Union Calendar No. 304
105TH CONGRESS
2D SESSION
H. R. 3433
[Report No. 105–537]
A BILL
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 opportu-
nities 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.
MAY 18, 1998
Reported with amendments, committed to the Committee
of the Whole House on the State of the Union, and or-
dered to be printed
IV
Union Calendar No. 304
105TH CONGRESS
2D SESSION
H. R. 3433
[Report No. 105–537]
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
MAY 18, 1998
Additional sponsors: Mr. RAMSTAD, Mr. ENGLISH of Pennsylvania, Mr.
HAYWORTH, Mr. HULSHOF, Mr. RANGEL, Mr. MATSUI, Mr. LEWIS of
Georgia, Mr. NEAL of Massachusetts, Mrs. THURMAN, Ms. KAPTUR, Ms.
LOFGREN, Mr. KLINK, Ms. SLAUGHTER, Mr. SHAYS, Mr. CRANE, Mr.
CAMP, Mr. BURTON of Indiana, Mr. NETHERCUTT, Mr. HOUGHTON, Mr.
NUSSLE, Mr. WELLER, Mr. MCDERMOTT, Mr. LEVIN, Mr. FRELING-
HUYSEN, and Mr. WAXMAN
MAY 18, 1998
Reported with amendments, committed to the Committee of the Whole House
on the State of the Union, and ordered to be printed
[Strike out all after the enacting clause and insert the part printed in italic]
[For text of introduced bill, see copy of bill as introduced on March 11, 1998]
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,
SECTION 1. SHORT TITLE AND TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Ticket to Work and Self-Sufficiency Act of 1998’’.
(b) TABLE OF CONTENTS.—The table of contents is as
follows:
Sec. 1. Short title and table of contents.
Sec. 2. The Ticket to Work and Self-Sufficiency Program.
Sec. 3. Extending medicare coverage for OASDI disability benefit recipients who
are using tickets to work and self-sufficiency.
Sec. 4. Technical amendments relating to drug addicts and alcoholics.
Sec. 5. Extension of disability insurance program demonstration project author-
ity.
Sec. 6. Perfecting amendments related to withholding from social security bene-
fits.
Sec. 7. Treatment of prisoners.
Sec. 8. Revocation by members of the clergy of exemption from social security cov-
erage.
Sec. 9. Additional technical amendment relating to cooperative research or dem-
onstration projects under titles II and XVI.
SEC. 2. THE TICKET TO WORK AND SELF-SUFFICIENCY PRO-
GRAM.
(a) IN GENERAL.—Part A of title XI of the Social Se-
curity Act (42 U.S.C. 1301 et seq.) is amended by adding
at the end the following new section:
‘‘THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM
‘‘SEC. 1147. (a) IN GENERAL.—The Commissioner of
Social Security shall establish a Ticket to Work and Self-
Sufficiency Program, under which a disabled beneficiary
may use a ticket to work and self-sufficiency issued by the
Commissioner in accordance with this section to obtain em-
ployment services, vocational rehabilitation services, or
other support services from an employment network which
is of the beneficiary’s choice and which is willing to provide
such services to such beneficiary.
‘‘(b) TICKET SYSTEM.—
‘‘(1) DISTRIBUTION OF TICKETS.—The Commis-
sioner of Social Security may issue a ticket to work
and self-sufficiency to disabled beneficiaries for par-
ticipation in the Program.
‘‘(2) ASSIGNMENT OF TICKETS.—A disabled ben-
eficiary holding a ticket to work and self-sufficiency
may assign the ticket to any employment network of
the beneficiary’s choice which is serving under the
Program and is willing to accept the assignment.
‘‘(3) TICKET
TERMS.—A ticket issued under
paragraph (1) shall consist of a document which evi-
dences the Commissioner’s agreement to pay (as pro-
vided in paragraph (4)) an employment network,
which is serving under the Program and to which
such ticket is assigned by the beneficiary, for such em-
ployment services, vocational rehabilitation services,
and other support services as the employment network
may provide to the beneficiary.
‘‘(4) PAYMENTS TO EMPLOYMENT NETWORKS.—
The Commissioner shall pay an employment network
under the Program in accordance with the outcome
payment system under subsection (h)(2) or under the
outcome-milestone payment system under subsection
(h)(3) (whichever is elected pursuant to subsection
(h)(1)). An employment network may not request or
receive compensation for such services from the bene-
ficiary.
