Ticket to Work and Work Incentives Advisory Panel
Inaugural Meeting Minutes
Sheraton Crystal City
Arlington, Virginia
July 24-25, 2000

The first public meeting of the Ticket to Work and Work Incentives Advisory Panel convened Monday, July 24, 2000 at 1:30 PM. All eleven members were in attendance: Sarah Wiggins Mitchell (Chair), Richard Burkhauser, Thomas P. Golden, Frances Gracechild, Christine M. Griffin, Larry D. Henderson, Jerome Kleckley, Stephanie Smith Lee, Bryon R. MacDonald, Stephen L. Start, and Susan Webb.

Susan Daniels, Deputy Commissioner of the Social Security Administration (SSA) welcomed the Panel. Dr. Daniels added that the Ticket to Work and Work Incentives Improvement Act launches a new way of viewing people with disabilities and increasing their employment opportunities. She emphasized that SSA needed to keep channels open to the public, as exemplified by the live webcasting of the first part of this meeting.

Ken McGill, Associate SSA Commissioner, Office of Employment Support Programs, (OESP) also greeted the Advisory Panel. Mr. McGill expressed SSA's strong interest in receiving advice from the Panel on issues of work incentives and employment, in particular regarding the implementation of TWWIIA.

Dr. Daniels then asked the Panelists to identify themselves and to discuss briefly what aspect of the legislation interested them most.

Ms. Lee stated that she wanted to make sure that the legislation benefits the maximum number of people, in part through creative payment systems.

Ms. Webb described the legislation as a truly grassroots initiative from people who have lived on the system. She thought the idea of consumer control and choice was key and that the program should not become one more bureaucratized system.

Ms. Mitchell noted the importance of information dissemination and assistance to assure full participation by beneficiaries. This had to be accomplished through outreach and education programs.

Mr. Start said that his priority was "to see that [the program] works." He foresaw an evolutionary process of constant improvements to the TWWIIA program to move substantial numbers of people off the rolls and back to work.

Mr. MacDonald observed that five separate Federal bureaucracies -- Medicaid, Medicare, Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), and Rehabilitation Services Administration (RSA) -- had been reformed by this legislation. He stressed the importance of benefits planning to convey necessary information to interested beneficiaries.

Mr. Golden agreed that benefits planning and outreach are critical. He also noted the safety net of expedited reinstatement and protection from Continuing Disability Reviews (CDRs).

Dr. Burkhauser emphasized the importance of asking providers to take increased risks, since success (i.e., tangible employment outcomes) will lead to payment.

Ms. Griffin stressed the work required at the state grassroots level, particularly in motivating state agencies to participate in the program.

Dr. Daniels then asked what the Panelists' hopes were for the role of the advocacy community.

Ms. Gracechild stated that gaining "quality jobs" is essential. There is a need to join with larger social justice communities to obtain jobs worth taking, complete with benefits, she added.

Ms. Webb described her background as an advocate and entrepreneur and pointed to the need to gain marketable skills and to remove barriers. She said that beneficiaries had to take risks and encouraged them to become entrepreneurs.

Ms. Lee stated that the program allowed people with disabilities greater choice and control. She looked forward to broad public participation through public hearings of the Advisory Panel as the regulations and programs are developed.

Mr. MacDonald emphasized the two huge challenges of the Federal regulatory process and state implementation of healthcare provisions. He pointed to the 20 advocacy coalitions working at the state level across multiple bureaucracies.

Mr. Start said that advocates needed to shift emphasis from ways for government to protect people with disabilities to an accent on their abilities and potential contribution to employers.

Ms. Mitchell stressed the importance of creating mechanisms by which the advocacy community could work with the Advisory Panel.

Mr. Golden expressed two concerns regarding equitable access: first, for youths in school-to-work transition and, second, for people with the most severe disabilities.

Dr. Burkhauser stated that SSA needed to shift its emphasis from providing protection to people who are not working to encouraging people to work. Ninety-five percent of Federal transfer payments are made to people not working, he said.

Mr. Henderson emphasized inclusion of people with significant disabilities who had a great deal to contribute.

