**Please Note: This is not the official Advice Report to the
Commissioner of the Social Security Administration on the Notice of
Proposed Rulemaking for the Ticket to Work and Self Sufficiency Program.
This is a duplicate version that is similar to the original, but may
have small differences. In instances where differences are found, the
original, hard-copy of the document should be used.**

**Ticket to Work and Work Incentives Advisory Panel**

**Advice Report to the Commissioner Of Social Security Administration on
the Notice of Proposed Rulemaking for the Ticket to Work and Self
Sufficiency Program**

**July 26, 2001**

**Message from the Panel**

It is the Panel's distinct honor to transmit to the Commissioner of
Social Security its Advice Report on the Notice of Proposed Rulemaking
(NPRM), published in the Federal Register on December 28, 2000, for the
Ticket to Work and Self-Sufficiency Program. The Ticket to Work and Work
Incentives Improvement Act of 1999 (Public Law 106-170) authorizes the
Ticket program to expand the universe of service providers available to
beneficiaries with disabilities. Social Security beneficiaries who are
seeking employment services, vocational rehabilitation services, and
other support services to assist them in obtaining, regaining, and
maintaining gainful employment can use a ticket and other work
incentives to secure work.

The recommendations in this report represent the Panel's informed
deliberations after publication of a Preliminary Advice Report on
February 21, 2001, public meetings and regional meetings**,** expert
input from the field, briefings from Agency officials, and further
research and analysis by the Panel. The Panel wishes to thank the Agency
staff for their cooperation and support of the Panel's efforts and to
acknowledge the Agency for its progress on implementation.

It is the Panel's duty to advise and assist the Commissioner in the
successful implementation of the Ticket program so that individuals with
disabilities nationwide can secure self-supporting employment. The Panel
believes this report is an important step toward successful
implementation.

**Table of Contents**

Table of Contents 3

Executive Summary and Recommendations 4

NPRM Issues, Public Input, Discussion and Recommendations 10

Introduction

NPRM Issue Areas

> Ticket to Work and Beneficiary Use
>
> Employment Network Requirements and Qualifications
>
> Dispute Resolution and Mediation
>
> Employment Network Payment
>
> Related Program Issues

Appendices 36

A.  Schedule of Panel Meetings and Other Activities

B.  List of Commenters

######### Letter to Commissioner Halter concerning Agency plans for implementation and first year roll-out

######### Response from the Office of the Actuary on Cost Implications of Proposals 

C.  Two EN Milestone Payment Models for SSI

######### Summary of Critical Issues Raised in Public Comments 

D.  Information in Response to Panel's Questions on Plan for and Impact
    of Ticket Rollout

E.  How to Contact the Panel

The Ticket to Work and Work Incentives Advisory Panel

**EXECUTIVE SUMMARY AND RECOMMENDATIONS**

This Advice Report represents the further thinking, public input,
deliberations, analysis and recommendations of the Ticket to Work and
Work Incentives Advisory Panel (the Panel). The Advice Report builds on
the advice and deliberations included in the Preliminary Advice Report
(PAR) sent to the Commissioner of the Social Security Administration on
the proposed rules for the Ticket to Work and Self-Sufficiency Program
on February 21, 2001. The proposed rules appeared in a Notice of
Proposed Rulemaking (NPRM) published in the Federal Register on December
28, 2000. The Panel collected additional information, did further
analysis, solicited additional public comment and further deliberated in
order to develop and submit this Advice Report on the NPRM to the
Commissioner.

Public Law 106-170, The Ticket to Work and Work Incentives Improvement
Act of 1999, established programs that are designed to provide SSA
beneficiaries with disabilities with a broader array of providers and
improved access to employment services and supports, vocational
rehabilitation services and other support services. The Law also
established the Ticket to Work and Work Incentives Advisory Panel, whose
duty is to advise the Commissioner of Social Security and the President
and Congress on issues related to work incentive programs, planning and
assistance for individuals with disabilities and the Ticket to Work and
Self-Sufficiency Program established under the Act.

The Panel is composed of twelve individuals, four of whom were appointed
by the President, four by the Senate and four by the House of
Representatives. The appointees represent a cross-section of individuals
with experience and expert knowledge as beneficiaries, consumer
advocates, providers, researchers, legal advocates, employers and
individuals in the fields of employment services, vocational
rehabilitation and other related support services. The majority of the
members are individuals with disabilities or their representatives.
There are current or former disability beneficiaries of Social Security
on the Panel as well.

A summary of the Panel's twenty**-**four final recommendations to the
Commissioner of SSA on the proposed rules precedes the full report. They
are separated into four categories. The numbering and sequence of the
recommendations do not reflect the order of importance.

#### SUMMARY OF PANEL RECOMMENDATIONS ON THE PROPOSED RULES

### [TICKET TO WORK AND BENEFICIARY USE]{.underline}

### 

### Recommendation 1: All SSI and SSDI adult disability beneficiaries, including those with a Medical Improvement Expected (MIE) designation, should be eligible to participate in the Ticket program.

**Recommendation 2:** Sixteen (16) and seventeen (17) year-old
beneficiaries, including those with an MIE designation, should be
eligible to participate in the Ticket program.

**Recommendation 3:** Eighteen (18) year-old beneficiaries who
participate in the Ticket program should receive the same protection
from redeterminations as other ticket users receive against CDR's.

**Recommendation 4:** SSA should conduct a cost-benefit analysis on the
feasibility of a beneficiary receiving more than one ticket within a
period of disability and/or a period of eligibility. The Agency should
assess the potential cost impact of beneficiaries using more than one
ticket in the Agency's overall evaluation report due to Congress.

**[EMPLOYMENT NETWORK REQUIREMENTS AND QUALIFICATIONS]{.underline}**

**Recommendation 5:** An employment network (EN) should be required to
retain staff that are otherwise qualified based on education or direct
services experience, such as employees with a college degree in a
related field, including but not limited to vocational counseling,
education, human resources, human relations, social work, teaching, or
psychology or employees with equivalent experience. SSA should not
require licensure and/or certification that would exclude employers or
other types of providers qualified to work with people with disabilities
such as those who offer non-traditional supports that result in
employment. The key criterion should be whether the entity is capable of
successfully providing the service agreed to by the EN and the
beneficiary. SSA should delete Section 411.315(c). The State agency
certification process should not be used to limit who can participate as
an EN in the Ticket program.

**Recommendation 6:** Delete Section 411.325(g) and Section 411.325(h)
from the list of EN reporting and collection requirements. Section
411.325(g) currently requires "...among other things, submitting to the
Program Manager, on an annual basis, a financial report that shows the
percentage of the employment network's budget that was spent on serving
beneficiaries with tickets\..."

**Recommendation 7:** The Panel recommends that timely progress be
defined by the terms and conditions of the IWP, as agreed to by the
beneficiary and the EN. The reporting mechanism should be the annual
report in Section 411.325(e).

**Recommendation 8:** SSA should permit other individualized service
delivery plans to be used as substitutes to the IWP provided they meet
the minimum requirements detailed in the statute.

Recommendation 9: **SSA should re-write Section 411.385 to clarify that
an SSA beneficiary, whether a youth or adult, with a ticket who applies
for or is** **receiving State Vocational Rehabilitation services has a
choice in deciding whether to assign his/her ticket to the State VR
agency, to assign it to another EN, or not to assign it at all. An
18-year old who is already receiving VR services and who then receives a
ticket from SSA, should not be required to deposit the ticket with the
State VR system.**

###### DISPUTE RESOLUTION 

**Recommendation 10:** All beneficiaries should have access to
Protection and Advocacy (P&A) services.

**Recommendation 11:** Mediation should be available as an avenue for
resolving disputes but it should not be mandatory. It should be an
option available to the parties to the dispute, after the Program
Manager has considered the matter for resolution.

-   All parties must agree to enter into mediation.

-   Mediation should be external to the Social Security Administration
    and should not be provided or paid for by Protection and Advocacy
    agencies. Participation in the mediation process should not bar a
    party's access to further appeals.

-   Because mediation is a more efficient and cost-effective way to
    resolve disputes, the Social Security Administration should set
    aside additional funds to support the use of mediation for all
    parties.

-   The Social Security Administration should look at other successful
    mediation program models such as those established at the Equal
    Opportunity Employment Commission (EEOC) and the Department of
    Justice.

**Recommendation 12:** All decisions by the Social Security
Administration involving disputes between or among all parties should,
at the option of the parties, be subject to external review by either
the Social Security Administration\'s administrative review process
and/or judicial review.

**Recommendation 13:** Information about protection and advocacy
services and how to access them should be available at any time to all
beneficiaries seeking or using SSA or other work incentive programs,
including the ticket. Specifically, a beneficiary should receive a
formal notice of the availability of protection and advocacy services
when he or she is issued a ticket and at the following junctures in the
process:

-   When he or she applies to the employment network for services;

-   At the signing of his or her Individual Work Plan;

-   In the event his or her services are decreased, suspended or
    terminated; or,

-   When he or she files a complaint against the employment network.

**Recommendation 14:** The beneficiary's filing of a complaint with the
Program Manager (PM) against an EN should, with the beneficiary's
consent, trigger a notice to the Protection and Advocacy agency
regarding the dispute to allow for an inquiry by the Protection and
Advocacy agency as to the beneficiary's wish for protection and advocacy
assistance.

**Recommendation 15:** Notices from the EN and the Protection and
Advocacy agency, the beneficiary's IWP and any other documents should be
in accessible format and, where practicable, in the beneficiary's
primary means or language of communication.

**Recommendations 16:** Timelines for dispute resolution should be as
follows:

-   Employment networks should have fifteen (15) working days to resolve
    a complaint filed by a beneficiary. If not resolved satisfactorily,
    the beneficiary should be permitted to request a review by the
    Program Manager.

-   The request for review, with the submission of all supporting
    documentation by both parties, should be submitted within ten (10)
    working days after the beneficiary receives the employment network's
    decision.

-   The Program Manager should complete its review and render a decision
    within fifteen (15) working days, unless the parties agree to
    mediation.

-   If the parties agree to mediation, mediation should commence within
    ten (10) working days after the Program Manager receives the
    parties' request for mediation and should be completed within
    twenty (20) working days after it is scheduled.

-   The Social Security Administration should have no more than
    twenty (20) working days to resolve individual appeals.

-   All disputes involving employment networks, State Vocational
    Rehabilitation agencies, and the Program Manager must be resolved
    within sixty (60) working days, including Social Security
    Administration review and issuance of a decision.

**Recommendation 17:** During the appeals process, services and supports
to the beneficiary should be continued at the same level; that is,
services and supports should not be reduced or suspended by the
employment network without the beneficiary's consent.

**Recommendation 18:** All parties in a dispute should have access to
all information that is being considered and used to render a decision
in the dispute.

### [EMPLOYMENT NETWORK PAYMENT RECOMMENDATIONS]{.underline}

**Recommendation 19:** SSA should adopt a payment structure that pays at
least four milestone payments: 1) at the signing of the IWP; 2) at 3
months of SGA; 3) at 7 months of SGA; and 4) at 12 months of SGA.

Specifically the system would:

Pay a minimal milestone when a beneficiary and employment network signs
an IWP;

Pay an additional milestone payment equal to the first two proposed
(i.e., 3 and 7 months of SGA) at the end of 12 months of SGA;

Amortize the milestone payments over the entire 60-month outcome-only
payment period rather than the 12 months proposed;

Pay a significantly greater overall percentage of the outcome-only
payment option under the milestone/outcome payment option than the
proposed 85% and should consider at least 95%; and,

Equalize the monthly outcome payments under the milestone/outcome
payment period rather than the graduated method proposed in the NPRM.

**Recommendation 20:** In the Adequacy of Incentives Report due to
Congress in December 2002, SSA should address the efficacy of
individualized milestones. The Panel recommends that SSA also consider
the immediate implementation of a second tier of the milestone system.
Such a system would provide individualized milestones for individuals
with a need for on-going support services, individuals who need
high-cost accommodations, individuals who earn a sub-minimum wage, and
individuals who work and receive partial cash benefits along the lines
of systems already in use in Massachusetts, Oklahoma and other states.
(These systems use the individualized planning process to determine if
and when a different set of milestones is necessary, and establish a
plan for payments and accountability for the payments.)

**Recommendation 21:** The Panel recommends SSA interpret "benefits not
payable" as a reduction in benefits rather than zero cash benefits.

**Recommendation 22:** Because the Title II and Title XVI programs are
distinctly different from each other with differing processes and
timelines, SSA should develop two milestone/outcome payment systems, one
for SSI recipients and another for SSDI beneficiaries, that take into
account the differences between the two programs and that factor into
consideration, issues of concurrent beneficiaries.

**Recommendation 23:** SSA should commission a full-cost benefit study
to evaluate the Ticket to Work and Work Incentives Programs. Such a
study should begin with a more complete view of the direct savings to
the SSA Trust Fund, but should also consider savings to the Federal
Treasury and increased productivity to the nation as a whole. Such a
study would, at a minimum consider the impact of increased Federal
Insurance Contributions Act (FICA) contributions by working
beneficiaries, reduced use of Medicare, cash savings to the general fund
by SSI recipients who work but who only receive partial cash benefits
and estimated general fund savings beyond 60 months. The study should
also consider reduced use of all other government transfers and
increased taxes paid. It should consider the addition to Gross National
Product from increased work. It should evaluate costs and benefits from
SSA's point of view, from the view of the Federal government, and from
the view of the beneficiary and from society as a whole.

**Recommendation 24:** SSA should resolve the conflict between Sections
411.510 and 411.390 regarding VR's choice of payment systems for
beneficiaries who are already clients of VR.

**NPRM ISSUES, PUBLIC INPUT,**

**DISCUSSION AND RECOMMENDATIONS**

**INTRODUCTION**

The Ticket to Work and Work Incentives Advisory Panel's (the Panel's)
duty is to advise the Commissioner of the Social Security
Administration, the President, and the Congress on the implementation
and operation of the Ticket to Work and Self-Sufficiency Program and on
issues related to work incentives programs and planning and assistance
for individuals with disabilities. One of the Panel's first tasks
outlined in the Ticket to Work and Work Incentives Improvement Act
(TWWIIA) is to advise the Commissioner on the regulations for the Ticket
program. The Panel, since its initial meeting in July 2000, has focused
much attention on the Notice of Proposed Rulemaking (NPRM) published in
the Federal Register on December 28, 2000.

In addition to the issues that are directly addressed in the NPRM, the
Panel and the Agency have received numerous comments that relate to
other work incentive and return-to-work program issues and, as such,
could have significant impact on the success or failure of the programs
in the Ticket to Work and Work Incentives Improvement Act. Hence, the
Panel feels it important to raise these broader issues as well in this
report in an effort to call attention to them and begin working on them
with the Agency. These issues appear in the section following the
Panel's recommendations on the NPRM.

###### NPRM ISSUE AREAS

In September, the Panel created four workgroups to focus on the four
broad topic areas covered in the NPRM: Ticket to Work and Beneficiary
Use of Ticket; Employment Network Requirements and Qualifications;
Dispute Resolution; and, Provider Payment. This final Advice Report
reflects the work of these workgroups, expert advice from invited guests
of the workgroups, public input and Panel deliberations.

#### Panel Efforts to Solicit Input

The Panel felt it was very important to reach out to a variety of
constituents, beneficiaries and advocates to solicit comments and
opinions about the NPRM and the Agency\'s plans for ticket
implementation. To achieve this, during the regular quarterly meetings
of the Panel, a specific period was set aside for public comments. The
Panel also conducted five other public meetings in Washington, DC, and
Phoenix, Arizona and five public regional meetings - in Utah, Minnesota,
Arizona, Georgia and New York. The Panel also held eight public
conference calls and two West Coast regional conference calls. The total
hours of public comments from the public and regional meetings and
conference calls are approximately 22. Lists of the relevant Panel
meetings, conference calls, and commenters appear in Appendices A & B.

At each meeting, citizens with disabilities, their advocates, providers
of services, and other stakeholders, were provided ample opportunity to
comment. Additionally, individual Panel members attended numerous local,
state and national level meetings and have been asked to speak to a
variety of groups and organizations about the Panel and the issues in
the ticket's implementation. The Panel also solicited and received
correspondence from the public regarding the Agency\'s ticket
implementation plans and the NPRM.

In sum, the Panel has made a concerted effort to solicit input from a
broad cross-section of program constituents by holding meetings in
Washington, D.C., as well as regional meetings and teleconferences
across the country. The hours of public comments and the numerous
letters and e-mails received by the Panel reflect this effort**.** The
Panel also reviewed the public comments sent to SSA in response to the
NPRM and the catalogue of these comments prepared by the Agency. A
review of the public comments sent to SSA on the NPRM for the Ticket
program shows that an overwhelming majority focused on five key issue
areas: (1) who should be eligible for a ticket; (2) the adequacy of the
payment structure; (3) the number of tickets a beneficiary may receive;
(4) how to determine "timely progress"; and (5) qualifications and
evaluations of employment networks. Several commenters raised issues
regarding the participation of Vocational Rehabilitation agencies and
concerns about overpayment issues and how they might affect ticket users
and ENs.

