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106-10 July 14, 1999
Senate Passes S. 331 The Work Incentives Improvements Act of 1999
On June 16, 1999, the Senate passed S. 331, the Work Incentives
Improvement Act of 1999, by a vote of 99 - 0. This bill addresses barriers
to work for individuals with disabilities. It would: expand the
availability of health care coverage for working individuals with
disabilities; establish a Ticket to Work and Self-Sufficiency Program; and
provide such individuals with meaningful opportunities to work.
The bill contains the following provisions:
Expanded Availability of Health Care Services
State Options under Medicaid
- Would expand, for individuals who are at least 16, but less than 65,
years of age, the States' options and funding for the Medicaid buy-in
for workers with disabilities by permitting States to: (1) liberalize
limits on resources and income, and (2) provide the opportunity for
employed individuals with medically determinable impairments, as
determined by the Secretary of Health and Human Services (HHS), to buy
into Medicaid even though they are no longer eligible for Social
Security Disability Insurance (SSDI) or Supplemental Security Income
(SSI) disability benefits due to medical improvement. For purposes of
the Medicaid buy-in, the States are authorized to require individuals to
pay premiums, or other cost-sharing charges, set on a sliding scale
based on income.
- Would be applicable with respect to medical assistance for items and
services furnished on or after October 1, 1999.
- Would require the General Accounting Office (GAO) to report on these
options not later than 3 years after enactment.
Continuation of Medicare Coverage
- Would extend premium-free Medicare Part A coverage for people with
disabilities who return to work during the 6-year period beginning with
the first month that begins after enactment. Further, it would extend
coverage for subsequent months for individuals entitled to health care
benefits as of the last month of the 6-year period.
- Would be applicable for months beginning with the first month that
begins after the date of enactment.
- Would require GAO to examine the effectiveness and cost of providing
such premium-free Medicare Part A coverage and to recommend whether such
coverage should be continued after the 6-year period.
Responsibilities of the Secretary of Health and Human Services
- Would direct the Secretary of HHS to:
- provide grants to establish State infrastructures to support
working individuals with disabilities; and
- create a demonstration of a Medicaid buy-in for people whose
disabilities have not yet gotten severe enough to cause them to stop
work and file for benefits.
- Would be effective upon enactment.
Election by Disabled Beneficiaries to Suspend Medigap Insurance
- Would allow workers with disabilities who have Medicare coverage and
a Medigap policy to suspend the premiums and benefits of the Medigap
policy if they have employer-sponsored coverage.
- Would be applicable with respect to requests made after the date of
enactment.
Ticket to Work and Self-Sufficiency Program
General
- Would direct the Commissioner to establish a Ticket to Work and
Self-Sufficiency Program (Program) which would provide SSDI
beneficiaries and SSI disability recipients with a ticket they may use
to obtain vocational rehabilitation (VR) services, employment services,
or other support services from an employment network of their choice.
Responsibilities of the Commissioner of Social Security
- Would select and enter into agreements with one or more
organizations in the public or private sector to serve as a program
manager(s) to assist the Commissioner in administering the Program.
- Would terminate agreements with program manager(s) who fail to meet
the performance standards specified in the agreements.
- Would preclude program managers from direct participation in the
delivery of services to beneficiaries or from holding a financial
interest in an employment network in the service area covered by the
program manager's agreement.
- Would select, and enter into agreements with, employment networks,
including alternate participants who choose to act as an employment
network, to provide services under the Program.
- Would terminate agreements with employment networks whose
performance is inadequate.
- Would provide for periodic reviews of employment networks to ensure
effective quality assurance in the provision of services.
- Would provide for a process to resolve disputes between
beneficiaries and employment networks, between program managers and
employment networks, and between program managers and providers of
services.
Responsibilities of the Program Manager(s)
- Would perform such tasks as assigned by the Commissioner.
- Would recruit, and recommend for selection by the Commissioner,
employment networks which can provide services under the Program.
- Would monitor employment networks under its jurisdiction to ensure
that beneficiaries have adequate choices of services and reasonable
access to services, e.g., case management, benefits counseling,
supported employment, job training, placement, and follow-up services.
- Would ensure that employment networks comply with the terms of their
agreements with the Commissioner and that payment by the Commissioner to
an employment network is warranted.
