**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^

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A.  ^Letter\ to\ Commissioner\ Halter\ concerning\ Agency\ plans\ for\ implementation\ and\ first\ year\ roll-out^

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A.  ^Response\ from\ the\ Office\ of\ the\ Actuary\ on\ Cost\ Implications\ of\ Proposals\ ^

B.  Two EN Milestone Payment Models for SSI

C.  ^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\ ]{.underline}^

**^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]{.underline}^

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]{.underline}^

**^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\ a^^ll\ 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?^**

**^Summa^^ry\ 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]{.underline}^

#### ^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^**

^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\ ^**

**^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.^

·
^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\ 49th\ to\ 60th\ 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>
<tbody>
<tr class="odd">
<td><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>
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</tr>
<tr class="even">
<td></td>
<td></td>
<td><p><sup>Fiscal year</sup></p></td>
<td><p><sup>Total,</sup></p>
<p><sup><u>2001-10</u></sup></p></td>
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<tr class="odd">
<td><p><sup>Option</sup></p></td>
<td></td>
<td><p><sup><u>2001</u></sup></p></td>
<td><p><sup><u>2002</u></sup></p></td>
<td><p><sup><u>2003</u></sup></p></td>
<td><p><sup><u>2004</u></sup></p></td>
<td><p><sup><u>2005</u></sup></p></td>
<td><p><sup><u>2006</u></sup></p></td>
<td><p><sup><u>2007</u></sup></p></td>
<td><p><sup><u>2008</u></sup></p></td>
<td><p><sup><u>2009</u></sup></p></td>
<td><p><sup><u>2010</u></sup></p></td>
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<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><p><sup>Ticket to Work program effects based on implementation as
specified in the Notice of Proposed Rulemaking (NPRM):</sup></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>OASDI benefit payments </sup></p></td>
<td></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>$2</sup></p></td>
<td><p><sup>$2</sup></p></td>
<td><p><sup>$3</sup></p></td>
<td><p><sup>-$10</sup></p></td>
<td><p><sup>-$20</sup></p></td>
<td><p><sup>-$29</sup></p></td>
<td><p><sup>-$41</sup></p></td>
<td><p><sup>-$64</sup></p></td>
<td><p><sup>-$101</sup></p></td>
<td><p><sup>-$258</sup></p></td>
<td><p><sup>Federal SSI payments </sup></p></td>
<td></td>
<td><p><sup>-$1</sup></p></td>
<td><p><sup>-4</sup></p></td>
<td><p><sup>-12</sup></p></td>
<td><p><sup>-19</sup></p></td>
<td><p><sup>-21</sup></p></td>
<td><p><sup>-18</sup></p></td>
<td><p><sup>-18</sup></p></td>
<td><p><sup>-27</sup></p></td>
<td><p><sup>-48</sup></p></td>
<td><p><sup>-67</sup></p></td>
<td><p><sup>-235</sup></p></td>
<td><p><sup>Subtotal, OASDI and SSI </sup></p></td>
<td></td>
<td><p><sup>-1</sup></p></td>
<td><p><sup>-2</sup></p></td>
<td><p><sup>-10</sup></p></td>
<td><p><sup>-16</sup></p></td>
<td><p><sup>-31</sup></p></td>
<td><p><sup>-38</sup></p></td>
<td><p><sup>-47</sup></p></td>
<td><p><sup>-68</sup></p></td>
<td><p><sup>-112</sup></p></td>
<td><p><sup>-168</sup></p></td>
<td><p><sup>-493</sup></p></td>
<td><p><sup>Revisions to estimated program effects due to the inclusion
of newly disabled persons classified as Medical Improvement
Expected(MIE) in the population receiving tickets:</sup></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>Ticket to Work program:</sup></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>OASDI benefit payments </sup></p></td>
