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Ticket to Work and Work Incentives Advisory Panel
Closed Administrative Meeting
Embassy Suites Hotel
Alexandria, Virginia
September 26, 2000 (Afternoon Session)
[Note: The minute taker was not present at any of the Panel activities on September 25 or during the morning of September 26.]
The afternoon session was called to order at 1:30 PM by Ms. Sarah Wiggins Mitchell, Chair. Ten members were in attendance: Sarah Wiggins Mitchell, Richard Burkhauser, Thomas P. Golden, Frances Gracechild, Christine M. Griffin, Larry D. Henderson, Jerome Kleckley, Stephanie Smith Lee, Bryon R. MacDonald, and Susan Webb. Absent was Stephen L. Start.
Ken McGill, Associate SSA Commissioner, Office of Employment Support Programs, briefed the Panel on TWWIIA developments. The TWWIIA draft regulations are still being held up in the Office of Management and Budget. SSA is operating under a continuing resolution through October 6th. The TWWIIA Program Manager contract will be announced in the course of the week. Technical assistance grants for Benefits Planning, Advocacy and Outreach (BPA&O) have been announced. More than one center will be funded. SSA did not receive any applications in many states and will have to re-announce the grant competition in those states. There will be multiple awards in most states. The Protection and Advocacy grant announcement will appear shortly. It is not competitive, and no specific dollar amount has been attached to it.
Ms. Mitchell asked how the Employment Support Representatives (ESRs) will work in each state. Mr. McGill stated that he wanted to receive community input on this. Mr. MacDonald inquired if the ESR appropriation was separate from the $23 million allocated for BPA&O. Mr. McGill said it was. He added that more ESRs will be trained, depending on the success of the pilot program.
Mr. Golden asked if SSA was setting up a management information system for BPAO projects. Mr. McGill replied that SSA did not want to put a heavy reporting burden on these projects. SSA needs to make operational decisions. He reiterated that SSA did not obtain full national coverage in the first cut. Mr. Golden asked about any relation between the BPA&O grants and the Department of Labor (DOL) Change Grants. Mr. McGill replied that SSA is coordinating with DOL and Heath Care Financing Administration (HCFA), but that there was no formal relation. The requirements and areas were different. Mr. McGill emphasized that the BPA&O effort will be critical in the first TWWIIA rollout states.
Turning to the public comment period following publication of the regulations, Ms. Lee asked if an individual gave the Panel input, could the Panel channel these comments into the regulatory process. She sought guidance on mechanics of the comment period. Mr. McGill said that Ms. Marie Strahan (Advisory Panel Executive Director) and Mr. Jeff Funk of OESP should consult SSA legal counsel on this process. He welcomed any Panel analysis and added that there will be a rush to issue final regulations following the 60-day comment period. Ms. Strahan asked if SSA expected final regulations to be issued before Inauguration Day. Mr. McGill replied that this was no different from any other date. Ms. Strahan added that the final rule will go back to OMB for final review.
Mr. McGill noted that the OESP team working on the "2 for 1" Demonstration Project will be coming before the Panel. Ms. Strahan said the team was scheduled for the next meeting. Dr. Burkhauser asked if the Demonstration Project will only take place in the rollout states. This will have an effect on eligibility for benefits, he added. Mr. McGill said he was seeking Panel input on this question. He also noted that the Panel could provide input on the payment system, as he anticipated some changes in the payment structure after the first rollout. There should be an ongoing consultation with the Panel on this issue and the structure and reporting requirements of Employment Networks (ENs).
Ms. Webb asked for data from the Gallup survey of potential ENs. Mr. McGill said that the report will go to the Program Manager and will be passed to the Panel. He did note that 60% of the provider respondents were nonprofits and 40% were for-profits or government agencies. Ms. Webb inquired if a beneficiary had to be "zeroed out" of cash benefits for ENs to receive payments. Mr. McGill replied affirmatively in the case of outcome payments. Ms. Webb noted that, in the draft regulations, milestone payments were earmarked for 3 months and 6 months after employment. Dr. Burkhauser added that the definition of employment was earnings beyond the level of Substantial Gainful Activity (SGA). SSDI recipients would face an "income cliff" at this point.
Mr. MacDonald asked if the $700 benchmark was indexed. Mr. McGill replied that SSA was paying providers, not beneficiaries. SGA is indexed, but at a lower level for people who are blind. Mr. Golden said this was an inherent lack of equity for the blind.
Ms. Lee asked if a beneficiary can change ENs without going through the dispute resolution process. Ms. Webb said there may need to be agreement between the EN and the beneficiary to change. Ms. Lee noted that Congress took out the "show cause" language. Mr. McGill stated that the EN may bring this issue to SSA. Ms. Griffin observed that the beneficiary will probably not receive services from a new EN until agreement is worked out with the old EN. Ms. Lee noted that there was some inconsistency between Congressional intent and limitations of FACA on the Advisory Panel.