- Would ensure beneficiaries are allowed changes in employment
networks for good cause without being deemed to have rejected services
under the Program.
Employment Network(s)
- Would assume responsibility for coordination and delivery of
services under the Program to an individual assigning his/her ticket to
work and self-sufficiency to an employment network.
- May consist of a one-stop delivery system established under the
Workforce Investment Act of 1998 or either a single provider of such
services or a group of providers organized to combine their resources
into a single entity.
- Would provide services either directly or by entering into
agreements with other providers which can furnish appropriate services.
- Would serve prescribed service areas and take measures to ensure
that services provided under the Program meet the requirements of
individual work plans.
- Would meet the financial reporting requirements prescribed by the
Commissioner. Prepares periodic reports, on at least an annual basis,
itemizing specific outcomes achieved with respect to services provided
to beneficiaries.
- Would develop and implement an individual work plan in partnership
with each beneficiary that includes a statement of the: (1)
beneficiary's vocational goal, (2) services and supports necessary to
accomplish that goal, (3) terms and conditions related to the provision
of those services and supports, (4) rights and remedies available to the
beneficiary, and (5) beneficiary's right to modify his/her work plan if
needed. The individual work plan is effective upon written approval by
the beneficiary and a representative of the employment network.
Employment Network Payment Systems
- Would authorize the Commissioner to pay an employment network under
either an outcome payment system or an outcome-milestone payment system.
Each employment network will elect the payment system under which it
will be paid.
- Under the outcome payment system, an employment network would be
paid a percentage, not to exceed 40 percent, of the national average
SSDI or SSI payment for each month that a beneficiary does not receive
a benefit payment due to work activity for a period not to exceed 60
months.
- The outcome-milestone payment system would combine outcome
payments with payments for achieving one or more milestones directed
toward assisting the beneficiary in achieving permanent employment.
However, the total amount of outcome-milestone payments must be less
than the total amount of payments if the employment network were paid
under the outcome payment system.
- Would require the Commissioner to review periodically the
specifications of the payment system (percentage and total payment) to
ensure that the system provides an adequate incentive for employment
networks to assist beneficiaries in entering the workforce.
- Would allow the Commissioner to alter the percentage or total
permissible payments, as well as the number and amount of milestone
payments, to allow an adequate incentive for employment networks.
State Agency Participation
- Would permit a State VR agency to elect participation in the Program
as an employment network with respect to each disabled beneficiary for
whom it will provide services.
- State VR agencies participating in the Program would provide
services under plans approved under title I of the Rehabilitation Act of
1973.
- Would require a written agreement between the State VR agency and
the employment network before a State VR agency can accept any referral
of a disabled beneficiary from an employment network assigned a ticket
to work by the disabled beneficiary.
- Would direct the Commissioner and the Secretary of Education
jointly to prescribe regulations specifying the terms of such
agreements.
- Would prohibit payment to an employment network if the employment
network makes referrals to the State VR agency without entering into a
written agreement with such State VR agency or in violation of the
terms of the written agreement.
- Would require the Commissioner, if the amendments have not been
fully implemented in a State, to determine through regulations the
extent (1) to which the requirement concerning prompt referral to the
State VR agency applies, and (2) of the Commissioner's authority to
provide vocational rehabilitation services by agreement or contract with
other public or private agencies in the State.
Continuing Disability Reviews
- Would prohibit the Commissioner from initiating continuing
disability reviews during the period that a beneficiary is using a
ticket to work and self-sufficiency.
Financing
- Would require payments to employment networks to be made from the
Federal Old-Age, Survivors and Disability Insurance Trust Funds (OASDI)
in the case of title II disability beneficiaries who return to work and
from appropriations made available for making SSI payments under title
XVI. The costs for administrative expenses must be allocated as
appropriate from amounts made available for the administration of title
II and title XVI.
Regulations
- Would direct the Commissioner to prescribe regulations necessary to
implement the Ticket to Work and Self-Sufficiency Program not later than
1 year after the date of enactment.
Effective Date of the Program
- Would be effective with the first month following 1 year after
enactment.
Scope of Program Implementation
- Would direct the Commissioner to implement the amendments in
graduated phases at sites selected by the Commissioner to ensure the
refinement of the Program processes prior to full implementation.
- Would require the Commissioner to fully implement the Program as
soon as practicable, but not later than 3 years after the effective
date.
