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Social Security Administration
Ticket to Work and Work Incentives Advisory Panel Meeting Minutes
January 9, 2001
Debra Morrison called the meeting to order at approximately 8:45 a.m. She stated that Sarah Wiggins Mitchell will chair the meeting. The primary purpose of the meeting is to consider public comment and deliberate on the TWWIIA regulations.
The following panel members were present:
Thomas Golden, Larry Henderson, Steve Start, Frances Gracechild, Bryon MacDonald, Chris Flaten, Jerome Kleckley, Richard Burkhauser, Stephanie Lee.
Marie Strahan, Ken McGill, Theda Zawaiza, and several other SSA staff were present.
Ms. Mitchell reviewed the agenda. The meeting will begin by taking comments from the general public, followed by a presentation on TWWIIA implementation by Ken McGill. After a break, the panel will deliberate on TWWIIA regulations. The panel will discuss questions for the general public to use to review the NPRM prepared by the work groups after lunch, with approval by the end of the day. Adjournment will be at 5:00 p.m.
The deliberations will continue on Day Two. Day Two will also consist of presentations by House and Senate staffers and additional public comment. The panel will also finalize dates and locations of regional meetings and teleconferences. Day Two will conclude with a business meeting, considering past meeting minutes, operating procedures, and the annual report. The panel will also determine the agenda for the next regional meeting, to take place in Bethesda MD on February 6-8.
Public Comment
Ms. Mitchell opened the public comment portion of the meeting. A summary of the public comment is provided below:
Mr. Dennis Borne, Program Manager, Supported Employment Consultation and Training Center: Borne suggested that having the tickets initiated before the regulations are adopted was problematic. The rest of his comments consisted of questions to the panel. He asked how the PM would contract with the EN and how quality assurance would be insured. How disputes will be handled is a major concern, due to Maximus's lack of experience in this regard.
With regard to EN's, Borne asked what assurance they will have of being paid for the entire five years of the ticket outcome period, given the current climate of policy change. Who will be responsible for providing supports to the consumer once SGA has been achieved? Can a person come back for a ticket within 24 months, if their medication has changed and they now can work? If payments to providers are not adequate, there will be no choice for people with disabilities, since providers will decline to participate. What are the qualifications of an EN and how will EN's be accredited? He stated that milestone payments should be made before the individual reaches SGA. How does a Vocational Rehabilitation agency receive payment?
Regarding consumers, Mr. Borne felt that the regulations are extremely complicated. What will SSA do to educate the public, including consumers, about TWWIIA? What happens to a consumer who moves in the middle of their Ticket training? How will overpayments be avoided? P and A's may not have the expertise to represent beneficiaries with all types of disabilities who have ticket problems. How will they be trained to deal with a broad array of consumers and benefit issues?
Ms. Wiggins asked what the specific concern is regarding Ticket start up before the regulations are finalized. He clarified that the concern is providing unclear direction to providers. Mr. MacDonald asked Mr. Borne for concrete suggestions to address the questions he had raised. He also asked for recommendations to address overpayments as related to the Ticket implementation. Mr. MacDonald stated providers' concern that if SSA can't issue beneficiary checks in the correct amount, provider payments will not be accurate. Mr. Borne agreed that this was a matter of concern, but did not have specific recommendations.
Mr. Paul Seifert, IAPSRS: Mr. Seifert raised a concern about exclusion of people who are deemed to be in the Medical Improvement Expected (MIE) category at the time of their SSI/SSDI application from the Ticket program. Many applicants with psychiatric disabilities are placed in this category. He stated that there is a significant difference between someone with a mental illness and someone with a lower limb fracture who is expected to recover. He also expressed concern that an individual with a psychiatric disability may be able to work within the first two years and not in the third year because of a disability exacerbation. Under current regulations, this individual would lose their Ticket due to lack of employment in the third year. He also suggested that tying the milestones to SGA, with payment for milestones at such low levels, badly damages the program for small providers. Providers take all the risk, with no risk to the SSA program. Another problem is that SSI payments are lower than SSDI beneficiary payments and the threshold at which SSI recipients lose all cash benefits is higher than the SSDI SGA level. The regulations say the beneficiary should be receiving zero cash benefits before outcome payments are made to the provider. This is not what the law stipulates regarding SSI recipients. Payments should be made for individuals who receive partial cash benefits under Title Sixteen. Outcome payments could be made at fifty, then seventy five percent of the benefit level.
Finally, Mr. Seifert stated that Social Security should be the one that confirms that the individual has ceased receiving benefits so that EN's don't get payments when SSA records still show that the individual is receiving benefits.
Ms. Mitchell asked for clarification on the partial benefits issue and whether there was legislative history on this matter. Mr. Seifert stated that the issue had been discussed by Congressional staff, who purposely wrote the legislation vaguely on this issue. Mr. Burkhauser pointed out that the long period of eligibility for reduced payments for SSI recipients will seriously affect the willingness of providers to get involved with these recipients. This problem could be addressed through the milestone payment system.