During this first year of Panel activity, specific issues and concerns
regarding implementation and rollout of the Ticket program and the
proposed regulations have surfaced repeatedly in public comments and in
Panel deliberations. After extensive discussion in the January and
February meetings, the Panel concluded a letter outlining key
implementation issues and concerns should be sent to the Acting
Commissioner of SSA, prior to close of the NPRM public comment period
(See Appendix C for copy of letter). The Panel is encouraged the letter
dated February 21, 2001 sent to Acting Commissioner Halter resulted in
the Agency's decision to delay issuing the Request for Proposals (RFP)
for employment networks for 45 days in order to make many changes
recommended by the Panel. In addition, the Agency decided to delay
issuing tickets until the Regulations are issued after the publication
of the RFP for employment networks.

SSA has provided the Panel regular briefings and updates on the NPRM and
administrative implementation activities such as evaluation plans, the
responsibilities and activities of the Program Manager (Maximus, Inc.),
contracting, grant-making, and other critical administrative rollout
activities. The Panel recognizes the implementation and rollout of the
new Ticket program pose tight timeframes and may demand major changes in
the culture and business practices of the Agency. The Panel commends the
Agency for its diligence in carefully listening to and studying all of
the public comments and for giving thoughtful consideration to the
advice of the Panel. The Panel believes if implemented carefully, with
input from the Panel and constituents, the Ticket to Work and
Self-Sufficiency Program has the potential to improve greatly the
quality and availability of rehabilitation services, employment services
and supports, and related health services for our nation's citizens with
disabilities.

**[TICKET TO WORK AND BENEFICIARY USE]{.underline}**

**Issue: Should disability beneficiaries classified with a "Medical
Improvement Expected (MIE)" diary be eligible to participate in the
Ticket program?**

**Summary of Input**: Public comment supported the inclusion of
beneficiaries with the MIE designation in the Ticket program. Members of
the public commented that the policy should be that services should be
available to all disability beneficiaries sooner, rather than later,
because recent research supports findings the longer someone receives
cash benefits, the harder it is for them to become self-supporting. The
public also stated that most people with an MIE designation do not know
they have been given that designation. Further, testimony to the Panel
indicated in their practical experience, people with MIE designations
undergo delayed initial Continuing Disability Reviews (CDRs) often years
after the date on which they were supposed to occur. Concern was
expressed by national leaders from the mental health advocacy community
and national organizations representing people who are developmentally
disabled, that people with long-term mental illness (such as bipolar
disorder) and cognitive impairments receive this designation
disproportionately, and often with no real indication improvement is
likely. In addition, members of the public were of the opinion if the
designation of the MIE diary category for CDRs was used to limit a
person's access to a benefit, it must be subject to due process review
or appeal. In addition, Agency officials stated it is not known how many
beneficiaries have their benefits terminated due to a CDR based on the
MIE designation, reapply based on a decline in their condition, and then
are awarded benefits a second time.

**Discussion:** The Panel agreed limiting a person's access to a Federal
benefit (i.e. the ticket) without providing for a due process review is
questionable practice and policy. If this exclusion remains in the final
rule, it should outline a procedure for timely review and appeal. This
would increase the administrative burden to SSA, the cost of which may
outweigh the possible savings to the programs created by such exclusion.
One likely consequence may be the length of time required to process all
appeals, not just MIE cases, will be negatively impacted, that is, all
appeal cases would take longer given the additional caseload.

If the rule becomes final with its effect to limit a person's access to
the benefits of the Ticket program, SSA should commit to policy and
procedures ensuring that beneficiaries with the MIE designation receive
their initial CDR on schedule. The exclusion of beneficiaries with the
MIE designation from participation in the Ticket program does not appear
to be justified. The SSA program and policy officials were not able to
provide the Panel with a sound statistical analysis to justify this
exclusion. The Panel was not provided with data on how long it takes for
a person with the MIE designation to have the initial CDR completed.
There was also no information that indicated a significant number of
people with the MIE designation would be terminated after the completion
of their initial CDR. There was no evidence to counter the argument that
people with a MIE designation would be more successful in staying off
the rolls through being allowed early participation in the Ticket
program, even if their initial CDR resulted in a termination of
benefits.

The proposed regulation states that a person who is awarded benefits
with an MIE diary for the scheduling of their first Continuing
Disability Review (CDR) is not eligible for the Ticket program until
after the completion of their first CDR. A beneficiary with this
designation is scheduled to have his or her case reviewed within 6 to 18
months after receiving benefits. This MIE category was created for the
sole purpose of determining when the first CDR for a beneficiary should
be completed.

In 1999, there were 60,766 DI and SSI adult beneficiaries who were
classified first time MIEs on the rolls. Data from the Disability
Determination Services decision files indicate that in 1999, 9,663
beneficiaries with a MIE designation were ceased for medical
improvement. According to SSA's Office of Disability, on the average,
about 16% of initial Titles II and XVI MIE allowances which come up for
first-time CDRs are ceased because of medical improvement, usually 18-24
months after allowance. The Panel asked for and received cost estimates
from the SSA Office of the Actuary (OACT) concerning the cost
implications of including beneficiaries with an MIE designation in the
population receiving tickets. OACT estimates the cost at \$747 million
for OASDI benefit payments and \$75 million for Federal SSI benefit
payments for a net subtotal of \$822 million over the period of
2001-2010**.** (See Appendix D)

**Recommendation 1:** All SSI and SSDI adult disability beneficiaries,
including those with a Medical Improvement Expected (MIE) designation,
should be eligible to participate in the Ticket program.

**Issue: Should transition-aged youth (16-18) be eligible to receive and
use a ticket in the Ticket to Work and Self-Sufficiency Program?**

**Summary of Input:** The Panel and the Agency received many comments
from the public on this issue, the majority of which supported providing
tickets to at least 16 and 17 year olds. There was consensus from the
public that the longer people receive cash benefits the less likely they
are to be able to achieve independence and become self-supporting. The
public also agreed that the expectations created for a young person with
a disability might be the most important factor in whether they work or
rely on benefits and allowing them to participate in the Ticket program
makes another tool available to encourage positive expectations. Experts
told the Panel that schools themselves could potentially be employment
networks for youth.

The majority of comments received by the Panel were that making
transition-aged youth ineligible for the Ticket program would send the
wrong message to youth and could have the effect of encouraging lifelong
dependency upon benefits. There may or may not be a determinable
increase in cost to the program in the short-term. However, the
long-term benefits to the program and the youth beneficiaries could far
outweigh those expenditures. Many youth may not choose to participate in
the program until after they are 18, but those who wish to participate
should be allowed to do so. Programs and policy in the Individuals with
Disabilities Education Act (IDEA) and the Workforce Investment Act
promote seamless programming from school to work for students and young
adults with and without disabilities.

On the other hand, the Consortium for Citizens with Disabilities (CCD)
commented it was their understanding that SSA is currently evaluating
the process used by State Disability Determination Services for
conducting the required redeterminations at age 18. According to CCD,
the project is being carried out with the American Association of
University Affiliated Programs, and it is CCD's view that until SSA has
had the opportunity to assess the outcome of the project, it may be
premature to lower the eligibility age for tickets.

**Discussion:** The proposed regulations limit participation in the
Ticket program to disability beneficiaries between the ages of 18 and
64. The Panel engaged in extended debate over whether to provide access
to the Ticket program to 16 and 17 year olds. Panel members raised a
number of concerns regarding the issuing of tickets to this age group.
They included the following concerns:

\(1\) Providing a ticket to 16- or 17-year-old youths might be construed
as pressuring them into early employment instead of emphasizing
educational goals;

\(2\) The Ticket is an adult program and that it was not in the
taxpayer's best interest to use different criteria to give young people
a ticket in a program for which they might not actually qualify as
adults;

\(3\) Providing this age group with a ticket may have the unintended
consequence of allowing States to supplant their mandatory obligations
to serve these students under the Individuals with Disabilities
Education Act (IDEA), thus precluding these students from any other
options; fears that ENs would not want to serve 16-18 year olds because
the mechanism that triggers EN payments is beneficiary exit from the
program, a doubtful outcome for someone in that age group, especially
because they are unlikely to work fulltime;

\(4\) The reasonable expectation that the VR system and other resources
serve 16-18 year olds, along with still unanswered questions regarding
the impact on student choice of the assignment of tickets to VR; and

\(5\) Uncertainties regarding the potential impact of the unresolved
question of whether a beneficiary will be allowed more than one ticket.

Finally, although cost was not the primary reason for objecting to
tickets being given to this age group, the issue of costs was raised.
Some Panel members expressed concerns over projected costs provided by
the Office of the Actuary that estimated participation by 16-18 year
olds would cost \$284 million over the period 2001-2010, leading to
questions about such expenditure of scarce resources. A different
financial concern was brought up in the context of whether EN's who take
tickets from youth and are successful in meeting the program's
employment goals, will then be eligible for payments if the youth do not
meet the adult medical standards.

Despite the concerns raised above by some Panel members, the majority
felt very strongly that many young people with disabilities would be
positively impacted by the opportunities the ticket could provide. Some
Panel members expressed their belief that the Ticket program could
especially benefit poor and minority students. The majority specifically
noted that: only 25 percent of all Americans get a four year college
degree; a much smaller percentage of youth with disabilities go on to
higher education; 38 percent drop out of high school before graduation
or before receiving their General Equivalency Diploma (GED); and a
significant minority get into trouble and wind up in the juvenile
justice system. The majority also felt part of the reason for creating
the Ticket program in the first place was to increase consumer choices,
a goal that would be totally ignored if the only option youth with
disabilities had was the VR system And, finally, it was pointed out that
cost estimates from the Office of the Actuary showed only the costs at
the front end of having 16-18 year olds in the program**,** and did not
project any savings at the other end, even after 10 years, precluding
consideration of the possibility that the general funds would actually
save money by the inclusion of young people in the Ticket program.

**Recommendation 2:** Sixteen (16) and seventeen (17) year-old
beneficiaries, including those with an MIE designation, should be
eligible to participate in the Ticket program.

**Issue: Should young people with disabilities on SSI benefits be
protected against a medical redetermination at age 18 if they are
participating in the Ticket program?**

**Summary of Input:** Regarding the issue of protection against a
redetermination at age 18, the Panel received Congressional questions
and input from the Office of the Actuary (OACT) regarding the current
requirement that disabled young SSI beneficiaries must undergo a medical
review (redetermination) at age 18 using different, more stringent adult
disability standards. As a result of this process, in the year 2000,
some 44.2% of 18-year old SSI beneficiaries initially had their benefits
ceased. Further data from the Office of Disability showed of those 44.2
% whose benefits were initially ceased, many successfully appealed and
had their benefits continued. Hence, after all appeals, the actual
18-year old redetermination cessation rate dropped to 32.7%. The Panel
asked the Office of the Actuary to supply cost estimates on the
increased expenditures could accrue if youth with disabilities who
activate their ticket prior to notification of an age 18 redetermination
were given benefit protection similar to the CDR deferral provisions.
The Office of the Actuary estimates the cost of deferring
redeterminations for 18-year olds would be \$256 million over the period
2001-2010. In summary, if 16-18 year olds were included in the Ticket
program and had their medical redeterminations deferred, the OACT
estimates the net cost to be \$540 million (i.e., \$284 + \$256 million)
over the period 2001-2010**.** (See OACT estimates in Appendix D.)

**Discussion:** Under current rules, all 18 year-old SSI recipients must
undergo a medical redetermination in order to be determined disabled
under the adult standards. Under section 301 of the 1980 disability
amendments (PL 96-265, section 301), if these youth, prior to turning
age 18, are participating in a VR program that is expected to result in
employment, their benefits are protected. Specifically, they still have
a medical review, but if SSA makes a medical cessation decision, their
benefits are nevertheless continued \-- this is sometimes referred to as
section 301 protection**.** The proposed rules would continue the
redetermination requirement before 18-year old beneficiaries would be
able to receive a ticket.

The Panel discussed the ramifications of providing protection from
medical redeterminations for 18-year olds who participate in the Ticket
program. The idea would be to provide protections similar to those
already afforded to ticket participants from CDR's. Simply providing the
protection currently given 18-year olds who, prior to turning 18, are in
VR programs will not produce the desired effect. Although youth in VR
programs have their benefits protected, they still have a medical
review. However, such a review for an 18-year old ticket user would mean
that if the youth were found ineligible to meet the adult medical
standards, an EN would not be paid for the young person's successful
work outcomes. The Panel is greatly concerned therefore no EN will serve
these youth if they must first have a medical redetermination. For that
reason, the Panel is recommending CDR-type protection be given to
18-year olds who participate in the Ticket program so EN's would be
eligible for payments for successful outcomes.

Panelists who dissented felt: (1) granting such protection would extend
eligibility to those who would not otherwise be eligible for benefits as
adults; (2) a redetermination needed to be done before an 18-year old is
given a ticket to ensure the person still meets the definition of
disability under SSI; (3) including these youths who would not otherwise
be eligible on to the adult SSI rolls, will eventually lead SSA to
exercise more scrutiny with respect to the contracts between consumers
and providers.

However, the majority of the Panel felt that 18-year olds who choose to
participate in the Ticket program should be entitled to the same
protections against a medical review as anyone else who is a ticket
user. The arguments made in support of extending protection include:

(1) Unless the protection is offered, no provider is going to serve
    youth with disabilities;

(2) The rationale for not serving them is simply a perceived potential
    saving to the program;

(3) The choice of age 18 as a determinant of adult functioning for these
    youth with disabilities is arbitrary and capricious. For example,
    most young students are still eligible for coverage under their
    parents' health insurance until age 22 or 23;

(4) Despite contention by some that there are other options available
    for transition-age youth with disabilities, the reality is that the
    services are not readily available. Instead, there is a waiting
    lists in most States and the numbers on it are in the thousands and
    in some States, in the tens of thousands;

(5) Research has repeatedly demonstrated the sooner people are engaged
    in preparation for going to work, the greater the probability of
    long-term employment. Therefore any program, such as the ticket,
    that encourages heading towards employment early was good policy;

(6) Protection should be extended to these youths because otherwise,
    under the final program regulations, some people who participated in
    the program would be treated differently based on certain
    characteristics, and would not be entitled to all the protections
    accorded to other participants in the program.

**Recommendation 3:** Eighteen (18) year-old beneficiaries who
participate in the Ticket program should receive the same protection
from redeterminations as other ticket users receive against CDR's.

**Issue: Should a person be entitled to more than one ticket within a
period of disability?**

**Summary of Input:** Concern was expressed by the public that
beneficiaries would not be able to find ENs to provide services to them
if they have a partially used ticket. Current research (See Schur, Lisa;
Contingent and Part-time Employment Among Workers with Disabilities:
Barriers and Opportunities; School of Management and Labor Relations;
Rutgers University; 2000;) finds people with disabilities are twice as
likely as non-disabled people to work in part time and temporary work.
Concern was raised that the program would not work for a large segment
of beneficiaries particularly those with disabilities episodic in
nature.

**Discussion:** Many beneficiaries using the Ticket program are likely
to go in and out of work, and not transition at first attempt from
receipt of cash benefits to 60 months of continuous employment. A
beneficiary whose ticket is partially used and needs other continuing
support services may have a difficult time finding an EN willing to work
with them. For example, a beneficiary returns to cash benefits after a
work stoppage in the expedited reinstatement provision of TWWIIA. The
person wants to return to work again and decides he/she needs support
services. This consumer will be at a distinct disadvantage if interested
in continuing to work. There is nothing in the Statute that prevents a
beneficiary from receiving a second ticket and there may well be
unassessed cash savings to SSA programs in allowing two or more tickets
to a beneficiary, as warranted or appropriate.

In Section 411.125(b), the proposed rule states a person can have only
one ticket during a period of entitlement for which a beneficiary is
eligible to receive disability benefits. Regardless, if a beneficiary
returned to work and her or his employment network received 35 out of 60
outcome payments, and the beneficiary then became unable to work, his or
her ticket would only have 25 outcome payments left to pay out. That is
what is being described as a partially used ticket. A related issue is
whether an EN, new or old, would be willing to provide a full array of
services to a beneficiary with a partially used ticket and a
significantly reduced number of payments.

**Recommendation 4:** SSA should conduct a cost-benefit analysis on the
feasibility of a beneficiary receiving more than one ticket within a
period of disability and/or a period of eligibility. The Agency should
assess the potential cost impact of beneficiaries using more than one
ticket in the Agency's overall evaluation report due to Congress.

#### [EMPLOYMENT NETWORK REQUIREMENTS AND QUALIFICATIONS]{.underline}

**Issue: Who should be in an employment network (EN) providing services
to beneficiaries who are ticket holders?**

**Summary of Input:** Many of the commenters said State licensure laws
dictate requirements for certain professions and providers so SSA should
defer to those State rules. Some commenters expressed concern that the
quality of services may be compromised if provided by less than trained
personnel. However, they recognized the benefits of allowing support and
other services by non-traditional providers if rendered under the
auspices of an EN who is ultimately accountable for the services
provided.

