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 You are here: Home > Panel Documents > Official Correspondence > Annual Report to the President and Congress Year Two


August, 2002

The Ticket to Work and Work Incentives Advisory Panel

Table of Contents

A Message from the Chair
Executive Summary
Background
Annual Interim Report to Congress
Progress Report on the Ticket to Work and Self-Sufficiency Program
Appendices
  1. The Panel
  2. Letters from the Panel
  3. Home Page on the Web
  4. AOI Advice Report: Executive Summary
  5. $1 for $2 Advice Report: Executive Summary

Panel members at February 2002 Quarterly Meeting. Back row, l to r: Richard Burkhauser, Stephen Start, Stephanie Smith Lee, Kristin Flaten, Bryon MacDonald, Thomas Golden, Sarah Wiggins Mitchell. Front row, l to r: Frances Gracechild, Larry Henderson, Christine Griffin, Susan Webb, Jerome Kleckley.

Panel members and SSA Regional Commissioner listen to public testimony on proposed regulations. l to r: Jerome Kleckley, Sarah Wiggins Mitchell, Thomas Golden, Beatrice Disman.


A Message from the Chair

On behalf of the Ticket to Work and Work Incentives Advisory Panel, it is my privilege to issue our second annual interim report to Congress and a progress report on the implementation of the Ticket to Work and Self-Sufficiency Program. This document reports on the findings, issues, conclusions, and recommendations of the Panel regarding implementation of the Ticket to Work and Work Incentives Improvement Act and related programs by the Social Security Administration (SSA). It delineates particular issues with a number of specific recommendations to Congress. It also includes a summary of the Panel's activities and its advice and recommendations to SSA during year two of implementation.

Public Law 106-170, the Ticket to Work and Work Incentives Improvement Act of 1999, (the Act) establishes the Ticket to Work and Work Incentives Advisory Panel within SSA. The duty of the Panel is to advise the Commissioner of Social Security, the President, and Congress on issues related to work incentive programs, planning and assistance for individuals with disabilities, and on the implementation of the Ticket to Work and Self-Sufficiency Program.

This was a year of limited activity in terms of actual Ticket Program implementation by SSA. However, it was a year of extensive activity in terms of the establishment of a policy framework and a regulatory foundation on which to implement a variety of the Act's programs and projects. To assist in establishing this framework, the Panel provided formal advice to the Commissioner of Social Security and the President on a number of substantive matters. Panel members also hosted policy roundtables of researchers and other experts on specific program issues. The Panel published two advice reports on the proposed Ticket Program regulations. Other advice was provided to the Commissioner in letters, experts roundtables, and public meetings.

The Panel has a firm commitment to public access and public input. All Panel activities, meeting schedules, and publications were made available to the public on the Panel's email listserve and on its Website. The Panel has conducted numerous public meetings and provided opportunities for input from citizens with disabilities, public and private providers, and other program constituents.

It is my privilege to share with you this combined Annual Interim Report and Ticket Program progress report.

Respectfully submitted,

Sarah Wiggins Mitchell, Chair

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Executive Summary

The Ticket to Work and Work Incentives Improvement Act, passed in the Senate by a vote of 99-0, reflects a shift in the nation's attitude toward persons with disabilities and the contributions they can make to our economy and society. The provisions in the Act, which involves a public-private partnership, were tightly woven to ensure that there would be an array of services and options for persons with disabilities who enter the workforce. Now tickets are rolling out. More than 1.2 million tickets have been mailed and approximately 1,500 have been assigned to providers. Nationwide, more than 300 private sector Employment Networks (ENs) have been approved to accept tickets in the initial 13 roll-out States.

As Phase I of the implementation continues, the Panel has several concerns, enumerated below. One cross-cutting concern involves the funding and resources for new programs and service systems. When Congress created the new administrative duties and grant programs under the Act, it did not provide additional administrative resources to SSA to support the new duties and programs. The funding for the administration of these new provisions must compete with every other service priority and administrative responsibility of SSA. Given the current field service demands in claims processing and appeals, the continuing increase in disability applications, and the impending retirement of the baby boomers, there is evidence that the Ticket Program and related provisions may not be getting the resources needed to succeed at this critical startup phase.

The major resource issues fall into two categories. First, starting a new program calls for an initial investment of money and personnel to ensure that everyone involved knows about the program and the roles of the partnering organizations. This is especially important for the programs created under the Act, as they involve many Federal, State, local, and private organizations. Such information issues include implementation of the employment service representative (ESR) model, field training, public education marketing, and outreach. Second, the Panel believes that two eligibility issues relating to the Ticket Program should be addressed--the ineligibility of both youth and beneficiaries with medical improvement expected (MIE).

The Panel believes that such near-term investments should be evaluated in the light of long-term savings to the disability programs. In 1996, the Government Accounting Office (GAO) estimated that if only 1 percent of the disability beneficiaries on the rolls returned to work, lifetime cash benefits would be reduced by $2.9 billion (GAO/HEHS-96-133, SSA Disability: Return-to-Work Strategies from Other Systems May Improve Federal Programs, July 1996, p. 2). These savings would double if as many as 2 percent of the beneficiaries returned to work. With Trust Fund savings in mind, the Panel recommends that Congress increase SSA's administrative budget and personnel ceiling to ensure that designated Ticket-related resources are adequate in the light of both SSA's new role under the Ticket Program and the challenges of its longstanding claims processing and customer service responsibilities.

Recommendations

Resource-Intensive Recommendations

  • Public education and field training. The budget allocated to training by SSA is a fraction of the training budget of the State vocational rehabilitation (VR) program. This is especially problematic for a new program that relies on both beneficiaries and providers to make informed choices and that relies on many Federal, State, and private strategic partners to coordinate their efforts. The Panel urges Congress to direct SSA to increase its training and technical support efforts supporting implementation of the Act.
  • Employment Support Representatives. The Act states that "the Commissioner shall establish a corps of trained, accessible, and responsive work incentives specialists within [emphasis added] the Social Security Administration who will specialize in disability work incentives under titles II and XVI...." There are currently 36 ESRs in SSA's system of 1,300 field offices that service over 8 million adults with disabilities currently on the rolls who will receive a ticket. The Panel believes that many more ESRs are needed and that they should be permanent employees, dedicated on a full-time basis to the critical employment support work. The Panel's position is consistent with recommendations from SSA's recent ESR evaluation report (November 2001).
  • Marketing and outreach. An immediate, coordinated national marketing and public information program explaining the array of programs to the general public, providers, and employers and providing accurate and timely information to beneficiaries about their options is crucial to the success of the projects and programs under the Act, particularly the Ticket Program. The Panel is concerned that SSA has not allocated sufficient resources for this much-needed effort.
  • Medical Improvement Expected. Beneficiaries with the MIE designation cannot participate in the Ticket Program until after the completion of their first continuing disability review. The Panel believes that these beneficiaries would benefit from as little interruption as possible in their employment and that immediate eligibility for employment services is warranted.
  • Transition-aged youth. The Panel believes that 16- and 17-year-old youth should be allowed to participate in the Ticket Program. Prohibiting their participation will send the wrong message to young SSI recipients and SSDI beneficiaries and encourage lifelong dependency on benefits.

Other Administrative and Work Incentive Recommendations

  • Overpayments. Advocates for persons with disabilities have voiced concern about SSA's ability to process monthly earnings reports without routinely generating overpayments. Monthly benefit processing under the SSI program, which also depends on monthly income reports from beneficiaries, has long been fraught with delays and overpayments. Overpayments are also a problem in the SSDI program. The Panel recommends that SSA investigate the causes of overpayments and ensure that the staff and priorities allocated to processing monthly earnings reports for SSI and SSDI beneficiaries are commensurate with the workload.
  • Adequacy of Incentives (AOI). In its Advice Report on AOI, the Panel recommends that (1) owing to delays in issuing the tickets, the deadlines for issuing SSA's AOI Report to Congress and implementing the new alternative incentives be extended by the same amount of time as the Ticket roll-out has been delayed (13 months) and (2) SSA provide to the Panel, Congress, and the President ongoing interim reporting on the participation in the Ticket Program by members of four hard-to-serve beneficiary groups. (See Appendix C for the executive summary of the Panel's Advice Report on AOI.)
  • EN reimbursement for clients receiving partial benefits. Some beneficiaries will require more effort and long-term support from ENs to achieve successful employment. In some cases, these beneficiaries may not be able to work enough hours or earn enough money to eliminate Social Security benefits. ENs will not be able to serve these clients unless they can be paid for clients who receive partial benefits while working.
  • $1 for $2 benefit offset. In the Act, Congress mandated a demonstration project to consider the effects of a $1 for $2 benefit offset on induced entry, that is, to estimate how many persons would come on the rolls as a result of the benefit offset. A number of experts have raised concerns about the cost and reliability of estimates from such a demonstration. The Panel therefore recommends that Congress amend the statute to enable SSA to defer research on induced entry and to permit use of either demonstration or nondemonstration methodologies. (See Appendix D for the executive summary of the Panel's Advice Report on $1 for $2 benefit offset research.)
  • Protection and Advocacy (P&A;) restrictions. The P&A; grant program created in the Act was established to ensure that the rights of SSA beneficiaries are protected as they return to work. SSA is restricting the representation activities of the P&A; grantees and implementing the program so narrowly that beneficiaries' rights are at great risk. The Panel urges Congress to direct SSA to reexamine this interpretation to reflect the intent of Congress and allow the P&A; systems to fully represent SSA beneficiaries.

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Background

Summary of the Ticket to Work and Work Incentives Improvement Act of 1999

Enacted on December 17, 1999, this law is administered by the Social Security Administration. It increases beneficiary choice in obtaining rehabilitation and vocational services; removes barriers that require people with disabilities to choose between health care coverage and work; and ensures that more Americans with disabilities can work and lessen their dependence on public benefits. The provisions of the law become effective at various times, generally beginning 1 year after enactment.

Title I--Ticket to Work and Self-Sufficiency and Related Programs

Subtitle A--Ticket to Work and Self-Sufficiency and Related Programs

Most Social Security and Supplemental Security Income (SSI) disability beneficiaries will receive a "ticket" that they can use to obtain vocational rehabilitation, employment, or other support services from an approved provider of their choice. This voluntary program is being phased in nationally over 3 years. It establishes a Program Manager (PM), Employment Networks (ENs), and payment systems; calls for a report on the adequacy of incentives and the establishment of a dispute resolution mechanism; provides for suspension of Continuing Disability Reviews (CDRs) for persons using the ticket; and establishes the Ticket to Work and Work Incentives Advisory Panel.

Subtitle B--Elimination of Work Disincentives

Subtitle B eliminates the work activity standard as a basis for review of an individual's disability status and provides for expedited reinstatement of disability benefits if the person does not continue working.

Subtitle C--Work Incentives Planning and Outreach

Subtitle C sets up the Work Incentives Outreach Program, including external Benefits, Planning Assistance, and Outreach programs (BPA&Os;) and the internal corps of Social Security experts on work incentives and employment. It establishes a grant program for a Protection and Advocacy (P&A;) agency in each State to assist beneficiaries.

Title II--Expanded Availability of Health Care Services

Title II expands State options under Medicaid for workers with disabilities. It calls for a GAO study on extending Medicare coverage for Social Security recipients and establishes State infrastructure grant authority and demonstration projects. It calls for a demonstration of coverage under Medicaid of workers with potentially severe disabilities and enables disabled beneficiaries to suspend Medigap coverage.

Title III--Demonstration Projects and Studies

Title III extends the Disability Insurance (DI) program demonstration authority and calls for specific studies and reports, including a demonstration study on a $1 reduction in benefits for every $2 earned.

