I
105TH CONGRESS
2D SESSION
H. R. 3433
To amend the Social Security Act to establish a Ticket to Work and Self-
Sufficiency Program in the Social Security Administration to provide
beneficiaries with disabilities meaningful opportunities to return to work
and to extend Medicare coverage for such beneficiaries, and to amend
the Internal Revenue Code of 1986 to provide a tax credit for impair-
ment-related work expenses.
IN THE HOUSE OF REPRESENTATIVES
MARCH 11, 1998
Mr. BUNNING (for himself and Mrs. KENNELLY of Connecticut) introduced
the following bill; which was referred to the Committee on Ways and Means
A BILL
To amend the Social Security Act to establish a Ticket
to Work and Self-Sufficiency Program in the Social Se-
curity Administration to provide beneficiaries with dis-
abilities meaningful opportunities to return to work and
to extend Medicare coverage for such beneficiaries, and
to amend the Internal Revenue Code of 1986 to provide
a tax credit for impairment-related work expenses.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
participate in the Program (or to revoke any such
election) as an employment network. The Commis-
sioner shall provide for periodic opportunities for ex-
ercising such elections (and revocations).
‘‘(2) TREATMENT OF STATE AGENCIES.—Any
such election (or revocation) by a State agency de-
scribed in section 222 or 1615 taking effect during
any period for which an individual residing in the
State is a disabled beneficiary and a client of the
State agency shall not be effective with respect to
such individual to the extent that such election (or
revocation) would result in any change in the meth-
od of payment to the State agency with respect to
the individual from the method of payment to the
State agency with respect to the individual in effect
immediately before such election (or revocation).
‘‘(3) EFFECT
OF
PARTICIPATION
BY
STATE
AGENCY.—
‘‘(A) STATE AGENCIES PARTICIPATING.—
In any case in which a State agency described
in section 222 or 1615 elects under paragraph
(1) to participate in the Program—
‘‘(i) the employment services, voca-
tional rehabilitation services, and other
support services which, upon assignment of
tickets to work and self-sufficiency, are
provided to disabled beneficiaries by the
State agency acting as an employment net-
work shall be governed by plans for voca-
tional 
rehabilitation 
services 
approved
under title I of the Rehabilitation Act of
1973, and
‘‘(ii) the provisions of section 222(d)
and the provisions of section 1615 shall
not apply with respect to such State.
‘‘(B) STATE
AGENCIES
ADMINISTERING
MATERNAL AND CHILD HEALTH SERVICES PRO-
GRAMS.—Subparagraph (A) shall not apply
with respect to any State agency administering
a program under title V of this Act.
‘‘(d) RESPONSIBILITIES OF THE COMMISSIONER OF
SOCIAL SECURITY.—
‘‘(1) SELECTION AND QUALIFICATIONS OF PRO-
GRAM MANAGERS.—The Commissioner of Social Se-
curity shall enter into agreements with one or more
organizations in the private or public sector for serv-
ice as a program manager to assist the Commis-
sioner in administering the Program. Any such pro-
gram manager shall be selected by means of a com-
petitive bidding process, from among organizations
in the private or public sector with available exper-
tise and experience in the field of vocational rehabili-
tation or employment services.
‘‘(2) TENURE, RENEWAL, AND EARLY TERMI-
NATION.—Each agreement entered into under para-
graph (1) shall provide for early termination upon
failure to meet performance standards which shall be
specified in the agreement and which shall be
weighted to take into account any performance in
prior terms. Such performance standards shall in-
clude (but are not limited to)—
‘‘(A) measures for ease of access by bene-
ficiaries to services, and
‘‘(B) measures for determining the extent
to which failures in obtaining services for bene-
ficiaries fall within acceptable parameters, as
determined by the Commissioner.
‘‘(3) PRECLUSION
FROM
DIRECT
PARTICIPA-
TION IN DELIVERY OF SERVICES IN OWN SERVICE
AREA.—Agreements under paragraph (1) shall pre-
clude—
‘‘(A) direct participation by a program
manager in the delivery of employment services,
vocational rehabilitation services, or other sup-
port services to beneficiaries in the service area
covered by the program manager’s agreement,
and
‘‘(B) the holding by a program manager of
a financial interest in an employment network
or service provider which provides services in a
geographic area covered under the program
manager’s agreement.
‘‘(4) 
SELECTION
OF
EMPLOYMENT
NET-
WORKS.—The Commissioner shall select and enter
into agreements with employment networks for serv-
ice under the Program. Such employment networks
shall be in addition to State agencies serving as em-
ployment networks pursuant to elections under sub-
section (c).
