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Social Security Administration
Ticket to Work and Work Incentives Advisory Panel Meeting
December 19, 2000
Ms. Debra Morrison opened the meeting at 1:30 and stated that Sarah Wiggins Mitchell would preside. The following panel members were present: Sarah Wiggins, Mitchell Chair, Richard Burkhauser, Kris Flaten, Frances Gracechild, Thomas Golden, Stephanie Lee, Bryon MacDonald, and Larry Henderson.
SSA staff members present were Marie Strahan, Joe Hickman, Mary Anne Daly, Jeff Funk, Debra Morrison, Fred Belmore and Lisa Ekman.
Others present included Kara Freeburg with Anchor, Jill Castina with the Center for Independent Living in North Central Florida, Pat Beattie with National Industries for the Blind, Susan Goodman, Leslie Jackson with the American Occupational Therapy Association.
Ms. Wiggins stated that the primary purpose of the meeting was to review the questions that the panel workgroups had drafted. The Panel would consider the questions from the ticket workgroup and finalize the questions from the milestone workgroup that have been edited since the last call. At 3:15, administrative issues would be considered, including the agenda and dates for the regional meetings, and the agenda for the January in-person meeting in Washington D.C. The panel would not have time to discuss the Annual Report until the January meeting. The panel will also approve minutes and review a training session planned for January 8.
Milestones: Ms. Mitchell stated that she and Ms. Flaten had worked on the language in question Seven that was discussed during the last teleconference. The question as re-drafted stated, "Should the IWP include statements by the beneficiary and the employment network indicating what responsibilities they are each agreeing to fulfill, and including what the beneficiary will do to provide earnings information to the employment network?" Mr. MacDonald suggested that the required statement also include an explanation of how the consumer and the employment network will provide needed information to the Program Manager. He stated that the problem is that once consumers get jobs, they have no incentive to provide the employment information to the Network. Ms. Lee stated that the intent of the IWP as stated in the law is to set forth what services would be provided and that the statement should not request additional information. Ms. Gracechild asked where the appropriate place for this additional statement would be and Ms. Lee stated that it should not be included.
There was disagreement among the panel members as to whether Question Seven should be asked. Ms. Mitchell felt that "terms and conditions" was contractual language that enabled both the EN and the consumer to state their responsibilities. Ms. Gracechild moved that we adopt the revised language as proposed by Ms. Mitchell including Mr. MacDonald's revision to include "Program Managers as stipulated by law." She also suggested that "needed information" be substituted for "earnings". MacDonald seconded. Ms. Lee expressed concern that the individual work plan was supposed to be a statement of services and support to be provided to the consumer and was concerned that the Panel was requesting information beyond what Congress had mandated. Ms. Wiggins agreed to send the proposed language to the panel. Mr. Golden clarified that the proposed language would include programmatic requirements, as well as the primary purpose of the IWP, which was to provide services and support. He suggested that the emphasis of the question could be changed by initiating the question with "Should the IWP, in addition to its primary purpose of providing services and supports." Ms. Lee stated that she still felt the plans should not go beyond what was specified by law, when the panel had already stated that they did not want to go further than the legislation in any other area. Mr. Burkhauser clarified that the questions did not state the panel's position but asked for public input. The motion passed with Ms. Lee opposing.
Mr. MacDonald asked if there was software being developed for the EN's to report to the Program Managers. Ms. Daly stated that SSA was currently concentrating on communications between the Program Managers and SSA. Mr. MacDonald asked if staff could get back to the panel on how EN's would communicate with the Program Managers.
Mr. Golden asked about Section 301 coverage, which deals with continuation of benefits in case of medical recovery. Does a beneficiary's recovery impact the payment to the provider or the EN? Mr. Hickman stated that protection under Section 301 would be extended to beneficiaries under the ticket program, and that benefits would be paid until completion of the rehabilitation program. Ms. Daly stated that at some point, conforming regulations between Section 301 and the Ticket legislation will need to be written. Dr. Burkhauser stated that a list of questions to be dealt with in future regulations should be developed and forwarded to the panel.
Dr. Burkhauser also asked who would be the payer of first resort in the case of an individual on Medicare or Medicaid who finds a job with health benefits. Ms. Strahan said that she would forward this question to HCFA.
Ms. Strahan stated that Brian Rasmussen from the policy staff at UCP had joined the call.
Ms. Mitchell stated that staff should track these questions. Mr. Golden will draft a question to obtain provider input on the Section 301 issue mentioned above.
Ticket Questions: Mr. MacDonald stated that his group had drafted two paragraphs that would be placed in front of the entire set of questions. These paragraphs advise the public that the official public comment period is not officially open and that the purpose of the questions was to give the public additional time for consideration and input. He also read the table of contents to the Panel.
The following paragraphs summarize the questions and the Panel's discussion.
Section I: Who gets the ticket?
1. Which beneficiaries should get the ticket: age ranges, etc. (For example, should beneficiaries be eligible for a ticket at age 16?)
