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Ticket to Work Questions and Answers Distribution of Tickets Distribution of TicketsQUESTION: With the new regulations in effect, will Tickets be mailed to everyone who is eligible to participate in the Ticket to Work program, or will they only be mailed to individuals being determined eligible for disabilities benefits and beneficiaries previously classified as medical improvement expected (MIE)?
QUESTION: How and when will a beneficiary be informed that he or she has a Ticket? ANSWER: When a person is determined eligible for SSDI and/or SSI benefits, she/he will receive a paper Ticket in the mail that is accompanied by a letter from SSA explaining the Ticket to Work program. Under the revised Ticket regulations, all beneficiaries who are determined eligible for SSDI and/or SSI will be eligible to receive a Ticket. For those beneficiaries who were determined eligible for SSDI and/or SSI benefits prior to the new regulations and classified as “medical improvement expected” (MIEs), they became eligible for a Ticket on July 21, 2008, when the new regulations became effective. These beneficiaries will receive a Ticket in the mail sometime between December 2008 and February 2009. However, these beneficiaries can still participate in the Ticket program prior to receive their Tickets in the mail by requesting a Ticket on Demand from MAXIMUS. Ticket AssignmentQUESTION: Will a beneficiary whose VR case was closed within the past year receive a new Ticket, if s/he qualifies, and be able to assign the Ticket to an EN to receive follow-along services?
Employment NetworksQUESTION: What qualifications must an applicant have to become an EN? Where do entities interested in becoming ENs apply?
ANSWER: Grants/fees paid by Medicaid, State VR agencies, or any similar entities have no bearing on an agency's ability to qualify as an EN under the Ticket program. We welcome HCB Waiver and other Medicaid funded community providers to apply to be ENs, provided they meet the following criteria: Entities Deemed Automatically Qualified to Be ENsQUESTION: How will One-Stop Career Centers enter into agreements with SSA to become ENs? Section 411.310(d) of the final regulations states that “One-stop delivery systems established under subtitle B of title I of the Workforce Investment Act of 1998 (29 U.S.C. 2811 et seq.) may participate in the Ticket to Work program as ENs and do not need to respond to the RFP. However, in order to participate in the Ticket to Work program, the one-stop delivery system must enter into an agreement with the Commissioner to be an EN and must maintain compliance with general and specific selection criteria as described in Section 411.315 in order to remain an EN. ANSWER: One-Stop Delivery Systems must enter into a contract with SSA in order to become an EN. The EN RFP explains the requirements for becoming an EN, as well as the duties and responsibilities of being an EN. The language found in the RFP forms the basis of the eventual EN contract. That is why a One-Stop Center must become familiar with the contents of the RFP. To become an EN contractor, a One-Stop must comply with the requirements spelled out in the RFP, some of which require a written response. SSA has simplified this process. QUESTION: Will American Indian Vocational Rehabilitation programs authorized under Section 121 of the Rehabilitation Act have the ability to get reimbursement under the Cost Reimbursement program? ANSWER: No. The revised Ticket regulations do not make any changes to the traditional Cost Reimbursement program. As in the past, only State VR agencies are eligible to participate in the traditional Cost Reimbursement program. Employer as an ENQUESTION: How would an employer of people with disabilities who receive SSI or SSDI benefits serve as an EN and collect Milestone and Outcome payments for employees who are already working and are earning above SGA? ANSWER: An employer may collect Milestone and Outcome payments based on the same rules as a non-employer EN. If an employer who has elected the Outcome/Milestone payment system accepts assignment of the Ticket of a beneficiary who is already an employee, SSA will take into consideration work the beneficiary engaged in during the 18 months prior to Ticket assignment to determine which Phase 1 Milestone payments would be available to the employer (see FAQ regarding Recent Work Rule). Only months when the beneficiary worked with earnings above the Trial Work Period level would be considered. Otherwise, Phase 2 Milestone payments and Outcome payments would be available to the employer EN as these beneficiary employees attained