Distribution of Tickets
Employment Networks
Entities Deemed Automatically Qualified to Be ENs
Employer as an EN
EN Payments
Self-Employment
Recent Work Rule
EN Payment Process and Procedures
Transition to the New Payment Schedules
Questions about Beneficiaries
Timely Progress
General VR Questions
Partnership Plus: Sequential Services from VR and then an EN
EN-VR Referral Agreements
VR Data Reporting and Collection

Distribution of Tickets

QUESTION: How and when will a beneficiary be informed that he or she has a Ticket?

ANSWER: All adult beneficiaries who qualify for Social Security Disability Insurance benefits and/or Supplemental Security Income benefits based on disability or blindness will receive a letter and a paper Ticket in the mail from SSA explaining the Ticket to Work program. 

Employment Networks

QUESTION: What qualifications must an applicant have to become an EN? Where do entities interested in becoming ENs apply?

ANSWER: An EN may be any public or private entity, so long as the EN assumes responsibility for the coordination and/or delivery of employment, vocational rehabilitation or other support services to Ticket holders to help them achieve their employment goals. An EN may be an agency, an organization, a consortium of organizations, or an individual. 

To learn more about the qualifications for becoming an EN, please visit the EN Request for Quotations (RFQ) letter.   The RFQ is also available for downloading from SSA's website, www.ssa.gov/work or by going to http://www.ssa.gov/work/enrfp.html.

Social Security staff are available to answer any questions you may have about becoming an EN and submitting a Blanket Purchase Agreement (BPA) quotation. Please direct your questions to the Employment Network Contracts Team as follows:

QUESTION:  Can organizations that receive funding from other sources, like a Medicaid Home and Community Based Waiver, be Employment Networks? If so, are there any restrictions?

ANSWER: Grants/fees paid by Medicaid, State VR agencies, or any similar entities have no bearing on an agency's ability to qualify as an EN under the Ticket program. We welcome HCB Waiver and other Medicaid funded community providers to apply to be ENs, provided they meet the following criteria:

CFR 20, Part 411, Sec. 411.305 defines those entities eligible to be an EN as "any ...private entity that assumes responsibility for the coordination and delivery of services under the Ticket to Work program to disabled beneficiaries... A single entity or an association of or consortium of entities combining their resources is eligible to be an EN. The entity may provide these services directly or by entering into an agreement with other organizations or individuals to provide the appropriate services or other assistance that a beneficiary with a Ticket may need to find and maintain employment that reduces dependency on disability benefits. ENs may include, but are not limited to: (a) Any public or private entity, including charitable and religious organizations, that can provide directly, or arrange for other organizations or entities to provide, employment services, vocational rehabilitation services, or other support services…"
The Ticket program pays an EN for helping the beneficiary achieve certain employment outcomes. It does not pay for the cost of services. Nevertheless, you should check with your funding source to determine whether EN payments might affect your existing funding.

Entities Deemed Automatically Qualified to Be ENs

QUESTION: How will One-Stop Career Centers enter into agreements with SSA to become ENs? 

ANSWER: One-Stop Delivery Systems must enter into a contract with SSA in order to become an EN. 

SSA has pre-qualified One-Stop Centers to be ENs. That means they have been deemed to have met the qualification requirements found in Part II--Section 1 of the RFP and need not submit any documentation of qualifications. One-Stops are deemed to have met the liability insurance requirements found in Part IV--Section 5 and need not submit evidence of insurance coverage.  

To become an EN, a One-Stop need only complete and submit to SSA a 12-page portion of the RFP found in Part III--EN Proposal Documentation Requirements. This completed documentation constitutes the One-Stop's EN contract proposal and provides the information that MAXIMUS will put on its web site (http://www.yourtickettowork.com) to advertise to beneficiaries that the One-Stop is an approved EN and the information that MAXIMUS needs to direct deposit EN payments into the One-Stops back account.

The EN RFP is available for downloading from SSA's website, www.ssa.gov/work or by going to http://www.ssa.gov/work/enrfp.html. One-Stops interested in becoming ENs are encouraged to contact SSA's EN Contract Team by telephone toll free at 866-584-5180 or by email at ENcontracts@ssa.gov for assistance in completing the required documentation.