<td></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>1</sup></p></td>
<td><p><sup>1</sup></p></td>
<td><p><sup>2</sup></p></td>
<td><p><sup>-1</sup></p></td>
<td><p><sup>-11</sup></p></td>
<td><p><sup>-18</sup></p></td>
<td><p><sup>-25</sup></p></td>
<td><p><sup>-35</sup></p></td>
<td><p><sup>-49</sup></p></td>
<td><p><sup>-135</sup></p></td>
<td><p><sup>Federal SSI payments </sup></p></td>
<td></td>
<td><p><sup>(<u>1</u>/)</sup></p></td>
<td><p><sup>-3</sup></p></td>
<td><p><sup>-6</sup></p></td>
<td><p><sup>-9</sup></p></td>
<td><p><sup>-9</sup></p></td>
<td><p><sup>-10</sup></p></td>
<td><p><sup>-15</sup></p></td>
<td><p><sup>-22</sup></p></td>
<td><p><sup>-32</sup></p></td>
<td><p><sup>-42</sup></p></td>
<td><p><sup>-148</sup></p></td>
<td><p><sup>Continuing Disability Reviews:</sup></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>OASDI benefit payments </sup></p></td>
<td></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>2</sup></p></td>
<td><p><sup>11</sup></p></td>
<td><p><sup>32</sup></p></td>
<td><p><sup>72</sup></p></td>
<td><p><sup>108</sup></p></td>
<td><p><sup>135</sup></p></td>
<td><p><sup>153</sup></p></td>
<td><p><sup>173</sup></p></td>
<td><p><sup>195</sup></p></td>
<td><p><sup>882</sup></p></td>
<td><p><sup>Federal SSI payments </sup></p></td>
<td></td>
<td><p><sup>(<u>1</u>/)</sup></p></td>
<td><p><sup>1</sup></p></td>
<td><p><sup>4</sup></p></td>
<td><p><sup>11</sup></p></td>
<td><p><sup>24</sup></p></td>
<td><p><sup>32</sup></p></td>
<td><p><sup>33</sup></p></td>
<td><p><sup>37</sup></p></td>
<td><p><sup>39</sup></p></td>
<td><p><sup>41</sup></p></td>
<td><p><sup>222</sup></p></td>
<td><p><sup>Net effect of MIE inclusion:</sup></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>OASDI benefit payments </sup></p></td>
<td></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>3</sup></p></td>
<td><p><sup>12</sup></p></td>
<td><p><sup>34</sup></p></td>
<td><p><sup>71</sup></p></td>
<td><p><sup>97</sup></p></td>
<td><p><sup>117</sup></p></td>
<td><p><sup>128</sup></p></td>
<td><p><sup>138</sup></p></td>
<td><p><sup>146</sup></p></td>
<td><p><sup>747</sup></p></td>
<td><p><sup>Federal SSI payments </sup></p></td>
<td></td>
<td><p><sup>(<u>1</u>/)</sup></p></td>
<td><p><sup>-2</sup></p></td>
<td><p><sup>-2</sup></p></td>
<td><p><sup>3</sup></p></td>
<td><p><sup>15</sup></p></td>
<td><p><sup>22</sup></p></td>
<td><p><sup>18</sup></p></td>
<td><p><sup>15</sup></p></td>
<td><p><sup>7</sup></p></td>
<td><p><sup>-1</sup></p></td>
<td><p><sup>75</sup></p></td>
<td><p><sup>Subtotal, OASDI and SSI </sup></p></td>
<td></td>
<td><p><sup>(<u>1</u>/)</sup></p></td>
<td><p><sup>1</sup></p></td>
<td><p><sup>10</sup></p></td>
<td><p><sup>37</sup></p></td>
<td><p><sup>86</sup></p></td>
<td><p><sup>119</sup></p></td>
<td><p><sup>135</sup></p></td>
<td><p><sup>143</sup></p></td>
<td><p><sup>145</sup></p></td>
<td><p><sup>145</sup></p></td>
<td><p><sup>822</sup></p></td>
<td><p><sup>Revisions to Federal SSI payments due to the inclusion of
SSI disabled children aged 16 and older in the population receiving
tickets 2/:</sup></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>Ticket to Work program:</sup></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>Federal SSI payments </sup></p></td>
<td></td>
<td><p><sup>-1</sup></p></td>
<td><p><sup>-7</sup></p></td>
<td><p><sup>-19</sup></p></td>
<td><p><sup>-32</sup></p></td>
<td><p><sup>-40</sup></p></td>
<td><p><sup>-41</sup></p></td>
<td><p><sup>-47</sup></p></td>
<td><p><sup>-64</sup></p></td>
<td><p><sup>-86</sup></p></td>
<td><p><sup>-110</sup></p></td>
<td><p><sup>-446</sup></p></td>
<td><p><sup>Continuing Disability Reviews:</sup></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>Federal SSI payments </sup></p></td>