Strategic Partners, Public and Private

Throughout the Ticket to Work and Work Incentives Improvement Act, there are references to other government agencies at the national, State, and local levels, and to private sector service providers, all of whom are key partners with SSA in implementing the Act. Effective collaboration among the following strategic partners will be critical to the success of the Ticket Program.

Title I--Ticket to Work and Self-Sufficiency and Related Programs

The Social Security Administration has selected Maximus as the Program Manager (PM) to recruit Employment Networks (ENs) in States. SSA Field Offices administer the benefit programs. Employment Services Representatives (ESRs) work within SSA to implement the Ticket Program and other employment provisions. The Ticket to Work and Work Incentives Advisory Panel provides advice to SSA, the President, and Congress on the implementation of the Act. Protection and Advocacy Systems (P&As;) in States are funded by SSA to help beneficiaries obtain information and advocacy support related to employment services and dispute resolution. Benefits, planning, assistance, and outreach programs are funded by SSA and provide benefits counseling to beneficiaries. State Vocational Rehabilitation (VR) agencies, funded by the Rehabilitation Services Administration in the Department of Education (ED), provide rehabilitation and a broad range of return-to-work services for SSA beneficiaries. Special Education at the State level is funded through the Office of Special Education Programs in ED and serves beneficiaries between the ages of 14 and 22 in school-to-work transition programs. One-Stop Employment Centers at the local level, funded through the Employment and Training Administration of the Department of Labor (DOL), are specifically mentioned in the law as potential ENs and may include State vocational rehabilitation agencies as a one-stop partner. Other parts of DOL, such as the Office of Disability Employment Policy, are involved in public policy decisions at the national level that potentially affect beneficiaries returning to work.

Title II--Expanded Availability of Health Care Services

Centers for Medicaid and Medicare Services of the Department of Health and Human Services (HHS) at the national level and State Medicaid agencies are partners in providing increased medical coverage for beneficiaries. Other Federal agencies--namely, the Administration on Developmental Disabilities, the Maternal and Child Health Bureau, and the Center for Mental Health Services, also in HHS--fund programs to provide advocacy, residential, and employment support services to low-income SSA beneficiaries from specific beneficiary populations.

Title III--Demonstration Projects and Studies

SSA's Office of Policy conducts or commissions the mandated projects and studies. The National Institute on Disability and Rehabilitation Research and the Interagency Committee on Disability Research in ED, as well as the Assistant Secretary for Planning and Evaluation in HHS, also undertake or coordinate research on Ticket participants and other persons with disabilities.

Other Partners for Titles I, II, and III

The Section 8 Housing program in the Department of Housing and Urban Development (HUD) and the Transit Subsidy Program in the Department of Transportation (DOT) provide housing and transportation benefits for SSA beneficiaries.

Panel Activities

Between December 17, 2000, and December 16, 2001, the Panel held four quarterly meetings, two additional full Panel meetings, and numerous teleconferences. It provided opportunities for over 25 hours of public testimony and ongoing written comments on the implementation of the Act. It conducted extensive workgroup and committee meetings. Representatives of the Panel testified before a congressional committee and participated in more than 43 events, logging over 300 hours of presentations to strategic partners to provide public education on disability, employment, and health as those topics relate to the Act. Many of these events were nationwide, with audiences ranging from 30 to 600 people. The Panel has been briefed by congressional staff, advocates, grantees of SSA, and representatives of several Federal agencies, including SSA and the Centers for Medicare and Medicaid Services. The Panel held Experts Roundtables on research design issues related to the Adequacy of Incentives report and the $1 for $2 demonstration, both of which are provisions of the Act.

The Panel has completed several reports providing advice to the Commissioner of Social Security. Two reports completed in 2001--preliminary and final versions--advised on the regulations that SSA was developing for the Ticket Program. Two additional reports completed in early 2002 provided guidance on SSA research related to Adequacy of Incentives and the $1 for $2 benefit offset. Some conclusions from these two reports are summarized below.

The Panel launched its own Website in cooperation with the Office of Employment Support Programs. This site gives the public electronic access to information about the Panel's activities. Notices of all Panel meetings are posted there as well as in the Federal Register. Minutes of meetings and other documents produced by the Panel are posted as well. The Panel has an electronic mailbox to facilitate communication from the public. The Panel staff has developed a listserv of more than 1,700 disability advocates and organizations to communicate news and information to stakeholders.

Two standing committees were established: the Planning and Operations Committee and the Design and Evaluation Committee. Three temporary workgroups were appointed to analyze regulations of the Ticket to Work and Self-Sufficiency Program in preparation for deliberations by the entire Panel. The Panel continues to work cooperatively with its strategic partners under the Act.

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Annual Interim Report to Congress

Subtitle A of the Act states:

(f) The Ticket to Work and Work Incentives Advisory Panel.-- ...

(6) Reports.--

(A) Interim Reports.--The Panel shall submit to the President and the Congress interim reports at least annually.

This section of the report covers issues that affect not merely the Ticket Program but, for example, other programs established under the Act or other related programs administered by SSA.

Introduction

The passage of the Ticket to Work and Work Incentives Improvement Act in 1999 represents a bipartisan shift in the nation's attitude toward persons with disabilities and the contributions they can make to our economy and society. The dilemma is this: Even with advances in health and medical treatment and even with trends toward white collar and service employment, few people with disabilities are successfully integrated into the world of work; yet, when asked, many say they want to work. Part of the solution, as spelled out in the Act, gives Social Security disability beneficiaries the opportunity to individually address the barriers to success in the workforce. Each person has unique needs for employment services, accommodations and supports. The Ticket Program for the first time allows for services to be tailored to individual needs and goals, using a variety of public and private providers. While the Ticket Program itself makes resources available to Employment Networks to provide needed services, other provisions of the Act ensure additional supports such as continuation of health care coverage, expedited access to benefits should the need occur, access to information about benefits and the financial impact of working, and access to legal and technical assistance. The provisions in this law, involving a public-private partnership, were woven to ensure the availability of an array of services and options for persons with disabilities who attempt to enter the work force. Yet, as the tickets begin to roll out, the Panel has several concerns, including serious concerns about the lack of funding for a number of these new service systems.

Implementation Issues

The Panel provided extensive opportunities for public input during year two of implementation and comment from beneficiaries, advocates, and grantees raised many issues. Of particular note, public comment indicated that SSA is not sufficiently funding or implementing key provisions of the statute in a manner that is in keeping with congressional intent. Consequently, there is concern that the success of the program may be compromised. These concerns fall under the following specific areas.

* Employment Support Representatives

The Ticket to Work and Work Incentive Improvement Act states in Subtitle C, Section 1149(a)(2)(C), "the Commissioner shall establish a corps of trained, accessible, and responsive work incentives specialists within [emphasis added] the Social Security Administration who will specialize in disability work incentives under titles II and XVI...."

The legislative intent appears clear. The Panel strongly believes that national implementation of the ESR position is key to the successful implementation of the programs and work incentives improvements under the Act. It is also critical to improving customer service for beneficiaries who attempt to work and report earnings or attempt to use any of the current work incentives in the SSI and SSDI programs. SSA conducted a pilot project resulting in a report (November 2001) recommending that the ESR be established as a permanent position, with the broadest possible distribution nationwide. The ESR position, as defined in the pilot project, adheres to the language of the Act proposing designated specialists within SSA who specialize in work incentives under Titles II and XVI. However, the Panel is disappointed that SSA has not taken steps to firmly establish this position in the field offices. In fact, SSA is currently considering a proposal to add the work incentive specialist workload to that of the current field office staff. The pilot provided for 36 ESRs to test the model. By way of comparison, SSA has 55,000 field staff located in 1,300 field offices. These staff service approximately 8 million adults with disabilities currently on the rolls who have received or will receive a ticket, as well as hundreds of thousands who currently report earned income. The Panel's position that all interested beneficiaries should have reasonable access to a full-time work incentive specialist, as defined and recommended in the ESR pilot project. In addition, the Panel believes that ESRs should be permanent SSA employees, dedicated on a full-time basis to clearly defined work incentives and employment support work.

* Public Education and Field Training

Beginning with the recent release of the first tickets, beneficiaries of SSA disability programs will choose how and from whom they access vocational rehabilitation, employment services, and other supports. At the same time, providers, both private sector ENs and existing agencies, will choose which tickets to accept. These choices bring challenges with regard to the ability of stakeholders to make decisions or to promote the program. These stakeholders include beneficiaries with disabilities, their families, their supporters and advocates, providers of community rehabilitation services, State VR agencies, educators, employers, and other Federal and State agencies. If the Ticket Program and work incentives are to succeed, these stakeholders must make informed choices and fully understand their roles.

The challenge is compounded by the extent of knowledge needed for informed choice and effective administration. At a minimum, this includes outreach, training, and technical support in the areas of SSA's disability and return to work programs and work incentive provisions; other Federal benefit programs and work incentive provisions administered by agencies such as the Rehabilitation Services Administration, Department of Labor (DOL), Department of Housing and Urban Development (HUD), Temporary Assistance for Needy Families (TANF), and the Internal Revenue Service; workers' compensation and unemployment insurance; public health insurance provisions and protections (e.g., Medicaid, Medicare, and State Child Health Insurance Programs); protection and advocacy programs; and skills needed for practitioners in developing and providing employment supports.

As a baseline for comparison, it might be useful to summarize the training budget of the existing State-Federal vocational rehabilitation program. This program, administered by the Rehabilitation Services Administration (RSA) and operated by State systems using 26,300 employees nation-wide, served 1,210,000 consumers in 1999. The State systems successfully placed 223,668 into employment. To accomplish this end, RSA funded 297 training and technical support grants costing a total of $40 million.

To appreciate the training and technical support needs of stakeholders, one must first understand the number and type of stakeholders affected by the Ticket Program. More than 360,000 beneficiaries of Supplemental Security Income (SSI) reported earned income in December 2000. This number included those using benefit offsets and other work incentives. Over the first half of calendar year 2002, SSA released tickets to 2.4 million beneficiaries with disabilities in 13 States identified for roll-out of the Ticket Program; 2.5 million more tickets are expected to be released between September and December 2002. Currently, SSA reports that more than 300 Employment Networks have been approved to provide services and supports. These numbers do not include more than 80 State VR agencies that will also participate in the Ticket Program.

To date, the Social Security Administration has allocated less than $4 million per year for training and technical assistance to support implementation of the Act across five contracts. This total includes an estimate of training budgeted by SSA's contractor, Maximus. Given the potential impact of the Ticket Program and the health care work incentives on the lives of individuals with disabilities and other stakeholders, and the amount of information needed to ensure its effectiveness, adequate resources must be allocated to training and technical support on the national, regional, State, and local levels.

* Expedited Reinstatement and Disabled Adult Children, Disabled Widows, and Disabled Widowers

The Panel's position is that all beneficiaries should have an equal opportunity to participate in the Ticket Program. Unless current field instruction policy concerning Disabled Adult Children (DAC) is made permanent in regulations, the Panel believes that DACs will not participate in the program or, if they do, they may be harmed because of a decrease in their benefit amount if they attempt to go to work. The Panel urges SSA to move forward as planned to expeditiously promulgate the expedited reinstatement regulations and to include DACs, widows, widowers, and divorced spouses in those regulations.

Before the establishment of the expedited reinstatement policy created by the field instructions, a DAC who exhausted the Extended Period of Eligibility (EPE) and worked above the Substantial Gainful Activity (SGA) level and subsequently lost his or her job was required to file a new application and receive benefits based on his or her own earnings record (instead of the earnings record of a parent). Disabled widows, widowers, and surviving divorced spouses face the same problem. Under SSA's current policy, DACs who apply and qualify for expedited reinstatement to benefits will receive benefits again under DAC status, so they will be able to participate in the Ticket Program or other work provisions under the same protections as other beneficiaries, without fear of losing their status should their employment end during the eligibility period for expedited reinstatement.

