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Testimony of Mr. Martin Gerry, Deputy Commissioner for
Disability and Income Security Policy, before the House Committee on Ways
and Means, Subcommittee on Social Security, on the implementation of the
Ticket to Work and Work Incentives Improvement Act
(P.L. 106-170)
September 26, 2002Mr. Chairmen and Members of the Subcommittees:
Thank you for inviting me today to discuss the Social Security
Administration's (SSA) implementation of the Ticket to Work and
Self-Sufficiency Program ("Ticket program"). As you know, Mr. Chairman,
President Bush has a strong interest in disability issues. The President
has said that he is committed to tearing down the remaining barriers to
equality that face Americans with disabilities today. His "New Freedom
Initiative" will help Americans with disabilities by increasing access to
assistive technologies, expanding educational opportunities, and
increasing the ability of Americans with disabilities to integrate into
the workforce.
I would like to express my thanks to you, Mr.Chairman, Mr. Matsui, and
members of the Subcommittee, for your hard work and support in making the
Ticket program a reality. Established as part of the Ticket to Work and
Work Incentives Improvement Act of 1999 ("Ticket Act"), it was a crucial
element of meeting that legislation's goal to remove barriers to
employment that many Americans with disabilities face. Because of the
Ticket Program, beneficiaries will have more choices in obtaining
employment support services to help them reach their employment goals.
Today I would like to provide an update on the implementation of the
Ticket program, and touch upon a few related issues.
Implementation of the Ticket to Work Program
First, let me briefly outline this program. A disabled beneficiary
receives a Ticket if he or she is between the ages of 18 and 64 and his or
her medical condition is not expected to improve in the near future. The
beneficiary may take the Ticket to the State Vocational Rehabilitation
Agency or any of the employment service providers who offer employment
support services in the community. These providers are called Employment
Networks (ENs). The beneficiary and the Employment Network will jointly
develop a plan of services leading to employment. In addition, SSA will
not schedule a periodic continuing disability review (CDR) for a
beneficiary who is receiving services from an EN. I will discuss these
provisions in more detail later.
We are implementing the Ticket program in three phases. By using a
staggered approach to implementation we can further develop and refine the
program before it is fully in place. About 2.4 million beneficiaries with
disabilities are eligible to receive Tickets to Work in the 13 States
selected for the first phase of the program. From February through June
2002, we mailed Tickets to most of these beneficiaries in a graduated
release. (Because of the impact of last year's terrorist attacks, we
developed a slightly delayed release schedule for Tickets in New York.)
Using this method provided time to develop an infrastructure of ENs within
these states to serve the beneficiaries and to ensure that they were aware
of the program's availability. Currently we have more than 400 ENs in
place.
We believe the program is off to a good start. Participation is
voluntary, and I am happy to report that as of this month more than 7,000
beneficiaries out of the 2.4 million beneficiaries eligible to receive
Tickets have assigned their Tickets to ENs or the State vocational
rehabilitation agencies in the initial 13 States. We expect to see higher
numbers of beneficiaries participating as we gain experience and the
program matures, but we know we have much work to do to make those
expectations a reality.
The second phase of the program will begin in November 2002. During
this phase of the Program, approximately 2.6 million beneficiaries are
eligible to receive Tickets in 20 additional States and the District of
Columbia. Then in 2003, we will release Tickets to the approximately 3.3
million beneficiaries in the remaining 17 States and the U.S. Territories
during the third and final implementation phase. By January 2004, we will
have fully implemented the Ticket program.
Employment Networks
I would now like to focus on the role of the EN in the Ticket program.
Under the Ticket Act, the Commissioner enters into agreements with
qualified State, local, or private organizations to serve as ENs. These
ENs will then provide vocational rehabilitation, employment, and other
support services to beneficiaries with disabilities to assist them to find
and maintain employment.
Employment Networks operate under agreements with SSA, and can be any
qualified State or local government agency, or a private entity, that
assumes responsibility for the coordination and delivery of services under
the Ticket program. An EN may be a one-stop delivery system established
under the Workforce Investment Act of 1998; a State Vocational
Rehabilitation Agency; a single provider of services; or a group of
providers organized to combine their resources into a single entity.
