TICKET 101 OVERVIEW 1 1 November, 2010 Hosted/Facilitated by: Miranda Kennedy Presented by Kevin Nickerson, NDI Technical Assistance Team Members

 DEI Projects at the state level and/or local level participating LWIBs are required to become Employment Networks under Social Security Administration’s Ticket to Work Program.  Training and Technical Assistance to DEI Projects in attaining Employment Network status and implementing effective EN operations is provided under U.S. DOLETA contract with NDI Consulting, Inc. and the National Disability Institute (NDI).  Evaluation of the impact of the DEI Projects implementation and outcomes as Employment Network will be provided under U.S. DOL ODEP contract with Social Dynamics. 2 2

Ticket 101 Learning Objectives  What is the Ticket to Work Program  Ticket to Work Basics  Review of 2008 Changes to the Ticket to Work Program rules  EN models and partnerships  What’s my next step? How do we apply? 3

 Consistent with Challenge Mission  Established as an EN in 2001  First Ticket assigned in NYS to private EN  Knowledge of SSA benefits increased Ticket holder confidence in services and assisted with referrals to program  Increasing Ticket assignments now due to changes in regulations which occurred in The Challenge EN Experience

 2 nd EN in Nation to achieve 60 th Outcome payment (achieved March, 2007)  Our second 60 th Outcome measure occurred in May, 2009  Our third 60 th Outcome measure occurred in July, 2010

 A Social Security Administration Program  Established through the signing of legislation in December 1999, The Ticket to Work and Work Incentives Improvement Act  Provides payments to participating Employment Networks for assisting Social Security beneficiary’s in becoming more self-sufficient through employment

 A program designed to assist Social Security beneficiaries in the return to work through the provision of employment services from public and private providers  Allows Social Security beneficiary’s to receive a Ticket to Work which may be assigned to a participating Employment Network for assistance in achieving their desired vocational goal  Expands the universe of choices people with disabilities have in getting assistance in the return to work through participating Employment Networks

 The goal:  A Shift: Self-sufficiency. Decrease the Ticket Holder’s dependence on their cash benefits by increasing their work effort to substantial gainful activity level and beyond. Customer Service. A shift in how Rehabilitation services are offered, increasing beneficiary choice and customer service

Choice  EN’s offer another level of choice to Social Security beneficiaries  Increased need for exemplary Customer Service in providing rehabilitation services is important, especially as more EN providers become available State VR ITA’s SBA PASS MBI One Stop EN WIPA

In 2008, SSA made several improvements to the Ticket to Work employment program to increase participation. Today you will learn about these improvements and…….  Ticket to Work program basics  New payment structure  How Partnership Plus works  Next Steps to becoming an Employment Network 12

The Ticket to Work and Work Incentives Improvement Act was passed in 1999 and provided benefits to SSA Disability beneficiaries & EN’s including:  Yearly cost of living increases for Ticket Payments to EN’s  Two new work incentives ◦ Extended Medicare benefits ◦ Expedited Reinstatement of Benefits  Medicaid Buy-In Programs  Work Incentive Planning and Assistance projects  Ticket to Work and Self-Sufficiency employment program 13

 Creates an opportunity for any entity (other than a Federal Department) to become a Ticket to Work ‘Employment Network’ and begin receiving payments for supporting ‘Ticket Holders’ as they work at increasing their earning capacity. ◦ Ticket Holders are qualified Social Security Disability Beneficiaries ages 18 to 64, receiving Title XVI and/or Title II benefits (SSI or SSDI) ◦ Now both Medical Improvement Expected (MIE) and Medical Improvement Not Expected (MINE) groups are eligible due to changes in TtW regulations from 2008  Offers long-term funding to ensure Ticket Holders receive ongoing return to work support.  Increases choice for Ticket Holders and Employment Networks allowing both to choose who they work with under the program. 14

Ticket to Work – Provider basics  This is a voluntary program (you do not have to participate, although DEI projects have committed to becoming EN’s as a part of this grant)  Provides additional monetary support to approved providers (Employment Networks) who assist Social Security beneficiaries with disabilities in obtaining and maintaining employment 15

Ticket to Work – Ticket Holder basics  This is a voluntary program - as a Ticket Holder, I do not have to participate.  Provides Ticket Holders with CHOICE – as a Ticket Holder, I decide who I assign my Ticket to based upon who I feel can best provide the services I need.  Ensures continued employment support – as a Ticket Holder, I know you will continue to provide me support beyond the time that State VR or Medicaid funding permits in some cases.  Actively participating in the Ticket to Work program suspends a Ticket Holder’s medical Continuing Disability Review – as a Ticket Holder, I can return to work without fear that I will medically improve before I am gainfully employed. 16

