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How many payment options are available to Employment Networks (ENs)?
What's the difference between an outcome payment month and a milestone?
What's the SGA threshold amount?
Don't benefits stop automatically when a beneficiary earns more than the SGA threshold amount?
In terms of total payments, what is the difference between the two EN payment systems?
Are the payments under the two EN payment systems based on the individual`s benefit rate or on the costs an EN incurs?
What is the payment rate for the outcome payment system?
What are the payment rates for the outcome-milestone payment system?
Are there any other criteria for a milestone or outcome payment month?
When does a Ticket terminate?
Can an EN change its elected payment system?
Must a State vocational rehabilitation (VR) agency elect an EN payment system?
Is it possible to pay more than one EN?
How are payment requests processed?
SGA and Payment Tables
How many payment options are available to Employment Networks (ENs)?
Two. At the time an EN becomes an approved provider it can elect either the:
- Outcome payment system, under which it will receive payment for outcome payment months only; or
- Outcome-milestone payment system, under which it will receive reduced payments for outcome payment months in exchange for milestone payments in advance of the first outcome payment.
What's the difference between an outcome payment month and a milestone?
An outcome payment month is a month in which SSA pays no Federal cash disability benefits to a beneficiary because of
work or earnings. Under both EN payment systems, the maximum number of outcome payment months for each Ticket is 60. These
60 outcome payment months do not have to be consecutive.
A milestone occurs after a beneficiary starts working and before Federal cash
benefits stop because of work or earnings. There are four milestones for which
an EN can be paid. A beneficiary attains a milestone when he/she has gross
earnings from employment (or net earnings from self-employment) that exceed
SSA's substantial gainful activity (SGA) threshold amount for the number of
months specified in the following table.
MILESTONE |
NUMBER OF MONTHS EARNINGS MUST BE MORE THAN THE SGA THRESHOLD
AMOUNT |
1 |
1 month |
2 |
3 months within a 6-month period |
3 |
6 months within a 12-month period |
4 |
9 months within a 18-month period |
What's the SGA threshold amount?
The SGA threshold amount refers to the level of earnings that SSA uses when
it evaluates the work activity of an individual for disability entitlement
purposes. Each year SSA calculates two SGA threshold amounts. One is for individuals
who are statutorily blind and the other is for those who are not. View
the actual SGA threshold amounts for calendar year 2009.
Don't benefits stop automatically when a beneficiary earns more than the SGA threshold amount?
No, and that`s why one of the two EN payment options provides for milestone payments. SSA has two programs that provide cash benefits based on disability or blindness.
- The Social Security Disability Insurance (SSDI) program provides benefits to "insured" workers, their adult children, and their widow(er)s.
- The Supplemental Security Income (SSI) program provides benefits to individuals with limited income and resources.
Each disability program has different employment support provisions that allow beneficiaries to test their ability to work while protecting their eligibility for cash payments and health care. So it is possible for a beneficiary to earn more than the SGA threshold amount in a month and still receive Federal cash benefits under one or both disability programs. To find out more about SSA`s employment support provisions, click on the "resources tool kit" link at SSA`s work website, http://www.ssa.gov/work. From there you can get information about "work incentives" and pull up a copy of SSA`s "Red Book" on employment support.
In terms of total payments, what is the difference between the two EN payment systems?
If an EN were eligible to receive all 60 outcome payments with respect to a Ticket, then the payments under the outcome-milestone payment system would be about 90% of what would be payable under the outcome payment system.
The difference in total payments lies in the fact that under the outcome-milestone payment system:
- the outcome payment rate is lower; and
- each outcome payment is reduced by an amount equal to 1/60th of the milestone payments received by an EN with respect to an individual.
Are the payments under the two EN payment systems based on the individual`s benefit rate or on the costs an EN incurs?