* Marketing and Outreach

The Ticket Program represents a dramatic change in the role of the Social Security Administration and its relationship to its customers with disabilities. No longer will SSA only process claims and disburse checks; instead, it will also offer employment support and direct help for beneficiaries who return to work. SSA recently began the process of mailing tickets to more than 8 million current SSA beneficiaries. Based on public comment, the Panel is convinced that most beneficiaries who will receive a ticket do not know what it is, what to do with it, or why it has been sent to them.

In recent public forums, White House staff and senior SSA executives have acknowledged the need for an outreach campaign to market the Ticket Program, not only to beneficiaries but also to employers and providers. An immediate, coordinated public information campaign to explain the provider and employer opportunities, and beneficiary choices and protections, under the Ticket Program is crucial. The Panel is concerned that SSA has not allocated sufficient resources for this effort. As far as the Panel has been able to determine, the only allocation for marketing is through the contract with the program manager, Maximus, and these funds are allocated only to recruit potential Employment Networks.

Many other Federal agencies that have new programs to administer have designated specific resources for public education to ensure public understanding of Congress' intent and the program's potential impact. For example, when the Americans with Disabilities Act was first passed, the Equal Employment Opportunity Commission budgeted $3 million for marketing and outreach in the first year and $1 million per year thereafter. The Child Health Insurance Program (CHIP) launched a large national campaign as well as State public education campaigns.

Without adequate marketing, the Panel expects low participation rates in the Ticket Program. Low rates can be mistakenly interpreted as reflecting a lack of interest by beneficiaries, providers, and employers, when they may simply mean that few of the stakeholders are aware of the Program. The Panel has encouraged SSA to immediately develop a national marketing and outreach plan for the Ticket Program and for all the work supports and incentives. The plan should be coordinated with SSA's major partners under the Act and should be adequately funded compared with other new Federal programs of similar size. The marketing and outreach plan should involve the White House, the Commissioner of Social Security, and other high profile Congressional, Federal, and State partners. This will help to assure beneficiaries of their protections under the Act.

* Protection and Advocacy Grants

The Panel is concerned that the P&A; program established under the Ticket Act is being implemented so narrowly that it will be ineffective in protecting the rights of beneficiaries. Beneficiaries who attempt to return to work require advice and advocacy on a number of issues at several points throughout the process. The Panel believes that SSA's current interpretation of the role of the P&A; grantees will not permit them to provide the advocacy needed to help SSA beneficiaries return to work.

For example, SSA is prohibiting the use of grant funds to represent a beneficiary against SSA on issues related to overpayments. It is likely that many beneficiaries returning to work will not have their benefits adjusted in a timely manner and will receive an overpayment (see below). Anxiety about receiving an overpayment has been a powerful disincentive to work. It is likely to become even more prevalent as the Ticket Program is implemented.

SSA also prohibits the use of grant funds to address systemic issues that may inhibit the work attempts of beneficiaries. Many concerns that arise for one beneficiary are also concerns for others. For example, lack of accessible transportation alternatives or poor interagency coordination in service provision may negatively affect the work attempts of many beneficiaries in a given geographical area. The P&A; grantees may not have enough resources to represent every beneficiary individually. Without the current restrictions on the use of grant funds, P&A; grantees could maximize their effectiveness by advocating for changes to systems that would positively affect numerous beneficiaries.

The Panel's judgement is that Congress intended P&A; grantees to be able to provide whatever representation a disability beneficiary requires to return to work, including on issues that SSA is currently prohibiting. The Act defined the role of P&A; as providing "(1) information and advice about obtaining vocational rehabilitation and employment services; and (2) advocacy or other services that a disabled beneficiary may need to secure or regain gainful employment." This language is broad and certainly does not exclude the activities that SSA is currently prohibiting. The Panel urges SSA to reevaluate the restrictions on the use of grant funds to reconcile them with the intent of Congress and ensure that P&A; grantees can protect the rights of SSA beneficiaries. To the extent that benefits planning, assistance, and outreach (BPA&O;) grantees face similar restrictions, the Panel urges the President and Congress to direct SSA to reevaluate those restrictions as well.

* Wage Reporting, Overpayments, and the Ticket Program

The Panel has some misgivings that SSA's longstanding problems with overpayments will be exacerbated under the Ticket Program. Many beneficiaries who have attempted to return to work in the past have been charged with overpayments that they are required to repay. If this issue is not resolved, fear of being charged with an overpayment could act as a powerful disincentive to participation in the Ticket Program. In addition, overpayments charged to beneficiaries who participate in the program may ultimately cause their work attempts to fail.

At the end of fiscal year (FY) 1999, SSI beneficiaries owed SSA more than $3.8 billion in overpayments (GAO-01-778, Social Security Administration: Status of Achieving Key Outcomes and Addressing Major Management Challenges, June 2001, p.12). All participants in the Ticket Program will follow administrative procedures for reporting monthly earnings that are similar to the procedures used for the SSI Program. As more beneficiaries attempt to work under the Ticket Program and as they report their earnings monthly, this problem will only get worse if it is not addressed quickly and comprehensively.

According to SSA's FY 2001 Performance and Accountability Report (p. 190), examination of FY 1996-FY 1999 data shows that wages and excess resources were the top causes of overpayments. The Panel realizes that a variety of factors may contribute to delays in benefit adjustments due to changes in wages or resources, resulting in overpayments. These factors include beneficiaries not reporting earnings or other changes to their income/resources to SSA in a timely manner, SSA delay in processing earnings reports or adjusting benefit amounts, and lack of performance goals for field office personnel related to postentitlement actions. The Panel encourages the President and Congress to direct SSA to examine all possible causes of overpayments related to SSA's procedures and to aggressively pursue a real and lasting solution to the overpayment problem for all beneficiaries who begin or return to work. On a separate but related issue, the Panel is convinced ESRs will improve SSA's ability to address overpayment issues for beneficiaries. In addition the Panel maintains that P&A; grantees and BPA&O; grantees would be effective in helping beneficiaries to deal with the consequences of overpayments and that they should have the authority to do so.

$1 for $2 Demonstration Project

Under the current program, during a Trial Work Period (TWP) or the 3-month grace period that follows it, the beneficiary receives full cash benefits regardless of earnings level. However, after the TWP and the grace period, a beneficiary who earns even $1 more than the SGA receives no cash benefits. Many people consider this so-called "cash cliff" to be a major deterrent to work effort. Under the $1 for $2 benefit offset proposal, as earnings exceed a specified disregard amount, benefits would, instead, be reduced by $1 for each $2 of earnings. Thus, a beneficiary would no longer be subject to a sudden loss of all benefits if earnings exceed the SGA amount.

In enacting the Ticket Act, Congress included a requirement that SSA conduct a demonstration project to evaluate the cost, program entry, and program exit effects of a Social Security Disability Insurance (SSDI) $1 for $2 benefit offset. Section 302 states,

The Commissioner of Social Security shall conduct demonstration projects for the purpose of evaluating, through the collection of data, a program for Title II disability beneficiaries (as defined in section 1148(k)(3) of the Social Security Act) under which benefits payable ... are reduced by $1 for each $2 of the beneficiary's earnings that is above a level to be determined by the Commissioner.

The Panel has produced an Advice Report for the Commissioner of Social Security to focus expertise on the policy and technical issues associated with $1 for $2 benefit offset research. The report is based on extensive public comment, consultations with experts from SSA, the views of nationally recognized experts who attended the Panel's Expert Roundtable on November 16, 2001, and the opinions of Panel members.

One of the Panel's recommendations in the $1 for $2 Advice Report calls for an amendment to the Act. Congress mandated a demonstration project to consider the effects of a $1 for $2 offset on induced entry; that is, to estimate how many persons would come on the rolls as a result of the $1 for $2 benefit offset. At this point, the feasibility of such an induced entry demonstration project has been considered by experts from SSA, outside experts consulting for SSA,and experts consulting with the Panel. Many of these experts have raised concerns that the costs of such a demonstration project would be prohibitive ($500 million or more) and that the project may not yield reliable estimates. The Panel therefore recommends that Congress amend the statute to enable SSA to defer research on induced entry and to permit use of either demonstration or nondemonstration methodologies. (See Appendix D for the executive summary of the Advice Report on $1 for $2 benefit offset research.)

Study Proposed: Comprehensive Cost-Benefit Analysis of Ticket-Related Programs

The Panel, concerned that some program benefits may be understated, recommends that the President and Congress direct the Commissioner to commission a full cost-benefit study to evaluate the Ticket to Work and Work Incentives Programs. Such a study should begin with a more complete view of the direct savings to the SSA Trust Fund but should also consider savings to the Federal treasury and increased productivity for the Nation as a whole. It would, at a minimum, consider the impact of increased Federal Insurance Contributions Act (FICA) contributions by working beneficiaries, reduced use of Medicare and Medicaid, cash savings to the general fund by SSI recipients who work and receive only partial cash benefits, and estimated general fund savings beyond 60 months. The study should also consider reduced use of other government transfers, increased taxes paid, and the addition to gross national product from increased work. It should evaluate costs and benefits from the point of view of SSA, the Federal Government, the beneficiary, and society as a whole. The Panel feels that such a study could capture the unacknowledged benefits that will accrue from participation in the program. The Panel has also made this recommendation directly to the Commissioner.

Emerging Issues

The Panel continues to gather information regarding the administration of the work incentives, the implementation of the various programs and projects under the Act in general, and the roll-out of the Ticket Program specifically. This information comes from a myriad of sources, including; public testimony, reports from SSA, data analysis, reports and testimony from GAO, research findings, public and private policy analysts conference presentations, hearings, testimony from beneficiaries and grantees and feedback from the Panel's listserv and Website. The following are some of the emerging issues the Panel is analyzing and following closely:

  • Panel members have some misgivings that beneficiaries could be required to deposit their tickets with existing Federal or State agencies in order to receive services they are already entitled to by virtue of their disability, economic status, or employment status. In the face of budget shortfalls, States may have an incentive to require such behavior because of current formulas for Federal matching, thus limiting choice for certain beneficiaries.
  • Employment Networks are reporting a potential adverse effect on the ENs' outcome payments when beneficiaries use other work incentives, such as benefit offsets. They are also concerned about the potential difficulty of collecting earnings data from clients for 60 months.
  • Vocational rehabilitation agencies have expressed concern regarding reimbursement issues in two situations: (1) when the agencies receive referrals from ENs for paid services to individuals who have already assigned their tickets to an EN and (2) when beneficiaries receive services from the State VR agency and choose not to deposit their ticket with that agency.
  • Many Federal programs share a common policy objective--to promote economic self-sufficiency among persons with disabilities. However, while the agencies administering these programs have agreed to coordinate and provide integrated and seamless services, the specific mechanisms for achieving integrated services have yet to be designed or implemented. Common outcomes, data collection, and reporting need to be explored.
  • It appears that States with Medicaid buy-in programs have stable programs that enjoy a good deal of public support. Recently, however, several States in the process of setting up such programs have reversed course or are at least reconsidering their commitments. In all cases, the concern is program costs. These concerns need to be explored.
  • The Center for Medicare and Medicaid Services administers the buy-in programs and the grant programs used to establish them. Recently the Panel learned from a CMS quarterly report that CMS has only three employees dedicated to administering these grants and programs for the whole country--a somewhat dire situation, given the importance of health care for persons with disabilities who hope to return to work.