‘‘(c) STATE PARTICIPATION.—
‘‘(1) PERIODIC ELECTIONS.—Each State agency
administering or supervising the administration of
the State plan approved under title I of the Rehabili-
tation act of 1973 may elect to participate in the
Program (or to revoke any such election) as an em-
ployment network. The Commissioner shall provide
for periodic opportunities for exercising such elections
(and revocations).
‘‘(2) TREATMENT
OF
STATE
AGENCIES.—Any
such election (or revocation) by a State agency de-
scribed in paragraph (1) taking effect during any pe-
riod for which an individual residing in the State is
a disabled beneficiary and a client of the State agen-
cy shall not be effective with respect to such individ-
ual to the extent that such election (or revocation)
would result in any change in the method 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 AGEN-
CY.—
‘‘(A) STATE AGENCIES PARTICIPATING.—In
any case in which a State agency described in
paragraph (1) elects under paragraph (1) to
participate in the Program—
‘‘(i) the employment services, voca-
tional rehabilitation services, and other sup-
port services which, upon assignment of
tickets to work and self-sufficiency, are pro-
vided to disabled beneficiaries by the State
agency acting as an employment network
shall be governed by plans for vocational re-
habilitation services approved under title I
of the Rehabilitation Act of 1973, and
‘‘(ii) the provisions of section 222(d)
and the provisions of subsections (d) and (e)
of section 1615 shall not apply with respect
to such State.
‘‘(B) STATE AGENCIES ADMINISTERING MA-
TERNAL
AND
CHILD
HEALTH
SERVICES
PRO-
GRAMS.—Subparagraph (A) shall not apply with
respect to any State agency administering a pro-
gram under title V of this Act.
‘‘(4) SPECIAL
REQUIREMENTS
APPLICABLE
TO
CROSS-REFERRAL TO CERTAIN STATE AGENCIES.—
‘‘(A) IN GENERAL.—In any case in which
an employment network has been assigned a
ticket to work and self-sufficiency by a disabled
beneficiary, no State agency shall be deemed re-
quired, under this section, title I of the Rehabili-
tation Act of 1973, or a State plan approved
under such title, to accept any referral of such
disabled beneficiary from such employment net-
work unless such employment network and such
State agency have entered into a written agree-
ment that meets the requirements of subpara-
graph (B).
‘‘(B) TERMS
OF
AGREEMENT.—An agree-
ment required by subparagraph (A) shall specify,
in accordance with regulations prescribed pursu-
ant to subparagraph (C)—
‘‘(i) the extent (if any) to which the
employment network holding the ticket will
provide to the State agency—
‘‘(I) reimbursement for costs in-
curred in providing services described
in subparagraph (A) to the disabled
beneficiary, and
‘‘(II) other amounts from pay-
ments made by the Commissioner to
the employment network pursuant to
subsection (h), and
‘‘(ii) any other conditions that may be
required by such regulations.
‘‘(C) REGULATIONS.—The Commissioner of
Social Security and the Secretary of Education
shall jointly prescribe regulations specifying the
terms of agreements required by subparagraph
(A) and otherwise necessary to carry out the pro-
visions of this paragraph.
‘‘(D) PENALTY.—No payment may be made
to an employment network pursuant to sub-
section (h) in connection with services provided
to any disabled beneficiary if such employment
network makes referrals described in subpara-
graph (A) in violation of the terms of the con-
tract required under subparagraph (A) or with-
out having entered into such a contract.
‘‘(d) RESPONSIBILITIES OF THE COMMISSIONER OF
SOCIAL SECURITY.—
‘‘(1) SELECTION AND QUALIFICATIONS OF PRO-
GRAM MANAGERS.—The Commissioner of Social Secu-
rity shall enter into agreements with one or more or-
ganizations in the private or public sector for service
as a program manager to assist the Commissioner in
administering the Program. Any such program man-
ager shall be selected by means of a competitive bid-
ding process, from among organizations in the pri-
vate or public sector with available expertise and ex-
perience in the field of vocational rehabilitation 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 weight-
ed to take into account any performance in prior
terms. Such performance standards shall include (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 de-
termined by the Commissioner.
‘‘(3) PRECLUSION FROM DIRECT PARTICIPATION
IN DELIVERY OF SERVICES IN OWN SERVICE AREA.—
Agreements under paragraph (1) shall preclude—
‘‘(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 man-
ager’s agreement.
