Social Security Administration
Ticket to Work and Work Incentives Advisory Panel Meeting
March 26-28, 2001

Monday, March 26, 2001

Deborah Morrison called the meeting to order at approximately 10:00 a.m. She explained that the purpose of the meeting was to deliberate upon the final Advice Report concerning TWWIIA and turned the meeting over to Sarah Mitchell, who asked panel members to introduce themselves. The following members were present:

Sarah Wiggins Mitchell, Chair
Stephen Start
Jerome Kleckley
Frances Gracechild
Susan Webb
Bryon MacDonald
Kris Flaten
Christine Griffin
Thomas Golden
Larry Henderson
Stephanie Lee (by telephone)

Staff of SSA included Marie Strahan, Ilene Zeitzer, Kristen Breland, Joe Hickman and Deborah Morrison.

Audience participants included:

Edward Bachand
Ilene Baylinson
Skip Bingham
Ronald Calhoun
Marty Furry
Mary Hartle-Smith
Kimberly Irwin
Nicole Latzo-Jeffords
Dan O'Brien
Mike O'Brien
Phil Pangrajio
Jim Salmon
Mary Satterfield

Ms. Mitchell reviewed the meeting agenda. She stated that from 10:30 to 12 noon, Ilene Zeitzer would review the draft Advice Report and review public comments. The rest of the day would be taken up by panel deliberations. Tuesday morning will be devoted to public testimony and comment. After lunch, the panel will continue its deliberations about issues not included in the Advice Report. On Wednesday, the panel will continue its deliberations about the final Advice Report through the middle of the afternoon. The meeting will end with a discussion of panel business and will close at 4:00 p.m.

Mr. MacDonald asked that the two for one demonstration project be included in the discussion of other issues. Ms. Mitchell agreed that this would be added. Ms. Webb welcomed the panel to Phoenix and stated that a reception has been scheduled after today's meeting, sponsored by the Arizona RSA, ABIL and Webb Transitions.

Ms. Mitchell thanked the staff for their hard work and thanked Mr. Start and Ms. Gracechild for their testimony before Congress. She introduced Ilene Zeitzer to review the draft final Advice Report. She stated that staff began with the preliminary Advice Report and made changes. These changes are in bold. The Table of Contents has changed, with the addition of a summary of consumer comments. Information has also been added in the Appendix. Ms. Strahan stated that two of the response memos from the Actuaries would be faxed to the panel today. These will address MIE and the 16 to 18 year old eligibility and the Burkhauser request on alternative payments.

Ms. Zeitzer continued by saying that the recommendations have not been altered from the original report. She stated that another section of the report contains issues that have not yet been fully addressed by the panel, e.g., ability to bank any months of work in the first 24 months when considering timely progress. The SSA is still in the process of counting and tabulating the original comments, many of which need to be scanned, since they were not submitted in electronic format. Staff is forwarding these comments to the panel. A three-page summary of public comments has also been prepared. Many of the public comments contain multiple issues that also need to be sorted out. This means that the list of critical issues from the public comments is not complete. However, the comments received so far cluster around some of the issues that the Advisory Panel has been discussing.

Mr. MacDonald stated that the report did an excellent job of summarizing the public comment and testimony. In response to a question from Ms. Flaten, Ms. Zeitzer stated that the numbers reflect the number of people who addressed each issue, not how each commenter felt about the issue. In response to a question from Mr. Golden, Ms. Strahan stated that a similar grid could probably not be completed for the public comments delivered to the panel, but that the summaries of public comment could be included as appendices.

Ms. Mitchell asked what type of process the panel wanted to use to review the report. She suggested that the panel break into subcommittees to review the document. Ms. Lee left the meeting because she was having difficulty hearing over the telephone. Ms. Webb stated that it would be difficult to deal with the outcome and milestone issue without Mr. Burkhauser's presence or the reports from the actuary. Mr. MacDonald suggested that the report be considered by the panel as a whole, to optimize time. Ms. Strahan suggested that the panel review the recommendations and decide whether to keep them or add to them. She also suggested that the panel look at the official public comments. The panel agreed to review the document as a whole panel and to begin with the body of the report (page 8).

Issue One: Inclusion of Transition Age Youth

Ms. Strahan stated that the Consortium on Citizens with Disabilities and the ARC had disagreed with the panel's recommendation. The panel discussed this issue as it relates to SSI benefits redetermination at age 18 and whether the ticket must be deposited with the State VR agency. Ms. Flaten suggested that language be included that raises the redetermination of benefit eligibility as an issue. The concern is that an individual who receives a ticket at age 16 may be determined ineligible for benefits at age 18. If the person is receiving VR services under an IPE, they would be protected from benefit loss until the plan had been completed. This is an unintended consequence of serving beneficiaries from 16 to 18 years old. The other concern is that VR begins working with children at age 16. This means that the ticket must be deposited with VR, because another section of the regulations states that if VR has established a relationship with an individual, the ticket must be deposited with VR. Staff will draft language that addresses both of these issues. Ms. Flaten pointed out that SSA has commissioned a report on the redetermination process at age 18, which should be mentioned in the report. Mr. MacDonald also felt that the issue of one ticket per beneficiary bears on this issue.