The Panel will continue to monitor, research, and analyze these and other issues in the coming months.

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Progress Report on the Ticket to Work and Self-Sufficiency Program

Subtitle A of the Act states:

(2) Duties of the Panel.--It shall be the duty of the Panel to-- ...

(B) with respect to the Ticket to Work and Self-Sufficiency Program established under section 1148 of such Act-- ...

(iv) furnish progress reports on the Program to the Commissioner and each House of Congress.

Therefore, this section of the report covers issues that affect the Ticket to Work and Self Sufficiency Program only and do not affect other programs established by the Act or other programs and work incentives administered by SSA or the Department of Health and Human Services.

Current Status

The final regulations were issued in December 2001 and a phased roll-out of the tickets has now begun. SSA is issuing approximately 2.4 million tickets over a 4-month period to beneficiaries in the first 13 implementation States. The ticket distribution will take place over 2 years as follows:

Phase I 2.4 million beneficiaries
(early 2002)

Phase II 2.6 million beneficiaries
(late 2002)

Phase III 3.5-4.0 million beneficiaries
(2003)

SSA has mailed roughly 1.2 million tickets to beneficiaries in Phase I States (Maximus information as of May 31, 2002), and more than 1,500 tickets have been assigned to a provider. The Program Manager, Maximus, has recruited more than 300 Employment Networks in the initial 13 roll-out States and the ENs have been approved to begin serving beneficiaries by SSA.

Panel Analysis of the Final Regulations

On December 28, 2000, SSA published a notice of proposed rulemaking (NPRM) in the Federal Register. The Ticket to Work and Work Incentives Advisory Panel has provided the Commissioner of Social Security with two advice reports on the proposed rules, a preliminary advice report issued in January 2001 and a final advice report issued in July 2001. The Panel was pleased that the Commissioner considered and chose to adopt, in whole or part, a number of its 24 recommendations; however, the majority of the recommendations were not adopted.

The Panel has reviewed the final regulations and has decided that certain of the recommendations not adopted by SSA are of great importance to the success of the overall Ticket Program. They remain critical and need policy attention, if not in SSA, then perhaps in Congress. Therefore, these issues and recommendations are included in this progress report to Congress and, again, to the Commissioner of Social Security. The four topic areas are ticket eligibility and use; Employment Network requirements and qualifications; protection and advocacy and dispute resolution; and provider payments.

* Ticket Eligibility and Use

The Panel made four recommendations related to ticket eligibility and the conditions under which a beneficiary would receive a ticket. Because SSA did not accept its recommendations, the Panel remains concerned that excluding certain groups of beneficiaries from participation in the Ticket Program will limit the success of the program and lead to continued dependence on benefits.

First, the Panel recommended that all SSI and SSDI adult disability beneficiaries, including those with a Medical Improvement Expected (MIE) designation, be eligible to participate in the Ticket Program. Numerous studies have found that the sooner someone with a recent work history begins receiving employment services, the more likely the person will be to return to work. Delaying the onset of those services, even by a short time, makes it substantially less likely that the individual will attempt to, or succeed in, returning to work.

SSA, however, stated in the final rule that because beneficiaries with MIE designations have medical conditions expected to improve in a relatively short time, they could be expected to return to work without the services under the Ticket Program. The Panel takes issue with this assumption. Currently, few beneficiaries with the MIE designation are leaving the rolls voluntarily to return to employment. In addition, on average, only 16 percent of beneficiaries with this designation are ceased for medical improvement after their initial continuing disability review (CDR). A substantial number of beneficiaries (51,044 in 1999, for example) will therefore be denied this important benefit for up to 2 years on average, based on what the Panel believes is a faulty assumption.

The Panel believes that the decision to exclude beneficiaries with the MIE designation was based primarily on short-term cost considerations. When the Congressional Budget Office (CBO) estimated the costs of the Ticket Program (House Report 106-220, Committee on Commerce, July 1, 1999, p. 7), it assumed that MIE beneficiaries would not be eligible. However, these estimates may have failed to take into account the long-term savings to the programs that could be realized through early intervention. The Panel remains convinced that beneficiaries with the MIE designation will benefit significantly from participation in the Ticket Program and should be included.

SSA says it will evaluate the methodology used to classify individuals MIE to "assess possible ways to improve the system for use in identifying those beneficiaries for whom near-term medical improvement should preclude the immediate receipt of a ticket." While the Panel agrees with the need for this assessment, it also believes that SSA should provide a process to appeal the MIE designation, because arguably, it is being used to determine eligibility for an SSA benefit of monetary value to the beneficiary, that is, the Ticket.

Second, the Panel also recommended that 16- and 17-year-old beneficiaries, including those with an MIE designation, should be eligible to participate in the Ticket Program. SSA did not adopt this recommendation. In considering this issue, Panel members have discussed concerns that transition-aged youth should not be diverted from educational goals and that they should not be encouraged to participate in a program they may not qualify for as adults. Furthermore, ENs may be reluctant to serve such youth because of the length of time it may take to obtain employment.

Notwithstanding such reservations, the Panel takes the position that making transition-aged youth ineligible for the Ticket Program sends the wrong message to youth and could encourage lifelong dependence on benefits. As with beneficiaries with the MIE designation, the Panel believes that short-term costs were the primary reason youth were excluded from the Program. However, the long-term benefits to young beneficiaries and long-term program savings could far outweigh the short-term costs. We realize that SSA is struggling with this policy issue and the Panel commends SSA for its work on the demonstration on early intervention for youth as well as its plans for other youth demonstration projects.

Third, the Panel believes that 18-year-old beneficiaries who participate in the Ticket Program should receive the same protection from redeterminations that other ticket users receive from CDRs. Although youth in VR programs have their benefits protected, they still may have a medical review. However, such a review for an 18-year-old ticket user would mean that if the youth were found ineligible under the adult medical standards, the EN would not be paid for a successful work outcome. The Panel is concerned that even if SSA were to issue tickets to 16- and 17-year-olds, no EN will serve these youth if they must first have a medical redetermination.

Finally, the Panel recommended that SSA conduct a cost-benefit analysis of the feasibility of a beneficiary receiving more than one ticket within a period of disability or eligibility. In its overall evaluation report to Congress, SSA should assess the potential cost impact of beneficiaries using more than one ticket. The final rule limits the number of tickets a person may receive during any period for which he or she is either a Title II disability beneficiary or a Title XVI disability or blind beneficiary and his or her Title XVI eligibility has not terminated. 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 who needs continuing support services may have a difficult time finding an EN that is willing to work with him or her.

* Employment Network Requirements and Qualifications

Five recommendations were made concerning Employment Network requirements and qualifications. Of these, three were adopted by the SSA.

The final regulations articulated a "timely progress" requirement, although there are no timely progress requirements in the statute. The regulatory timely progress requirements are directly related to the suspension of CDRs to determine whether the person continues to meet the definition of disability under Social Security. A ticket user must meet the timely progress requirements to maintain the medical CDR suspension. The Panel recommended that timely progress be defined by the terms and conditions of the Individual Work Plan (IWP) as agreed to by the beneficiary and the EN. The reporting mechanism should be the annual report in Section 411.325(e). However, SSA believes that there is sufficient flexibility in the timely progress rules to accommodate the unique needs of individuals with disabilities. Further, SSA believes that if it allows the individual and the EN or State VR agency to define progress, it would not be possible to develop a consistent and standardized method to determine timely progress for program administration and integrity purposes. The Panel takes issue with SSA's positions.

The Panel has concerns related to how the Federal/State VR system will operate in this new environment involving a competitive Ticket Program. In one particular area, the Panel's recommendation to SSA was not adopted. The Panel recommended that SSA should rewrite Section 411.385 to clarify that an SSA beneficiary with a ticket, who applies for or is receiving State VR services--whether a youth or adult--has a choice in deciding whether to assign his or her ticket to the VR agency, to another EN, or not to assign it at all. An 18-year-old who is already receiving VR services and who then receives a ticket from SSA should not be required to deposit the ticket with the State VR system. The Panel believes that congressional intent was to create the Ticket Program as an additional tool that the beneficiary could use to supplement what is already available under current programs. The final rule retains the policy wherein a beneficiary with a ticket who signs an Individual Plan for Employment (IPE) with a VR agency will be considered to have assigned the ticket to that VR agency. The Panel does not agree with this procedure.

* Protection and Advocacy Services

The Panel is convinced that all beneficiaries should have access to P&A; services. SSA agreed and adopted the Panel's recommendation that information about the services and how to access them should be available at any time to all beneficiaries seeking or using SSA or other work incentive programs, including the Ticket Program. In addition, SSA agreed that all notices will be available in accessible formats.

The Panel also recommended that the beneficiary's filing of a complaint with the Program Manager against an EN should, with the beneficiary's consent, trigger a notice to the P&A; agency regarding the dispute to allow for an inquiry by the P&A; agency as to the beneficiary's wish for protection and advocacy assistance. Automatic notification of the P&A; agency when the beneficiary files a complaint is a proactive way to ensure advocacy for the beneficiary and may expedite the resolution of the dispute. SSA did not adopt this recommendation. The Panel continues to support automatic notification.

* Dispute Resolution

As the Ticket Program is implemented, disputes between various parties are bound to arise. The Panel holds that having adequate procedures and protections in place for beneficiaries to resolve disputes is essential to the success of the program. Toward that end, the Panel made five recommendations regarding dispute resolution--none of which SSA adopted. The Panel is concerned, therefore, that the dispute resolution procedures in the final rule lack sufficient protections to give beneficiaries enough confidence to participate in the program.

The Panel takes the position that participants in the Ticket Program should have more than one tool to address disputes. The Panel recommended that voluntary mediation be available as an avenue for resolving disputes. In addition, the Panel recommended that it be available to all parties to the dispute, after the Program Manager has considered the matter for resolution. Mediation should be external to SSA and should not bar a party's access to further appeals.

SSA did not address the use of mediation as a means of resolving disputes in the final rule implementing the Ticket Program. Although SSA believes that a full and fair hearing is provided for, the Panel urges SSA to set aside additional funds to support the use of mediation for all parties as an efficient and cost-effective way of resolving disputes. SSA should look at other successful mediation program models, such as those established at the Equal Opportunity Employment Commission and the Department of Justice.

The Panel remains concerned about how long it will take to resolve a complaint and about the beneficiary's training and employment status during the complaint review process. There should be strict timelines to minimize the adverse impact on all parties when a complaint is filed. The final regulations either do not reflect timelines for dispute resolution or, where they do, they are inadequate. The Panel recommended that during the appeals process, services and supports to the beneficiary should continue at the same level; that is, the EN should not reduce or suspend services and supports without the beneficiary's consent. Although SSA believes that this requirement is inconsistent with the voluntary participation of ENs, the Panel is equally concerned about the negative impact of disputes on beneficiaries, for example, disruption of services and the continued application of timely progress guidelines. The Panel, therefore, supports a "pendency rule" wherein all services and supports would continue pending the outcome of the appeals process. Finally, in order for all involved parties--beneficiaries, ENs, the Program Manager, and SSA--to reach informed decisions in disputes, all parties must have equal access to all information.

Under the law, the Commissioner of Social Security is required to provide for full and fair reviews. SSA has pointed out that dispute resolution in a multiprovider framework will differ from dispute resolution under a one-provider framework: A beneficiary will have the option to switch providers rather than pursue resolution of the dispute. Nonetheless, the Panel is not convinced that the regulatory sections on dispute resolution in the final rule provide for full and fair reviews. Rather, these sections are virtually unchanged from the proposed rule. The Panel believes that the requirement for a full and fair review flows into and through the SSA decisions and does not rest with just the Employment Networks or the Program Manager. This appears to be where the process breaks down. SSA gives no specifics with regard to how it will provide full and fair reviews.

