reentering In-Use Status. If you failed to meet the timely
progress guidelines for continuing to use a ticket, you may reenter in-
use status. The requirements for reentering in-use status depend on how
far you progressed before you failed to meet the timely progress
guidelines.
(1) If you failed to meet the timely progress guidelines during the
initial 24-month period, in your 24-month progress review, or in your
first annual work review.
(i) If you failed to meet the timely progress guidelines during the
initial 24-month period, in your 24-month progress review, or in your
first annual work review, you may reenter in-use status by completing 3
months of work at the SGA level (as defined in Sec. 411.185) within a
rolling 12-month period. The rolling 12-month period must begin after
the effective date of the decision that you failed to meet the timely
progress guidelines.
(ii) When you have completed this requirement, you will be
reinstated to in-use status, provided that your ticket is assigned to
an EN or State VR agency.
(iii) After you are reinstated to in-use status, your next 12-month
work review period will begin. During this 12-month work review period,
you will be required to work at least 6 months at the SGA level (as
defined in Sec. 411.185). The PM will conduct an annual work review at
the end of this 12-month work review period to determine if you have
met this requirement. After this, the PM will conduct annual work
reviews in the usual manner.
(2) If you failed to meet the timely progress guidelines in your
second annual work review.
(i) If you failed to meet the timely progress guidelines in your
second annual work review, you may reenter in-use status by completing
6 months of work at the SGA level (as defined in Sec. 411.185) within a
rolling 12-month period. The rolling 12-month period must begin after
the effective date of the decision that you failed to meet the timely
progress guidelines.
(ii) When you have completed this requirement, you will be
reinstated to in-use status, provided that your ticket is assigned to
an EN or State VR agency.
(iii) After you are reinstated to in-use status, your next 12-month
work review period will begin. During this 12-month work review period,
you will be required to work at least 6 months with earnings at the
level specified in Sec. 411.185(a)(2), Sec. 411.185(b)(2), or
Sec. 411.185(c)(2). The PM will conduct an annual work review at the
end of this 12-month work review period to determine if you have met
this requirement. After this, the PM will conduct annual reviews in the
usual manner.
(3) If you failed to meet the timely progress guidelines in any
work review after your second work review.
(i) If you failed to meet the timely progress guidelines in any
work review after your second work review, you may reenter in-use
status by completing 6 months of work within a rolling 12-month period
with earnings in each of the 6 months at the level specified in
Sec. 411.185(a)(2), Sec. 411.185(b)(2), or Sec. 411.185(c)(2). The
rolling 12-month period must begin after the effective date of the
decision that you failed to meet the timely progress guidelines.
(ii) When you have completed this requirement, you will be
reinstated to in-use status, provided that your ticket is assigned to
an EN or State VR agency.
(iii) After you are reinstated to in-use status, your next 12-month
work review period will begin. During this 12-month work review period,
you will be required to work at least 6 months with earnings at the
level specified in Sec. 411.185(a)(2), Sec. 411.185(b)(2), or
Sec. 411.185(c)(2). The PM will conduct an annual work review at the
end of this 12-month work review period to determine if you have met
this requirement. After this, the PM will conduct annual work reviews
in the usual manner.
Exceptions to the Timely Progress Guidelines
Sec. 411.220 What if I am temporarily unable to participate in my
employment plan?
(a) General. (1) If you are temporarily unable to participate in
your employment plan during the initial 24-month period of using a
ticket, you may choose to place your ticket in inactive status.
(2) Months in which your ticket is in inactive status do not count
toward the time limitations for making timely progress toward self-
supporting employment.
(3) Your ticket is not considered to be in use during periods in
which it is in inactive status. Therefore you will once again be
subject to continuing disability reviews.
(4) You may not place your ticket in inactive status after the
initial 24-month period of using a ticket.
(b) How to place your ticket in inactive status. (1) To place a
ticket in inactive status, you must submit a written request to the PM
asking that your ticket be placed in inactive status. The request must
include a statement from your EN or State VR agency that you will not
be participating in your plan or receiving services from them during
the period of inactive status.
(2) The period of inactive status begins on the first day of the
first month after the PM receives your request.
(c) How to reactivate your ticket. (1) If your ticket is still
assigned to an EN or State VR agency, you may reactivate your ticket
and return to in-use status at any time by submitting a written request
to the PM.
(2) Your ticket will be reactivated beginning with the first day of
the month following the month in which the PM receives your request.
(d) If the PM is told that you are not actively participating in
your employment plan. If the PM is told that you are not actively
participating in your employment plan, the PM will give you the choice
of resuming active participation in your employment plan or placing
your ticket in inactive status. See Sec. 411.192.
Sec. 411.225 What if my ticket is no longer assigned to an EN or State
VR agency?
(a) If your ticket was once assigned to an EN or State VR agency
and is no longer assigned, you are eligible for an extension period of
up to 3 months to reassign your ticket. You are eligible for an
extension period if your ticket is no longer assigned because--
(1) You retrieved your ticket because you were dissatisfied with
the services being provided (see Sec. 411.145(a)); or
(2) Your EN went out of business or is no longer approved to
participate as an EN in the Ticket to Work program, or your EN or State
VR agency is no longer willing or able to provide you with services for
any other reason (see Sec. 411.145(b)).
(b) During the extension period, the ticket will still be
considered to be in use. This means that you will not be subject to
continuing disability reviews during this period.
(c) Time spent in the extension period will not count toward the
time limitations for the timely progress guidelines.
[[Page 82865]]
(d) The extension period--
(1) begins on the first day on which the ticket is no longer
assigned (see Sec. 411.145); and
(2) ends 3 months after it begins or when you assign your ticket to
a new EN or State VR agency, whichever is sooner.
(e) If you do not assign your ticket by the end of the extension
period, the ticket will no longer be in use and you will once again be
subject to continuing disability reviews.
Subpart D--Use of One or More Program Managers to Assist in
Administration of the Ticket to Work Program
Sec. 411.230 What is a PM?
A program manager (PM) is an organization in the private or public
sector that has entered into an agreement to assist us in administering
the Ticket to Work program. We will use a competitive bidding process
to select one or more PMs.
Sec. 411.235 What qualifications are required of a PM?
A PM must have expertise and experience in the field of vocational
rehabilitation or employment services.
Sec. 411.240 What limitations are placed on a PM?
A PM is prohibited from directly participating in the delivery of
employment services, vocational rehabilitation services, or other
support services to beneficiaries with tickets in the PM's designated
service delivery area. A PM is also prohibited from holding a financial
interest in an employment network (EN) or service provider that
provides services under the Ticket to Work program in the PM's
designated service delivery area.
Sec. 411.245 What are a PM's responsibilities under the Ticket to Work
program?
A PM will assist us in administering the Ticket to Work program by
conducting the following activities:
(a) Recruiting, recommending, and monitoring ENs. A PM must recruit
and recommend for selection by us public and private entities to
function as ENs under the program. A PM is also responsible for
monitoring the ENs operating in its service delivery area. Such
monitoring must be done to the extent necessary and appropriate to
ensure that adequate choices of services are made available to
beneficiaries with tickets. A PM may not limit the number of public or
private entities being recommended to function as ENs.
(b) Facilitating access by beneficiaries to ENs. A PM must assist
beneficiaries with tickets in accessing ENs.
