Ms. Deborah Morrison opened the meeting at 1:20pm. The following members were present: Sarah Wiggins Mitchell (Chair), Susan Webb, Bryon MacDonald, Larry Henderson. Jerome Kleckley, Steve Start, Kristen E. Flaten, Thomas Golden, and Chris Griffin. Other people in attendance were Doug Kensley, Kim Musheno of the ARC. Beverly Rollins of the Social Security Administration Advisory Committee, Helen Harper, of Newcastle Delaware, Paul Van Dorn of the Riverside California Community Access Center, and Michael Weinstein, of National Industries for the Blind.
Staff present were Mary Anne Daley, Tamara Allen, Kristen Breland, Lisa Ekman, Marie Strahan, and Theda Zawaiza.
Ms. Strahan stated that Richard Burkhauser, Frances Gracechild, and Stehanie Smith Lee would not be attending.
Ms. Mitchell welcomed the panel and the public to the meeting. She explained that the meeting would consist of panel deliberations on questions that each of the work groups had drafted to look at the issues and concerns raised in the proposed NPRM. There will also be some administrative issues discussed at 3:15, including the regional meetings and an update from Ms. Strahan. The operating procedures will also be considered.
Ms. Mitchell asked the group to keep in mind the purpose of the questions and to whom the questions are being directed. Mr. MacDonald stated that their work group had developed a table of contents for the portion of the proposed NPRM and questions that covered their work group topics. He stated that the document with the questions might be a bit complex because it is difficult to ask the question without providing the background. Mr. MacDonald's understanding of the purpose of the questions was to provide the public the mechanism to give input into the panel deliberations. Mr. Start stated that another purpose was to draw attention to issues that the panel feels are of particular concern to the general public, or those that are particularly important. Mr. Start stated that the questions will be posted on the bulletin board for public viewing. The public input will help the panel to frame the issues. The background information is contained in the document because the NPRM is not out and cannot be referenced. The questions will also help to organize the public's thoughts when the NPRM is out.
There was some concern expressed by panel members about whether the NPRM should be referenced at all in the draft questions if the NPRM has not been released. Panel members decided to discuss concepts contained in the NPRM without specific references to section numbers.
Ms. Webb stressed that the questions are somewhat complex because the panel needs a high level of sophistication in the public responses. Ms. Mitchell countered that putting out sophisticated and complex questions would put the panel out of touch with most consumers.
Mr. MacDonald stated that the regulations are being written in simple language, compliance with President Clinton's directive to make government documents consumer friendly. Ms. Mitchell suggested that the questions could be formatted (set off or bolded) to make them more readable to the public.
Payment Workgroup: Ms. Webb stated that, at the teleconference held on November 21, members of the public who testified said that the milestone payments as proposed by SSA were not workable. Based upon this input, Mr. Burkhauser had developed three options for the workgroup:
Option One: There should be a third milestone at 12 months of SGA. This would be $1400 for SSDI and $900 for SSI. Those milestones should be amortized (spread) over the first 24 months of outcome payment.
Option Two: This plan is similar to Option One, except that it spreads the milestone payment over the entire 60 months of the payback period.
Option Three: This option adds to the total outcome payment by eliminating the milestone outcome payment penalty, making it 95 percent rather than 85 percent.
Ms. Webb stated that there was general consensus of the workgroup on all questions except Question Seven. Question One asks about the service population, including those that are hard to serve. Question Two asks about the milestone payments and how they should be structured. Question Three asks about individualized outcome payments, how they should be administered, and what danger there might be of overpayments to the ENs under an individualized milestone system. The question also asks what could be done to minimize overpayments.
Question Four addressed the creaming issue; how can payments be equalized to provide incentives to serve people with more complex disabilities. Question Five dealt with payments to ENs serving beneficiaries who receive less than minimum wage, or receive partial cash benefits. The question relates to how outcome payments can be structured fairly for these individuals until the equity study called for in the legislation is completed. Mitchell suggested that language relating to the equity study be struck because the equity study is not considered in the NPRM. Question Six addresses the problem of the outcome payment beginning when the benefits actually stop. The SGA for blind people is much higher than for people with other disabilities, and much higher for SSI than for SSDI. This means that beneficiaries are less likely to discontinue these benefits, causing a delay in the milestone payment. How can the milestone system be equalized for employment networks serving these different constituencies?
Question Seven is the question where there were divergent views in the workgroup. The question asks if the individual work plan should include a statement by the beneficiary that he or she will make a good faith effort to pursue training and employment in a timely manner. Ms. Mitchell stated that this statement was not measurable or definable and therefore meaningless to include. Some panel members felt that the beneficiary should certify that he or she is making a good faith effort, reflecting an equal partnership between the beneficiary and the EN. Other panel members felt that such a statement could be the basis for litigation between the beneficiary and the EN. Mr. Start stated that the work plan should be a commitment between the employment network and the beneficiary, with responsibilities of each party set forth. Ms. Mitchell suggested a statement certifying that the beneficiary has read and understood the obligations of both parties under the agreement. Mr. Start stated that the work plan should represent an equal relationship between the EN and the participant. Mr. Start felt that the statement should describe the specific activities to be undertaken by the EN and the beneficiary. The language should stress the partnership between the consumer and the agency. Ms. Flaten will work with Ms. Mitchell to develop proposed language.
