2/7/02

Note:  the following information is based on a 1/31/02 RSA Region V conference call with SSA and Maximus staff, and follow-up phone calls to SSA.  SSA is compiling information and will be disseminating it to further clarify process and answer questions.  Until this is done, the purpose of the following is to provide a guide to ticket assignment and payment system options.  If you have reliable information to add to this, please e-mail vickie.vanderkar@rsc.state.oh.us.

Payment System and Ticket Assignment

Summary:  On a case-by-case basis, state VRAs have a choice between cost reimbursement and ticket (EN) payment when serving beneficiaries 1) who assign their tickets to the VRA by signing the SSA ticket assignment form 1365, or 2) who are new to the VRA after receiving their tickets but have not signed the form 1365.  Choice of payment system is limited to cost reimbursement for serving beneficiaries 1) who have not been issued tickets, or 2) who are already being served by the VRA when they receive tickets and who have not signed form 1365.

TICKET

Ticket assignment to the VRA is the general rule of thumb.  A beneficiary’s ticket must be assigned to a VRA for the VRA to seek reimbursement or ticket payment for serving the beneficiary.  The beneficiary first must have a ticket available for assignment.  There must be no previous EN payment on the beneficiary’s ticket.  The beneficiary’s signature is required on the SSA ticket assignment form 1365.

There are two exceptions to this general rule of ticket assignment in which a VRA may still seek reimbursement or ticket payment when the beneficiary has not signed form 1365:

1)     for a beneficiary already being served by the VRA at the time the beneficiary receives their ticket -- the VRA can seek reimbursement, as long as the beneficiary does not assign their ticket to an EN before the VRA can submit a claim for reimbursement

2)     for a beneficiary new to the VRA after the beneficiary receives a ticket -- the VRA may obtain ticket assignment by submitting a photocopy of the signed IPE and the partially completed SSA form 1365.  Form 1365 will not have the beneficiary’s signature but will have other important information, e.g. the VRA’s selected payment system—cost reimbursement or ticket (EN) payment.  SSA expects that this will be a rare situation, and that VRAs will be able to obtain most, if not all, needed beneficiary signatures on the 1365.  (The rationale for this exception is that by signing the IPE, the beneficiary is essentially agreeing to assign their ticket to the VRA, and the partial 1365 completes the ticket assignment by providing other information, e.g. type of payment selected.)

Implication for VRA:

Ticket assignment is critical to avoid missed reimbursement opportunities and to avoid situations requiring dispute resolution relating to ticket assignment and payment.  VRAs should pursue ticket assignment with all ticket holders. 

Note:  The following was not discussed during the 1/31/02 Region V RSA conference call on ticket to work, although it was confirmed via phone call to SSA.

NO TICKET

Beneficiary was not issued a ticket

Final Regs 411.355(c)

The State VR agency may seek payment only under its elected EN payment system whenever it serves as an EN.  When serving a beneficiary who was not issued a ticket, the State VR agency may seek payment only under the cost reimbursement payment system.  

Submission of claims

For ticket (EN) payments

VRAs submit claims for ticket payments to Maximus.

For traditional reimbursement

VRAs submit claims for reimbursement to SSA OESP Claims Processing Unit in Baltimore.  (This unit has access to database relating to ticket assignment.)