(1) A PM must establish and maintain lists of the ENs available to
beneficiaries with tickets in its service delivery area and make these
lists generally available to the public.
(2) A PM must ensure that all information provided to beneficiaries
with tickets about ENs is in accessible formats. For purposes of this
section, accessible format means by media that is appropriate to a
particular beneficiary's medical impairment(s).
(3) A PM must take necessary measures to ensure that sufficient ENs
are available and that each beneficiary under the Ticket to Work
program has reasonable access to employment services, vocational
rehabilitation services, and other support services. The PM shall
ensure that services such as the following are available in each
service area, including rural areas: case management, work incentives
planning, supported employment, career planning, career plan
development, vocational assessment, job training, placement, follow-up
services, and other services that we may require in an agreement with a
PM.
(4) A PM must ensure that each beneficiary with a ticket is allowed
to change ENs. When a change in the EN occurs, the PM must reassign the
ticket based on the choice of the beneficiary.
(c) Facilitating payments to ENs. A PM must facilitate payments to
the ENs in its service delivery area. Subpart H explains the EN payment
systems and the PM's role in administering these systems.
(1) A PM must maintain documentation and provide regular assurances
to us that payments to an EN are warranted. The PM shall ensure that an
EN is complying with the terms of its agreement and applicable
regulations.
(2) Upon the request of an EN, the PM shall make a determination of
the allocation of the outcome or outcome-milestone payments due to an
EN based on the services provided by the EN.
(d) Administrative requirements. A PM will perform such
administrative tasks as are required to assist us in administering and
implementing the Ticket to Work program. Administrative tasks required
for the implementation of the Program may include, but are not limited
to:
(1) Reviewing individual work plans (IWPs) submitted by ENs for
ticket assignment. These reviews will be conducted to ensure that the
IWPs meet the requirements of Sec. 411.465.
(2) Reviewing amendments to IWPs to ensure that the amendments meet
the requirements in Sec. 411.465.
(3) Ensuring that ENs only refer an individual to a State VR agency
for services pursuant to an agreement regarding the conditions under
which such services will be provided.
(4) Resolving a dispute between an EN and a State VR agency with
respect to agreements regarding the conditions under which services
will be provided when an individual is referred by an EN to a State VR
agency for services.
Evaluation of Program Manager Performance
Sec. 411.250 How will SSA evaluate a PM?
(a) We will periodically conduct a formal evaluation of the PM. The
evaluation will include, but not be limited to, an assessment examining
the following areas:
(1) Quality of services;
(2) Cost control;
(3) Timeliness of performance;
(4) Business relations; and (5) customer satisfaction.
(b) Our Project Officer will perform the evaluation. The PM will
have an opportunity to comment on the evaluation, and then the
Contracting Officer will determine the PM's final rating.
(c) These performance evaluations will be made part of our database
on contractor past performance to which any Federal agency may have
access.
(d) Failure to comply with the standards used in the evaluation may
result in early termination of our agreement with the PM.
Subpart E--Employment Networks
Sec. 411.300 What is an EN?
An employment network (EN) is any qualified entity that has entered
into an agreement with us to function as an EN under the Ticket to Work
program and 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 EN.
Sec. 411.305 Who is eligible to be an EN?
Any qualified agency or instrumentality of a State (or political
subdivision thereof) or a private entity that assumes responsibility
for the coordination and delivery of services under the Ticket to Work
program to disabled beneficiaries is eligible to be an EN. A single
entity or an association of or consortium of entities combining their
resources is eligible to be an EN. The entity may provide these
services
[[Page 82866]]
directly or by entering into an agreement with other organizations or
individuals to provide the appropriate services or other assistance
that a beneficiary with a ticket may need to find and maintain
employment that reduces dependency on disability benefits. ENs may
include, but are not limited to:
(a) Any public or private entity that can provide directly, or
arrange for other organizations or entities to provide, employment
services, vocational rehabilitation services, or other support
services.
(b) State agencies administering or supervising the administration
of the State plan approved under title I of the Rehabilitation Act of
1973, as amended (29 U.S.C. 720 et seq.) may choose, on a case-by-case
basis, to be paid as an EN under the payment systems described in
subpart H of this part. For the rules on State VR agencies'
participation in the Ticket to Work program, see subpart F of this
part.
(c) One-stop delivery systems established under subtitle B of title
I of the Workforce Investment Act of 1998 (29 U.S.C. 2841 et seq.).
(d) Alternate participants currently operating under the authority
of section 222(d)(2) of the Social Security Act.
(e) Organizations administering Vocational Rehabilitation Services
Projects for American Indians with Disabilities authorized under
section 121 of part C of title I of the Rehabilitation Act of 1973, as
amended (29 U.S.C. 750 et seq.).
(f) Public or private schools that provide VR or employment
services, conduct job training programs, or make services or programs
available that can assist students with disabilities in acquiring
specific job skills that lead to employment. This includes transition
programs that can help students acquire work skills.
(g) Employers that offer job training or other support services or
assistance to help individuals with disabilities obtain and retain
employment or arrange for individuals with disabilities to receive
relevant services or assistance.
Sec. 411.310 How does an entity apply to be an EN and who will
determine whether an entity qualifies as an EN?
(a) An entity applies by responding to our Request for Proposal
(RFP), which will be published in the Commerce Business Daily or online
through the Federal government's electronic posting system. Since
recruitment of ENs will be an ongoing process, the RFP will be open and
continuous. The entity must respond in a format prescribed in the RFP
announcement. In its response, the entity must assure SSA that it is
qualified to provide employment services, vocational rehabilitation
services, and other support services to disabled beneficiaries, either
directly or through arrangements with other entities. For example, the
entity must assure that it is licensed, certified, accredited, or
registered to provide these services or is able to arrange for other
entities to provide these services.
(b) The PM will solicit service providers and other qualified
entities to respond to the RFP on an ongoing basis. The PM will conduct
a preliminary review of responses to the RFP from applicants located in
the PM's service delivery area and make recommendations to the
Commissioner regarding selection. The Commissioner will decide which
applicants will be approved to serve as ENs under the program.
Sec. 411.315 What are the minimum qualifications necessary to be an
EN?
To serve as an EN under the Ticket to Work program, an entity must
meet and maintain compliance with both general selection criteria and
specific selection criteria.
(a) The general criteria include:
(1) Having systems in place to protect the confidentiality of
personal information about beneficiaries seeking or receiving services;
(2) Being accessible, both physically and programmatically, to
beneficiaries seeking or receiving services;
(3) Not discriminating in the provision of services based on a
beneficiary's age, gender, race, color, creed, or national origin;
(4) Having adequate resources to perform the activities required
under the agreement with us or the ability to obtain them;
(5) Complying with the terms and conditions in the agreement with
us, including delivering or coordinating the delivery of employment
services, vocational rehabilitation services, and other support
services; and
(6) Implementing accounting procedures and control operations
necessary to carry out the Ticket to Work program.
(b) The specific criteria that an entity must meet to qualify as an
EN include:
(1)(i) Using staff who are qualified under applicable
certification, licensing, or registration standards that apply to their
profession; or
(ii) Using staff that are otherwise qualified based on education or
experience, such as by using staff with a college degree in a related
field such as vocational counseling, human relations, teaching, or
psychology; and
(2) Providing medical and related health services 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.
(c) An 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 in the
State.