No. The payments are based on the payment calculation base (PCB) for the calendar year in which the beneficiary attains the outcome payment month or milestone. The PCB is the national average disability benefit payable under each of SSA`s two disability programs. In December of each year, SSA will calculate, and post to its webpage, an SSDI and an SSI PCB for milestones and outcome months achieved in the following calendar year. SSA will use the:
- SSDI PCB when computing the payment due an EN for serving an SSDI or
a concurrent SSDI/SSI beneficiary; and
- SSI PCB when computing the payment due an EN for serving an SSI beneficiary,
who is not concurrently an SSDI beneficiary.
As the national average disability benefit payable tends to rise every year due, in part, to cost-of-living adjustments, the annual computation of the PCB should increase.
View the actual PCBs for years beginning with 2002 here.
What is the payment rate for the outcome payment system?
It is 67% of the applicable PCB for the calendar year in which the beneficiary achieves the outcome payment month. This is the maximum amount that the law allows.
View the actual outcome payment amounts under the outcome payment system for years beginning with 2002 here.
What are the payment rates for the outcome-milestone payment system?
The following
chart summarizes the payment rates for the outcome-milestone payment system.
They represent a percentage of the applicable PCB for the calendar year in
which the beneficiary attains the milestone or outcome payment month.
TYPE
OF PAYMENT |
PAYMENT
RATE
(AS % OF THE APPLICABLE PCB) |
Milestone
1 |
120% |
Milestone 2 |
120% |
Milestone 3 |
120% |
Milestone 4 |
120% |
View the actual milestone and outcome payment amounts under the outcome-milestone payment system for years beginning with 2002.
Are there any other criteria for a milestone or outcome payment month?
Yes. There are three additional criteria.
- The milestones for which payment may be made must occur before the first
outcome payment month. Thus, an EN may actually receive fewer than four milestone
payments for a particular beneficiary it serves.
- A month after disability-based benefits terminate for work or earnings
can be an outcome payment month only if the individual:
- earns more than the SGA threshold amount in the month; and
- is not entitled to or eligible for any type of monthly cash benefits from SSA for that month.
- An EN may be paid only for milestones or outcome payment months that
a beneficiary attains:
- after assigning the Ticket to the EN; and
- before the Ticket terminates.
When does a Ticket terminate?
Generally, a Ticket terminates with the earliest of the following:
- the month in which disability benefits terminate for reasons other than work and earnings;
- the month an individual entitled to Social Security widow(er)`s benefits based on disability attains age 65; or
- the month following the month an individual receiving SSI benefits on account of disability or blindness attains age 65.
However, should disability-based benefits terminate for work or earnings, then different rules apply. Under these rules, a Ticket terminates with the earliest of the following:
- the month the individual attains full retirement age (beginning in 2003 SSA`s full retirement age will increase gradually from age 65 to age 67);
- the month the individual dies;
- the month the individual becomes entitled to or eligible for a non-disability-based benefit from Social Security;
- the month SSA makes a subsequent unfavorable disability determination (i.e., the month SSA denies a subsequent application for disability benefits, or the month SSA decides not to approve a request to reinstate disability-based benefits); or
- the month the SSA makes a favorable disability determination (i.e., the month the individual again becomes entitled to or eligible for disability-based benefits based on a new application, or the month the individual is eligible to receive another Ticket because SSA approves a request to reinstate disability-based benefits).
Can an EN change its elected payment system?
Yes. SSA will periodically give an EN the opportunity to change its elected payment system. The change will apply to prospective clients only. It will not apply to clients who have already assigned their Tticket to the EN under the EN`s earlier elected payment system.
Must a State vocational rehabilitation (VR) agency elect an EN payment system?
Yes. However, when a State VR agency is serving a person with a Ticket, a State VR agency can elect, on a case-by-case basis, to be paid as an EN under its chosen EN payment system or to be paid under the traditional VR cost reimbursement payment system.
Is it possible to pay more than one EN?
Yes. It is possible for more than one EN to receive payment for serving the same beneficiary at different times. "Partnership Plus" may allow Ticket beneficiaries to assign their Ticket to an EN after receiving services from State VR. Look here to see some examples of states that are using the new Partnership Plus aspect of the Ticket to Work program. Please see the F.A.Q. for more questions and answers concerning Partnership Plus.