Issue Two: MIE Exclusion

Ms. Strahan suggested that these issues be considered after the information from the Actuary is received. Ms. Mitchell asked the panel to address issues other than cost at this time. There were no other issues raised. The panel will revisit the MIE exclusion when the Actuary's information is received.

Issue Three: Number of Tickets per Period of Eligibility

Mr. MacDonald felt that this recommendation should be stronger and the panel request that SSA justify with cost implications why beneficiaries should not receive more than one ticket. Ms. Flaten felt that the panel should take a strong position, not just ask for a justification. Mr. Start felt that the panel should look at the cost, but the recommendation should not completely depend upon cost. He recommended that the report say that people should receive more than one ticket and that SSA should assess the cost of issuing more than one ticket. Mr. Start also recommended that the "easy back on" provision be referred to parenthetically as expedited reinstatement. The panel supported Mr. Start's recommendations.

Issue Four: Certification of ENs

Mr. Golden suggested that the Summary of Input section needs clarification because professions, not providers, are currently credentialed. He felt that the report should talk about non-traditional, rather than non-credentialed, providers. Mr. Golden will work with staff to clarify this. Mr. MacDonald mentioned Susan Prokop's testimony to the panel on this issue. The important point is that providers be capable of successfully providing the service agreed to by the agency and the participant. Mr. Golden pointed out that this statement does not provide real guidance to the PM in determining who should be a provider. Staff will redraft this language, using the testimony from Prokop's.

Issue Five: Financial Reporting from the EN

This recommendation deletes certain reporting requirements for ENs. Mr. MacDonald asked if the panel should provide an alternative reporting requirement and Ms. Webb suggested that the amount, rather than the percentage, spent on services that led to employment would be an acceptable alternative that would meet the Congressional mandate. The EN would report what it costs to serve beneficiaries but would not be required to report their total budget. Mr. Start felt that any data collected should help determine whether the outcome payments are adequate. If the data does not provide this information, it should not be required.

Ms. Webb felt strongly that the ticket program should be market driven and should not contain any reporting requirements. She suggested a study in which ENs could volunteer to participate, to determine the adequacy of payments. Another suggested option was to ask the PM to report problems with payment levels in its annual report to SSA, e.g., if a provider goes out of business because the payments are inadequate, this should be reported. Mr. Hickman drew the panel's attention to the law's conforming amendments and other portions of the legislation that would appear to require such reporting. Mr. Start recommended a study in which providers could voluntarily participate. The meeting recessed at 12:10 p.m.

Ms. Mitchell reconvened the meeting at 1:45 p.m. She opened the meeting with a discussion of recommendation Five. Ms. Webb suggested that items G and H be eliminated and that the issue should be reconsidered after consultation with Mr. McGill tomorrow. This recommendation was adopted.

Issue Six: Timely Progress

Mr. MacDonald commended the panel for this recommendation. Mr. Golden agreed and stated that beneficiaries may return to work during the first two years, which is more quickly than the standard proposed by SSA would dictate. Ms. Gracechild expressed concern that if the ENs report lack of progress to SSA and beneficiaries then receive a CDR, this destroys the trust relationship between the agency staff and the beneficiary. Ms. Webb also expressed concern that some ENs might purposefully do nothing but get CDR protections for their beneficiaries. Other panel members felt that this would be a rare occurrence. Ms. Strahan suggested that the panel recommend broad guidelines, with the actual determination of timely progress taking place between the agency and the beneficiary.

Mr. Golden asked what would happen if the individual needs to suspend the IWP due to disability relapse or exacerbation. Is there a way to "stop the clock" during this period? He wondered if SSA would or would not conduct CDRs during a time of IWP suspension. Ms. Griffin felt that beneficiaries would probably pass a CDR if they were going through a period of increased disability. Ms. Webb supported the idea of "banking" months of work during the first two years, to reserve months of employment that could forestall a CDR during such a period. This would provide incentive for the beneficiary to work during the first two years. Ms. Mitchell pointed out that the months of work are irrelevant under the Panel's current recommendation. Mr. Start recommended that the PM be required to request progress reports from the EN on beneficiary progress related to the IWP.

Mr. Hickman stated that the legislation requires that the PM will conduct reviews every 24 months. Mr. Golden stated that the PM requirements would be less under the Panel's proposal. After much additional discussion, the Panel decided to support its original recommendation. Mr. Start suggested that a broad guideline could include "active participation in program elements outlined in the plan". Ms. Gracechild stated that "the plan should be measurable, specific and attainable". The panel supported the existing recommendation, with the addition of Mr. Start's and Ms. Gracechild's suggestions.

Issue Seven: Use of IPE for IWP

The recommendation will stand as proposed.