‘‘(4) SELECTION OF EMPLOYMENT NETWORKS.—
The Commissioner shall select and enter into agree-
ments with employment networks for service under
the Program. Such employment networks shall be in
addition to State agencies serving as employment net-
works pursuant to elections under subsection (c).
‘‘(5) TERMINATION OF AGREEMENTS WITH EM-
PLOYMENT NETWORKS.—The Commissioner shall ter-
minate agreements with employment networks for in-
adequate performance, as determined by the Commis-
sioner.
‘‘(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 measure-
ments. The Commissioner shall ensure that the results
of the periodic reviews are made available to bene-
ficiaries who are prospective service recipients as they
select employment networks. The Commissioner shall
ensure the performance of periodic surveys of bene-
ficiaries receiving services under the Program de-
signed to measure customer service satisfaction.
‘‘(7) DISPUTE RESOLUTION.—The Commissioner
shall provide for a mechanism for resolving disputes
between beneficiaries and employment networks and
between program managers and employment net-
works. 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 Commissioner
in carrying out the Commissioner’s duties in admin-
istering 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 ap-
propriate to ensure that adequate choices of services
are made available to beneficiaries. Employment net-
works may serve under the Program only pursuant to
an agreement entered into with the Commissioner
under the Program incorporating the applicable pro-
visions of this section and regulations thereunder, and
the program manager shall provide and maintain as-
surances to the Commissioner that payment by the
Commissioner to employment networks pursuant to
this section is warranted based on compliance by such
employment networks with the terms of such agree-
ment and this section. The program manager shall
not impose numerical limits on the number of em-
ployment networks to be recommended pursuant to
this paragraph.
‘‘(3) 
FACILITATION
OF
ACCESS
BY
BENE-
FICIARIES TO EMPLOYMENT NETWORKS.—A program
manager shall facilitate access by beneficiaries to em-
ployment networks. The program manager shall en-
sure that each beneficiary is allowed changes in em-
ployment networks for good cause, as determined by
the Commissioner, without being deemed to have re-
jected services under the Program. The program man-
ager shall establish and maintain lists of employment
networks available to beneficiaries and shall make
such lists generally available to the public. The pro-
gram manager shall ensure that all information pro-
‘‘(1) QUALIFICATIONS
FOR
EMPLOYMENT
NET-
WORKS.—Each employment network serving under
the Program shall consist of an agency or instrumen-
tality of a State (or a political subdivision thereof) or
a private entity, which assumes responsibility for the
coordination and delivery of services under the Pro-
gram to individuals assigning to the employment net-
work tickets to work and self-sufficiency issued under
subsection (b). No employment network may serve
under the Program unless it demonstrates to the Com-
missioner substantial expertise and experience 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 sin-
gle provider of such services or of an association of
such providers organized so as to combine their re-
sources into a single entity. An employment network
may meet the requirements of subsection (e)(4) by
providing services directly, or by entering into agree-
ments with other individuals or entities providing ap-
propriate employment services, vocational rehabilita-
tion 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 re-
habilitation services, and other support services
provided under the Program by, or under agree-
ments entered into with, the employment network
are provided under appropriate individual work
plans meeting the requirements of subsection (g).
‘‘(3) ANNUAL FINANCIAL REPORTING.—Each em-
ployment network shall meet financial reporting re-
quirements 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 spe-
cific services provided by the employment network.
Such reports shall conform to a national model pre-
scribed under this section. Each employment network
shall provide a copy of the latest report 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 bene-
ficiary, 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 WORK PLANS.—
‘‘(1) IN GENERAL.—Each employment network
shall—
‘‘(A) take such measures as are necessary to
ensure that employment services, vocational re-
habilitation services, and other support services
provided under the Program by, or under agree-
ments entered into with, the employment network
are provided under appropriate individual work
plans as defined by the Commissioner, and
‘‘(B) develop and implement each such indi-
vidual work plan, in the case of each beneficiary
receiving such services, in a manner that affords
such beneficiary the opportunity to exercise in-
formed choice in selecting an employment goal
and specific services needed to achieve that em-
ployment goal.
A beneficiary’s individual work plan shall take effect
upon approval by the beneficiary.
‘‘(2) VOCATIONAL EVALUATION.—In devising the
work plan, the employment network shall undertake a
vocational evaluation with respect to the beneficiary.
