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
1. Can an EN Request Payment from the Beneficiary/Recipient Who Assigned the Ticket to the EN?
No. The law prohibits an EN from requesting or receiving compensation from the beneficiary/recipient for services the EN provides under the Ticket to Work program.
2. Does SSA Reimburse an EN for the Cost of Services Provided?
No. Under the EN payment systems, SSA pays an EN based on specific work-related milestones and outcomes that a beneficiary/recipient who assigns the ticket to the EN (or a State VR agency serving as an EN) achieves. SSA does not pay for the specific cost of services that the EN (or State VR agency serving as an EN) provides.
3. Does SSA Base Outcome and Milestone Payments on the Benefit Payment Each Individual Receives?
No. SSA bases milestone and outcome payments on the average disability benefit the agency paid to beneficiaries in the preceding calendar year. Milestone and outcome payments are percentages of the applicable average benefit amount. Each year SSA calculates two averages. It uses:
the title II average when an EN (or State VR agency serving as an EN) serves a title II only or concurrent beneficiary; and
the title XVI average when an EN (or State VR agency serving as an EN) serves a title XVI only recipient.
4. Can an EN Keep the Money It Gets Even If a Beneficiary/Recipient Does Not Achieve All 60 Outcome Months?
Yes. An EN (or a State VR agency serving as an EN) can keep each milestone and outcome payment for which it is eligible, even though the beneficiary/recipient does not achieve all 60 outcome months.
5. Is It Possible to Pay More than One EN for the Same Milestone or Outcome Payment Month?
Yes. If a beneficiary/recipient has assigned the ticket to more than one EN at different times and more than one EN requests payment, then SSA can split the payment. In splitting the payment, SSA will consider the contribution of the services provided by each EN toward the achievement of the milestone or outcome.
6. Can a State VR Agency and an EN Receive Payments for Serving the Same Beneficiary/Recipient?
Yes, provided the State VR agency serves the beneficiary/recipient as an EN. However:
if a State VR agency is paid under the cost reimbursement payment system with respect to a ticket, a subsequent payment cannot be made on the same ticket to an EN (or to a State VR agency serving as an EN); and conversely,
if an EN (or a State VR agency serving as an EN) is paid under one of the two EN payment systems with respect to a ticket, a subsequent payment cannot be made on the same ticket to a State VR agency under the cost reimbursement payment system.