**Connecticut Bureau of Rehabilitation Services (BRS)**

**General Vocational Rehabilitation Program**

**Response to the NPRM**

**Amendments to the Ticket to Work and Self-Sufficiency Program**

**For More Information, contact:**

**Brenda Moore, Director, Bureau of Rehabilitation Services**

**(860) 424-4848**

[**Brenda.moore@po.state.ct.us**](mailto:Brenda.moore@po.state.ct.us)

**Or**

**Amy Porter, Education Consultant, Bureau of Rehabilitation Services**

**(860) 424-4864**

**amy.porter@po.state.ct.us**

**General:**

We are pleased with the proposed changes to the Ticket regulations. They
demonstrate a sincere attempt to build on the strengths of the current
system, and to allow for more collaborative models of service provision.
Our belief is that collaboration in the Ticket program will lead to
greater outcomes than the strictly competitive model of the current
program.

The proposed regulations are structured into four major categories: 1)
state participation and beneficiary choice, 2) Employment Network
payment system, 3) ticket eligibility, and 4) additional matters for
comment. ***Comments from the Connecticut Bureau of Rehabilitation
Services (BRS) mirror those from the Council of State Administrators for
Vocational Rehabilitation, and follow the same structure outlined in the
NPRM.***

1.  **State Participation and Beneficiary Choice**

The proposed changes will separate the cost reimbursement system from
the ticket payment system, but in effect will extend CDR protections for
beneficiaries regardless of the payment system selected by the State VR
agency. This is a positive change for beneficiaries, because they have
access to a broader array of supports under the new model.

We are in full support of the intent of this section, and applaud SSA
for incorporating ideas that have been generated in a number of forums.
When we get beyond intent, and think through the operationalization of
these changes, there are a number of considerations yet to be addressed.

> **Agreements.** The proposed regulations are silent on the issue of
> agreements between an EN and a State VR agency if the EN refers a
> beneficiary for VR services.
>
> **Recommendation**: The requirement for agreements comes directly from
> the legislation. BRS would like to see some joint guidance developed
> for states to ensure some consistency of intent and practice to
> support positive outcomes for beneficiaries receiving services from
> both a State VR Agency and an Employment Network.
>
> **Notification to SSA of State VR involvement**. If a beneficiary's
> ticket is considered "in use" once they develop a plan with the State
> VR agency, a process to notify SSA of the IPE needs to be developed.
>
> **Recommendation**: We suggest that you continue to use the 1365
> process, amending the form so that it doesn't include the
> beneficiary's signature. The revised 1365 (or similar form) would have
> to define whether the form is being submitted for "in use" ticket
> status or is a request for an assignment to the VR agency/EN. Three
> options would be offered.

(1) If a beneficiary becomes ticket eligible while in VR services, the
    VR agency cannot take the ticket assignment, but the consumer would
    be able to have the ticket under the "in use" status.

(2) If the VR agency chooses cost reimbursement for a consumer entering
    services, again the ticket would be considered "in use" and the 1365
    would need to reflect this ticket status. There could also be a
    "referral to EN" for ongoing support services section added to the
    form.

(3) VR chooses to use the outcome payment system for a new ticket
    assignment.

## Sequencing of Services. The proposed regulations seem to assume a certain sequence of services for the beneficiary. The sequence, as interpreted in the proposed regulations, would have the beneficiary starting services with a state VR agency and then receiving services from an Employment Network. We envision instances where the individual chooses to go to an EN first, such as a One Stop or another provider, and that provider refers the beneficiary to VR for additional services. In this instance, the EN might be eligible for Phase 1 and Phase 2 milestones, and the VR agency may be eligible for Cost Reimbursement.

> **Recommendation**: Ensure that the development of policy or guidance
> around the new partnership model maximizes a beneficiary's ability to
> obtain services and support from both a State VR agency and an EN,
> regardless of which organization the beneficiary accesses first.
> Partnerships between State VR agencies and Employment Networks should
> be driven by beneficiary need. The financial aspect of the partnership
> should accommodate the services, not drive them.