Each vocational evaluation shall set forth in writing
such elements and shall be in such format as the Com-
missioner shall prescribe. The Commissioner may
provide for waiver by the beneficiary of such a voca-
tional evaluation, subject to regulations which shall be
prescribed by the Commissioner providing for the per-
missible timing of, and the circumstances permitting,
such a waiver.
‘‘(h) EMPLOYMENT NETWORK PAYMENT SYSTEMS.—
‘‘(1) ELECTION
OF
PAYMENT
SYSTEM
BY
EM-
PLOYMENT NETWORKS.—
‘‘(A) IN GENERAL.—The Program shall pro-
vide 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 uti-
lized exclusively in connection with such employ-
ment network (except as provided in subpara-
graph (B)).
‘‘(B) METHOD
OF
PAYMENT
TO
EMPLOY-
MENT NETWORKS.—Any such election by an em-
ployment network taking effect during any pe-
riod for which a disabled beneficiary is receiving
services from such employment network shall not
be effective with respect to such beneficiary to the
extent that such election would result in any
change in the method of payment to the employ-
ment network with respect to services provided to
such beneficiary from the method 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 re-
quirements 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,
during the individual’s outcome payment period,
for which benefits (described in paragraphs (2)
and (3) of subsection (k)) are not payable to such
individual.
‘‘(C) COMPUTATION OF PAYMENTS TO EM-
PLOYMENT NETWORK.—The payment schedule of
the outcome payment system shall be designed so
that—
‘‘(i) the payment for each of the 60
months during the outcome payment period
for which benefits (described in paragraphs
(2) and (3) of subsection (k)) are not pay-
able 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 percent.
‘‘(3) OUTCOME-MILESTONE PAYMENT SYSTEM.—
‘‘(A) IN GENERAL.—The outcome-milestone
payment system shall consist of a payment
structure governing employment networks elect-
ing such system under paragraph (1)(A) which
meets the requirements of this paragraph.
‘‘(B) EARLY PAYMENTS UPON ATTAINMENT
OF MILESTONES IN ADVANCE OF OUTCOME PAY-
MENT
PERIODS.—The outcome-milestone pay-
ment system shall provide for one or more mile-
stones, with respect to beneficiaries receiving
services from an employment network under the
Program, which are directed toward the goal of
permanent employment. Such milestones shall
form a part of a payment structure which pro-
vides, in addition to payments made during out-
come payment periods, payments made prior to
outcome payment periods in amounts based on
the attainment of such milestones.
‘‘(C) LIMITATION ON TOTAL PAYMENTS TO
EMPLOYMENT NETWORK.—The payment schedule
of the outcome milestone payment system shall be
designed so that the total of the payments to the
employment network with respect to each bene-
ficiary is less than, on a net present value basis
(using an interest rate determined by the Com-
‘‘(B) OUTCOME
PAYMENT
PERIOD.—The
term ‘outcome payment period’ means, in con-
nection with any individual who had assigned a
ticket to work and self-sufficiency to an employ-
ment network under the Program, a period—
‘‘(i) beginning with the first month,
ending after the date on which such ticket
was assigned to the employment network,
for which benefits (described in paragraphs
(2) and (3) of subsection (k)) are not pay-
able to such individual by reason of engage-
ment in work activity, and
‘‘(ii) ending with the 60th month (con-
secutive or otherwise), ending after such
date, for which such benefits are not pay-
able to such individual by reason of engage-
ment 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 percentage specified in para-
graph (2)(C), the total payments permissible
under paragraph (3)(C), and the period of time
specified in paragraph (4)(B) to determine
whether such percentages, such permissible pay-
ments, and such period provide an adequate in-
centive for employment networks to assist bene-
ficiaries to enter the workforce, while providing
for appropriate economies. The Commissioner
may alter such percentage, such total permissible
payments, 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 MILESTONE
PAYMENTS.—The Commissioner shall periodi-
cally review the number and amounts of mile-
stone payments established by the Commissioner
pursuant to this section to determine whether
they provide an adequate incentive for employ-
ment networks to assist beneficiaries to enter the
workforce, taking into account information pro-
vided to the Commissioner by program man-
agers, 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 milestone payments ini-
tially established by the Commissioner pursuant
to this section to the extent that the Commis-
sioner determines that such an alteration would
allow an adequate incentive for employment net-
works to assist beneficiaries to enter the work-
force. Such alteration shall be based on informa-
tion provided to the Commissioner by program
managers, the Ticket to Work and Self-Suffi-
ciency Advisory Panel, or other reliable sources.