(d) We will not use the following as an EN:
(1) Any entity that has had its license, accreditation,
certification, or registration suspended or revoked for reasons
concerning professional competence or conduct or financial integrity;
(2) Any entity that has surrendered a license, accreditation,
certification, or registration with a disciplinary proceeding pending;
or
(3) Any entity that is precluded from Federal procurement or non-
procurement programs.
Sec. 411.320 What are an EN's responsibilities as a participant in the
Ticket to Work program?
An EN must--
(a) Enter into an agreement with us.
(b) Serve a prescribed service area. The EN must designate the
geographic area in which it will provide services. This will be
designated in the EN's agreement with us.
(c) Provide services directly, or enter into agreements with other
entities to provide employment services, vocational rehabilitation
services, or other support services to beneficiaries with tickets.
(d) Ensure that employment services, vocational rehabilitation
services, and other support services provided under the Ticket to Work
program are provided under appropriate individual work plans (IWPs).
(e) Elect a payment system at the time of signing an agreement with
us (see Sec. 411.505).
(f) Develop and implement each IWP in partnership with each
beneficiary receiving services 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 employment goal. Each
IWP must meet the requirements described in Sec. 411.465.
Sec. 411.321 Under what conditions will SSA terminate an agreement
with an EN due to inadequate performance?
We will terminate our agreement with an EN if it does not comply
with the requirements under Secs. 411.320 and
[[Page 82867]]
411.325 and the conditions in the agreement between SSA and the EN,
including minimum performance standards relating to beneficiaries
achieving self-supporting employment and leaving the benefit rolls.
Sec. 411.325 What reporting requirements are placed on an EN as a
participant in the Ticket to Work program?
An EN must:
(a) Report to the PM each time it accepts a ticket for assignment.
(b) Submit a copy of each signed IWP to the PM.
(c) Submit to the PM copies of amendments to a beneficiary's IWP.
(d) Submit to the PM a copy of any agreement the EN has established
with a State VR agency regarding the conditions under which the State
VR agency will provide services to beneficiaries who are referred by
the EN under the Ticket to Work program.
(e) Report to the PM the specific outcomes achieved with respect to
specific services the EN provided or secured on behalf of beneficiaries
whose tickets it accepted for assignment. Such reports shall conform to
a national model prescribed by us and shall be submitted to the PM at
least annually.
(f) Provide a copy of its most recent annual report on outcomes to
each beneficiary attempting to assign a ticket to it and assure that a
copy of its most recent report is available to the public while
ensuring that personal information on beneficiaries is kept
confidential.
(g) Meet our financial reporting requirements. These requirements
will be described in the agreements between ENs and the Commissioner,
and will include, among other things, submitting to the program
manager, on an annual basis, a financial report that shows the
percentage of the employment network's budget that was spent on serving
beneficiaries with tickets, including the amount that was spent on
beneficiaries who return to work and those who do not return to work.
(h) Collect and record such data as we shall require, in a form
prescribed by us.
(i) Adhere to all requirements specified in the agreement with the
Commissioner and all regulatory requirements in part 411 of chapter III
of 20 CFR.
Sec. 411.330 How will SSA evaluate an EN's performance?
(a) We will periodically review the results of the work of each EN
to ensure effective quality assurance in the provision of services by
ENs.
(b) In conducting such a review, we will solicit and consider the
views of the consumers the EN serves and the PM which monitors the EN.
(c) ENs must make the results of these periodic reviews available
to disabled beneficiaries to assist them in choosing among available
ENs.
Subpart F--State Vocational Rehabilitation Agencies' Participation
Participation in the Ticket to Work Program
Sec. 411.350 Must a State VR agency participate in the Ticket to Work
program?
Yes. Each State agency administering or supervising the
administration of the State plan approved under title I of the
Rehabilitation Act of 1973, as amended (29 U.S.C. 720 et seq.), must
participate in the Ticket to Work program if it wishes to receive
payments from SSA for serving disabled beneficiaries.
Sec. 411.355 What payment options does a State VR agency have under
the Ticket to Work program?
(a) The Ticket to Work program provides different payment options
that are available to a State VR agency for providing services to
disabled beneficiaries. A State VR agency participates in the program
in one of two ways when providing services to a particular disabled
beneficiary under the program. On a case-by-case basis, the State VR
agency may participate either--
(1) As an employment network (EN); or
(2) Under the cost reimbursement payment system (see subpart V of
part 404 and subpart V of part 416 of this chapter).
(b) When the State VR agency serves a beneficiary with a ticket as
an EN, the State VR agency will be paid according to the payment system
it has elected for this purpose, either the outcome payment system or
the outcome-milestone payment system (described in Sec. 411.500).
(c) The State VR agency must use its elected EN payment system
whenever it functions as an EN. The State VR agency will have periodic
opportunities to change the payment system it uses when serving as an
EN. When serving a beneficiary who was not issued a ticket, the State
VR agency may seek payment only under the cost reimbursement payment
system.
(d) The State VR agency may not change the payment system selected
for a specific beneficiary once the ticket has been assigned and the
payment system has been chosen, even if the State VR agency elects a
new EN payment system at a later date.
Sec. 411.360 How does a State VR agency become an EN?
(a) As the Ticket to Work program is implemented in States, we will
notify the State VR agency in writing about payment systems available
under the program. The letter will ask the State VR agency to choose a
payment system to use when it chooses to function as an EN.
(b) When serving beneficiaries holding tickets, the State VR agency
may choose, on a case-by-case basis, to seek payment under its elected
EN payment system or under the cost reimbursement payment system.
Sec. 411.365 How does a State VR agency notify SSA about its choice of
a payment system for use when functioning as an EN?
(a) The State VR agency must respond in writing to our letter
regarding implementation of the Ticket to Work program and tell us
which EN payment system it will use when it chooses to function as an
EN for any beneficiary who has a ticket.
(b) The Governor or the Governor's designated representative must
sign the letter. The letter must reach SSA by the deadline in our
letter.
Sec. 411.370 Does a State VR agency ever have to function as an EN?
No. A State VR agency may choose on a case-by-case basis whether it
will function as an EN when serving a beneficiary with a ticket. It may
continue to serve all beneficiaries with tickets under the cost
reimbursement payment system. However, even if the State VR agency is
not serving as an EN, it still must tell the program manager (PM)
whenever a beneficiary with a ticket is accepted for services to ensure
that the beneficiary's ticket is assigned to that agency.
Sec. 411.375 Does a State VR agency continue to provide services under
the requirements of the State plan approved under title I of the
Rehabilitation Act of 1973, as amended, when functioning as an EN?
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 of 1973, as amended, even when functioning as an EN.
Ticket Status
Sec. 411.380 How does a State VR agency determine whether a person
seeking services has a ticket?
Once the State VR agency determines that a person seeking VR
services is a disabled beneficiary, the State VR agency must contact
the PM to verify the beneficiary's ticket status to see if--
[[Page 82868]]
(a) The beneficiary has a ticket which is available for assignment
(see Sec. 411.140); or
(b) the beneficiary has a ticket that has already been assigned to
an EN.
Sec. 411.385 What does a State VR agency do if a beneficiary who is
applying for services has a ticket that is available for assignment?