The Panel suggested that all decisions by SSA involving disputes between or among all parties should, at the option of the parties, be subject to external review, either SSA's administrative review process or judicial review. All parties to disputes should have access to an external appeal process beyond what the regulation currently offers. This access would more fully ensure fairness and impartiality throughout the dispute resolution process. While cognizant that such a review could pose additional problems under the current system, the Panel contends that SSA should take the initiative by providing an external review process that is accessible and fair.

In addition, ticket holders should have access to a dispute resolution process that affords them as much protection as people receiving vocational and employment services who are not using a ticket. A VR client with a disability has access to a more comprehensive process for resolving disputes, including mediation, than a person using a ticket with an EN. The Panel is concerned about the inequity this situation creates for ticket users.

* Provider Payment

Two of the Panel's six recommendations on provider payment were adopted in the final rule. One important change is that the final regulations provide for a payment structure involving milestone payments, and SSA adopted many features of the Panel's recommended structure.

In the AOI report mandated by Congress, SSA should address the efficacy of individualized milestones. The Panel will soon publish an Advice Report to the Commissioner of Social Security that provides guidance on the design of SSA's analysis of the adequacy of incentives.

The Panel recommends that SSA also consider the immediate implementation of a second tier of the milestone system. Such a system would provide individualized milestones for individuals who need ongoing support services, those who need high-cost accommodations, those who earn a subminimum wage, and those who work and receive partial cash benefits, consistent with systems already in use in Massachusetts, Oklahoma, and other States. These systems use the individualized planning process to determine if and when a different set of milestones is necessary, and establish a plan for payments and accountability for the payments. Allowing individualized milestones for individuals who are more difficult to serve better matches the current work and payment rules and would provide incentives and supports necessary for ENs to serve these individuals.

The Panel recommends that SSA interpret "benefits not payable" as a reduction in benefits rather than zero cash benefits. Under the interpretation of zero cash benefits, some groups of beneficiaries would have to earn considerably more before they would reach the point of zero cash benefits and thereby trigger payments to providers. This places them at a distinct disadvantage and creates little or no incentive for providers to serve them. SSA and CBO estimates were based on an assumption of zero cash benefits, and other provisions in the statute indicate that Congress intended that eligibility would be based on zero cash benefits. Based on current statutory language about the way the program is to operate in its initial phase, SSA has interpreted benefits not payable as zero cash benefits; however, congressional staffers and others are open to studying and revisiting this issue. The Commissioner has the authority to change the interpretation, but the program must be in place and evaluated before payment structures are adjusted.

The Panel recommended that because the SSDI and SSI programs have distinct rationales, beneficiary populations, administrative processes, and timelines, SSA should develop two milestone/outcome payment systems--one for SSI recipients and another for SSDI beneficiaries--that reflect program differences and the special issues of concurrent beneficiaries. As proposed, the payment systems discourage ENs from serving SSI beneficiaries, because ENs would receive a smaller return for similar effort and it could take considerably longer for SSI beneficiaries to reach the point in employment when ENs can be paid. A consistent outcome-payment threshold for all ticket users could level the playing field, making all ticket users equally attractive to ENs in terms of when a payment can be made.

Adequacy of Incentives

In enacting the Ticket Act, Congress recognized that the Ticket Program would not be equally available to all persons with disabilities. In particular, some people with significant disabilities might be involuntary nonparticipants. That is, they might be willing to work but because of factors such as their need for ongoing support and services or high-cost accommodations, they might not find an Employment Network willing or able to accept their ticket under the existing financial incentives of the Ticket Program.

To address this equity issue, Congress included in the statute a requirement that SSA design and implement a payment system to allow this population to participate in the Ticket Program. The Commissioner is required to report to Congress on recommendations for a method of adjusting payment rates to ENs to ensure equitable participation for individuals in four specific groups--those needing ongoing support and services, those needing high-cost accommodations, those earning a subminimum wage, and those who work and receive partial cash benefits. The Commissioner must implement the necessary adjusted payment rates prior to full implementation of the Ticket Program. The statute requires that SSA consult with the Panel during the development and evaluation of the report relating to the four groups.

The Panel has published an advice report to the Commissioner that brings expertise to bear on these complex issues and the design of the AOI study. This report reflects public comment, the views of experts from SSA, the recommendations of nationally recognized experts brought together for an Experts Roundtable on July 27, 2001, and the recommendations of the Panel itself. (See Appendix C for the executive summary of the Panel's Advice Report on AOI.)

Two of the Panel's recommendations from the Advice Report on AOI call for action from Congress:

  • The Panel recommended that, because of delays in issuing the tickets, the deadlines for the AOI report to Congress and for implementing the new alternative incentives be extended by the same amount of time as the Ticket Program roll-out has been delayed (13 months). That is, the AOI report would be due 49 months, rather than 36 months, after the enactment date.
  • The Panel recommended that SSA provide to the Panel, Congress, and the President ongoing interim reporting on the participation in the Ticket Program by members of the four hard-to-serve beneficiary groups.

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Appendix A: The Panel

Members of the Panel

Twelve individuals serve on the Panel: four appointed by the President, four by the Senate, and four by the House of Representatives. The appointees represent a cross-section of experience and expert knowledge as recipients, providers, veterans, employers, and employees in the fields of employment services, vocational rehabilitation, and other disability-related support services. Most are individuals with disabilities or their representatives. Several have personal experience as beneficiaries of Social Security.

Richard V. Burkhauser, Ph.D., Sarah Gibson Blanding Professor of Policy Analysis and chair, Department of Policy Analysis and Management, Cornell University, Ithaca, NY. He has lectured, published, and testified extensively on the employment and economic well-being of people with disabilities. The Senate appointed him for a 2-year term ending in 2002.

Kristin E. Flaten, M.Div., Mental Health and Benefits Advocacy Specialist, Lifetrack Resources, Inc., St. Paul, MN. She also operates a small business providing work incentive planning, advocacy, benefits analysis, and support services while serving on the State Rehabilitation Council and the State Advisory Council on Mental Health. The President appointed her for a 2-year term ending in 2002.

Thomas P. Golden, M.S., C.R.C., faculty, Cornell University, Program on Employment and Disability, School of Industrial and Labor Relations, Ithaca, NY. He directs training, technical assistance, and organizational development projects on work incentives, transition systems change, and employment for people with disabilities. The President appointed him for a 2-year term ending in 2002.

Frances Gracechild, Executive Director, Resources for Independent Living, Inc., Sacramento, CA. She also serves as an instructor at California State University at Sacramento and the president of Health Access of California. The House of Representatives appointed her to serve a 2-year term ending in 2002.

Christine M. Griffin, J.D., Executive Director, Disability Law Center, Boston, MA. She is a Trustee for the Paralyzed Veterans of America Spinal Cord Research Foundation and a member of the bar in Massachusetts and Washington, DC. The Senate appointed her to serve a 4-year term ending in 2004.

Larry D. Henderson, Executive Director, Independent Resources, Inc., Wilmington, DE. He serves as chair of the Developmental Disabilities Planning Council of Delaware. Previously, he was associated with the Salvation Army's Family Service Department. The Senate appointed him to serve a 2-year term ending in 2002.

Jerome Kleckley, M.S.W., C.S.W., Director, Hospital Services for the Eastern Paralyzed Veterans Association, Jackson Heights, NY. As a Navy veteran, he has been actively involved in veterans' issues, serving as an advocate for veterans with disabilities. The House appointed him to serve a 4-year term ending in 2004.

Stephanie Smith Lee, Governmental Affairs Representative of the National Down Syndrome Society, Oakton, VA. She has played a key role in the passage of Federal disability legislation and has led successful grassroots advocacy efforts at the local, State, and Federal levels. She was recently nominated to the National Council on Disability by the President. The Senate appointed her to serve a 4-year term ending in 2004. On February 20, 2002, Ms. Lee resigned from the Panel to accept the position of Director, Office of Special Education Programs, U.S. Department of Education.

Bryon R. MacDonald, Project and Policy Development Manager, California Work Incentives Initiative, World Institute on Disability, Oakland, CA. He provides State and national consulting, training, and leadership on employment support, health care, and benefits planning programs for persons with disabilities. The President appointed him to serve a 4-year term ending in 2004.

Sarah Wiggins Mitchell, R.N., M.S.W., J.D., Chair, President, and Executive Director, New Jersey Protection and Advocacy, Inc. She is a member of the bar in New Jersey and Pennsylvania and has a background in nursing and social work. The President appointed her to chair the Panel for a 4-year term ending in 2004.

Stephen L. Start, President and Chief Executive Officer, S.L. Start & Associates, Spokane, WA, a company that provides professional management, rehabilitation, and residential services for people with disabilities, seniors, and economically disadvantaged individuals. The House appointed him to serve a 4-year term ending in 2004.

Susan Webb, M.B.A., S.P.H.R., Director, ABIL Employment Services. She served on the Board of Directors of the National Council on Independent Living as its Social Security Subcommittee chair. She is also a former SSDI beneficiary who used program work incentives to return to work. The House appointed her to serve a 2-year term ending in 2002.

Membership and Terms

The Panel may experience significant turnover in membership during 2002, because the terms of 6 of the 12 members will end during the year. This will provide an opportunity for the President, the House, and the Senate to each make two new appointments or reappointments. Appointments are for 4 years. A current member may serve after the expiration of his or her term until a successor takes office.

Responsibilities of the Panel

The Ticket to Work and Work Incentives Improvement Act of 1999, Public Law 106-170 (the Act), established the Ticket to Work and Work Incentives Advisory Panel (the Panel) within SSA on December 17, 1999. The Panel is governed by the provisions of the Act; Public Law 92-463, as amended, which sets forth standards for the formation and use of advisory committees; and the General Services Administration (GSA) regulations on the Federal Advisory Committee Act. The original charter establishing the Panel was submitted to the GSA and filed with the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate on March 21, 2000; the charter was renewed in March 2002. Members were appointed by the President, the House of Representatives, and the Senate during May and June 2000. The Commissioner of the Social Security Administration swore in Panel members on July 24, 2000.

Panel duties include advising the President, Congress and the Commissioner of Social Security on issues related to work incentive programs, planning, and assistance for individuals with disabilities and the Ticket to Work and Self-Sufficiency Program. Operating procedures governing the activities of the Panel have been developed and approved. The Panel meets quarterly, alternating locations between Washington, DC, and roll-out States to hear regional testimony. The Panel transmits an annual interim report on the implementation of the Act to the President and Congress. This is the second such report. A final report is due no later than December 17, 2007. The Panel terminates on January 16, 2008, 30 days after the submission of its final report.

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Appendix B: Letters from the Panel

1. Sarah Wiggins Mitchell letter to Acting Commissioner of the Social Security Administration William A. Halter, February 20, 2001.

2. Sarah Wiggins Mitchell letter to President George W. Bush, November 30, 2001.

3. Sarah Wiggins Mitchell letter to Commissioner of the Social Security Administration Jo Anne Barnhart, January 7, 2002.

Ticket to Work and Work Incentives Advisory Panel

February 20, 2001

William A. Halter
Acting Commissioner of Social Security
6401 Security Blvd.
Room 960 Altmeyer Building
Baltimore, MD 21235

Dear Acting Commissioner Halter:

I am writing on behalf of the Ticket to Work and Work Incentives Advisory Panel (the Panel) to express the Panel's concerns regarding certain provisions in the Notice of Proposed Rule Making (NPRM), as well as the Social Security Administration's (SSA) plans for implementation and first year roll-out of the Ticket program in thirteen states.