‘‘(i) SUSPENSION OF DISABILITY REVIEWS.—During
any period for which an individual is using a ticket to work
and self-sufficiency issued under this section, the Commis-
sioner (and any applicable State agency) may not initiate
a continuing disability review or other review under section
221 of whether the individual is or is not under a disability
or a review under title XVI similar to any such review
under section 221.
‘‘(j) AUTHORIZATIONS.—
‘‘(1) TITLE
II
DISABILITY
BENEFICIARIES.—
There are authorized to be transferred from the Fed-
eral Old-Age and Survivors Insurance Trust Fund
and the Federal Disability Insurance Trust Fund
each fiscal year such sums as may be necessary 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 entitled to
benefits under section 223 or who are entitled to bene-
fits under section 202(d) on the basis of the wages
and self-employment income of such beneficiaries,
shall be charged to the Federal Disability Insurance
Trust Fund, and all other money paid from the Trust
Funds under this section shall be charged to the Fed-
eral Old-Age and Survivors Insurance Trust Fund.
The Commissioner of Social Security shall determine
according to such methods and procedures as shall be
prescribed under this section—
‘‘(A) the total amount to be paid to pro-
gram managers and employment networks under
this section, and
‘‘(B) subject to the provisions of the preced-
ing sentence, the amount which should be
charged to each of the Trust Funds.
‘‘(2) TITLE
XVI
DISABILITY
BENEFICIARIES.—
Amounts authorized to be appropriated to the Social
Security Administration under section 1601 (as in ef-
fect pursuant to the amendments made by section 301
of the Social Security Amendments of 1972) shall in-
clude amounts necessary to carry out the provisions
of this section with respect to title XVI disability
beneficiaries.
‘‘(k) DEFINITIONS.—For purposes of this section—
‘‘(1) DISABLED
BENEFICIARY.—The term ‘dis-
abled beneficiary’ means a title II disability bene-
ficiary or a title XVI disability beneficiary.
‘‘(2) TITLE
II
DISABILITY
BENEFICIARY.—The
term ‘title II disability beneficiary’ means an indi-
vidual entitled to disability insurance benefits under
section 223 or to monthly insurance benefits under
section 202 based on such individual’s disability (as
defined in section 223(d)). An individual is a title II
disability beneficiary for each month for which such
individual is entitled to such benefits.
‘‘(3) TITLE XVI DISABILITY BENEFICIARY.—The
term ‘title XVI disability beneficiary’ means an indi-
vidual eligible for supplemental security income bene-
fits under title XVI on the basis of blindness (within
the meaning of section 1614(a)(2)) or disability
(within the meaning of section 1614(a)(3)). An indi-
vidual is a title XVI disability beneficiary for each
month for which such individual is eligible for such
benefits.
‘‘(4) SUPPLEMENTAL
SECURITY
INCOME
BENE-
FIT.—The term ‘supplemental security income benefit
under title XVI’ means a cash benefit under section
1611 or 1619(a), and does not include a State supple-
mentary payment, administered federally or other-
wise.
‘‘(l) REGULATIONS.—The Commissioner of Social Se-
curity shall prescribe such regulations as are necessary to
carry out the provisions of this section.’’.
(b) CONFORMING AMENDMENTS.—
(1) AMENDMENTS TO TITLE II.—
(A) Section 221(c) of such Act (42 U.S.C.
421(c)) is amended by adding at the end the fol-
lowing new paragraph:
‘‘(4) For suspension of reviews under this subsection
in the case of an individual using a ticket to work and
self-sufficiency, see section 1147(i).’’.
(B) Section 222(a) of such Act (42 U.S.C.
422(a)) is repealed.
(C) Section 222(b) of such Act (42 U.S.C.
422(b)) is repealed.
(D) Section 225(b)(1) of such Act (42
U.S.C. 425(b)(1)) is amended by striking ‘‘a pro-
gram of vocational rehabilitation services’’ and
inserting ‘‘a program consisting of the Ticket to
Work and Self-Sufficiency Program under sec-
tion 1147 or another program of vocational reha-
(i) by inserting ‘‘(1)’’ after ‘‘(c)’’; and
(ii) by adding at the end the following
new paragraph:
‘‘(2) For suspension of continuing disability reviews
and other reviews under this title similar to reviews under
section 221 in the case of an individual using a ticket to
work and self-sufficiency, see section 1147(i).’’.