<td></td>
<td><p><sup>(<u>1</u>/)</sup></p></td>
<td><p><sup>4</sup></p></td>
<td><p><sup>22</sup></p></td>
<td><p><sup>53</sup></p></td>
<td><p><sup>86</sup></p></td>
<td><p><sup>97</sup></p></td>
<td><p><sup>100</sup></p></td>
<td><p><sup>117</sup></p></td>
<td><p><sup>123</sup></p></td>
<td><p><sup>127</sup></p></td>
<td><p><sup>730</sup></p></td>
<td><p><sup>Net effect of inclusion of children without deferral of age
18 redeterminations:</sup></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>Federal SSI payments </sup></p></td>
<td></td>
<td><p><sup>-1</sup></p></td>
<td><p><sup>-3</sup></p></td>
<td><p><sup>3</sup></p></td>
<td><p><sup>21</sup></p></td>
<td><p><sup>46</sup></p></td>
<td><p><sup>57</sup></p></td>
<td><p><sup>53</sup></p></td>
<td><p><sup>53</sup></p></td>
<td><p><sup>36</sup></p></td>
<td><p><sup>18</sup></p></td>
<td><p><sup>284</sup></p></td>
<td><p><sup>Revisions to Federal SSI payments due to deferral of age 18
redeterminations in accordance with CDR deferral
provisions:</sup></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>Continuing Disability Reviews:</sup></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>Federal SSI payments </sup></p></td>
<td></td>
<td><p><sup>(<u>1</u>/)</sup></p></td>
<td><p><sup>(<u>1</u>/)</sup></p></td>
<td><p><sup>(<u>1</u>/)</sup></p></td>
<td><p><sup>1</sup></p></td>
<td><p><sup>9</sup></p></td>
<td><p><sup>28</sup></p></td>
<td><p><sup>47</sup></p></td>
<td><p><sup>56</sup></p></td>
<td><p><sup>58</sup></p></td>
<td><p><sup>57</sup></p></td>
<td><p><sup>256</sup></p></td>
<td><p><sup>Ticket to Work program effects if newly disabled MIEs and
certain disabled children are included and age 18 redeterminations are
treated as CDRs:</sup></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>OASDI benefit payments </sup></p></td>
<td></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>5</sup></p></td>
<td><p><sup>14</sup></p></td>
<td><p><sup>37</sup></p></td>
<td><p><sup>61</sup></p></td>
<td><p><sup>77</sup></p></td>
<td><p><sup>88</sup></p></td>
<td><p><sup>87</sup></p></td>
<td><p><sup>74</sup></p></td>
<td><p><sup>45</sup></p></td>
<td><p><sup>489</sup></p></td>
<td><p><sup>Federal SSI payments </sup></p></td>
<td></td>
<td><p><sup>-2</sup></p></td>
<td><p><sup>-9</sup></p></td>
<td><p><sup>-10</sup></p></td>
<td><p><sup>6</sup></p></td>
<td><p><sup>49</sup></p></td>
<td><p><sup>88</sup></p></td>
<td><p><sup>100</sup></p></td>
<td><p><sup>98</sup></p></td>
<td><p><sup>53</sup></p></td>
<td><p><sup>8</sup></p></td>
<td><p><sup>380</sup></p></td>
<td><p><sup>Total, OASDI and SSI </sup></p></td>
<td></td>
<td><p><sup>-2</sup></p></td>
<td><p><sup>-4</sup></p></td>
<td><p><sup>4</sup></p></td>
<td><p><sup>43</sup></p></td>
<td><p><sup>110</sup></p></td>
<td><p><sup>165</sup></p></td>
<td><p><sup>188</sup></p></td>
<td><p><sup>185</sup></p></td>
<td><p><sup>127</sup></p></td>
<td><p><sup>53</sup></p></td>
<td><p><sup>869</sup></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><p><sup><u>1</u>/ Net change in OASDI benefit payments or Federal
SSI payments of less than $500,000.</sup></p>
<p><sup><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. </sup></p>
<p><sup>Notes: 1. Above estimates based on the intermediate assumptions
of the 2000 OASDI Trustees Report and the 2000 SSI Annual
Report.</sup></p>
<p><sup> 2. Totals may not equal sum of rounded
components.</sup></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
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<td><p><sup>Social Security Administration</sup></p>
<p><sup>Office of the Chief Actuary</sup></p>
<p><sup>March 26, 2001</sup></p></td>
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</table>

