The Ticket and Employment Network Workgroup (Bryon MacDonald, Chair; Christine Flaten; Thomas Golden; Frances Gracechild and Jerome Kleckley). The Workgroup was staffed by Lisa Ekman and Theda Zawaiza.

The Workgroup met numerous times from September 2000 through January 2001 to address key issues in the Ticket program and in the provisions in the Notice of Proposed Rulemaking for the Ticket to Work and Self Sufficiency Program. Their review and discussion/deliberation of issues related directly to beneficiary use and operation of the Ticket program and to the work and qualifications of employment networks as service providers under the new law. What follows is a discussion of eight (8) key issues identified by the Workgroup, along with a brief discussion, summary of public comments, and their recommendations to the full Panel consideration. Each issue is discussed separately.

Issue One

Issue: Should transition-aged youth (16-18) be eligible to receive and use a Ticket in the Ticket to Work and Self – Sufficiency Program?

Discussion:

The proposed regulations limit participation in the Ticket program to disability beneficiaries between the ages of 18 and 64. 18 year old SSI recipients must be determined disabled under adults rules before being able to receive a Ticket. As youth prepare to transition out of school to the workforce, the Ticket program could be a value added tool to assist them to plan work.

Summary of public comment: The workgroup received comments from the public that overwhelmingly supported providing Tickets to at least 16 and 17 year olds. There was consensus that the longer people receive cash benefits the less likely they are to be able to get achieve independence and become self-supporting. The public also agreed that the expectations created for a young person with a disability might be the most important factor in whether they work or rely on benefits and that allowing them to participate in the Ticket program makes another tool available to encourage positive expectations. Experts told the workgroup that schools themselves could potentially be Employment Networks for youth.

Recommendation: The workgroup recommends that at least 16 and 17 year old beneficiaries be considered eligible to participate in the Ticket program.

Rationale: Making transition-aged youth ineligible for the ticket program would send the wrong message to youth and would have the effect of encouraging lifelong dependency upon benefits. There may or may not be a determinable increase in cost to the program in the short-term. The long-term benefits to the program and the youth beneficiaries could far outweigh those expenditures. Many youth may not choose to participate in the program until after they are 18, but those who wish to participate should be allowed to do so. Programs and policy in the Individuals with Disabilities Education Act and the Workforce Investment Act promote seamless programming from school to work for all students, for those with and without disabilities.

Issue Two

Issue: Should disability beneficiaries classified with a “Medical Improvement Expected (MIE)” diary be eligible to participate in the Ticket program?

Discussion: The proposed regulations state that a person who is awarded benefits with an MIE diary for the scheduling of their first Continuing Disability Review (CDR) is not eligible for the Ticket program until after the completion of their first CDR. A beneficiary with this designation is supposed to have their case reviewed within 18 months to three years after receiving benefits. This category was created for the sole purpose of determining when the first CDR for a beneficiary should be completed.

Summary of Public Comment: Public comment supported the inclusion of beneficiaries with the MIE diary in the Ticket program. Members of the public indicated that services should be available to all disability beneficiaries sooner rather than later as policy, since much recent research supports findings that the longer someone receives cash benefits the harder it is for them to become self-supporting. The public also cited that most people with MIE diary do not even know they have been given that designation. Further, testimony to the workgroup indicated that in their practical experience, people with MIE diaries undergo delayed initial CDRs often times years after the date on which they are supposed to. Concern was expressed that people with long term mental illness and cognitive impairments receive this designation disproportionately, often with no real indication that improvement is likely. In addition, members of the public indicated that if the award of the MIE diary would be used to limit a person’s access to a benefit, it must be subject to due process review or appeal.

Recommendation: All SSA disability beneficiaries with a MIE diary should be eligible to participate in the Ticket program. If they are excluded from participation in the program, the process for determining this designation must be changed. Beneficiaries should be notified that they are being given this designation, informed that it will prevent them from participating in the Ticket program and a process for appeal/due process review should be created.

Rationale: The exclusion of beneficiaries with the MIE diary from participation in the Ticket program does not appear to be justified. The SSA policy offices were not able to provide the Workgroup with a sound statistical analysis to justify this exclusion. The workgroup was not provided with data on how long it takes for a person with the MIE diary to have the initial CDR completed. There was also no information that indicated that a significant number of people with the MIE designation would be terminated after the completion of their initial CDR. There is no evidence to counter the argument that people with a MIE designation would be more successful in staying off the rolls through being allowed early participation in the Ticket program, even if their initial CDR would result in a termination of benefits. In addition, it is not known how many beneficiaries have their benefits terminated due to a CDR based on the MIE diary, reapply based on a decline in their condition and are re- awarded benefits.

It is questionable to limit a person’s access to a Federal benefit (i.e. the ticket) without providing for a due process review. If this exclusion remains in the Final Rule, a procedure for review and appeal should be created. This would increase the administrative burden to SSA, the cost of which may outweigh the possible savings to the programs created by such an exclusion. The resulting administrative burden to the SSA appeals process could have an impact on the length of time required to process all appeals, not just MIE cases.