**Discussion:** Many people with disabilities have a "circle of
support," that is, people whom they trust to provide additional support
services. Most often, these individuals are non**-**traditional support
providers. In some instances, they are family members, neighbors, or
friends who provide needed supports. The final rule regarding EN
qualifications should be broad enough to accommodate non-traditional
providers while accomplishing the stated purpose of the Ticket program,
to "expand the universe of service providers available to individuals
who are entitled to Social Security benefits based on disability\..." §
411.105 of the NPRM.

According to the proposed rule, an employment network is any qualified
entity which has entered into an agreement with SSA to function as an
EN, and assumes responsibility for the coordination and delivery of
employment services, vocational rehabilitation services, or other
support services to beneficiaries who have assigned their ticket to that
EN. The proposed rule would require an eligible entity assure that it is
licensed, certified, accredited, or registered if so required by State
law to provide these services either directly or through arrangements
with other entities. SSA should avoid the requirement for all employees
or contractors of ENs have to be licensed or credentialed. It would also
be reasonable to accept any business licensing or regulatory
requirements ordinarily imposed on an entity seeking to become an EN.
For example, proper guidelines regarding proof of the business as a
taxpaying, registered entity under federal and state law would also be
appropriate.

**Recommendation 5:** An employment network (EN) should be required to
retain staff that are otherwise qualified based on education or direct
services experience, such as employees with a college degree in a
related field, including but not limited to vocational counseling,
education, human resources, human relations, social work, teaching, or
psychology or employees with equivalent experience. SSA should not
require licensure and/or certification that would exclude employers or
other types of providers qualified to work with people with disabilities
such as those who offer non-traditional supports resulting in
employment. The key criterion should be whether the entity is capable of
successfully providing the service agreed to by the EN and the
beneficiary. SSA should delete Section 411.315(c). The State agency
certification process should not be used to limit who can participate as
an EN in the Ticket program.

**Issue: What financial reporting is needed by the Program Manager or
SSA from the employment network?**

**Summary of Input:** Many commenters recommended the Agency try to
"keep it simple" and not require unnecessary reporting. Some were
concerned that a few of the reporting requirements may place an undue
administrative burden on ENs and discourage the participation of
potential providers. Still others in the public and on the Panel were of
the opinion that it is inappropriate, invasive and unreasonable for SSA
to require these kinds of reports in an outcome-based program.

**Discussion:** While there is a substantive evaluation component in the
Ticket program, the Panel thinks using the financial reporting and
collection requirements in Section 411.325 (g) and 411.325(h) is not the
way to collect data for it. The requirement will prohibit providers and
employers from participating who have no intention of adding to the
financial disclosures they already make to the Federal government.
Instead, the Panel believes such information could be gathered through
voluntary participation by ENs in a study to determine the adequacy of
payments. In addition, the PM's could be asked to report problems with
payment levels in its annual report to SSA, especially if providers go
out of business or decide not to participate again because of inadequate
payment levels.

Section 411.325 of the NPRM outlines the proposed reporting requirements
of an EN. One of those requirements is for the EN to submit to the
Program Manager, annually, a financial report showing the percentage of
the employment network's budget spent on serving beneficiaries with
tickets.

**Recommendation 6:** Delete Section 411.325(g) and Section 411.325(h)
from the list of EN reporting and collection requirements. Section
411.325(g) currently requires "...among other things, submitting to the
Program Manager, on an annual basis, a financial report that shows the
percentage of the employment network's budget that was spent on serving
beneficiaries with tickets..."

**Issue: Should "timely progress" toward an employment goal be measured
by minimum standards for all beneficiaries, or, should the terms and
conditions agreed to in each IWP determine timely progress?**

**Summary of Input**: The Panel received public comment on this issue,
engaged in extensive discussion and deliberation and came to a consensus
on a recommendation.

**Discussion:** Beginning with a 24-month review after a ticket is
assigned to an EN, the proposed regulations require the Program Manager
to assess whether a beneficiary is making "timely progress towards
self-supporting employment" which will then keep Continuing Disability
Review (CDR) suspensions in place. There are no "timely progress"
requirements in the Statute. "Timely progress" requirements in the
proposed rule are directly related to the suspension of CDRs for Ticket
program users. A ticket holder must meet the "timely progress"
requirements to maintain the CDR suspension. One option would be to have
the same net outcome as the proposed rule for the first three years. It
would require the same minimum work standards for all ticket
participants in years three, four and five of an EN-ticket contract with
a beneficiary. The second option, and the option the Panel is
recommending, would individualize "timely progress" and place the
responsibility of proof and reporting on the EN with oversight by the
Program Manager.

Another question raised during Panel deliberations was whether or not
there should there be set minimum requirements for employment in years
four and five of ticket use in order to keep CDR suspensions in place.
The Statute and the proposed rule in Section 411.325 (e), require annual
progress reports from the EN to the Program Manager using progress
tracked in the Individual Work Plan.

**Recommendation 7:** The Panel recommends that timely progress be
defined by the terms and conditions of the IWP, as agreed to by the
beneficiary and the EN. The reporting mechanism should be the annual
report in Section 411.325(e).

**Issue: Should the State VR agency be allowed to use the Individual
Plan for Employment (IPE) as a substitute for the Individual Work Plan
(IWP)? If so, should other individualized service delivery plans be
acceptable alternatives, provided they meet the minimum standards
outlined in the Statute for an IWP?**

**Summary of Input:** The few commenters who discussed this issue stated
that the IPE or any other work plan meeting the minimum IWP standards
described in the Statute should be an acceptable alternative to the IWP.
They stressed the need to reduce duplication with the same person,
eliminate unnecessary paperwork, and reduce administrative burden.

**Discussion:** If a document already exists that meets the statutory
requirements of an IWP, there should not be a requirement for a
duplicate document. The proposed regulations recognize this and permit
State VR agencies to use the IPE as a substitute for the IWP. Other
programs should be permitted to do the same.

**Recommendation 8:** SSA should permit other individualized service
delivery plans to be used as substitutes to the IWP provided they meet
the minimum requirements detailed in the statute.

**Issue: When a SSA beneficiary with a ticket applies to the State VR
agency for services, should the beneficiary have the option of retaining
his/her ticket for use with other ENs?**

**Summary of Input:** The commenters to the Panel were concerned about
choice, both here and in the related context of the rule allowing only
one ticket per eligible beneficiary per period of entitlement for
benefits. The proposed rule should not presume an applicant for VR
services who is a SSA beneficiary would assign his or her ticket to VR.

Panel members received widespread comments that VR receives special
treatment in many respects throughout the rule. In this context, there
were comments that Section 411.385 needs clarification or change in the
context of other special arrangements in the rule for the State VR
agency.

NPRM Section 411.385 states:

> "What does a State VR agency do if a beneficiary who is applying for
> services has a ticket that is available for assignment?" (a) Once the
> State VR agency determines that a beneficiary who is applying for
> services has a ticket that is available for assignment (see Section
> 411.140) and the State VR agency and the beneficiary have agreed to
> and signed the individualized plan for employment (IPE) required under
> Section 102(b) of the Rehabilitation Act of 1973, as amended, the
> beneficiary's ticket is considered to be assigned.

**Discussion:** People with disabilities are eligible for a number of
public programs offering counseling, rehabilitation, training, job
placement, other employment services and support services from a wide
variety of State and Federal systems and delivered at Federal, State and
local levels. These systems include Federal housing programs, State
developmental disabilities services, State mental health services,
transportation services, one-stop training and employment services,
independent living services, transition and special education, health
care and related supports, and assistive technology, just to name a few.
The intent of the Ticket program was to expand services and supports,
not to limit them. A ticket should be seen as yet another tool the SSA
beneficiary can choose to use to supplement what is already available to
the individual under current public programs. Use of the ticket should
improve that individual's chance of success in employment.

The Panel is also concerned that certain current provisions regarding
young disability beneficiaries may unduly favor VR and severely limit
client choice. Under current provisions, disabled young SSI
beneficiaries who are receiving Vocational Rehabilitation (VR) services
under an Individual Plan for Employment (IPE) are protected from benefit
termination until the plan is completed. Furthermore, many VR agencies
begin working with disabled youth at age 16. The Panel is highly
supportive of the importance of encouraging employment-related services
in the transition years. However, the Panel is greatly concerned that as
a result of the multiple effects of these provisions, young disability
beneficiaries will be forced to assign their ticket to VR and therefore
will be precluded from the possibility of receiving services from other
ENs. The Panel believes that it is especially important for young people
with disabilities to have many career options and to play an active part
in the planning process.

Informed choice is a key concern of the Panel. The Agency's outreach on
the Ticket program should inform beneficiaries of the choice issues
raised when they decide to apply for VR services. Eligibility for VR
services and VR client status should not dictate when a beneficiary can
use his or her ticket or where a beneficiary can deposit his or her
ticket.

Recommendation 9: SSA should re-write Section 411.385 to clarify that an
SSA beneficiary, whether a youth or adult, with a ticket who applies for
or is receiving State Vocational Rehabilitation services has a choice in
deciding whether to assign his/her ticket to the State VR agency, to
assign it to another EN, or not to assign it at all. An 18-year old who
is already receiving VR services and who then receives a ticket from
SSA, should not be required to deposit the ticket with the State VR
system.

###### DISPUTE RESOLUTION AND MEDIATION

**Issue: Should protection and advocacy services be available to all
beneficiaries of the Social Security Administration regardless of
whether or not they are ticket users or living in a ticket roll out
state?**

**Discussion:** Section 1150(a)(b) (1) and (2) of the legislation
provides that SSA beneficiaries are eligible to obtain information and
advice about vocational rehabilitation and employment services and
advocacy or other services a person with a disability may need to secure
or regain gainful employment. There is no requirement in the legislation
that a beneficiary be a ticket holder or currently living in a roll-out
state in order to be eligible for protection and advocacy services.

**Summary of Input:** There was substantial public input in support of
protection and advocacy services being provided to all SSA
beneficiaries. Additionally, the Panel received substantial public
comment regarding the fact that beneficiaries face many barriers to
obtaining needed services and supports to enable them to go to work.
Commenters stated repeatedly that P&A services should be available to
assist all SSA beneficiaries, regardless of their status as a ticket
holder or residence in a ticket roll-out state.

**Recommendation 10:** All beneficiaries should have access to
Protection and Advocacy (P&A) services.

**Issue: Should mediation be a part of the dispute resolution process?**

**Summary of Input:** Commenters agree voluntary mediation should be
available to all parties involved in a dispute under the Ticket to Work
Program and mediation services should be paid for by the Agency.

**Discussion**: Subpart 1 of the proposed regulations on dispute
resolution (Section 411.600 et seq.) does not address the use of
mediation as a means of resolving disputes. Mediation is an informal,
cost-effective means of resolving disputes and should be available on a
voluntary basis. Neither Section 411.600 et seq., nor Section 411.435
addresses the use of mediation as a means of resolving disputes.
Sections 411.660 and 411.630 of the proposed regulations state that the
Social Security Administration makes the final decision in all disputes.
There is no mention of an opportunity for an external review process.

**Recommendation 11:** Mediation should be available as an avenue for
resolving disputes but it should not be mandatory. It should be an
option available to the parties to the dispute, after the Program
Manager has considered the matter for resolution.

-   All parties must agree to enter into mediation.

-   Mediation should be external to the Social Security Administration
    and should not be provided or paid for by Protection and Advocacy
    agencies. Participation in the mediation process should not bar a
    party's access to further appeals.

-   Because mediation is a more efficient and cost-effective way to
    resolve disputes, the Social Security Administration should set
    aside additional funds to support the use of mediation for all
    parties.

-   The Social Security Administration should look at other successful
    mediation program models such as those established at the Equal
    Employment Opportunity Commission (EEOC) and the Department of
    Justice.

**Issue: Should there be an external appeals process for all parties?
Should there be an opportunity for all parties to a dispute to have
access to a review of SSA's decision, either through a SSA review
process or an external judicial review process?**

**Summary of Input**: Commenters were unanimous in their recommendations
that all parties to disputes should have the opportunity to access an
external appeal process beyond what is currently offered in the
regulation. This more fully ensures fairness and impartiality are
observed throughout the dispute resolution process.

**Discussion:** The Panel was in complete agreement on the need for an
external review of SSA decisions but is cognizant such a review could
pose additional problems under the current system. Specifically, the
Administrative Law Judge system is already overburdened, resulting in
long delays of typically more than one year before claimants have their
cases heard. The Panel is concerned such waiting times could irreparably
harm the goals of the Ticket program as well as disadvantage both
beneficiaries and ENs alike. Resorting to the federal court system to
resolve such disputes may prove equally problematic. The Panel discussed
the possibility of SSA setting up an independent panel made up of SSA
and consumer representatives. The Panel believes SSA should take the
initiative for providing an external review process that is accessible
and fair.

**Recommendation 12:** All decisions by the Social Security
Administration involving disputes between or among all parties should,
at the option of the parties, be subject to external review by either
the Social Security Administration\'s administrative review process
and/or judicial review.

**Issue: At what point or points should a beneficiary receive
information about the availability of protection and advocacy services
and in what format should such information and other materials be
provided?**

**Summary of Input:** The Panel heard widespread comments that
beneficiaries should be provided with notice of their right to advocacy
and representation several times throughout their ticket experience.
Beneficiaries will be overwhelmed with information about this new
program and they should be reminded several times at key points
throughout their experience of their right to legal advocacy and
representation, especially, at the time of ticket issuance. All notices
of this right as well as other materials must be available in the
beneficiary's primary language or accessible means of communication.

**Discussion:** Section 411.465 (regarding requirements for an IWP) and
Sections 411.605 and 411.610 require notice regarding the availability
of protection and advocacy assistance in resolving disputes only to
beneficiaries who become ticket users. There is no reference in the
regulations to the need or requirement for all beneficiaries receive
information regarding protection and advocacy assistance in areas other
than dispute resolution or to beneficiaries who have not exercised their
option to use their ticket.

**Recommendation 13:** Information about protection and advocacy
services and how to access them should be available at any time to all
beneficiaries seeking or using SSA or other work incentive programs,
including the ticket. Specifically, a beneficiary should receive a
formal notice of the availability of protection and advocacy services
when he or she is issued a ticket and at the following junctures in the
process:

-   When he or she applies to the employment network for services;

-   At the signing of his or her individual work plan;

-   In the event his or her services are decreased, suspended or
    terminated; or

-   When he or she files a complaint against the employment network.

**Recommendation 14:** The beneficiary's filing of a complaint with the
Program Manager (PM) against an EN should, with the beneficiary's
consent, trigger a notice to the Protection and Advocacy agency
regarding the dispute to allow for an inquiry by the Protection and
Advocacy agency as to the beneficiary's wish for protection and advocacy
assistance.

**Recommendation 15:** Notices from the EN and the Protection and
Advocacy agency, the beneficiary's IWP and any other documents should be
in accessible format and, where practicable, in the beneficiary's
primary means or language of communication.

**Issue: Should there be time limits and other requirements imposed on
all parties involved in the dispute resolution process?**

**Summary of Input:** Commenters were concerned about the impact on a
beneficiary once a dispute arises. One aspect of concern is the length
of time it will take to resolve a complaint and what happens to the
beneficiary's training and employment status during the complaint review
process. It was suggested there should be strict timelines to minimize
the adverse impact on all parties when a complaint is filed.

**Discussion:** The Panel hosted lengthy public discussion on this topic
and was in agreement that timelines need to be spelled out in the final
regulations. The proposed regulations either do not reflect timelines
for dispute resolution or, where they do, they are inadequate. For
example, there are no timelines for the employment network's internal
grievance process or the Social Security Administration's review
process. (See Sections 411.435, 411.615, 411.625, and 411.630.)

**Recommendations 16:** Timelines for dispute resolution should be as
follows:

-   Employment networks should have fifteen (15) working days to resolve
    a complaint filed by a beneficiary. If not resolved satisfactorily,
    the beneficiary should be permitted to request a review by the
    Program Manager.

-   The request for review, with the submission of all supporting
    documentation by both parties, should be submitted within ten (10)
    working days after the beneficiary receives the employment network's
    decision.

-   The Program Manager should complete its review and render a decision
    within fifteen (15) working days, unless the parties agree to
    mediation.

-   If the parties agree to mediation, mediation should commence within
    ten (10) working days after the Program Manager receives the
    parties' request for mediation and should be completed within
    twenty (20) working days after it is scheduled.

-   The Social Security Administration should have no more than
    twenty (20) working days to resolve individual appeals.

-   All disputes involving employment networks, State Vocational
    Rehabilitation agencies, and the Program Manager must be resolved
    within sixty (60) working days, including Social Security
    Administration review and issuance of a decision.

**Recommendation 17:** During the appeals process, services and supports
to the beneficiary should be continued at the same level; that is,
services and supports should not be reduced or suspended by the
employment network without the beneficiary's consent.

