Ticket to Work Program Expedited Reinstatement of Benefits And Payments to ENs

Pre-Requisite Training: “Expedited Reinstatement of Benefits” 2

Objectives Define Expedited Reinstatement of Benefits (EXR). Describe how to assign a Ticket after an EXR has been requested/approved. Choose to take action against a possible overpayment. 3

What is EXR? The EXR provisions in the Ticket to Work and Work Incentive Improvement Act provides Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) beneficiaries with a critical safety net by reinstating benefits without the beneficiary having to file a new application IF the beneficiary has the same disability. 4

Key Facts about EXR EXR candidate – Work and earnings return to below Substantial Gainful activity (SGA) levels. Resources available through Operations Support Manager (OSM), Certified Work Incentive Coordinator (CWIC) and Social Security field offices. EN is not eligible for outcome payments when work/earnings fall below SGA 5

Progress Check Complete the following sentence by choosing A, B or C. EXR is a work incentive that provides a critical safety net when…. A.The beneficiary has work and earnings that stop at any time. B.The beneficiary successfully returns to work and then his earnings fall below SGA earnings due to disability. C.The beneficiary has used up her Trial Work Period. 6

Ticket Assignment After EXR When the EN checks assignability it may show that the Ticket is not assignable. The EN should: Ask the Ticket Holder if he/she has an approved EXR claim. Ask the Ticket Holder if they are in current pay status (receiving cash benefits) Interactive Voice Response System: Select option 1 for Ticket Assignability 7

Ticket Assignment After EXR How does an EN assign a Ticket after a beneficiary has been notified by Social Security that his/her EXR claims has been approved? Assignment only after an approved EXR A new period of disability with a new Disability Date of Onset (DDO) is established New Ticket and IWP created Indicate ‘current pay status’ and ‘may be EXR case’ 8

Ticket Assignment After EXR This process will allow: The OSM to verify EXR and assign the ticket. Complete the IWP, keep on file EN will receive Ticket assignment confirmation letter Date on the IWP should be the same as the date on the Ticket Assignment Request 9

How Does EXR Affect Ticket Payments? Outcome payments or Auto Pay Once provisional benefits begin, payments to the EN will stop. Beneficiary returns to current pay status under a new Ticket. 10

New Ticket for Approved EXR Case The EN with the new Ticket assignment All available payments available Exclusions under the prior Ticket do NOT apply New exclusions under the new Ticket DO apply: o Lookback earnings between the new DDO and before the Ticket Assignment Date o Vocational Rehabilitation services with a successful case closure o Terminated Ticket with VR successful case closure – Phase 1 milestones are not excluded. 11

Case Study – Joe TicketHolder SSDI recipient Working for ABC Warehouse as a forklift operator Original injury was knee damage His EN has been paid for outcome 30 Reinjured his knees and can not work Filed for provisional benefits under EXR EXR case was approved New DDO has been established Provisional Benefits have begun 12

Progress Check for Case Study What are the EN’s next steps to take when working with Joe to help him meet his goals of self-sufficiency? 1. Confirm that Joe (is choosing to return to work) wants to work and requires services of an EN under the Ticket to Work Program. 13

Progress Check for Case Study What are the EN’s next steps to take when working with Joe to help him meet his goals of self-sufficiency? 2. Complete a new IWP 14

Progress Check for Case Study What are the EN’s next steps to take when working with Joe to help him meet his goals of self-sufficiency? 3. Submit a Ticket Assignment Request via fax or mail, or the new IWP on the Portal 15

Progress Check for Case Study What are the EN’s next steps to take when working with Joe to help him meet his goals of self-sufficiency? 4. Indicate on the request or IWP that this is an EXR claim and beneficiary is in current pay status 16

Case Study – Joe TicketHolder Date of Disability Onset – June 17, 2012 IWP signed on December 9, 2012 New Ticket created for Joe EN provided services Joe returned to work immediately earning a little above Trial Work level. 17

Case Study Progress Check What payments could his EN potentially receive in the future? A.All phases and milestones B.Phase II and outcome payments C.Outcome payments only 18

Case Study – Jane TicketHolder Jane TicketHolder SSDI recipient Earning $1235 gross wages monthly No IRWEs Central Resources Inc. has received 10 outcome payments. 19

Case Study Continued Jane reinjured her back Three months of bed rest Applied for EXR Did not notify her EN Payment request diarized Log into the Secure Provider Portal to access your EN Payment Status Report 20

What are the next steps that Central Resources Inc. should do regarding their payment? 1.Confirm that there is an EXR case pending. 2.Develop a new IWP with Jane. 3.Submit a Ticket Assignment Request and indicate current pay status and EXR claim. 21

What to Expect Next Ticket Assignment request with EXR note Fourteen-day wait Letter and response o Confirmation letter may indicate a manual Ticket or Ticket assignment. o Denied assignment for other reasons. Program Integrity Hotline:

Overpayment Caution For many reasons, ENs must expect that beneficiaries who return to work, or enter the work force for the first time, may be assessed an overpayment. Preparing beneficiaries for this eventuality will go far in encouraging their work effort. “An overpayment is the total amount an individual received for any period which exceeds the total amount which should have been paid for that period” 23

Overpayment Caution Using Social Security’s telephone reporting, available to SSI recipients only, to report wages may minimize overpayments. Presently all SSDI must report earned income/wages to their local field office. For options on overpayment repayment and appeal and waiver rights, see Social Security’s publication at

Progress Check At what point is it possible for a beneficiary to receive an overpayment? A.When a beneficiary is receiving cash benefits and returns to work, i.e. receiving a paycheck and a benefits check at the same time. B.When a beneficiary is receiving cash benefits and enters the workforce for the first time. C.Both A and B 25

Questions? 26