Issue Eight: Choice in Ticket Assignment for VR Clients

Mr. Golden suggested that the 16 to 18 year old issue be raised in this section. Ms. Strahan suggested that the panel recommend that, because this is a problem that transcends two federal programs, the Commissioners of SSA and RSA develop a cooperative agreement between the two federal programs. Ms. Mitchell suggested that the panel needs additional technical assistance from VR officials on this issue. Ms. Strahan felt that the panel cannot address this issue through this report because it is not an issue that SSA can solve alone. It cannot be addressed through the NPRM. The panel might want to make a separate recommendation on this point through a letter to the President and Congress. Mr. MacDonald felt that the complexity of the relationship between VR and SSA Tickets is an NPRM issue.

Mr. Golden asked what happens to the Alternative Provider program once a state's beneficiaries receive their tickets and Hickman responded that the AP program expires. AP programs cannot continue to be APs. They must work with current beneficiaries as ENs. Mr. Hickman clarified that VR agencies have a choice as to whether they want to be a ticket taker or choose to be paid on a reimbursement basis. The panel broke at 3:40 p.m.

Ms. Mitchell opened the meeting at approximately 4:00 and stated that SSA expected the regulations to be finalized by the end of the summer. SSA has decided to delay issuance of the tickets till the regulations are finalized.

Issue Nine: Access to P and A Services

Mr. Golden suggested that "disabled beneficiaries" be changed to "people with disabilities". Ms. Strahan stated that SSA had already accepted Recommendation Nine and that P and A services will be available to all beneficiaries, irrespective of whether they are ticket holders.

Issue Ten: Mediation

This recommendation will stand as it is, with the addition that SSA should look toward other successful mediation models such as those established at the EEOC and the Department of Justice.

Issue Eleven: External Review of SSA Decisions

Ms. Griffin suggested that either SSA set up an alternative administrative review process or allow beneficiaries to go directly to court, after SSA makes its initial decision. This would avoid beneficiaries with ticket problems going into the ALJ system, which is currently badly overworked. Ms. Griffin suggested that the next step after SSA's decision should be the federal court. As it stands now, the SSA is the final step. There was consensus that there should be review beyond SSA and that this review should be the federal courts. Mr. Golden wondered how long the federal court process takes as compared to the ALJ process. Ms. Mitchell said that the federal court time was generally quicker, because federal judges have time limits on handling cases. Ms. Flaten suggested an independent panel with SSA and consumer representatives. Ms. Griffin expressed her hope that SSA would take the initiative to recommend an independent panel if the TWWIIA Panel recommended the federal court. The panel agreed to recommend "an external judicial process" without additional specifics.

Issues 12-17: Dispute Resolution and Information about Availability of P and A Services

Recommendation 12 stands as it is.

Ms. Flaten wondered if the beneficiary would file a complaint with the entity with whom they have a problem. Ms. Griffin said that most complaints are resolved at this level. Ms. Flaten suggested that beneficiaries be able to go directly to the PM and the P and A. Ms. Mitchell said that this would be extremely burdensome to the system and unfair to the EN. Complaints should be resolved at the lowest level possible. The PM need not be involved at this level. Language was added to Recommendation 13 that clarified that beneficiaries could go directly to the PM.

Recommendation 14 should include examples of different formats.

Recommendation 15 stands as it is.

Mr. Golden expressed concern about how continuation of benefits under an approved rehabilitation program relates to the Ticket. Recommendation 16 and 17 were approved as they are.

The meeting was adjourned at approximately 5:10 p.m.

Tuesday, March 27, 2001

Ms. Mitchell opened the meeting at approximately 9:00 a.m. The morning meeting will be devoted to panel public testimony and deliberations. During the afternoon, Ken McGill will be available by telephone to respond to issues raised by the panel and provide an update. Ms. Strahan stated that she had spoken with the Actuary's office and wanted to go through the memo provided yesterday with the panel. Ms. Mitchell stated that this would be handled later in the morning.

Public Comment

• Mr. Calhoun, New York State VR Agency: Timeframe for Implementation and Maintenance of Effort in VR

Mr. Calhoun stated that the State VR agency supports New York being an early implementation state. His agency is very anxious to help SSA shape the program. However, the regulations must be finalized and the infrastructure must be in place before the tickets are issued. The PM must recruit a sufficient number of ENs to serve beneficiaries in a broad geographic area. There must be sufficient time to train the VR counselors on ticket implementation. There is conflicting information-at one point, SSA said that 300,000 tickets would be distributed and at another time, that 520,000 tickets would be issued. The NY State Legislature is currently working on a Medicaid buy-in for the State of New York. This bill will probably not be in the implementation stage till next year. The VR agency strongly requests that SSA delay ticket mailing until September, when the foundation for support is in place. The agency further recommends that the tickets be distributed over the next 18 months, rather than four months, as currently proposed.

The TWWIIA has provided no "up front" funding for ticket implementation. The current requirement for maintenance of effort under the VR program is a significant problem. VR is planning to solicit funds from the Legislature to support costs of initiating Ticket services, but will not be able to pursue this funding because of the maintenance of effort requirements in the Rehabilitation Act. The maintenance of effort provision in the Rehabilitation Act requires that if states invest in vocational rehabilitation, they must continue this effort in future years, or lose the equivalent in federal dollars. The state would like to assist the agency in funding the up-front costs, but the state will be required to continue this level of effort indefinitely. The agency cannot take on this additional caseload without additional funds from the legislature. The legislature cannot provide temporary funding because of the maintenance of effort problem.