‘‘(5) TERMINATION OF AGREEMENTS WITH EM-
PLOYMENT
NETWORKS..—The Commissioner shall
terminate agreements with employment networks for
inadequate performance, as determined by the Com-
missioner.
‘‘(6) QUALITY ASSURANCE.—The Commissioner
shall provide for such periodic reviews as are nec-
essary to provide for effective quality assurance in
the provision of services by employment networks.
The Commissioner shall take into account the views
of consumers and the program manager under which
the employment networks serve and shall consult
with providers of services to develop performance
measurements. The Commissioner shall ensure that
the results of the periodic reviews are made available
to beneficiaries who are prospective service recipients
as they select employment networks. The Commis-
sioner shall ensure the performance of periodic sur-
veys of beneficiaries receiving services under the
Program designed to measure customer service satis-
faction.
‘‘(7) DISPUTE
RESOLUTION.—The Commis-
sioner shall provide for a mechanism for resolving
disputes between beneficiaries and employment net-
works and between program managers and employ-
ment networks. The Commissioner shall afford a
party to such a dispute a reasonable opportunity for
a full and fair review of the matter in dispute.
‘‘(e) PROGRAM MANAGERS.—
‘‘(1) IN GENERAL.—A program manager shall
conduct tasks appropriate to assist the Commis-
sioner in carrying out the Commissioner’s duties in
administering the Program.
‘‘(2) RECRUITMENT
OF
EMPLOYMENT
NET-
WORKS.—A program manager shall recruit, and rec-
ommend for selection by the Commissioner, employ-
ment networks for service under the Program. The
program manager shall carry out such recruitment
and provide such recommendations, and shall mon-
itor all employment networks serving in the Program
in the geographic area covered under the program
manager’s agreement, to the extent necessary and
appropriate to ensure that adequate choices of serv-
ices are made available to beneficiaries. Employment
networks may serve under the Program only pursu-
ant to an agreement entered into with the Commis-
sioner under the Program incorporating the applica-
ble provisions of this section and regulations there-
under, and the program manager shall provide and
maintain assurances to the Commissioner that pay-
ment by the Commissioner to employment networks
pursuant to this section is warranted based on com-
pliance by such employment networks with the terms
of such agreement and this section. The program
manager shall not impose numerical limits on the
number of employment networks to be recommended
pursuant to this paragraph.
‘‘(3) FACILITATION
OF
ACCESS
BY
BENE-
FICIARIES
TO
EMPLOYMENT
NETWORKS.—A pro-
gram manager shall facilitate access by beneficiaries
to employment networks. The program manager
shall ensure that each beneficiary is allowed changes
in employment networks for good cause, as deter-
mined by the Commissioner, without being deemed
to have rejected services under the Program. The
program manager shall establish and maintain lists
of employment networks available to beneficiaries
and shall make such lists generally available to the
public.
‘‘(4) ENSURING
AVAILABILITY
OF
ADEQUATE
SERVICES.—The program manager shall ensure that
employment networks provide employment services,
vocational rehabilitation services, or other support
services to beneficiaries throughout specified service
areas, including rural areas.
‘‘(5) REASONABLE ACCESS TO SERVICES.—The
program manager shall take such measures as are
necessary to ensure that sufficient employment net-
works are available and that each beneficiary receiv-
ing their services under the Program has reasonable
access to employment services, vocational rehabilita-
tion services, or other support services. Such services
may include case management, career planning, ca-
reer plan development, vocational assessment, job
training, placement, follow-up services, and such
other services as may be specified by the Commis-
sioner under the Program.
‘‘(f) EMPLOYMENT NETWORKS.—
‘‘(1) QUALIFICATIONS FOR EMPLOYMENT NET-
WORKS.—Each employment network serving under
the Program shall consist of an agency or instru-
mentality of a State (or a political subdivision there-
of) or a private entity, which assumes responsibility
for the coordination and delivery of services under
the Program to individuals assigning to the employ-
ment network tickets to work and self-sufficiency
issued under subsection (b). No employment network
may serve under the Program unless it demonstrates
to the Commissioner substantial expertise and expe-
rience in the field of employment services, vocational
rehabilitation services, or other support services for
individuals with disabilities and provides an array of
such services. An employment network shall consist
of either a single provider of such services or of an
association of such providers organized so as to com-
bine their resources into a single entity. An employ-
ment network may meet the requirements of sub-
section (e)(4) by providing services directly, or by
entering into agreements with other individuals or
entities providing appropriate employment services,
vocational rehabilitation services, or other support
services.