(a) Once the State VR agency determines that a beneficiary who is
applying for services has a ticket that is available for assignment
(see Sec. 411.140) and the State VR agency and the beneficiary have
agreed to and signed the individualized plan for employment (IPE)
required under section 102(b) of the Rehabilitation Act of 1973, as
amended, the beneficiary's ticket is considered to be assigned. (See
Sec. 411.165 et seq. for a description of how assigning a ticket may
affect continuing disability reviews.) The State VR agency must submit
the following information to the PM to ensure the assignment of the
beneficiary's ticket to the State VR agency and the recording of the
payment system selected for that beneficiary:
(1) A statement that the beneficiary has decided to assign his
ticket to the State VR agency and that an IPE has been agreed to and
signed by both the beneficiary and a representative of the State VR
agency;
(2) A statement of the vocational goal outlined in the
beneficiary's IPE; and
(3) A statement of the State VR agency's selection of the system
(either cost reimbursement or the previously elected EN payment system)
under which the State VR agency will seek payment for providing
services to the beneficiary.
(b) This information must be submitted to the PM in a format
prescribed by us and must include the signatures of both the
beneficiary, or a representative of the beneficiary, and the State VR
agency representative working with the beneficiary.
Sec. 411.390 What does a State VR agency do if a beneficiary to whom
it is already providing services has a ticket that is available for
assignment?
If, upon implementation of the Ticket to Work program in a State, a
beneficiary who is receiving services from the State VR agency under an
existing IPE has a ticket available for assignment and decides to
assign the ticket to the State VR agency, the State VR agency must
submit the information required in Sec. 411.385 to the PM to ensure the
assignment of that beneficiary's ticket to the State VR agency. Since
the services for that beneficiary were initiated under an IPE prior to
implementation of the Ticket to Work program, the State VR agency may
only seek payment under the cost reimbursement payment system (see
subpart V of part 404 and subpart V of part 416 of this chapter).
Sec. 411.395 Is a State VR agency required to provide periodic
reports?
(a) A State VR agency will be required to prepare periodic reports
on the specific outcomes achieved with respect to the specific services
the State VR agency provided to or secured for disabled beneficiaries
whose tickets it accepted for assignment. These reports must be
submitted to the PM at least annually.
(b) The State VR agency must also submit information to assist the
PM conducting the reviews necessary to assess a beneficiary's timely
progress towards self-supporting employment to determine if a
beneficiary is using a ticket for purposes of suspending continuing
disability reviews (see Sec. Sec. 411.165-411.200).
Referrals by Employment Networks to State VR Agencies
Sec. 411.400 Can an EN to which a beneficiary's ticket is assigned
refer the beneficiary to a State VR agency for services?
Yes. An EN may refer a beneficiary it is serving under the Ticket
to Work program to a State VR agency for services. However, a referral
can be made only if the State VR agency and the EN have an agreement
that specifies the conditions under which services will be provided by
the State VR agency. This agreement must be in writing and signed by
the State VR agency and the EN prior to the EN referring any
beneficiary to the State VR agency for services.
Agreements Between Employment Networks and State VR Agencies
Sec. 411.405 When does an agreement between an EN and the State VR
agency have to be in place?
Each EN must have an agreement with the State VR agency prior to
referring a beneficiary it is serving under the Ticket to Work program
to the State VR agency for specific services.
Sec. 411.410 Does each referral from an EN to a State VR agency
require its own agreement?
No. The agreements between ENs and State VR agencies should be
broad-based and apply to all beneficiaries who may be referred by the
EN to the State VR agency for services.
Sec. 411.415 Who will verify the establishment of agreements between
ENs and State VR agencies?
The PM will verify the establishment of these agreements. Each EN
is required to submit a copy of the agreement it has established with
the State VR agency to the PM.
Sec. 411.420 What information should be included in an agreement
between an EN and a State VR agency?
The agreement between an EN and a State VR agency should state the
conditions under which the State VR agency will provide services to a
beneficiary when the beneficiary is referred by the EN to the State VR
agency for services. Examples of this information include--
(a) Procedures for making referrals and sharing information that
will assist in providing services;
(b) A description of the financial responsibilities of each party
to the agreement;
(c) The terms and procedures under which the EN will pay the State
VR agency for providing services; and
(d) Procedures for resolving disputes under the agreement.
Sec. 411.425 What should a State VR agency do if it gets an attempted
referral from an EN and no agreement has been established between the
EN and the State VR agency?
The State VR agency should contact the EN to discuss the need to
establish an agreement. If the State VR agency and the EN are not able
to negotiate acceptable terms for an agreement, the State VR agency
should notify the PM that an attempted referral has been made without
an agreement.
Sec. 411.430 What should the PM do when it is informed that an EN has
attempted to make a referral to a State VR agency without an agreement
being in place?
The PM will contact the EN to explain that a referral cannot be
made to the State VR agency unless an agreement has been established
that sets out the conditions under which services will be provided when
a beneficiary's ticket is assigned to the EN and the EN is referring
the beneficiary to the State VR agency for specific services.
Resolving Disputes Arising Under Agreements Between Employment
Networks and State VR Agencies
Sec. 411.435 How will disputes arising under the agreements between
ENs and State VR agencies be resolved?
Disputes arising under agreements between ENs and State VR agencies
should be resolved using the following steps:
(a) When procedures for resolving disputes are spelled out in the
[[Page 82869]]
agreement between the EN and the State VR agency, those procedures
should be used.
(b) If procedures for resolving disputes are not included in the
agreement between the EN and the State VR agency and procedures for
resolving disputes under contracts and interagency agreements are
provided for in State law or administrative procedures, the State
procedures should be used to resolve disputes under agreements between
ENs and State VR agencies.
(c) If procedures for resolving disputes are not spelled out in the
agreement or in State law or administrative procedures, the EN or the
State VR agency may request that the PM recommend a resolution to the
dispute.
(1) The request must be in writing and include--
(i) A copy of the agreement;
(ii) Information on the issue(s) in dispute; and
(iii) Information on the position of both the EN and the State VR
agency regarding the dispute.
(2) The PM has 20 calendar days after receiving a written request
to recommend a resolution to the dispute. If either the EN or the State
VR agency does not agree with the PM's recommended resolution to the
dispute, the EN or the State VR agency has 30 calendar days after
receiving the PM's recommendation to request a decision by us on the
matter in dispute.
Subpart G--Requirements for Individual Work Plans
Sec. 411.450 What is an IWP?
An IWP is a required written document signed by an EN and a
beneficiary, or a representative of a beneficiary, with a ticket. It is
developed and implemented in partnership when a beneficiary and an EN
have come to a mutual understanding to work together to pursue the
beneficiary's employment goal under the Ticket to Work program.
Sec. 411.455 What is the purpose of an IWP?
The purpose of an IWP is to outline the specific employment
services, vocational rehabilitation services and other support services
that the EN and beneficiary have determined are necessary to achieve
the beneficiary's stated employment goal. An IWP provides written
documentation for both the EN and beneficiary. Both parties should
develop and implement the IWP in partnership. The EN will develop and
implement the plan in a manner that gives the beneficiary the
opportunity to exercise informed choice in selecting an employment
goal. Specific services needed to achieve the designated employment
goal are discussed and agreed to by both parties.
Sec. 411.460 Who is responsible for determining what information is
contained in the IWP?
The beneficiary and the EN share the responsibility for determining
the employment goal and the specific services needed to achieve that
employment goal. The EN will present information and options in a way
that affords the beneficiary the opportunity to exercise informed
choice in selecting an employment goal and specific services needed to
achieve that employment goal.