**Recommendation 18:** All parties in a dispute should have access to
all information that is being considered and used to render a decision
in the dispute.

### [EMPLOYMENT NETWORK PAYMENT]{.underline} 

**Issue: How can the milestone payment system be structured to encourage
providers to serve all eligible individuals, including those who are
harder to serve?**

**Summary of Input:** As proposed, the milestone payment system allows
two milestone payments to be made before the first outcome payment.
These milestones recognize those currently on either SSDI or SSI
benefits who are provided job-related services and return to work do not
immediately reach a level of employment that makes them ineligible for
cash benefits and their employment network eligible for outcome
payments.

For the most part, there was consensus among commenters and the experts
consulted that the milestone payment method proposed in the Notice of
Proposed Rulemaking (NPRM) is not feasible and, if not significantly
improved, will jeopardize the success of the Ticket program. They
encouraged the Panel to recommend to the Commissioner a payment design
that addresses provider choice and capitalization. As proposed, the
milestone payment structure is not attractive to potential employment
networks since it yields a smaller total payment than the outcome
payment system. It places the majority of burden and risk on the EN, and
requires an unrealistic up-front investment by the EN. Alternative
proposals were presented that add additional milestones, spread the
milestone payments over 5 years, and reduce the 15% penalty incurred by
ENs who choose milestone payments to 5%.

**Discussion:** A milestone payment system having more payments earlier
on in the employment process will attract more providers to the program
and thus afford consumers more choice in service provision. A system
paying a greater overall percentage of the outcome-only payment option
would be more appealing to ENs than the one that has been proposed. In
addition, a system providing for individualized milestones could
increase the likelihood that individuals with significant disabilities
would be served by ENs. Also, allowing for individualized milestones for
individuals who are more difficult to serve better matches the current
work and payment rules and would provide incentives and supports
necessary for ENs to serve these individuals.

**Recommendation 19:** SSA should adopt a payment structure that pays at
least four milestone payments: 1) at the signing of the IWP; 2) at 3
months of SGA; 3) at 7 months of SGA; and, 4) at 12 months of SGA.

Specifically the system would:

a)  Pay a minimal milestone when a beneficiary and employment network
    signs an IWP;

b)  Pay an additional milestone payment equal to the first two proposed
    (i.e., 3 and 7 months of SGA) at the end of 12 months of SGA;

c)  Amortize the milestone payments over the entire 60-month
    outcome-only payment period rather than the 12 months proposed;

d)  Pay a significantly greater overall percentage of the outcome-only
    payment option under the milestone/outcome payment option than the
    proposed 85% and should consider at least 95%; and,

e)  Equalize the monthly outcome payments under the milestone/outcome
    payment period rather than the graduated method proposed in the
    NPRM.

**Recommendation 20:** In the Adequacy of Incentives Report due to
Congress in December 2002, SSA should address the efficacy of
individualized milestones. The Panel recommends that SSA also consider
the immediate implementation of a second tier of the milestone system.
Such a system would provide individualized milestones for individuals
with a need for on-going support services, individuals who need
high-cost accommodations, individuals who earn a sub-minimum wage, and
individuals who work and receive partial cash benefits along the lines
of systems already in use in Massachusetts, Oklahoma and other states.
(These systems use the individualized planning process to determine if
and when a different set of milestones is necessary, and establish a
plan for payments and accountability for the payments.)

**Issue: How can the financial incentives to serve various groups of
beneficiaries be structured to be more equitable?**

**Summary of Input:** Among the various suggestions to restructure the
milestone system, the Panel received comments on specific models that
would allow distinctly different payment systems for SSI beneficiaries
and SSDI beneficiaries (See EN Payment Models in Appendix E as possible
examples of how such a system might be structured).

**Discussion:** Under the NPRM proposed system, most of the risk is with
the provider and requires a person not be receiving any cash benefits
before an outcome payment is made. The Panel recognizes it is SSA's
responsibility to interpret sections of the Act that require further
clarification for operational purposes. Furthermore, the Panel
understands the rationale of the Agency's interpretation of "benefits
not payable" to mean zero benefits. However, the Panel and the Agency
have received extensive comments that the Agency interpretation will
distinctly disadvantage certain groups of beneficiaries, when compared
to non-blind beneficiaries on DI benefits, from being served by EN's.
The disadvantage is financial to the EN's, but may ultimately adversely
affect the beneficiaries in these particular groups because they may not
be served. The reason for the disadvantaged position stems from the fact
that under the interpretation of zero cash benefits, some groups of
beneficiaries would have to earn considerably more before they would
reach the point of zero cash benefits and thereby trigger payments to
providers -- thus creating little or no incentives for providers to
serve them.

Specifically, under current rules, non-blind DI beneficiaries would
reach zero cash benefit status with earnings above \$740. In
comparison**,** SSI recipients are disadvantaged because of the current
\$1-for-\$2 cash offset in SSI work incentives. This would require SSI
recipients to earn more than \$1,145 (their current individual Federal
Benefit Rate) before an outcome payment is paid to an EN. As a result,
ENs could be less inclined to serve the SSI population, many of whom may
have lower education levels and a weaker work history than do most SSDI
beneficiaries. This would leave SSI recipients, large numbers of whom
have mental illness, mental retardation, cognitive or lifelong
disabilities, at a distinct disadvantage in the Ticket program.

Blind DI beneficiaries are also likely to be disadvantaged as potential
clients of EN's because under current rules, they would have to earn
more than \$1,240 before reaching zero cash benefit status. Finally,
concurrent beneficiaries may also be adversely affected by the
requirements to attain zero benefit status. Those on concurrent benefits
would have their DI benefits ceased with earnings above \$740, but as
long as their earnings were under \$1,145, their SSI payment would
continue indefinitely. Again, EN's may be reluctant to serve such
clients because they would not get any outcome payments until the
beneficiary's earnings were over \$1145.

The Panel understands the rationale for the Agency's interpretation that
an outcome payment can be made only when a beneficiary is totally off of
cash payments. However, the majority of the Panel is greatly concerned
these differing levels at which benefits reach zero, originally intended
to encourage work attempts by expanding the earnings potential of
various categories of beneficiaries while still protecting their benefit
status, will now create an unintended bias against their being served by
EN's or participating in the Ticket program. It is for this reason the
Panel urges the Agency to interpret "benefits not payable" differently
in the case of certain groups of beneficiaries who would otherwise be
disadvantaged as ticket users.

Furthermore, the Panel acknowledges and appreciates the frequent
references in the preamble of the legislation to "reducing dependency on
the cash benefits program" and therefore, believes all beneficiary
employment outcomes in the Ticket program are valued and that any
savings to the Trust Fund or the general funds should be viewed as a
positive outcome. The Panel urges the Agency to explore alternative
payment options to create adequate incentives for providers to serve
these other groups. A dissenting view on the Panel held the Agency
interpretation in the Regulations was consistent with Congressional
intent for zero cash benefits.

**Recommendation 21:** The Panel recommends SSA interpret "benefits not
payable" as a reduction in benefits rather than zero cash benefits.

**Issue: How can SSA restructure the milestone and outcome payment
system for SSI beneficiaries in order to account for existing work
incentives?**

**Summary of Input:** The Panel received briefings and documents from
senior SSA officials on various return-to-work programs and studies
undertaken by the Agency, e.g., the Gallup poll of potential employment
networks. The results indicated there is real interest in the program
from potential providers but certain beneficiaries, by virtue of their
group affiliation (e.g., blind DI beneficiary)---may not be served as
readily as others. One reason is the length of time from the beginning
of service provision to the point when payments to the EN can start is
distinctly longer for some groups. The Panel received extensive public
comment on this issue, most of which advocated for a common earnings
level threshold for outcome payments for all beneficiaries. Also,
commenters encouraged the Panel to recommend a payment system with
financial incentives to serve individuals who are harder to serve (i.e.,
individuals with a need for ongoing support and services, individuals
who need high-cost accommodations, individuals who earn a sub minimum
wage, and individuals who work and receive partial cash benefits.)
Further, the Panel heard it would be prudent of SSA to develop a payment
system that includes all beneficiaries with disabilities to heighten the
likelihood of savings to the programs.

**Discussion:** Of particular concern to the majority of the Panel are
the inequities in the financial incentives structure related to certain
beneficiaries, e.g., SSI beneficiaries and the harder-to-serve
population. As proposed, the payment systems discourage ENs from serving
SSI beneficiaries because the EN would receive a smaller return for
similar effort and it could take considerably longer for SSI
beneficiaries to reach the point in employment when ENs can be paid.
This situation occurs, because in contrast to the DI program that has
definite timelines, SSI benefits continue indefinitely as long as the
beneficiary is working under their individual Federal Benefit Rate.

The Panel is also interested in the development of an effective
milestone/outcome payment structure to address the barriers to service
provision for individuals who are harder to serve. A consistent
outcome-payment threshold for all ticket users could level the playing
field, making all ticket users equally attractive to ENs in the context
of when a payment can be made. A dissenting Panel view was that Congress
was aware of the differences in the two disability programs and it was
premature to recommend changes in the payment system when the issue will
be part of the Adequacy of Incentives report mandated by the
legislation.

**Recommendation 22:** Because the Title II and Title XVI programs are
distinctly different from each other with differing processes and
timelines, SSA should develop two milestone outcome payment systems, one
for SSI recipients and another for SSDI beneficiaries, that take into
account the differences between the two programs and that factor into
consideration, issues of concurrent beneficiaries.

**Recommendation 23:** SSA should commission a full-cost benefit study
to evaluate the Ticket to Work and Work Incentives Programs. Such a
study should begin with a more complete view of the direct savings to
the SSA Trust Fund, but should also consider savings to the Federal
Treasury and increased productivity to the nation as a whole. Such a
study would, at a minimum, consider the impact of increased Federal
Insurance Contributions Act (FICA) contributions by working
beneficiaries, reduced use of Medicare, cash savings to the general fund
by SSI recipients who work but who only receive partial cash benefits
and estimated general fund savings beyond 60 months. The study should
also consider reduced use of all other government transfers and
increased taxes paid. It should consider the addition to Gross National
Product from increased work. It should evaluate costs and benefits from
SSA's point of view, from the view of the Federal government, from the
view of the beneficiary and from society as a whole.

**Issue: There is an internal conflict in the NPRM between the language
in Section 411.510(c) and the language in Section 411.390 regarding the
State Vocational Rehabilitation agency's (VR) choice of payment methods
for beneficiaries who are already clients of VR.**

**Summary of Input:** There was no public input on this issue.

**Discussion**: Section 411.390 of the proposed regulations says the
State VR agency may only seek payment under the cost reimbursement
payment system for beneficiaries already receiving services under an
IPE. This rule is in direct conflict with Section 411.510(C) which
states that the State VR agency will notify the Program Manager of the
payment system election for each such beneficiary. The Panel had no
opinion about either of the rules but felt that the regulatory
provisions should be consistent.

Recommendation 24: SSA should resolve the conflict between Sections
411.510 and 411.390 regarding VR's choice of payment systems for
beneficiaries who are already clients of VR.

**Related Program Issues:**

**Overpayments**

The Panel heard from several advocates concerning resolution of SSA's
current problems concerning timely cessation of benefits and accurate
record-keeping and reporting is critical to the success or failure of
the Ticket program. The issue of accurate and timely record-keeping will
impact both on ticket users who work, but continue to be sent benefit
checks (overpayments), as well as on EN's who help them to go to work
but will not be able to receive outcome payments as long as the checks
continue**.** Many advocates believe the issue of overpayments threatens
to derail one of the underlying premises of the Ticket program i.e., to
reward EN\'s in a timely manner for their successful efforts in helping
beneficiaries leave the rolls for work. The Panel is greatly concerned
that slow or inaccurate record-keeping by SSA will undermine the goals
of the Ticket program by provoking negative reactions from providers and
beneficiaries alike, as well as increasing the frequency of disputes and
appeals. Though not part of the Proposed Regulations, the Panel
recommends that the Agency develop better, more timely and accurate
mechanisms for record-keeping and reporting so that current overpayment
problems are addressed before irreparable harm results to the Ticket
program and other employment support programs.

**Disabled Adult Children (DACs), Disabled Widows and Widowers**

Although the Statute indicates Congress intended for these groups of
beneficiaries with disabilities to be eligible to participate in the
Ticket program, the NPRM did not directly mention them. The Panel heard
from advocates that under the current law, members of these groups who
choose to participate in the Ticket program, go to work and then for
whatever reason fail at the work attempt, could be irreparably
financially disadvantaged. This would occur because, under current law,
a Disabled Adult Child (DAC) who, after exhausting the Extended Period
of Eligibility (EPE) and then works above SGA, loses his or her DAC
status. If he or she subsequently loses the job, his or her dependency
status based on the parent's earnings record is lost and new entitlement
must be established as a disabled beneficiary. That change in status
could well result in a significantly lower level of benefit because the
new entitlement would be based on the beneficiary's little or no
earnings record, whereas the previous DAC benefits were based on the
parent's earnings record**.**

The issue also pertains to disabled widows and widowers and disabled
surviving divorced spouses who stop receiving SSDI benefits due to work
activity above the SGA level. The Panel commends the Agency for their
quick response to this issue through providing new operating
instructions to field components to assure Expedited Reinstatement prior
to the actual publications of new Regulations. This temporarily ensures
individuals from the above-mentioned groups will be able to participate
in the Ticket program under the same protections as all other
beneficiaries in the program without fear of loss of their status should
their employment not continue. However, the Panel recommends SSA include
clarification in the Ticket regulations and in the Expedited
Reinstatement regulations to help ensure this policy is permanently
adopted and understood by the public. The Panel further urges SSA to
publish a repeal of, or a clarification of, any other regulations which
could be interpreted to result in the loss of these dependent or
survivor benefits.

**Unintended Disincentives: Interaction between Existing Work Incentives
and the Ticket Program:**

The Panel believes there are a variety of issues which must be studied
and addressed, related to the interaction between current work incentive
and SGA-work related rules and the Ticket program, that may work to
deter Ticket Program participation. Some of these issues are discussed
in the input and discussion sections prior to Recommendations 20, 21 and
22. Specifically, existing program incentives are meant to recognize
some individuals with severe disabilities have high or ongoing costs
associated with their disability. If these individuals work, the
expenditures for such costs are deducted from countable income in
determining whether or not they are working above SGA. For example,
Impairment-Related Work Expenses (IRWEs) can be used to exclude earned
income if the costs of the item or services are related to the
disability and are needed to work (such as attendant care services to
help prepare the person for work everyday). Blind Work Expenses (BWEs)
allow exclusion of earned income that is used to meet a variety of the
expenses of working, whether or not they are related to the blindness
(for example, childcare expenses).

The Panel has heard public comment and has discussed some of these
issues. The Panel is very concerned that under the rules of the Ticket
program, current work incentives to work may become disincentives to ENs
to provide services to people with these needs, because they must earn
considerably more than their counterparts who do not have those expenses
in order to achieve zero benefit status and trigger EN payment. For
example, someone who works and uses the costs of their medication for
schizophrenia as an IRWE, may be at a disadvantage as to whether the EN
would take his or her ticket.

Another issue related to existing rules concerns how SSA interprets the
value to be placed on an individual's work effort with regard to whether
it exceeds SGA for people in supported employment. The Panel received
comments from supported employment advocates that this issue continues
to be the subject of confusion and concern in the field. The Panel
believes that further guidance from the Agency or perhaps regulations
may be needed to address these concerns.

The Panel is very concerned that, unless the work incentive issues are
addressed, beneficiaries may be dissuaded from using a ticket to further
enhance their work effort. Therefore, the Panel believes SSA must act to
address these issues of complexity, conformity and inconsistency
immediately. The two sets of program rules, the Ticket Program and
current work incentive provisions, should act in concert and be clearly
working toward the same goal to maximize employment effort and earnings
for the program participants.