Mr. Calhoun commended the panel for the timeliness and detail of the Advice Report. The recommendations on Page Eight are well stated. The agency agrees with the Panel's recommendation on timely progress and choice in ticket deposit. However, the infrastructure necessary for smooth ticket implementation is missing. Training of staff and other infrastructure is needed for a smooth implementation.

A final concern is the accessibility of meeting materials. He stated that when Maximus was asked about this issue, the representative stated that providing accessible formats was new to them. This response was of great concern.

In response to a question from Ms. Webb, Mr. Calhoun stated that the rehabilitation agency was concerned about the influx of demand on the agency. He supported the inclusion of a wide variety of ENs to help absorb the demand.

Mr. Calhoun stated that there is no reasonable expectation that the milestone and outcome payments from SSA will cover the costs of providing services. The agency expects to use the cost reimbursement method and will not recoup these funds for several years. Because the Tickets are being rolled out all at once, there will be a significant bubble in service requests. The agency is expecting six percent of those who receive a ticket to seek services (approximately 25,000 beneficiaries) at a projected cost of between $15 and $25 million during the first 18 months.

Ms. Flaten asked about the up front costs for evaluation and assessment and wondered if this had a bearing on cost projections and Calhoun replied in the affirmative. Ms. Mitchell asked about the relationship between the rehabilitation agency and the ENs. Mr. Calhoun replied that the agency would be as supportive of ENs as possible and hoped that the agency would be able to work with as many One Stops and other agencies as possible.

• Michael O'Brien: Oklahoma Division of Vocational Rehabilitation: Reporting requirements for ENs, Comparable Benefits under the Rehabilitation Act and Reimbursement Issues.

Mr. O'Brien felt that the reporting requirements for ENs are in conflict with the market and outcome nature of the program. In business, you purchase a product because of what you think the product is worth and its quality. Cost to the manufacturer is irrelevant in your purchase decision.

The ticket may be considered a "comparable benefit." VR staff should not use comparable benefit as a control mechanism to get the ticket, but a way to stretch limited dollars.

He stated that there are reasons why VR gets a choice in payment methods. VR cannot choose its clients. VR must accept people who come through the door. Rehabilitation services for SSI and SSDI beneficiaries cost about twice as much as services for clients who do not receive benefits. Reimbursement enables the agency to serve both groups.

Finally, Mr. O'Brien said that there are many SSA beneficiaries the agency never gets paid for, including those who never achieve SGA (people who are blind, or have developmental or psychiatric disabilities).

Ms. Webb asked why VR agencies are supporting a delay in issuing the tickets. Mr. O'Brien stated that you cannot provide adequate training until the regulations are finalized. He has asked for new FTE's, trained vendors and staff to the extent possible, and begun recruiting ENs. He stated that there would probably be no ENs in Oklahoma because the Ticket program is not capitalized. He felt that delay in issuing Tickets is not the issue. The issue is capitalization and outcome payments.

Ms. Gracechild asked about the ability of VR to refuse services to a client seeking services and Mr. O'Brien stated that any eligible client must be provided requested services. The Oklahoma agency will ask for cost reimbursement on all people who are expected to achieve SGA, and ask for milestone payments on the remainder of Ticket users. In response to a question from Mr. Start, Mr. O'Brien stated that additional beneficiaries would come forward when Tickets are issued because of advertising, the increased incentives and reduced risk due to expansion of health insurance, and inclusion of all partners in the system who will encourage beneficiaries to work. He anticipated that 35 percent of those who receive a ticket would request services and ten percent would complete a plan. The panel took a break at approximately 10:30 a.m.

Ms. Mitchell called the meeting back to order at approximately 10:55 a.m. Stephanie Lee joined the meeting.

• Skip Bingham, Arizona Vocational Rehabilitation Agency: Order of Selection and Comparable Benefits.

Order of selection: People who receive SSA benefits are eligible for rehabilitation services under the VR program. A person must have to fit into the order of selection-they must fit into the significantly disabled category. The order of selection is written into the state plan.

Comparable Benefits: The ticket has no comparative value in terms of the comparable benefits requirement of the Rehabilitation Act. It is a promise to pay based upon a number of variables. It should not be considered as a comparable benefit. It is not the same as a grant or other benefit.

The third issue is a philosophical issue; the need for inherent fairness in reimbursement. If a person wishes to change their EN, VR counselors should not cajole them into remaining with the VR agency. ENs must work with each other to insure that this process is fair to each other and to consumers.

In response to a question from Ms. Webb, he stated his expectation that few ENs will materialize in Arizona. He felt they would not be on line by the time the Tickets are released. Ms. Mitchell stated that the Tickets would be released concurrently with finalization of the regulations. The RFP for ENs will be released significantly earlier than the Tickets. In response to a question from Ms. Flaten, Mr. Bingham stated that the agency expects to serve approximately 10,000 new clients under the Ticket program.