the designated levels of work and earnings to trigger these payments. If the employer EN had elected the Outcome payment system, there would be no penalty for any work done during the 18 months prior to Ticket assignment. Rather, the employer EN would receive Outcome payments beginning the first month after Ticket assignment that the beneficiary’s net earnings exceed the SGA amount and the beneficiary was placed in the zero cash benefit status. EN PaymentsQUESTION: Does SSA count the beneficiary's earnings when they are earned or when they are paid for the purpose of calculating payments to the Employment Network under the Ticket to Work Program? ANSWER: For all milestone payments and for all SSDI or concurrent beneficiaries we use earnings when earned--by the pay period, not the pay date. For SSI-only beneficiaries, during the outcome period before benefits are terminated, we use the earnings when received on the actual pay date. Maximus can provide training on this concept for approved Employment Networks.QUESTION: Do “gross earnings” mean earnings before Impairment Related Work Expenses (IRWE) deductions? Or, does it just refer to earnings before taxes? ANSWER: Gross earnings mean earnings before IRWE deductions and before taxes.QUESTION: To submit for the first Phase 1 Milestone, does a beneficiary need to earn $335 in a two week period or within one month? ANSWER: A beneficiary must earn $335 in one month for an EN to qualify for the first Phase 1 Milestone.QUESTION: Does the Trial Work Period threshold (i.e., $670 in 2008) that qualifies an EN for the Phase 1 Milestones apply to blind beneficiaries? ANSWER: The Trial Work Period (TWP) threshold is subject to an annual adjustment. SSA uses only one annual TWP dollar amount. It is the Substantial Gainful Activity (SGA) amount that has an annual blind and non-blind amount. The non-blind SGA amount for 2008 is $940 and the blind amount is $1570.QUESTION: Is $940 the SGA level for SSI and $1,570 the SGA level for SSDI? QUESTION: If an EN pays Ticket Holders for completing a job development or job search curriculum and the pay exceeds the minimum income requirement for Phase 1 Milestones, does that count as work and qualify the EN for Milestone payments?
QUESTION: Do internships count as employment for the purposes of Milestone or Outcome payments? QUESTION: Can Milestone or Outcome payments be used by an EN to make payments to a beneficiary? Is so, will SSA count the payment as income for the beneficiary? If yes, is it counted as earned or unearned income? QUESTION: Why is the potential number of Milestone payments different in Phase 2 for SSI recipients (i.e., up to18 payments) and SSDI beneficiaries (i.e., up to 11 payments)? Why is the number of potential Outcome payments different for SSI recipients (i.e., up to 60 payments) and SSDI beneficiaries (i.e., up to 36 payments)? QUESTION: If a VR agency that has elected the Outcome/Milestone payment option chooses to serve a beneficiary as an EN and VR is actively working with that beneficiary under an Individualized Plan for Employment, and if the beneficiary decides to discontinue services with VR and VR closes the beneficiary’s cases, how long does the beneficiary have to start reaching the levels of work and earnings that will trigger Milestone and Outcomes payments once the Ticket has been re-assigned to an EN? Also, does the beneficiary still have to be receiving service from the EN when s/he starts reaching the levels of work and earnings that trigger Milestone and Outcome payments?
Self-EmploymentQUESTION: How will self-employment count under the Ticket program? Will ENs be able to request certified payments for Ticket Holders who are engaged in self-employment? ANSWER:There are two ways for an EN to request payment for a self-employed Ticket Holder:
Recent Work RuleQUESTION: Please explain the recent work rule and provide a scenario of someone who was working in the 18 months prior to Ticket assignment. Please break down all situations and explain when each corresponding Phase 1 payment would not be available. ANSWER: Phase 1 Milestones may not available to an EN if, during the 18 months prior to the beneficiary first assigning his/her Ticket, the beneficiary worked and had earnings at a level equal to or above the amount designed as the Trial Work Period (TWP) level earnings for that year. The Phase 1 Milestone payment would be unavailable to the EN because the EN did not incur the cost of helping the beneficiary achieve that particular level of earnings. The chart below shows the level of work as described in 411.535(a) that would prevent the payment of each of the four Phase 1 Milestones.
