The Ticket to Work and Self-Sufficiency Program Training for Employment Networks and State Vocational Rehabilitation Agencies January 2007 Module 7 Outcome and Outcome-Milestone Payment Options Learning Objectives At the end of this unit you will be able to: Describe the EN's two payment options Cite Outcome Payment rate Cite the Outcome/Milestone Payment rate Describe the payment options available to State Vocational Rehabilitation Agencies List the sequence for payment for both payment options. Basic Definitions Outcome Payment Period A period of 60 months, consecutive or cumulative Cash benefits are not payable to the beneficiary due to earnings from work Begins with the first month and ends with the 60th month (after Ticket assignment) for which cash benefits are not payable to the beneficiary due to the performance of SGA or by reason of earnings from work Payment Calculation Base: Title II/SSDI Beneficiaries The average monthly disability insurance benefit payable for months during the preceding calendar year to all beneficiaries who are in current pay status for the month for which the benefit is payable SSDI PCB for 2006 is $946.02 Calculated annually by Social Security Administration Payment Calculation Base: Title XVI/SSI Beneficiaries The average monthly payment of SSI benefits based on disability payable for months during the preceding calendar year to all beneficiaries who: Have attained age 18 but not age 65, Are not concurrent Title II/Title XVI beneficiaries, and Are in current pay status for that month SSI PCB for 2006 is $545.85 Calculated annually by Social Security Administration Definition of the Payment Options Two Payment Options for ENs ENs select one payment option when entering into an agreement with Social Security Administration : Outcome Payment Option, or Outcome-Milestone Payment Option Outcome Payment Method Provides monthly payments to ENs for each month during the Outcome Payment Period Maximum number of Outcome Payments under each Ticket is 60 Months of payment do not have to be consecutive Outcome Payment Schedule Beneficiary's ticket is or was assigned to that EN-- EN receives an outcome payment for each month for which the beneficiary's cash benefits are not payable because of the performance of SGA or due to earnings from work Up to 60 payments available per Ticket Important to Note... Outcome Payments are only made during months that the beneficiary does not receive a cash benefit Therefore, Outcome Payments are not made during the Trial Work Period, even though the beneficiary might earn more than the SGA level Calculating Outcome Payments Each payment is valued at 40% of the payment calculation base for the year in which the month occurred, rounded to the nearest whole dollar Outcome Payments for 2007: SSI beneficiary- $218 SSDI beneficiary- $378 Value of payment does not increase if more than one EN requests payments for same beneficiary in the same month. Requesting Outcome Payments EN must submit: Request for Payment Form, and Evidence of the beneficiary's earnings (e.g. statement from employer, unaltered copy of pay stub, or W-2 if self-employed) If beneficiary's ticket is not assigned to EN at time of payment request, the EN does not have to submit evidence of beneficiary's work/earnings Outcome-Milestone Payment Method Provides up to four additional payments when a beneficiary completes up to four Milestones directed toward permanent employment/self-sufficiency Provides payments during the Outcome Payment Period Milestones Occur after the beneficiary starts to work Are based on earnings levels Designed to help ENs cover initial cost of providing services while waiting to qualify for Outcome Payments during time beneficiary is working to attain consistent employment at the SGA level Milestone Payments may be made during the Trial Work Period Criteria for Milestones First Milestone is met when beneficiary has worked for 1 calendar month within a 12-month period with earnings above the SGA level Second Milestone is met when beneficiary has worked for 3 calendar months in a 12-month period with gross earnings above the SGA level Criteria for Milestones Third Milestone is met when beneficiary has worked for 7 calendar months in a 12-month period with gross earnings above the SGA level Fourth Milestone is met when beneficiary has worked for 12 calendar months in a 15-month period with gross earnings above the SGA level Criteria for Milestones Milestones may be cumulative. Months used to meet the previous milestone(s) may be used to meet subsequent milestones Payment is made only if Milestone is met after Ticket has been assigned to the EN Calculating Outcome-Milestone Payments Total payments are less than the Outcome Payment method because of the 4 additional payments for milestones Total potential payment is about 85% of the total paid under the Outcome Payment method Calculating Milestone Payments Calculating Outcome Payments Under Outcome-Milestone Method Requesting Milestone Payments Milestones will only be paid if the Outcome/Milestone Payment Method was the EN's elected payment method at the time the beneficiary's ticket was assigned Milestone(s) must have occurred prior to the Outcome Payment Period EN must submit a Request for Payment Form and evidence of that the milestone was achieved (e.g. statement from employer, unaltered copy of pay stub, or W-2 if self-employed) Requesting Outcome Payments Under Outcome-Milestone Method EN must submit: Request for Payment Form, and Evidence of the beneficiary's earnings (e.g. statement from employer, unaltered copy of pay stub, or W-2 if self-employed) If beneficiary's ticket is not assigned to EN at time of payment request, the EN does not have to submit evidence of beneficiary's work/earnings State VR Agency Payment Processing State VR Agency Payment Options State VR Agencies may choose their method of payment on a case-by-case basis If functioning as an EN, then a State VR Agency can choose to be paid under their elected payment system Outcome Payment Method or Outcome-Milestone Payment Method Or the State VR Agency may elect to be paid under the traditional cost reimbursement payment method State VR Agencies' Requests for Payment MAXIMUS processes payment requests by State VR Agencies electing their EN payment method Payment requests through the traditional cost reimbursement payment method will be processed by Social Security Administration Changing the Elected EN Payment Method Time Periods for Changing Payment Methods Payment method can be changed once, at any time, during the first 12 months of having EN status, or within the first 12 months of the TTWP being implemented in the EN's state, and Payment method can be changed in the following 18 month period during "open" periods provided by the Social Security Administration. Determining Payment Arrangements When More Than One EN or State VR Agency Provides Service Two Entities Request Payment for Same Milestone or Outcome Payment MAXIMUS reviews the case and makes a determination as to amount allocated to one or both ENs If payment is split between two entities under different payment methods, then each is paid according to its own selected method Situations That Can Prevent Automatic EN Payment Insufficient/illegible evidence that the outcome or milestone was achieved Beneficiary did not report his/her earnings to Social Security Administration More than one EN submits a request for payment for the same month/beneficiary EN request payment under incorrect payment method Improving the Payment Systems Improving the Payment System Periodically, Social Security Administration will review the Payment Methods: Adequate incentive for ENs Limitation on monthly Outcome Payments as a percentage of the payment calculation base Difference in total payments between the two methods Length of the Outcome Payment period Number and amount of Milestone Payments Benefit savings and numbers of beneficiaries who go to work Tools Used by Social Security Administration to Review Payment System and TTWP Audits Reviews Studies Observations Result Measures: Benefit savings and number of beneficiaries who are gainfully employed The Ticket to Work and Self-Sufficiency Program Training for Employment Networks and State Vocational Rehabilitation Agencies January 2007