Evaluation
- Would require the Commissioner (after consultation with the Advisory
Panel, beneficiaries using Tickets, GAO, other Federal agencies, and
others with appropriate expertise) to design and conduct a series of
evaluations to assess the cost-effectiveness of the Program and the work
outcomes for beneficiaries receiving a ticket to work and self
sufficiency under the Program.
Reports
- Would require the Commissioner to report following the close of the
third and fifth fiscal years and prior to the close of the seventh
fiscal year ending after the effective date. Reports would be submitted
to the House Committee on Ways and Means and the Senate Committee on
Finance on the Commissioner's evaluation of the progress of activities,
as well as the success of the Program and the Commissioner's conclusions
on whether or how the Program should be modified.
Work Incentives Advisory Panel
- Would establish a Work Incentives Advisory Panel within the Social
Security Administration. The Panel would be composed of 12 members--4
appointed by the President; 2 each by the Speaker and the Minority
Leader of the House; and 2 each by the Majority and Minority Leaders of
the Senate. At least one-half of the members should be individuals with
disabilities or representatives of individuals with a disability, with
consideration given to current and former Social Security and
Supplemental Security Income disability beneficiaries Would require that
members be appointed not later than 90 days after enactment.
- Duties would include:
- Advising the President, Congress, and the Commissioner of Social
Security on issues related to work incentive programs, planning, and
assistance for individuals with disabilities, including work incentive
provisions under titles II, XI, XVI, XVIII, and XIX of the Social
Security Act.
- Advising the Commissioner with respect to the Ticket to Work and
Self- Sufficiency Program on the following:
- phase-in sites for implementation of the Program;
- access of disabled beneficiaries to employment networks, payment
systems, and management information systems to ensure the success of
the Program;
- the most effective designs for research and demonstration
projects associated with the Program or conducted with respect to
the reduction in disability insurance benefits based on earnings;
and
- development of performance measures for the employment networks.
- Furnishing progress reports on the Program to the Commissioner and
Congress.
- Would require the Panel to submit interim reports at least annually
and transmit a final report which includes a detailed statement of the
findings and conclusions of the Panel and its recommendations for
legislation and administrative actions, to the President and the
Congress not later than 8 years after the date of enactment.
- Would terminate the Panel 30 days after the date it submits its
final report.
- The costs for the Panel shall be made from amounts available for the
administration of title II and title XVI, and shall be allocated from
those amounts as appropriate.
Elimination of Work Disincentives
Work Activity Standard as a Basis for Review
- Would prohibit the use of work activity as a basis for review for
individuals who are entitled to disability insurance benefits under
section 223 of the Social Security Act (Act) or monthly insurance
benefits under section 202 of the Act based on disability and have
received such benefits for at least 24 months.
- Would allow for continuing disability reviews on a regularly
scheduled basis that are not triggered by work activity, and termination
of benefits if the individual has earnings that exceed the level of
earning established by the Commissioner to represent substantial gainful
activity (SGA).
- Would be effective upon enactment.
Expedited Reinstatement of Benefits
- Would provide that individuals, whose prior entitlement to
disability and health care benefits had been terminated as a result of
earnings from work activity, may request reinstatement of benefits
without filing a new application.
- Would require that such individuals (1) are unable to continue
working on account of their medical condition and (2) file a
reinstatement request during the 60-month period following the month of
termination.
- Would provide that, while SSA is making a determination (by applying
the medical improvement review standard) on the reinstatement request,
individuals would be eligible for the payment of provisional benefits
for a period of not more than 6 months.
- Would require that, if SSA makes a favorable determination, both the
individual's prior entitlement to benefits and the prior benefits of his
dependents who continue to meet the entitlement criteria would be
reinstated.
- Would be effective on the first day of the 13th month beginning
after the date of enactment.
Work Incentives Planning, Assistance, and Outreach
Work Incentives Outreach Program
- Would direct the Commissioner, in consultation with the Work
Incentives Advisory Panel, to establish a community-based work
incentives planning and assistance program for the purpose of providing
accurate information related to work incentives to disabled
beneficiaries.
- Under the Program, the Commissioner would be directed to:
- establish a competitive program of grants, cooperative agreements,
or contracts to provide benefits planning and assistance, including
information on the availability of protection and advocacy services,
to disabled beneficiaries;
- conduct directly, or through grants, cooperative agreements, or
contracts, ongoing outreach efforts; and
- establish a corps of work incentive specialists within the Social
Security Administration who specialize in title II and title XVI work
incentives for the purpose of providing accurate information to
disabled beneficiaries.