EN & Ticket Holder Connect EN & Ticket Holder discuss needs/services & Ticket Holder gets benefits planning. IWP is sent to Maximus – once approved, Ticket is assigned to EN (7 days +/-) IWP is sent to Maximus – once approved, Ticket is assigned to EN (7 days +/-) Ticket Holder Goes to Work & EN Collects Evidence of Earnings EN continues to provides services & supports in accordance with Ticket Holder’s IWP EN submits Payment Request to Maximus & receives Ticket Payment (30 days +/-) EN submits Payment Request to Maximus & receives Ticket Payment (30 days +/-) EN provides agreed upon services and supports EN & Ticket Holder Negotiate the Individual Work Plan (IWP) 17

Ticket Funding & Other funding sources  Training and Employment Notice No clarifies that Ticket funding is an additional revenue source for One-Stop delivery systems and is not considered program income and WILL NOT replace existing funding sources (i.e. funding is in addition to current funding sources, to be used how you see fit)  Braiding Medicaid funded services and Ticket to Work funds is not “double dipping”  The Centers for Medicare & Medicaid Services (CMS) clarified this recently in a State Medicaid Director Letter (SMD #10-002), See:  Choose Work Quarterly Newsletter of the Ticket to Work Program, Summer 2010 issue also reviews this concept:

Improvements to the Ticket-to- Work Program 19

2008 Improvements of Importance  Ticket payments have increased and allow for payments before the Ticket Holder works at SGA level  Ticket payment structure encourages the use of available work incentives with new Phase 2 payment structure  Tickets are now available to all beneficiaries with disabilities, ages 18 through 64 (with a few exceptions)  Timely progress reviews are now one time per year  Partnership with State Vocational Rehabilitation agencies are more clearly defined, and now called Partnership Plus 20

Type Ticket Holder Earnings EN Payment for SSDI EN Payment for SSI OutcomeEarnings sufficient for “zero” cash benefits status $711/mo. for up to 36 months $409/mo. for up to 60 months Total Possible Outcome Payments $25,596$24, Rates Outcome Payment System

TypeTicket Holder EarningsEN Payment for SSDI EN Payment for SSI Phase 1 Milestone 1$720/mo for 1 month (or $360 within a two week period)* $1,275 Milestone 2$720/mo for 3 months within 6 months (cumulative) $1,275 Milestone 3$720/mo for 6 months within 12 months (cumulative) $1,275 Milestone 4$720/mo for 9 months within 18 months (cumulative) $1,275 Total Potential Phase I Milestone Payments$5, Rates Milestone-Outcome Payment System: Phase 1 Milestones 23

 There are reasons some, or all of, Phase 1 payments may not be available to an EN: ◦ Recent Work Activity ◦ State VR history with Ticket Holder Understanding Phase 1 Payments

Recent Work Rule  Work at or above applicable Trial Work level earnings ($720 in 2010) within 18 months “prior to Ticket assignment” can impact EN access to Phase 1 Milestone payments  Does not apply to Tickets assigned prior to July 21, 2008  MAXIMUS has created a tool to explore a beneficiary recent work history >Check out the 18-Month Prior Earnings Tool at

Partnership Plus  VR Cost Reimbursement payments and EN Phase 2 Milestone and Outcome payments both possible for same beneficiary ◦ SSA will pay for sequential, but not concurrent, services  When VR chooses to serve a beneficiary under Cost Reimbursement, beneficiary’s Ticket is -- Not assigned to VR, and -- Cannot be assigned to another EN while VR case is open  New “in-use SVR” status extends Continuing Disability Review (CDR) protection to beneficiary while receiving VR services under Cost Reimbursement 26

Partnership Plus: VR Case Closure  Beneficiary can assign Ticket to an EN after VR case closure  Phase 1 Milestones not available to EN if VR closed case with beneficiary employed -- VR provided services leading to initial efforts at self-supporting employment -- SSA can pay EN for Phase 2 Milestones & Outcomes achieved after Ticket assignment 27

Type Ticket Holder Earnings EN Payment for SSDI EN Payment for SSI Phase 2Gross > SGA ($1000/non-blind; $1,640 for blind) $382/mo. (up to 11 mos.) $220/mo. (up to 18 mos.) Total Phase 2 Payments $4,202$3,960 Total Potential Ticket Payments Phases 1 and 2 $9,302$9, Rates Milestone-Outcome Payment System: Phase 2 Payments 28