Mr. MacDonald raised the concern about people who are in the EPE or under Section 1619 not being eligible for a ticket, even though they are still entitled to a payment if their earnings drop. Mr. Seifert felt that the Regulations should allow these beneficiaries to get tickets. He stated his feeling that whenever the regulation drafters made a decision regarding the public versus Social Security, the regulations always supported Social Security and constraint of the Ticket Program. He suggested that the distribution of tickets be as wide as possible.
Mr. Charles Harles, Executive Director of INABER: Mr. Harles expressed concern with the slow start of the program. INABER has planned a conference in Florida to publicize the Ticket start up, but the Ticket has not started yet. He stated that Maximus is not responsive to telephone information calls regarding the program. He raised concerns about regulatory requirements for state certification and personnel requirements that are too traditional, reflecting the professional bias of current rehabilitation programs. These requirements will limit the number of providers who can enter the system. Non- traditional programs may be excluded. He supported the comments Mr. Seifert made on milestone payments and stated that the draft regulations look nothing like the discussions that took place when the legislation was being considered. The current draft regulations, if adopted, will prevent providers from entering the program.
He continued by stating that providers are saying that there is no way they can participate in the milestone program. It is punitive in that it demands immediate employment results within twelve months. He further stated that there are no protections for the provider for consumers that switch providers, once substantial services have been provided. Another concern is that the Ticket will be automatically assigned to the State Vocational Rehabilitation agency if the beneficiary is a client of this agency. This represents a significant lack of choice for the individual. It also raises a question about what the obligation of the State VR Agency is regarding referrals to other providers.
Mr. MacDonald read the citation regarding State VR Agencies. He felt that the language was not clear. Mr. Golden asked for clarification about what the milestone payment was envisioned to look like during the legislative process. Mr. Harles stated that there was discussion about payment for assessments and other activities to provide some compensation for initial activities to get more people to enter into the Ticket Program.
Mr. Burkhauser echoed the concern about qualifications for providers as a barrier to entry. He asked how ENs would be protected from paying for evaluations from providers who were not qualified to provide them or who were not capable of providing services. Mr. Harles suggested some consideration based upon past performance. Mr. MacDonald asked if the education and experience requirements for employment provider staff would be sufficient, without the state licensure requirement and Mr. Harles responded affirmatively.
Mr. Harles stated that another issue is that new entities, consisting of provider consortia, are being created to provide holistic services to ticket holders and these new entities may not be certified. Mr. Harles also raised concern about whether providers will be able to track beneficiaries for the sixty month outcome payment period. Ms. Webb asked if providers could handle quarterly rather than monthly payments and he replied in the affirmative.
Mr. Damon Hicks, Supported Employment Consultation and Training Center: Section 590 states that an EN cannot assist a beneficiary in an appeal of a benefit. He expressed concern that a case manager from the EN might serve as an advocate for the individual, and may wish to assist the individual with a benefits appeal. This limits the effectiveness of an EN to provide holistic services. He stated that providers should be able to refuse to serve people with certain types of disability but not restrict services based upon severity of disability. In other words, an agency that serves people with psychiatric disabilities would not accept someone who is blind who does not have a psychiatric disability but must accept people with all levels of psychiatric disability.
Section 225 addresses how beneficiaries change ENs. The individual has three months to select a new EN. He stated that the PM should be required to provide a list of Ens and to provide information about P and A's. Choosing a new EN within a three-month period might be too ambitious. He also asked how an extended need for education, therapy or training would affect the beneficiary's ticket. The beneficiary is working on a goal, but not getting credit for working, since they will not have an employment outcome soon enough.
Leslie Jackson was called upon but was not present.
Mr. Mike O'Brien, DRS Oklahoma: Mr. O'Brien stated that the program is so under capitalized that all of the beneficiaries will continue to go to the State VR agencies because other providers will not participate. This will have a negative effect on customer choice. If the provider is worried about being paid, the program becomes a "work first" option, with long-term training and education de-emphasized. There is a requirement that a beneficiary be working by the third year. This encourages minimal training for low-end employment. Mr. O'Brien was also concerned about exclusion of the 16 to 18 year old children and those who expect medical improvement. The regulations emphasize the disability by making people wait for a CDR to get a ticket. Early intervention is crucial.
This concludes the public comment period.
Ms. Morris stated that presenters must submit their comments formally through the NPRM process, in addition to presenting them to the Panel. The committee is not a formal means of submitting input to the NPRM process.
Update on TWWIIA Regulations and Implementation: Ken McGill
The NPRM finally was published on December 28 and comments from the public are due on February 26th. The published version is exactly the same as the draft version that was circulated earlier, with the exception of the cost analysis and the due date for comments.
Final regulations were published on December 29th to index SGA beginning with $740, to index the TWP beginning with $540, and to increase self-employment hours from 40 to 80 under the TWP. The secondary SGA level was eliminated, along with the requirement to determine if a lesser level of earnings meets the SGA level. Student income exclusion was increased to $1290 per month, with the annual cap at $5200, indexed to inflation. About 600 comments were received on this NPRM, mostly of a positive nature. Instructions pertinent to these regulations have been sent to the field office directors.