Ms. Lee described the TWWIIA amendment that requires SSA to study the reimbursements and supports necessary to serve people who are more expensive to serve or need ongoing supports, and the importance of the advocacy community's advice on how to conduct the study and structure the payment systems so that people with more significant disabilities are served.

Dr. Daniels then introduced Kenneth Apfel, Commissioner of the Social Security Administration, who administered the oath to the Panel members. Commissioner Apfel applauded the establishment of the Advisory Panel and invited members to cooperate with SSA in changing the climate to a more work-based focus. He recognized the importance of public involvement through the efforts of the grassroots advocacy community in reshaping the nature of our institutions and our democracy. Inclusion, independence, and accessibility were dreams for people with disabilities 30 years ago, he added. TWWIIA was the most important legislation in this area since the Americans with Disabilities Act (ADA).

Commissioner Apfel drew a parallel with the Social Security Act, which President Roosevelt signed sixty-five years ago, at a time when many senior citizens were living in dire poverty. Institution-building for people with disabilities, as with the Social Security retirement system, will take time. He challenged the Panel to focus on how it can help SSA in a number of areas: implementation of TWWIIA through OESP, creation of programs for employment support specialists and benefits counselors, coordination of related grants, Program Manager operations, expedited benefit reinstatement, and the role of protection and advocacy agencies. In conclusion, Commissioner Apfel stated that, ten years from now, he hoped to see a new dynamic toward work emanating from this program.

Dr. Daniels noted that there was a great deal of information now available on TWWIIA and invited the public to follow progress on the SSA web site www.socialsecurity.gov/work. She added that TWWIIA was different, as it was largely the product of a grassroots movement from all sectors and areas. This movement has resulted in "a beautifully crafted set of new tools," she said, but nothing will happen automatically. People with disabilities still need to push open the door. She reminded the Panel that there were still many people with disabilities living in poverty, without hope, feeling trapped by the system.

Dr. Daniels then asked each Panelist to identify one unique personal characteristic that will contribute to the Panel deliberations.

Ms. Gracechild noted that "work has been redemption in my life." She added that she wanted to bring this opportunity to as many people as possible.

Ms. Mitchell stated that she has experienced a great deal of discrimination in her life, but that a sense of humor and a belief in hard work and the goodness of people have helped her to achieve her goals.

Mr. MacDonald emphasized his tenacity and consensus-building skills during the campaign to pass this legislation.

Ms. Griffin focused on her daily work with people with disabilities who face discrimination in the work place. She has needed both common sense and "an ability to cut through the BS."

Ms. Webb stressed that she represented the one SSDI recipient in 500 who managed to return to work. She said she brings common sense and personal experience to public policy.

Ms. Lee emphasized her background as mother of a child with cognitive disabilities and her experience in "helping family members and individuals with disabilities understand that they can make a difference in the public policy process.

Mr. Start spoke of his experience as a private provider dealing with private employers and labor unions.

Mr. Golden stated he is "a man of faith in people." He added that the Panelists should lead by example.

Mr. Henderson noted that, because of his disability, he brings "a little bit of reality" to the Panel. People with disabilities can adapt, he said, and with a little bit of reality, "they can accomplish whatever they want."

Ms. Mitchell, the Advisory Panel Chair, opened the second part of the meeting by running through the agenda and introducing Mr. McGill, who briefed the members on TWWIIA implementation.

Mr. McGill outlined major features of TWWIIA: the Ticket system, work incentive enhancements, the new work incentive service structure, health insurance improvements, and work incentive demonstration authority. He also discussed the roles of the Program Manager (whose contract selection process is already ongoing at SSA) and the Employment Networks (EN). In addition, he distinguished between the outcome and outcome-milestone payment systems for EN providers.

According to Mr. McGill, the program will go through a phased-in implementation process, beginning with a rollout in selected states in January 2001 and completing nationwide coverage by January 2004. The proposed regulations will be published in the Federal Register most likely in August, with a public comment period of undetermined length to follow.