In response to a question from Ms. Webb, Mr. Hickman stated that if a consumer moved a Ticket in the middle of the plan, Maximus would determine how the outcome payments would be split. He further stated that agreements between ENs and the state VR agency must be in place, but the substance of the agreement is outside the purview of SSA.

• Dan O'Brien: Oklahoma Department of Rehabilitative Services: How to Operationalize Choice, Level of Demand, and Outcome Payment Levels.

Mr. O'Brien stated that he directs a pilot project using a Ticket with people who have psychiatric disabilities. SSA has referred about 480 individuals to the project. They are invited to a local training and given a choice of four providers. Choosing a provider is a low-incidence, high-risk choice. The person has never done this before and the risks are quite high. Focus groups of people with psychiatric disabilities were asked what they would like to know before making this choice. This resulted in a report card that helps them make a choice. With respect to demand, the project has found that marketing, more information about work incentives, and better work incentives induce demand. He calls Ticket distribution the "coupon effect". If a person receives a coupon, he or she wants to use it, or at least find out what they can get for it. If forty percent of Ticket recipients call and ask questions about the coupon, it will crash the system.

Mr. O'Brien passed out a handout that is a supplement to the Advice Report Appendix C. It shows the aggregate savings estimates for two milestone payment options for SSI recipients.

• Marty Furry, private citizen

Mr. Furry stated his belief that the Ticket has a significant potential to assist people to go to work. He also believes that there are a lot of clients who want to work and a lot of providers with good intentions. He has a background in advertising. Marketing can raise the awareness of a service that can increase the demand for everyone's services. The law provides access and choice and it is incumbent upon providers to work together as partners to provide the best services to everyone. He stressed partnership rather than competition. Providers should look to people that have not been traditional partners, such as employers and non-traditional supports.

Ms. Mitchell turned the panel's attention to the memorandum from the SSA Actuary. Strahan explained that the memo addressed the MIE and 16-18 year old eligibility issue. Page two of the memo states that the 16 to 18 year old eligibility could have different costs, depending upon the outcome of the mandatory eligibility redetermination at age 18. These benefits would be continued if the individual is under an approved plan. In these cases, the agency would choose to treat the redetermination as a CDR, which would be suspended if the person were receiving a ticket. The Table shows the ten year cost analysis of serving 16 to 18 year olds with these assumptions and MIE under the Ticket program. Cost savings under the current program are $493 million over a ten-year period. The net effect of including these groups is $869 million in additional costs over a ten year period. This is a cost of $87 million per year. Mr. Start asked if the Actuary had projected a number of beneficiaries who would leave the rolls as a result of receiving services and Ms. Strahan responded in the affirmative. The cost comes in by waiving the CDR protections and the age 18 redetermination. The panel broke for lunch at 12:10 p.m.

Ms. Mitchell reconvened the panel at approximately 1:45 p.m. Ms. Strahan reviewed a list of items about which to speak to Mr. McGill. The questions are, issuance of more than one ticket per beneficiary, timely progress during a disability exacerbation and whether a CDR would be scheduled, and the rationale for the EN reporting requirements. Ms. Strahan pointed out that there is no such thing in the current program as a Ticket suspension. Either a Ticket is active or inactive during the first 24 months. It is either in use or it is not in use after the 24 months. Ms. Lee asked about the Disabled Adult Child issue and the impact of the Ticket on DAC SSDI eligibility. Ms. Zeitzer clarified that if a DAC works a certain number of months over SGA, they will lose their dependency status and thus their eligibility for SSDI as a DAC. This problem could be addressed through the expedited reinstatement provisions. Mr. MacDonald also asked for an update on the Two for One National Demonstration Project. Mr. Golden also asked for clarification about why SSA would choose to do CDRs rather than redeterminations at age 18, if beneficiaries between the ages of 16 and 18 are to be served.

Mr. McGill joined the meeting by telephone at approximately 2:05 p.m. Mr. McGill stated that the Acting Commissioner had decided to delay the issuance of RFPs for the ENs till the middle of April. About 500 comments were submitted to SSA and staff is in the process of cataloguing them. Ticket roll out will take place when the regulations are finalized. The P and A grants are being finalized. SSA is also training staff about the Ticket program. Ms. Mitchell raised concerns about specific requirements for P and As that will receive contracts from SSA. She will raise them at a later time. She also expressed concern that P and A staff have been denied participation in these trainings. Mr. McGill clarified that this was based upon restrictions in numbers of training participants. The P and As will be included in later trainings.

Mr. Golden asked about the memo from the Actuary to Mr. Burkhauser regarding the MIE and the 16 to 18 eligibility issue. He asked why it was OESP's preference to forego redeterminations and substitute CDRs. Mr. McGill felt that if these individuals were included, they should have the same protections as everyone else.

Ms. Webb asked Mr. McGill to clarify the rationale for the reporting requirements for ENs. Mr. McGill stated that the provision was based upon the Statute, which requires financial reporting. Mr. McGill stated that OESP would probably examine this issue when the final rules are drafted. Mr. MacDonald asked about provision H in the same section of the NPRM. He expressed concern that this requirement was extremely broad.

Mr. McGill stated that this was included to meet statutory requirements, but was currently under staff review.