##### APPENDIX A

**Schedule of Panel Meetings and Other Activities**

Ticket to Work and Work Incentive

**Advisory Panel**

# Public comment Periods during Panel Meetings and Other Activities

# 

#  **Panel Meeting Public Comment Period** 

1.  **July 24-25, 2000 2 Day Meeting 1 hr.**

2.  **September 11, 2000 Teleconference 45 min**

3.  **September 26-27, 2000 2 Day Meeting Briefing**

4.  **November 8, 2000 Teleconference 1 hr.**

5.  **November 13-15, 2000 3 Day Meeting 1 hr.**

6.  **November 27, 2000 Teleconference 1 hr.**

7.  **December 12, 2000 Teleconference 1 hr.**

8.  **December 19, 2000 Teleconference 1 hr.**

9.  **January 3, 2001 Teleconference 1 hr.**

**10. January 9-10, 2001 2 Day Meeting 2 hrs.**

**11. January 23, 2001 Teleconference 1 hr.**

**12. February 6-8, 2001 3 Day Meeting 3 hrs.**

**13. March 26-28, 2001 3 Day Meeting 2.5 hours**

**14. May 8-10, 2001 3 Day Meeting 1 hr.**

**15. June 22, 2001 Teleconference 2.5 hours**

## **REGIONAL MEETINGS**

#### Panel Meeting Public Comment Period 

1.  **January 22, 2001 Salt Lake City, Utah 3 hrs.**

2.  **January 24, 2001 Minneapolis, Minnesota 3 hrs.**

3.  **January 25, 2001 West Coast Teleconference 2 hrs.**

4.  **January 26, 2001 Phoenix, Arizona 4 hrs.**

5.  **January 29, 2001 Atlanta, Georgia 4 hrs.**

6.  **February 15, 2001 West Coast Teleconference 2 hrs.**

7.  **February 21, 2001 New York, New York 4 hrs.**

**APPENDIX B**

**List of Commenters**

**Social Security Administration**

**Ticket to Work and Work Incentives Advisory Panel**

**Teleconference**

**September 11, 2000**

# 

# List of Commenters

Ron Calhoun

Office of Vocational and Educational

Services for Individuals with Disabilities

New York Department of Education

Jenny Kaufmann

National Senior Citizens Law Center

Washington, DC

**Social Security Administration**

**Ticket to Work and Work Incentives Advisory Panel**

**Teleconference**

**International Trade Commission**

**Washington, DC**

**November 8, 2000**

# 

# List of Commenters

Marty Ford

Director of Government Affairs

ARC of the United States

Washington, DC

Cheryl Bates Harris

NAPAS

Washington, DC

Linda Landry

Disability Law Center

Boston, MA

Ann Maclaine

Director of the Louisiana Protection

and Advocacy Agency

New Orleans, LA

Murray Manus

Equip for Equality

Chicago, IL

Aleisa McKinlay

Public Policy Analyst

Advocacy Service

Lincoln, NE

Gary Richter

Indiana Protection and Advocacy

Indianapolis, IN

Edward Wollman

Disability Community Small Business

Development Center

Ann Arbor, MI

Dave Ziskind

Director of the Division of Program

Administration, RSA, Vocational

Rehabilitation Program

Washington, DC

Dave Zehner

Protection and Advocacy for People

with Disabilities

Charleston, SC

**Social Security Administration**

**Ticket to Work and Work Incentives Advisory Panel**

**Quarterly Meeting**

**Embassy Suites at Chevy Chase Pavilion**

**Washington, DC**

**November 13-15, 2000**

# 

# List of Commenters

Sue Augustus

SSI Coalition

Chicago, IL

Alan Bergman

President and CEO

Brain Injury Association

Alexandria, VA

Kara Freeburg

American Network of Community

Options and Resources (ANCOR)

Annandale, VA

Marty Ford

Director of Government Affairs

ARC of the United States

Washington, DC

Charles Harles

Executive Director

International Association of Business,

Industry and Rehabilitation (INABIR)

Washington, DC

Mitch Jessirich

World Institute on Disability

Oakland, CA

Jenny Kaufmann

National Senior Citizens Law Center

Washington, DC

Mary Kelly

National Association of

Developmental Disabilities Council

Washington, DC

Dan O'Brien

Oklahoma Department of

Rehabilitation Services

Oklahoma City, OK

Mike O'Brien

Oklahoma Department of

Rehabilitation Services

Oklahoma City, OK

Katherine Mario

New York Vocational and Educational Services for Individuals with
Disabilities (VESID)

Albany, NY

Celane McWhorter

Association for Persons in Supported Employment

Alexandria, VA

Susan Prokop

Paralyzed Veterans of America (PVA)

Washington, DC

Andrew Sperling

Director of Public Policy

National Association for the Mentally Ill (NAMI)

Arlington, VA

Michael Van Essen

AIDS Assistance Organization

Palm Springs, CA

**Social Security Administration**

**Ticket to Work and Work Incentives Advisory Panel**

**Meeting**

**Holiday Inn Capitol**

**Washington, DC**

**January 9-10, 2001**

# 

# List of Commenters

Dennis Born

Program Manager

Supported Employment Consultation

and Training Center

Anderson, IN

Paul Seifert

IAPSRS

Columbia, MD

Charles Harles

Executive Director of INABIR

Washington, DC

Damon Hicks

Supported Employment Consultation and Training Center

Anderson, IN

Mike O'Brien

DRS

Oklahoma City, OK

**APPENDIX C**

**Letter to Commissioner Halter**

**Concerning agency plans**

**For implementation**

**And first year roll out**

November 13, 2023

6401 Security Blvd.

Room 960 Altmeyer Building

Baltimore , MD 21235

Dear 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
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) denying access to the Ticket
program to over approximately 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

**APPENDIX D**

**Response from the**

**Office of the Actuary**

**On cost implications**

**Of Proposals**

![](media/image1.png){width="0.65in" height="0.65in"}SOCIAL SECURITY

# MEMORANDUM

Date: March 26, 2001 Refer To: **TCB**

To: Richard V. Burkhauser

Ticket to Work Advisory Panel

From: Bert Kestenbaum

Mary E. McKay

Office of the Chief Actuary

Subject: Estimates of the Short-Range Effects on OASDI Benefits and
Federal SSI Payments of Modifications to the Implementation of the
Ticket to Work Program Specified in the Notice of Proposed Rulemaking
(NPRM)---**INFORMATION**

> Under the provisions of P.L. 106--170 establishing the Ticket to Work
> (TTW) program, the Commissioner of Social Security has the authority
> to specify the details of certain aspects of the program\'s
> implementation. Three key aspects of this delegation of authority are
> (1) the timing of the program\'s startup in various States across the
> nation, (2) the determination of which disabled beneficiaries will be
> eligible to participate in the TTW program, and (3) the timing and
> amount of the milestone and outcome payments to employment networks
> (ENs) providing services under the program.
>
> We previously prepared estimates of the impact of the TTW program
> consistent with the proposed implementation as published in the NPRM.
> The key aspects incorporated into these estimates are described below.

-   The TTW program is assumed to be made available to 30, 60, and 100
    percent of the eligible population in the first, second, and third
    years, respectively, with implementation starting in some States
    early in calendar year 2001. Please note that, in actuality, the
    issuing of tickets will be delayed until the publication of the
    final regulation, resulting in a somewhat later startup in some
    States than has been assumed.

```{=html}
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```
-   The eligible population, as specified in the NPRM, will consist of
    disabled adults aged 18 to 64 who (1) have a permanent impairment;
    (2) have an impairment classified as medical improvement possible;
    or (3) have undergone at least one continuing disability review
    (CDR) for an impairment classified as medical improvement expected
    (MIE). SSI disabled children will be eligible to receive a ticket
    after attaining age 18 and undergoing a medical redetermination to
    assure that they meet the adult disability standard.

-   P.L 106--170 authorizes two payment systems under which ENs can be
    paid. The NPRM sets the monthly outcome payment under the
    outcome-only payment system at 40 percent of the payment calculation
    base. Outcome payments are made for each month for which OASDI or
    SSI disability benefits are not payable to the individual because of
    work, up to a maximum of 60 months.

> Under the outcome-milestone payment system, the NPRM provides for up
> to two milestone payments. The first milestone, set at 68 percent of
> the payment calculation base, is payable after the disabled
> beneficiary has worked for 3 months within a 12-month period and has
> earnings at or above the SGA amount for each of these 3 months. The
> second milestone, set at 136 percent of the payment calculation base,
> is payable after the disabled beneficiary has worked for 7 months
> within a 12-month period and has earnings at or above the SGA amount
> for each of these 7 months. Outcome payments increase from 30 percent
> of the payment calculation base for the first 12 outcome payments to
> 38 percent of the payment calculation base for the 49^th^ to 60^th^
> outcome payments. The first 12 outcome payments are reduced by the
> amount of any milestone payments made.

The TTW Advisory Panel has requested that we provide estimates for two
options to expand the group of disabled beneficiaries who are eligible
to receive tickets. The first option would extend eligibility to
disabled adults who are classified as MIEs and have not yet undergone a
CDR. The second option would further extend eligibility to SSI disabled
child recipients aged 16 to 18. This second option could have different
costs depending on whether a child recipient who was using a ticket
would still have to undergo a medical redetermination upon attainment of
age 18. If the timing of the medical redetermination were not affected,
a child recipient whose redetermination resulted in a decision to cease
benefits would only be protected under the provisions of the Social
Security Act which provide for benefit continuation while participating
in a vocational rehabilitation program. However, if age 18
redeterminations were to be treated as CDRs and deferred until the child
recipient were no longer participating in the TTW program, benefit
cessation would be delayed still further, resulting in additional SSI
program outlays. For purposes of completeness, the Office of Employment
Support Programs (OESP) has requested that we provide estimates for each
of these alternative treatments of age 18 redeterminations, although
OESP indicated that if tickets were to be given to disabled children
their preferred option would be to treat age 18 redeterminations as
CDRs.

> The net effect of the proposed options to expand the group of disabled
> beneficiaries is rather complicated due to the interaction between the
> TTW program and the separate legislative mandates to conduct CDRs of
> disabled adults and medical redeterminations of SSI disabled children
> attaining age 18. The attached table lays out the detailed aspects of
> these program outlay effects. The first tier of the table presents the
> estimated effects of TTW as specified in the NPRM. The succeeding
> tiers present the estimated effects of the proposed expansion options,
> including estimated additional costs attributable to providing
> disabled children subject to age 18 redeterminations the same benefit
> protection as adults due a CDR. As noted previously, the actual
> program startup depends on the timing of the publication of the final
> regulation and will be delayed somewhat from the assumed startup
> timing incorporated into our estimates.
>
> /S/
>
> Bert Kestenbaum., A.S.A.
>
> Actuary
>
> /S/
>
> Mary E. McKay, F.S.A.
>
> Actuary
>
> Attachment

<table style="width:100%;">
<colgroup>
<col style="width: 31%" />
<col style="width: 0%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="14"><p>Estimated increases(+) or decreases(-) in program
expenditures under the Ticket to Work program due to providing
additional services or protection to certain newly disabled individuals
and certain disabled children, fiscal years 2001-10</p>
<p>(In millions)</p></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td colspan="11">Fiscal year</td>
<td rowspan="2"><p>Total,</p>
<p><u>2001-10</u></p></td>
</tr>
<tr class="odd">
<td>Option</td>
<td></td>
<td><u>2001</u></td>
<td><u>2002</u></td>
<td colspan="2"><u>2003</u></td>
<td><u>2004</u></td>
<td><u>2005</u></td>
<td><u>2006</u></td>
<td><u>2007</u></td>
<td><u>2008</u></td>
<td><u>2009</u></td>
<td><u>2010</u></td>
</tr>
<tr class="even">
<td>Ticket to Work program effects based on implementation as specified
in the Notice of Proposed Rulemaking (NPRM):</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><blockquote>
<p>OASDI benefit payments</p>
</blockquote></td>
<td></td>
<td>–</td>
<td>$2</td>
<td colspan="2">$2</td>
<td>$3</td>
<td>-$10</td>
<td>-$20</td>
<td>-$29</td>
<td>-$41</td>
<td>-$64</td>
<td>-$101</td>
<td>-$258</td>
</tr>
<tr class="even">
<td><blockquote>
<p>Federal SSI payments</p>
</blockquote></td>
<td></td>
<td>-$1</td>
<td>-4</td>
<td colspan="2">-12</td>
<td>-19</td>
<td>-21</td>
<td>-18</td>
<td>-18</td>
<td>-27</td>
<td>-48</td>
<td>-67</td>
<td>-235</td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Subtotal, OASDI and SSI</p>
</blockquote></td>
<td></td>
<td>-1</td>
<td>-2</td>
<td colspan="2">-10</td>
<td>-16</td>
<td>-31</td>
<td>-38</td>
<td>-47</td>
<td>-68</td>
<td>-112</td>
<td>-168</td>
<td>-493</td>
</tr>
<tr class="even">
<td>Revisions to estimated program effects due to the inclusion of newly
disabled persons classified as Medical Improvement Expected(MIE) in the
population receiving tickets:</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Ticket to Work program:</p>
</blockquote></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><blockquote>
<p>OASDI benefit payments</p>
</blockquote></td>
<td></td>
<td>–</td>
<td>1</td>
<td colspan="2">1</td>
<td>2</td>
<td>-1</td>
<td>-11</td>
<td>-18</td>
<td>-25</td>
<td>-35</td>
<td>-49</td>
<td>-135</td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Federal SSI payments</p>
</blockquote></td>
<td></td>
<td>(<u>1</u>/)</td>
<td>-3</td>
<td colspan="2">-6</td>
<td>-9</td>
<td>-9</td>
<td>-10</td>
<td>-15</td>
<td>-22</td>
<td>-32</td>
<td>-42</td>
<td>-148</td>
</tr>
<tr class="even">
<td><blockquote>
<p>Continuing Disability Reviews:</p>
</blockquote></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><blockquote>
<p>OASDI benefit payments</p>
</blockquote></td>
<td></td>
<td>–</td>
<td>2</td>
<td colspan="2">11</td>
<td>32</td>
<td>72</td>
<td>108</td>
<td>135</td>
<td>153</td>
<td>173</td>
<td>195</td>
<td>882</td>
</tr>
<tr class="even">
<td><blockquote>
<p>Federal SSI payments</p>
</blockquote></td>
<td></td>
<td>(<u>1</u>/)</td>
<td>1</td>
<td colspan="2">4</td>
<td>11</td>
<td>24</td>
<td>32</td>
<td>33</td>
<td>37</td>
<td>39</td>
<td>41</td>
<td>222</td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Net effect of MIE inclusion:</p>
</blockquote></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><blockquote>
<p>OASDI benefit payments</p>
</blockquote></td>
<td></td>
<td>–</td>
<td>3</td>
<td colspan="2">12</td>
<td>34</td>
<td>71</td>
<td>97</td>
<td>117</td>
<td>128</td>
<td>138</td>
<td>146</td>
<td>747</td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Federal SSI payments</p>
</blockquote></td>
<td></td>
<td>(<u>1</u>/)</td>
<td>-2</td>
<td colspan="2">-2</td>
<td>3</td>
<td>15</td>
<td>22</td>
<td>18</td>
<td>15</td>
<td>7</td>
<td>-1</td>
<td>75</td>
</tr>
<tr class="even">
<td><blockquote>
<p>Subtotal, OASDI and SSI</p>
</blockquote></td>
<td></td>
<td>(<u>1</u>/)</td>
<td>1</td>
<td colspan="2">10</td>
<td>37</td>
<td>86</td>
<td>119</td>
<td>135</td>
<td>143</td>
<td>145</td>
<td>145</td>
<td>822</td>
</tr>
<tr class="odd">
<td>Revisions to Federal SSI payments due to the inclusion of SSI
disabled children aged 16 and older in the population receiving tickets
2/:</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><blockquote>
<p>Ticket to Work program:</p>
</blockquote></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Federal SSI payments</p>
</blockquote></td>
<td></td>
<td>-1</td>
<td>-7</td>
<td colspan="2">-19</td>
<td>-32</td>
<td>-40</td>
<td>-41</td>
<td>-47</td>
<td>-64</td>
<td>-86</td>
<td>-110</td>
<td>-446</td>
</tr>
<tr class="even">
<td><blockquote>
<p>Continuing Disability Reviews:</p>
</blockquote></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Federal SSI payments</p>
</blockquote></td>
<td></td>
<td>(<u>1</u>/)</td>
<td>4</td>
<td colspan="2">22</td>
<td>53</td>
<td>86</td>
<td>97</td>
<td>100</td>
<td>117</td>
<td>123</td>
<td>127</td>
<td>730</td>
</tr>
<tr class="even">
<td><blockquote>
<p>Net effect of inclusion of children without deferral of age 18
redeterminations:</p>
</blockquote></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Federal SSI payments</p>
</blockquote></td>
<td></td>
<td>-1</td>
<td>-3</td>
<td colspan="2">3</td>
<td>21</td>
<td>46</td>
<td>57</td>
<td>53</td>
<td>53</td>
<td>36</td>
<td>18</td>
<td>284</td>
</tr>
<tr class="even">
<td>Revisions to Federal SSI payments due to deferral of age 18
redeterminations in accordance with CDR deferral provisions:</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Continuing Disability Reviews:</p>
</blockquote></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><blockquote>
<p>Federal SSI payments</p>
</blockquote></td>
<td></td>
<td>(<u>1</u>/)</td>
<td>(<u>1</u>/)</td>
<td colspan="2">(<u>1</u>/)</td>
<td>1</td>
<td>9</td>
<td>28</td>
<td>47</td>
<td>56</td>
<td>58</td>
<td>57</td>
<td>256</td>
</tr>
<tr class="odd">
<td>Ticket to Work program effects if newly disabled MIEs and certain
disabled children are included and age 18 redeterminations are treated
as CDRs:</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><blockquote>
<p>OASDI benefit payments</p>
</blockquote></td>
<td></td>
<td>–</td>
<td>5</td>
<td colspan="2">14</td>
<td>37</td>
<td>61</td>
<td>77</td>
<td>88</td>
<td>87</td>
<td>74</td>
<td>45</td>
<td>489</td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Federal SSI payments</p>
</blockquote></td>
<td></td>
<td>-2</td>
<td>-9</td>
<td colspan="2">-10</td>
<td>6</td>
<td>49</td>
<td>88</td>
<td>100</td>
<td>98</td>
<td>53</td>
<td>8</td>
<td>380</td>
</tr>
<tr class="even">
<td><blockquote>
<p>Total, OASDI and SSI</p>
</blockquote></td>
<td></td>
<td>-2</td>
<td>-4</td>
<td colspan="2">4</td>
<td>43</td>
<td>110</td>
<td>165</td>
<td>188</td>
<td>185</td>
<td>127</td>
<td>53</td>
<td>869</td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="14"><p><u>1</u>/ Net change in OASDI benefit payments or
Federal SSI payments of less than $500,000.</p>
<p><u>2</u>/ Assumes disabled children who activate their ticket prior
to notification of an age 18 redetermination would be given benefit
protection under the provisions of the Act which provide for benefit
continuation while participating in a vocational rehabilitation program.
The cost of according those children the same benefit protection as
adults due a CDR is presented in the next tier of this table.</p>
<p>Notes: 1. Above estimates based on the intermediate assumptions of
the 2000 OASDI Trustees Report and the 2000 SSI Annual Report.</p>
<p>2. Totals may not equal sum of rounded components.</p></td>
</tr>
<tr class="odd">
<td colspan="5"></td>
<td colspan="9"><p>Social Security Administration</p>
<p>Office of the Chief Actuary</p>
<p>March 26, 2001</p></td>
</tr>
</tbody>
</table>

![](media/image1.png){width="0.65in" height="0.65in"}SOCIAL SECURITY

# MEMORANDUM

Date: April 11, 2001 Refer To: **TCB**

To: Richard V. Burkhauser

Ticket to Work Advisory Panel

From: Bert Kestenbaum

Mary E. McKay

Office of the Chief Actuary

Subject: Estimates of the Short-Range Effects on OASDI Benefits and
Federal SSI Payments of Alternatives to the Ticket to Work
Outcome-Milestone Payment System Specified in the Notice of Proposed
Rulemaking (NPRM)---**INFORMATION**

> Under the provisions of P.L. 106--170 establishing the Ticket to Work
> (TTW) program, the Commissioner of Social Security has the authority
> to specify the details of certain aspects of the program\'s
> implementation. Three key aspects of this delegation of authority are
> (1) the timing of the program\'s startup in various States across the
> nation, (2) the determination of which disabled beneficiaries will be
> eligible to participate in the TTW program, and (3) the timing and
> amount of the milestone and outcome payments to employment networks
> (ENs) providing services under the program.

We previously prepared estimates of the impact of the TTW program
consistent with the proposed implementation as published in the NPRM.
The key aspects incorporated into these estimates are described below.

-   The TTW program is assumed to be made available to 30, 60, and 100
    percent of the eligible population in the first, second, and third
    years, respectively, with implementation starting in some States
    early in calendar year 2001. Please note that, in actuality, the
    issuing of tickets will be delayed until the publication of the
    final regulation, resulting in a somewhat later startup in some
    States than has been assumed.