Although the criteria used to determine the availability of the Phase 1 Milestones based on a beneficiary’s recent work history are patterned after the criteria used to determine the attainment of the four Phase 1 Milestones, the criteria used in the recent work rule are not cumulative. Rather, each criterion should be applied independently. Thus, if a beneficiary worked with TWP level earning during 3 of the 6 months just prior to Ticket assignment but this work did not include the month just prior to Ticket assignment, the first Phase 1 Milestone would be available to the EN when the beneficiary attained the required levels of work and earnings; however the second Phase 1 Milestone would not be available. Similarly, a beneficiary who worked 9 of the last 18 months just prior to Ticket assignment, with earnings at the TWP level, might be eligible for 3 of the Phase 1 Milestones or none, depending on where the 9 months fell within the 18 month period. The example below provides an idea of how the recent work rule works. The recent work rule does not apply to Tickets assigned prior to July 21, 2008. The recent work rule applies only to the Phase 1 Milestones. Phase 2 Milestones are available to an EN when a beneficiary attains the necessary levels of work and earnings prior to commencement of the Outcome payment period, or if after that, as part of the reconciliation payment. Recent Work Example: A beneficiary decides to participate in the Ticket to Work Program and assigns her Ticket to an EN. During the interview to develop the Individualized Work Plan (IPE), a representative of the EN talks to the beneficiary about her work history during the 18 months prior to assigning her Ticket to the EN in August 2008. The beneficiary explains that she worked 9 of the last 18 months, but the work was somewhat irregular. The months that she worked are indicated below. 2007 ___ _____ 2008____________________________ Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug N Y Y Y Y Y N Y N N N N Y N Y Y N N TA The Ticket was assigned (TA) in August 2008. The first Milestone would be available to the EN since the beneficiary did not work in July 2008, the month immediately prior to Ticket assignment. The second Milestone would not be available to the EN because the beneficiary worked 3 of the six months just prior to Ticket assignment (i.e., Feb, Apr and May of 2008). The Third Milestone would be available to the EN because the beneficiary only worked 4 of the 12 months immediately prior to Ticket assignment (i.e., Sept. 2007 and Feb, Apr and May of 2008). The fourth Milestone would not be available to the EN because the beneficiary worked 9 of the 18 months immediately prior to Ticket assignment (i.e., Mar, Apr, May, Jun, July and Sept of 2007 and Feb Apr and May of 2008). MAXIMUS has created an electronic tool that can be used to explore the work and earnings history of a beneficiary and estimate the availability of each of the four Phase 1 Milestones for that particular beneficiary. Visit the MAXIMUS web site and check this tool out: www.yourtickettowork.com. EN Payment Process and ProceduresQUESTION: For evidence requirements for payment, SSA lists “original pay stubs” as primary evidence, and for secondary evidence “photocopies” of pay stubs plus a second source such as a signed beneficiary statement, state unemployment records, or Federal/state tax returns. Does this mean SSA will no longer accepted photocopies of pay stubs as primary evidence? ANSWER: This is correct because SSA has more closely aligned its earnings-related evidentiary requirements for EN payments with earnings-related evidentiary requirements used by SSA for other purposes. QUESTION: Are there any restrictions on when an EN can use primary and secondary evidence of work and earnings in submissions for EN payments? ANSWER: No, there are no restrictions. Primary evidence (e.g., pay stubs and/or an earnings statement prepared and signed by the employer) or secondary evidence (e.g., State Unemployment Insurance data) of work and earnings can be used when submitting payment requests for any EN payments. However, when submitting secondary evidence, two sources are required. (Section 411.575 C) QUESTION: How will EN payments be handled for a beneficiary whose Tickets were assigned prior to the effective date of the new regulations? How will these cases differ depending on whether or not Milestone and Outcome payments were made under the prior regulations? Will it be financially beneficial for an EN to un-assign a Ticket that received