Ms. Strahan asked for a rationale on the provision that limited each beneficiary to one ticket per period of disability. Mr. McGill stated that General Counsel was looking at this issue, but it was based upon the statute. Ms. Flaten expressed concern about how this provision would affect individuals who have episodic disabilities. She asked if the timely progress measurement could be more flexible. Mr. McGill stated that this area would also be reviewed.

Mr. MacDonald asked for an update about the SSDI Two for One Demonstrations. Mr. McGill stated that he had been meeting with states operating SSI and SSDI waiver projects. Many of these states want to be included in the national demonstration project. Ms. Lee asked about the DAC issue raised above. Mr. McGill stated that there had been some public comments about this. He felt this problem could be solved through the "easy back on" provisions. They will be able to get back on the rolls easily if they are unsuccessful at work. This became effective on January 1, 2001, so it is currently in effect. Ms. Lee felt some education to the field would be very helpful, to raise awareness about this policy. The panel thanked Mr. McGill for being available.

Ms. Mitchell turned to Page 19 of the final Advice Report.

Issue 18: Milestone Payment Structure

Mr. Golden expressed concern that there is an inherent conflict between existing work incentives and Ticket outcome payments. If a person uses work incentives to continue to receive benefits, the EN does not get paid. The EN would not have a self interest in telling people about work incentives. Ms. Webb felt that the work incentives were set up to assist a person to ease off, not remain on, benefits. This is in conflict with the requirement that beneficiaries "zero out" of benefits before ENs get paid. Ms. Lee asked what the impact would be if the outcome payments considered gross earnings and disregarded the work incentives. Mr. Golden suggested that SSA should either value part-time employment or examine alternatives to the existing work incentives, such as the Earned Income Tax Credit. Ms. Flaten said the problem with disregarding the incentives and paying outcomes while the person is still on benefits is lack of cost savings to the Trust Fund. Ms. Flaten suggested that SSA be allowed to reduce the level of benefits to the IRWE amount, if the individual is earning above SGA. In other words, SSA would pay the IRWE, such as the monthly personal assistance bill for the person. Mr. Golden asked if the panel had received legal counsel on whether the law required that benefits be "zeroed out." Mr. Start pointed out that Kim Hildred had not interpreted the statute to mean that payments would be made only when beneficiaries "zeroed out" of SSI benefits.

Mr. Golden asked staff to research what percent of the total number of reimbursements requests submitted to SSA by VR are not paid due to work incentives. This might provide the foundation for a recommendation to SSA. He suggested that comments be added that the panel was pleased with the definition of SGA included in the timely progress requirement and conduct a cost benefit analysis of excluding work incentives from calculation of outcome payments. Ms. Mitchell felt this might be more appropriate under Recommendation 19. Ms. Flaten suggested that the panel request additional information from SSA and then fashion recommendations related to SSI, DI and work incentives shared between the two programs.

With regard to VR reimbursement data, Mr. Hickman stated that some states submit every successful closure to SSA for reimbursement without checking to see if the client is on SS benefits. Others submit only those cases they know to be Social Security beneficiaries. States receive information stating the reason why certain clients' costs are not being reimbursed.

Mr. Golden asked for a cost projection on using gross wage rates, excluding work incentives, in making outcome payments. Mr. Start asked how many people actually use the work incentives. If this number is low, the costs of implementation will not be high. The Payment Committee will develop draft recommendations on exclusion of SSI and SSDI work incentives when outcome payments are determined. The draft will be emailed to the rest of the panel. Ms. Flaten and Mr. Golden will join this committee for purposes of crafting these recommendations.

Recommendation 20: Threshold at which ENs are paid

Ms. Mitchell wondered on what basis this recommendation is being made. Ms. Lee questioned whether the blindness population should be mixed in with the hard to serve population in this recommendation. She felt that the issues could be explained separately with minor editorial changes. Mr. MacDonald felt that this recommendation was not consistent with the statute. The statute clearly references SGA under the DI program. The consensus of the panel was that Recommendation 20 cannot stand as it is. Mr. MacDonald suggested that the outcome payment be based upon the benefit reduction percentage but this would not address the SSDI issue. This matter will be referred to the payment committee, with the addition of Mr. Golden and Ms. Flaten.

Issue 21: Study

This recommendation stands with minor edits to include the discussion of work incentives.

Issue 22: Conflict in Language about VR Payment Methods

The panel did not have an opinion about this matter and left it to SSA to resolve this issue. This recommendation stands as it is.

The meeting was adjourned at 5:15 p.m.

Wednesday, March 28, 2001

Ms. Mitchell opened the meeting at approximately 9:15 a.m. and turned to other issues outside the NPRM. These issues include overpayments, how the Ticket works with other state programs, PR and public education, how the Ticket works with other work incentives, P and A contract issues, and the Disabled Adult Child.