## Timing of the Start of Long-Term Services

> The proposed regulations state that the EN cannot begin working with a
> beneficiary until the VR agency has stopped providing services. This
> could have a negative impact on a beneficiary. Based on the
> Rehabilitation Act, a VR consumer will not have their case closed with
> the VR agency until the person is stable in employment, and achieves
> 90 days of employment with no paid services provided. Given this
> 90-day "service free" period, the proposed regulations could lead to a
> gap in service provision, depending on the interpretation.
>
> **Recommendation**: Allow the EN to pick-up services at whatever point
> it will best support the beneficiary. Regardless of the time the EN
> picks up the beneficiary for services, the EN will not get paid until
> the beneficiary achieves an employment outcome. This may open up
> opportunities for SSA to remove any restrictions on when an EN can
> begin to provide services.

## Prohibition for VR serving as an EN after Cost Reimbursement

> There is concern about section 411.385 (b) which reads *". . . the
> beneficiary may assign his or her ticket to an EN after completing
> services with the State VR agency, other than a State VR acting as an
> EN."* There are two issues that arise from this restriction:

1)  VR is the only provider in a given state or geographical area

2)  The VR agency, in a broader role, has the capacity to provide
    long-term supports through programs other than the State VR program.
    For instance, the state may have a fully state-funded employment
    supports program that uses no Title I funds from the Rehabilitation
    Act.

> **Recommendation**: For the first issue, the VR agency can continue to
> provide services and claim payment under the cost reimbursement
> system. In the second example, however, the State VR agency would not
> be reimbursed for these costs. We would suggest changing the language
> to "State VR program" rather than "State VR agency" so that if there
> are state funded (or non Title I funds) used, the VR agency can get
> paid as an EN.
>
> **Beneficiary Choice after VR Chooses an EN payment system**.
>
> If a VR agency chooses to participate as an EN, thus choosing one of
> the EN payment systems, this creates an unintended consequence of
> limiting a beneficiary's choice. The financial decision of a State VR
> agency should never impact the level of choice or service that a
> beneficiary can receive through the use of their Ticket to Work.
>
> **Recommendation**: This issue will require careful consideration to
> ensure that beneficiary choice is never limited by the financial
> decisions of a State VR agency.

# Employment Network Payment System

The proposed regulations provide for a more generous EN payment system.
These changes are positive, and will hopefully result in increased
choice of providers for beneficiaries seeking services. The biggest
concern with the payment system is the impact of the complexity on the
recruitment and retention of ENs.

**Recommendation:** Providing the option for Employment Networks and
State VR Agencies to choose between outcomes and outcome-milestones on a
case-by-case basis may increase participation in the Ticket program.

2.  **Ticket Eligibility for Beneficiaries Whose Conditions May
    Medically Improve**

We are pleased to see the inclusion of individuals whose disabilities
may improve. This provides the opportunity for an early rehabilitation
or support intervention for individuals with conditions that may
improve, hopefully leading to greater employment outcomes in this
population.

**Recommendation:** To increase the likelihood of success for this
population, SSA may want to consider providing some additional
information to these individuals upon award of benefits. Using the
concept of early intervention, it would be best to get information to
applicants on the availability of work supports as early as possible.

3.  **Additional Matters for Comment**

### Multiple Tickets in a period of entitlement

"The first issue is whether a beneficiary should be eligible for more
than one ticket in a period of entitlement for SSDI or SSI benefits."

> For individuals who need long-term supports to maintain employment, it
> is often difficult to find a long-term support provider. If an
> individual needs ongoing supports, the Ticket may provide an
> opportunity to cover those support needs.
>
> **Recommendation:** We recommend developing a system that supports
> individuals with ongoing support needs, either through the provision
> of multiple tickets in a single period of entitlement or through some
> mechanism to extend the ticket for individuals who have been certified
> as being in need of ongoing supports.

### Definition of "Using a Ticket"

*"The second issue is whether an how we should simplify the definition
of 'using a ticket' under the Ticket to Work program."*

The current rules for "using a ticket" and "timely progress" are complex
and difficult to understand for both beneficiaries and providers. For
those individuals who are worried about the effect of Continuing
Disability Reviews, any new layer of complexity will serve as an
additional barrier to successful work return.

