THE FINAL TICKET REGULATIONS ARE OUT!
On December 28, 2001, the final ticket regulations were published in the Federal Register. You can get the entire text of the regulations at http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=2001_register&docid=01-31567-filed.
There were not significant changes in the final regulations. SSA clarified some of the regulations in response to comments. Here are some highlights of the final regulations:
1. SSA did not change the eligibility guidelines for the ticket. Although SSA received many comments requesting that transition age youth and beneficiaries with a medical diary designation of medical improvement expected, be eligible for tickets, SSA did not change the rules to allow these groups to automatically receive a ticket. SSA is asking the public for suggestions on how to better serve transition age youth. You can submit your comments to SSA by February 26, 2022 at TTWWIIA@ssa.gov, or directly on the SSA website at http://policy.ssa.gov/si/ttwwiia.nsf.
2. SSA clarified that a beneficiary is only entitled to one ticket per period of disability, but if a beneficiary loses entitlement to benefits and is later reinstated to benefits under expedited reinstatement, the beneficiary is entitled to another ticket in the first month they are entitled to reinstated benefits.
3. SSA also clarified that both SSDI and SSI beneficiaries must be receiving cash benefits in order to receive a ticket.
4. SSA clarified that only an individual eligible for VR services may assign the ticket to a VR agency, and that a VR agency must cease providing services to individuals who are no longer for VR services.
5. The timely progress guidelines for using a ticket are only used by SSA to determine whether a beneficiary is using a ticket for purposes of protection against initiation of a medical continuing disability review (CDR). Beneficiaries who do not meet the timely progress guidelines may still participate in the Ticket to Work program, receive services and generate outcome and milestone payments to Employment Networks (ENs). However, these beneficiaries may be subject to CDRs.
6. SSA modified its regulation to allow a beneficiary who has worked in months during the initial 24 month period to use those months of work to meet the work requirements of the first 12 month progress review period if the work was done at the requisite level.
7. SSA made changes to indicate that a State VR agency which selects the cost reimbursement payment system may be eligible for payment under that system even though the beneficiary is determined to be no longer using a ticket. SSA also made changes to indicate that an EN or State VR agency serving a beneficiary as an EN may receive milestone or outcome payments for which it is eligible even though the beneficiary is considered to be no longer using a ticket. Beneficiaries who do not meet the timely progress guidelines may continue to receive services from their service providers. This appears to be a fairly significant change, since it means that if the beneficiary cannot meet the timely progress guidelines, there is still an incentive for the EN or State VR agency to continue to provide services as SSA will still be able to make milestone or outcome payments.
8. SSA will provide the Program Manager – Maximus – with a list of all ticket-eligible beneficiaries by geographic area and disability impairment. Maximus will provide, within the limitations of the Privacy Act, the ENs, with information from this list for beneficiaries eligible to receive tickets in their area. Maximus will encourage ENs to use the lists to market their services with the beneficiaries.
9. Maximus will be responsible for making determinations regarding the allocation of outcome or milestone payments when the beneficiary has been served by more than one EN.
10. SSA clarified that friends or family who meet the qualifications to be an EN can apply to be an EN, but an individual cannot serve as his or her own EN. SSA noted that the legislation requires some level of education, experience, or expertise in providing employment related services, and does not permit SSA to use, as an EN, providers with no demonstrated qualifications or experience in providing or arranging for these types of services.
11. Potential ENs must comply with all relevant State laws that govern entities that provide employment services, vocational rehabilitation services and other support services.
12. A State VR agency is precluded from being paid under the cost reimbursement payment system if an EN or a State VR agency serving a beneficiary as an EN has been paid by SSA under one of the EN payment systems with respect to the same ticket. Likewise, if a State VR agency has been paid by SSA under the cost reimbursement system with respect to a ticket, such payment precludes any subsequent payment by SSA under one of the EN payment systems based on the same ticket.
13. A beneficiary who is receiving services from a State VR agency under an existing IPE when he or she receives their ticket should have the opportunity to make an informed choice regarding their decision to assign their ticket to the VR agency. Thus the State VR agency cannot require a beneficiary to assign their ticket to the VR agency.
14. SSA clarified that although the agreements that State VR agencies must sign with ENs regarding referrals should be broad-based, a State VR agency may enter into an individualized agreement with an EN to meet the needs of a single beneficiary if both wish to do so. SSA does not have the authority to require an EN to enter into an agreement with a State VR agency unless the EN is going to make a referral of beneficiaries to a State VR agency for services.
15. Payment systems – In response to the number of comments on this section, SSA made four changes.
a. First, SSA added two milestones. The first additional milestone is met when the beneficiary works for one calendar month and gross earnings for that month over the SGA threshold amount. The other additional milestone, which is actually the fourth milestone, is met when the beneficiary works for 12 calendar months within a 15 month period and has gross earnings for each of those 12 months that are more than SGA.
b. Second, they doubled the total value of the potential milestone payments. The total value of the milestone payments is approximately 20 percent of the potential payments possible under the milestone-outcome payment system. In terms of the 2001 payment amounts this would be approximately $3,096 for SSDI beneficiaries and $1,874 for SSI beneficiaries.
c. Third, SSA spread, over 60 months, as opposed to 12, the outcome payments reductions made on account of the milestone payments received.
d. Fourth, SSA substituted a flat outcome payment rate of 34 percent for the graduated monthly outcome payments proposed.
16. SSA can pay an EN for services it rendered after a beneficiary reassigns the ticket to another EN. Maximus will determine the allocation of payment to more than one EN.
17. ENs may receive funding from other sources. This clarification may be helpful for ENs who have other local, state or federal contracts to provide employment services.
18. SSA did not make any changes in the dispute resolution section of the regulations.
The final regulations are effective January 28, 2002. If you have any comments on these regulations, you can e-mail them to email@example.com.
We expect that SSA will begin mailing tickets at the end of January.
Role of the SSA Field Offices
Beneficiaries will receive a Ticket package that will contain a brief explanation of the Ticket program, and instructions to call the toll-free number at Maximus for more information. Beneficiaries who call SSA local offices or the 800 number at SSA will be referred to Maximus. The toll free number at Maximus is 1-866-968-7842 (V); 1-866-833-2967 (TTY).
The Ticket legislation created a work incentive protection to encourage SSDI beneficiaries who have been entitled to disability benefits for at least 24 months to return to work. Under this new provision, SSA will not initiate a continuing disability review solely because of work activity, or completion of a Trial Work Period. This also applies to concurrent beneficiaries.
INDIVIDUAL SSI $545/MONTH
COUPLE SSI $817/MONTH
SUBSTANTIAL GAINFUL ACTIVITY $780/MONTH
BLIND SGA $1,300/MONTH
TRIAL WORK PERIOD $560/MONTH
STUDENT EARNED INCOME EXCLUSION $1,320/MONTH - $5,340/YEAR