Type Ticket Holder Earnings EN Payment for SSDI EN Payment for SSI Outcome PhaseNet > SGA ($1000/non-blind; $1,640 /blind) AND 0 cash benefit $382/mo. for up to 36 months $220/mo. for up to 60 months Total Outcome Phase Payments $13,752$13,200 Total Potential Ticket Payments $23,054$22, Rates 29 Milestone-Outcome Payment System: Outcome Payments

 The overall goal of the Ticket program continues to be self- sufficiency  Part-time work can increase an individuals self-sufficiency, and in some cases, reduce benefits reliance  Example: Joe works 20 hours/week and makes $8.50/hour, monthly average wage=$736  This example would qualify your EN for Milestone payments  NOTE: Your IWP needs to be developed showing the Ticket Holder will achieve at least TWL earnings in order to be assigned by Maximus, however, the overall goal is to assist the individual in achieving greater levels of self-sufficiency, and strive for SGA level earnings Will becoming an EN help me with individuals that can only work part-time?

Milestone Reconciliation Payment  Occurs when Beneficiary moves quickly into the Outcome Payment Period  Includes all Milestones “available” at time of first Ticket assignment that remain “unpaid” due to the start of the Outcome payment period  Reconciliation payment made when 12th Outcome payment is achieved 31

Requesting Ticket Payments Three options for requesting payment: 1. Evidentiary Payment Request (EPR) -- Requires primary evidence of earnings 2. Certification Payment Request (CPR) -- Uses secondary evidence of earnings 3. Auto Pay -- SSA gathers evidence of earnings starting at Outcome payment #13 (less work for EN, takes longer to get paid) 32

Benefits of becoming an EN include: 1. Increase your bottom line - Get paid for the work you are already doing 2. Ticket payments are your own to use as you wish 3. Generous funding stream – $23, 054 (SSDI) and $22,260 (SSI) per successful beneficiary who achieves all payments 33

Q & A To ask a question/make a comment please click on the “raised hand icon” OR submit it via the Q&A panel, both are located on the right hand toolbar 34

 Funds through the Ticket program are flexible to use as you wish, however, so is the Business Model you choose to develop for your Employment Network  The following are examples of strategies found in various locations across the U.S.

This example shows a collaborative web allowing for referral and mentoring efforts amongst separate EN’s Ideally, State Vocational Rehabilitation provides information about all EN options when closing a case Each EN completes a separate application to operate as an independent EN Local Level Strategy

State Vocational Rehabilitation Agency Partnership Plus Advantages: Sharing of information & resources, staffing and community outreach Specific Advantage of collaboration with One- Stop: Access to database of potential Ticket holders who wish to return to work Collaborative Agreement Strategy

Consortium Strategy STATE VR Partnership Plus 20% of payments for administrative functions (i.e. billing / marketing) EN of Record Providers of Employment Services 80% of payments go to providers under local agreement

Policy / Outreach / Reporting EN of Record – State level – operating under one EIN State Vocational Rehabilitation Agency Partnership Plus Possible contractor for Ticket Administration Provide direct service to Ticket holders / Follow-up supports / data collection

Becoming an Employment Network Get the EN RFP at  Download and complete on your computer  Cover letter provides information on how to contact SSA  Advised not to mail your RFP, send by:   Fax number:

RFP Basic Components  Must have an Employer Identification Number (EIN), also known as the Tax ID #  Must have general business or professional liability insurance in effect (minimum of $500,000 per occurrence)  Must have a DUNS number (contact Dun & Bradstreet at or apply online at  Must register your DUNS number through the Central Contractor Registration (CCR) process (  Must complete forms for simple security clearance for all staff working with beneficiaries or handling personally identifying information of beneficiaries 42

CESSI, the Program Manager for Recruitment and Outreach, will assist you in completing the RFP….  Contact Emily Malsch, National EN Specialist: One-Stops, CESSI, the Program Manager for Recruitment and Outreach, at or (703) x203  REGISTER for the EN Application Walk-through Teleconference for DEI Grantees on November 17 th from 3pm to 4:30pm EST: )  documentation requirements  review forms  Q & A  Additional help is available through SSA’s Employment Network Contracts Team   Call:

Once you become an Employment Network, MAXIMUS, the Operations Support Manager for the Ticket to Work program will: ◦ Handle the process for assigning & un-assigning Tickets ◦ Maintain the list of approved ENs ◦ Process Ticket payments ◦ Conduct timely progress reviews ◦ Staff an EN Help Desk ◦ Provide training & technical assistance to ENs Visit the MAXIMUS w ebsite at 44

Ticket to Work Program Resources: Visit SSA’s Work Site at: Visit CESSI’s web site at: Visit the MAXIMUS web site at: or call: ENVR (3687) 45

Kevin Nickerson Program Associate NDI Technical Assistance Team 46