On January 1, the "easy back on" regulations were implemented and information regarding these provisions is being sent to the field.
Benefits planning grantees are receiving training during the month of January. Additional states receiving awards will be announced this week. Applications for states that have not been awarded were published in the Federal Register this week.
Mr. McGill stated that staff will forward public comments on the TWWIIA NPRM to the Panel as SSA receives them.
Mr. McGill stated that SSA is putting processes and structures into place to support implementation of the TWWIIA. Staff training is being initiated for the field offices. Tele-service representatives are also receiving information. Maximus has been awarded a contract to initiate the ticket program. They have an 800 number and are assisting with implementation in thirteen start-up states. SSA is planning to publish a Request for Quotations (RFQ) to enroll employment networks into the system. If SSA initiates this process immediately, the draft regulations in the NPRM will apply. Contracts would be later modified based upon changes in the regulations when they are finalized.
Mr. McGill stated that Social Security should not give out Tickets to beneficiaries before ENs are signed up. He asked for input as to when the best time to initiate Ticket distribution would be.
Ms. Flaten asked what the advantage would be in distributing Tickets before the regulations are finalized. Mr. McGill stated that Congress had laid out specific implementation schedules for the TWWIIA. Mr. McGill also expressed concern about delaying the implementation until a final regulation is developed. This may be a lengthy process because of the Administrative transition.
Ms. Lee expressed concern that there are many people who would receive a Ticket with nowhere to redeem it because of a lack of providers, especially if the regulations are not finalized. Ms. Webb asked if the SSA actuaries could explain how the Administration developed the Payment Calculation Base (PCB) and Mr. McGill stated that a formal request to the Actuary will be submitted on behalf of the panel. She also asked whether the Congressional data obtained during the bill's passage was examined in calculating the outcome payments.
Mr. MacDonald commented that the ENs might get a negative first taste of the program due to the licensure and administrative requirements in the NPRM. He felt that the program should not be publicized until the regulations are finalized.
Mr. Start expressed concern that a beneficiary's Ticket automatically reverts to VR if the beneficiary is receiving services from a VR agency. Mr. McGill will follow up and clarify this issue. Mr. Start was concerned that if the tickets are released before there is a network in place, all beneficiaries will end up using the VR system, because this will be their only choice. This pushes people back into the same ineffective system they were in before the TWWIIA was passed. This provision also discourages partnerships between VR and private providers.
Ms. Mitchell said that it was not unusual to go forward with implementation of a program without regulations. In response to a question, Mr. McGill stated that the RFQ was simply a request for applications for providers, with no guarantee of payment or number of individuals served. It differs from a contract in that it simply allows agencies to provide services under the program. Ms. Lee suggested that the panel make a formal recommendation as to whether the RFQ should be released.
Mr. Golden asked what the repercussions would be for an unmet implementation deadline. Mr. McGill said that he wasn't sure, but that SSA needs to make a good faith effort to implement the legislation in a timely way. Mr. Bolden encouraged the Agency not to proceed too quickly, thus ignoring quality considerations.
Ms. Gracechild asked if she could see the RFQ and how it defines a positive outcome. She asked if a calibrated payment could be included for providers who help people get higher than entry level jobs, for example, with a higher than average wage. A panel member pointed out that this would be an incentive to serve people with higher educations. Ms. Webb asked if language encouraging higher-level placements could be included in the regulations. She further suggested that SSA keep to the Congressionally mandated schedule. She supported roll out of the Tickets as planned. She felt that ENs would enroll as providers in the Ticket program, even though they may not like the current proposed regulations. She further stated that consumers would advocate strongly for agencies to sign up. Lee countered by saying that the regulations were problematic enough to prevent providers from signing up. Ms. Strahan suggested that the Panel explore a way to roll out pieces of the regulation that everyone is comfortable with and retain or reserve those where there is extensive public disagreement.
The panel took a break at 10:40 and Ms. Mitchell reconvened the meeting at 11:00.
Ms. Mitchell identified several issues for panel deliberation. First is the Ticket roll out process and the timing of the RFQ. Another issue is whether the Tickets should be distributed before the rulemaking process is completed. Third is the preparation activities that need to take place before the roll out. When is it likely that the Benefits Planning Agencies and the P and As will be ready to support the program? Lee asked if the panel could discuss the issue that Ms. Strahan raised about reserving portions of the regulations. Ms. Gracechild expressed concern about the Maximus contract of $57 million. She stated that based upon her research on Maximus, they have received very mixed reviews. She felt the Panel should provide significant oversight of this contract. Ms. Mitchell suggested that this contract is not part of the NPRM or next steps of implementation. Mr. Golden felt that this was an appropriate discussion at this time, since roll out states that hear these reviews or have had negative experiences may be hesitant to get involved. Mr. MacDonald suggested that a presentation from Maximus be scheduled.