payments under the prior regulations and re-assign it after the new regulations take effect? ANSWER: The new EN payment schedule and rates will apply to any EN payment made for work attained after the effective date of the new regulation. This means that cases on which a payment was attained before the effective month of the new regulations, which are referred to as “transition cases,” and new Ticket cases (i.e. cases on which no payment was attained before the new regulations were in effect) may benefit from the new EN payment system schedule for work attained beginning with the effective date of the regulations. Un-assigning and re-assigning a Ticket would have no meaningful purpose since the work attained beginning July 21, 2008 qualifies for payment under the new EN payment schedule and rates for the EN payment system in effect for that particular Ticket Holder. QUESTION: When does SSA count earnings to determine whether an EN is entitled to a payment under the Ticket program----when they are earned or when they are actually paid? ANSWER: That depends on what type of payment is being made and whether the Ticket Holder is a SSDI or SSI beneficiary, or one who receives benefits from both programs (known as a concurrent beneficiary). For all Milestone payments and for all SSDI or concurrent beneficiaries, SSA uses earnings when they are earned--by the pay period, not the pay date. For SSI -only beneficiaries during the Outcome period, but before benefits are terminated, SSA uses earnings when paid. QUESTION: If an EN is tracking a beneficiary that it previously served and learns that that beneficiary eventually went to work and reached the levels of work and earnings necessary to trigger Milestone and/or Outcome payments, can the EN collect the EN payments even though the EN is no longer serving that beneficiary? ANSWER: Upon receiving a payment request, MAXIMUS will make a decision about whether an EN that formerly had the beneficiary’s Ticket assignment provided services that contributed to the beneficiary's attainment of levels of work and earnings that triggered Milestone and/or Outcome payments (see 411.581). If more that one EN is requesting the same payment(s), MAXIMUS will determine the allocation of payment to each EN based on the contribution of services of each EN (see 411.560). Transition to the New Payment SchedulesQUESTION: Please explain how SSA will handle Ticket payments on beneficiaries who had attained work and earnings that had triggered Outcome payments prior to the effective date of the new regulations. ANSWER: The dollar amount for Outcome payments differ depending on the EN payment system under which the Outcome payment is being paid. Under the new Outcome/Milestone payment system, the amounts are $353 for SSDI and $203 for SSI. Under the new Outcome payment system, the amounts are $657 a month for SSDI and $377 a month for SSI. These dollar amounts are for transition cases and new cases on EN payment requests for earnings attained beginning with the effective date of the new regulation. QUESTION: SSA will only accept payment requests for Milestones and Outcomes attained under the prior rules until 3/31/09, or until SSA makes the first payment on a Ticket under Section 411.525. If an EN submitted a payment request and got paid under the new rules and then found out later based on an Earnings Inquiry Request or other secondary sources that Milestones or Outcomes should have been paid under the prior rules, would the EN get paid for those prior Milestones and Outcomes? ANSWER: The 3/31/09 date only applies to the timeframe allowed to submit payment requests for work attained prior to the effective date of the regulation. There currently is no timeframe by which you must request ongoing payments in general; therefore, for now you may request payments for work attained beginning with the effective date of the new regulations at your own pace. We will make a payment for any month(s) for which you qualify regardless of the sequence of the months in which you request payments. Questions about BeneficiariesQUESTION: According to Section 411.175, a beneficiary whose Ticket was in use before SSA determined that the beneficiary was no longer disabled, may continue to receive benefit payments, in certain circumstances. What are these circumstances? ANSWER:In accordance with the other SSA regulations referenced in 411.175, a Ticket Holder who receives a decision that benefits will cease because his/her health has improved may apply for benefit continuation on the basis of being