Mr. MacDonald asked how SSA saw the role of the Advisory Panel in the regulatory process, specifically if the Panel would be able to review the regulations and provide comments before publication in the Federal Register. Mr. McGill replied that SSA could not release a draft form of the regulations to the Panel due to the public setting and tight timing. He welcomed Panel input on the different pieces in the legislation that will lead to the regulations and other structures as well as input into the proposal and regulatory process. Mr. Start requested an Advisory Panel meeting to be set up during the comment period in order to review the proposed regulations.

Ms. Mitchell asked for the specific time lines for the regulatory process and bulleted information about the topics that will be covered in the regulations. Mr. Gaines replied that the public comment period on SSA regulations is usually 60 days. Mr. Start requested an Advisory Panel meeting to be set up during the comment period in order to review and comment on the proposed regulations.

Resuming his briefing, Mr. McGill stressed the rigorous evaluation process that will focus on specified data elements and criteria, including number of beneficiaries in the system, number of ENs, and outcomes. Results from the evaluation process will be incorporated in periodic, mandated reports to Congress. Among specific proposals being developed, he noted: selection of sites for initial rollout of the Ticket; calculation of Outcome payments to ENs; amount and criteria for earning Milestone payments; selection of beneficiaries receiving Tickets; definition of what is meant by "using a Ticket," and dispute resolution mechanisms.

Mr. McGill addressed the expedited benefit reinstatement provision as part of an expanded "safety net" of work incentive enhancements. This "easy back on" provision will provide 6-month provisional (and nonrefundable) benefits that are payable while SSA is deciding on the individual's reinstatement request. It will be effective nationwide on January 1, 2001. Another work incentive enhancement, according to Mr. McGill, is the provision that beneficiaries using the Ticket will not be scheduled for medical continuing disability reviews (CDRs).

Moving to service structures, Mr. McGill described the development of the corps of SSA employment support representatives (ESRs) as an important way to improve work incentives program operations. The pilot class of 32 SSA employment support representatives just graduated from intensive training in Atlanta and will be deployed to the 10 SSA regions. He outlined alternative models for ESR operations, either individually situated in a local office or else based in a cadre setting, where several ESRs could operate from the same office.

Ms. Mitchell asked how many ESRs were projected and if they would be the "point person" for every beneficiary that has a work incentive issue. Mr. McGill said that he had no figure on the numbers, but that the ESR would serve as the "point person" for the office, while claims representatives (who will also receive training) would still answer general questions from beneficiaries.

Mr. Golden asked if SSA intended to outplace ESRs in other community agencies. Mr. McGill responded that the priority was to build up internal SSA expertise. Dr. Daniels added that the external benefits planners would work closely with the ESRs. Ms. Webb emphasized that, the earlier SSA starts, the better. People who are just getting on benefits, she said, needed a vision of getting off benefits, and the ESRs could play a role. Mr. McGill concurred. Ms. Griffin asked if the placement of the first 32 ESRs was at all related to the rollout locations. Mr. McGill said no.

Mr. McGill then proceeded to outline the benefits planning process of grants, contracts, or cooperative agreements to increase expertise at the community level. The competition is closing the week of the meeting. SSA is also receiving input from the 12 State Partnership Initiatives that have run pilot benefits counseling programs. Awards are scheduled at the end of FY 2000, though there has yet to be any appropriations passed for implementation. Mr. McGill also outlined the program of up to $7 million authorized to fund state protection and advocacy systems to assist beneficiaries.

The Health Care Financing Administration (HCFA) has primary jurisdiction over the Medicare provisions of the legislation, Mr. McGill noted. The law extends premium-free Part A Medicare for 4 ½ years beyond current law for beneficiaries who work. Mr. McDonald asked who issues guidance on Medicare and CDRs. Mr. McGill replied that HCFA had responsibility on Medicare, while SSA had responsibility on CDRs, but both agencies had to play together. Mr. McGill then described Medicaid features of the legislation that are state-driven and require coordination with HCFA. These provisions permit states more flexibility to cover people with disabilities who work, including a buy-in for those on SSI/SSDI who have medically improved.

Mr. McGill noted that the law reinstated SSA's demonstration project authority on Title II work incentives. He cited specific authority to conduct a demonstration of the $1 for $2 earnings offset for SSDI beneficiaries and looked forward to receiving input from the Panel on this project.

