II
106TH CONGRESS
1ST SESSION
H. R. 1180
IN THE SENATE OF THE UNITED STATES
OCTOBER 19, 1999
Received
AN ACT
To amend the Social Security Act to expand the availability
of health care coverage for working individuals with dis-
abilities, to establish a Ticket to Work and Self-Suffi-
ciency Program in the Social Security Administration
to provide such individuals with meaningful opportunities
to work, and for other purposes.
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Ticket to Work and Work Incentives Improvement Act
of 1999’’.
(b) TABLE OF CONTENTS.—The table of contents is
as follows:
Sec. 1. Short title; table of contents.
TITLE I—TICKET TO WORK AND SELF-SUFFICIENCY AND
RELATED PROVISIONS
Subtitle A—Ticket to Work and Self-Sufficiency
Sec. 101. Establishment of the Ticket to Work and Self-Sufficiency Program.
Subtitle B—Elimination of Work Disincentives
Sec. 111. Work activity standard as a basis for review of an individual’s dis-
abled status.
Sec. 112. Expedited reinstatement of disability benefits.
Subtitle C—Work Incentives Planning, Assistance, and Outreach
Sec. 121. Work incentives outreach program.
Sec. 122. State grants for work incentives assistance to disabled beneficiaries.
TITLE II—EXPANDED AVAILABILITY OF HEALTH CARE SERVICES
Sec. 201. Expanding State options under the medicaid program for workers
with disabilities.
Sec. 202. Extending medicare coverage for OASDI disability benefit recipients.
Sec. 203. Grants to develop and establish State infrastructures to support
working individuals with disabilities.
Sec. 204. Demonstration of coverage under the medicaid program of workers
with potentially severe disabilities.
Sec. 205. Election by disabled beneficiaries to suspend medigap insurance when
covered under a group health plan.
TITLE III—DEMONSTRATION PROJECTS AND STUDIES
Sec. 301. Extension of disability insurance program demonstration project au-
thority.
Sec. 302. Demonstration projects providing for reductions in disability insur-
ance benefits based on earnings.
Sec. 303. Studies and reports.
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TITLE IV—MISCELLANEOUS AND TECHNICAL AMENDMENTS
Sec. 401. Technical amendments relating to drug addicts and alcoholics.
Sec. 402. Treatment of prisoners.
Sec. 403. Revocation by members of the clergy of exemption from social secu-
rity coverage.
Sec. 404. Additional technical amendment relating to cooperative research or
demonstration projects under titles II and XVI.
Sec. 405. Authorization for State to permit annual wage reports.
Sec. 406. Assessment on attorneys who receive their fees via the Social Security
Administration.
Sec. 407. Prevention of fraud and abuse associated with certain payments
under the medicaid program.Extension of authority of State
medicaid fraud control units.
Sec. 408. Extension of authority of State medicaid fraud control units.
Sec. 409. Special allowance adjustment for student loans.
TITLE I—TICKET TO WORK AND
SELF-SUFFICIENCY AND RE-
LATED PROVISIONS
Subtitle A—Ticket to Work and
Self-Sufficiency
SEC. 101. ESTABLISHMENT OF THE TICKET TO WORK AND
SELF-SUFFICIENCY PROGRAM.
(a) IN GENERAL.—Part A of title XI of the Social
Security Act (42 U.S.C. 1301 et seq.) is amended by add-
ing after section 1147 (as added by section 8 of the Non-
citizen Benefit Clarification and Other Technical Amend-
ments Act of 1998 (Public Law 105–306; 112 Stat.
2928)) the following:
‘‘THE TICKET TO WORK AND SELF-SUFFICIENCY
PROGRAM
‘‘SEC. 1148. (a) IN GENERAL.—The Commissioner
of Social Security shall establish a Ticket to Work and
Self-Sufficiency Program, under which a disabled bene-
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ficiary may use a ticket to work and self-sufficiency issued
by the Commissioner in accordance with this section to
obtain employment services, vocational rehabilitation serv-
ices, or other support services from an employment net-
work which is of the beneficiary’s choice and which is will-
ing to provide such services to such beneficiary.
‘‘(b) TICKET SYSTEM.—
‘‘(1) DISTRIBUTION
OF
TICKETS.—The Com-
missioner of Social Security may issue a ticket to
work and self-sufficiency to disabled beneficiaries for
participation in the Program.
‘‘(2) ASSIGNMENT
OF
TICKETS.—A disabled
beneficiary holding a ticket to work and self-suffi-
ciency may assign the ticket to any employment net-
work of the beneficiary’s choice which is serving
under the Program and is willing to accept the as-
signment.
‘‘(3) TICKET
TERMS.—A ticket issued under
paragraph (1) shall consist of a document which evi-
dences the Commissioner’s agreement to pay (as
provided in paragraph (4)) an employment network,
which is serving under the Program and to which
such ticket is assigned by the beneficiary, for such
employment services, vocational rehabilitation serv-
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ices, and other support services as the employment
network may provide to the beneficiary.