in a program of Vocational Rehabilitation with an EN or a State VR agency, or because s/he has a Plan to Achieve Self-Sufficiency (PASS) or a few other reasons. If SSA finds that the program increases the likelihood that the beneficiary will remain off the benefit rolls, the beneficiary may be awarded benefit continuation until his/her program of Vocational Rehabilitation is completed. QUESTION: How does a beneficiary put his/her Ticket into "inactive status" with MAXIMUS? ANSWER: A beneficiary who is working with an EN or a State VR agency under cost reimbursement may have his/her Ticket placed in “inactive status” at any time by submitting a written request to MAXIMUS, asking that the Ticket be placed in “inactive status.” “Inactive status” will begin with the first day of the month following the month MAXIMUS receives the request. The beneficiary will be subjected to a medical Continuing Disability Review during those months if his/her case becomes due one. (See 411.192) Timely ProgressQUESTION: Under the new regulations, MAXIMUS will be responsible for reviewing a beneficiary’s timely progress every 12 months. If a beneficiary is unable to provide sufficient evidence to MAXIMUS, what information and data will a VR agency have to submit to MAXIMUS to demonstrate timely progress? For example, will paper copies of grade transcripts be required? Will there be a template or standardized set of questions from MAXIMUS to answer? What types of data should VR begin to track on beneficiaries to be prepared to answer MAXIMUS’ questions related to a beneficiary’s timely progress? ANSWER: The new regulations simplify the documentation and timely progress review reporting requirements. However, as a last resort, MAXIMUS will ask the EN or State VR agency to certify a beneficiaries' progress, although they will not require an EN or State VR agency to provide evidence of a beneficiaries' progress. MAXIMUS will use a multi-list format to allow ENs and State VR agencies to respond “yes” or “no” to whether each beneficiary on the list has met certain work, education or technical training requirements. QUESTION: Please define and clarify the various percentage requirements for college and vocational school training programs to be counted as timely progress. Specifically, what is 60% of a full-time course load? What is 75%? Will SSA provide examples? ANSWER: Educational institutions or technical or trade schools inform students what constitutes a full-time course load for a particular institution. Once the number of credits that constitute a full-time course load is identified, the percentage of that number can be calculated. For example, if the full-time course load is 12 credits, 60 percent of 12 is 7 and 75 percent of 12 is 9. (Always round down to the nearest whole credit). General VR QuestionsQUESTION: When will a new/revised VR Provider Handbook be available and will it be available electronically? ANSWER: The revised VR Provider Handbook was sent to interested parties in November 2008. A copy of the VR Provider Handbook can be requested by contacting SSA’s VR Helpdesk at VRHelpdesk@ssa.gov. The VR Provider Handbook will be available on the Internet shortly. QUESTION: Can SSA perform a medical Continuing Disability Review (CDR) on a Ticket eligible beneficiary receiving services from a State VR agency under the Cost Reimbursement payment method? ANSWER: No, not under the new regulations. Now, when a State VR agency chooses to serve a beneficiary under Cost Reimbursement and sends the proper documentation to MAXIMUS, the beneficiary’s Ticket is placed in a new status called "In-Use/SVR" which carries with it the same protection against medical Continuing Disability Reviews that were previously only associated with a Ticket being assigned and "in-use." QUESTION: Do State VR agencies need to do anything for the beneficiaries they were serving under Cost Reimbursement prior to the effective date of the new regulations so that the beneficiary’s Ticket use status is converted to the new status of “In-Use/SVR”? ANSWER: If the Ticket was assigned prior to June 30, 2008, and the State VR agency has elected Cost Reimbursement and notified us of the Ticket assignment, conversion to “In-Use/SVR” status will be automatic. QUESTION: Is Cost Reimbursement the only payment option to VR agencies for Tickets that were assigned prior to July 21, 2008? ANSWER: No, the new regulations have not changed the payment options available to State VR agencies on a case by case basis. State VR agencies can choose Cost Reimbursement