TN 1 (06-07)

DI 60090.001 The 4-State Benefit Offset Pilot Demonstration (BOPD)

A. Introduction

The 4-State Benefit Offset Pilot Demonstration (BOPD) consists of four statewide projects that SSA is funding in Connecticut, Utah, Vermont, and Wisconsin. This pilot demonstration will test the effects of reducing benefits for title II disability beneficiaries $1 for every $2 of earnings over the SGA amount (for both non-blind and blind beneficiaries) during the extended period of eligibility (EPE). Full monthly benefits will continue to be paid to auxiliaries during the offset period. The demonstration also will test the effects of extending the duration of the EPE from the current 36 months to 72 months, and of altering rules that we use in determining countable earnings during the EPE. In addition, the initiation of medical CDRs will be suspended for project participants.

Field Office (FO) direct participation in this demonstration is limited. A centralized unit in OCO has been established to administer payments issued under the BOPD. FO's must be aware of how the BOPD offset is applied because overpayment development resulting from BOPD payments will be routinely processed by FO's. See DI 60090.001C.5.

The overall goal of this pilot demonstration is to provide information that will be used to develop a national benefit offset demonstration project to be conducted at a larger number of sites. SSA is working with a contractor to develop the design of this national demonstration, which is estimated to begin in 2007.

Enrollment in the BOPD began in August 2005. Participation is limited to beneficiaries who receive only T2 disability benefits as number holders and, if the TWP has ended, are within 71 months of the end of their trial work period (TWP) at the time of enrollment. A description of the program rules that have been modified by waivers follows.

B. Description of BOPD program rules

The following rules apply to BOPD participants. Generally, the BOPD program rules are effective beginning with the month after the month in which the beneficiary signs a written consent to participate in the BOPD. The date the beneficiary signed the consent form is also considered the date that the beneficiary enrolled in the project. The suspension of the initiation of medical CDRs is effective on that date.

  • Expand the EPE from the current 36 months to 72 months.

  • Usual rules relating to the TWP, SGA cessation and the grace period continue to apply.

  • Pay benefits for months in which the project participant has SGA level earnings (for BOPD purposes) after the grace period and during the expanded EPE, subject to the benefit offset. Earnings during the beneficiary’s EPE which are in or before the month the beneficiary enrolled in the BOPD will be treated using usual rules, e.g., benefits will be suspended for any month after the grace period in which the beneficiary did SGA. See DI 60090.012 for procedures on determining the offset benefit amount.

  • Pay full benefits to dependents on the record of a project participant for months during the EPE in which the participant’s benefit is subject to offset.

  • Consider earnings during the offset period within the EPE on an annual basis and use averaging to determine whether countable earnings for BOPD purposes are above the SGA amount and, if so, to calculate the offset amount. The offset period begins with the month after the month of enrollment in the BOPD or the month after the grace period, whichever is later. It ends when the EPE ends or, if earlier, when the beneficiary withdraws from the BOPD or ceases to be eligible for the demonstration. See DI 60090.010A.2.

  • Make outcome payments to Employment Networks under the Ticket to Work program as if the beneficiary were not participating in the demonstration project.

  • Suspend the initiation of medical CDRs. This provision takes effect on the date on which the beneficiary signs a written consent form. See DI 60090.001C.7.

There are no changes to Medicare entitlement rules.

C. General—BOPD responsibilities-FO and TSC

All SSA administrative activities for the BOPD, including work CDRs and TWP service month determinations, will be centralized in the Office of Central Operations' Office of Disability Operations (OCO). General FO and TSC responsibilities are described in this section.

1. BOPD inquiries

FOs and TSCs will not have any role in selecting project participants or implementing the BOPD project. Recruitment and enrollment of BOPD participants will be done by state project personnel-see DI 60090.001E. If a caller inquires about the BOPD, refer the caller to the appropriate project contact in DI 60090.001E.

2. Identifying project participants

Project participants can be identified in several ways:

  • Special message on the MBR reading as follows:

Attention: Benefit Offset Demonstration Case. DO NOT TAKE ANY ACTION before calling (analyst name) in OCO CPS for instructions.

  • The same message will also be recorded on the Remarks screen of the DCF and the Development Worksheet of eWork.

  • a code of "D3" in the DEMO INDICATOR field of the DEMO screen on the DCF,see MSOM CDR 005.002. The PARTICIPATION START DATE reflects the date the beneficiary enrolled in the BOPD, i.e., the date that the beneficiary signs the informed consent.

  • Participants who are subject to offset will also have the code "D3" in the DPI field (Demonstration Project Indicator) on the BENEFIT line of the MBR (see MSOM T2PE 007.045 and SM 00510.175). The DST field (Demonstration Project Start Date) indicates the first month the beneficiary is subject to offset.

  • a listing code of GBODP in PCACS.