Mr. Start stated that the application process for the RSVP program was the most complicated process he had ever observed and that the RFQ process was reported to be extremely complex, extending way beyond the intent of the law. Ms. Webb stated that we should not make a recommendation on this issue until the panel has a chance to see what the RFQ actually says. Ms. Strahan clarified that the Office of Acquisitions and Grants controlled the RFQ process. She stated that McGill might not be able to implement the Panel's recommendations in this area. The panel may want to invite someone from this office to participate in the meeting tomorrow. Ms. Lee strongly stated that we should not go forward with the RFQ until issues in the proposed regulations are resolved. Mr. MacDonald stated that the Statute only specified that the Ticket roll out must take place within the next three years. There was no additional roll out specification. Mr. Golden stated that if the regulations were changed significantly, the RFQ would have to be reissued. The consensus of the panel was to make recommendations on the RFQ when they have an opportunity to review it. They requested that Mr. McGill present this document at the Tuesday morning session.
Ms. Webb asked which of the roll out states have a licensing requirement that would be effected during the roll out. Mr. Golden stated that even in states where licensure wasn't a requirement, there were certain standards that providers needed to adhere to that may be impacted by the regulations and possibly the RFQ. He recommended waiting until the panel has a chance to review the RFQ. Mr. Start stated that in the three states in which he worked, providers must obtain certification by the State Vocational Rehabilitation Agency to be a provider.
Ms. Mitchell stated that the regulations might take twelve to eighteen months to become finalized. Mr. MacDonald felt that the consumer and provider constituencies could put pressure on OMB to get the regulations out more quickly. Mr. Start recommended not issuing the tickets until the providers are enrolled, but not necessarily waiting till the final regulations are released.
Ms. Webb expressed concern about beneficiaries waiting for the ticket. The proposed rule does allow for a consumer to request a ticket. Perhaps SSA could get the tickets and the process in place for distribution as soon as practical. There are consumers and providers who are ready and they should not be discouraged. She stated that immediate availability of Tickets is especially important because of the CDR provisions. Lee suggested that the Panel go forward with reviewing the NPRM and consider each provision as to whether it should be implemented or reserved. The panel will start these deliberations this afternoon.
Ms. Strahan shared a timeline for preparation of the panel's report. Staff activities include distribution of questions to the public and preparation of a draft and final report. The Panel should approve questions today and staff will immediately distribute them. Questions will be distributed by Friday, January 12. The work group reports must be reviewed and approved by the panel by January 17th for approval by January 24. Staff will then begin drafting the preliminary report. A summary from staff of public comments that have been made to the panel during meetings and regional hearings will be prepared by February 2. Transcripts are available if the panel wants to view any of the public comments made to the panel thus far. A draft of the report will be prepared by February 2 and a final report will be prepared by the 6th for publication on February 9. Ms. Strahan recommended discussion of issues but no final resolution of these issues in the draft Advice Report. The final Advice Report will provide specific recommendations after the NPRM comment period is closed.
In response to a panel question, Ms. Strahan stated that the Commissioner is obligated to consider the panel's report, but is not obligated to agree with or support everything in the report. Individual panel members can submit their own comments through the NPRM process. One additional staff person will be retained to assist with these activities.
Ms. Lee expressed concern that the subcommittees may not have their work group reports ready by January 17th.Ms. Mitchell clarified that staff will do much of the drafting of the work group reports. Ms. Strahan suggested that the Preliminary Advice Report be used to raise issues and that the panel recommend resolutions in the Final Advice Report. Staff feels this is doable if the panel can agree on content.
Golden asked if the actuarial data would be included in the preliminary report and Ms. Strahan said it would depend upon when the information was received. The timeline proposed by Ms. Strahan was accepted, with the exception of the January 24th conference call. The conference call will be scheduled for 1:30 on January 23. A motion to approve the schedule and timeline was made, seconded, and passed.
The panel adjourned at 11:45 a.m. and reconvened at approximately 1:15 p.m.
The afternoon session began with a review of the questions from the Employment Network working group. Mr. MacDonald distributed draft questions to the group. He stated that Ms. Flaten had developed a format style that the work group was recommending. The work group has rewritten the questions to be about three and one half pages in length. The first set of questions cover who is eligible for a Ticket, They added a question asking "if a beneficiary is currently a client of the state VR, or applying for VR services, should the beneficiary be able to deposit his/her ticket with a different provider, that is, someone other than the state VR agency?"
The law differs from the regulations on the issue of where beneficiaries with open VR cases should be able to take their ticket. Mr. MacDonald also felt that if a beneficiary is in the application process for VR services, they should be able to make a choice whether to give their ticket to VR or not. Language will be added to clarify the intent of the statute.
Mr. Start wondered if the question should be revised to emphasize that the rules for tickets for private and state VR agencies be the same. There is an implication in the regulations that the ticket automatically is assigned to VR. What should beneficiaries' options be with regard to depositing the ticket?
Mr. Golden stated that the question regarding whether those who do not receive cash benefits because they are covered under Section 1619 status should receive a ticket will be reviewed by legal counsel.