Mr. MacDonald expressed the concern that if there was too much "administrivia" in the program, neither consumers nor providers would participate. The contract needs to be somewhat flexible to enable changes without creating additional paperwork. Mr. Start stated that the days of serving "the poor disabled person" with no expectation that the person will make a contribution towards his or her own goals are over. You cannot have respect for a person without having expectations of them. Providers have to have expectations of consumers to treat them with respect.
Question Eight deals with the 85 percent payment rate and whether it is adequate. It asks what payment structure would be fair and equitable. Mr. Start suggested that the term "treatment" used in this question be substituted with the term "access." Mr. MacDonald suggested that the question be more directed to providers, since the purpose of the Ticket is to attract more providers into the rehabilitation system.
Question Nine asks how milestones should be amortized (or spread out) during the outcome payment period, and over what period of time? Is the appropriate time period one year?
Question Ten: asks how documentation of beneficiary earnings should be provided to the employment network? What remedy should be available to protect the provider if the beneficiary and the employer do not cooperate with reporting? In response to a question, Mary Anne Daley stated that SSA makes the payment to the employment network. The program manager reviews documentation and notifies SSA that the payment is recommended. Staff clarified that SSA obtained FICA tax records quarterly and that the records were four to six months behind. Mr. MacDonald expressed his nervousness about creating a burdensome and inefficient system for collecting this information. He pointed to problems with beneficiary overpayments. Ms. Webb stated that beneficiaries would not want anyone contacting the employer about their wages. Mr. Start added that the employment network should not have to track salary information monthly for sixty months from the employer. This is not appropriate. Mr. MacDonald stated that since information from the IRS to SSA is not timely, this is not an option. Mr. Start stated that the proposed milestone system is not workable, from the providers' perspective. "If we don't fix the milestone payment system, the program will not work." Ms. Mitchell asked why a monthly employment report was required. Mr. Start suggested a two or three month reporting period. Mr. MacDonald stated that SSA should assume some of this information collection workload. SSA has the incentive to facilitate this record keeping; the consumer does not. Mr. Start stated that providers will not participate if they don't get paid;
Ms. Flaten stated that having the employment networks track consumer earnings by getting copies of paychecks from consumers was extremely intrusive. Mary Anne Daley stated that all reporting databases report quarterly and not more often. These systems require an inference of monthly earnings from quarterly statements, which is problematic. The employers report to IRS and IRS reports quarterly to Social Security. Ms. Webb expressed concern that if the consumer doesn't cooperate and the employer doesn't cooperate, the EN does not get paid. This is why the work group is seeking broad comments in this area. Ms. Webb asked if the EN could be paid quarterly, for example.
Question Eleven asks if development and signing of the IWRP by the EN and the beneficiary to the plan should be a milestone with a payment. What should that payment be? Mr. Start stated that the milestone should be about equal to the cost of providing these services.
Ms. Mitchell stated that the questions will be distributed to the panel members and approved at next week's teleconference. The other two work groups will present their questions next week also.
Administrative Issues
Ms. Mitchell turned to administrative matters. A decision should be made as to whether the panel members want to be involved in setting up the regional meetings, or if the panel wants the contractor to set them up. The New York forum will be held in conjunction with a Cornell University sponsored training on TWWIIA. Tom Golden agreed to work on this. Ms. Webb said that she would handle arrangements for Phoenix, in terms of getting space, etc. The contractor will need to do the teleconference, duplicating, CART reporting, and interpreters. She proposed January 26 at 9:00 for the hearing. Ms. Webb said she would moderate the Salt Lake hearing, but would need more support from the contractor. A panel member should moderate at each hearing. Ms. Strahan stated that only the panel members in the geographic area would attend these hearings. Dates, times and locations will be announced, hopefully in the Federal Register. The contractor will work with Ms. Flaten on the Minnesota hearing but will take primary responsibility to set it up. Conference calls will be held in California.
Ms. Strahan stated that she is requesting permission from SSA's Personnel Department to hire a temporary consultant to attend the meetings and write a summary report for presentation to the panel.
Ms. Mitchell stated that her meeting with Commissioner Apfel was extremely successful. Several advocates were also in attendance. She asked the Commissioner to clarify lines of communication between SSA staff, the Commissioner's office and the TWWIIA and SSA Advisory Committee. SSA staff is following up.
Ms. Mitchell stated that the operating procedures will be approved at next week's meeting. Ms. Strahan pointed out that Section Seven has not been finalized. Mitchell requested that panel members be ready to finalize the section next week.
Ms. Strahan reported that the moving date for the new office is eminent, hopefully before the January meeting. A small open house is being planned for the January or February meetings.
Ms. Strahan stated that there is no news about the NPRM or about the employment funding applications. P&A applications are being held up and staff will find out why.
Mr. MacDonald requested that staff develop a best-case scenario under which the beneficiary salary and EN payment information should be reported and processed.
The meeting was adjourned at 3:40.