> **Recommendation:** We strongly recommend using the beneficiary's
> Individual Plan for Employment (IPE) if the person is working with a
> State VR agency, or the Individual Work Plan (IWP) if the person is
> working with an Employment Network. These plans are mutually developed
> and there are timeframes and activities embedded into the plan to
> ensure progress toward the individual's work goal. Using these plans
> provides an individualized approach to determining timely progress,
> allowing for variations in level of service and time to complete the
> plan. The State VR agencies conduct annual reviews of the IPEs to
> ensure that services are on target and that timeframes are being met.

### Evidence Requirements for EN Payments

*"The third issue is whether the evidence requirements for EN payment
are unnecessarily burdensome."*

State VR programs have, for the most part, been utilizing Unemployment
Insurance (UI) records for evidence of earnings. While these records
have some limitations, they are the most consistent means for obtaining
earnings verification. Employment Networks do not have access to this
data system, and report difficulty in trying to obtain evidence of
earnings.

**Recommendation:** In order to increase participation of EN's in the
Ticket program, SSA may need to consider a national system of verifying
earnings. Such a national system would also benefit VR agencies. VR
agencies are not able to secure earnings evidence for individuals who
work in state or federal government jobs, are self-employed, or are in a
number of other excluded categories for wages in the UI system.

### Payment of Phase I Milestones

*"The fourth issue is whether there are any circumstances under which
SSA should pay both Phase 1 and Phase 2 milestones to an EN for
beneficiaries who assign their ticket after SSA has made a payment to
the State VR agency under the cost reimbursement payment system."*

There will be situations where a beneficiary may have received services
from a State VR agency and worked successfully for a period of time, and
then lost their job. Some of these individuals may come back to the
State VR agency for services, and some might go directly to an EN. If
the EN has to provide placement services once again, this may
necessitate considerable time and resources.

**Recommendation**: In situations where the EN begins working with an
individual when the individual is unemployed, SSA should consider paying
the EN both Phase 1 and Phase 2 milestones.

# 

# Additional Considerations

-   **SSA Approach to Applicants:** If the Ticket to Work program is
    truly going to have an impact on beneficiaries, SSA needs to
    consider the message that individuals are hearing from the time that
    they apply for benefits. Particularly as the program expands to
    include individuals whose conditions are expected to improve
    (MIE's), SSA may want to consider a change in its approach to
    applicants. A new approach would include discussions about work from
    the moment a person applies, and talk about the fact that an
    individual might be able to get support from a State VR agency or an
    Employment Network. In this approach, cash benefits might be
    discussed as a transitional support for applicants. Another addition
    would be to offer benefits counseling to the applicant to begin
    thinking about their total benefits and employment.

    -   **DDS Referrals:** Since the State VR and EN are no longer in
        competition, allow VR to receive referrals from the DDS.   Many
        individuals with disabilities assume they can't work.   When a
        referral comes from the DDS, a VR Counselor can contact the
        individual and help them understand that with the right training
        and supports, they indeed can resume employment.

    -   **Access to Data:** Allow State VR agencies to obtain SSI/SSDI
        (SVES) from the DDS on VR consumers.   This will both speed up
        and improve the accuracy of VR cost reimbursement claims.

    -   **Increase Funding for Benefits Counseling:** The current
        SSA-funded Benefits Planning, Assistance, and Outreach (BPAO)
        program has tremendous potential to impact the employment rate
        for SSA beneficiaries. Using a comprehensive approach, benefits
        counselors help to allay fears that beneficiaries may have about
        going to work, and provide information that beneficiaries need
        in order to make informed choices about their employment
        options. This program, however, remains underfunded. We strongly
        recommend that SSA request additional funding for a benefits
        counseling program in order to support the intent and the
        utility of the Ticket to Work and Self-Sufficiency Program.

Thank you for the opportunity to comment. We are eager to see the
proposed changes implemented, and we look forward to a continued
partnership as we try to make this program work to its full potential.