QUESTION: Will American Indian Vocational Rehabilitation programs authorized under Section 121 of the Rehabilitation Act have the ability to get reimbursement under the Cost Reimbursement program?

ANSWER: No. Only State VR agencies are eligible to participate in the traditional Cost Reimbursement program.

Employer as an EN

QUESTION: How would an employer of people with disabilities who receive SSI or SSDI benefits serve as an EN and collect Milestone and Outcome payments for employees who are already working and are earning above SGA?

ANSWER: An employer may collect Milestone and Outcome payments based on the same rules as a non-employer EN.  If an employer who has elected the Outcome/Milestone payment system accepts assignment of the Ticket of a beneficiary who is already an employee, SSA will take into consideration work the beneficiary engaged in during the 18 months prior to Ticket assignment to determine which Phase 1 Milestone payments would be available to the employer). Only months when the beneficiary worked with earnings above the Trial Work Period level would be considered. Otherwise, Phase 2 Milestone payments and Outcome payments would be available to the employer EN as these beneficiary employees attained the designated levels of work and earnings to trigger these payments. If the employer EN had elected the Outcome payment system, there would be no effect on Outcome payments for any work done during the 18 months prior to Ticket assignment. Rather, the employer EN would receive Outcome payments beginning the first month after Ticket assignment that the beneficiary’s net earnings exceed the SGA amount and the beneficiary was placed in the zero cash benefit status.

EN Payments

QUESTION: Does SSA count the beneficiary's earnings when they are earned or when they are paid for the purpose of calculating payments to the Employment Network under the Ticket to Work Program?

ANSWER: For all milestone payments and for all SSDI or concurrent beneficiaries we count earnings when earned--by the pay period, not the pay date. For SSI-only beneficiaries, during the outcome period before benefits are terminated, we count the earnings when received according to the actual pay date. MAXIMUS can provide training on this concept for approved Employment Networks.

QUESTION: Do “gross earnings” mean earnings before Impairment Related Work Expenses (IRWE) deductions? Or, does it just refer to earnings before taxes?

ANSWER: Gross earnings mean earnings before IRWE deductions and before taxes.

QUESTION: To submit for the first Phase 1 Milestone, does a beneficiary need to earn 50 % of Trial Work level earnings ($360 in 2012) in a two week period or within one month?

ANSWER: EN should submit a payment request for Phase 1 Milestone 1 payments after the beneficiary is working in a Trial Work level job that is expected to continue. If the beneficiary earns at least 50% of Trial Work level but less than full Trial Work level, the EN must provide pay stub evidence that the earnings occurred within a 2-week period or that the beneficiary is expected to earn or earned full Trial Work level within the next two months.

QUESTION: Does the Trial Work Period threshold (i.e., $720 in 2012) that qualifies an EN for the Phase 1 Milestones apply to blind beneficiaries?

ANSWER: Yes. SSA uses one annual Trial Work Period dollar amount for blind and non-blind beneficiaries. It is the Substantial Gainful Activity (SGA) amount that has an annual blind and non-blind amount. The Trial Work Period and SGA amounts are both subject to an annual adjustment.

QUESTION: If an EN pays Ticket Holders for completing a job development or job search curriculum and the pay exceeds the minimum income requirement for Phase 1 Milestones, does that count as work and qualify the EN for Milestone payments?

QUESTION: Do internships count as employment for the purposes of Milestone or Outcome payments?

ANSWER: Any earnings or education obtained during an internship would count towards the timely progress requirements and any earnings during an internship would count towards the requirements for any phase of payments to an EN. 

QUESTION: Can Milestone or Outcome payments be used by an EN to make payments to a beneficiary?  Is so, will SSA count the payment as income for the beneficiary? If yes, is it counted as earned or unearned income?