```{=html}
<!-- -->
```
-   The eligible population, as specified in the NPRM, will consist of
    disabled adults aged 18 to 64 who (1) have a permanent impairment;
    (2) have an impairment classified as medical improvement possible;
    or (3) have undergone at least one continuing disability review for
    an impairment classified as medical improvement expected. SSI
    disabled children will be eligible to receive a ticket after
    attaining age 18 and undergoing a medical redetermination to assure
    that they meet the adult disability standard.

-   P.L. 106--170 authorizes two payment systems under which ENs can be
    paid. The NPRM sets the monthly outcome payment under the
    outcome-only payment system at 40 percent of the payment calculation
    base. Outcome payments are made for each month for which OASDI or
    SSI disability benefits are not payable to the individual because of
    work, up to a maximum of 60 months.

> Under the outcome-milestone payment system, the NPRM provides for up
> to two milestone payments which were designed to equal in total 10
> percent of the total outcome payments available under the
> outcome-milestone payment system. The first milestone, set at 68
> percent of the payment calculation base, is payable after the disabled
> beneficiary has worked for 3 months within a 12-month period and has
> earnings at or above the SGA amount for each of these 3 months. The
> second milestone, set at 136 percent of the payment calculation base,
> is payable after the disabled beneficiary has worked for 7 months
> within a 12-month period and has earnings at or above the SGA amount
> for each of these 7 months. Outcome payments increase from 30 percent
> of the payment calculation base for the first 12 outcome payments to
> 38 percent of the payment calculation base for the 49^th^ to 60^th^
> outcome payments. The first 12 outcome payments are further reduced by
> the amount of any milestone payments made.

At the request of the TTW Advisory Panel we prepared estimates for two
options to expand the group of disabled beneficiaries who are eligible
to receive tickets. These estimates were presented in our memorandum
dated March 26, 2001.

The TTW Advisory Panel has also requested that we provide estimates for
several alternatives to the TTW outcome-milestone payment system
specified in the NPRM. These alternatives are described below.

-   Alternative 1---Increase the total potential milestone payments to
    20 percent of the total outcome payments available under the
    outcome-milestone payment system by establishing a third milestone
    payment equal to the sum of the first two milestone payments. This
    third milestone would be payable after the disabled beneficiary
    completes 12 months of SGA. In addition, increase from 12 to 24 the
    number of outcome payments from which the milestone payments will be
    recovered.

-   Alternative 2---Same as alternative 1 except increase from 12 to 60
    the number of outcome payments from which the milestone payments
    will be recovered.

-   Alternative 3---Same as alternative 2 except set all outcome
    payments under the outcome-milestone payment system to 38 percent of
    the payment calculation base. Since the total potential milestone
    payments are assumed to equal 20 percent of the total potential
    outcome payments, the milestone payments are proportionately higher
    than those in alternative 2.

-   Alternative 4---The Advisory Panel also requested estimates for
    several options which provide for establishing milestones much
    earlier in the process than does the NPRM. Rather than prepare
    separate estimates for each of these options for which it may be
    difficult to differentiate costs, we have developed one alternative
    to show the order of magnitude of program costs that might be
    expected under such an alternative. For this alternative we increase
    the potential milestone payments to 40 percent of the total
    potential outcome payments under the outcome-milestone payment
    system with about 60 percent of these milestone payments payable
    much earlier in the process than under the payment system specified
    in the NPRM. Outcome payments average 34 percent of the payment
    calculation base similar to the NPRM. The recovery of milestone
    payments is spread over all 60 outcome payments.

> The attached table 1 presents the estimated impact on program outlays
> of these proposed alternatives to the outcome-milestone payment
> system. The differences between the estimated program expenditures for
> these alternatives and the estimated program expenditures for the TTW
> program based on the proposed implementation as specified in the NPRM
> are presented in table 2. These estimates are based on the
> intermediate assumptions of the 2000 OASDI Trustees Report and the
> assumptions underlying the 2000 SSI Annual Report. As noted
> previously, the actual program startup depends on the timing of the
> publication of the final regulation and will be delayed somewhat from
> the assumed startup timing incorporated into our estimates. It should
> also be noted that these estimates should be considered quite rough
> and providing order of magnitude estimates only since there is little
> experience upon which to base them.
>
> /S/
>
> Bert Kestenbaum, A.S.A.
>
> Actuary
>
> /S/
>
> Mary E. McKay, F.S.A.
>
> Actuary
>
> Attachments: 2

<table style="width:100%;">
<colgroup>
<col style="width: 31%" />
<col style="width: 0%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="14"><p>Table 1—Estimated increases(+) or decreases(-) in
OASDI benefits and Federal SSI payments under the Ticket to Work program
for selected alternatives to the outcome-milestone payment system,
fiscal years 2001-10</p>
<p>(In millions)</p></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td colspan="11">Fiscal year</td>
<td rowspan="2"><p>Total,</p>
<p><u>2001-10</u></p></td>
</tr>
<tr class="odd">
<td>Option</td>
<td></td>
<td><u>2001</u></td>
<td><u>2002</u></td>
<td colspan="2"><u>2003</u></td>
<td><u>2004</u></td>
<td><u>2005</u></td>
<td><u>2006</u></td>
<td><u>2007</u></td>
<td><u>2008</u></td>
<td><u>2009</u></td>
<td><u>2010</u></td>
</tr>
<tr class="even">
<td><strong>Ticket to Work program effects based on implementation as
specified in the Notice of Proposed Rulemaking:</strong></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><blockquote>
<p>OASDI benefit payments</p>
</blockquote></td>
<td></td>
<td>–</td>
<td>$2</td>
<td colspan="2">$2</td>
<td>$3</td>
<td>-$10</td>
<td>-$20</td>
<td>-$29</td>
<td>-$41</td>
<td>-$64</td>
<td>-$101</td>
<td>-$258</td>
</tr>
<tr class="even">
<td><blockquote>
<p>Federal SSI payments</p>
</blockquote></td>
<td></td>
<td>-$1</td>
<td>-4</td>
<td colspan="2">-12</td>
<td>-19</td>
<td>-21</td>
<td>-18</td>
<td>-18</td>
<td>-27</td>
<td>-48</td>
<td>-67</td>
<td>-235</td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Subtotal, OASDI and SSI</p>
</blockquote></td>
<td></td>
<td>-1</td>
<td>-2</td>
<td colspan="2">-10</td>
<td>-16</td>
<td>-31</td>
<td>-38</td>
<td>-47</td>
<td>-68</td>
<td>-112</td>
<td>-168</td>
<td>-493</td>
</tr>
<tr class="even">
<td><strong>Alternative 1—establish a 3<sup>rd</sup> milestone and
extend recovery of milestone payments to 24 months:</strong></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><blockquote>
<p>OASDI benefit payments</p>
</blockquote></td>
<td></td>
<td>–</td>
<td>2</td>
<td colspan="2">7</td>
<td>16</td>
<td>12</td>
<td>-1</td>
<td>-14</td>
<td>-25</td>
<td>-47</td>
<td>-85</td>
<td>-133</td>
</tr>
<tr class="even">
<td><blockquote>
<p>Federal SSI payments</p>
</blockquote></td>
<td></td>
<td>-1</td>
<td>-4</td>
<td colspan="2">-10</td>
<td>-17</td>
<td>-19</td>
<td>-16</td>
<td>-16</td>
<td>-24</td>
<td>-41</td>
<td>-58</td>
<td>-205</td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Subtotal, OASDI and SSI</p>
</blockquote></td>
<td></td>
<td>-1</td>
<td>-2</td>
<td colspan="2">-3</td>
<td>-1</td>
<td>-7</td>
<td>-17</td>
<td>-30</td>
<td>-49</td>
<td>-88</td>
<td>-143</td>
<td>-338</td>
</tr>
<tr class="even">
<td><strong>Alternative 2—establish a 3<sup>rd</sup> milestone and
extend recovery of milestone payments to 60 months:</strong></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><blockquote>
<p>OASDI benefit payments</p>
</blockquote></td>
<td></td>
<td>–</td>
<td>2</td>
<td colspan="2">8</td>
<td>19</td>
<td>21</td>
<td>13</td>
<td>2</td>
<td>-13</td>
<td>-39</td>
<td>-80</td>
<td>-66</td>
</tr>
<tr class="even">
<td><blockquote>
<p>Federal SSI payments</p>
</blockquote></td>
<td></td>
<td>(<u>1</u>/)</td>
<td>-4</td>
<td colspan="2">-9</td>
<td>-14</td>
<td>-15</td>
<td>-12</td>
<td>-11</td>
<td>-18</td>
<td>-32</td>
<td>-45</td>
<td>-160</td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Subtotal, OASDI and SSI</p>
</blockquote></td>
<td></td>
<td>(<u>1</u>/)</td>
<td>-2</td>
<td colspan="2">-1</td>
<td>5</td>
<td>6</td>
<td>1</td>
<td>-9</td>
<td>-31</td>
<td>-71</td>
<td>-125</td>
<td>-226</td>
</tr>
<tr class="even">
<td><strong>Alternative 3—establish a 3<sup>rd</sup> milestone, extend
recovery of milestone payments to 60 months, and increase outcome
payments:</strong></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><blockquote>
<p>OASDI benefit payments</p>
</blockquote></td>
<td></td>
<td>–</td>
<td>4</td>
<td colspan="2">16</td>
<td>35</td>
<td>47</td>
<td>39</td>
<td>29</td>
<td>14</td>
<td>-12</td>
<td>-53</td>
<td>119</td>
</tr>
<tr class="even">
<td><blockquote>
<p>Federal SSI payments</p>
</blockquote></td>
<td></td>
<td>(<u>1</u>/)</td>
<td>-2</td>
<td colspan="2">-6</td>
<td>-8</td>
<td>-8</td>
<td>-4</td>
<td>-2</td>
<td>-4</td>
<td>-9</td>
<td>-16</td>
<td>-58</td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Subtotal, OASDI and SSI</p>
</blockquote></td>
<td></td>
<td>(<u>1</u>/)</td>
<td>2</td>
<td colspan="2">10</td>
<td>27</td>
<td>39</td>
<td>35</td>
<td>27</td>
<td>10</td>
<td>-21</td>
<td>-69</td>
<td>61</td>
</tr>
<tr class="even">
<td><strong>Alternative 4—establish additional milestones earlier in the
process and extend recovery of milestone payments to 60
months:</strong></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><blockquote>
<p>OASDI benefit payments</p>
</blockquote></td>
<td></td>
<td>60</td>
<td>154</td>
<td colspan="2">300</td>
<td>341</td>
<td>358</td>
<td>371</td>
<td>382</td>
<td>375</td>
<td>357</td>
<td>329</td>
<td>3,028</td>
</tr>
<tr class="even">
<td><blockquote>
<p>Federal SSI payments</p>
</blockquote></td>
<td></td>
<td>4</td>
<td>21</td>
<td colspan="2">35</td>
<td>52</td>
<td>46</td>
<td>57</td>
<td>93</td>
<td>135</td>
<td>159</td>
<td>165</td>
<td>768</td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Total, OASDI and SSI</p>
</blockquote></td>
<td></td>
<td>64</td>
<td>175</td>
<td colspan="2">335</td>
<td>393</td>
<td>404</td>
<td>428</td>
<td>475</td>
<td>510</td>
<td>516</td>
<td>494</td>
<td>3,796</td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="14"><p><u>1</u>/ Net change in OASDI benefit payments or
Federal SSI payments of less than $500,000.</p>
<p>Notes: 1. Above estimates based on the intermediate assumptions of
the 2000 OASDI Trustees Report and the 2000 SSI Annual Report.</p>
<p>2. Totals may not equal sum of rounded components.</p></td>
</tr>
<tr class="even">
<td colspan="5"></td>
<td colspan="9"><p>Social Security Administration</p>
<p>Office of the Chief Actuary</p>
<p>April 11, 2001</p></td>
</tr>
</tbody>
</table>

<table style="width:100%;">
<colgroup>
<col style="width: 31%" />
<col style="width: 0%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="14"><p>Table 2—Estimated OASDI benefits and Federal SSI
payments in excess of those estimated for the Ticket to Work program
based on implementation as specified in the Notice of Proposed
Rulemaking (NPRM), due to selected alternatives to the outcome-milestone
payment system, fiscal years 2001-10</p>
<p>(In millions)</p></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td colspan="11">Fiscal year</td>
<td rowspan="2"><p>Total,</p>
<p><u>2001-10</u></p></td>
</tr>
<tr class="odd">
<td>Option</td>
<td></td>
<td><u>2001</u></td>
<td><u>2002</u></td>
<td colspan="2"><u>2003</u></td>
<td><u>2004</u></td>
<td><u>2005</u></td>
<td><u>2006</u></td>
<td><u>2007</u></td>
<td><u>2008</u></td>
<td><u>2009</u></td>
<td><u>2010</u></td>
</tr>
<tr class="even">
<td><strong>Ticket to Work program based on implementation as specified
in the NPRM</strong></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><blockquote>
<p>OASDI benefit payments</p>
</blockquote></td>
<td></td>
<td>–</td>
<td>–</td>
<td colspan="2">–</td>
<td>–</td>
<td>–</td>
<td>–</td>
<td>–</td>
<td>–</td>
<td>–</td>
<td>–</td>
<td>–</td>
</tr>
<tr class="even">
<td><blockquote>
<p>Federal SSI payments</p>
</blockquote></td>
<td></td>
<td>–</td>
<td>–</td>
<td colspan="2">–</td>
<td>–</td>
<td>–</td>
<td>–</td>
<td>–</td>
<td>–</td>
<td>–</td>
<td>–</td>
<td>–</td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Subtotal, OASDI and SSI</p>
</blockquote></td>
<td></td>
<td>–</td>
<td>–</td>
<td colspan="2">–</td>
<td>–</td>
<td>–</td>
<td>–</td>
<td>–</td>
<td>–</td>
<td>–</td>
<td>–</td>
<td>–</td>
</tr>
<tr class="even">
<td><strong>Alternative 1—establish a 3<sup>rd</sup> milestone and
extend recovery of milestone payments to 24 months:</strong></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><blockquote>
<p>OASDI benefit payments</p>
</blockquote></td>
<td></td>
<td>–</td>
<td>(<u>1</u>/)</td>
<td colspan="2">$5</td>
<td>$13</td>
<td>$22</td>
<td>$19</td>
<td>$15</td>
<td>$16</td>
<td>$17</td>
<td>$16</td>
<td>$125</td>
</tr>
<tr class="even">
<td><blockquote>
<p>Federal SSI payments</p>
</blockquote></td>
<td></td>
<td>–</td>
<td>(<u>1</u>/)</td>
<td colspan="2">1</td>
<td>2</td>
<td>3</td>
<td>2</td>
<td>2</td>
<td>3</td>
<td>7</td>
<td>9</td>
<td>30</td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Subtotal, OASDI and SSI</p>
</blockquote></td>
<td></td>
<td>–</td>
<td>(<u>1</u>/)</td>
<td colspan="2">6</td>
<td>15</td>
<td>25</td>
<td>21</td>
<td>17</td>
<td>19</td>
<td>24</td>
<td>25</td>
<td>155</td>
</tr>
<tr class="even">
<td><strong>Alternative 2—establish a 3<sup>rd</sup> milestone and
extend recovery of milestone payments to 60 months:</strong></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><blockquote>
<p>OASDI benefit payments</p>
</blockquote></td>
<td></td>
<td>–</td>
<td>(<u>1</u>/)</td>
<td colspan="2">6</td>
<td>16</td>
<td>31</td>
<td>33</td>
<td>31</td>
<td>28</td>
<td>25</td>
<td>21</td>
<td>192</td>
</tr>
<tr class="even">
<td><blockquote>
<p>Federal SSI payments</p>
</blockquote></td>
<td></td>
<td>–</td>
<td>$1</td>
<td colspan="2">3</td>
<td>5</td>
<td>6</td>
<td>6</td>
<td>7</td>
<td>9</td>
<td>16</td>
<td>22</td>
<td>74</td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Subtotal, OASDI and SSI</p>
</blockquote></td>
<td></td>
<td>–</td>
<td>1</td>
<td colspan="2">9</td>
<td>21</td>
<td>37</td>
<td>39</td>
<td>38</td>
<td>37</td>
<td>41</td>
<td>43</td>
<td>266</td>
</tr>
<tr class="even">
<td><strong>Alternative 3—establish a 3<sup>rd</sup> milestone, extend
recovery of milestone payments to 60 months, and increase outcome
payments:</strong></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><blockquote>
<p>OASDI benefit payments</p>
</blockquote></td>
<td></td>
<td>–</td>
<td>2</td>
<td colspan="2">14</td>
<td>32</td>
<td>57</td>
<td>59</td>
<td>58</td>
<td>55</td>
<td>52</td>
<td>48</td>
<td>377</td>
</tr>
<tr class="even">
<td><blockquote>
<p>Federal SSI payments</p>
</blockquote></td>
<td></td>
<td>–</td>
<td>2</td>
<td colspan="2">6</td>
<td>11</td>
<td>14</td>
<td>14</td>
<td>16</td>
<td>23</td>
<td>39</td>
<td>51</td>
<td>177</td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Subtotal, OASDI and SSI</p>
</blockquote></td>
<td></td>
<td>–</td>
<td>4</td>
<td colspan="2">20</td>
<td>43</td>
<td>71</td>
<td>73</td>
<td>74</td>
<td>78</td>
<td>91</td>
<td>99</td>
<td>554</td>
</tr>
<tr class="even">
<td><strong>Alternative 4—establish additional milestones earlier in the
process and extend recovery of milestone payments to 60
months:</strong></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><blockquote>
<p>OASDI benefit payments</p>
</blockquote></td>
<td></td>
<td>$60</td>
<td>152</td>
<td colspan="2">298</td>
<td>338</td>
<td>368</td>
<td>391</td>
<td>411</td>
<td>416</td>
<td>421</td>
<td>430</td>
<td>3,286</td>
</tr>
<tr class="even">