**^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.^

·
^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\ 49th\ to\ 60th\ 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^

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<td><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>
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<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td><p><sup>Fiscal year</sup></p></td>
<td><p><sup>Total,</sup></p>
<p><sup><u>2001-10</u></sup></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><p><sup>Option</sup></p></td>
<td></td>
<td><p><sup><u>2001</u></sup></p></td>
<td><p><sup><u>2002</u></sup></p></td>
<td><p><sup><u>2003</u></sup></p></td>
<td><p><sup><u>2004</u></sup></p></td>
<td><p><sup><u>2005</u></sup></p></td>
<td><p><sup><u>2006</u></sup></p></td>
<td><p><sup><u>2007</u></sup></p></td>
<td><p><sup><u>2008</u></sup></p></td>
<td><p><sup><u>2009</u></sup></p></td>
<td><p><sup><u>2010</u></sup></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><p><strong><sup>Ticket to Work program effects based on
implementation as specified in the Notice of Proposed
Rulemaking:</sup></strong></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>OASDI benefit payments </sup></p></td>
<td></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>$2</sup></p></td>
<td><p><sup>$2</sup></p></td>
<td><p><sup>$3</sup></p></td>
<td><p><sup>-$10</sup></p></td>
<td><p><sup>-$20</sup></p></td>
<td><p><sup>-$29</sup></p></td>
<td><p><sup>-$41</sup></p></td>
<td><p><sup>-$64</sup></p></td>
<td><p><sup>-$101</sup></p></td>
<td><p><sup>-$258</sup></p></td>
<td><p><sup>Federal SSI payments </sup></p></td>
<td></td>
<td><p><sup>-$1</sup></p></td>
<td><p><sup>-4</sup></p></td>
<td><p><sup>-12</sup></p></td>
<td><p><sup>-19</sup></p></td>
<td><p><sup>-21</sup></p></td>
<td><p><sup>-18</sup></p></td>
<td><p><sup>-18</sup></p></td>
<td><p><sup>-27</sup></p></td>
<td><p><sup>-48</sup></p></td>
<td><p><sup>-67</sup></p></td>
<td><p><sup>-235</sup></p></td>
<td><p><sup>Subtotal, OASDI and SSI </sup></p></td>
<td></td>
<td><p><sup>-1</sup></p></td>
<td><p><sup>-2</sup></p></td>
<td><p><sup>-10</sup></p></td>
<td><p><sup>-16</sup></p></td>
<td><p><sup>-31</sup></p></td>
<td><p><sup>-38</sup></p></td>
<td><p><sup>-47</sup></p></td>
<td><p><sup>-68</sup></p></td>
<td><p><sup>-112</sup></p></td>
<td><p><sup>-168</sup></p></td>
<td><p><sup>-493</sup></p></td>
<td><p><strong><sup>Alternative 1</sup><sup>—</sup><sup>establish a
3</sup><sup>rd</sup><sup> milestone and extend recovery of milestone
payments to 24 months:</sup></strong></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>OASDI benefit payments </sup></p></td>
<td></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>2</sup></p></td>
<td><p><sup>7</sup></p></td>
<td><p><sup>16</sup></p></td>
<td><p><sup>12</sup></p></td>
<td><p><sup>-1</sup></p></td>
<td><p><sup>-14</sup></p></td>
<td><p><sup>-25</sup></p></td>
<td><p><sup>-47</sup></p></td>
<td><p><sup>-85</sup></p></td>
<td><p><sup>-133</sup></p></td>
<td><p><sup>Federal SSI payments </sup></p></td>
<td></td>
<td><p><sup>-1</sup></p></td>
<td><p><sup>-4</sup></p></td>
<td><p><sup>-10</sup></p></td>
<td><p><sup>-17</sup></p></td>
<td><p><sup>-19</sup></p></td>
<td><p><sup>-16</sup></p></td>
<td><p><sup>-16</sup></p></td>
<td><p><sup>-24</sup></p></td>
<td><p><sup>-41</sup></p></td>
<td><p><sup>-58</sup></p></td>
<td><p><sup>-205</sup></p></td>
<td><p><sup>Subtotal, OASDI and SSI </sup></p></td>
<td></td>
<td><p><sup>-1</sup></p></td>
<td><p><sup>-2</sup></p></td>
<td><p><sup>-3</sup></p></td>
<td><p><sup>-1</sup></p></td>
<td><p><sup>-7</sup></p></td>
<td><p><sup>-17</sup></p></td>
<td><p><sup>-30</sup></p></td>
<td><p><sup>-49</sup></p></td>
<td><p><sup>-88</sup></p></td>
<td><p><sup>-143</sup></p></td>
<td><p><sup>-338</sup></p></td>
<td><p><strong><sup>Alternative 2</sup><sup>—</sup><sup>establish a
3</sup><sup>rd</sup><sup> milestone and extend recovery of milestone
payments to 60 months:</sup></strong></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>OASDI benefit payments </sup></p></td>
<td></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>2</sup></p></td>
<td><p><sup>8</sup></p></td>
<td><p><sup>19</sup></p></td>
<td><p><sup>21</sup></p></td>
<td><p><sup>13</sup></p></td>
<td><p><sup>2</sup></p></td>
<td><p><sup>-13</sup></p></td>
<td><p><sup>-39</sup></p></td>
<td><p><sup>-80</sup></p></td>
<td><p><sup>-66</sup></p></td>
<td><p><sup>Federal SSI payments </sup></p></td>
<td></td>
<td><p><sup>(<u>1</u>/)</sup></p></td>
<td><p><sup>-4</sup></p></td>
<td><p><sup>-9</sup></p></td>
<td><p><sup>-14</sup></p></td>
<td><p><sup>-15</sup></p></td>
<td><p><sup>-12</sup></p></td>