or their EN payment system and could do so prior to July 21st. However, the process for choosing Cost Reimbursement is now a simplified process. State VR agencies no longer have to obtain ticket assignment to receive Cost Reimbursement. If the State VR agency elects cost reimbursement and the beneficiary has a ticket which would otherwise be available for assignment and the VR Agency sends in the proper documentation to MAXIMUS, the beneficiary will be considered “In-Use/SVR.” QUESTION: When must a State VR agency choose which program (i.e., the Cost Reimbursement program or the Ticket program) they intend to be paid under for a particular Ticket Holder? Can the State VR agency change its mind later and switch the payment method for a particular beneficiary from being paid as an EN to being paid under Cost Reimbursement or vice-versa depending on the case? ANSWER: State VR agencies must choose between the Cost Reimbursement program and its elected EN payment system at the time that the beneficiary is signing an IPE or SSA-1365 with the State VR agency. The payment system selected at that time is the one that applies to that beneficiary during the entire time the VR case is open. A State VR agency is not permitted to change the payment system for a beneficiary once the case has been opened and the payment system has been selected. QUESTION: How and when will a beneficiary be informed he or she has an in-use Ticket status with a State VR agency? ANSWER: SSA will send the beneficiary a letter when he or she has an “in-use” status or an “In-Use/VR” status with a State VR agency. QUESTION: Can a beneficiary reassign his or her Ticket to a different EN while a State VR agency has an open case and the Ticket status is “In Use/VR”? ANSWER: No, a beneficiary cannot assign his or her Ticket to an EN while a case is open with the State VR agency. It is essential that State VR agencies report case openings to MAXIMUS, using the processes available for reporting either Ticket assignments or case openings under the Cost Reimbursement program. Otherwise, the official records will not reflect that a case is open with the State VR agency and an EN would be able to establish a Ticket assignment. QUESTION: If an EN serves a beneficiary who does not attain all the payments available on the Ticket, and then the beneficiary decides to return to a VR agency to whom s/he had previously assigned the Ticket, can the VR agency accept the Ticket again and resume Ticket payments? In the situation described above, would VR be able to serve this beneficiary under Cost Reimbursement? ANSWER: A beneficiary may re-assign his/her Ticket to an EN, including a State VR agency (acting as an EN), with which the beneficiary formerly assigned the Ticket. However, only those Milestone and Outcome payments initially available and not yet paid when the Ticket is re-assigned would be available for payment once the beneficiary attained applicable levels of work and earnings. Because the VR agency had previously held the Ticket as an EN, it would not be able to receive Cost Reimbursement from SSA if it later serves the beneficiary under Cost Reimbursement for the same period of VR. Partnership Plus: Sequential Services from VR and then an ENQUESTION: How does the new Partnership Plus option work? ANSWER: The new Ticket regulations create an exciting opportunity for new EN-VR partnerships under which SSA will pay a State VR agency and an EN for assisting the same beneficiary, although the services must be provided sequentially and not concurrently. This is possible under the new “Partnership Plus” option because a Ticket Holder may receive services from a State VR agency without assigning the Ticket. Under the new regulations, the State VR agency no longer has to have Ticket assignment in order to submit for Cost Reimbursement. Now, when the State VR agency chooses to serve a beneficiary under Cost Reimbursement and sends proper documentation to MAXIMUS, the beneficiary’s Ticket is placed in a new status called "In-Use SVR" which carries with it the same protection against medical Continuing Disability Reviews which was previously only associated with a Ticket being assigned and "in-use." During the time the beneficiary has an open VR case, the Ticket is not available for assignment to another EN. After the VR case is closed, the beneficiary may assign the Ticket to an EN and receive job retention services, ongoing support services, or other services and supports to maintain employment and increase his/her earnings. Milestones are