Overpayment Issue: Mr. MacDonald stated that this is a program wide issue in both the SSI and SSDI programs. He felt that SSA should look to the business community and other experts to solve the problem. The problem relates to wage reporting, and whether ENs will be paid if SSA still shows the beneficiary as receiving payments. Ms. Webb said that the SSA needs to track wages better and that consumers need to have an easier way to report their earnings. She suggested a plastic card, similar to an ATM card that consumers could use to report wages. Ms. Webb asked if the beneficiary no longer gets a check, under the current system, how long do they have to report wages? Ms. Strahan stated that if beneficiaries want the easy back on provisions, they must continue to report. Ms. Gracechild felt that it should be SSA's responsibility to remind beneficiaries to report, if a report has not been received by a certain date. Ms. Webb said that the State VR agencies are tracking this issue, but this is not timely enough for the EN to receive payments. Mr. Golden requested a briefing on a wage reporting system being used in Wisconsin. Ms. Flaten suggested that any recommendation be forwarded to the SSA Advisory Committee. Mr. MacDonald's general recommendation, which states that SSA needs to develop solutions that solve the wage reporting and overpayment problem as it relates to the Ticket, as well as the general overall problem, was supported by the panel. The issue will also be highlighted in the Advice Report, either in a separate section or in the introduction.

Ms. Webb further suggested that SSA examine its own database to determine which beneficiaries are not receiving checks and therefore which ENs should get payments. Mr. Hickman stated that this information is obtained from the employer or the beneficiary pay stubs. The most updated information is from the beneficiary. If the beneficiary doesn't report, the most updated information is from the employer. If the employee does not submit documentation, SSA obtains the information when the employer reports taxes on the W2 form the next year.

How the Ticket works with Other State Programs

Ms. Mitchell explained that the NPRM addresses the relationship between VR and other ENs. The question has been raised about what is the relationship between the ticket and other state agencies, such as those that serve people with psychiatric disabilities. Mr. MacDonald pointed out that the reason there are specific references to VR is because of the existing reimbursement system between the State VR agencies and SSA. Ms. Mitchell stated the concern of these state agencies, that if they have access to Ticket funds, they will lose state funding. Mr. Start suggested a regulation that says that funds shall not be supplanted by Ticket funds and that cooperative agreements, similar to those with VR, should be established. Ms. Lee suggested that "best practices" at the state level should be explored. The panel agreed that this is an ancillary issue that should be addressed in the Advice Report.

Two for One Demonstration Project

Mr. MacDonald reminded the panel that Mr. Van de Water reported that his office was struggling with how to measure certain issues mandated by statute, such as induced demand, related to the program. He further stated that staff of the Pathways to Independence Program in Wisconsin had met with SSA officials to discuss how states that are already doing demonstrations can partner with SSA. He expressed concern that the dialogue has taken place without much panel input. Ms. Mitchell said that an evaluation committee of the panel had been established and that this committee should take the lead in following this demonstration. Ms. Lee stated that there are state two-for-one waivers that SSA has not acted upon, that have a bearing on the design of the national study. Ms. Flaten said that she has received feedback that the state demonstrations are dragging in their implementation because the states are waiting for SSA waiver approval. Ms. Mitchell stated that the charge to the evaluation committee would be discussed this afternoon. Staff agreed to identify the SSA staff person who is in charge of the two-for-one state waivers.

PR and Public Education

Ms. Mitchell explained that testimony before the panel revealed that consumers lacked information about the Ticket Program. She asked if the panel should recommend a public relations campaign to Social Security. Mr. Golden felt that this should be integrated into SSA's overall PR program and the office that handles this. Mr. MacDonald read public testimony that expressed fear that people will lose benefits if they try to use the Ticket program. The panel decided to ask Mr. McGill if there is a PR plan for the Ticket Program and whether the regional offices are involved. Pending Mr. McGill's response and whether the panel feels this response is sufficient, the panel will communicate directly with the Commissioner about the importance of attention to this issue at the highest levels of the organization.

Disabled Adult Children (DAC)

Ms. Lee stated that the SSA Statute does not specifically address the reinstatement of benefits for DACs. She reminded the panel that Mr. McGill had stated that DACs should be included in the "easy back on" provisions, as well as widows and widowers. Ms. Lee recommended that these issues be addressed in the report, referencing DACs, widows and widowers in the expedited reinstatement and the TWWIIA regulations. Ms. Strahan stated that it is extremely important for beneficiaries to retain their DAC status rather than establish their own work record under DI because the DAC benefits are generally higher, since they are based upon a parent's income. Ms. Flaten pointed out that some of these individuals end up better off because they become eligible for SSI and receive medical benefits. The panel supported Ms. Lee's recommendation.

P and A Representation

Ms. Griffin stated that SSA is discussing conditions under which the P and A can represent people using funding under the TWWIIA. One problem is that SSA must approve any information developed by the P and A. They are defining what is connected to employment and are saying that overpayments and CDRs do not relate to employment and thus the P and A cannot represent beneficiaries on these issues using SSA money. Ms. Griffin said that her subcommittee would meet and monitor this issue. The consensus of the panel was that the restrictions being discussed by SSA seemed unreasonable.

Mr. Golden wondered why P and As are allowed to do benefits planning when a system of BPA and O has already been established. Ms. Griffin responded that the P and A portion of the statute is quite broad. Mr. Start suggested that the panel recommend an advocacy and representation role as it relates to benefits planning.