<td><p><sup>-11</sup></p></td>
<td><p><sup>-18</sup></p></td>
<td><p><sup>-32</sup></p></td>
<td><p><sup>-45</sup></p></td>
<td><p><sup>-160</sup></p></td>
<td><p><sup>Subtotal, OASDI and SSI </sup></p></td>
<td></td>
<td><p><sup>(<u>1</u>/)</sup></p></td>
<td><p><sup>-2</sup></p></td>
<td><p><sup>-1</sup></p></td>
<td><p><sup>5</sup></p></td>
<td><p><sup>6</sup></p></td>
<td><p><sup>1</sup></p></td>
<td><p><sup>-9</sup></p></td>
<td><p><sup>-31</sup></p></td>
<td><p><sup>-71</sup></p></td>
<td><p><sup>-125</sup></p></td>
<td><p><sup>-226</sup></p></td>
<td><p><strong><sup>Alternative 3</sup><sup>—</sup><sup>establish a
3</sup><sup>rd</sup><sup> milestone, extend recovery of milestone
payments to 60 months, and increase outcome
payments:</sup></strong></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>OASDI benefit payments </sup></p></td>
<td></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>4</sup></p></td>
<td><p><sup>16</sup></p></td>
<td><p><sup>35</sup></p></td>
<td><p><sup>47</sup></p></td>
<td><p><sup>39</sup></p></td>
<td><p><sup>29</sup></p></td>
<td><p><sup>14</sup></p></td>
<td><p><sup>-12</sup></p></td>
<td><p><sup>-53</sup></p></td>
<td><p><sup>119</sup></p></td>
<td><p><sup>Federal SSI payments </sup></p></td>
<td></td>
<td><p><sup>(<u>1</u>/)</sup></p></td>
<td><p><sup>-2</sup></p></td>
<td><p><sup>-6</sup></p></td>
<td><p><sup>-8</sup></p></td>
<td><p><sup>-8</sup></p></td>
<td><p><sup>-4</sup></p></td>
<td><p><sup>-2</sup></p></td>
<td><p><sup>-4</sup></p></td>
<td><p><sup>-9</sup></p></td>
<td><p><sup>-16</sup></p></td>
<td><p><sup>-58</sup></p></td>
<td><p><sup>Subtotal, OASDI and SSI </sup></p></td>
<td></td>
<td><p><sup>(<u>1</u>/)</sup></p></td>
<td><p><sup>2</sup></p></td>
<td><p><sup>10</sup></p></td>
<td><p><sup>27</sup></p></td>
<td><p><sup>39</sup></p></td>
<td><p><sup>35</sup></p></td>
<td><p><sup>27</sup></p></td>
<td><p><sup>10</sup></p></td>
<td><p><sup>-21</sup></p></td>
<td><p><sup>-69</sup></p></td>
<td><p><sup>61</sup></p></td>
<td><p><strong><sup>Alternative 4</sup><sup>—</sup><sup>establish
additional milestones earlier in the process and extend recovery of
milestone payments to 60 months:</sup></strong></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>OASDI benefit payments </sup></p></td>
<td></td>
<td><p><sup>60</sup></p></td>
<td><p><sup>154</sup></p></td>
<td><p><sup>300</sup></p></td>
<td><p><sup>341</sup></p></td>
<td><p><sup>358</sup></p></td>
<td><p><sup>371</sup></p></td>
<td><p><sup>382</sup></p></td>
<td><p><sup>375</sup></p></td>
<td><p><sup>357</sup></p></td>
<td><p><sup>329</sup></p></td>
<td><p><sup>3,028</sup></p></td>
<td><p><sup>Federal SSI payments </sup></p></td>
<td></td>
<td><p><sup>4</sup></p></td>
<td><p><sup>21</sup></p></td>
<td><p><sup>35</sup></p></td>
<td><p><sup>52</sup></p></td>
<td><p><sup>46</sup></p></td>
<td><p><sup>57</sup></p></td>
<td><p><sup>93</sup></p></td>
<td><p><sup>135</sup></p></td>
<td><p><sup>159</sup></p></td>
<td><p><sup>165</sup></p></td>
<td><p><sup>768</sup></p></td>
<td><p><sup>Total, OASDI and SSI </sup></p></td>
<td></td>
<td><p><sup>64</sup></p></td>
<td><p><sup>175</sup></p></td>
<td><p><sup>335</sup></p></td>
<td><p><sup>393</sup></p></td>
<td><p><sup>404</sup></p></td>
<td><p><sup>428</sup></p></td>
<td><p><sup>475</sup></p></td>
<td><p><sup>510</sup></p></td>
<td><p><sup>516</sup></p></td>
<td><p><sup>494</sup></p></td>
<td><p><sup>3,796</sup></p></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
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<td></td>
<td></td>
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<td></td>
<td></td>
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<td></td>
<td></td>
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<td></td>
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<td></td>
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<td></td>
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<td></td>
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<td></td>
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<td></td>
<td></td>
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<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
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<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><p><sup><u>1</u>/ Net change in OASDI benefit payments or Federal
SSI payments of less than $500,000.</sup></p>
<p><sup>Notes: 1. Above estimates based on the intermediate assumptions
of the 2000 OASDI Trustees Report and the 2000 SSI Annual
Report.</sup></p>
<p><sup> 2. Totals may not equal sum of rounded
components.</sup></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