Turning to TWWIIA implementation developments, Mr. McGill stated that the decision on the Program Manager contract will be made before the end of the fiscal year. The Program Manager will operate nationally on the following implementation issues:

• Enroll, train and provide technical assistance to ENs in rollout states;
• Assist in collecting data on ENs;
• Assist in managing the flow of Tickets ("who is signing up with whom?");
• Monitoring relationships between ENs and beneficiaries;
• Providing data for system-wide evaluations.

He added that there will be one nationwide Program Manager entity. A key role for the Advisory Panel will be to assure consistency between the Program Manager contract and the TWWIIA regulations.

Ms. Webb asked if the EN program would look like the RSVP (Referral System for Vocational Rehabilitation Providers) program. Mr. McGill replied that the structure of the system was defined in the legislation.

Ms. Lee asked if any demonstration projects were planned using nontraditional employment service providers (i.e., families of beneficiaries). Mr. McGill said that demo projects are not necessary - the law itself gives SSA the authority to have experimentation and innovation with nontraditional providers. He added: "We also have demonstration authority to research particular issues or do something differently than the rest of the system."

Ms. Webb stressed that consumer choice and control were needed. She asked about the level of information on beneficiaries that could be shared with ENs. Mr. McGill responded that ENs will have access to beneficiary data and that SSA will base this system on the Alternate Participant model.

Mr. MacDonald noted that the Department of Labor (DOL) and the Presidential Task Force on Employment of Adults with Disabilities had recently rolled out grants with language that was compatible with TWWIIA. He inquired if SSA planned any more cooperation with DOL and the Task Force. Mr. McGill stated that the one-stop career centers (established under the Workforce Investment Act) could operate as ENs. SSA's State Partnership Initiatives were also bringing together resources of DOL, the one-stops, and vocational rehabilitation agencies.

Ms. Webb stated that she hoped SSA would open the program as broadly as possible in order to empower consumers to take responsibility. She asked how EN providers without deep pockets can survive. She warned that the program may be moving away from consumer control to a "VR look-alike" through the one-stops. There is a huge built-in advantage for the one-stops and VR agencies, with little room for the private sector, she added.

Mr. McGill responded that "the legislation gives us a lot of flexibility and a chance to do what's right here." For her part, Dr. Daniels acknowledged the dilemma. The advantage of state agency programs was never directly addressed in TWWIIA legislation. She said that SSA needed to investigate other channels for encouraging small provider participation (i.e., SBA loan programs, community development finance programs, etc.).

Day Two

The Advisory Panel resumed its public meeting deliberations Tuesday, July 25, at 9 AM. Ms. Mitchell stated that the Panel will want an opportunity to respond to the TWWIIA regulations. She acknowledged that the Panel was starting late because of the delay in appointments. But she hoped the Panel could reach consensus on providing input on the regulations during this meeting.

In this respect, Ms. Webb asked for a "primer" briefing on the SSA regulatory process. Mr. McGill raised the issue of eligibility for the Ticket. Dr. Burkhauser asked if all SSDI/SSI recipients would be eligible for the Ticket. Mr. MacDonald noted that the decision to participate would be entirely in the hands of consumers, though administrative costs could be a limiting factor. Ms. Webb added that beneficiaries are "scared to death" of SSA. SSA employees should not decide if beneficiaries are prepared to go to work. Ms. Gracechild concurred, saying that "creaming" assumptions can be very dangerous.

Mr. Start stressed that any prior selection process would violate the philosophical intent of the legislation that is market- and consumer-driven. Ms. Mitchell agreed that any selection process would create an arbitrary line that would be subject to challenge. Mr. McGill concurred that his personal preference was a broad definition of who gets the Ticket.

The Panel reached consensus on the importance of a broad definition of who gets the Ticket and discussed various ways to formally relay recommendations to SSA. Ms. Lee suggested that the Panel may wish to vote and make formal recommendations on four or five issues, including the issue of who gets a Ticket. She stated that her understanding is that it was not Congressional intent to limit Ticket holders. Mr. MacDonald pointed out that the regulatory process includes policy making and that the Panel should vote on specific recommendations regarding regulatory policy.