- Would direct the Commissioner to award a grant, cooperative
agreement, or contract to an entity based on a percentage of the
population of disabled beneficiaries in the State where the entity is
located. No entity will receive a grant, cooperative agreement, or
contract for a fiscal year that is less than $50,000 or more than
$300,000. The total amount of all grants, cooperative agreements, and
contracts awarded for a fiscal year may not exceed $23 million.
- Would provide that the costs be paid from amounts made available for
the administration for title II and title XVI, and that allocations be
made from those amounts as appropriate.
- Would authorize $23 million to be allocated for each of fiscal years
2000 through 2004.
- Would be effective upon enactment.
Protection and Advocacy
- Would authorize the Commissioner to make payments to protection and
advocacy systems established in each state. Each system that receives
payment would be required to submit an annual report to the Commissioner
and the Work Incentives Advisory Panel.
- Would provide that protection and advocacy systems be paid the
greater of $100,000 or 1/3 of 1 percent of the amount available for
payments for a fiscal year.
- Would provide that payments be made from amounts available for the
administration for title II and title XVI, and would be allocated from
those amounts as appropriate. Any amounts allotted for payments to a
protection and advocacy system would remain available until the end of
the succeeding fiscal year.
- Would authorize $7 million to be appropriated for each of fiscal
years 2000 through 2004.
- Would be effective upon enactment.
Demonstration Projects and Studies
Permanent Disability Insurance Program Demonstration Project Authority
- Would: (1) permanently authorize section 505 of the Social Security
Disability Amendments of 1980 (Authority for Demonstration Projects),
(2) direct the Commissioner to conduct demonstrations related to sliding
scale benefit offsets using variations in the amounts of the offset as a
proportion of earned income, and (3) permit presumptively eligible
applicants to participate in demonstration projects.
- Would direct the Commissioner to submit: (1) interim reports on or
before June 9 of each year on the progress of the demonstration
projects, and (2) a final report not later than 90 days after the
termination of any experiment or demonstration project carried out under
this provision.
- Would be effective upon enactment.
Reduction in Disability Benefits Based on Earnings
- Would direct the Commissioner to conduct demonstration projects to
evaluate the effects of a $1 for $2 withholding of SSDI payments for
earnings over a level specified by the Commissioner.
- Would provide that the demonstration projects should determine:
- the effects, if any, of induced entry and reduced exit;
- the extent, if any, to which the project being tested is affected
by whether it is being conducted in a locality within an area under
the administration of the Ticket to Work and Self-Sufficiency Program;
and,
- the savings to the Trust Funds and other Federal programs as a
result of the project.
- Would require the Commissioner to determine the annual cost, the
reasons for the return to work of beneficiaries who participate in the
project, the employment outcomes of beneficiaries who return to work as
a result of participation in the project.
- Would permit the Commissioner to evaluate the merits of the trial
work period and the period of extended eligibility as part of the
projects.
- Would authorize the Commissioner to waive compliance with the title
II benefit provisions and the Secretary of Health and Human Services to
waive compliance with the benefit requirements of title XVIII, insofar
as is necessary for a thorough evaluation of the alternative methods
under consideration.
- Would require the Commissioner to submit a written report to the
House Committee on Ways and Means and the Senate Committee on Finance 90
days prior to the start of a project. Also, would require the
Commissioner to submit periodic reports not later than 2 years after the
date of enactment, and annually thereafter, on the progress of the
project(s) and a final report on all demonstration projects to the
Congressional committees not later than 1 year after their completion.
Funding
- Would provide that expenditures for the demonstration projects be
made from the Federal Disability Insurance Trust Fund and the Federal
Old-Age and Survivor's Insurance Trust Fund as determined appropriate by
the Commissioner of Social Security, and from the Federal Hospital
Insurance Trust Fund and the Federal Supplementary Medical Insurance
Trust Fund as determined by the Secretary of Health and Human Services,
to the extent provided in advance in appropriation Acts.
- Would be effective upon enactment.