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<td></td>
<td></td>
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<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
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<td></td>
<td></td>
<td></td>
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<td></td>
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<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td><p><sup>Social Security Administration</sup></p>
<p><sup>Office of the Chief Actuary</sup></p>
<p><sup>April 11, 2001</sup></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
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<td></td>
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<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
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<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
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<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
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<td></td>
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<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
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<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
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<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
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<td></td>
<td></td>
<td></td>
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<td></td>
<td></td>
<td></td>
<td></td>
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<td></td>
<td></td>
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<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><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>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td><p><sup>Fiscal year</sup></p></td>
<td><p><sup>Total,</sup></p>
<p><sup><u>2001-10</u></sup></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><p><sup>Option</sup></p></td>
<td></td>
<td><p><sup><u>2001</u></sup></p></td>
<td><p><sup><u>2002</u></sup></p></td>
<td><p><sup><u>2003</u></sup></p></td>
<td><p><sup><u>2004</u></sup></p></td>
<td><p><sup><u>2005</u></sup></p></td>
<td><p><sup><u>2006</u></sup></p></td>
<td><p><sup><u>2007</u></sup></p></td>
<td><p><sup><u>2008</u></sup></p></td>
<td><p><sup><u>2009</u></sup></p></td>
<td><p><sup><u>2010</u></sup></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><p><strong><sup>Ticket to Work program based on implementation as
specified in the NPRM</sup></strong></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>OASDI benefit payments </sup></p></td>
<td></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>Federal SSI payments </sup></p></td>
<td></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>Subtotal, OASDI and SSI </sup></p></td>
<td></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>–</sup></p></td>
<td><p><strong><sup>Alternative 1</sup><sup>—</sup><sup>establish a
3</sup><sup>rd</sup><sup> milestone and extend recovery of milestone
payments to 24 months:</sup></strong></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>OASDI benefit payments </sup></p></td>
<td></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>(<u>1</u>/)</sup></p></td>
<td><p><sup>$5</sup></p></td>
<td><p><sup>$13</sup></p></td>
<td><p><sup>$22</sup></p></td>
<td><p><sup>$19</sup></p></td>
<td><p><sup>$15</sup></p></td>
<td><p><sup>$16</sup></p></td>
<td><p><sup>$17</sup></p></td>
<td><p><sup>$16</sup></p></td>
<td><p><sup>$125</sup></p></td>
<td><p><sup>Federal SSI payments </sup></p></td>
<td></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>(<u>1</u>/)</sup></p></td>
<td><p><sup>1</sup></p></td>
<td><p><sup>2</sup></p></td>
<td><p><sup>3</sup></p></td>
<td><p><sup>2</sup></p></td>
<td><p><sup>2</sup></p></td>
<td><p><sup>3</sup></p></td>
<td><p><sup>7</sup></p></td>
<td><p><sup>9</sup></p></td>
<td><p><sup>30</sup></p></td>
<td><p><sup>Subtotal, OASDI and SSI </sup></p></td>
<td></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>(<u>1</u>/)</sup></p></td>
<td><p><sup>6</sup></p></td>
<td><p><sup>15</sup></p></td>
<td><p><sup>25</sup></p></td>
<td><p><sup>21</sup></p></td>
<td><p><sup>17</sup></p></td>
<td><p><sup>19</sup></p></td>
<td><p><sup>24</sup></p></td>
<td><p><sup>25</sup></p></td>
<td><p><sup>155</sup></p></td>
<td><p><strong><sup>Alternative 2</sup><sup>—</sup><sup>establish a
3</sup><sup>rd</sup><sup> milestone and extend recovery of milestone
payments to 60 months:</sup></strong></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>OASDI benefit payments </sup></p></td>
<td></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>(<u>1</u>/)</sup></p></td>