The Advisory Panel then heard oral reports from its working groups. Reporting for the Ticket/EN working group, Mr. MacDonald posed the following questions: "Who gets the Ticket? When are they using it? What constitutes use? These questions are somewhat problematic, as there is little guidance in the legislation. The Commissioner can define these guidelines. It appears all beneficiaries aged 18-64 will receive the Ticket. The working group thought SSA should consider youth in transition (14 years and older) as they move out of IDEA coverage. Dr. Burkhauser asked if this might mean "zeroing out" SSI benefits for youth in transition. Mr. MacDonald added that "zeroing out" might pose a problem for beneficiaries age 64 or older. There is statutory latitude for SSI beneficiaries.
Ms. Strahan stated it was necessary to look at the SSI definitions. Disability is a category that is age-defined. She added her staff will do the research on this. Ms. Lee also asked about unintended consequences for Title II children, owing to provisions of the draft regulations.
Mr. MacDonald added that there is a "sunset" provision on issuance of Tickets. However, there does not appear to be a "sunset" on use of the Ticket in the bill. Ms. Strahan said that the issuance of the Ticket to all beneficiaries will likely raise issues on CDRs. Dr. Burkhauser noted that the decision to issue the Ticket to all beneficiaries was a Panel achievement; previously, SSA had determined that a beneficiary had to be on the rolls two years before receiving the Ticket.
On use of the Ticket, Mr. MacDonald said that the bill had only one line on suspension of CDRs, i.e., that this was to be determined by the Commissioner. Suspension of CDRs will be governed by the level of demonstrable progress of the beneficiary toward employment. This progress will be documented through the reporting system to the Program Manager. The use of the Ticket will begin with the signing of an individual work plan by the beneficiary and the EN, he added.
Mr. Golden stated that the individual work plan should not be part of the reporting system. He added that SSA had not provided sufficient briefing information on this question. Ms. Webb added that Mr. McGill had indicated there was nothing new on this issue outside of the legislation.
The second working group to report focused on Dispute Resolution and Protection and Advocacy. Ms. Griffin stated that there were two situations for dispute resolution: 1) the individual beneficiary vs. the EN, leading to an internal review by the EN that could be monitored by the Program Manager; and 2) non-individual disputes, i.e., between ENs, between the EN and the Program Manager etc. SSA would have a review process in the latter case.
Ms. Strahan noted that the overall effectiveness of the entire system needed to be considered. Ms. Griffin asked about how discrimination by an EN would be determined. An EN might have to choose among beneficiaries in order to provide services. She expressed concern about the mandatory EN internal review and stressed that the beneficiary needs protection from the start. She stated that participation of the Protection and Advocacy (P&A) agency needs to be assured. When a beneficiary files a complaint with the EN, both the Program Manager and the P&A agency should be notified. Mediation should take place at the Program Manager level through the services of a professional mediator. She noted that there was a question of who would pay for this mediation process. She added that SSA making the final decision was unfair to the beneficiary. Further, she proposed a "stay put" provision (as in IDEA), where the beneficiary would receive minimal services from the EN during mediation.
Ms. Mitchell observed that the beneficiary may not want continued services with the old EN and that this was an area that needed to be addressed. Ms. Griffin added that the EN may want to terminate. Ms. Lee said that it was up to the Program Manager to decide who gets what. Ms. Mitchell asked if the beneficiary could expedite the process, perhaps through the alternative of mandatory mediation.
Ms. Griffin stated that the P&A agency has a broad role in the process and can provide information and advice, particularly on the rights and responsibilities of the beneficiary. She believed that P&A information and advice should be offered nationally (not only in the first rollout states). The Panel should discuss the matter with concerned organizations and individuals: NAPAS, the DLC in Massachusetts, ADAPT, NARPPS, Julie Chamberlin, Alan Bergman at BIA, Sue Swenson at ADD, Project with Industry groups (i.e., I-NABIR).
Ms. Lee emphasized the need to head off disputes, adding that there are too many disputes under IDEA. She suggested consulting with parent representatives (Linda Shepherd, Patty Smith). The Program Manager must ask the beneficiary if the EN provided services, she added. Ms. Strahan noted that the Program Manager has a mandated contract, draws its authority from the law, and is accountable to the U.S. Government.
Ms. Webb brought up the EN "creaming" issue that raises discrimination questions under Title II of the ADA. She asked if the EN had any choice in this matter. Ms. Mitchell said that this might be a case of permissible discrimination, although some might disagree. Ms. Griffin added that there is going to be a tension between advancing employment opportunities and doing it in a discriminatory way. Ms. Strahan added that other Federal programs (Medicare, Medicaid) enroll providers). Ms. Griffin observed that these providers have to take all beneficiaries.