‘‘(2) REQUIREMENTS RELATING TO PROVISION
OF
SERVICES.—Each employment network serving
under the Program shall be required under the
terms of its agreement with the Commissioner to—
‘‘(A) serve prescribed service areas,
‘‘(B) meet, and maintain compliance with,
both general selection criteria (such as profes-
sional and governmental certification and edu-
cational credentials) and specific selection cri-
teria (such as the extent of work experience by
the provider with specific populations), and
‘‘(C) take such measures as are necessary
to ensure that employment services, vocational
rehabilitation services, and other support serv-
ices provided under the Program by, or under
agreements entered into with, the employment
network are provided under appropriate individ-
ual employment plans meeting the requirements
of subsection (g).
‘‘(3) ANNUAL
FINANCIAL
REPORTING.—Each
employment network shall meet financial reporting
requirements as prescribed by the Commissioner.
‘‘(4) PERIODIC OUTCOMES REPORTING.—Each
employment network shall prepare periodic reports,
on at least an annual basis, itemizing for the covered
period specific outcomes achieved with respect to
specific services provided by the employment net-
work. Such reports shall conform to a national
model prescribed under this section. Each employ-
ment network shall provide a copy of the latest re-
port issued by the employment network pursuant to
this paragraph to each beneficiary upon enrollment
under the Program for services to be received
through such employment network. Upon issuance of
each report to each beneficiary, a copy of the report
shall be maintained in the files of the employment
network pertaining to the beneficiary. The program
manager shall ensure that copies of all such reports
issued under this paragraph are made available to
the public under reasonable terms.
‘‘(g) INDIVIDUAL EMPLOYMENT PLANS.—
‘‘(1) IN GENERAL.—Each employment network
shall—
‘‘(A) take such measures as are necessary
to ensure that employment services, vocational
rehabilitation services, and other support serv-
ices provided under the Program by, or under
agreements entered into with, the employment
network are provided under appropriate individ-
ual employment plans as defined by the Com-
missioner, and
‘‘(B) develop and implement each such in-
dividual employment plan, in the case of each
beneficiary receiving such services, in a manner
that affords such beneficiary the opportunity to
exercise informed choice in selecting an employ-
ment goal and specific services needed to
achieve that employment goal.
A beneficiary’s individual employment plan shall
take effect upon approval by the beneficiary.
‘‘(2) EMPLOYMENT EVALUATION.—In devising
the employment plan, the employment network shall
undertake an employment evaluation with respect to
the beneficiary. Each employment evaluation shall
set forth in writing such elements and shall be in
such format as the Commissioner shall prescribe.
‘‘(h) EMPLOYMENT NETWORK PAYMENT SYSTEMS.—
‘‘(1) ELECTION OF PAYMENT SYSTEM BY EM-
PLOYMENT NETWORKS.—
‘‘(A) IN
GENERAL.—The Program shall
provide for payment authorized by the Commis-
sioner to employment networks under either an
outcome payment system or an outcome-mile-
stone payment system. Each employment net-
work shall elect which payment system will be
utilized by the employment network, and, for
such period of time as such election remains in
effect, the payment system so elected shall be
utilized exclusively in connection with such em-
ployment network (except as provided in sub-
paragraph (B)).
‘‘(B) METHOD OF PAYMENT TO EMPLOY-
MENT
NETWORKS.—Any such election by an
employment network taking effect during any
period for which a disabled beneficiary is receiv-
ing services from such employment network
shall not be effective with respect to such bene-
ficiary to the extent that such election would re-
sult in any change in the method of payment to
the employment network with respect to serv-
ices provided to such beneficiary from the meth-
od of payment to the employment network with
respect to services provided to such beneficiary
as of immediately before such election.
‘‘(2) OUTCOME PAYMENT SYSTEM.—
‘‘(A) IN GENERAL.—The outcome payment
system shall consist of a payment structure gov-
erning employment networks electing such sys-
tem under paragraph (1)(A) which meets the
requirements of this paragraph.
‘‘(B) PAYMENTS MADE DURING OUTCOME
PAYMENT PERIOD.—The outcome payment sys-
tem shall provide for a schedule of payments to
an employment network, in connection with
each individual who is a beneficiary, for each
month described in paragraph (4)(B) in connec-
tion with such individual which occurs during
the individual’s outcome payment period.
‘‘(C) COMPUTATION OF PAYMENTS TO EM-
PLOYMENT NETWORK.—The payment schedule
of the outcome payment system shall be de-
signed so that—
‘‘(i) the payment for each of the 60
months during the outcome payment pe-
riod which are described in paragraph
(4)(B) is equal to a fixed percentage of the
payment calculation base for the calendar
year in which such month occurs, and
‘‘(ii) such fixed percentage is set at a
percentage which does not exceed 40 per-
cent.
‘‘(3) 
OUTCOME-MILESTONE
PAYMENT
SYS-
TEM.—
‘‘(A) IN
GENERAL.—The outcome-mile-
stone payment system shall consist of a pay-
ment structure governing employment networks
electing such system under paragraph (1)(A)
which meets the requirements of this para-
graph.