ANSWER: Yes, an EN may use Milestone or Outcome payments to make payments to a beneficiary. Any payments an EN makes to a beneficiary will be treated as unearned income by Social Security, which could affect SSI benefit eligibility.
SSA must count income under the regulations, but SSA also has work incentives outreach efforts to help beneficiaries plan for how income affects them. In addition to work incentives specialists within SSA, Section 1148 of the Social Security Act established Work Incentive Planning and Assistance Organizations in communities across the country that provide benefits planning and assistance to help beneficiaries anticipate and plan for the effect of work and earnings and other income on their SSI and/or SSDI benefits.

QUESTION: If a VR agency that has elected the Outcome/Milestone payment option chooses to serve a beneficiary as an EN and VR is actively working with that beneficiary under an Individualized Plan for Employment, and if the beneficiary decides to discontinue services with VR and VR closes the beneficiary’s cases, how long does the beneficiary have to start reaching the levels of work and earnings that will trigger Milestone and Outcomes payments once the Ticket has been re-assigned to an EN? Also, does the beneficiary still have to be receiving service from the EN when s/he starts reaching the levels of work and earnings that trigger Milestone and Outcome payments? 

ANSWER: The ability to begin working and/or increasing their earnings will vary from beneficiary to beneficiary. Under the Ticket to Work program there is no established timeframe in which a beneficiary must reach certain Milestones and Outcomes for the sake of participating in the program. However, there are established levels of work, education and/or technical training that a beneficiary is expected to attain each year to be considered to be making “timely progress” which is necessary to continue the suspension of medical Continuing Disability Reviews (see CFR 20, Part 411, Section 411.180 (c)).

There also is no requirement for a beneficiary to remain in service with an EN for the EN to be eligible to receive EN payments. A beneficiary may un-assign his/her Ticket at any time. Nevertheless, an EN may be paid for helping a beneficiary reach work-related Milestones and/or Outcomes attained during the Ticket assignment and after the EN no longer has the Ticket assignment provided the EN can show that the services it provided contributed to the beneficiary’s attainment of the levels of work and earnings that trigger the Milestone and/or Outcome payments (see CFR 20, Part 411, Section 411.581).

QUESTION: How will self-employment count under the Ticket program?  Will ENs be able to request certified payments for Ticket Holders who are engaged in self-employment?

1. ENs will be paid when the net SEI is posted to SSA records (usually within nine months after the end of the year, if the Ticket Holder files a timely tax return). ENs should be aware that the payment process may be somewhat lengthy for beneficiaries with Tickets that pursue self-employment.

Recent Work Rule

QUESTION: Please explain the recent work rule and provide a scenario of someone who was working in the 18 months prior to Ticket assignment.  Please break down all situations and explain when each corresponding Phase 1 payment would not be available.

ANSWER: Phase 1 Milestones may not be available to an EN if, during the 18 months prior to the beneficiary first assigning his/her Ticket, the beneficiary worked and had earnings at a level equal to or above the amount designed as the Trial Work Period (TWP) level earnings for that year. The Phase 1 Milestone payment would be unavailable to the EN because the EN did not incur the cost of helping the beneficiary achieve that particular level of earnings. The chart below shows the level of work as described in 411.535(a) that would prevent the payment of each of the four Phase 1 Milestones.

Although the criteria used to determine the availability of the Phase 1 Milestones based on a beneficiary’s recent work history are patterned after the criteria used to determine the attainment of the four Phase 1 Milestones, the criteria used in the recent work rule are not cumulative. Rather, each criterion should be applied independently. Thus, if a beneficiary worked with TWP level earning during 3 of the 6 months just prior to Ticket assignment but this work did not include the month just prior to Ticket assignment, the first Phase 1 Milestone would be available to the EN when the beneficiary attained the required levels of work and earnings; however the second Phase 1 Milestone would not be available. Similarly, a beneficiary who worked 9 of the last 18 months just prior to Ticket assignment, with earnings at the TWP level, might be eligible for 3 of the Phase 1 Milestones or none, depending on where the 9 months fell within the 18 month period. The example below provides an idea of how the recent work rule works. The recent work rule does not apply to Tickets assigned prior to July 21, 2008.
The recent work rule applies only to the Phase 1 Milestones. Phase 2 Milestones are available to an EN when a beneficiary attains the necessary levels of work and earnings prior to commencement of the Outcome payment period, or if after that, as part of the reconciliation payment.

