Implications for Public VR Agencies

“To Ticket or Not to Ticket”

A Presentation By:
Amy Porter, CT VR
Peter Baird, VT VR


TICKET TO WORK
Part of the Ticket to Work and Work Incentive Improvement Act of 1999 (TWWIIA), signed by President Clinton in Dec 1999


What are the Basics?
Title I: 
Ticket to Work & Self-Sufficiency

Title II: 
Expansion of Health Care

Title III: 
Demonstration Projects/Studies


Goals of Ticket to Work and Work Incentive Improvement Act Legislation
Lower the barriers to employment for people who receive SSI and SSDI.
Encourage beneficiaries to access vocational services to assist them return to work. 


Goals of Ticket to Work (cont)

Provide more vocational options for beneficiaries.
Create a comprehensive set of supports for employed people with disabilities.



POLITICAL CONSIDERATIONS
The impact on resources and reimbursement revenue on VR agency
Outreach/Marketing
Choice of partnerships
Ensuring informed consumer choice 
Cooperation with advocacy groups



Outreach
Identification of Ticket Holders
Relationships with Other ENs
Marketing
Training of Agency and Partner Staff
Competitive Edge



Title I: Who Gets A Ticket?
13 pilot states
Everyone 18 and over receiving SSI and SSDI except those expected to make a “medical recovery” (Proposed)
Approximately 2.5 million beneficiaries and recipients in pilot states
Will be sent out over several months


Intake
Benefits Screening
Ticket Status
Benefit Status
Assignment of Tickets
Reassignment of Tickets
Systems Changes



What Does Consumer Do With Ticket?
Not required to use Ticket.
If seeking vocational services, can give it to any registered “employment network.” (EN)
Can move Ticket between EN’s



Tickets and Consumers 
Consumer is exempt from continuing disability reviews while using a Ticket (but must make progress towards employment after 2 years- proposed).
Again, the Ticket has no cash value for consumers!



Plan
Benefits Advisement
Ticket Decisions/Informed Choice
Ticket Registration
Outcome vs. Milestone
Decision Makers


What is an Employment Network?
An EN is “an agency or instrumentality of a state or private entity” that assumes responsibility for delivering services to individuals who assign them Tickets.
EN’s are a single provider or an association of providers organized to combine their resources into a single entity. 
May provide services directly or through contracts or other arrangements.
And EN must have qualifications, serve a prescribed area, and must do an individual work plan with each consumer served.



How is EN paid?
No consumer control over payment beyond choice of giving Ticket to EN.
EN must choose one of two systems: Outcome or outcome-milestone.
Outcome payments occur when consumer earns enough that they no longer get a cash benefit from SSA. Payment is equal to 40% of average national payment for SSDI or SSI. Payments can occur for up to 60 non-consecutive months.
Outcome-milestone payments occur at 3 months of work above SGA, and again at 7 months above SGA. Total milestones are less than $1400, and maximum total payments are 85% of straight outcome payments. 
Public VR can additionally choose traditional reimbursement on a case-by-case basis


Agreements- ENs and With VR
VR can be a part of multiple employment networks
EN must have agreement with VR before referral
Program Manager will resolve disputes


Sample EN Agreements
VR-Mental Health Centers
VR-Projects With Industry
VR-One-Stops
VR-Employers
VR-????


Program Manager (Maximus)
SSA will distribute Tickets
Maximus will recruit ENs, and monitor performance of ENs.
Maximus will facilitate consumer access to ENs and facilitate movement of Tickets between ENs.
Maximus will resolve disputes and oversee agreements between ENs.
Agreements between ENs and VR agencies should include dispute resolution clause.


Closure
Benefits Management Plan
Long-Term Follow Up
Tracking
Intervention During Post-Employment
Changes in Employment Generally Lead to Changes in Benefit Status. 
Earnings Reporting


What Does this Mean for VR??
Don’t panic (But wake up!!!!)
Change in procedure, not practice
Key Issues: Identification, intake, choice of payment, formation of ENs, no automatic assignment of Ticket



Changing Landscape
Comprehensive Systems
Changes in the System
Cash Benefits and Medical Benefits are de-linked
SSA Changes
Changes in Medical Options
Grant Opportunities


Challenges
Informing Consumers
Educating Providers
Forming Viable ENs
Changing Practice
Systems Changes
Tracking Tickets, Employment
Be Alert for Potential Abuses


Positive Outcomes
Federal Focus on Employment of Persons with Disabilities
Long-Term Follow Up Systems
Partnerships
Comprehensive Work Incentive Systems
Opportunity to Reevaluate our System