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 You are here: Home > Panel Documents > Official Correspondence > Advisory Letter to Acting Commissioner Halter - February 20, 2001


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 during its January. 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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