As you know, the Panel has received regular briefings and updates from the Associate Commissioner for Employment Support Programs, Kenneth McGill, on NPRM implementation activities such as contracting and grant-making, and other critical administrative rollout activities. We have also received updates and information on program evaluation activities from the Acting Deputy Commissioner of Policy, Paul Van de Water. Both have been helpful in briefing the Panel on SSA's activities and in responding to requests for information. We are very appreciative of their cooperation.

The Panel recognizes that the implementation and rollout of the new TWWIIA programs pose enormous challenges to SSA and to the field of rehabilitation as a whole. We believe, however, if implemented cautiously, and with serious consideration given to input from the Panel and constituents, these programs have the potential to improve the overall quality and availability of rehabilitation services, employment services and supports, and related health services for our nation's citizens with disabilities. In keeping with this belief and with our commitment to the success of TWWIIA in increasing employment rates for people with disabilities, the Advisory Panel members take very seriously their responsibility to advise and assist the Commissioner of SSA.

After the Panel's initial meeting in July 2000, and its subsequent briefings on both TWWIIA and the NPRM, Panel members felt it was essential to reach out to a variety of constituent groups and advocates to solicit comments and opinions about the NPRM and the plans for Ticket implementation. To achieve this the Panel has conducted eleven days of public meetings and seven public conference calls since July 2000. We have hosted over twenty (20) hours of public comment at those meetings. Additionally, public meetings in Phoenix, Minneapolis, Salt Lake, and Atlanta as well as teleconferences in California have been devoted solely to public comment on the NPRM. We have also solicited and received correspondence from the public regarding SSA's Ticket implementation plans and the NPRM. Not only have individual Panel members attended numerous meetings in their home states, but many also have been asked to speak to groups and organizations about the Panel and TWWIIA implementation.

During the past six months of Panel activity, specific issues relating to implementation and rollout and the proposed regulations in the NPRM, have surfaced repeatedly in public comment and in Panel deliberations. After extensive discussion in our January and February meetings, the Panel concluded that a letter outlining key implementation issues and concerns should be sent immediately, prior to close of the NPRM public comment period.

Issue one involves the NPRM's exclusion of certain beneficiaries from the Ticket program, specifically those who have a Medical Improvement Expected (MIE) diary and transition age youth 16-18 years old. We are aware that SSA officials did consider including both of these populations early in the development of the NPRM. We have requested an analysis of the cost implications for including these populations from the Office of the Actuary.

With regard to the exclusion of beneficiaries with an MIE diary, the Panel has four specific concerns. They are: (1) reports indicate that the MIE designation has a disproportionate impact on consumers who are diagnosed with mental illness; (2) placing someone in the MIE category appears to be based solely on diagnosis; (3) the NPRM does not address appeal and due process issues raised when denying a benefit (i.e., a Ticket) to a beneficiary based on a designation that most beneficiaries do not even know they carry; and, (4) in denying access to the Ticket program to over 60,000 beneficiaries a year when only a small subgroup of approximately 9,600 (i.e. actual ticket users) are ceased by a Continuing Disability Review (CDR), is questionable public policy.

More specifically, in 1999, there were 60,766 DI and SSI adult beneficiaries on the rolls who were classified first time MIEs. The decision files of disability determination services indicate that in 1999, that same year, 9,663 beneficiaries with an MIE diary were ceased because of medical improvement. No one knows how many of those who were ceased would be likely to use a ticket. But, overall estimates of ticket use are very low. To exclude tens of thousands from the program for the savings realized by such a small number seems questionable. The Panel recommends that this entire population be included in the Ticket program in the final rule. Until a final rule is published, SSA's communications and information should be silent on this proposed exclusion.

With regard to the exclusion of transition aged youth, the Panel strongly recommends that SSA include this population in the Ticket program in the final rule. Other Federal agencies, such as the Office of Special Education Programs, the National Council on Disability and the President's Task Force on Employment of Adults with Disabilities, also support their inclusion in the Ticket program. The President's Task Force has recommended and promoted the inclusion of transition aged youth in all Federal employment policies and programs in their annual report to the President issued in December 2000. A well researched finding with this population is that success in employment is directly related to early intervention. Panel members believe that working with young people early on is sound public policy and makes good common sense. We do not believe that the potential savings outweigh the benefits of reaching these young people to prevent a lifetime of poverty and dependence.

The second major issue is the inadequacy of the proposed milestones payment system in the NPRM. After extensive public comments, testimony by experts and hours of deliberation, the Panel has concluded that the proposed milestone payment amounts and payment frequency outlined in the NPRM are grossly inadequate for the vast majority of private entities that are looking to become employment networks (ENs). There are thousands of small and medium-sized private non-profit and private for-profit rehabilitation and employment service providers in local communities all over the country that have expressed interest in this program. The Panel has received extensive public comments from individuals and organizations representing these providers and all have indicated that the proposed milestone payment system is inadequate.

The inadequacy of the payment system as proposed in the NPRM would also restrict the use of Tickets by those who are harder to serve. If Ticket implementation moves forward without the payment system issue resolved, it is likely that many individuals who are harder to serve will be unable to find an EN willing to take their Ticket.

Many commenters stated that if the milestone payment process issues are not resolved before SSA tries to enroll ENs, SSA will find that few, if any, ENs will sign up to provide services. Testimony from a number of State Vocational Rehabilitation Agencies (State VRs) further indicated that if no ENs sign up, all beneficiaries who want to use their Ticket will be forced to come to State VRs for services. This will create havoc in the VR Agency's system since State VR's are not prepared to deal with the onslaught of applicants. This will defeat the core purpose of the Ticket program--to expand the number of providers working with SSA beneficiaries. It will also undermine the goal of providing a real choice of providers for all beneficiaries.

The third major issue relates to the protections to be accorded beneficiaries and the provision of timely dispute resolution services. In the NPRM, the burden to know of, and seek out, assistance and dispute resolution services is on the beneficiary. This is unrealistic and can lead to the denial of critical advocacy services for beneficiaries in need. We received extensive public comment on this issue from a number of advocates in the current State Protection and Advocacy Systems for people with developmental disabilities, people with mental illness and other disabilities, as well as clients of the State Vocational Rehabilitation system. Their experience, specifically with the Client Assistance Program for individuals served by the State Vocational Rehabilitation Agency, is that consumers must receive up-front and regular notice of the availability of advocacy services in order for the service to be effective in protecting beneficiaries and preventing disputes. People with disabilities should be notified of the availability of advocacy services when they receive their Ticket and at critical junctures throughout the process. It is not sufficient to provide information about the availability of protection and advocacy services only at the beginning of the process. Beneficiaries need to be reminded often that the service is available to them at any time. The Panel recommends that early and frequent notice be instituted immediately, beginning with public education brochures and distributed with the initial mailing of Tickets to beneficiaries in the rollout states.

A fourth issue reflects the Panel's concern regarding to two reporting requirements. They are the reporting requirements for beneficiary earnings and the requirement that ENs submit an annual financial report showing the percentage of the EN's budget spent on serving beneficiaries.

To require ENs to provide monthly beneficiary earnings reports is unrealistic, costly, burdensome and unworkable for most ENs. Panel members believe that ENs will not be able to collect this information on a monthly basis and perhaps will find even quarterly difficult. The beneficiary has almost no incentive to provide earnings information after he/she is no longer receiving cash benefits. In addition, the requirement of an annual financial report is confusing at best, and can be burdensome and intrusive at worst. It appears unnecessary in the overall evaluation of effectiveness of the program. We believe it will discourage potential providers because it is unnecessarily intrusive and there is no indication what the government will do with the information once it collects it. What would an EN report? How would the information be used? Could it be used to propose a decrease in the payment and/or profit of ENs?

In addition to these major issues, the Panel in a recent meeting discussed two non-NPRM concerns with regard to the actual rollout of the program. After a briefing on the terms and conditions of the draft Request for Proposals (RFP) for employment networks, and after receipt of public comments from State VR representatives at the meeting, the Panel discussed the planned schedule for roll-out of the RFP and the Ticket. All of the members present agreed that the terms and conditions in the RFP appeared to unnecessarily limit the types of providers the program would enroll and that many of the terms were confusing. Some members were also very concerned that beneficiaries would receive a Ticket and there would be no ENs signed up to provide services.

After receiving further information from Mr. McGill that appeared to address some of the Panel's concerns and thorough discussion and deliberation during its February meeting, the Panel passed a motion by a 4/3 vote to recommend that SSA not release the RFP for the ENs or Tickets to beneficiaries until the regulations are final. The final poll of the entire Panel after the meeting indicated that five (5) of the Panel members were in favor of the motion and six (6) were opposed. Further motions, one to delay the distribution of Tickets until the final rules are issued, and one to delay publishing the RFP for at least two months after the NPRM comment period closes, were supported by the majority of Panel members with 10/1 and 9/2 in favor respectively.

The Panel is very appreciative of SSA efforts to move forward with the Ticket program and we are aware of the tight timeframes in the statute. Given the significance of the issues raised and concerns expressed, however, we recommend that SSA proceed with caution and with due regard for the input of the Panel and the public.

Finally, the Panel recommends that all public information and public education materials, as well as communications to the field and to the public, include plain and clear language acknowledging that the above NPRM issues are not resolved and that current implementation activities should not be confused with final decision-making on the regulatory issues in question. Any such communication should indicate that SSA plans to work with advocates, providers, constituents, the new Administration and Congress to resolve the NPRM issues in a balanced and reasonable way.

We further urge SSA to be very careful in public education materials and in all communication with beneficiaries to state clearly that to date, no one is excluded from the Ticket program. It takes only one rumor, regardless of its veracity, to have the effect of exclusion for large numbers of people whose history and experience is full of exclusions.

The Panel shares your enthusiasm and commitment to this very important program, and we look forward to working with SSA to ensure that its promise becomes a reality for people with disabilities. To that end, we would appreciate receiving a written response to this letter. If you have questions, please contact Marie Strahan, Executive Director for the Advisory Panel, or me.

Thank you for your cooperation and support. I look forward to hearing from you.

Sincerely,

/S/

Sarah Wiggins Mitchell, Chair

cc: Marie Strahan
Glenna Donnelly
Ken McGill
Paul Van De Water

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Ticket to Work and Work Incentives Advisory Panel

November 30, 2001

President George Bush
1600 Pennsylvania Ave
Washington, D.C. 20502

Dear Mr. President:

I am writing on behalf of the Ticket to Work and Work Incentives Advisory Panel (the Panel) and the millions of Social Security beneficiaries and Supplemental Security Income recipients with disabilities, to urge the immediate issuance of the implementing regulations for the Ticket to Work and Self Sufficiency Program (the Ticket Program). These regulations were forwarded to the Office of Management and Budget (OMB) on August 21, 2001, for their review. The Social Security Administration (SSA) forwarded a revised version of the regulations to OMB on November 15, based on extensive consultations between the SSA and OMB staffs. These final regulations are critically important to the Administration's efforts under the New Freedom Initiative to increase opportunities for people with disabilities to begin or return to work.

The Ticket to Work and Work Incentives Advisory Panel is a bipartisan Panel within the Social Security Administration established by the Congress and appointed by the President and the Congress to advise the President, the Congress, and the Commissioner of Social Security on issues related to work incentive programs, planning and assistance for individuals with disabilities. At the Panel's quarterly meeting in November 2001, Panel members expressed deep concerns about the delay in the Ticket Program's implementation because final regulations have not been issued. There is, as well, growing frustration in the disability community nationally that, because of the considerable time it is taking to get final regulations issued, the Ticket Program remains an unfulfilled promise. For this reason the Panel unanimously voted to request that final regulations be issued immediately.