Responding to Panel concerns on how the regulations are drafted, Dr. Daniels enumerated four basic elements. First, SSA looks for Congressional intent: 1) in the actual wording of the legislation; 2) in any committee reports; 3) in any subcommittee reports; and 4) in the costing of the bill, primarily based on Congressional Budget Office (CBO) estimates. Beyond these four elements, she added, SSA examines best prior practices and any relevant Congressional floor statements.

Given these factors, Dr. Burkhauser asked if any SSI/SSDI recipients would necessarily be excluded from the Ticket. Mr. Start observed that there may be an issue of "induced demand," in which people with disabilities might quit their jobs to obtain TWWIIA benefits, especially expanded health care coverage. Mr. McGill agreed that there could be a degree of "induced demand." Mr. Start clarified that he has heard the opinion expressed about "induced demand," but doesn't believe it.

Ms. Webb noted that only 1 in 500 beneficiaries leave the rolls to work. She proposed the following motion: "The Advisory Panel advises the Administration that all SSI/SSDI beneficiaries receive the Ticket to Work." The motion was seconded and passed unanimously.

Ms. Lee stated that there may be some misunderstanding regarding the CBO assumptions that were used to estimate the costs of serving people with significant disabilities. She said that Congressional staff relayed that CBO did take these costs under consideration in costing several equity amendments that were included as part of the final bill. Ms. Mitchell asked Mr. McGill and his staff to provide information on each of the Congressional intent factors mentioned by Dr. Daniels.

Mr. McGill raised the issue of beneficiaries conceivably exploiting the protection from CDRs by becoming Ticket users. He asked if the Panel had any recommendations on restrictions to discourage this practice. Mr. MacDonald replied that what was needed was a baseline or starting point to determine when the Ticket was actually in use. He asked if this starting point would be a written agreement between the beneficiary and the EN.

Ms. Mitchell stated that Ticket use had to be officially initiated before a beneficiary signs a contract. Mr. MacDonald noted that there would be a stage of "shopping around" ENs, in which the beneficiary would demonstrate an intent toward an employment goal. Dr. Burkhauser wondered if "thinking about the Ticket" could serve to postpone a CDR.

Mr. Start cited the welfare baseline example, in which a recipient must show evidence that he/she is actively seeking services within a given period. This commitment would need a monitoring process, he added. Ms. Webb brought up the idea of a waiver of the work plan. Too often, she noted, providers go to considerable expense to draw up a work plan, only to have the beneficiary decide that he/she is not really interested in work. The Independent Living program has such a waiver provision.

Ms. Lee emphasized the importance of the individual work plans and stated that the law does not allow a waiver of the plan. Upon request of the Chair, she read and explained the Individual Work Plan section of the law. The law requires that the plan must be developed in partnership with the beneficiary and include: informed choice in selecting an employment goal and services; goals for earnings and job advancement; a statement of the services and supports to reach the goals: a statement of rights, including the right to change providers; the availability of protection and advocacy services, etc. Waiving the plan would waive the beneficiary's ability to participate in planning their services and employment and eliminate information about their rights. However, the plans need not be complex or lengthy.

Ms. Webb agreed that the work plan should be kept simple and added that consumers needed protection to assure satisfactory service from the ENs.

Ms. Mitchell observed that the Panel had no definitive answer at this point to Mr. McGill's question on CDR protection.

Again addressing the regulatory issue, Dr. Daniels stated that SSA was operating under an emergency timeline, trying to publish a Notice of Proposed Rulemaking (NPRM) in August. If the regulations are not published at that time, she added, then the January 2001 implementation date could not be attained. With the transition in administrations, the entire timeline could be pushed back 9 to 24 months. Among additional issues, she cited the following questions: What can SSA afford? What provisions will deter abuse? What level of regulation constitutes a reasonable safeguard? All these issues play into writing the regulations. She urged the Panel to work within the framework of what is possible. Because of time constraints, the Panel will not be able to make recommendations in the final SSA policymaking deliberations on the NPRM.

Tamara Allen, Consultant to SSA, noted that the Charter of the Advisory Panel provided for the option of producing a public Report of Advice to the Commissioner.