Employment Networks can provide services directly or by entering into
agreements with other organizations or individuals to provide the
appropriate services. ENs will only be paid based on their success in
assisting beneficiaries to secure and maintain employment and move off the
disability benefit rolls.
On April 13, 2001, the Agency published a Request for Proposals for
organizations in the 13 States in the first phase of the Program wishing
to serve as ENs. On April 25, 2002, SSA published an amended Request for
Proposals from organizations wishing to serve as ENs, based on the final
regulations published on December 28, 2001. Our Program Manager, MAXIMUS,
is currently evaluating and making recommendations on the organizations
responding to the Request for Proposals. MAXIMUS and the Agency are also
marketing the Ticket program to other prospective ENs through mailings, EN
recruitment fairs, and other contacts. As of September 2002, we have
received over 500 applications from providers to be ENs, and have entered
into agreements with more than 425 providers to serve as ENs. We are
working hard to attract sufficient providers of employment services so
that beneficiaries will enjoy the degree of choice when selecting an EN
that members of Congress and people with disabilities envisioned when the
Ticket Act was developed. ENs report that beneficiaries are apparently
already comparing available ENs before deciding where to assign their
Tickets. ENs are already setting up client interviews and are beginning to
provide services to beneficiaries. We believe that these activities have
increased demand for their services. For instance, as of early September
2002, over 60 percent of the tickets assigned were assigned by "new"
participants (beneficiaries who had previously not received VR services
and who first Ticket to Work program). I might note that, out of this
group, about one-third assigned their Tickets to an EN. The remaining
two-thirds signed plans for services with their State Vocational
Rehabilitation Agency. We are and will continue to look carefully at the
Ticket assignments to make sure that beneficiaries have a range of choice
of providers envisioned by the legislation.A key element of the Ticket
program is that the beneficiary bears none of the cost of employment,
vocational, or other support services. It is the Agency that pays an EN
for providing services to a beneficiary. An EN can elect to receive
payment under one of two systems. Under the Outcome Payment System an EN
will be paid for each month, up to sixty months, in which a beneficiary it
is serving does not receive cash benefits due to work or earnings. Under
the Outcome-Milestone Payment System, an EN will receive payment when a
beneficiary it is serving achieves one or more milestones toward
self-supporting employment. Under this second payment system the EN will
also receive reduced outcome payments for each month, up to sixty months,
that a beneficiary does not receive cash benefits due to work or earnings.
The Agency has provided up to four milestones for which an EN can be paid.
We have begun receiving and processing the first requests for milestone
and outcome payments from the ENs. The first milestone payment was made
during May 2002.
As I mentioned, the Ticket Act also calls for the Commissioner to enter
into an agreement with a Program Manager to assist the Agency in
administering the Ticket to Work Program, MAXIMUS, Inc. Among MAXIMUS'
duties are recruiting, recommending, and monitoring the ENs selected by
SSA to provide services; facilitating beneficiary access to the ENs;
facilitating payment to the ENs; and resolving disputes between
beneficiaries and ENs under the program. I am pleased to note that the ENs
and beneficiaries appear to be satisfied with the level of service
provided by MAXIMUS.
As an Agency, we appreciate the important role our employees play in
successfully implementing any new policy. That is why we arranged for
training sessions on Ticket to Work and employment support topics during
all three phases of the Ticket implementation. We have already completed
the training sessions for the first phase, and will hold the sessions for
the second phase in October 2002. We are also developing specialized
training for field employees on employment supports.
Other Supports for Return to Work
While the Ticket program is the central element of the Ticket to Work
Act, that law includes several other provisions that seek to encourage
disability beneficiaries to return to work. Importantly, these provisions
benefit disabled individuals even if they are not using their Ticket. I
will summarize the implementation status of these provisions.
Pursuant to Section 121 of the Ticket Act, we established Benefits
Planning, Assistance and Outreach (BPAO) program to fund organizations to
help disability beneficiaries understand the effect of work activities on
their benefits and explain other existing programs which assist disability
beneficiaries who wish to work. In fiscal years 2000 and 2001, we awarded
cooperative agreements under the BPAO program to 116 organizations, which
are located nationwide and all U.S. territories. So far, more than 28,000
beneficiaries have received help from BPAO organizations.