The Ticket legislation was signed into law in December 1999, after strong bi-partisan support in both the House of Representatives and the Senate. Leaders of both parties spoke of swift implementation and promised a new era in which people with disabilities seeking employment will have real choices and benefit from true competition in the field of employment services and rehabilitation. It has been almost two years since the passage of the legislation and people with disabilities, their families and rehabilitation providers are anxiously awaiting the start of the Program. For many of us it is very discouraging to note that after 24 months, not one Ticket has been issued to a beneficiary.

We commend you on the announcement of the New Freedom Initiative in February 2001, and on your continuing commitment to address the needs and concerns of people with disabilities by increasing access to assistive technologies, expanding opportunities, increasing the ability of individuals with disabilities to integrate into the work force and promoting increased integration into the community. In the New Freedom Initiative you referenced the implementation of the Ticket to Work and Work Incentives Improvement Act of 1999. You stated, "Through Executive Action the Administration is committed to supporting agencies in the continued swift implementation of this law." Swift issuance of the final implementing regulations is what the Panel is now urging.

Again, we request that you direct the immediate issuance of these important implementing regulations so that the Ticket to Work Program's promises of real choice and expanded services for millions of Americans with disabilities who want to work can be fulfilled.

Sincerely,

Sarah Wiggins Mitchell
Chairperson

cc: The Honorable Mitchell E. Daniels, Jr.
Director, Office of Management and Budget

The Honorable Jo Anne B. Barnhart
Commissioner of Social Security

The Honorable William M. Thomas
Chairman, Committee on Ways and Means
House of Representatives

The Honorable Max S. Baucus
Chairman, Committee on Finance
United States Senate

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Ticket to Work and Work Incentives Advisory Panel

January 7, 2002

Jo Anne Barnhart
Commissioner of Social Security Administration
6401 Security Boulevard
Room 900
Baltimore, MD 21244

Dear Commissioner Barnhart:

I am writing on behalf of the Ticket to Work and Work Incentives Advisory Panel (the Panel) to encourage you to provide full funding for the Ticket to Work and Work Incentives Improvement Act's SSA grant programs. Specifically they are the Benefits Planning, Assistance and Outreach grant program and the Protection and Advocacy grant program. These two programs are authorized in the statute at $23 million and $7 million, respectively.

The panel is aware that the Senate Committee on Appropriations in Senate Report 107-84 encouraged the Agency to fund both of these grant programs at their authorized level for fiscal year 2002. It is the opinion of the Panel, and of the advocates and consumers that worked for the passage of the Ticket legislation, that the funding specified in the statute is the minimum needed for the initial implementation of these essential direct-service grant programs. It is expected that these amounts will increase as the Ticket, the Medicaid Buy- In and the Workforce Investment Act programs continue to roll out and expand.

It is our understanding that the Social Security Administration (the Agency) has funded the Protection and Advocacy grants program for FY2002 at $5 million, a 30% reduction from the authorized $7 million level. This is also 30% less than the State designated Protection and Advocacy agencies thought they would receive based on last year's mid-year funding. The new funding cycle should have begun on December 1, 2001 but grants were awarded effective January 2002, with no provision for funding the State P&A; agencies for the month of December 2001. Further, we are concerned that the Benefits Planning, Assistance and Outreach funding may also be cut in the next round of awards. The reduced amount of funding for the Protection and Advocacy programs, coupled with the uncertainty in funding for the Benefits Planning, Assistance and Outreach grantees, sends a message to beneficiaries, their families and advocates that the Agency may not be serious about the successful implementation of the Ticket Act programs.

These two programs were designed to provide long-needed and critical benefits planning and advocacy services directly to SSI recipients and SSDI beneficiaries. For many years beneficiaries with disabilities have expressed great fear and uncertainty about the loss of critical health care and use of the current work incentives with regard to employment and return to work attempts. Beneficiaries of the two programs have testified to Congress that they need accurate and timely information and advocacy services for several reasons. One, such assistance is needed so that beneficiaries might better manage and cope with a confusing and complicated array of Federal, State and local benefits programs, employment supports and health related services. And two, it will provide direct help to beneficiaries in working with the wide array of public and private rehabilitation providers in the new Ticket program. In fact, each State and locality will have a very different set of benefits, services, providers and systems, requiring local and client-specific advice, information and advocacy; advice, information and advocacy that these local and state grant programs are uniquely designed to deliver.

The Panel members recognize that this is a very difficult budget year for all Federal programs and we want to assure you that the Panel is supportive of the new spending needed for security and public safety. At the same time, we believe that the new Ticket to Work and Work Incentives Improvement Act programs have the potential to greatly improve the quality and availability of rehabilitation, employment supports and health services for millions of Americans with disabilities. In keeping with this, Panel members view their advisory role very seriously and ask that you provide us with a formal response to this letter as soon as possible.

Marie Strahan, the Panel's Executive Director, or I, are available at (202) 358-6430, to address any questions or concerns that you may have. We look forward to a continued partnership with you and the Agency staff to ensure the successful implementation and operation of these important new programs.

Sincerely,

/s/

Sarah Wiggins Mitchell

cc:

The Honorable William M. Thomas
Chairman, Committee on Ways and Means
House of Representatives

The Honorable Max S. Baucus Chairman, Committee on Finance
United States Senate

Martin Gerry
Deputy Commissioner
Office of Disability
and Income Security Programs

Ken McGill
Associate Commissioner
Office of Employment Support Programs

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Appendix C: Home Page on the Web

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Appendix D: AOI Advice Report

Executive Summary

The purpose of the Panel's Advice Report is to provide analysis and recommendations regarding design of the Adequacy of Incentives Study authorized by the Ticket to Work and Work Incentives Improvement Act of 1999. The Adequacy of Incentives Study was mandated by Congress to evaluate how the Ticket to Work and Self-Sufficiency Program can be used to increase employment among those with significant disabilities. The Commissioner is required to report to Congress on recommendations for a method or methods to adjust payment rates to Employment Networks to ensure the participation of individuals with disabilities in four specific groups. The Commissioner must implement the necessary adjusted payment rates prior to full implementation of the Ticket to Work and Self-Sufficiency Program. The statute requires that the Panel be consulted during the development and evaluation of the study.

This Advice Report is based on relevant documents, including reports from an Experts Roundtable and public testimony coordinated and convened by the Design and Evaluation Committee of the Work Incentives Advisory Panel in Washington, DC, on July 27, 2001. In addition, this Advice Report is based on related research on employment of people with significant disabilities and targets the four groups in the disability population noted in the Adequacy of Incentives provision of the legislation who are likely to be "involuntary nonparticipants." These four groups are individuals with a need for ongoing support and services, individuals who need high-cost accommodations, individuals who earn a subminimum wage, and individuals who work and receive partial cash benefits.

Summarized in this Advice Report are a report by the Social Security Administration (Working Paper 003, Design of the Study of the Adequacy of Incentives for the Ticket to Work Program, Huynh and O'Leary, July 14, 2001); key points from the July 27, 2001, Experts Roundtable; and Panel and Experts Roundtable recommendations that will provide a framework for additional research related to the Adequacy of Incentives. The points offered in this Advice Report are intended to support and enhance, not supplant, the overall proposal described by the Social Security Administration's Office of Policy in Working Paper 003 and discussed at the Experts Roundtable.

Panel Recommendations The 13 recommendations offered here include recommendations from the Panel related to the ongoing process for the Adequacy of the Incentives Study. They are followed by recommendations from the Experts Roundtable on nine specific issues raised by the Social Security Administration (SSA) and/or the Panel.

* Design Process of the Study

Panel Recommendation 1: An ongoing structure must be established for review of emerging information, analysis of trends, and creation of recommendations regarding modification of incentives and making use of multiple evaluation methods.

Panel Recommendation 2: The Social Security Administration should convene an Adequacy of Incentives Advisory Team, similar to the team of consultants approach being used under the $1 for $2 research, for ongoing technical support for the Adequacy of Incentives Study, specifically related to the four targeted groups. This group should consist of diverse individuals who have research background, knowledge, and/or expertise in the successful employment of individuals in the four groups. This group could include, but not be limited to, the experts identified by the Panel for the Adequacy of Incentives Experts Roundtable. These experts would be charged to further develop recommendations from the Experts Roundtable for serious consideration by the Social Security Administration. At least two members of the Adequacy of Incentives Advisory Team should become members of the Technical Evaluation Support Group, the technical group advising Social Security Administration on overall Ticket evaluation, to ensure coordination of the two research efforts.

Panel Recommendation 3: Given the impact of this and other studies the Office of Policy conducts on the lives of people with disabilities and their families, the Office of Policy should develop a policy and practice for incorporating the input and experiences of consumers, their families, and/or their representatives as it develops new research designs, including the Adequacy of Incentives Study.

Panel Recommendation 4: As the Ticket to Work and Self-Sufficiency Program is implemented, the Social Security Administration should provide to the Panel, Congress, and the President ongoing interim reporting on the participation of members of the four targeted groups in the Ticket to Work and Self-Sufficiency Program.

Panel Recommendation 5: The Panel recommends that Congress approve a technical amendment to require the Social Security Administration to provide to the Panel, Congress, and the President ongoing interim reporting on the participation of members of the four targeted groups in the Ticket to Work and Self-Sufficiency Program.

Panel Recommendation 6: Ongoing data collected and outcomes determined for the Adequacy of Incentives Study should be included in the Social Security Administration's overall Ticket evaluation research.

Panel Recommendation 7: Due to delays in issuing the tickets, the deadline for the Adequacy of Incentives Report to Congress should be extended by the amount of time the ticket roll-out has been delayed (13 months). The Panel recommends that Congress approve an amendment to adjust the timeline for the Adequacy of Incentives Report so that it is due 49 months, rather than 36 months, after the enactment date. Implementation of the necessary adjusted payment rates should occur as soon as practical following the release of the Adequacy of Incentives Report but no later than 1 year after its release. Further, the Panel requests preliminary progress reports on the Adequacy of Incentives Study at 36 and 42 months after the date of enactment of the law.

* Identifying the Four Groups

Panel Recommendation 8: While there is a need to take advantage of what is known about the diagnostic categories with high proportions of those most likely to fall into one of the four groups relative to work capability, the Social Security Administration, in addition to diagnostic data, should use other information, such as survey information, information on earnings, onset date, and medical improvement assessments. SSA should also go to outside data sources, such as those identified in Experts Roundtable Recommendation 1 (below), to identify members of the four target groups.

* Survey Methodology

Panel Recommendation 9: The Social Security Administration has proposed a survey to supplement its administrative data, improving its ability to target the four groups. If the survey uses a telephone protocol, the protocol should include two other elements. First, there should be face-to-face home interviews if the phone survey fails for a given respondent, except for cases of incorrect phone numbers, empty residences, and so on. Second, if the potential respondent's disability prevents effective participation in the survey, the interviewer should use as a proxy another individual who knows the respondent well and, preferably, who has communicated on the respondent's behalf in the past, such as a parent, spouse, sibling, or supervisor in a group home. Members of the Adequacy of Incentives Advisory Team (see Panel Recommendation 2) should review the interview protocol used by the contractor conducting the survey.