<td><p><sup>6</sup></p></td>
<td><p><sup>16</sup></p></td>
<td><p><sup>31</sup></p></td>
<td><p><sup>33</sup></p></td>
<td><p><sup>31</sup></p></td>
<td><p><sup>28</sup></p></td>
<td><p><sup>25</sup></p></td>
<td><p><sup>21</sup></p></td>
<td><p><sup>192</sup></p></td>
<td><p><sup>Federal SSI payments </sup></p></td>
<td></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>$1</sup></p></td>
<td><p><sup>3</sup></p></td>
<td><p><sup>5</sup></p></td>
<td><p><sup>6</sup></p></td>
<td><p><sup>6</sup></p></td>
<td><p><sup>7</sup></p></td>
<td><p><sup>9</sup></p></td>
<td><p><sup>16</sup></p></td>
<td><p><sup>22</sup></p></td>
<td><p><sup>74</sup></p></td>
<td><p><sup>Subtotal, OASDI and SSI </sup></p></td>
<td></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>1</sup></p></td>
<td><p><sup>9</sup></p></td>
<td><p><sup>21</sup></p></td>
<td><p><sup>37</sup></p></td>
<td><p><sup>39</sup></p></td>
<td><p><sup>38</sup></p></td>
<td><p><sup>37</sup></p></td>
<td><p><sup>41</sup></p></td>
<td><p><sup>43</sup></p></td>
<td><p><sup>266</sup></p></td>
<td><p><strong><sup>Alternative 3</sup><sup>—</sup><sup>establish a
3</sup><sup>rd</sup><sup> milestone, extend recovery of milestone
payments to 60 months, and increase outcome
payments:</sup></strong></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>OASDI benefit payments </sup></p></td>
<td></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>2</sup></p></td>
<td><p><sup>14</sup></p></td>
<td><p><sup>32</sup></p></td>
<td><p><sup>57</sup></p></td>
<td><p><sup>59</sup></p></td>
<td><p><sup>58</sup></p></td>
<td><p><sup>55</sup></p></td>
<td><p><sup>52</sup></p></td>
<td><p><sup>48</sup></p></td>
<td><p><sup>377</sup></p></td>
<td><p><sup>Federal SSI payments </sup></p></td>
<td></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>2</sup></p></td>
<td><p><sup>6</sup></p></td>
<td><p><sup>11</sup></p></td>
<td><p><sup>14</sup></p></td>
<td><p><sup>14</sup></p></td>
<td><p><sup>16</sup></p></td>
<td><p><sup>23</sup></p></td>
<td><p><sup>39</sup></p></td>
<td><p><sup>51</sup></p></td>
<td><p><sup>177</sup></p></td>
<td><p><sup>Subtotal, OASDI and SSI </sup></p></td>
<td></td>
<td><p><sup>–</sup></p></td>
<td><p><sup>4</sup></p></td>
<td><p><sup>20</sup></p></td>
<td><p><sup>43</sup></p></td>
<td><p><sup>71</sup></p></td>
<td><p><sup>73</sup></p></td>
<td><p><sup>74</sup></p></td>
<td><p><sup>78</sup></p></td>
<td><p><sup>91</sup></p></td>
<td><p><sup>99</sup></p></td>
<td><p><sup>554</sup></p></td>
<td><p><strong><sup>Alternative 4</sup><sup>—</sup><sup>establish
additional milestones earlier in the process and extend recovery of
milestone payments to 60 months:</sup></strong></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p><sup>OASDI benefit payments </sup></p></td>
<td></td>
<td><p><sup>$60</sup></p></td>
<td><p><sup>152</sup></p></td>
<td><p><sup>298</sup></p></td>
<td><p><sup>338</sup></p></td>
<td><p><sup>368</sup></p></td>
<td><p><sup>391</sup></p></td>
<td><p><sup>411</sup></p></td>
<td><p><sup>416</sup></p></td>
<td><p><sup>421</sup></p></td>
<td><p><sup>430</sup></p></td>
<td><p><sup>3,286</sup></p></td>
<td><p><sup>Federal SSI payments </sup></p></td>
<td></td>
<td><p><sup>5</sup></p></td>
<td><p><sup>25</sup></p></td>
<td><p><sup>47</sup></p></td>
<td><p><sup>71</sup></p></td>
<td><p><sup>68</sup></p></td>
<td><p><sup>75</sup></p></td>
<td><p><sup>111</sup></p></td>
<td><p><sup>162</sup></p></td>
<td><p><sup>207</sup></p></td>
<td><p><sup>233</sup></p></td>
<td><p><sup>1,002</sup></p></td>
<td><p><sup>Total, OASDI and SSI </sup></p></td>
<td></td>
<td><p><sup>65</sup></p></td>
<td><p><sup>177</sup></p></td>
<td><p><sup>345</sup></p></td>
<td><p><sup>409</sup></p></td>
<td><p><sup>436</sup></p></td>
<td><p><sup>466</sup></p></td>
<td><p><sup>522</sup></p></td>
<td><p><sup>578</sup></p></td>
<td><p><sup>628</sup></p></td>
<td><p><sup>663</sup></p></td>
<td><p><sup>4,288</sup></p></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
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<tr class="odd">
<td><p><sup><u>1</u>/ Net change in OASDI benefit payments or Federal
SSI payments of less than $500,000.</sup></p>
<p><sup>Notes: 1. Above estimates based on the intermediate assumptions
of the 2000 OASDI Trustees Report and the 2000 SSI Annual
Report.</sup></p>
<p><sup> 2. Totals may not equal sum of rounded
components.</sup></p></td>
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<td></td>
<td><p><sup>Social Security Administration</sup></p>
<p><sup>Office of the Chief Actuary</sup></p>
<p><sup>April 11, 2001</sup></p></td>
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</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.^