Mr. McGill asked about the composition of ENs and their operation. The legislation provided a broad definition with a list of possible entities and an array of services. He stated that the Ticket is an outcome-based system. SSA pays when the individual goes to work and is not required to look very much at the composition of the EN and what is being provided, as long as protections are in place so people are not abused.

Stressing maximum participation, Mr. MacDonald suggested the possibility that a diverse group of consumers and community organizations could apply for an SBA loan to become an EN. Ms. Gracechild asked if a new organization would have to be formed. Ms. Webb expressed doubt whether the SBA would approve such a loan. Mr. MacDonald responded that the group would have to demonstrate staff background in employment services.

Ms. Gracechild noted that smaller ENs would require milestone payments. Ms. Mitchell added that SSA should encourage creativity among ENs. Ms. Griffin observed that any employer could conceivably become an EN. Mr. Start stated that the intent was for coverage to be as broad as possible. He cited the problem of coverage in rural areas, and suggested that smaller organizations might want to come together in a network to provide such coverage. In addition, an employer could partner with an employment provider.

Mr. McGill asked for Panel suggestions on the outcome vs. milestone-outcome payment structure. He sought guidance on how much SSA should pay for milestones, given that the total outlay for milestone-outcome payments must be less than the total for purely outcome payments.

Ms. Gracechild said that milestone payments would be an incentive for small nonprofits (including independent living centers) to participate. Ms. Webb said that the Panel needed CBO budget data to determine costs to SSA and that such data should be published in the NPRM.

Mr. Start stated that the Return-to-Work Group did some extensive modeling and found that the payment system could become very expensive. According to their estimates, the very costly outreach program could result in 10% of beneficiaries participating in the Ticket program. Some 60-70% of these would actually complete a work plan, and 60-70% of this smaller group would actually find a job. The model projected that 70-80% of those who found a job would actually remain employed to the point where the EN could begin collecting outcome payment. Thus, according to this model, only about 5% of the cases would result in ENs receiving outcome payments. The Return-to-Work Group recommended a minimum frontload milestone payment of $300 for completing a work plan and an additional milestone payment of $1000-1200 for 30-60 days of employment.

Ms. Gracechild emphasized the imperatives to serve people at the bottom economically and to assure participation by people with severe disabilities. Cost-effectiveness should only be one of many considerations, she insisted. Ms. Lee concurred on this equity issue and added the people with severe disabilities often required on-the-job supports as well. She added that any information included in the NPRM about CBO scoring should be framed by the type of description just given by Mr. Start.

Citing the saving and loans disaster, Dr. Burkhauser warned that to the degree that the government provides protection against market risks, it must also increase its regulation of market behavior. Hence, there is a tradeoff that consumers and providers must recognize. To the degree they want freedom to contract on their own without government interference, they must accept the risk of failure. The more milestones they add, the more the program will resemble a fee-for-service system that will require increased government regulation.

Mr. Start stated that the providers must be free to make choices about whom they take, but acknowledged the "creaming" issue. Here, he said, the government should assume some of the risk by providing incentives for bringing the severely disabled into the system. Demonstration projects further down the road could survey those beneficiaries not being served and recommend remedies.

Mr. McGill noted that SSA's report to Congress will address this issue. He added that the 60-month payment period provided incentives for ENs to provide work supports.

Mr. Start stated that VR agencies and one-stops might eventually monopolize the system. The SSA regulations should be written to avoid this. Ms. Mitchell noted that VR agencies, by default, might inherit the hard-to-serve. Mr. Start thought that this was "a red herring." In his view, the state VR agencies shoulder no risk, since they are reimbursed 100% of their expenses by two agencies, RSA and SSA. The playing field is already uneven, he concluded.

Ms. Mitchell noted that, under these circumstances, the consumer would not have any choice. Mr. MacDonald stressed that the VR agency was technically one among equals and should not exercise undue influence on how other ENs should operate. Dr. Burkhauser said SSA should open up the process to non-traditional providers. Providing full information on ENs to beneficiaries might level the playing field for smaller ENs, he added. The problem remained that the people with the greatest risk represent the least return for ENs. He recommended additional payments through some other system.