The second Milestone would not be available to the EN because the beneficiary worked 3 of the six months just prior to Ticket assignment (i.e., Feb, Apr and May of 2008).

The Third Milestone would be available to the EN because the beneficiary only worked 4 of the 12 months immediately prior to Ticket assignment (i.e., Sept. 2007 and Feb, Apr and May of 2008).

The fourth Milestone would not be available to the EN because the beneficiary worked 9 of the 18 months immediately prior to Ticket assignment (i.e., Mar, Apr, May, Jun, July and Sept of 2007 and Feb Apr and May of 2008).

MAXIMUS has created an electronic tool that can be used to explore the work and earnings history of a beneficiary and estimate the availability of each of the four Phase 1 Milestones for that particular beneficiary. Visit the MAXIMUS web site and check this tool out: www.yourtickettowork.com.

EN Payment Process and Procedures

QUESTION: For evidence requirements for payment, SSA lists “original pay stubs” as primary evidence, and for secondary evidence “photocopies” of pay stubs plus a second source such as a signed beneficiary statement, state unemployment records, or Federal/state tax returns. Does this mean SSA will no longer accepted photocopies of pay stubs as primary evidence?

ANSWER: SSA has more closely aligned its earnings-related evidentiary requirements for EN payments with earnings-related evidentiary requirements used by SSA for other purposes. However, SSA will still accept good quality photocopies of pay stubs.

QUESTION: Are there any restrictions on when an EN can use primary and secondary evidence of work and earnings in submissions for EN payments?

ANSWER: No, there are no restrictions. Primary evidence (e.g., pay stubs and/or an earnings statement prepared and signed by the employer) or secondary evidence (e.g., State Unemployment Insurance data) of work and earnings can be used when submitting payment requests for any EN payments.

QUESTION: When does SSA count earnings to determine whether an EN is entitled to a payment under the Ticket program----when they are earned or when they are actually paid?

ANSWER:  That depends on what type of payment is being made and whether the Ticket Holder is a SSDI or SSI beneficiary, or one who receives benefits from both programs (known as a concurrent beneficiary). For all Milestone payments and for all SSDI or concurrent beneficiaries, SSA uses earnings when they are earned--by the pay period, not the pay date.  For SSI -only beneficiaries during the Outcome period, but before benefits are terminated, SSA uses earnings when paid.

QUESTION: If an EN is tracking a beneficiary that it previously served and learns that the beneficiary eventually went to work and reached the levels of work and earnings necessary to trigger Milestone and/or Outcome payments, can the EN collect the EN payments even though the EN is no longer serving that beneficiary? 

Transition to the New Payment Schedules

After July 2008, the following would apply.

• A) If an EN received Outcome payments on a case for work and earnings attained in a month prior to July 2008, the case will be transitioned from an Outcome payment to an Outcome payment beginning with the first Outcome payment month occurring July 2008 or later. When this happens, the number of Outcome payments will be adjusted. Under the transition rules in the regulations, an EN will receive a maximum of 60 payments or less depending on how much money was paid on that Ticket prior to July 2008. The EN will not be notified of how many payments are left on a transitioned case; however, Section 411.551(c) of the new regulations describes how that number will be derived.
• B) When an EN did not receive any Outcome payments on a case for work and earnings attained in any month prior to July 2008, a total of 36 Outcome payments would be available under the new rules for SSDI or concurrent beneficiaries and a total of 60 Outcome payments would be available for SSI only beneficiaries.

Questions about Beneficiaries

ANSWER: In accordance with the other SSA regulations referenced in 411.175, a Ticket Holder who receives a decision that benefits will cease because his/her health has improved may apply for benefit continuation on the basis of being in a program of Vocational Rehabilitation with an EN or a State VR agency, or because s/he has a Plan to Achieve Self-Sufficiency (PASS) or a few other reasons. If SSA finds that the program increases the likelihood that the beneficiary will remain off the benefit rolls, the beneficiary may be awarded benefit continuation until his/her program of Vocational Rehabilitation is completed.