‘‘(4) 
PAYMENTS
TO
EMPLOYMENT
NET-
WORKS.—The Commissioner shall pay an employ-
ment network under the Program in accordance with
the outcome payment system under subsection
(h)(2) or under the outcome-milestone payment sys-
tem under subsection (h)(3) (whichever is elected
pursuant to subsection (h)(1)). An employment net-
work may not request or receive compensation for
such services from the beneficiary.
‘‘(c) STATE PARTICIPATION.—
‘‘(1) IN GENERAL.—Each State agency admin-
istering or supervising the administration of the
State plan approved under title I of the Rehabilita-
tion Act of 1973 may elect to participate in the Pro-
gram as an employment network with respect to a
disabled beneficiary. If the State agency does elect
to participate in the Program, the State agency also
shall elect to be paid under the outcome payment
system or the outcome-milestone payment system in
accordance with subsection (h)(1). With respect to a
disabled beneficiary that the State agency does not
elect to have participate in the Program, the State
agency shall be paid for services provided to that
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beneficiary under the system for payment applicable
under section 222(d) and subsections (d) and (e) of
section 1615. The Commissioner shall provide for
periodic opportunities for exercising such elections.
‘‘(2) EFFECT
OF
PARTICIPATION
BY
STATE
AGENCY.—
‘‘(A) STATE AGENCIES PARTICIPATING.—
In any case in which a State agency described
in paragraph (1) elects under that paragraph to
participate in the Program, the employment
services, vocational rehabilitation services, and
other support 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 rehabilita-
tion services approved under title I of the Reha-
bilitation Act of 1973.
‘‘(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.
‘‘(3) AGREEMENTS BETWEEN STATE AGENCIES
AND EMPLOYMENT NETWORKS.—State agencies and
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employment networks shall enter into agreements re-
garding the conditions under which services will be
provided when an individual is referred by an em-
ployment network to a State agency for services.
The Commissioner of Social Security shall establish
by regulations the timeframe within which such
agreements must be entered into and the mecha-
nisms for dispute resolution between State agencies
and employment networks with respect to such
agreements.
‘‘(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 1 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-
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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
include—
‘‘(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
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
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geographic area covered under the program
manager’s agreement.
‘‘(4) 
SELECTION
OF
EMPLOYMENT
NET-
WORKS.—
‘‘(A) IN
GENERAL.—The Commissioner
shall select and enter into agreements with em-
ployment networks for service under the Pro-
gram. Such employment networks shall be in
addition to State agencies serving as employ-
ment networks pursuant to elections under sub-
section (c).
‘‘(B) ALTERNATE PARTICIPANTS.—In any
State where the Program is being implemented,
the Commissioner shall enter into an agreement
with any alternate participant that is operating
under the authority of section 222(d)(2) in the
State as of the date of the enactment of this
section and chooses to serve as an employment
network under the Program.
‘‘(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.
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‘‘(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 solicit and consider the
views of consumers and the program manager under
which the employment networks serve and shall con-
sult with providers of services to develop perform-
ance 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
Commissioner shall ensure that the periodic surveys
of beneficiaries receiving services under the Program
are designed to measure customer service satisfac-
tion.
‘‘(7) DISPUTE
RESOLUTION.—The Commis-
sioner shall provide for a mechanism for resolving
disputes between beneficiaries and employment net-
works, between program managers and employment
networks, and between program managers and pro-
viders of services. 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.—
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‘‘(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
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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 without being deemed to
have rejected services under the Program. When
such a change occurs, the program manager shall re-
assign the ticket based on the choice of the bene-
ficiary. Upon the request of the employment net-
work, the program manager shall make a determina-
tion of the allocation of the outcome or milestone-
outcome payments based on the services provided by
each employment network. The program manager
shall establish and maintain lists of employment net-
works available to beneficiaries and shall make such
lists generally available to the public. The program
manager shall ensure that all information provided
to disabled beneficiaries pursuant to this paragraph
is provided in accessible formats.
‘‘(4) ENSURING
AVAILABILITY
OF
ADEQUATE
SERVICES.—The program manager shall ensure that
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employment services, vocational rehabilitation serv-
ices, and other support services are provided to
beneficiaries throughout the geographic area covered
under the program manager’s agreement, 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 services under the Program has reasonable ac-
cess to employment services, vocational rehabilitation
services, and other support services. Services pro-
vided under the Program may include case manage-
ment, work incentives planning, supported employ-
ment, career planning, career plan development, vo-
cational assessment, job training, placement, follow-
up services, and such other services as may be speci-
fied by the Commissioner under the Program. The
program manager shall ensure that such services are
available in each service area.
