DI 55060.005 Overview of EN Payment Policies
A. Preview – informational material
The following paragraphs contain information about the policies related to payments under the Ticket to Work program. This information is being provided to give Field components an overview of these policies. Field components will not be directly involved in making payment decisions.
B. Policy – payment options available to ENs under the ticket to work program
1. How Many Payment Options Are Available to ENs under the Ticket to Work Program?
The outcome payment system provides payment for outcome payment months only.
The outcome-milestone payment system provides for reduced payments for outcome payment months in exchange for milestone payments in advance of the first outcome payments.
2. What Is an Outcome Payment Month?
An outcome payment month is any month for which Social Security disability benefits and Federal SSI cash benefits are not payable to the individual because of work or earnings. (In other words, if a beneficiary/recipient receives a Federal cash disability or blindness payment for a month, then an EN can not be paid for that month.) An EN can receive payment for up to 60 outcome payment months. The months do not have to be consecutive, but there are specific rules about when the outcome payment months must occur (e.g., after the ticket is first assigned and before the ticket terminates).
3. What Is a Milestone?
A milestone occurs after a beneficiary/recipient starts working and before cash benefits stop because of work and earnings. We can pay an EN for up to four milestones, provided the individual's gross earnings from employment (or net earnings from self-employment) exceed the SGA threshold amount for a specified number of months.
4. Which EN Payment System Pays More?
It depends on how many milestones and/or outcome payment months are ultimately achieved by the beneficiary/recipient. Under the outcome-milestone payment system an EN, can receive up to 20 percent of the total possible payment as milestone payments. However, in exchange for these early payments, the total payments under the outcome-milestone payment system are about 85 percent of what is potentially payable under the outcome payment system if the beneficiary/recipient achieves all 60 outcome payment months. So, if all the payments are received under the two payment systems, the total payment available under the outcome payment system is more than the total payment available under the outcome-milestone payment system.
5. When Does an EN Elect a Payment System?
An EN elects a payment system at the time it enters into an agreement with SSA to serve as an EN.
6. Can an EN Change Its Elected Payment System?
Yes. At specified times an EN can change its elected payment system.
7. Does a Change in an EN's Elected Payment System Apply to All Beneficiaries/Recipients It Serves?
No. It applies to those beneficiaries/recipients who assign their tickets to the EN after the effective date of the election change only.
C. Policy – payment options available to state VR agencies under the ticket to work program
1. Must a State VR Agency Elect an EN Payment System?
Yes. However, subject to certain limitations (see DI 55060.005D.6.), the State VR agency can elect, on a case-by-case basis to be paid under:
its chosen EN payment system (i.e., the outcome payment system or the outcome milestone payment system), or
the traditional VR cost reimbursement payment system (see DI 13510.001).
2. When Does a State VR Agency Elect an EN Payment System?
At the time SSA implements the Ticket to Work program in the State, SSA will notify each State VR agency by letter about the payment systems available under the program. The letter will ask the State VR agency to choose a payment system to use when it functions as an EN.
3. Can a State VR Agency Change Its Elected EN Payment System?
Yes. The rules that apply to an EN about changing its elected payment system (see DI 55060.005B.6. and DI 55060.005B.7.) also apply to a State VR agency when it wants to change its elected EN payment system.
4. When Does a State VR Agency Make Its Payment Choice with Respect to a Particular Ticket?
At the time a ticket is assigned or reassigned to a State VR agency, a State VR agency must make its payment choice. It may be paid under its elected EN payment system or under the VR cost reimbursement payment system, subject to certain limitations (see DI 55060.005D.6.).
D. Policy – other issues related to payments under the ticket to work program