QUESTION: How does a beneficiary put his/her Ticket into "inactive status" with MAXIMUS?

ANSWER: A beneficiary who is working with an EN or a State VR agency under cost reimbursement may have his/her Ticket placed in “inactive status” at any time by submitting a written request to MAXIMUS, asking that the Ticket be placed in “inactive status.”  “Inactive status” will begin with the first day of the month following the month MAXIMUS receives the request. The beneficiary will be subjected to a medical Continuing Disability Review while the Ticket is in this status if his/her case becomes due one. The beneficiary may continue working with an EN or a State VR agency while the Ticket is in this status. (See 411.192)

Timely Progress

QUESTION: Under the new regulations, MAXIMUS will be responsible for reviewing a beneficiary’s timely progress every 12 months.  If a beneficiary is unable to provide sufficient evidence to MAXIMUS, what information and data will a VR agency have to submit to MAXIMUS to demonstrate timely progress?   For example, will paper copies of grade transcripts be required?  Will there be a template or standardized set of questions from MAXIMUS to answer?  What types of data should VR begin to track on beneficiaries to be prepared to answer MAXIMUS’ questions related to a beneficiary’s timely progress?

ANSWER: We have simplified the documentation and timely progress review reporting requirements. As a last resort, MAXIMUS will ask the EN or State VR agency to certify a beneficiaries' progress, but they will not require an EN or State VR agency to provide evidence of a beneficiaries' progress. MAXIMUS will use a multi-list format to allow ENs and State VR agencies to respond “yes” or “no” to whether each beneficiary on the list has met the required work and to easily indicate the number of education or technical training credits the beneficiary has earned.

General VR Questions

QUESTION: Can SSA perform a medical Continuing Disability Review (CDR) on a Ticket eligible beneficiary receiving services from a State VR agency under the Cost Reimbursement payment method?

ANSWER: No. When a State VR agency chooses to serve a beneficiary under Cost Reimbursement and sends the proper documentation to MAXIMUS, the beneficiary’s Ticket is placed in a new status called "In-Use/SVR" which carries with it the same protection against medical Continuing Disability Reviews that were previously only associated with a Ticket being assigned and "in-use." 

QUESTION: Is Cost Reimbursement the only payment option to VR agencies for Tickets that were assigned prior to July 21, 2008?

ANSWER: No, since the Ticket program was implemented State VR agencies have been permitted to choose on a case by case basis whether they want to serve a beneficiary under the cost reimbursement option or under their chosen EN payment system.  The process for choosing Cost Reimbursement is now simplified.  If the State VR agency elects cost reimbursement, it should send MAXIMUS a monthly electronic file with the required information about the newly opened cases they are reporting. MAXIMUS will place the cases in “In-Use/SVR” and notify the VR agency of this action, or which cases cannot be placed in “In-Use/SVR” status.

QUESTION: How and when will a beneficiary be informed he or she has an in-use Ticket status with a State VR agency?

ANSWER: SSA will send the beneficiary a letter when he or she assigns a Ticket to an EN or State VR agency or receives services from a State VR agency which has chosen the cost reimbursement option.

QUESTION: Can a beneficiary reassign his or her Ticket to a different EN while a State VR agency has an open case and the Ticket status is “In Use/VR”?

ANSWER: No, a beneficiary cannot assign his or her Ticket to an EN while a case is open with the State VR agency. It is essential that State VR agencies report case openings to MAXIMUS, using the processes available for reporting either Ticket assignments or case openings under the Cost Reimbursement program. Otherwise, the official records will not reflect that a case is open with the State VR agency and an EN would be able to establish a Ticket assignment.

QUESTION: If an EN serves a beneficiary who does not attain all the payments available on the Ticket, and then the beneficiary decides to return to a VR agency to which s/he had previously assigned the Ticket, can the VR agency accept the Ticket again and resume Ticket payments? In the situation described above, would VR be able to serve this beneficiary under Cost Reimbursement?