Sec. 411.465 What are the minimum requirements for an IWP?
(a) An IWP must include at least--
(1) A statement of the vocational goal developed with the
beneficiary, including, as appropriate, goals for earnings and job
advancement;
(2) A statement of the services and supports necessary for the
beneficiary to accomplish that goal;
(3) A statement of any terms and conditions related to the
provision of these services and supports;
(4) A statement that the EN may not request or receive any
compensation for the costs of services and supports from the
beneficiary;
(5) A statement of the conditions under which an EN may amend the
IWP or terminate the relationship;
(6) A statement of the beneficiary's rights under the Ticket to
Work program, including the right to retrieve the ticket at any time if
the beneficiary is dissatisfied with the services being provided by the
EN;
(7) A statement of the remedies available to the beneficiary,
including information on the availability of advocacy services and
assistance in resolving disputes through the State P&A System;
(8) A statement of the beneficiary's rights to privacy and
confidentiality regarding personal information, including information
about the beneficiary's disability;
(9) A statement of the beneficiary's right to seek to amend the IWP
(the IWP can be amended if both the beneficiary and the EN agree to the
change); and
(10) A statement of the beneficiary's right to have a copy of the
IWP made available to the beneficiary, including in an accessible
format chosen by the beneficiary.
(b) The EN will be responsible for ensuring that each IWP contains
this information.
Sec. 411.470 When does an IWP become effective?
(a) An IWP becomes effective if the following conditions are met--
(1) It has been signed by the beneficiary or the beneficiary's
representative, and by a representative of the EN; and
(2) The PM verifies that the beneficiary has a ticket that is
eligible for assignment and records the beneficiary's decision to
assign his or her ticket.
(b) If the conditions in paragraph (a) of this section are met, the
IWP becomes effective on the date it was signed by both parties.
Subpart H--Employment Network Payment Systems
Sec. 411.500 Definitions of terms used in this part.
(a) Payment Calculation Base means for any calendar year--
(1) In connection with a title II disability beneficiary (including
a concurrent title II/title XVI disability beneficiary), the average
monthly disability insurance benefit payable under section 223 of the
Act for months during the preceding calendar year to all beneficiaries
who are in current pay status for the month for which the benefit is
payable; and
(2) In connection with a title XVI disability beneficiary (who is
not concurrently a title II disability beneficiary), the average
monthly payment of Supplemental Security Income (SSI) benefits based on
disability payable under title XVI (excluding State supplementation)
for months during the preceding calendar year to all beneficiaries
who--
(i) Have attained age 18 but have not attained age 65;
(ii) Are not concurrent title II/title XVI beneficiaries; and
(iii) Are in current pay status for the month for which the payment
is made.
(b) Outcome Payment Period means a period of 60 months, not
necessarily consecutive, for which Social Security disability benefits
and Federal SSI cash benefits are not payable to the individual because
of the performance of substantial gainful activity (SGA) or by reason
of earnings from work. This period begins with the first month, ending
after the date on which the ticket was first assigned, for which such
benefits are not payable due to SGA or earnings. This period ends with
the 60th month, consecutive or otherwise, ending after such date, for
which such benefits are not payable due to SGA or earnings.
(c) Outcome Payment System is a system providing a schedule of
[[Page 82870]]
payments to an employment network (EN) for each month, up to a total of
60 months, during the outcome payment period. The maximum number of
outcome payment months for each ticket is sixty.
(d) Outcome-Milestone Payment System is a system providing a
schedule of payments to an EN that includes, in addition to payments
during the outcome payment period, payment for completion by a
beneficiary of up to two milestones directed toward the goal of
permanent employment. Milestones occur prior to the beginning of the
outcome payment period. Milestone payments consist of payments in
addition to any payments made during the outcome payment period. The
total payments under the outcome-milestone payment system, with respect
to each beneficiary who assigns a ticket to the EN, must be less than,
on a net present value basis, the total payments that would be payable
to the EN under the outcome payment system.
Sec. 411.505 How is an EN paid by SSA?
An EN can elect either of two payment systems. These systems are
the outcome payment system and the outcome-milestone payment system.
The EN will elect a payment system at the time the EN enters into an
agreement with SSA. (For State VR agencies, see Sec. 411.365). The EN
may periodically change its elected payment system as described in
Sec. 411.515.
Sec. 411.510 How is the State VR agency paid under the Ticket to Work
program?
(a) The State VR agency's payment choices are described in
Sec. 411.355.
(b) The State VR agency's decision to serve the beneficiary must be
communicated to the program manager (PM). At the same time, the State
VR agency must notify the PM of its selected payment system for that
beneficiary.
(c) For each beneficiary who is already a client of the State VR
agency prior to receiving a ticket, the State VR agency will notify the
PM of the payment system election for each such beneficiary at the time
the ticket is assigned to the State VR agency.
Sec. 411.515 Can the EN change its elected payment system?
(a) Yes. Any change in the elected EN payment system will apply to
beneficiaries who assign their ticket to the EN after the EN's change
in election becomes effective. A change in the EN's election will
become effective with the month following the month in which the EN
notifies us of the change. For beneficiaries who already assigned their
ticket to the EN under the EN's earlier elected payment system, the
EN's earlier elected payment system will continue to apply.
(b) During the 12 months following the month the EN first elects a
payment system, the EN can choose to make one change in its elected
payment system at any time.
(c) After an EN (or a State VR agency) first elects a payment
system, as part of signing the EN agreement with us (for State VR
agencies, see Sec. 411.365), the EN (or State VR agency) will have the
opportunity to change from its existing elected payment system during
times announced by us. We will offer the opportunity for ENs (and State
VR agencies) to make a change in their elected payment system at least
every 18 months following January 2001.
Sec. 411.520 How are beneficiaries whose ticket is assigned to an EN
affected by an EN's change in elected payment system?
A change in an EN's elected payment system has no affect upon the
beneficiaries who have assigned their ticket to an EN.
Sec. 411.525 How are the EN payments calculated under each of the two
EN payment systems?
(a) For payments for outcome payment months, both EN payment
systems use the payment calculation base as defined in
Sec. 411.500(a)(1) or (a)(2), as appropriate. This base uses the
preceding calendar year's national average disability benefit payment
information to compute the values for payments made to ENs for outcome
payment months during the next calendar year.
(1)(i) Under the outcome payment system, we can pay up to 60
monthly payments to the EN. For each month for which Social Security
disability benefits and Federal SSI cash benefits are not payable to
the individual because of work or earnings, the EN is eligible for a
monthly outcome payment. Payment for an outcome payment month under the
outcome payment system is equal to a fixed percentage of the payment
calculation base for the calendar year in which such month occurs. This
percentage is 40 percent.
(ii) If a disabled beneficiary's entitlement to Social Security
disability benefits ends (see Sec. Sec. 404.316(b), 404.337(b) and
404.352(b) of this chapter) or eligibility for SSI benefits based on
disability or blindness terminates (see Sec. 416.1335 of this chapter)
because of the performance of SGA or by reason of earnings from work
activity, we will consider any month after the month in which such
entitlement ends or eligibility terminates to be a month for which
Social Security disability benefits and Federal SSI cash benefits are
not payable to the individual because of work or earnings if--
(A) The individual has gross earnings from employment (or net
earnings from self-employment as defined in Sec. 416.1110(b) of this
chapter) in that month that are at or above the SGA dollar amount in
Sec. 404.1574(b)(2) of this chapter (or in Sec. 404.1584(d) of this
chapter for an individual who is statutorily blind); and
(B) The individual is not entitled to any monthly benefits under
title II or eligible for any benefits under title XVI for that month.