Mr. MacDonald proposed the following motion: Encouraging innovative ways to bring new service providers as broadly as possible into the Ticket program should be the policy goal of the Ticket program in general. The motion was seconded, and it was carried unanimously.

Mr. Start stated that the work plans and regulations should be kept simple. Dr. Burkhauser observed that the evaluation process had to measure accurately the impact of the system. Good intentions are not enough, he added, and participation must lead to real outcomes. There is a need for serious outside evaluation. He asked which states would roll out the program first. The choice of states in the first phase could affect the evaluation. Another evaluation issue he cited was SSA's reporting of reasons for leaving employment, i.e., whether it was for health reasons or other issues.

Ms. Mitchell then opened up the meeting for public comment.

Ms. Yvonne Smith, a mental health consumer, stated that the VR system does not work. The mentally ill need more support because of their propensity toward relapses.

Mr. Paul Seifert, Director of Government Affairs at the International Association for Psychosocial Rehabilitation Services, asked how many Tickets a person could receive in a lifetime. He also asked about how the Ticket program related to existing return-to-work programs for SSI recipients and whether partial reduction in benefits for such an SSI recipient (due to employment) would result in an outcome payment to the EN. He warned that overpayments to ENs could accrue if SSA did not administer the system efficiently. He added that the VR system is obligated to serve all SSI/SSDI recipients seeking to return to work. He insisted that the Advisory Panel should be part of the interagency sharing of data and should not be railroaded. Finally, he suggested that SSA issue an interim final rule to cover the initial phase-in period.

Ms. Amy Osman of HCFA indicated her agency's readiness to cooperate with the Advisory Panel on implementation of the Medicaid provisions.

The Advisory Panel resumed its deliberations. Ms. Mitchell asked about planning for future meetings.

Mr. Start inquired if an interim final rule was possible in this case. Mr. MacDonald emphasized that trust is the number one issue for SSA. He asked whether there was a possibility for Panel participation in meetings on TWWIIA regulations at the Deputy Commissioner level. He also noted the precedent of the Workforce Investment Act, which was implemented under interim final regulations.

Ms. Webb said that the Panel should commit to whatever time was necessary and should request information on administration of the program. Ms. Mitchell suggested that a Panel report to the Commissioner was one avenue. Mr. MacDonald mentioned that the NPRM was not yet at the Office of Management and Budget and that perhaps the Advisory Panel had time to develop a contingency plan. Ms. Lee endorsed the idea of presenting a report of advice to the Commissioner.

Ms. Reggie Sajauskas of SSA/OESP suggested meeting three weeks after publication of the NPRM. The Advisory Panel, she noted, would not see the regulations before publication because SSA would then have to go public with the NPRM.

Mr. MacDonald said that the contribution of the Advisory Panel to the regulatory process will be very important. Ms. Mitchell concurred that the Panel could impact rulemaking by submitting a report to the Commissioner.

Ms. Webb observed that the Panel, as a public group of experts, should be concerned that public comments following NPRM publication be thoroughly scrutinized by SSA. She also expressed the concern that the Panel report will go to the Commissioner without public knowledge.

Ms. Mitchell agreed that the report should be available to the public and suggested web page posting. Ms. Webb suggested that the NPRM include information on the Advisory Panel report, with an invitation to the public to respond to the Panel report. Ms. Mitchell added that the report could serve as a guide to the public.

Ms. Griffin noted that the Panel will see the NPRM at the same time as the public. Mr. MacDonald recommended that the Panel report should be made public as soon as possible. Ms. Mitchell suggested an extended Panel meeting in September, immediately following NPRM publication.

Mr. Start proposed the following motion: The Advisory Panel recommends that SSA use 60 days or the longest comment period reasonable to allow qualitative review by the Panel and the public. The motion was seconded, and it carried unanimously.

Ms. Gracechild asked what obligation the Commissioner had to respond to the Panel report. Ms. Mitchell replied that the Commissioner was under no obligation, but hopefully a dialogue would ensue. Ms. Lee added that the Panel was mandated to provide advice to the President and Congress as well. The panel agreed by consensus to produce such an advice report.