The next two questions posed by the work group addressed how many tickets a beneficiary should get during the same period of disability. For example, what happens to a beneficiary who gets a ticket, works for four years and leaves the job to go back on the disability rolls? Should they get a second ticket? Should the second ticket be set to full value or should that person's ticket only be valued at the remaining ten months?
The next question dealt with who should be in an employment network. Should non-traditional providers and support people be included as ENs? The question asks the audience to give examples. Mr. Start suggested that the question ask if ENs should insure inclusion of non-traditional providers, rather than "circles of support" in their employment networks. A discussion was held as to whether non-traditional providers must be included within each provider network. Panel members were concerned about what employment network qualifications would support inclusion of non-traditional support people. Should non-traditional support people be qualified as ENs or should they be included as a provider within an EN? Strahan pointed out that the Ens must serve a prescribed service area, so having an EN that serves one or two people is not consistent with the statute. Ms. Webb felt that the question should ask whether this non-traditional provider could be a ticket taker. Ms. Webb's suggestion redefines the Employment Network. She asked why a person must go through an EN to get to the non-traditional service provider? Ms. Strahan clarified that the PM has to assure that all geographic areas are covered and has to enter into make sure sufficient ENs are available. Ms. Lee suggested that the panel keep both of the above questions in this section. The panel made edits to the work group question to read as follows:
"Who should be in an employment network? Who should be in an employment network providing services to Ticket holders (beneficiaries)? Give us examples of organizations or businesses that might provide more choice and quality of services? Should non-traditional support people be allowed to contract as employment networks? Should non-traditional support people be allowed to be included as providers in an employment network? Should a beneficiary be allowed to be his/her own service provider? Should collectives of beneficiaries be in an employment network as group providers to each other? Should an employer be allowed to be a Ticket program provider for employment outcomes in that company?"
The next question, regarding qualifications of providers, was discussed. Mr. Burkhauser expressed concern about how qualifications will be determined for non-traditional providers. Mr. Burkhauser felt that any person should be qualified as a provider within an employment network. He suggested that "may or may not" be included in the question regarding provider qualifications to make the question less biased. He continued that who is a provider is the most significant feature of this portion of the Act because it enables non-traditional providers to participate, turning the traditional VR system upside down.
The paragraph beginning with "Some beneficiaries" was deleted.
Mr. MacDonald stated that the final sections cover the IWP. Additionally, the questions cover whether staff should have personnel training and professional backgrounds and asks the public to clarify what they would require as qualifications for provider staff.
The next question asks if timely progress toward the employment goal should be measured by minimum standards for all beneficiaries, or should specifications in the IWP determine timely progress. Mr. Burkhauser suggested that the question should be, "Should timely progress be measured by minimum standards for all beneficiaries or should the terms and conditions specified in the IWP determine timely progress?
Individual Work Plans: The panel considered whether this section should specify that Individual Education Plans be included as possible substitutes for IWP's in this question. One panel member suggested that the question read, "Should the regulations allow a substitution of another plan, such as the IEP?" Mr. Start stated that the IEP is not employment related and will make the IWP more complicated.
Ms. Webb expressed concern that the rules automatically assume that State VR is doing good work and that the employment networks need all kinds of quality control. There is much less oversight of the VR plans than the IWPs. She felt that the rules governing the IWP, which is an agreement between the consumer and the EN, should be the same for plans developed through VR and private providers. She proposed the question, "Should VR be excepted from the review of IWP's? If so, should other service delivery plans be acceptable, provided that they meet the minimum standards outlined in the Statute? Another question might be, "Should the requirements of the IWP be more or less prescriptive for everyone?"
Mr. Hickman, SSA staff, reviewed the statutory requirements of the IWP. He stated that what is in the statute is reflected in the proposed regulations. Everything that is required in the State VR plan is required in the IWP. Ms. Webb stated that this explanation satisfied her concern.
Ms. Flaten raised a question about the effective date of the IPE developed by the consumer and the state VR agency. She felt that the IPE, if it is a substitute for the IWP, could be in effect before the consumer has a chance to decide if he or she wants the State VR agency to be the ticket provider. The panel decided to drop the last part of the question originally proposed by the work group. The panel agreed on the following question:
"Should the State VR agency be allowed to use the Individual Plan for Employment (IPE) as a substitute for the Individual Work Plan (IWP)? If so, should other individualized service delivery plans be acceptable alternatives, provided they meet the minimum standards outlined in the statute?"
Payment Questions
Ms. Webb walked through the changes to the proposed work group questions. She said that Question Seven was changed to eliminate the reference to SGA for SSI recipients. Ms. Flaten and Ms. Mitchell clarified the language in Question Seven. "Should an agreement be included in the IWP as to whether and how the beneficiary will report wages to the provider?" Ms. Lee suggested that the focus of the question be redirected to how this information should be provided. Ms. Mitchell suggested that this be added to the existing question. She felt that the panel should be sure that the questions are not biased; Lee's question assumes that the employee will provide this information. Ms. Lee suggested that the question should be, "If yes, how should this information be provided to the Employment Network?" Ms. Mitchell pointed out that the panel already voted on this language and Lee dropped her concern.