Reports and Studies
- Would require the General Accounting Office to study:
- the extent to which existing tax credits and other employer
incentives under current law encourage employers to hire and retain
individuals with disabilities. A report would be due to the Committee
on Ways and Means of the House of Representatives and the Committee on
Finance of the Senate not later than 3 years after the date of
enactment of this Act;
- the coordination of SSDI and SSI programs as they relate to
individuals who are eligible for benefits under both programs, or
whose eligibility changes from one program to the other. The study
should focus on the effectiveness of work incentives and medical
coverage for these individuals. A report would be due to the
Congressional committees not later than 3 years after the date of
enactment; and
- the SGA levels applicable to disabled beneficiaries; whether the
levels serve as a disincentive for those returning to work, the merits
of increasing SGA levels, and the rationale for not indexing the
levels to inflation. A report would be due to the Congressional
committees not later than 2 years after the date of enactment of this
Act.
- Would direct the Commissioner to report to the House Ways and Means
Committee and the Senate Finance Committee, not later than 90 days after
enactment, on all income disregards applicable to beneficiaries under
SSDI and SSI programs. The report should specify the most recent
statutory or regulatory change in each disregard; estimate the current
value of any disregard if the disregard had been indexed for inflation;
and recommend any further changes.
- Would be effective upon enactment.
Technical Amendments
Drug Addicts and Alcoholics (DA&A)
- Would amend the Contract with America Advancement Act of 1996
(P.L. 104-121) to clarify SSA's authority to make SSDI medical
redeterminations after January 1, 1997. (A similar SSI provision was
included in the Balanced Budget Act of 1997, P.L. 105-33.)
- Would expand the applicability of the provisions in P.L. 104-121
which authorize the Commissioner to determine if a representative
payee would be in the best interest of a disabled beneficiary who is
incapable and has a DA&A condition, and whether such individual
should be referred to a State agency for substance abuse treatment
services.
- Would be effective as if included in the enactment of section 105
of the Contract with America Advancement Act of 1996 (P.L. 104-121).
Treatment of Prisoners
- Would extend the incentive payment provisions now in effect for
SSI prisoners to OASDI, and would authorize the Commissioner to
provide, on a reimbursable basis, this reported information to any
agency administering a Federal or federally assisted cash, food, or
medical assistance program.
- Would be applicable to individuals whose period of confinement in
an institution begins on or after the first day of the fourth month
beginning after the month of enactment.
- Would eliminate the OASDI requirement that confinement stem from a
crime punishable by imprisonment for more than 1 year--like SSI,
benefits would be suspended for any month throughout which the person
was confined because of a crime or finding of not guilty by reason of
insanity.
- Would be applicable to individuals whose period of confinement in
an institution begins on or after the first day of the fourth month
beginning after the month of enactment.
- Would provide that an institution does not get two incentive
payments when the reported prisoner is a concurrent OASDI/SSI
beneficiary--the programs would split the cost of the payment.
- Would be effective as if included in enactment of the Personal
Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L.
104-193).
- Would prohibit the payment of monthly benefits to any title II
beneficiary who upon completion of a prison term remains confined by
court order to a public institution based on a finding that the
individual is a sexually dangerous person or a sexual predator.
- Would be effective with respect to benefits for months ending
after the date of enactment.
Revocation by Members of the Clergy of Exemption from Social
Security Coverage
- Would create a 2-year window of opportunity to allow members of
the clergy who applied for and received an exemption from Social
Security coverage to revoke the exemption.
- The application for revocation would have to be filed before the
due date for the income tax return for the applicants second taxable
year beginning after 12/31/99. The revocation would be effective, at
the applicant's option, beginning with either the first or second
taxable year beginning after 12/31/99.
Cooperative Research or Demonstration Projects Under Title II and
Title XVI
- Would clarify the Commissioner's authority to make grants and
payments under cooperative research or demonstration projects in
advance or by way of reimbursement to carry out demonstration projects
and cooperative research not only for title XVI, but also title II
under section 1110(a) of the Social Security Act.
- Would be effective as if included in the enactment of the Social
Security Independence and Program Improvement Act of 1994 (P.L.
103-296).
Authorization for State to Permit Annual Wage Reports
- For purposes of income and eligibility verification for various
welfare programs, would authorize States to permit employers to submit
wage reports of domestic workers on an annual basis (rather than on a
quarterly basis).
- Would be applicable to wage reports required to be submitted on or
after the date of enactment.
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