‘‘(f) EMPLOYMENT NETWORKS.—
‘‘(1) QUALIFICATIONS FOR EMPLOYMENT NET-
WORKS.—
‘‘(A) IN GENERAL.—Each employment net-
work serving under the Program shall consist of
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an agency or instrumentality of a State (or a
political subdivision thereof) or a private entity,
that assumes responsibility for the coordination
and delivery of services under the Program to
individuals assigning to the employment net-
work tickets to work and self-sufficiency issued
under subsection (b).
‘‘(B) ONE-STOP DELIVERY SYSTEMS.—An
employment network serving under the Pro-
gram may consist of a one-stop delivery system
established under subtitle B of title I of the
Workforce Investment Act of 1998.
‘‘(C) COMPLIANCE WITH SELECTION CRI-
TERIA.—No employment network may serve
under the Program unless it meets and main-
tains compliance with both general selection cri-
teria (such as professional and educational
qualifications, where applicable) and specific se-
lection criteria (such as substantial expertise
and experience in providing relevant employ-
ment services and supports).
‘‘(D) SINGLE OR ASSOCIATED PROVIDERS
ALLOWED.—An employment network shall con-
sist of either a single provider of such services
or of an association of such providers organized
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so as to combine their resources into a single
entity. An employment network may meet the
requirements of subsection (e)(4) by providing
services directly, or by entering into agreements
with other individuals or entities providing ap-
propriate employment services, vocational reha-
bilitation 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; and
‘‘(B) 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 indi-
vidual work 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,
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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. The program manager shall ensure that
copies of all such reports issued under this para-
graph are made available to the public under reason-
able terms.
‘‘(g) INDIVIDUAL WORK PLANS.—
‘‘(1) REQUIREMENTS.—Each employment net-
work 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 indi-
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vidual work plans that meet the requirements of
subparagraph (C);
‘‘(B) develop and implement each such in-
dividual work plan, in partnership with 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;
‘‘(C) ensure that each individual work plan
includes at least—
‘‘(i) a statement of the vocational goal
developed with the beneficiary, including,
as appropriate, goals for earnings and job
advancement;
‘‘(ii) a statement of the services and
supports that have been deemed necessary
for the beneficiary to accomplish that goal;
‘‘(iii) a statement of any terms and
conditions related to the provision of such
services and supports; and
‘‘(iv) a statement of understanding re-
garding the beneficiary’s rights under the
Program (such as the right to retrieve the
ticket to work and self-sufficiency if the
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beneficiary is dissatisfied with the services
being provided by the employment net-
work) and remedies available to the indi-
vidual, including information on the avail-
ability of advocacy services and assistance
in resolving disputes through the State
grant program authorized under section
1150;
‘‘(D) provide a beneficiary the opportunity
to amend the individual work plan if a change
in circumstances necessitates a change in the
plan; and
‘‘(E) make each beneficiary’s individual
work plan available to the beneficiary in, as ap-
propriate, an accessible format chosen by the
beneficiary.
‘‘(2) EFFECTIVE UPON WRITTEN APPROVAL.—
A beneficiary’s individual work plan shall take effect
upon written approval by the beneficiary or a rep-
resentative of the beneficiary and a representative of
the employment network that, in providing such
written approval, acknowledges assignment of the
beneficiary’s ticket to work and self-sufficiency.
‘‘(h) EMPLOYMENT NETWORK PAYMENT SYSTEMS.—
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such an alteration would better provide the in-
centive and economies described in the pre-
ceding sentence.
‘‘(B) NUMBER
AND
AMOUNT
OF
MILE-
STONE
PAYMENTS.—The Commissioner shall
periodically review the number and amounts of
milestone payments established by the Commis-
sioner pursuant to this section to determine
whether they provide 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 Work
Incentives Advisory Panel established by section
101(f) of the Ticket to Work and Work Incen-
tives Improvement Act of 1999, and other reli-
able 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
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Commissioner by program managers, the Ticket
to Work and Work Incentives Advisory Panel
established by section 101(f) of the Ticket to
Work and Work Incentives Improvement Act of
1999, or other reliable sources.
‘‘(C) REPORT ON THE ADEQUACY OF IN-
CENTIVES.—The Commissioner shall submit to
Congress not later than 36 months after the
date of the enactment of the Ticket to Work
and Work Incentives Improvement Act of 1999
a report with recommendations for a method or
methods to adjust payment rates under sub-
paragraphs (A) and (B), that would ensure ade-
quate incentives for the provision of services by
employment networks of—
‘‘(i) individuals with a need for ongo-
ing support and services;
‘‘(ii) individuals with a need for high-
cost accommodations;
‘‘(iii) individuals who earn a submin-
imum wage; and
‘‘(iv) individuals who work and receive
partial cash benefits.
The Commissioner shall consult with the Ticket
to Work and Work Incentives Advisory Panel