Finally, if this rule stand and its effect is to limit a person’s access to the benefit of the Ticket program, SSA should commit to ensuring that beneficiaries with the MIE designation receive their initial CDR in a timely manner.

The effect of the proposed rule for a young adult beneficiary (18 year old) requesting a Ticket could be equivalent to an application for benefits process. We believe such a request would trigger the following review and determination process, given the proposed rule as written. SSA will have to consider:

• whether the beneficiary has been found disabled under adult rules;

• is not in an MIE category;

• or has been found disabled after his/her first CDR after being in an MIE category; and,

• is in current pay status which is not an overpayment because of wage reporting that has not been recorded and followed up on a timely basis.

Issue Three

Issue: Should a person be entitled to more than one ticket within a period of disability?

Discussion: The proposed rule states that a person can have only one ticket during a period of entitlement for which a beneficiary is eligible to receive disability benefits. If a beneficiary returned to work and their Employment Network (EN) received 35 out of the 60 outcome payments and the beneficiary then became temporarily unable to work due to their disability, that ticket would only have 25 outcome payments left on their ticket (“a partially used ticket”). At issue is whether an EN (new or old) be willing to provide services to that beneficiary with the reduced number of payments (only 25) that the EN would be eligible for?

Summary of public comment: Concern was expressed by the public that beneficiaries would not be able to find ENs that would provide services to them if they have a partially used ticket. Current research (Schur, 2000) finds that people with disabilities are twice as likely as non-disabled people to work in part time and temporary work. Concern was raised that the program would not work for a large segment of the population it is intended to serve.

Recommendation: SSA should conduct a cost benefit analysis on the feasibility of a beneficiary receiving more than one ticket;

OR

SSA should begin the Ticket program by deleting the restriction in 411.125 (b) limiting a beneficiary to one Ticket per period of entitlement. SSA should conduct a cost benefit analysis on the feasibility of a beneficiary receiving more than one ticket, and continue to assess the impact and practical guidance learned on this procedure in its “Adequacy of incentives” report due to Congress at the end of the Ticket implementation period.

Rationale: Many beneficiaries using the Ticket program are likely to go in and out of work, and not transition at first attempt from receipt of cash benefits to 60 months of continuous employment. A beneficiary whose Ticket is partially used and needs other support services may have a difficult time finding an EN willing to work with them. These consumers will be at a distinct disadvantage even though they are interested in continuing to work. There is no statutory guidance not to allow a beneficiary a second ticket or to permit the first ticket to be “reset” back to full value in these circumstances.

Issue Four

Issue: Who should be in an Employment Network providing services to beneficiaries who are ticket holders?

Discussion: According to the proposed rule, an Employment Network is any qualified entity that has entered into an agreement with SSA to function as an EN, and assumes responsibility for the coordination and delivery of employment services, vocational rehabilitation services, or other support services to beneficiaries who have assigned their ticket to that EN. An eligible entity must assure that it is licensed, certified, accredited, or registered to provide these services either directly or through arrangements with other entities.

Summary of Public Comments: Many commenters stated that State licensure laws dictate requirements for certain providers so SSA should defer to those State rules. Some commenters expressed concern that the quality of services may be compromised if provided by less that trained personnel, however, they recognized the benefits of allowing support and other services by non-credentialed providers if under the auspices of an EN who is ultimately accountable for the services provided.

Recommendation: An EN should be required to retain staff that are otherwise qualified based on education or direct services experience, such as by using staff with a college degree in a related field, including but not limited to vocational counseling, human relations, teaching, or psychology. SSA should not require licensure and/or certification that would exclude employers or others qualified to work with people with disabilities that offer non-traditional supports that result in employment. Delete § 411. 315 (c)

Rationale: Many people with disabilities have a “circle of support,” that is, people who they trust to provide ancillary and support services. Most often, these individuals are non-credentialed support providers. In some instances, they are family members, neighbors, or friends. The regulation regarding EN qualifications should be broad enough to accommodate non-traditional providers and accomplish the purpose of the Ticket program, to “expand the universe of service providers available to individuals who are entitled to Social Security benefits based on disability...” § 411.105

Issue Five

Issue: What financial reporting is needed by the Employment Network to the Program Manager or SSA?

Discussion: Section 411.325 of the proposed regulations addresses the reporting requirements placed on an EN. One of those requirements is for the EN to submit to the Program Manager, annually, a financial report that shows the percentage of the Employment Network’s budget that was spent on serving beneficiaries with tickets.

Summary of Public Comments: Commenters recommended that the agency “keep it simple” and not require reporting that is not necessary. Some were concerned that a few of the reporting requirements may place an undue administrative burden on ENs and discourage the participation of potential providers.