(2) Under the outcome-milestone payment system, we can pay the EN
for up to two milestones achieved by a beneficiary who has assigned his
or her ticket to the EN. In addition to the milestone payments, monthly
outcome payments can be paid to the EN during the outcome payment
period.
(b) Under the outcome-milestone payment system, the EN's total
payments for a beneficiary will be less than, on a net present value
basis, the total payments if the EN were paid under the outcome payment
system. Under the outcome-milestone payment system, the EN's total
potential payment is about 85 percent of the total that would have been
potentially payable under the outcome payment system for the same
beneficiary.
(c) We will pay an EN to whom the individual has assigned a ticket
only for milestones or outcomes achieved in months prior to the month
in which the ticket terminates (see Sec. 411.155). We will not pay a
milestone or outcome payment to an EN based on an individual's work
activity or earnings in or after the month in which the ticket
terminates.
Sec. 411.530 How will the outcome period payments be reduced when paid
under the outcome-milestone payment system?
Under the outcome-milestone payment system, the outcome payment for
each of the first 12 outcome payment months is reduced by an amount
equal to 1/12th of the milestone payments already made based on a
ticket.
Sec. 411.535 What are the milestones for which an EN can be paid?
(a) Under the outcome-milestone payment system, there are two
milestones for which the EN can be paid. Both milestones occur after
the beneficiary starts to work. The earnings levels for both milestones
are the dollar amounts we use when we consider if
[[Page 82871]]
work activity is SGA. We will use the dollar amounts in
Sec. 404.1574(b)(2) of this chapter for beneficiaries who are not
statutorily blind, and we will use the dollar amounts in
Sec. 404.1584(d) of this chapter for beneficiaries who are statutorily
blind. We will use these dollar amounts in order to measure if the
beneficiary's earnings level meets the milestone objective.
(1) The first milestone is met when the beneficiary has worked for
3 calendar months within a 12-month period and has gross earnings from
employment (or net earnings from self-employment as defined in
Sec. 416.1110(b) of this chapter) at the SGA dollar amount or above for
each of the 3 months.
(2) The second milestone is met when the beneficiary has worked for
7 calendar months within a 12-month period and has gross earnings from
employment (or net earnings from self-employment as defined in
Sec. 416.1110(b) of this chapter) at the SGA dollar amount or above for
each of the 7 months. Any of the 3 months used to meet the first
milestone can be included in the 7 months used to meet the second
milestone.
(b) An EN can be paid for a milestone only if the milestone is met
after a beneficiary has assigned his or her ticket to the EN. A
milestone is met when the 3rd month is attained for milestone one, and
when the 7th month is attained for milestone two as described under
paragraph (a) of this section.
Sec. 411.540 What are the payment amounts for each of the milestones?
(a) The payment for the first milestone is equal to 68 percent of
the payment calculation base for the calendar year in which the month
of attainment of the milestone occurs. The payment approximates the
average value of two monthly outcome payments under the outcome-
milestone payment system.
(b) The payment for the second milestone is equal to 136 percent of
the payment calculation base for the calendar year in which the month
of attainment of the milestone occurs. The payment approximates the
average value of four monthly outcome payments under the outcome-
milestone payment system.
(c) The month of attainment of the first milestone is the 3rd
month, within a 12-month period, in which the individual has the
required earnings as described in Sec. 411.535.
(d) The month of attainment of the second milestone is the 7th
month, within a 12-month period, in which the individual has the
required earnings as described in Sec. 411.535.
Sec. 411.545 What are the payment amounts for outcome payment months
under the outcome-milestone payment system?
The amount of each monthly outcome payment under the outcome-
milestone payment system is as follows--
(a) Beginning with the 1st outcome payment month and ending with
the 12th outcome payment month, the payment for an outcome payment
month is equal to 30 percent of the payment calculation base for the
calendar year in which the month occurs, reduced by an amount equal to
\1/12\ of the total of the milestone payments made with respect to a
ticket.
(b) Beginning with the 13th outcome payment month and ending with
the 24th outcome payment month, the payment for an outcome payment
month is equal to 32 percent of the payment calculation base for the
calendar year in which the month occurs.
(c) Beginning with the 25th outcome payment month and ending with
the 36th outcome payment month, the payment for an outcome payment
month is equal to 34 percent of the payment calculation base for the
calendar year in which the month occurs.
(d) Beginning with the 37th outcome payment month and ending with
the 48th outcome payment month, the payment for an outcome payment
month is equal to 36 percent of the payment calculation base for the
calendar year in which the month occurs.
(e) Beginning with the 49th outcome payment month and ending with
the 60th outcome payment month, the payment for an outcome payment
month is equal to 38 percent of the payment calculation base for the
calendar year in which the month occurs.
Sec. 411.550 What are the payment amounts for outcome payment months
under the outcome payment system?
Under the outcome payment system, the payment for an outcome
payment month is equal to 40 percent of the payment calculation base
for the calendar year in which the month occurs.
Sec. 411.555 Can the EN keep the milestone and outcome payments even
if the beneficiary does not achieve all 60 outcome months?
Yes. The EN can keep each milestone and outcome payment for which
the EN is eligible, subject to adjustment under Sec. 411.560.
Sec. 411.560 Is it possible to pay a milestone or outcome payment to
more than one EN?
Yes. It is possible for more than one EN to receive payment based
on the same milestone or outcome. If the beneficiary has assigned the
ticket to more than one EN at different times, and more than one EN
requests payment for the same milestone or outcome payment under its
elected payment system, the PM will make a determination of the
allocation of payment to each EN. The PM will make this determination
based upon the services provided by each EN.
Sec. 411.565 What happens if two or more ENs qualify for payment on
the same ticket but have elected a different EN payment system?
We will pay each EN according to its elected EN payment system in
effect at the time the beneficiary assigned the ticket to the EN.
Sec. 411.570 Can an EN request payment from the beneficiary who
assigned a ticket to the EN?
No. Section 1148(b)(4) of the Act prohibits an EN from requesting
or receiving compensation from the beneficiary for the services of the
EN.
Sec. 411.575 How does the EN request payment for milestones or outcome
payment months achieved by a beneficiary who assigned a ticket to the
EN?
The EN will send its request for payment, evidence of the
beneficiary's work or earnings and other information to the PM.
(a) Milestone payments. (1) We will pay the EN for milestones only
if the outcome-milestone payment system is the elected EN payment
system at the time the beneficiary assigned a ticket to the EN.
(2) The EN must request payment for each milestone achieved by a
beneficiary who has assigned a ticket to the EN. The request must
include evidence that the milestone was achieved, and other information
as we may require, to evaluate the EN's request. We do not have to stop
monthly benefit payments to the beneficiary before we can pay the EN
for milestones achieved by the beneficiary.
(b) Outcome payments. (1) We will pay an EN an outcome payment for
a month if--
(i)(A) Social Security disability benefits and Federal SSI cash
benefits are not payable to the individual for that month due to work
or earnings; or
(B) The requirements of Sec. 411.525(a)(1)(ii) are met in a case
where the beneficiary's entitlement to Social Security disability
benefits has ended or eligibility for SSI benefits based on disability
or blindness has
[[Page 82872]]
terminated because of work activity or earnings; and
(ii) We have not already paid for 60 outcome months on the same
ticket.