triggered when a beneficiary's gross earnings are above the specified threshold, and Outcome payments are attained when the beneficiary's net earnings are above SGA and the beneficiary is in zero cash payment status. If the State VR agency closed the case with the beneficiary in employment, the Phase 1 Milestones payments would not be available to the EN as the VR agency has provided the services that initially led to the beneficiary’s employment. QUESTION: What payments are available to an EN after the beneficiary has worked with the State VR agency either under cost reimbursement or as an EN? ANSWER: A beneficiary who works with a State VR agency that chooses to serve him/her under the Cost Reimbursement program would be able to use his/her Ticket with an EN once the State VR agency closes the beneficiary’s case. If the beneficiary is working when the State VR Agency closes his/her case, the EN to which the beneficiary assigned his/her Ticket would be able to receive Phase 2 Milestone and Outcome payments as the beneficiary attained the required levels of work and earnings. QUESTION: Is the Partnership Plus option only available when the VR agency is serving a beneficiary under the tradition Cost Reimbursement program? ANSWER: Yes. As in the past, VR can choose on a case-by-case basis whether to serve a beneficiary under the traditional Cost Reimbursement program or as an EN under the Ticket to Work Program. If VR chooses to serve a beneficiary under the Cost Reimbursement program, the new option for VR and an EN to provide sequential, but not concurrent services, comes in to play. VR can provide the up front services the beneficiary needs to get to work and, after the VR case is closed, the beneficiary can assign his/her Ticket to an EN for job retention or ongoing support services. If the beneficiary gets to earnings (after deductions for Impairment Related Work Expenses and subsidies) above SGA for 9 months within a 12 months period, the VR agency can submit for Cost Reimbursement. As soon as the beneficiary's earnings get to the gross SGA level (i.e., without deducting any work incentives), the EN can start submitting requests for Phase 2 Milestones. When the beneficiary's net earnings are above SGA and the beneficiary is placed in zero cash benefit status, the EN can start submitting for Outcome payments. The Phase 1 Milestones are not available to the EN if VR closed the case with the beneficiary in employment. This is because the VR agency provided the services that got that beneficiary into employment and SSA only pays for Milestones and Outcomes achieved after Ticket assignment. In a couple of states, VR is planning to reimburse ENs for some or all of the Phase 1 Milestones based on the assumption that the job retention or ongoing support services contributed to the beneficiary's success in getting to 9 months of net SGA earnings, at which time VR is able to submit for Cost Reimbursement. QUESTION: Can a beneficiary be served by both a State VR agency under Cost Reimbursement program and an EN at the same time? If a beneficiary currently has his or her Ticket assigned to an EN, does a State VR agency need to get the Ticket “unassigned” from an EN in order to serve the beneficiary under Cost Reimbursement? ANSWER: SSA will not make Cost Reimbursement payments to a State VR agency for the same period during which the Ticket is assigned to an EN. The State VR agency should check with MAXIMUS to learn whether a potential client's Ticket is available. However, this scenario provides a unique opportunity to take advantage of the Partnership Plus option. Under Partnership Plus, a State VR agency may arrange with any EN to have the EN unassign the Ticket to accommodate the beneficiary receiving services from the State VR agency under Cost Reimbursement, with the intention of the beneficiary reassigning the Ticket to the EN for follow up services once the State VR agency closes the case. However, this does not happen automatically. The EN and the beneficiary must sign a new IWP after VR closes the case. Another alternative is for a referring EN to keep the Ticket assignment and have an agreement with the State VR agency which clearly states the types of services to be provided by each entity. In some states, ENs and State VR agencies are designing interagency agreements to facilitate equitable revenue sharing and a coordinated system of services for beneficiaries. EN-VR Referral Agreements
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Last reviewed or modified Tuesday Apr 28, 2009 |