How are payment requests processed?
ENs send requests for payment, evidence of a beneficiary`s work or earnings, and other information to SSA`s Ticket to Work Program Manager (PM), MAXIMUS, Inc. MAXIMUS, Inc. reviews the information and makes a recommendation for payment to SSA. SSA then determines all final approvals for payment.
SGA and Payment Tables
Substantial Gainful Activity (SGA) Threshold Amounts
Beginning With Calendar Year 2002
Calendar
Year |
SGA Threshold Amount
Beneficiary Is Not Statutorily Blind |
SGA Threshold Amount
Beneficiary Is Statutorily Blind |
2002 | $780
| $1,300 |
2003 | $800
| $1,330 |
2004 | $810
| $1,350 |
2005 | $830
| $1,380 |
2006 | $860
| $1,450 |
2007 | $900
| $1,500 |
2008 | $940
| $1,570 |
2009 | $980
| $1,640 |
Payment Calculation Bases (PCBs)
Beginning With Calendar Year 2002
Calendar
Year |
SSDI
PCB |
SSI
PCB |
2002 | $791.68
| $476.80 |
2003 | $819.19
| $491.05 |
2004 | $840.61
| $498.34 |
2005 | $868.20
| $510.23 |
2006 | $900.69
| $523.95 |
2007 | $946.02
| $545.85 |
2008 | $981.17
| $563.35 |
2009 | �$1,009.21
| $576.24 |
Payment Rates Under the Outcome
Payment System
Beginning With Calendar Year 2002
Calendar
Year
Outcome Payment
Month Attained |
Outcome
Payment Rate SSDI or Concurrent (SSDI/SSI) Ticket Beneficiary |
Outcome
Payment Rate SSI Only Ticket Beneficiary |
2002 |
$317 |
$191 |
2003 |
$328 |
$196 |
2004 |
$336 |
$199 |
2005 |
$347 |
$204 |
2006 |
$360 |
$210 |
2007 |
$378 |
$218 |
01/2008-06/2008 |
$392 |
$225 |
07/2008-12/2008 |
$657 |
$377 |
2009 |
$676 |
$386 |
Payment Rates Under the Milestone-Outcome
Payment System Beginning With Calendar Year 2002
I. Milestone Payment Rates (Old Rules)
Calendar
Year
Milestone
Attained |
Outcome Payment Rate SSDI or Concurrent (SSDI/SSI) Ticket Beneficiary |
Milestone # |
1 |
2 |
3 |
4 |
|
Milestone Payment Rate SSI Only Ticket Beneficiary
|
Milestone # |
1 |
2 |
3 |
4 |
|
2002 |
|
|
2003 |
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2004 |
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2005 |
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2006 |
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2007 |
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II. Outcome Payment Rates (Old Rules)
Calendar
Year
Outcome Payment
Month Attained |
Outcome
Payment Rate SSDI or Concurrent (SSDI/SSI) Ticket Beneficiary |
Outcome
Payment Rate SSI Only Ticket Beneficiary |
2002 | $269 | $162 |
2003 | $279 | $167 |
2004 | $286 | $169 |
2005 | $295 | $173 |
2006 | $306 | $178 |
2007 | $322 | $186 |
01/2008-06/2008 | $334 | $192 |
III. Outcome and Milestone Payment Rates (New Rules)
Calendar
Year Milestone
Attained |
Outcome
Payment Rate SSDI or Concurrent (SSDI/SSI) Ticket Beneficiary |
Outcome
Payment Rate SSI Only Ticket Beneficiary |
Phase 1 Milestones |
Phase 2 Milestones and Outcome Payments |
Phase 1 Milestones |
Phase 2 Milestones and Outcome Payments |
07/2008-12/2008 | $1,117 |
$353 |
$1,117 |
$203 |
2009 | $1,211 |
$363 |
$1,211 |
$207 |
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