ANSWER: A beneficiary may re-assign his/her Ticket to an EN, including a State VR agency (acting as an EN), with which the beneficiary formerly assigned the Ticket. However, only those Milestone and Outcome payments initially available and not yet paid when the Ticket is re-assigned would be available for payment once the beneficiary attained applicable levels of work and earnings. If the VR agency had previously held the Ticket as an EN and was paid, it would not be able to receive Cost Reimbursement from SSA if it later serves the beneficiary under Cost Reimbursement for a different period of VR. A VR agency cannot be paid Cost Reimbursement and under its chosen EN payment system on the same Ticket.

Partnership Plus: Sequential Services from VR and then an EN

QUESTION: How does the new Partnership Plus option work? 

ANSWER: After the VR case is closed, the beneficiary may assign the Ticket to an EN and receive job retention services, ongoing support services, or other services and supports to maintain employment and increase his/her earnings.  The period of VR and the EN’s Ticket assignment dates cannot overlap. SSA will pay both providers for sequential periods of service but not for simultaneous periods of service.  State VR agencies are encouraged to notify MAXIMUS of VR case closings as close as possible to the date of the action so that the Ticket can be made available to an EN for ongoing support services. If the State VR agency closed the case with the beneficiary in employment, the Phase 1 Milestones payments would not be available to the EN as the VR agency has provided the services that initially led to the beneficiary’s employment. The EN to which the beneficiary assigned his/her Ticket would be able to receive Phase 2 Milestone and Outcome payments as the beneficiary attained the required levels of work and earnings.

QUESTION: Is the Partnership Plus option only available when the VR agency is serving a beneficiary under the tradition Cost Reimbursement program?

ANSWER: Yes. If VR chooses to serve a beneficiary under the Cost Reimbursement program, the option for VR and an EN to provide sequential, but not concurrent services, comes in to play.

QUESTION: Can a beneficiary be served by both a State VR agency under Cost Reimbursement program and an EN at the same time? If a beneficiary currently has his or her Ticket assigned to an EN, does a State VR agency need to get the Ticket “unassigned” from an EN in order to serve the beneficiary under Cost Reimbursement?

ANSWER: SSA will not make Cost Reimbursement payments to a State VR agency for the same period during which the Ticket is assigned to an EN. The State VR agency should check with MAXIMUS to learn whether a potential client's Ticket is available. However, this scenario provides a unique opportunity to take advantage of the Partnership Plus option. Under Partnership Plus, a State VR agency may arrange with any EN to have the EN unassign the Ticket to accommodate the beneficiary receiving services from the State VR agency under Cost Reimbursement, with the intention of the beneficiary reassigning the Ticket to the EN for follow up services once the State VR agency closes the case. However, this does not happen automatically. The EN and the beneficiary must sign a new IWP after VR closes the case. Another alternative is for a referring EN to keep the Ticket assignment and have an agreement with the State VR agency which clearly states the types of services to be provided by each entity. In some states, ENs and State VR agencies are designing interagency agreements to facilitate equitable revenue sharing and a coordinated system of services for beneficiaries.

EN-VR Referral Agreements

QUESTION: Can an EN who has a beneficiary’s Ticket assignment refer that Ticket Holder to a State VR agency for services (such as a vocational evaluation) without losing the Ticket assignment?

ANSWER: An EN that holds a beneficiary's Ticket assignment may refer the beneficiary to a State VR agency for services.  However, to do this, the EN and State VR agency must have an agreement that specifies the conditions under which the State VR agency will provide services.  The agreement must be in writing and signed by both parties before the EN can refer a Ticket Holder to the State VR agency.  Ticket assignment will remain with the referring EN, unless unassigned first.
As an alternative under Partnership Plus, provided that all steps are taken in consultation with the beneficiary and the State VR agency, the beneficiary may unassign his/her Ticket and place it in In-Use/SVR status for the period that the VR case is open, and reassign it to an EN after VR services are complete and the case is closed.

QUESTION: What direction or assistance is available regarding how to structure agreements between an EN and a State VR agency regarding referrals of individuals by an EN to a State VR agency?

