Commissioner of Social Security
P.O. Box 17703
Baltimore, MD 21235-7703
Re: Proposed TWWIIA
regulations published December 28, 2021
The SSI Coalition for a Responsible Safety Net is a policy and advocacy organization that focuses on the public benefit programs that assist low-income seniors and people with disabilities. The Coalition is especially interested in addressing the employment barriers the public benefit programs pose to those who want to return to work.
Since the publication in the Federal Register of the proposed TWWIIA regulations, the SSI Coalition has participated in discussions in the State of Illinois, as well as around the country, with advocates, state vocational rehabilitation agencies, private rehabilitation providers, SSA employees and SSI and SSDI beneficiaries on the efficacy of these proposed regulations. To state that there is a sense of disappointment in the regulations would be an understatement. While SSA is to be commended for creating the Office of Employment Support and staffing it with creative, forward-thinking folks, the shortcomings in the proposed regulations reflect a misunderstanding of the marketplace and fail to further the intent of the legislation.
SSA could alleviate some of the discontent over the proposed ticket regulations by stressing that the ticket is another tool in the work incentives package, and that the ticket may be best used by those who do not need extensive pre-employment services and/or training. Many beneficiaries have been led to believe that the ticket is the alternative to traditional state vocational rehabilitation; perhaps this message is not the message that SSA really wants to send about the ticket program.
The following comments are grouped by subpart, not specific to each paragraph in the proposed regulations. The comments reflect the views of the SSI Coalition, although most, if not all of the sentiments have been expressed and shared by others around the country.
B – Tickets Under the Ticket to Work Program
As noted by SSA in the preamble to the proposed rules, there are three groups of beneficiaries that have been excluded from eligibility for a Ticket. These three groups – those with a Medical Improvement Expected medical diary date who have not had at least one continuing disability review, 18 year old SSI beneficiaries who have not been redetermined as disabled under the adult disability standard, and SSI beneficiaries under the age of 18 – will not have the choice that the Ticket program promises to all other beneficiaries.
The first two excluded groups have to rely on the vagaries of the review and appeals process before their eligibility for a ticket would be determined. SSA has already noted that due to the delay in the passage of their budget for FY 2001, they will be conducting fewer continuing disability reviews this year. Medical continuing disability reviews are rarely processed on a timely basis. The 18 year old redetermination process is also delayed by sometimes lengthy appeals. Even if half of the 18 year olds are eventually found not disabled under the adult disability standard, that process could take a couple of years. Why deny these young transition age youth the opportunity to obtain employment services under the Ticket? If the individuals in these two groups are more likely to be found not disabled after a review, they would most likely benefit from using the Ticket. If the payment system for employment networks is revised, (see comments below) there could be a real incentive to work with these groups.
The third group that is excluded from eligibility is the SSI beneficiaries under the age of 18. Again, what better way to encourage these beneficiaries to go to work than to hand them a Ticket to Work. That would send a powerful message to these age group. If the pre-employment services take place while the student/SSI beneficiary is in high school, the student could be ready to perform at the substantial gainful activity upon graduation, and the employment network would be poised to receive the outcome payments. If this group does not receive a ticket, SSA should do a pilot project with this group in several areas of the country where they will receive a ticket. In addition, SSA needs to focus more attention on the transition age youth and work harder to ensure that students, teachers and parents receive work incentive information at the beginning of transition planning.
We are also concerned about the distribution and outreach information on the actual Ticket to beneficiaries, local SSA field offices and the teleservice centers. SSA’s notices to beneficiaries are widely viewed as incomprehensible and misleading. It is important that beneficiaries receive accurate and understandable information about the ticket from all components of SSA.
C – Suspension of Continuing Disability Reviews for
Beneficiaries Who Are Using a Ticket
The existing work incentives are already too complicated for many beneficiaries to understand. The proposed regulations in this subpart are, as noted in the preamble to this section, "fairly complex." This complexity will discourage some beneficiaries from using the ticket. There will be many beneficiaries who will not be able to grasp the guidelines for using a ticket, not using a ticket, making timely progress, how many months they must work over SGA, placing the ticket into inactive status, etc. Because of this complexity, SSA must ensure that the Program Manager and the Employment Networks have very simple, concise written materials explaining these concepts for beneficiaries and their support system – family, representative payee, case managers, etc.
In addition, by allowing beneficiaries almost 2 years, 9 months to prepare for employment, the employment networks will not be paid for that length of time as well. This will not incent providers to work with beneficiaries who need a lengthy preparation time.
Subpart D – Use of One or More Program Managers To Assist in the Administration of the Ticket to Work Program
Maximus must be accessible to beneficiaries who have questions and must be available for face-to-face hearings on disputes between the Employment Networks and the ticket holders. Many beneficiaries do not have any knowledge of Maximus and thus do not have any kind of "comfort level" with the Program Manager. We hope that Maximus staff has received competent disability awareness training. Maximus must also be prepared to provide simple written materials for beneficiaries explaining the ticket program.