(2) The EN must submit a request for payment for an outcome payment
month in order to begin receiving outcome payments for a ticket
assigned to the EN by a beneficiary. The request for payment must
include proof of the beneficiary's work or earnings that is sufficient
for us to determine that we can stop the beneficiary's monthly Federal
cash benefit payments due to work or earnings. For a payment for a
month after the month in which the beneficiary's entitlement to Social
Security disability benefits ends or eligibility for SSI benefits based
on disability or blindness terminates due to work activity or earnings,
the EN must submit proof that the individual has gross earnings from
employment or net earnings from self-employment in that month that are
at or above the applicable SGA dollar amount as described in
Sec. 411.525(a)(1)(ii). For an individual who is self-employed,
evidence of his or her work activity or earnings should be obtained
from the individual. For an individual who is an employee, evidence of
his or her work activity or earnings is best obtained from the employer
or the employer's designated payroll preparer.
(3) Before we stop a beneficiary's monthly benefit(s) payment
because of work or earnings, we review his or her work effort. A
request accompanied by a Work Activity Report (form SSA-821) can
expedite processing the payment request. The Work Activity Report is a
form that the beneficiary completes.
(4) While an EN does not need to submit separate requests to
continue payments for each outcome month, an EN must continue to submit
evidence that the beneficiary's level of work or earnings is sufficient
to preclude payment of monthly Social Security disability and Federal
SSI cash benefits. For cases described in Sec. 411.525(a)(1)(ii), the
EN must continue to submit proof of the individual's gross earnings
from employment or net earnings from self-employment (see paragraph
(b)(2) of this section). An EN cannot receive an outcome payment for
any month for which a Social Security disability benefit or a Federal
SSI cash benefit is payable to the beneficiary.
(5) ENs can submit the evidence of work or earnings to the PM on a
monthly basis or an EN can submit 2 months worth of evidence every
other month.
Sec. 411.580 Can an EN receive payments for milestones or outcome
payment months that occur before the beneficiary assigns a ticket to
the EN?
No. An EN may be paid only for milestones or outcome payment months
that are achieved after the ticket is assigned to the EN.
Sec. 411.585 Can a State VR agency and an EN both receive payment for
serving the same beneficiary?
Yes. It is possible if the State VR agency serves the beneficiary
as an EN. In this case, both the EN and the State VR agency may be
eligible for payment based on the same ticket.
(a) If a State VR agency is paid by us under the cost reimbursement
payment system with respect to a ticket, such payment precludes any
subsequent payment by us based on the same ticket to an EN or to a
State VR agency serving as an EN under either the outcome payment
system or the outcome-milestone payment system.
(b) If an EN or a State VR agency serving a beneficiary as an EN is
paid by us under one of the EN payment systems with respect to a
ticket, such payment precludes subsequent payment to a State VR agency
under the cost reimbursement payment system based on the same ticket.
Sec. 411.590 What can an EN do if the EN disagrees with our decision
on a payment request?
(a) If an EN other than a State VR agency has a payment dispute
with us, the dispute shall be resolved under the dispute resolution
procedures contained in the EN's agreement with us.
(b) If a State VR agency serving a beneficiary as an EN has a
dispute with us regarding payment under an EN payment system, the State
VR agency may, within 60 days of receiving notice of our decision,
request reconsideration in writing. The State VR agency should send the
request for reconsideration to the PM. The PM will forward to us the
request for reconsideration and a recommendation. We will notify the
State VR agency of our reconsidered decision in writing.
(c) An EN cannot appeal determinations we make which affect a
beneficiary's right to benefits. Only the beneficiary or his or her
representative can appeal these determinations. (See Secs. 404.900
through 404.999 and 416.1400 through 416.1499 of this chapter.)
(d) If an appeal by a beneficiary regarding entitlement or
eligibility for disability benefits results in a revised determination,
our revised determination could affect the EN's payment or result in an
adjustment to payments already made to the EN. While the EN cannot
appeal our determination about a beneficiary's right to benefits, the
EN may furnish any evidence the EN has which may support a change in
our determination on the beneficiary's appeal.
Sec. 411.595 What oversight procedures are planned for the EN payment
systems?
We use audits, reviews, studies and observation of daily activities
to identify areas for improvement. Internal reviews of our systems
security controls are regularly performed. These reviews provide an
overall assurance that our business processes are functioning as
intended. The reviews also ensure that our management controls and
financial management systems comply with the standards established by
the Federal Managers' Financial Integrity Act and the Federal Financial
Management Improvement Act. These reviews operate in accordance with
the Office of Management and Budget Circulars A-123, A-127 and Appendix
III to A-130. Additionally, our Executive Internal Control Committee
meets periodically and provides further oversight of program and
management control issues.
Sec. 411.597 Will SSA periodically review the outcome payment system
and the outcome-milestone payment system for possible modifications?
(a) Yes. We will periodically review the system of payments and
their programmatic results to determine if they provide an adequate
incentive for ENs to assist beneficiaries to enter the work force,
while providing for appropriate economies.
(b) We will specifically review the limitation on monthly outcome
payments as a percentage of the payment calculation base, the
difference in total payments between the outcome-milestone payment
system and the outcome payment system, the length of the outcome
payment period, and the number and amount of milestone payments, as
well as the benefit savings and numbers of beneficiaries going to work.
We will consider altering the payment system conditions based upon the
information gathered and our determination that an alteration would
better provide for the incentives and economies described above.
[[Page 82873]]
Subpart I--Ticket to Work Program Dispute Resolution
Disputes Between Beneficiaries and Employment Networks
Sec. 411.600 Is there a process for resolving disputes between
beneficiaries and ENs?
Yes. After an IWP is signed, a process is available which will
assure each party a full, fair and timely review of a disputed matter.
This process has three steps.
(a) The beneficiary can seek a solution through the EN's internal
grievance procedures.
(b) If the EN's internal grievance procedures do not result in an
agreeable solution, either the beneficiary or the EN may seek a
resolution from the PM.
(c) If either the beneficiary or the EN is dissatisfied with the
resolution proposed by the PM, either party may request a decision from
us.
Sec. 411.605 What are the responsibilities of the EN regarding the
dispute resolution process?
The EN must:
(a) Have grievance procedures that a beneficiary can use to seek a
resolution to a dispute under the Ticket to Work program;
(b) Give each beneficiary seeking services a copy of its internal
grievance procedures;
(c) Inform each beneficiary seeking services of the right to refer
a dispute first to the PM for review, and then to us for a decision;
and
(d) Inform each beneficiary of the availability of assistance from
the State P&A system.
Sec. 411.610 When should a beneficiary receive information on the
procedures for resolving disputes?
Each EN must inform each beneficiary seeking services under the
Ticket to Work program of the procedures for resolving disputes when--
(a) The EN and the beneficiary complete and sign the IWP;
(b) Services in the beneficiary's IWP are reduced, suspended or
terminated; and
(c) A dispute arises related to the services spelled out in the
beneficiary's IWP or to the beneficiary's participation in the program.
Sec. 411.615 How will a disputed issue be referred to the PM?