The figure of $740 per month included in Question Six is in error. The figure will be deleted and substituted with language clarifying the break-even point for SSI. Ms. Flaten recommended that the question related to SSI be separated out from the question related to blind beneficiaries. The panel agreed to the following:
"The substantial gainful activity (SGA) level for blind beneficiaries currently is $1240. Will ENs be discouraged from serving these beneficiaries because of the higher SGA? For beneficiaries receiving SSI, will ENs be discouraged from serving these beneficiaries because they must reach a higher level of earnings before reaching 0-cash benefits status?"
Ms. Mitchell again stated that Question Ten, as proposed by the work group, assumes that the beneficiary will provide the information about earnings to the EN. A panel member proposed to drop the last question from number Ten and move the first part of Question Ten to Question Eight. Question Eight was approved as follows:
"How should documentation of beneficiary earnings be provided by the EN to the Program manager to validate payments due to the EN?"
Mr. MacDonald again suggested that software be developed to assist providers in reporting to the ENs. Ms. Strahan clarified that this is not an NPRM issue. She added that the only reasonable answer to this question is "yes".
Ms. Mitchell needed to excuse herself from the meeting and asked Mr. MacDonald to chair the meeting. Mr. Henderson presented the dispute resolution questions.
Disputes between Beneficiaries and ENs: Mr. Henderson read the questions. The question considered whether various timelines for each stage of the dispute resolution process be included, and how much time should be allowed at each stage. Should mediation services be available and at what point in the process? Who should pay for the mediation and how should beneficiaries be informed? Mr. MacDonald asked a question about Question Seven and whether notifying P and As about all beneficiaries' grievances violates beneficiary confidentiality. Ms. Strahan suggested that this question be put on hold until Ms. Mitchell and Ms. Griffin could respond, early tomorrow morning.
The panel also felt that Question Eight was biased. The panel suggested, "In an appeal to the PM, should the PM be required to request and accept information from both the EN and the beneficiary regarding a dispute?"
Question Ten was considered. It was stated that P and A services are supposed to cover work incentives in general, not just appeals. This does include BPA and O services. However, the regulations only deal with the ticket portion of the services. Mr. Hickman stated that other regulations will be developed to cover these issues.
The questions dealing with disputes between ENs and service providers, and between ENs and PNs were read. The panel decided to rewrite the questions about disputes between beneficiaries and Ens to apply to disputes between providers and PNs.
The panel affirmed the questions, with the exception of Question Seven in the Dispute Resolution Section, to be considered tomorrow morning.
The Annual Progress Report of the Panel was distributed for review and a vote will be scheduled tomorrow afternoon.
The meeting was adjourned at 4:30 p.m.
Social Security Administration
Ticket to Work and Work Incentives Advisory Panel Meeting
Minutes
January 10, 2001
Ms. Mitchell called the meeting to order at 1:30 p.m. Ms. Lee and Ms. Gracechild were absent from this portion of the meeting; Ms. Griffin was present.
Ms. Mitchell stated that the morning meeting had been cancelled so that Panel members could participate in the Roosevelt Memorial ceremony. Ms. Mitchell turned to Question Seven, which remained for consideration from the previous day. She stated that, when a beneficiary filed a complaint, their complaint would be forwarded to the P and A for assistance. When the IWP is signed, the beneficiary would be advised of the complaint forwarding process and the individual could consent or refuse to consent. This notification would not be sent without the consumer's consent. The question will be clarified to reflect the requirement of consumer consent.
With regard to Question Eight (Should the PM be required to request and except information from the EN and the beneficiary regarding disputes and should Social Security be required to ask the PM and the EN for this information during disputes?) Ms. Webb clarified the intent of the question, to insure that both parties were given the opportunity to present information to the entity in an appeal. The dispute resolution questions were adopted.
Formatting of Questions: Ms. Flaten provided a draft format for the questions. She stated her intent to get intelligent input from consumers who may not have the opportunity to read the NPRM. Ms. Mitchell stated a concern about the check off/agree disagree responses because some questions do not lend themselves to this format. Ms. Mitchell stated her intent to get the questions out by the end of the week. Ms. Flaten stated her concern about the quick turn around for the hearings and the panel's lack of preparation to get people to the hearing. MacDonald expressed concern about language changes that reformatting might require. He expressed the priority of getting the questions distributed, with formatting a second priority. Ms. Mitchell agreed to instruct staff to get the questions in consistent format based upon the wording that the panel had approved. Staff will include the checklist that categorizes respondents. Staff will also include an encouragement to provide input in other ways beyond the hearing.
Regional Meetings: Mr. MacDonald explained that conference calls, rather than in-person meetings, would be held in California to minimize time and travel commitment requirements.
Ms. Mitchell reviewed the Panel schedule of meetings and conference calls. The New York meeting was cancelled for lack of planning time; it was originally scheduled for Friday, January 12 and will be scheduled for a later time. Ms. Webb stated that several people have taken significant time to mail or present technical information to the panel and she thanked them. She stated that the panel has not received significant input from consumers and this is the purpose of the hearings. She strongly desires to meet our mandate to provide advice to the SSA Commissioner in a timely way and not disappoint the SSI/SSDI beneficiaries who want to work. Ms. Mitchell stated that the panel should make the effort to reach out to parts of the country outside the DC area.