Ms. Mitchell drew the panel's attention to a memo from the ARC requesting SSA to develop a model grievance procedure for ENs that contains a checklist or guidelines for minimum requirements. Dispute Resolution Committee will review this matter.

How Does the Ticket Work with Work Incentive Issues?

Ms. Flaten explained her concern that there is a specific prohibition in the statute for ENs to charge consumers, but some ENs use their services, such as job placement, as an IRWE, especially if they cannot afford to provide the services. The provider charges the consumer and the consumer declares the service as an IRWE and pays the provider from their SSA check. The Payment Subcommittee will address this issue. The panel broke for lunch at approximately 12:15 p.m.

The meeting was reconvened at approximately 1:45 p.m. Ms. Mitchell asked if there were any other issues the panel wanted to address or needed additional information about. Mr. MacDonald asked if he could develop a bullet point for the ancillary portion of the Advice Report. The point would discuss the urgency of granting waivers to the State two-for-one projects. He will work with Ms. Zeitzer on this issue. Ms. Lee also stressed the importance of initiating the "vulnerable populations" report, mandated by the legislation.

Ms. Lee asked for more in-depth information about VR and the Ticket, specifically what happens to young students receiving transitional services. She suggested that this issue be on the agenda for the quarterly meeting. Mr. MacDonald suggested that outreach to specific groups, including transition age students, be considered. Mr. MacDonald also asked for a venue to consider needed technical amendments to the legislation.

Mr. Start expressed concern that the larger providers, such as Goodwill, are not convinced that the Ticket system will work and are not planning to enroll as ENs. He suggested that computer models need to be developed that show providers how the system can work. Ms. Strahan said that there are some funds to do outreach to specific populations for panel members who are interested.

The panel looked at the recommendation in the Advice Report related to milestone payments. Ms. Flaten expressed concern that there were no dollar amounts in the recommendation. Numbers from the NPRM should be added to this recommendation and the amount of $300 for the first milestone should be added. Mr. Start also suggested the development of a proposed payment model that can be shared with potential ENs.

Business Meeting

Meeting Location and Schedule

Ms. Flaten suggested that meetings outside of Washington DC be held in roll out states. The next meeting is scheduled for May 8-10 and Ms. Mitchell stated that a number of people had suggested moving the meeting to Washington DC. There are a number of SSA officials that will be invited to the meeting and the panel could also tour the new offices. The panel decided to hold the May meeting in Washington DC. The August meeting was originally scheduled for the West Coast. Ms. Mitchell suggested that the meeting be sometime in the last two weeks of August. Oregon, which is a roll-out state, was suggested as another option. Ms. Mitchell suggested Portland, Oregon on August 21-23. The next meeting is scheduled for November 13-15 in Washington. South Carolina and Florida were suggested for February 2002. The panel favored Florida, on February 12-14.

Committees

Ms. Mitchell suggested that the Operations Committee be changed to the Planning and Operations Committee to enable the panel to conduct planning activities. She stated that there is no need for a Finance Committee because staff handles these issues. She suggested that this committee be deleted. The panel moved, seconded and passed a motion to make these changes in the operating procedures. Mr. MacDonald suggested that the Evaluation Committee be renamed to the Evaluation and "something else" Committee. The committee will consist of Mr. Burkhauser, Mr. Golden, Mr. MacDonald, Ms. Webb, Ms. Flaten, and Ms. Lee. The Evaluation Committee is involved with all mandated evaluations, and will recommend and execute certain other studies. The Evaluation Committee will come up with a name for itself.

The Planning Committee will consist of Mr. Start, Ms. Gracechild, Mr. Henderson, Mr. Kleckley, and Ms. Griffin, along with Ms. Mitchell. Ms. Mitchell recommended that both committees have conference calls within the very near future. The Planning Committee will have its call on April 11, 4:00 EST.

Ms. Mitchell stated that speaking engagements for the panel must be prioritized in light of limited resources. Priorities will need to be established within the next year. Ms. Mitchell asked for volunteers from the panel to do presentations. Ms. Webb, Ms. Griffin, Ms. Flaten, Mr. Start and Mr. MacDonald volunteered.

Ms. Strahan stated that the Panel's website is in test mode and a presentation is being planned for the May meeting. An additional day will be added to the May meeting to deal with administrative issues, such as identification cards for panel members.

Ms. Strahan stated that the Preliminary Advice Report was distributed broadly throughout the advocacy community, Congress and the Administration. There are a number of other reports that will need to be printed. She suggested that 5,000 copies of each report be made. Panel members asked for five copies each and will request additional copies as needed.

Ms. Strahan said that top-level policy positions for the panel are being advertised and SSA has received the authority to hire two policy positions and a budget person. The recruitment for the policy positions closes on April 6. Ms. Strahan will be attending the Senior Executive Fellows Program at Harvard University during the month of April. Ms. Zeitzer will be the Acting Director.

Ms. Mitchell raised the issue of the timeline for the Advice Report. The projected date of completion is mid-May. The panel will look at the final report at the May meeting.

The meeting was adjourned at 3:15 p.m.