<td><blockquote>
<p>Federal SSI payments</p>
</blockquote></td>
<td></td>
<td>5</td>
<td>25</td>
<td colspan="2">47</td>
<td>71</td>
<td>68</td>
<td>75</td>
<td>111</td>
<td>162</td>
<td>207</td>
<td>233</td>
<td>1,002</td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Total, OASDI and SSI</p>
</blockquote></td>
<td></td>
<td>65</td>
<td>177</td>
<td colspan="2">345</td>
<td>409</td>
<td>436</td>
<td>466</td>
<td>522</td>
<td>578</td>
<td>628</td>
<td>663</td>
<td>4,288</td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="14"><p><u>1</u>/ Net change in OASDI benefit payments or
Federal SSI payments of less than $500,000.</p>
<p>Notes: 1. Above estimates based on the intermediate assumptions of
the 2000 OASDI Trustees Report and the 2000 SSI Annual Report.</p>
<p>2. Totals may not equal sum of rounded components.</p></td>
</tr>
<tr class="even">
<td colspan="5"></td>
<td colspan="9"><p>Social Security Administration</p>
<p>Office of the Chief Actuary</p>
<p>April 11, 2001</p></td>
</tr>
</tbody>
</table>

**APPENDIX E**

**Two EN Milestone Payment**

**Models for SSI**

**Model Presented by Paul J. Seifert**

**International Association of Pscho-Social Rehabilitation**

**Services**

**This proposal restructures the milestone-outcome system for
beneficiaries in order to account for the existing work incentives. It
would allow outcome payments when the amount of earnings of a SSI
recipient partially reduces their SSI check because of earnings or
income. The amount paid would still be based on the maximum of 40% of
the benefit not paid. Such a proposal might pay a \$500 milestone the
first month a SSI recipient worked and earned over \$125 in gross
income. A second milestone would be paid in the next month the SSI
recipient earned over \$325 in gross income. In any month after the
second milestone was paid that the SSI recipient's income was between
\$326 and \$550, SSA would pay an outcome payment of \$53. In any month
after the milestone was paid in which the recipient's income was between
\$551 and \$750, SSA would pay an outcome payment of \$93. In any month
where earnings were between \$751 and \$1002, SSA would pay \$138. This
is calculated using average Federal SSA payment as determined by in
calculating the payment calculation base for SSI. The amount of the
outcome payment would be paid according to the 40% maximum allowed under
the law.**

Prepared by: Paul J. Seifert, Int\'l Assoc. of Psychosocial
Rehabilitation Services \-- February 7, 2001

SSA\'s PROPOSED SSI MILESTONE-OUTCOME PAYMENT SYSTEM

Monthly Countable Amount of SSI Cash Milestone Monthly Outcome SSA

Earnings Income Benefit Offset Payment Payment Payment Amt Breakeven

\$1 to \$85 \$0 \$0 \$459 \$0

\$100 \$15 \$7.50 \$451.50 \$0

\$125 \$40 \$20 \$439 \$0 Under this

\$150 \$65 \$32.50 \$426.50 \$0 scenario, SSA

\$175 \$90 \$45 \$414 \$0 breaks even at

\$200 \$115 \$57.50 \$401.50 \$0 dollar one

\$225 \$140 \$70 \$389 \$0

\$250 \$165 \$82.50 \$376.50 \$0 SSA shares no

\$275 \$190 \$95 \$364 \$0 risk under this

\$300 \$215 \$107.50 \$351.50 \$0 scenario

\$325 \$240 \$120 \$339 \$0

\$350 \$265 \$132.50 \$326.50 \$0

\$375 \$290 \$145 \$314 \$0

\$400 \$315 \$157.50 \$301.50 \$0

\$425 \$340 \$170 \$289 \$0

\$450 \$365 \$182.50 \$276.50 \$0

\$475 \$390 \$195 \$264 \$0

\$500 \$415 \$207.50 \$251.50 \$0

\$525 \$440 \$220 \$239 \$0

\$550 \$465 \$232.50 \$226.50 \$0

\$575 \$490 \$245 \$214 \$0

\$600 \$515 \$257.50 \$201.50 \$0

\$625 \$540 \$270 \$189 \$0

\$650 \$565 \$282.50 \$176.50 \$0

\$675 \$590 \$295 \$164 \$0

\$700 \$615 \$307.50 \$151.50 \$0

\$725 \$640 \$320 \$139 \$0

**\$740 \$655 327.50 \$131.50** **\$300/3 months**

**\$600/7 months**

\$750 \$665 \$332.50 \$126.50 \$0

\$775 \$690 \$345 \$114 \$0

\$800 \$715 \$357.50 \$101.50 \$0

\$825 \$740 \$370 \$89 \$0

\$850 \$765 \$382.50 \$76.50 \$0

\$875 \$790 \$395 \$64 \$0

\$900 \$815 \$407.5 \$51.50 \$0

\$925 \$840 \$420 \$39 \$0

\$950 \$865 \$432.50 \$26.50 \$0

\$975 \$890 \$445 \$14 \$0

\$1000 \$915 \$457.50 \$1.50 \$0

\$1003 \$918 \$459 \$0.00 **Year 1 2 3 4 5** **\$57, \$141, \$150,
\$158, \$167**

Prepared by: Paul J. Seifert, Int\'l Assoc. of Psychosocial
Rehabilitation Services \-- February 7, 2001

ALTERNATIVE SSI MILESTONE-OUTCOME SYSTEM

Monthly Countable Amount of SSI Cash Milestone Monthly Outcome SSA

Earnings Income Benefit Offset Payment Payment Payment Amt Breakeven

\$1 to \$85 \$0 \$0 \$459 \$0

\$100 \$15 \$7.50 \$451.50 \$0

\$125 \$40 \$20 \$439 \$500 \$0 25 months

\$150 \$65 \$32.50 \$426.50 \$0

\$175 \$90 \$45 \$414 \$0

\$200 \$115 \$57.50 \$401.50 \$0

\$225 \$140 \$70 \$389 \$0

\$250 \$165 \$82.50 \$376.50 \$0

\$275 \$190 \$95 \$364 \$0

\$300 \$215 \$107.50 \$351.50 \$0

\$325 \$240 \$120 \$339 \$1000 \$0 13 months

\$350 \$265 \$132.50 \$326.50 \$53 11 months

\$375 \$290 \$145 \$314 \$53

\$400 \$315 \$157.50 \$301.50 \$53 Total Payment

\$425 \$340 \$170 \$289 \$53 \$4,680

\$450 \$365 \$182.50 \$276.50 \$53 milestone \$1,500

\$475 \$390 \$195 \$264 \$53 outcome \$3,180

\$500 \$415 \$207.50 \$251.50 \$53

\$525 \$440 \$220 \$239 \$53 6 months

\$550 \$465 \$232.50 \$226.50 \$93 10 months

\$575 \$490 \$245 \$214 \$93

\$600 \$515 \$257.50 \$201.50 \$93 Total payment

\$625 \$540 \$270 \$189 \$93 \$7,080

\$650 \$565 \$282.50 \$176.50 \$93 milestone \$1,500

\$675 \$590 \$295 \$164 \$93 outcome \$5,580

\$700 \$615 \$307.50 \$151.50 \$93

\$725 \$640 \$320 \$139 \$93

**\$750 \$665 \$332.50 \$126.50 \$93** 6 months

\$775 \$690 \$345 \$114 \$138 7 months

\$800 \$715 \$357.50 \$101.50 \$138

\$825 \$740 \$370 \$89 \$138

\$850 \$765 \$382.50 \$76.50 \$138 Total payment

\$875 \$790 \$395 \$64 \$138 \$9,780

\$900 \$815 \$407.5 \$51.50 \$138 milestone \$1,500

\$925 \$840 \$420 \$39 \$138 outcome \$8,280

\$950 \$865 \$432.50 \$26.50 \$138

\$975 \$890 \$445 \$14 \$138

\$1000 \$915 \$457.50 \$1.50 \$138 5 months

\$1003 \$918 \$459 \$0.00 \$150 5 months

milestone outcome Total payment

\$1,500 + \$9,000 = \$10,500

Example of a Ticket Scenario that Addresses a Number of the Equity of

Access Issues

Prepared by Dan O'Brien, OK Department of Rehabilitation Services

# Potential Breakeven Scenario for SSI Recipients

If the intent of the ticket is to create a breakeven scenario for the
SSA, then SSI must be considered separately from SSDI as the baseline
assumptions are different. Specifically, savings accrue, i.e., some
benefits are not payable, from any SSI work activity that exceeds \$85
per month whereas for SSDI no savings accrue below SGA. This allows a
breakeven scenario for SSI based on payment of milestone and outcome
payments using 35% of the benefits not payable due to work activity.

+----------+----------+-----------+-----------+---------------+-------+
| M        | Payment  | Payment   | Payment   | Cumulative    | Total |
| ilestone | Criteria | Threshold |           | Savings to    |       |
|          |          |           |           | SSA           | \+ or |
|          |          |           |           |               | --    |
+----------+----------+-----------+-----------+---------------+-------+
| Job      | Minimum  | Earnings  | \$1,000   | \`\$58        | -942  |
| P        | 1 month  | of at     |           |               |       |
| lacement | work     | least     |           |               |       |
|          |          | \$200     |           |               |       |
+----------+----------+-----------+-----------+---------------+-------+
| Job      | Minimum  | Avg.      | \$1,000   | \             | -1497 |
| Training | 3 months | earnings  |           | $445+58=\$503 |       |
| Complete | work     | in the    |           |               |       |
|          |          | last 2    |           |               |       |
|          |          | months of |           |               |       |
|          |          | at least  |           |               |       |
|          |          | \$530     |           |               |       |
|          |          | (trial    |           |               |       |
|          |          | work      |           |               |       |
|          |          | period    |           |               |       |
|          |          | amount)   |           |               |       |
+----------+----------+-----------+-----------+---------------+-------+
| Int      | Minimum  | Avg.      | \$1,000   | \$7           | -1725 |
| egration | 6 months | earnings  |           | 72+503=\$1275 |       |
| into     | of work  | in the    |           |               |       |
| Worksite |          | last 3    |           |               |       |
|          |          | months of |           |               |       |
|          |          | at least  |           |               |       |
|          |          | \$        |           |               |       |
|          |          | 600/month |           |               |       |
+----------+----------+-----------+-----------+---------------+-------+
| At       | Minimum  | Avg.      | \$1,000   | \$93          | -1787 |
| tainment | of 9     | earnings  |           | 8+1275=\$2213 |       |
| of SGA   | months   | in last 3 |           |               |       |
|          | work     | months at |           |               |       |
|          |          | least SGA |           |               |       |
|          |          | (\$700)   |           |               |       |
+----------+----------+-----------+-----------+---------------+-------+
| Q        | 3 months | Monthly   | Quarterly | Breakeven     |       |
| uarterly | of job   | earnings  |           | point beyond  |       |
| Job      | r        | at        | a)  \$234 | 9 mo.         |       |
| R        | etention |           |           | Milestone     |       |
| etention |          | a)        | b)  \$323 |               |       |
| Outcome  |          | \$530+/mo |           | a)  13 months |       |
| Payment  |          |           | c)  \$480 |               |       |
|          |          | b)        |           | b)  9 months  |       |
|          |          | \$700+/mo | 35% of    |               |       |
|          |          |           | benefits  | c)  6 months  |       |
|          |          | c)  \     | not paid  |               |       |
|          |          | $1000+/mo |           |               |       |
+----------+----------+-----------+-----------+---------------+-------+

**APPENDIX F**

**Summary of Critical Issues**

**Raised in Public Comments**

**Summary of Critical Issues from Public Comments**

Public comments on the NPRM for the Ticket to Work and Self-Sufficiency
Program were garnered from five sources: U.S. mail, e-mail, Panel public
meetings, Panel regional meetings, and from SSA. The public comments
sent to SSA were catalogued by subject by the agency. The catalogue of
comments can be accessed at www.ssa.gov/work. The comments
overwhelmingly addressed five issues:

Provider Payment

Ticket Eligibility

Employment Network Qualifications

Number of Tickets per Beneficiary

Determining "Timely Progress"

Also, of major concern to those who made public comments were the
participation of Vocational Rehabilitation Agencies in the Ticket
program and evaluation of Employment Networks. Specifically, respondents
addressed over 20 issues related to the NPRM and several issues that are
indirectly related, e.g., overpayments. What follows are excerpts, by
topic, of comments that typify those received.

**PROVIDER PAYMENT**

"The proposed regulations set the payment rate for ENs that select the
outcome-milestone payment system at 85% of the total payments made under
the outcome-only payment system. The law only specifies that the total
payment to an EN opting to take the milestone/outcome payment system
must be lower than the total paid to an EN under the outcome-only system
(Section 101 (h) (3)(C). Setting the percentage so low will discourage
many providers from participating in the Ticket program. Milestone
payments were included in the law to allow providers who can not afford
to wait months if not years until a beneficiary is completely off
benefits before receiving any type of payment to participate in the
program. Setting the percentage this low will likely create a
disincentive that keeps those providers from participating, thus,
undermining the goal of increasing consumer choice."

"Given that a \$1 difference in payment would meet the letter of the
law, the rate should be set to create an incentive for as many providers
as possible to participate in the program. SSA should consider raising
the percentage closer to 100 percent in order to accomplish that goal."

"The milestone payments proposed in this section are inadequate to
encourage any new entities to participate in the program. Small and
medium size service providers will be unable to offer Ticket holders the
tailored services required to allow them to succeed in their search for
work if they receive no payment until after a person has worked for
three months. The rationale for including milestone payments in the law
was to provide an incentive for providers to participate in the Ticket
program and encourage as many different entities as possible to do so.
The system proposed in the NPRM will not accomplish this objective. In
fact, the proposed milestone payment system may actually create a
disincentive for many providers.

In addition, the proposed design of the milestones will likely have a
negative impact on beneficiaries considered "hard to serve." Agencies
that do decide to participate in the program will have no reason to work
with Ticket holders whose service needs are costly, more intensive,
and/or longer in duration. Obviously, the longer it takes a beneficiary
to become employed, the longer it will be before the EN receives a
payment. Milestones should be designed in a more flexible way so that
the payments create an incentive for ENs to serve a broader range of
beneficiaries, regardless of the level of services needed. Authorizing a
milestone payment for the completion of a distinct, measurable goal in
the IWP is one way to encourage agencies to become ENs (e.g., with some
type of limit on the number and amount of any pre-employment
milestones). For example, the completion of a training course by a
ticket holder could entitle the EN to a milestone payment. This
milestone could be in addition to the milestones in the proposed
regulations or as a substitute for one of them. This type of milestone
would also encourage ENs to serve people with more significant
disabilities who require more time and/or more intensive services to
acquire the skills necessary to transition permanently off benefits.

While this pre-employment milestone could be viewed as contrary to the
ideal of paying only for an employment outcome, this is not the case.
Completing a goal in the IWP is itself a measurable outcome that, in the
view of the EN, will lead to employment. The PM could be required to
agree with the EN on which particular objective in an IWP would warrant
the payment of a milestone. While paying only for the outcome of
employment is a worthy goal, it must be balanced with the ability to
recruit and retain ENs. If limiting all payment to post employment
causes very few (or no) agencies to participate as ENs, there will be no
outcomes for which to pay as no beneficiaries will be leaving the rolls
and there will be no corresponding savings to the trust funds.

The payment system has a built‑in bias toward higher functioning
beneficiaries who have short‑term, low‑cost needs. It will discourage
employment networks from working with the very beneficiaries the program
is supposed to be aimed at ‑ persons with longer‑term, higher-­cost
needs. This will leave out, for example, persons with severe mental
illnesses, traumatic brain injury, pronounced or multiple developmental
disabilities, or anyone whose vocational training requires a greater
investment in time and assistive technology.

The payment system is biased against beneficiaries who must reach a
higher level of earnings (for example, blind beneficiaries with higher
substantial gainful activity levels) before the employment network is
paid. The payment system also has a built‑in bias toward established
providers pursuing traditional methods to become employment networks.
New providers with innovative approaches are not likely to have the
capital resources and cash flow to operate under the payment systems,
especially the milestone payments.