Ms. Mitchell agreed to officiate at the Atlanta meeting, but stated that she would do it by teleconference. Ms. Webb asked if the regional meetings would include both teleconferences and in-person meetings and the panel agreed in the affirmative. The agenda will not be a part of the Federal Register notice.
Ms. Webb stated her preference for an initial script that outlined the purpose and logistics of the hearing. The panel member would then open the meeting up for five-minute presentations. Mr. Start asked if summaries of the legislation and regulations will be provided at the hearings and whether the regulations will be provided on site. Ms. Webb also asked if interpreters and alternative formats would be available. Ms. Strahan stated that interpreters and personal assistants are always provided. Ms. Mitchell stated that an agenda and other handouts would be provided in alternative formats, and some print and disk copies of the regulations would be available. Braille and large print copies of the regulations should be requested from Social Security.
Ms. Strahan asked if the panel was requesting general response from the public or response to the proposed regulation and Ms. Webb stated that the intent was to obtain comments on the proposed regulations. Mr. MacDonald also suggested a twenty-minute overview of the draft regulations to orient the group at the beginning of the public hearing. Ms. Mitchell stated that people may enter and exit throughout the meeting, making an introduction impossible. Mr. MacDonald expressed his strong preference for a brief overview. Mr. Start asked if the panel members would answer questions and respond to comments or just listen to public comment. Ms. Mitchell stated that the panel's role is to obtain input from the public, not to educate them about the regulations. Mr. MacDonald felt that if the overview is not provided, the level of public input would be less effective. Ms. Griffin said that if panel members provided the overview, they would be put into the position of having to answer questions and this was not the panel's role. Mr. Burkhauser felt that the panel should restrict the hearings to obtaining consumer comment, not educating them. After much discussion, this was the consensus of the panel.
In response to a question from a panel member, Ms. Strahan stated that requests for reimbursement for travel will come through Social Security and for miscellaneous expenses will come through Conwal.
Ms. Mitchell moved to a discussion of panel recommendations on which regulations should be implemented as soon as possible and which ones should be delayed. Mr. McGill stated that copies of the RFQ, requested by the panel, were not ready for distribution but might be emailed by next week. Ms. Webb asked about language that would enable the EN to submit a contract amendment to conform to final regulations, if they are significantly modified from the NPRM. Ms. Mitchell asked the panel for a recommendation as to whether the Tickets should be released before the Rule is finalized.
In response to a question from Mr. MacDonald, Mr. McGill stated that Maximus, the PM, was setting systems in place to enable them to operate the Ticket Program. They are doing behind the scenes work to prepare for Ticket implementation. They are currently hiring staff to respond to 800 number calls.
Ms. McGill responded to a question from Start by saying that the RFQ would be out by the end of January and that the turn-around would be accomplished quickly. Mr. Start asked if the tickets would be released before or after the providers were on-line. Webb stated that she had modified her opinion after significant thought and that the tickets should be released after providers were enrolled. While some consumers may want to proceed with the ticket, they should not be made widely available until there are providers ready to provide services. Ms. Flaten disagreed, saying it was better to have things in place before starting. A negative start discourages people from participation. Change in the middle of the program will be harmful to beneficiaries. Start suggested that ENs would probably market their services to beneficiaries to recruit ticket holders.
Ms. Strahan named a few of the issues that the panel had raised concerns about during the last day. She suggested that the panel draft a letter to the Commissioner asking that these items be changed or delayed. Ms. Mitchell stated that the issue on the table was whether tickets should be issued before or after providers were enrolled, and whether the RFQ should be distributed before the Regulations were finalized. Mr. Start moved that the panel advise that SSA release the RFQ with the proviso that it is based upon draft regulations and that SSA release the tickets 90 days after release of the RFQ. Ms. Webb seconded the motion.
Ms. Mitchell expressed concern about releasing the RFQ before the panel has reviewed it. She also asked what the consequences of a 60-day delay in ticket release would be. Mr. McGill spoke to the legislative mandate of a timely release. Implementation is to take place over a three-year phase in period, beginning in Year 2001. Ms. Mitchell stated that she could not vote on the motion until the panel has a chance to review the RFQ. Mr. Burkhauser concurred. Mr. Start amended his motion to read, "subject to review of the RFQ by the panel". He suggested that the panel hold an additional conference call to review the RFQ. Webb asked whether this could be done under FACA rules and whether this issue could be placed in the federal register. There is a conference call already scheduled for January 23, when this issue could be considered. Mr. McGill agreed to share the document with the panel before the conference call.
Mr. Start stated that if the opportunity for review was not provided, the panel should write a letter to the President, the Congress, and the SSA Commissioner saying that the panel wishes to provide input but the opportunity has not been provided. Ms. Strahan stated that Social Security policy prohibited sharing of final Commerce Business Daily documents with sectors of the public before publication and clarified that the panel was requesting a draft.