The beneficiary or the EN may ask the PM to review a disputed
issue. The PM will contact the EN to submit all relevant information
within 10 working days. The information should include:
(a) A description of the disputed issue(s);
(b) A summary of the beneficiary's position, prepared by the
beneficiary or a representative of the beneficiary, related to each
disputed issue;
(c) A summary of the EN's position related to each disputed issue;
and
(d) A description of any solutions proposed by the EN when the
beneficiary sought resolution through the EN's grievance procedures,
including the reasons the beneficiary rejected each proposed solution.
Sec. 411.620 How long does the PM have to recommend a resolution to
the dispute?
The PM has 20 working days to provide a written recommendation. The
recommendation should explain the reasoning for the proposed
resolution.
Sec. 411.625 Can the beneficiary or the EN request a review of the
PM's recommendation?
(a) Yes. After receiving the PM's recommendation, either the
beneficiary or the EN may request a review by us. The request must be
in writing and received by the PM within 15 working days of the receipt
of the PM's recommendation for resolving the dispute.
(b) The PM has 10 working days to refer the request for a review to
us. The request for a review must include:
(1) A copy of the beneficiary's IWP;
(2) Information on the disputed issue(s);
(3) Any relevant evidence; and
(4) The PM's conclusion(s) and recommendation(s).
Sec. 411.630 Is SSA's decision final?
Yes. Our decision is final. If either the beneficiary or the EN is
unwilling to accept our decision, either has the right to terminate its
relationship with the other.
Sec. 411.635 Can a beneficiary be represented in the dispute
resolution process under the Ticket to Work program?
Yes. Both the beneficiary and the EN may use an attorney or other
individual of their choice to represent them at any step in the dispute
resolution process. The P&A system in each State and U.S. Territory is
available to provide assistance and advocacy services to beneficiaries
seeking or receiving services under the Ticket to Work program,
including assistance in resolving issues at any stage in the dispute
resolution process.
Disputes Between Beneficiaries and State VR Agencies
Sec. 411.640 Do the dispute resolution procedures of the
Rehabilitation Act of 1973, as amended, apply to beneficiaries seeking
services from the State VR agency?
Yes. The procedures in the Rehabilitation Act of 1973, as amended,
apply to any beneficiary who has assigned a ticket to a State VR
agency. The Rehabilitation Act requires the State VR agency to provide
each person seeking or receiving services with a description of the
services available through the Client Assistance Program authorized
under section 112 of the Rehabilitation Act of 1973, as amended. It
also provides the opportunity to resolve disputes using formal
mediation services or the impartial hearing process in section 102(c)
of the Rehabilitation Act of 1973, as amended.
Disputes Between Employment Networks and Program Managers
Sec. 411.650 Is there a process for resolving disputes between ENs and
PMs, other than disputes on a payment request?
Yes. Under the agreement to assist us in administering the Ticket
to Work program, a PM is required to have procedures to resolve
disputes with ENs that do not involve an EN's payment request. (See
Sec. 411.590 for the process for resolving disputes on EN payment
requests.) This process must ensure that:
(a) The EN can seek a solution through the PM's internal grievance
procedures.
(b) If the PM's internal grievance procedures do not result in a
mutually agreeable solution, the PM shall refer the dispute to us for a
decision.
Sec. 411.655 How will the PM refer the dispute to us?
The PM has 20 working days from the failure to come to a mutually
agreeable solution with an EN to refer the dispute to us with all
relevant information. The information should include:
(a) A description of the disputed issue(s);
(b) A summary of the EN's and PM's position related to each
disputed issue; and
(c) A description of any solutions proposed by the EN and PM when
the EN sought resolution through the PM's grievance procedures,
including the reasons each party rejected each proposed solution.
Sec. 411.660 Is SSA's decision final?
Yes. Our decision is final.
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Subpart J--The Ticket to Work Program and Alternate Participants
Under the Programs for Payments for Vocational Rehabilitation
Services
Sec. 411.700 What is an alternate participant?
An alternate participant is any public or private agency (other
than a participating State VR agency described in Secs. 404.2104 and
416.2204 of this chapter), organization, institution, or individual
with whom the Commissioner has entered into an agreement or contract to
provide VR services to disabled beneficiaries under the programs
described in subpart V of part 404 and subpart V of part 416 of this
chapter. In this subpart J, we refer to these programs as the programs
for payments for VR services.
Sec. 411.705 Can an alternate participant become an EN?
In any State where the Ticket to Work program is implemented, each
alternate participant whose service area is in that State will be asked
to choose if it wants to participate in the program as an EN.
Sec. 411.710 How will an alternate participant choose to participate
as an EN in the Ticket to Work program?
(a) When the Ticket to Work program is implemented in a State, each
alternate participant whose service area is in that State will be
notified of its right to choose to participate as an EN in the program
in that State. The notification to the alternate participant will
provide instructions on how to become an EN and the requirements that
an EN must meet to participate in the Ticket to Work program.
(b) An alternate participant who chooses to become an EN must meet
the requirements to be an EN, including--
(1) Enter into an agreement with SSA to participate as an EN under
the Ticket to Work program (see Sec. 411.320);
(2) Agree to serve a prescribed service area (see Sec. 411.320);
(3) Agree to the EN reporting requirements (see Sec. 411.325); and
(4) Elect a payment option under one of the two EN payment systems
(see Sec. 411.505).
Sec. 411.715 If an alternate participant becomes an EN, will
beneficiaries for whom an employment plan was signed prior to
implementation be covered under the Ticket to Work program payment
provisions?
No. When an alternate participant becomes an EN in a State in which
the Ticket to Work program is implemented, those beneficiaries for whom
an employment plan was signed prior to the date of implementation of
the program in the State, will continue to be covered for a limited
time under the programs for payments for VR services (see
Sec. 411.730).
Sec. 411.720 If an alternate participant chooses not to become an EN,
can it continue to function under the programs for payments for VR
services?
Once the Ticket to Work program has been implemented in a State,
the alternate participant programs for payments for VR services begin
to be phased-out in that State. We will not pay any alternate
participant under these programs 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 that date, we will pay the alternate
participant, under the programs for payments for VR services, for
services provided prior to January 1, 2004 if all other requirements
for payment under these programs are met. We will not pay an alternate
participant under these programs for any services provided on or after
January 1, 2004.
Sec. 411.725 If an alternate participant becomes an EN and it has
signed employment plans, both as an alternate participant and an EN,
how will SSA pay for services provided under each employment plan?
We will continue to abide by the programs for payments for VR
services in cases where services are provided to a beneficiary under an
employment plan signed prior to the date of implementation of the
Ticket to Work program in the State. However, we will not pay an
alternate participant under these programs for services provided on or
after January 1, 2004. For those employment plans signed by a
beneficiary and the EN after implementation of the program in the
State, the EN's elected EN payment system under the Ticket to Work
program applies.
Sec. 411.730 What happens if an alternate participant signed an
employment plan with a beneficiary before Ticket to Work program
implementation in the State and the required period of substantial
gainful activity is not completed by January 1, 2004?
The beneficiary does not have to complete the 9-month continuous
period of substantial gainful activity (SGA) prior to January 1, 2004,
in order for the costs of the services to be payable under the programs
for payments for VR services. The 9-month SGA period can be completed
after January 1, 2004. However, SSA will not pay an alternate
participant under these programs for the costs of any services provided
after December 31, 2003.
[FR Doc. 00-32924 Filed 12-27-00; 8:45 am]
BILLING CODE 4191-02-P