If a beneficiary says he or she is a BOPD participant and the DCF and MBR do not reflect the indicator codes or special message, contact BOPD staff immediately (either the person listed in DI 60090.001E. or another individual designated through locally agreed upon procedures) to confirm participation. If the BOPD contact confirms participation, forward this information to OCO CPS for the appropriate input using the ADMIN MSG. The routing indicator for OCO CPS is SAXIZ. If the BOPD contact cannot confirm participation, refer the individual to the BOPD contact for their state.

3. Disclosure

Under the contracts that make up the BOPD, the BOPD projects have an "agent" relationship with SSA for conducting the demonstration. To become BOPD participants, individuals (or their representative, as appropriate) must sign an informed consent form that advises them of how the project will be conducted and that participation is voluntary. SSA has approved the consent forms. FOs may release information to the designated project contact listed in DI 60090.001E. without obtaining an additional consent form.

4. Work reports

In most cases project participants will report their earnings to the BOPD projects, which will forward this information to OCO over the beneficiary's signature. If a BOPD participant reports earnings to the FO or TSC, establish a work report in eWork and issue a receipt following normal procedures outlined in DI 13010.020 or TC 17001.075. All BOPD participants have eWork work reviews pending in the OCO BOPD Workgroup location, so the work report will automatically be transferred to their location. Also, alert OCO CPS via an ADMIN MSG or call the phone number indicated in the MBR special message to alert BOPD workgroup members to the work report (see MSOM ADMIN 002.004). The Routing Indicator for this project is SAXIZ. Refer the beneficiary to the appropriate BOPD project contact listed in DI 60090.001E. and ask them to make any future work and earnings reports during their project participation through these state contacts.

5. Overpayments

FO's are responsible for routine overpayment development and must have an understanding of the BOPD program rules. If a BOPD participant is overpaid, take requests for waiver and/or appeal and make the appropriate ROAR inputs.

Overpayments for BOPD participants will be handled following the usual overpayment policy and procedures in GN 02201.000. If information is needed regarding offset benefits to determine without fault, contact the appropriate state project contact in DI 60090.001E. or the BOPD Workgroup. If a beneficiary who is receiving offset payments agrees to partial withholding, make input to ROAR and notify OCO/CPS of the withholding agreement either by ADMIN MSG or via phone using the number on the MBR. OCO will adjust the offset payments to begin overpayment withholding.

6. Work CDR in progress

If a work review is pending and development has started when a beneficiary enrolls in the BOPD, the BOPD Workgroup will contact the FO to and request the FO to complete development following usual procedures, then transfer the review and any supporting documentation to the workgroup in OCO. DO NOT effectuate any work issue determinations, or send any notices to a BOPD participant.

7. Medical CDRs for project participants

Initiation of medical CDRs for project participants will be suspended as of the date they sign the informed consent. If a beneficiary says that he or she signed an informed consent for the BOPD project on or before the CDR initiation date, check the PARTICIPATION START DATE field of the DEMO screen of the DCF to determine the date of enrollment. The CDR initiation date is the date the CDR notice is sent-see DI 13010.610D. Check the DIRECT RELEASE INITIATION DATE field of the QCDR screen of the DCF to determine the date the notice was sent.

  • If the CDR was initiated before the date the informed consent was signed, the CDR will continue.

  • If the CDR was initiated on or after the date the beneficiary enrolled in the BOPD, stop the CDR. Close the medical CDR in the DCF with an entry of STOP CDR. Send the CDR deferral notice in NL 00705.355. Also, contact OCO/CPS via phone or using the ADMIN MSG as described in DI 60090.001C.5. to ensure the case is not re-selected for a medical CDR.

D. Procedure - transferring DCF Development Worksheet VY Issues for Ticket to Work cases to OCO

The Ticket to Work Program Manager uses a batch process to pass gross earnings for ticket users to the Office of Systems, which then posts the earnings to the DCF as alleged earnings. This action may create a systems-generated T2VY (verify earnings) issue on the DCF Development Worksheet (CDRW) for the servicing FO. (See DI 55030.010 and DI 13010.605)

If a systems-generated VY issue of the TYPE TICKET is received in the FO for a BOPD participant, review the MBR for the special message or the DCF for the D3 demo indicator. If present, transfer the T2VY issue to OCO (see DI 55030.030) by over-writing the data in two fields of the appropriate issue line of the CDRW screen:

  • LOC field: Enter “PC7”

  • UNIT field: Enter “CPS”

Annotate remarks "DEMO—D3 Offset/erngs verify/Wrk Determinations needed"). OCO will be responsible for verifying the earnings, making work determinations and posting the verified earnings information on the VERN screen. Continue to transfer the VY issues while the beneficiary is a BOPD participant. In addition, inform your AWIC of this action.

E. BOPD project contacts

State

Name of Project

Contact Name

Position Title

Telephone Number

Connecticut

Benefit Offset Project

Amy Porter

Project Director

(860) 424-4864

Utah