(c) EFFECTIVE DATE.—Subject to subsection (d), the
amendments made by subsections (a) and (b) shall take ef-
fect with the first month following one year after the date
of the enactment of this Act.
(d) GRADUATED IMPLEMENTATION OF PROGRAM.—
(1) IN GENERAL.—Not later than one year after
the date of the enactment of this Act, the Commis-
sioner of Social Security shall commence implementa-
tion of the amendments made by this section (other
than paragraphs (1)(C) and (2)(B) of subsection (b))
in graduated phases at phase-in sites selected by the
Commissioner. Such phase-in sites shall be selected so
as to ensure, prior to full implementation of the Tick-
et to Work and Self-Sufficiency Program, the develop-
ment and refinement of referral processes, payment
systems, computer linkages, management information
systems, and administrative processes necessary to
provide for full implementation of such amendments.
Subsection (c) shall apply with respect to paragraphs
(1)(C) and (2)(B) of subsection (b) without regard to
this subsection.
(2) REQUIREMENTS.—Implementation of the
Program at each phase-in site shall be carried out on
a wide enough scale to permit a thorough evaluation
of the alternative methods under consideration, so as
to ensure that the most efficacious methods are deter-
mined and in place for full implementation of the
Program on a timely basis.
(3) FULL IMPLEMENTATION.—The Commissioner
shall ensure that the Program is fully implemented as
soon as practicable on or after the effective date speci-
fied in subsection (c) but not later than six years
after such date.
(4) ONGOING EVALUATION OF PROGRAM.—
(A) IN GENERAL.—The Commissioner shall
design and conduct a series of evaluations to as-
sess the cost-effectiveness of activities carried out
under this section and the amendments made
thereby, as well as the effects of this section and
the amendments made thereby on work outcomes
for beneficiaries receiving tickets to work and
self-sufficiency under the Program.
(B) METHODOLOGY.—
(i) DESIGN
AND
IMPLEMENTATION.—
The Commissioner shall design the series of
evaluations after receiving relevant advice
from experts in the fields of disability, voca-
tional rehabilitation, and program evalua-
tion and individuals using tickets to work
and self-sufficiency under the Program. In
designing and carrying out such evalua-
tions, the Commissioner shall consult with
the Comptroller General of the United
States and other agencies of the Federal
Government and with private organizations
with appropriate expertise. Before provision
of services begins under any phase of Pro-
gram implementation, the Commissioner
shall ensure that plans for such evaluations
and data collection methods are in place
and ready for implementation.
(ii) SPECIFIC
MATTERS
TO
BE
AD-
DRESSED.—Each such evaluation shall ad-
dress (but is not limited to):
(I) the annual cost (including net
cost) of the Program and the annual
cost (including net cost) that would
have been incurred in the absence of
the Program;
(II) the determinants of return to
work, including the characteristics of
beneficiaries in receipt of tickets under
the Program;
(III) the types of employment
services, vocational rehabilitation serv-
ices, and other support services fur-
nished to beneficiaries in receipt of
tickets under the Program who return
to work and to those who do not return
to work;
(IV) the duration of employment
services, vocational rehabilitation serv-
ices, and other support services fur-
nished to beneficiaries in receipt of
tickets under the Program who return
to work and the duration of such serv-
ices furnished to those who do not re-
turn to work and the cost to employ-
ment networks of furnishing such serv-
ices;
(V) the employment outcomes, in-
cluding wages, occupations, benefits,
and hours worked, of beneficiaries who
return to work after receiving tickets
under the Program and those who re-
turn to work without receiving such
tickets;
(VI) the characteristics of provid-
ers whose services are provided within
an employment network under the Pro-
gram;
(VII) the extent (if any) to which
employment networks display a greater
willingness to provide services to dis-
abled beneficiaries;
(VIII) the characteristics (includ-
ing employment outcomes) of those
beneficiaries who receive services under
the outcome payment system and of
those beneficiaries who receive services
under the outcome-milestone payment
system;
(IX) 
measures 
of 
satisfaction
among beneficiaries in receipt of tick-
ets under the Program; and
(X) reasons for (including com-
ments solicited from beneficiaries re-