Recommendation: The workgroup recommends that section 411.325(g) be deleted from the list of reporting requirements. Continued SSA dialogue with the Panel and interested stakeholders on this rule may generate specific and timely recommendations on how to meet the needs that warranted this rule, in less invasive ways for potential ENs.

Rationale: While there is a substantive evaluation component in the Ticket program, using the financial reporting requirements in 411.325 (g) is not the way to collect data for it. The requirement will prohibit providers and employers from participating who have no intention of adding to the financial disclosures they already make to the federal government. An experienced Human Resources manager for a computer manufacturer said this to one of our Panel members at a Ticket program briefing:

“Do not add to the current complexities of hiring a qualified employee.”

Issue Six

Issue: Should “timely progress” be measured by minimum standards for all beneficiaries, or, should the terms and conditions specified in each IWP determine timely progress?

Discussion: Beginning with a 24 month review after a Ticket is assigned to an EN, the proposed regulations allow the Program Manager to assess whether a beneficiary is making “timely progress towards self-supporting employment” which will then keep Continuing Disability Review (CDR) suspensions in place. The “timely progress” requirement in the proposed rule is not found in the statute

Should there be set minimum requirements for employment in years four and five for all to keep CDR suspensions in place? The statute and the proposed rule (in a separate section, Section 411.325 (e)) require annual progress reports from the EN to the PM. Using progress tracked in the Individual Work Plan, should the annual reporting in 411.325 (e) be used to report timely progress as well? The workgroup did not reach consensus on a recommendation at this time.

Summary of Public Comment: The workgroup did not receive strong public comments or recommendations on this issue.

Recommendation: As an alternate, the Workgroup is recommending that the program require proof of three months of employment at anytime in the first three years of the Ticket program as proof of timely progress?

Rationale: This would be the same net outcome as the proposed rule for the first years.

It allows the PM to make findings about future employability, and requires the same minimum work standards for all Ticket participants in years three, four and five of an EN Ticket contract with a beneficiary.

Issue Seven

Issue: Should the State VR agency be permitted to use the Individual Plan for Employment (IPE) as a substitute for the Individual Work Plan (IWP)? If so, should other individualized service delivery plans be acceptable alternatives, provided they meet the minimum standards outlined in the statute for an IWP?

Discussion: The proposed regulations allow the state VR agency to use the IPE as a substitute for the IWP.

Summary of Public Comment: The few commenters who touched on this issue stated that the IPE or any other work plan that meets the minimum IWP standards described in the statute should be an acceptable alternative to the IWP. They stressed to need to reduce duplication with the same person, unnecessary paperwork, and administrative burden.

Recommendation: Other individualized service delivery plans should be allowed as a substitute to the IWP provided they meet the minimum requirements detailed in the statute.

Rationale: If a document already exists that specifies all of the requirements of an IWP there should not be a requirement to duplicate it.

Issue Eight

Issue: When an SSA beneficiary with a Ticket applies to the state VR agency for services, should the beneficiary have the option of retaining their Ticket for use with other ENs?

Discussion: Panel members received widespread comments that VR receives special treatment in many respects throughout the rule. In this context, there have been comments that § 411.385 needs clarification or change in the context of other special arrangements in the rule for state VR.

Section 411.385 states:

“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 beneficiary who is applying for services has a ticket that is available for assignment (see § 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.

Summary of Public Comment: The commnenters we heard from are concerned about choice, both here and in the connected context of the rule allowing only one Ticket per eligible beneficiary per period of entitlement for benefits. The proposed rule should not leave an applicant for VR services who is an SSA beneficiary intimidated that they must assign their Ticket to VR.

Recommendation: Section 411.385 needs to be re-written to read that an SSA beneficiary with a Ticket should be able to apply for and receive public VR services based on their independent eligibility for the public VR program. At the same time, the beneficiary should be able to retain their SSA Ticket for deposit to a separate EN for other services and supports.

Rationale: A collateral rule allows a beneficiary only one Ticket per period of entitlement. A significant number of SSA beneficiaries have long term and life long disabilities. The Ticket program should be about customer choice as to the assignment(s) of a Ticket. VR is independently Federally funded to provide services to people with the most severe disabilities and eligibility for VR should not, in an of itself, determine where a beneficiary can deposit their Ticket.

Issue Nine

Work Group One discussed the "current pay status" requirement in the draft NPRM in Section 411.125. That section provides that an SSA SSDI or SSI beneficiary must be in current cash pay status to be eligible to receive a Ticket. Our Workgroup members are concerned about this requirement because it would exclude SSDI beneficiaries in EPE status or SSI recipients in 1619(b) status with earnings just above cut off points, hardly an optimum outcome given current SSA provisions and SSI supplements in many parts of the country.

The Workgroup did not come to a consensus or a recommendation in our deliberation on this issue because we were not certain of the parameters of the law as it relates to this issue. To keep our deliberation on the NPRM within the legal parameters of the statute, we are seeking a General Counsel opinion on what the statute allows in this regard.