ANSWER: 20 CFR 411.420 about agreements states:
The agreement between an EN and a State VR agency should state the conditions under which the State VR agency will provide services to a beneficiary when the beneficiary is referred by the EN to the State VR agency for services. Examples of this information include-
(a) Procedures for making referrals and sharing information that will assist in providing services;
(b) A description of the financial responsibilities of each party to the agreement;
(c) The terms and procedures under which the EN will pay the State VR agency for providing services; and
(d) Procedures for resolving disputes under the agreement.
There is no set format or template for agreements between State VR agencies and ENs.  SSA and MAXIMUS have copies of some agreements which can be sent to ENs or State VR agencies to assist in developing their own agreements.

VR Data Reporting and Collection

QUESTION: What documentation will VR have to provide to MAXIMUS to show that the Ticket is “In Use/SVR" under the VR Cost Reimbursement option?

ANSWER: None. In-Use SVR cases should be reported electronically. For Cost Reimbursement cases, the State VR agency need only indicate to MAXIMUS the date that the IPE was signed, the date the case was closed, and whether the beneficiary was working when the VR case was closed.

QUESTION: What does a State VR agency need to submit to MAXIMUS to show that they have an open case that will be eligible for payment for a Ticket Holder under either the Cost Reimbursement payment option or to be paid as an EN? Have the new regulations changed this process?

ANSWER: When a State VR agency is operating as an EN, it must complete, sign and have the beneficiary sign the SSA-1365, State Agency Ticket Assignment Form, and return this form to MAXIMUS.  Under the new regulation the SSA-1365, State Agency Ticket Assignment Form, should not be used for cases the agency opens under the Cost Reimbursement program.  It should only be used when the State VR agency is operating as an EN under its elected EN payment system with the Ticket assigned. An IPE for a beneficiary being served under the Cost Reimbursement program should no longer include a statement that the beneficiary is assigning the Ticket to the State VR agency.  

However, if the beneficiary has consented to assign the Ticket to the State VR agency but has not signed an SSA-1365, the process has not changed. In this case MAXIMUS will continue to accept an unsigned SSA-1365 along with an IPE bearing a statement of the beneficiary's informed consent to assign the Ticket as evidenced by the beneficiary's signature.

ANSWER: For Cost Reimbursement cases, procedures are developed to accommodate MAXIMUS periodically receiving an electronic file listing beneficiaries whose cases were opened and closed by the State VR agency, and the dates of these actions. There two important reasons for reporting this information: 1) to ensure that these beneficiaries are placed in the new “in-use SVR” status that affords them the same protections against medical Continuing Disabilities Reviews as beneficiaries who have their Tickets assigned; and 2) to have the names of these beneficiaries removed from the list that MAXIMUS maintains identifying beneficiaries with Tickets available for assignment. Consequently, it is important for this information to be reported to MAXIMUS monthly.
Concerning the VR case closure data, if MAXIMUS is not notified of the VR case closure in a timely manner the beneficiary may not benefit from the 90 day window to reassign a Ticket without losing the protection against medical Continuing Disability Reviews (CDRs).

ANSWER:  State VR agencies can elect to send in their data by expanding the file and changing the data or by providing only new information each month.  However, MAXIMUS would prefer that only the new information be submitted each month.

State VR agencies may send only new data each month.  The only data that can be resend monthly should be SSNs that are not in the database (Code 1) or not assignable (Code 8).

Here's the explanation of the new Status Code Values:
 Status Code Values

QUESTION: When a State VR agency submits data monthly to MAXIMUS, are there specific desired formats for Social Security Numbers (SSN) and dates?

ANSWER: The SSN should include dashes.  The required format for the date is MM/DD/YYYY.

QUESTION: How should State VR agencies submit their monthly updates to MAXIMUS?

ANSWER:  There are several ways that the data can be sent.

QUESTION: Is there a particular date each month by which MAXIMUS must receive monthly updates from State VR agencies?

ANSWER: SSA has not established a set date for monthly submissions of the data.  State VR agencies may submit the data file any time during the month.