Mr. MacDonald requested a formal response from SSA regarding Panel participation in the last round of decision making before NPRM publication. He also asked that the NPRM reference the Advisory Panel report.

Ms. Mitchell asked if the group preferred meeting as a Panel of the whole or in subcommittees. Mr. Start responded that the Panel needed a generalized discussion of the regulations at the next meeting and then could break up into subcommittees. Ms. Mitchell suggested that Day One could focus on general discussion, Day Two on subcommittee work, and Day Three on bringing it all together into a report. Ms. Gracechild noted that breaking up into subcommittees could be difficult with only 11 people on the Panel.

Mike Greenberg, Deputy Associate Commissioner of SSA/OESP, then introduced Bill Halter, Deputy Commissioner. Mr. Halter welcomed the Advisory Panel and expressed SSA's readiness to cooperate with the Panel. SSA has made it a priority to implement this legislation very quickly. However, he noted that the House of Representatives cut $160 million from the President's budget request for SSA, while the Senate cut $130 million. These pending cuts could constrain SSA implementation plans for the Ticket program. In terms of public dissemination of information, Mr. Halter emphasized SSA's commitment to utilizing information technology, as exemplified by the webcast of the first part of this meeting.

Mr. MacDonald inquired about SSA customer service responsiveness. Mr. Haller said that the task was to deal with customer need and desires in the way that the customer wants to be served. Ms. Webb asked about the existence of an SSA listserv to disseminate information to the Panel members. Mr. Halter responded that the Social Security E-news listserv was free and available to the public by subscribing on the SSA website.

Dr. Burkhauser asked about indicators of program success over the next five years. Mr. Halter responded that the program would undergo a rigorous evaluation process. He also anticipated Advisory Panel input into the process. However, he was reluctant at this time to set a numerical goal, but did add that results would be put through a rigorous cost-benefit analysis.

Mr. MacDonald noted the need for cultural changes, including the need to change official language so that it would be perceived as less threatening to beneficiaries. Mr. Halter pointed to language changes already implemented on the SSA website. He also said SSA is working on the Vice President's "plain language initiatives," and could use Advisory Panel assistance in these efforts.

Mr. Start stated that, in an outcome-based program, the provider carried more of the risk. He asked if SSA intended to allocate more money and assume more of the risk in the program. Mr. Halter responded that SSA was prepared to take measured risks, but that some moves may require legislative change.

Ms. Griffin asked about the cost of implementation in January. Mr. Halter said he would communicate the data to the Panel, but added that, in a time of budget constraints, it is a difficult managerial proposition to take on new initiatives.

Ms. Lee asked if this data would take into account savings to the Trust Fund in not paying benefits. Mr. Halter said it would, but cautioned that this involved "two pots of money." The annual appropriation represented a very small part of SSA spending. Approximately 98% of SSA spending was programmatic, i.e., benefits coming out of the Trust Fund. He added that there is no direct fungibility between savings to the Trust Fund and administrative appropriations. There is also the issue of "pay for" offsets for appropriations. Any $130-160 million cut will complicate everything.

The Panel then heard presentations by SSA/OESP staff on the Advisory Panel Charter, regulations under the Federal Advisory Committee Act, Panel budget, staff allocation, time and attendance, travel, and administrative support.

Following these presentations, Ms. Mitchell recommended scheduling teleconference call briefings by SSA staff on the TWWIIA legislation and implementation issues before the September meeting. It was agreed to hold the first teleconference call on August 22^nd, starting at 1:30 PM EST, and the second on August 30^th, starting at 1:30 PM EST. As these teleconference calls are administrative and will not involve Panel discussion, they do not need to be open to the public.

It was agreed that the next public meeting of the Advisory Panel will take place September 26-27-28 in the Washington, D.C. area.

Mr. MacDonald asked for an SSA staff outline of the NPRM provisions to be prepared once the NPRM is made public. Dr. Burkhauser asked that SSA staff prepare answers (based on sections of the NPRM) to Mr. McGill's circulated list of questions on TWWIIA implementation.

The Advisory Panel meeting then adjourned at 5:15 PM.