Ms. Mitchell called a break at 3:45 and the meeting was reconvened at 4:00.
Mr. McGill stated that he would release a draft document for review before the teleconference on January 23 and be prepared to take panel comments. This will be a public teleconference, which will be published in the Federal Register on an expedited basis. Mr. Start tabled his motion until January 23.
Ms. Strahan stated that a representative from the Office of Requisition and Grants was not available this afternoon to present on the RFQ. Ms. Strahan also stated that Ms. Webb's request on how SSA actuaries had developed the Payment Calculation Base (PCB) upon which milestone payments were based was still pending. Mr. McGill also stated that there was an announcement on SSA's website about the benefit planning grants SSA had recently awarded. The Request for application for the remaining states has also been posted. Mr. McGill further stated that he was looking forward to the panel's final report, but that individual panel members can comment on the NPRM within the 60-day timeline. There is no requirement that the Panel as a whole respond within 60 days. He suggested, however, that the advisory report be completed as soon as possible after the sixty-day comment period is over.
Administrative Issues
Ms. Mitchell stated that the public comment period originally scheduled for this morning would be rescheduled for the first day of the February meeting. In the meantime, anyone who wants to make comments in writing may do so. Mr. MacDonald thanked members of the public who had come to the meeting.
The minutes from the December 12 and 19 meetings were approved as mailed. The Operating Procedures were considered. Ms. Mitchell asked the panel to consider how selection of the chairperson would be handled in her absence. The panel decided that a chair could be picked at the meeting from the members present. The panel moved, seconded, and approved the operating procedures.
The draft annual report was presented. Ms. Mitchell stated that Mr. Golden and Ms. Gracechild had reviewed the draft and felt comfortable with it, with minor editing changes. Ms. Flaten asked if veterans could be included in the list of panel member representation under the Message from the Chair. She also requested that the term "disability" be added before the term "support services" in that paragraph. In the next paragraph, she asked that providers and economists be added as areas of expertise. The panel gave informal approval for staff to proceed.
Ms. Strahan stated that the six new staff positions to support the panel have been approved. This includes a budget analyst and three policy positions. The two top positions are a GS-14 and a GS-15. SSA is searching nationally for these positions. Staff of the panel has secured office space at 400 Virginia Avenue. A contract has been signed. The cost of this space is $350,000 per year and will be paid for by SSA from sources other than the panel's budget. It will be renovated by the end of January, with a proposed move in date in early February.
The website will be ready for demonstration by February 14. The Panel's budget will be prepared by the February meeting based upon the FY 2001 allocation.
The next quarterly meeting will take place from February 6-8 at the Bethesda Hyatt. Ms. Mitchell asked that the panel set aside one day to consider the draft advice report, which is based upon the work group reports. The panel will also take public comment during the first of the three-day meeting. House and Senate staff has also been invited. Ms. Webb suggested that the Actuary be invited to brief the panel on the benefits calculations, if this information has not been provided beforehand. Ms. Webb also asked that time be allotted for panel members to report back on the success of the regional meetings. The first day will consist of public comments, reporting back from the briefings, and the other items mentioned above. The second day will be reserved for the advice report.
Ms. Webb stated that the perception of the public is that once an NPRM is out, there is very little opportunity for change. Ms. Webb stated her disagreement with that perception. She asked how much time the panel would require to review the NPRM in detail. Ms. Mitchell stated her preference that this be done in a face-to-face meeting. Ms. Webb suggested that panel members submit their individual thinking in writing and hold a teleconference prior to a face-to-face meeting at the end of March to hammer out differences of opinion. Other panel members stated that they did not wish to write an individual position prior to the discussion. Ms. Webb clarified that this would not be a requirement of all panel members, only those who chose to. Mitchell suggested that an additional two-day meeting be scheduled. The date will be set at the next teleconference meeting on January 23. The beginning of the week of March 19th was proposed.
Ms. Webb asked about the specifics of how reporting of employee income would be handled and how outcome payments to the EN would be calculated. These and other issues will be deliberated at the February meeting.
Mr. Burkhauser asked for cost estimates from the Actuary's Office on including the MIE and the 16 to 18 year old beneficiaries in the Ticket program. Ms. Strahan stated that certain requests to the Actuary's Office are kept confidential, so if the Panel requests such information, it may be covered under a confidentiality request. Mr. Burkhauser will work with staff on fashioning these requests.
Ms. Webb expressed concern about the administrative cost to the ENs of collecting employment information from consumers. She wondered what SSA was capable of in terms of collecting this information. Ms. Strahan will request a presentation or additional information from the agency.
Ms. Griffin expressed concern about forwarding all names of beneficiaries to the employment networks. Mr. McGill clarified that this process was legitimate, because an individual signed a waiver for an employment referral. Ms. Griffin expressed concern that the waiver was for release to the State Vocational Rehabilitation agency, not the EN. This question should be reconsidered at a later date.
The meeting was adjourned at 5 p.m.
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