‘‘(B) EARLY
PAYMENTS
UPON
ATTAIN-
MENT OF MILESTONES IN ADVANCE OF OUT-
COME PAYMENT PERIODS.—The outcome-mile-
stone payment system shall provide for one or
more milestones, with respect to beneficiaries
receiving services from an employment network
under the Program, which are directed toward
the goal of permanent employment. Such mile-
stones shall form a part of a payment structure
which provides, in addition to payments made
during outcome payment periods, payments
made prior to outcome payment periods in
amounts based on the attainment of such mile-
stones.
‘‘(C) LIMITATION ON TOTAL PAYMENTS TO
EMPLOYMENT NETWORK.—The payment sched-
ule of the outcome milestone payment system
shall be designed so that the total of the pay-
ments to the employment network with respect
to each beneficiary is less than, on a net
present value basis (using an interest rate de-
termined by the Commissioner that appro-
priately reflects the cost of funds faced by pro-
viders), the total amount to which payments to
the employment network with respect to the
beneficiary would be limited if the employment
network were paid under the outcome payment
system.
‘‘(4) DEFINITIONS.—For purposes of this sub-
section—
‘‘(A) PAYMENT CALCULATION BASE.—The
term ‘payment calculation base’ means, for any
calendar year—
‘‘(i) in connection with a title II dis-
ability beneficiary, the average disability
insurance benefit payable under section
223 for all beneficiaries for months during
the preceding calendar year, and
‘‘(ii) in connection with a title XVI
disability beneficiary (who is not concur-
rently a title II disability beneficiary), the
average payment of supplemental security
income benefits based on disability payable
under title XVI (excluding State sup-
plementation) to all beneficiaries having
attained 18 years of age for months during
the preceding calendar year.
‘‘(B) OUTCOME
PAYMENT
PERIOD.—The
term ‘outcome payment period’ means, in con-
nection with an individual who is a disabled
beneficiary, a period—
‘‘(i) beginning with the first month—
‘‘(I) for which benefits are not
payable to such individual by reason
of engagement in substantial gainful
activity, and
‘‘(II) which ends after such bene-
ficiary has assigned a ticket to work
and self-sufficiency to an employment
network, and
‘‘(ii) ending with the 60th month
(consecutive or otherwise) following the
first month for which benefits are not pay-
able to such individual by reason of en-
gagement in work activity.
‘‘(5) PERIODIC REVIEW AND ALTERATIONS OF
PRESCRIBED SCHEDULES.—
‘‘(A) PERCENTAGES
AND
PERIODS.—The
Commissioner of Social Security shall periodi-
cally review the percentages specified in para-
graphs (2)(C) and (3)(C) and the period of
time specified in paragraph (4)(B) to determine
whether such percentages and such period pro-
vide an adequate incentive for employment net-
works to assist beneficiaries to enter the work-
force, while providing for appropriate econo-
mies. The Commissioner may alter any of such
percentages or such period of time to the extent
that the Commissioner determines, on the basis
of the Commissioner’s review under this para-
graph, that such an alteration would better pro-
vide the incentive and economies described in
the preceding sentence.
‘‘(B) NUMBER
AND
AMOUNT
OF
MILE-
STONE
PAYMENTS.—The Commissioner shall
periodically review the number and amounts of
milestone payments initially established by the
Commissioner pursuant to this section to deter-
mine whether to allow an adequate incentive for
employment networks to assist beneficiaries to
enter the workforce, taking into account infor-
mation provided to the Commissioner by pro-
gram managers, the Ticket to Work and Self-
Sufficiency Advisory Panel, and other reliable
sources. The Commissioner may from time to
time alter the number and amounts of mile-
stone payments initially established by the
Commissioner pursuant to this section to the
extent that the Commissioner determines that
such an alteration would allow an adequate in-
centive for employment networks to assist bene-
ficiaries to enter the workforce. Such alteration
shall be based on information provided to the
Commissioner by program managers, the Ticket
to Work and Self-Sufficiency Advisory Panel, or
other reliable sources.
‘‘(i) AUTHORIZATIONS.—
‘‘(1) TITLE
II
DISABILITY
BENEFICIARIES.—
There are authorized to be transferred from the
Federal Old-Age and Survivors Insurance Trust
Fund and the Federal Disability Insurance Trust
Fund each fiscal year such sums as may be nec-
essary to carry out the provisions of this section
with respect to title II disability beneficiaries. Money
paid from the Trust Funds under this section with
respect to title II disability beneficiaries who are en-
titled to benefits under section 223 or who are enti-