The third working group covered EN payment issues. Ms. Webb said that, at the next Panel meeting, SSA should provide briefings on its previous studies, Project Network, and Choice Grants. These represent different payment models. Ms. Lee recommended a study on the adequacy of incentives for smaller providers who need ongoing support. The Commissioner has to consult on this issue with the Panel, which should receive briefings from SSA.
Ms. Webb suggested a teleconference with respondents from the Gallup survey and a hearing on milestone/outcome payment methodology, including the questions of "zeroing out," milestone payments at 3 and 6 months post-employment, and proposals for individualized milestones. Ms. Lee added that many in the disability community support individualized milestones along lines of the PASS program. She gave completion of an individual work plan (IWP) as an example. Ms. Gracechild added that an IWP could be an integral part of a contract with the EN.
Ms. Lee noted that Sen. Kennedy saw milestone payments as equity for the EN "creaming" issue. Ms. Webb asked if the reported dollar amount of the milestones ($1100 each) was attractive or reasonable. Ms. Deborah Morrison of the Panel Staff stated that milestones are to be figured at 68% of the Payment Calculation Base (PCB) over 3 months. Dr. Burkhauser called the SSI PCB at $500 at 68% over 3 months equaling approximately $1100. Ms. Strahan added staff would provide additional information on this.
Ms. Griffin noted that potential participants in ENs will have to be convinced. Ms. Webb asked if ENs could make ends meet and suggested possibly increasing the number of milestones or decreasing the payment period. Ms. Lee stressed that the 60-month payment period was statutory. Dr. Burkhauser observed that SSA could reduce the 40% cap on outcome payments and add more milestone payments.
Ms. Webb said she wanted to see the specifics of the NPRM on deductions from SA for IRWEs, BWEs, and PASS. She asked what would be the milestone consideration if the EN worked in tandem with the state VR agency or another EN. Mr. MacDonald stated that the VR agency must serve the consumer who is working with an EN. Ms. Webb asked about the effect of the "2 for1" Demonstration Project for milestone/outcome payments. She wondered if milestones should not be structured to help the beneficiary advance in his/her career during the 60-month payment period. Ms. Lee agreed that ENs should have incentives to work with beneficiaries to undertake job advancement.
Ms. Webb also brought up the issue of a different payment structure for people who are harder to serve. At present "one size fits all." She suggested perhaps a larger percentage of outcome payments. Ms. Lee said that there will be an SSA study of this issue on a demonstration basis. Ms. Strahan added that this report will focus on the adequacy of incentives during the first two years. Conceivably, there could be more upfront milestones, but, she noted, the statute caps outcomes at the 40% level.
The final period of the meeting was devoted to scheduling and other administrative questions. Ms. Mitchell recommended a three-day public meeting November 13-15, with Day 1 devoted to public comment on specific issues, Day 2 to public deliberations, work group reporting and written comments, and Day 3 to Panel business. Ms. Strahan noted that there will be less than one month to submit Panel final comments to the SSA docket after the November meeting. Staff needed time to draft the final report. Ms. Mitchell added that the Panel still doesn't know when the regulations will appear; she asked how much time the staff would need to write the report.
Mr. MacDonald said that the report needs to come out as soon as possible after the November meeting. Dr. Burkhauser added that he couldn't imagine writing it in three days. Ms. Mitchell observed that the deliberation process has to be in public. She suggested that the staff could draft the report after the meeting and the Panel could review and revise it during a public teleconference. Mr. MacDonald noted that the Panel should seek public comment on its report. Ms. Strahan pointed to time constraints owing to the limits of the public comment period. She added that there were many ways for the public to comment-by mail, fax, email etc. Ms. Lee said that the report need not be 50 pages, but should be easy to read and to understand. Ms. Strahan estimated it would take staff a week to turn the report around.
Ms. Mitchell suggested putting the final document on the SSA website. Lisa Ekman of the Panel Staff said that it would take three working days to put the report on the website. Ms. Webb asked if staff could have a draft report on November 27th. There was consensus among Panel members that the Panel would agree to concise positions at the November meeting for the staff to turn into a draft report. Ms. Webb noted that, if the Panel approved the report on November 27th, it could be posted on the website by December 1st. The Panel approved the purchase of computer notebooks for each member and endorsed staff recommendation of a separate computer network with separate email addresses. Mr. MacDonald advocated holding a public teleconference before November 13th to provide the public with one more opportunity to testify. It was agreed to hold the public teleconference on Wednesday, November 8th, from 1:30 to 3:30 PM EST. The Advisory Panel then adjourned at 5 PM.
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