**TICKET ELIGIBILITY**

Transition-aged youth (ages 16 & 17) should be allowed to participate in
the Ticket to Work program. Youth with disabilities have tremendous
potential to achieve independence from benefits and enter the world of
work. Every possible support and service should be made available to
young SSI beneficiaries to ensure that they do not begin a life-long
dependency on public benefits. Substantial evidence indicates that the
longer a person remains on benefits, the less likely they are to be able
to successfully enter the workforce. Given all these facts, it is not
sound public policy to exclude them from this program. While it may be
difficult to coordinate participation by those under 18 with existing
statute (e.g. the CDR protection for beneficiaries using a ticket with
the required 18 year old redetermination), administrative difficulty
does not justify the categorical exclusion of a class of people that are
likely to benefit substantially from inclusion in the program.

Disability beneficiaries with the designation MIE should be eligible to
participate in the Ticket program prior to the completion of the first
CDR. People in this category probably have a recent work history and are
highly likely to succeed in their work attempt if appropriate services
and supports are available. With only 16% of beneficiaries with the MIE
designation having their benefits ceased when their first CDR is
completed, the other 84% of this population who remain eligible for
benefits would be unjustly prevented from participating in the program
by the proposed regulations. While the first CDR is scheduled to be
conducted at sometime between 3 and 18 months after the award of
benefits, it often takes several years for these reviews to be
completed. Once again, the longer a person remains on benefits, the less
likely that person is to be able to become independent again. Hence,
beneficiaries with the MIE designation are one of the most likely groups
to be able to benefit from this program and should be included.

The apparent rationale for the exclusion of this category of
beneficiaries is the cost of outcome payments for someone whose benefits
would have been ceased at the first CDR - presumably resulting in
increased expenditures rather than savings to the Trust Fund. This
viewpoint appears to be shortsighted. Without thorough tracking of the
MIE beneficiaries who are ceased at the initial CDR, it is impossible to
know the true impact of their inclusion in the Ticket program on overall
expenditures. For instance, it would be important to know exactly how
many of the 16% whose benefits are ceased are likely to reapply for and
receive benefits in the future. It would also be useful to know how many
actually go to work rather then simply applying for and receiving other
public benefits.

It is difficult to justify the exclusion of this population without
first obtaining this type of data. If this exclusion remains in place,
SSA is strongly encouraged to change the administrative procedure that
governs the award of the MIE designation. Many, probably most,
beneficiaries that are currently categorized as MIE do not even know it.
This has not mattered in the past because the only consequence of being
labeled MIE was to have a diary for a CDR sooner than other
beneficiaries. If the proposed regulations are implemented with this
provision intact, beneficiaries must be made explicitly aware of the
fact that they have been placed in this category. In addition, since
this designation will limit access to a benefit, the decision must be
appealable. Currently SSA has no process in place to appeal the decision
to place a beneficiary in this group.

**EMPLOYMENT NETWORK QUALIFICATIONS**

Employment network qualifications set out in the law are fairly general.
Those of us who helped to develop the legislation were determined not to
impose any arbitrary barriers to entities wishing to serve an individual
who wants to go to work. We remind SSA that a major objective of the
Ticket to Work program was to get away from the heavy reliance on state
vocational rehabilitation agencies and traditional rehabilitation models
which, in fact, did not work for many people. It was particularly
important that ENs would not be limited by licensing or certification
criteria unrelated to their mission.

Section 411.315, which sets out EN minimum qualifications, has a number
of troubling aspects as currently constituted. The language seems to
imply that employment networks must provide health and medical services
and includes stipulations that an EN must have "applicable certificates,
licenses or other credentials if such documentation is required by state
law....\" Where a profession requires licensing or credentialing under
state law, such a requirement is certainly reasonable. However, SSA
should avoid giving the impression that all employees or contractors of
ENs have to be licensed or credentialed. Also reasonable would be any
business licensing or regulatory requirements ordinarily imposed on an
entity that seeks to become an EN. For example, proper guidelines
regarding proof of the business as a taxpaying, registered entity under
federal and state law would obviously be appropriate. SSA must make it
clear that standards must be met only where required for licensed
professionals and that any services such as those outlined in subsection
\[C\] would only be those provided in the normal course of business.

SSA should clarify the regulations to avoid the interpretation that
[only]{.underline} state certification or licensing will qualify an
entity as an EN. Instead, SSA should make it clear that there are any
number of avenues by which a provider can qualify as an EN:
certification or licensing under applicable state law; credentialing
under other nationally recognized standards; or education or experience
in successful employment of people with disabilities. What must remain
the key criteria is whether the entity is capable of successfully
providing the service agreed to by the EN and the beneficiary. Questions
have arisen in various discussions about ENs whether families or
personal support networks could serve as an EN. If the family or group
of friends can meet the requirements of an EN, then they should be able
to serve as an EN. However, we suspect that a beneficiary\'s family or
friends would be in a better position to associate themselves with or
subcontract with an EN to provide services to an individual,
particularly if the extent of their services are limited to that
individual. However, we urge SSA to make it clear that such arrangements
are allowed through individual arrangements with an EN.

**NUMBER OF TICKETS PER BENEFICIARY**

There should be no limit on the number of Tickets a person can receive
over the course of a lifetime, as long as a person is not using more
than one ticket at a time. People eligible for the program have very
severe disabilities that may not allow them to work consistently or for
long periods of time the first time they attempt to work. Limiting the
number of tickets would ignore the reality that disability can be a
sporadic, episodic, lifelong event or that other factors such as job
loss may trigger the need for additional assistance in the future.

**DETERMINING TIMELY PROGRESS**

The proposed rules regarding \"timely progress\" discriminate against
persons with disabling conditions that are episodic and intermittent in
nature (e.g., some persons with chronic mental illness). While some
people may not be able to work right away, others might be able to work
sooner, but may experience difficulties later. It is not fair to those
who can work earlier to penalize them because their work effort did not
fall precisely within the stringent timeframe as currently prescribed in
the proposed regulations. Further, the proposed rule virtually ignores
that many people may work at gradually increasing levels of income or
hours, but never reach the SGA earnings threshold.

Beneficiaries should be able to "bank" work months in the first two
years to count towards the work requirements in later years. In year 5
and beyond, work in excess of the six-month requirement should count
toward the next year's requirement. Further, increasing amounts of work
or earnings, even if below SGA, should be evaluated as meeting the
definition of "progressively higher levels of employment" in order for a
person to keep their CDR protection.

**APPENDIX G**

**Information in Response**

**To Panel's Questions on Plan for Impact**

**Of Ticket Rollout**

February 7, 2001

[NOTE TO SARAH WIGGINS MITCHELL FOR THE TWIIA ADVISORY
PANEL]{.underline}

As requested, I am sending the following information regarding our
planning dates and numbers for distribution of Tickets. The number of
individual Tickets that we expect to send out in the first year is about
2.3 million, including both beneficiaries currently on the rolls and new
beneficiaries added during the year. This estimate is based on the most
recent sounts provided by our systems administrators. The break down is
based on a systems selection of people by terminal digit of the Social
Security number, as follows:

Mar 2001 (terminal digit 1) 236,000

Apr 2001 (term. digits 2,3) 452,000

May 2001 (term digiits 4,5,6) 669,000

Jun 2001 (term. Digits 7,8,9,0) 885,000

Jul 2001 and ongoing 20,000

Note that each month after March includes new accretions with the
terminal digits up to and including the terminal digits released for
that month. For example, in May 2001, we will release terminal digits
4,5 and 6 selected in March plus all new accretions ending in digits
1-6---new accretions ending in 7-0 will be released in June.

I will be attending the Panel sessions on February 8 and will be glad to
answer any questions you might have.

**APPENDIX H**

**How to contact the Panel**

**Contact Information**

**Anyone requiring materials in alternative formats, information
regarding this document or the Ticket to Work and Work Incentives
Advisory Panel should contact the Panel staff. Records are kept of all
Panel proceedings and are available for public inspection under the
Federal Advisory Committee Act by appointment at the Panel office.**

**Anyone requiring information may contact the Panel staff.**

**Ticket to Work and Work Incentives Advisory Panel**

**Social Security Administration**

**400 Virginia Avenue, SW, Suite 700**

**Washington, DC, 20004.**

**Phone at (202) 358-6430**

**Fax at (202) 358-6440**

**Email to** <TWIIAPanel@ssa.gov>

**Advisory Panel Staff**

**Marie Parker Strahan, Executive Director**

**Kristin Breland**

**Lisa Ekman**

**Mildred Owens**

**Gordon Richmond**

**Ilene Zeitzer**

**Tamara Allen, Consultant**

**Theda Zawaiza, Ph. D., Consultant**

**(The official copy of this document contains a printout of the Panel
Website. To view the site, please visit**
<http://www.ssa.gov/work/panel>

### The Ticket to Work and Work Incentives Advisory Panel

**Establishment of the Panel**

The Ticket to Work and Work Incentives Improvement Act of 1999, Public
Law 106-170, established the Ticket to Work and Work Incentives Advisory
Panel (the Panel) within the Social Security Administration on December
17, 1999. Members were appointed by the President, the House of
Representatives and the Senate during May and June of 2000. The
Commissioner of the Social Security Administration, Kenneth S. Apfel,
swore in the Panel on July 24, 2000.

Panel duties include advising the Commissioner of Social Security and
reporting to the President and Congress on issues related to work
incentives programs, planning, and assistance for individuals with
disabilities and the Ticket to Work and Self-Sufficiency Program
established under the Ticket to Work and Work Incentives Improvement Act
(TWWIIA).

The Panel is composed of 12 members. The President, the Senate and the
House of Representatives each appointed four. Appointments are for
four-year terms. Of the members first appointed, one-half are appointed
for a term of two years and the remaining are appointed for four years.

The Chair of the Panel is appointed by the President for a 4-year term.

# 

# **Members of the Panel** 

### 

### Sarah Wiggins Mitchell, R.N., M.S.W., J. D., Chair

Sarah Wiggins Mitchell is the President and Executive Director of the
New Jersey Protection and Advocacy, Inc., the designated protection and
advocacy system for the State. She was appointed by President Clinton to
chair the Panel for a four-year term. She is a member of the New Jersey
and Pennsylvania Bars and has a background in nursing and social work.

**Richard V. Burkhauser, Ph.D.**

Dr. Richard V. Burkhauser serves as the Professor of Policy Analysis and
Chair, Department of Policy Analysis and Management at Cornell
University, Ithaca, NY. He is also active as a consultant, writer and
researcher, focusing on various economic and social issues relating to
persons with disabilities.

#### Thomas P. Golden

Mr. Golden is a faculty member of Cornell University's Program on
Employment and Disability in the School of Industrial and Labor
Relations in Ithaca, NY. He is currently project director for numerous
efforts focusing on training and activities relating to work incentives
for people with disabilities.

#### Kristin E. Flaten, M. Div.

Ms. Flaten is an Employment Consultant for Lifetrack Resources, Inc.,
St. Paul, MN. She started her own small business, INITIATIVES, dedicated
to enhancing the lives of persons with mental illnesses by providing
educational and support services, advocacy, benefits analysis, and work
incentive plans.

#### Frances Gracechild

Frances Gracechild is the Executive Director, Resources for Independent
Living, Inc., Sacramento, CA and instructor at California State
University at Sacramento. She is president of Health Access America and
serves as a commissioner for the California Attorney General's
Commission on Disability.

#### Christine M. Griffin, J.D.

Christine M. Griffin is the Executive Director, Disability Law Center,
Boston, MA. She is a Trustee for the Paralyzed Veterans of America
Spinal Cord Research Foundation and is a member of the Massachusetts and
the Washington, DC Bar.

#### Larry D. Henderson

Mr. Henderson is the Executive Director of Independent Resources, Inc.,
Wilmington, DE and chair of the Developmental Disabilities Planning
Council of Delaware. Prior to his current position he was associated
with the Salvation Army's Family Service Department.

#### Jerome Kleckley

Jerome Kleckley, MSW, CSW, is the Director of Hospital Services for the
Eastern Paralyzed Veterans Association in Jackson Heights, NY and an
advocate for veterans with disabilities. He is a veteran of the U.S.
Navy and has been actively involved in veteran\'s issues.

#### Stephanie Smith Lee

Stephanie Smith Lee is the Governmental Affairs Representative of the
National Down Syndrome Society and resides in Oakton, VA. She has played
a key role in the passage of Federal disability legislation and has led
successful grass roots advocacy efforts at the local, State and Federal
levels.

#### Bryon R. MacDonald

Mr. MacDonald is employed as a Public Policy Advocate with the World
Institute on Disability, Oakland, CA. He is a Board member at large of
the National Council on Independent Living and chair of that
organization's Social Security Subcommittee. For many years, he has
developed employment support and benefits counseling programs and served
as a consultant to several advisory committees on employment support for
persons with disabilities.

#### Stephen L. Start

Stephen L. Start is the founder, President and Chief Executive Officer
of S.L. Start & Associates, Spokane, WA, a company that provides
professional management, rehabilitation, and residential services for
people with disabilities, seniors and economically disadvantaged
individuals. He is a member of numerous national and regional
residential and rehabilitation boards.

#### Susan Webb

Susan Webb is the President, Webb Transitions, Inc. of Phoenix, AZ. A
former Social Security Disability Insurance beneficiary, she used work
incentives and vocational rehabilitation services to return to work. She
has served on the Board of Directors of the National Council on
Independent Living for three consecutive years, serving as its Social
Security Subcommittee chair.

####### Advisory Panel Staff

Marie Parker Strahan, Executive Director

Kristen Breland

Lisa Ekman

Mildred Owens

Gordon Richmond

Ilene Zeitzer

Tamara Allen, Consultant

Theda Zawaiza, Ph.D., Consultant