* Supplementary Research

Panel Recommendation 10:
Recognizing the need for research to supplement what can be studied using Social Security administrative data, SSA has proposed a program of supplementary research. It has solicited the suggestions of the Panel for possible research topics to supplement the research using SSA data. The Panel recommends the following:

  • Review existing research on the four groups or related groups, including relevant behavioral demonstrations and field experiments.
  • Conduct or commission new research on these groups using State data or other Federal data.
  • Conduct or commission new research related to Employment Networks and other providers.
  • Review and consider best practices of successful programs relating to employment of those with significant disabilities.
  • Review best practice systems of results-based funding and/or individual milestones payments.
  • Conduct or commission a review of supported employment literature, research, and best practices.
  • Conduct or commission ongoing demonstration projects, modeling, and evaluation of the effectiveness of alternative incentives identified.

* Employment Networks

Panel Recommendation 11: SSA should identify the data elements that Employment Networks (ENs) should collect on whom they serve and do not serve from the four functional groups identified in the statute. The data should include descriptions of why a ticket is accepted or is not accepted on the basis of the EN's perception of cost, degree of difficulty, or lack of expertise on the part of the EN to provide the necessary services. SSA should use a sampling of ENs rather than requiring all ENs to collect the data. SSA should pay the ENs to offset the administrative burden of management information system design.

Panel Recommendation 12: SSA should conduct or commission qualitative research, including interviews and focus groups as appropriate, to assess the adequacy of current incentives to large and small providers, including community rehabilitation programs. Information and recommendations should be collected regarding the amount and timing of payments and other factors that affect potential participation in the Ticket Program and integrated community employment at minimum wage or higher levels for individuals in the four groups.

* Various and Diverse Populations

Panel Recommendation 13: SSA should ensure that the data collected include attention to national demographics such as rural and urban settings, minority representation, and socioeconomic conditions across the country.

* Recommendations From the Experts Roundtable

The Panel convened an Experts Roundtable on July 27, 2001, as part of its effort to bring expertise to bear in advising SSA on the design of the Adequacy of Incentives Study. Following are the recommendations that emerged from the Experts Roundtable in response to the nine questions posed by the Social Security Administration and the Panel. The Panel strongly urges the Social Security Administration to seriously consider and further develop these recommendations in designing research related to the Adequacy of Incentives Study and its context within the broader evaluation of the Ticket to Work and Self-Sufficiency Program.

* Identifying the Four Groups

Roundtable Recommendation 1: In addition to the administrative data sets SSA has proposed using, use appropriate Federal databases (e.g., Office of Special Education and Rehabilitative Services, Rehabilitation Services Administration, and Department of Labor); State databases (e.g., State developmental disability agencies and State mental health agencies); data from providers of day treatment, day activity programs, sheltered workshops, and supported employment programs (e.g., data from the Employment Intervention Demonstration Program funded by the Center for Mental Health Services); and existing research studies in order to identify and gather information from and about members of the four groups. In addition, the Helen Keller National Center has data on 7,000 persons who are deaf and blind, some of whom are seeking employment.

Roundtable Recommendation 2: Oversample potential members of these four groups who can be located in the administrative data from Social Security, Office of Special Education and Rehabilitative Services, Rehabilitation Services Administration, Medicaid, the Department of Labor, and/or other Federal sources.

* Outcomes of Interest

Roundtable Recommendation 3: Track basic employment outcomes (jobs, wages, hours, choice, etc.) for members of the four groups once identified.

Roundtable Recommendation 4: Gather information about access to and use of the Ticket, with particular attention to whether nonparticipation is voluntary or involuntary.

Roundtable Recommendation 5: Conduct or commission qualitative research, including interviews and focus groups, to gather more extensive information about participation, economic and other benefits, and ways to attain improved incentives.

Roundtable Recommendation 6: Analyze the data collected related to patterns of outcomes, cost/benefit, participation, and modifications of incentives for members of these four groups compared with others making use of the ticket.

* Maximizing Outcomes

Roundtable Recommendation 7: The Social Security Administration should ensure that studies of these four groups include attention to the issue of the "mix" of funding, government programs, and other incentives and disincentives that affect the employment of people with disabilities. These studies should include analysis of how various funding streams can be used together to enhance incentives to Employment Networks and providers and result in employment for people in the four groups.

* Successful Efforts to Employ People With Significant Disabilities in Community Employment at Minimum Wage Levels or Higher

Roundtable Recommendation 8: The Social Security Administration should study the successes of supported employment programs, Rehabilitation Services Administration Choice projects, and other demonstration projects of the past decade for members of these four groups.

* Other Methods to Identify Members of the Four Groups

Roundtable Recommendation 9: The Social Security Administration should consult other databases to identify members of the four groups. Such databases should include other existing national samples as well as State databases for persons with developmental disabilities, persons with mental illness, persons with deafness and blindness, persons with brain injuries, and persons with other disabilities.

* Individualized Milestone Payments

Roundtable Recommendation 10: The Social Security Administration should study the current and recent experiences of States that have begun using results-based funding or some form of payment for individualized milestones toward employment.

Roundtable Recommendation 11: The Social Security Administration should conduct or commission cost/benefit analyses and create demonstration projects on modifying the incentives to Employment Networks and providers of services, showing how members of the four groups can benefit from the Ticket and from employment that partially reduces benefits.

* Various and Diverse Populations

Roundtable Recommendation 12: The Social Security Administration should ensure that the data collected include attention to national demographics such as rural and urban settings, minority representation, and socioeconomic conditions across the country.

* Including Consumers, Family Members, and/or Their Representatives in the Study Design and Implementation

Roundtable Recommendation 13: Given the impact of this and other studies the Office of Policy conducts on the lives of people with disabilities and their families, the Office of Policy should develop a policy and practice for incorporating the input and experiences of consumers, their families, and/or their representatives as it develops new research designs, including the Adequacy of Incentives Study.

* Including Employment Networks in the Study Design and Implementation

Roundtable Recommendation 14: The Social Security Administration should gather data related to the costs to Employment Networks and providers of services and the timeframes for providing access to the Ticket and employment for members of these four groups.

Roundtable Recommendation 15: The Social Security Administration should study the relationship between perceived disincentives and actual incentives for Employment Networks and providers of services, including incentives for small providers of services.

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Appendix E: $1 for $2 Advice Report

Executive Summary

In this report, the Ticket to Work and Work Incentives Advisory Panel (the Panel) provides advice to the Commissioner of Social Security on the most effective designs for demonstrations and other research associated with a proposal for a $1 for $2 benefit offset under the Social Security Disability Insurance (SSDI) program. The $1 for $2 benefit offset is intended to eliminate the "cash cliff" associated with the SSDI program, thereby encouraging work and providing savings to the Trust Fund. A demonstration is authorized in Section 302 of the Ticket to Work and Work Incentives Improvement Act of 1999 (the Ticket Act). The Ticket Act requires the Commissioner to conduct demonstration projects and compile other data to evaluate the $1 for $2 proposal. It also requires the Commissioner to take into account the advice of the Panel (Title III, Section 302 (b) (1)).

This Advice Report is based on relevant documents and testimony, including Social Security Administration (SSA) reports considering SSA's draft evaluation plan for the $1 for $2 Program. In addition, this Report is based upon an Experts Roundtable held in Washington, D.C. on November 16, 2001, as well as public comments made before and after the Roundtable. The Panel gratefully acknowledges the expert advice of Robert Moffitt, Ph.D., who drafted earlier versions of this report.

This report discusses both demonstration methodologies and nondemonstration methodologies. By demonstration methodology, we mean a methodology that uses random assignment to place current beneficiaries into treatment and control groups and measures the effects of the Program by comparing the outcomes for individuals in the groups. By nondemonstration methodology we mean a methodology that involves a particular data set that is available or can be gathered, together with a statistical methodology that uses the data set to generate estimates.

Recommendations

Panel Recommendation 1: $1 For $2 Demonstration for Current Beneficiaries

The Panel endorses the intent of SSA, consistent with the Ticket Act, to use a demonstration methodology to evaluate the effect of a $1 for $2 benefit offset in encouraging current beneficiaries to earn more and exit the SSDI program, as well as to evaluate associated outcomes and budgetary costs.

Panel Recommendation 2: Employment Supports

The Panel recommends that the following employment supports be in effect for both the treatment and control groups throughout the duration of the demonstration:

  • Access to local community-based benefits planning services (or their reasonable equivalent).
  • Access to local community-based protection and advocacy services (or their reasonable equivalent).
  • Access to responsive local work incentive specialists (or their reasonable equivalent) within SSA.
  • Access to ongoing, understandable information on the treatment and its interaction with other programs and services administered by SSA.

Panel Recommendation 3: Disregard Level for the $1 for $2 Current Beneficiaries Demonstration

The Panel recommends that the indexed Substantial Gainful Activity (SGA) amount be used as the disregard, consistent with the principle that beneficiaries should be held harmless relative to the current SSDI program. The Panel encourages SSA to pursue options to encourage work and reduce costs consistent with this principle.

Panel Recommendation 4: Sample Size for the Exit and Work Incentives Demonstration

The Panel endorses the proposal by SSA to use 5,000 individuals in each treatment group and in each control group for the demonstration.

Panel Recommendation 5: Accounting Period

The panel recommends a monthly accounting period for the demonstration projects. To simplify accounting for both beneficiaries and SSA, the accounting system should be consistent with that used for the Supplementary Security Income (SSI) program.

Panel Recommendation 6: Deferring the Induced Entry Evaluation

The Panel recommends that SSA undertake the current beneficiary demonstration on the $1 for $2 benefit offset, deferring the induced entry evaluation. This alternative was raised in the Tuma report dated November 5, 2001. After lengthy deliberation with experts and beneficiaries, the Panel thinks this approach is cautious and cost effective. The Panel further recommends that SSA request a technical amendment from Congress to permit a delay in the evaluation of induced entry.

Panel Recommendation 7: Induced Entry Evaluation Proposals

The Panel recommends that, when SSA decides to undertake the evaluation of induced entry, it should seek at least five independent designs from outside experts and organizations, each proposing the most cost-effective methodology (either demonstration or nondemonstration) to measure induced entry.

SSA should report the designs proposed to the Panel so that the Panel can compare them to SSA's draft recommendation involving the National Survey of Health and Activity (NSHA) as the data set and a structured statistical modeling approach to translate the data into induced entry estimates. This comparison will permit the Panel to make a more informed judgment on nondemonstration and demonstration evaluation alternatives in providing its advice to SSA. Further, the Panel recommends that SSA seek a technical amendment from Congress to permit SSA to implement either a demonstration methodology or a nondemonstration methodology in studying induced entry associated with the $1 for $2 benefit offset.

Panel Recommendation 8: Other Studies, Including Studies of the Determinants of Return to Work

The Panel recommends that SSA's Office of Policy (OP) should follow and report on parallel research projects across the country that inform on determinants of return to work and related issues, and incorporate relevant findings into SSA research on the $1 for $2 benefit offset or on topics related to Section 302 in general.

* Contact Information

Ticket to Work and Work Incentives Advisory Panel

Social Security Administration
400 Virginia Avenue, SW, Suite 700
Washington, DC 20024
Phone at (202) 358-6430
Fax at (202) 358-6440
E-mail to TWWIIAPanel@ssa.gov
Website: www.socialsecurity.gov/work/panel

* Advisory Panel Staff

Marie Parker Strahan, Executive Director
Tamara Bibb Allen
Shirletta Banks
Kristen M. Breland
Lisa D. Ekman
Mildred D. Owens
Gordon Richmond
Bernard Wixon

Anyone requiring materials in alternative formats, information regarding this document or the Ticket to Work and Work Incentives Advisory Panel should contact the Panel staff. Records are kept of all Panel proceedings and are available for public inspection under the Federal Advisory Committee Act by appointment at the Panel office.



Social Security Administration
Ticket to Work and Work Incentives Advisory Panel
SSA Pub. No. 63-011
August, 2002

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