Section 122 of the legislation authorized SSA to make payments in each
State to the protection and advocacy system established pursuant to the
Developmental Disabilities Assistance and Bill of Rights Act. The payments
are made to the Protection and Advocacy (P&A) systems for the purpose
of providing services to assist in protecting the rights of disability
beneficiaries in their return to work efforts. The P&As are to provide
information and advice about obtaining VR and employment services, as well
as advocacy or other services that a beneficiary needs to secure or regain
gainful employment. In FY 2001, we awarded 57 P&A grants nationwide,
and in the U.S. territories. All P&A projects have completed
implementation efforts and are providing the required information and
advocacy services. By the end of 2001, they had provided services to over
10,000 beneficiaries.
The Ticket Act also reduced the need for disability beneficiaries to
choose between returning to work and receiving health care coverage. It
extended Medicare coverage for working individuals with disabilities by an
additional four and a half years, and expanded the Medicaid program to
give the states the option of providing coverage to more working people
with disabilities. This extension of coverage became effective on October
1, 2000. Twenty-six states already have Centers for Medicare and Medicaid
Services (CMS) approved plans for extending Medicaid coverage in place and
an additional eight states have passed enabling legislation and are
working with CMS to gain approval for their plans. Additionally,
approximately 52,000 persons have benefited from the extension of Medicare
coverage.
Also, the Ticket Act included two sections that sought to eliminate
work disincentives for all disability beneficiaries, even those not using
tickets. Under Section 112, an individual whose benefits terminated
because of work activity can request that benefits start again without
having to complete a new application. While the Agency determines the
requestor's eligibility for reinstatement, he or she can receive
provisional benefits for up to six months. This process is called
expedited reinstatement. Since this provision became effective on January
1, 2001, we have adjudicated almost 12,000 expedited reinstatement claims
that have been filed. We have completed SSA instructions and training for
field employees, and expect to publish a Notice of Proposed Rulemaking on
the provisions of expedited reinstatement in the winter. Under Section
111, a Social Security Disability Insurance beneficiary's work activity
will not trigger a CDR if he or she has received benefits for at least 24
months. This provision became effective on January 1, 2002. We have
completed instructions and training for field employees to familiarize
them with the new provision, and we expect to publish a Notice of Proposed
Rulemaking on the provisions of suspending CDRs also in the winter.
One of the systems enhancements we are developing to prevent triggering
a CDR is called the Disability Claims File. This system will link the
software that tracks work information and the end of the trial work period
for beneficiaries to the system that controls medical diaries.
Additionally, because one system will track all work information and
control all continuing disability reviews, we expect to improve our
ability to properly handle work reports, reducing both the number of
incorrect payments and our processing time for these reviews. We have
begun efforts to improve automation of these workloads and expect further
enhancements.
Work Incentive Specialists
Section 121 of the Ticket Act requires SSA to establish a corps of
specialists devoted to issues related to work incentives. From July 2000
to September 2001 we piloted an Employment Support Representative position
as we look for ways to provide that service. We are considering how best
to provide employment support-related information and services to
beneficiaries with disabilities who want to work, within the context of
our overall operations. We have not made any decisions yet.
Conclusion
Finally, I thank you, Mr. Chairman, Mr. Matsui, and all the members of
the Subcommittee, for showing continued dedication to the Ticket program.
Thanks to that commitment, we look forward to toward providing more
beneficiaries with the additional opportunities and tools they need to
enter or reenter the workforce.
I would also like to acknowledge the valuable input we have received
from the Ticket Advisory Panel and the Social Security Advisory Board. We
are committed to achieving the goal set by Congress to improve access to
jobs for Americans with disabilities. I believe, and I am sure you will
agree, that the nation benefits greatly when all of its citizens have the
opportunity to make the most of their talents. We shall implement the
Ticket program with the goal of realizing this idea.
Again, thank you for inviting me to be here today. I look forward to
working with you to successfully implement the Ticket program.
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