Subpart E – Employment Networks
Due to the delay in publishing the RFP for Employment Networks, we do not know the possible entities that will apply to become an Employment Network. Our concern about the qualifications for Employment Networks set out in the proposed regulations is that they may eliminate smaller entities and/or those whose employees do not have sufficient educational backgrounds to meet the requirements. For instance, if employees of centers for independent living who have worked with people with disabilities do not exactly meet the qualifications set out in the proposed regulations, SSA will have lost another opportunity to open up the ticket program to non-traditional providers.
Subpart F – State Vocational Rehabilitation Agencies’ Participation
There is some confusion in the interpretation of this section of the proposed regulations. For instance, if a beneficiary wants to receive Title I vocational rehabilitation services from the state vocational rehabilitation (VR) agency, but does not want to place his or her ticket with the vocational rehabilitation agency, can the state VR require the beneficiary to place the ticket with VR in order to receive Title I services? Can a state VR refuse to provide Title I services to a beneficiary who has already placed his or her ticket with an Employment Network? We would be opposed to a system where a beneficiary had to choose between Title I services from the state VR and receiving services from an Employment Network with the ticket. Although we do not condone "double-dipping" by beneficiaries, if the Employment Network is unable to provide all the services that a beneficiary requires to achieve self-sufficiency, the beneficiary should be permitted to receive additional services through the state VR.
In addition, if the agreement between the state VR agency and the Employment Network is allowed to require the Employment Network to reimburse the state VR for any services the beneficiary receives from VR while the ticket is placed with the EN, how would an EN be able to recoup unexpected costs that could arise during the course of the beneficiary using a ticket? This possibility would again discourage providers from choosing to be ENs.
Subpart H – Employment Network Payment Systems
The payment system is the most problematic part of these proposed regulations. Private vocational rehabilitation providers as well as potential non-traditional entities that may have thought about becoming Employment Networks are discouraged by the low reimbursement rates for both the milestone and outcome payment systems in the proposed regulations. The milestone payments are too low, and too late, to encourage potential providers of employment services. The payment of milestones only after attainment of substantial gainful activity will reduce the number of successful ticket users and Employment Networks. Milestone payments should be paid based on the attainment of specific milestones in an individual’s work plan, instead of after attainment of substantial gainful activity.
Another problem with the payment system is the burden imposed on employment networks to report a beneficiary’s earnings each month to the Program Manager in order to be paid. The amount of paperwork that this system will create is astronomical. What happens to Employment Networks when the ticket users bounce in and out of substantial gainful activity? What if a ticket user starts to work at substantial gainful activity (SGA) and then cannot work at SGA for three or four years hence? Again, the complexity of the regulations poses enormous problems for ticket users and Employment Networks alike.
The proposed payment system will not attract traditional or non-traditional entities, nor will it give beneficiaries more choice.
Subpart I – Ticket to Work Program Dispute Resolution
Funding for the protection and advocacy organizations is inadequate to provide sufficient services. The protection and advocacy organizations are being asked to do more than they are currently capable of doing, (i.e., representing individuals with Social Security issues, which many protection and advocacy organizations do not do), especially with inadequate funding.
Is the dispute resolution program different than the system already in place under the Rehabilitation Act for vocational rehabilitation complaints? If the proposed regulations create a new system, this may confuse beneficiaries who receive services from both Employment Networks and state vocational rehabilitation agencies. The proposed regulations do not appear to require a face-to-face hearing with the Program Manager. If a beneficiary faces a loss of benefits because of an adverse decision by the Program Manager, a beneficiary should have the option of a face-to-face hearing. There should be deadlines for the EN to make a decision, as well as the Program Manager. The manner in which SSA or the Program Manager will inform beneficiaries of the dispute resolution process should also be spelled out at different points in the ticket process.
If a protection and advocacy organization decides that there should be either mediation or an alternative dispute resolution process, SSA, the Program Manager or the Employment Network should pay for those services. The ticket holder will probably not be in any financial position to pay.
Finally, what recourse is there for a beneficiary after SSA’s final decision? The proposed regulations are silent on whether the normal SSA appeals process is available to aggrieved ticket users. Can a ticket user go to federal court? The regulations need to be much more specific on the appeals process.
The preamble to the proposed regulations clearly states the intent of the TWWIIA legislation. The proposed regulations, however, fall short of the good intentions. The TWWIIA legislation offered hope for more choice to beneficiaries, increased access to health care and other incentives to return to work. The proposed regulations, as presently written, fail to deliver to beneficiaries the choice of employment services. We hope that SSA will heed the tide of discontent and rewrite the regulations according to the many suggestions received from the advocates, providers and beneficiaries.
SSI Coalition for a Responsible Safety Net
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