<table>
<tbody>
<tr class="odd">
<td><p><sup>Milestone</sup></p></td>
<td><p><sup>Payment Criteria</sup></p></td>
<td><p><sup>Payment Threshold</sup></p></td>
<td><p><sup>Payment</sup></p></td>
<td><p><sup>Cumulative Savings to SSA</sup></p></td>
<td><p><sup>Total</sup></p>
<p><sup>+ or –</sup></p></td>
<td></td>
<td></td>
<td></td>
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</tr>
<tr class="even">
<td><p><sup>Job Placement</sup></p></td>
<td><p><sup>Minimum 1 month work</sup></p></td>
<td><p><sup>Earnings of at least $200</sup></p></td>
<td><p><sup>$1,000</sup></p></td>
<td><p><sup>`$58</sup></p></td>
<td><p><sup>-942</sup></p></td>
<td><p><sup>Job Training Complete</sup></p></td>
<td><p><sup>Minimum 3 months work</sup></p></td>
<td><p><sup>Avg. earnings in the last 2 months of at least $530 (trial
work period amount)</sup></p></td>
<td><p><sup>$1,000</sup></p></td>
<td><p><sup>$445+58=$503</sup></p></td>
<td><p><sup>-1497</sup></p></td>
<td><p><sup>Integration into Worksite</sup></p></td>
<td><p><sup>Minimum 6 months of work</sup></p></td>
<td><p><sup>Avg. earnings in the last 3 months of at least
$600/month</sup></p></td>
<td><p><sup>$1,000</sup></p></td>
<td><p><sup>$772+503=$1275</sup></p></td>
<td><p><sup>-1725</sup></p></td>
<td><p><sup>Attainment of SGA</sup></p></td>
<td><p><sup>Minimum of 9 months work</sup></p></td>
<td><p><sup>Avg. earnings in last 3 months at least SGA
($700)</sup></p></td>
<td><p><sup>$1,000</sup></p></td>
<td><p><sup>$938+1275=$2213</sup></p></td>
<td><p><sup>-1787</sup></p></td>
</tr>
<tr class="odd">
<td><p><sup>Quarterly Job Retention Outcome Payment</sup></p></td>
<td><p><sup>3 months of job retention</sup></p></td>
<td><p><sup>Monthly earnings at</sup></p></td>
<td><ol type="a">
<li><p><sup>$530+/mo</sup></p></li>
<li><p><sup>$700+/mo</sup></p></li>
<li><p><sup>$1000+/mo</sup></p></li>
</ol>
<p><sup>Quarterly</sup></p>
<ol type="a">
<li><p><sup>$234</sup></p></li>
<li><p><sup>$323</sup></p></li>
<li><p><sup>$480</sup></p></li>
</ol>
<p><sup>35% of benefits not paid</sup></p></td>
<td><p><sup>Breakeven point beyond 9 mo. Milestone</sup></p></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

a.  ^13\ months^

b.  ^\ 9\ months^

c.  ^\ 6\ months^

**^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\ ^**

**^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\ ^**

### ^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