2. After explanatory material, the question asked if beneficiaries should be eligible for a ticket if they are expected to improve at the time eligibility for benefits is determined? Ms. Strahan asked that all statistics used in question background materials be sourced. Mr. Golden felt that the explanatory information leading to the question was a bit biased. Ms. Strahan stated that the question should refer to a Continuing Disability Review Diary and other language in the Social Security statute. Mr. MacDonald stated that of the 43,000 MIE, 16 percent were found recovered at 18 to 24 months or at their first CDR. Staff will assist the workgroup with the explanatory material.
3. Should a beneficiary be able to get a second full value ticket, if they lose their job and go back on the rolls during the same period of disability? Staff stated that this will vary based upon whether the person goes back on benefits during the same eligibility period or whether they go through a new application process. The second sentence of this question was explanatory and the Panel made minor edits.
4. Should a beneficiary be eligible for a ticket if he or she currently working, but still receiving benefits under the 1619 program? This individual receives Medicaid but no cash benefits. Ms. Strahan clarified that the ticket would have no value to the Employment Network because the beneficiary would be receiving no cash benefits to base full payments upon. Ms. Lee pointed out that the person could be looking for career advancement and want to use an EN to further their career. Dr. Burkhauser stated that the question should tell the audience that people who receive no cash benefits are not eligible for the ticket. There is nothing in the regulations to determine how payment should be made, because the person gets no benefits. This leads to an unintended consequence of excluding people from the ticket program who have already shown the desire to work. Mr. Golden stated that these individuals could use the PASS. Mr. MacDonald expressed concern that these individuals are left out of the program until their earnings drop low enough to receive cash benefits. This may induce people to quit their jobs. The Panel decided to include this question.
Section 2: EN Qualifications.
1. Who should be qualified to provide services as an EN? Should individual support people or other non-traditional providers be included as ENs and thus eligible for ticket payments? This question will be included with minor edits.
2. Should an employer be allowed to be an EN? This would enable the employer to be paid to train and hire a beneficiary in its own company, similar to an OJT situation. Mr. Golden asked if sheltered workshops and other non-integrated work settings should be included as EN's. Mr. Golden agreed to draft a question to address this issue.
There was an extensive discussion about what happened to the Trial Work Period if an individual went back on benefits because of the "easy back on" provisions of the law. Staff clarified that the TWP is refreshable after five years. The nine months accumulate over five years, so at any moment in time, the beneficiary goes back over the last 60 months and counts the months of work. Any working months that have accrued after five years are dropped off the record. The beneficiary will not get another Extended Period of Eligibility when the TWP is used up. A second EPE is only earned when a person completely leaves the rolls.
3. Should there be a mechanism for beneficiaries to recommend to the PM that a particular entity be included as an EN? Mr. Golden stated that an EN can also approach a PM and request inclusion.
4. This question asks about what qualifications should be required of an EN. Mr. Golden suggested that this question be placed directly after Question One above.
5. Question Five was approved as written, but will also be placed below Question One.
6. What criteria should be developed to define a successful outcome? Panel members agreed that this may differ in different areas of the country-California versus other locales. Should the SSA rules speak to this issue?
Ms. Mitchell stated that there are two sections left of Mr. MacDonald's questions as well as the Dispute Resolution Questions in their entirety. Ms. Mitchell asked if the questions could be finalized at the January meeting. The panel agreed and Ms. Strahan stated that the questions could be sent to the public directly after approval.
Mr. MacDonald queried about the development of a MIS system to enable Ens to report to the PM. Ms. Gracechild said that the complexity of the MIS would significantly impact the smaller, non-traditional providers.
Mr. MacDonald suggested that the questions be reviewed and adopted on the first day of the January Meeting. The panel will also agree on question formatting. After staff completes the revisions and formatting, the questions will be emailed to the panel before distribution to the public. This will enable distribution on listservs and networks but probably not in the Federal Register before the regional conferences.
Administrative Matters: The minutes for the November 8 and November 27 teleconferences were considered and approved by the Panel.
Ms. Strahan asked Mr. Golden for the date of the New York regional forum. Mr. Golden proposed January 12, although the questions would probably not be finalized by then. The Atlanta forum will probably take place during the last week in January. Ms. Strahan will work with Ms. Mitchell on finalizing the dates.
Ms. Strahan stated that she was attempting to establish some Panel training on the SSI and SSDI programs, eligibility determination, administrative structure of SSA, including the field offices, administrative structure of the Ticket implementation, and the financing of the SSI and SSDI programs. Mr. Golden will also provide some training on the work incentives under SSI and SSDI. Ms. Strahan will send out an agenda and ask the Panel which members might want to attend. Panel members who want to attend should arrive on the evening of the 7th to attend this training.
Ms. Strahan also stated that the panel needs to provide input to staff on the website. Decisions need to be provided to the contractor by noon tomorrow, so input is needed immediately. Staff will proceed with the panel's biographical sketches for the annual report. Two panel members had minor revisions. Staff also clarified that there is no word on the NPRM.
Ms. Mitchell thanked staff for inviting the panel to the NASI conference on Friday, December 8. It was very worthwhile.
The meeting was adjourned at 3:40 pm.
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