AUGUST 17, 2006 VCU WEBCAST Captioning Provided By: Caption First, Inc. LUCY MILLER: Hi, everybody. I don't know how I always get the most fascinating subjects to do webcasts on. The last one I did was substantial gainful activity. Now I have understanding section 301. Many of you or all of you have been through your initial BPAO training on this. You have been through some training on this already. The reason we are offering this webcast is because section 301 changed significantly in 2005. We will go over those changes. What is section 301? It is when an individual continues to receive Social Security disability payments, even though they no longer meet the medical definition of disability. That would be Social Security's definition. The reason that section 301 is important, is it allows certain eligible individuals to retain those important cash benefits and the medical insurance that goes with the Social Security disability benefits, even after they have medically improved. The reason this is a good thing is that it allows individuals to complete a vocational rehabilitation program. It is a way for people to build their skills, so that hopefully, they won't have to go back on the benefits again at a later date. And really this is the way for Social Security to invest in an individual. It's really solid social policy. Think about it. If Social Security can let an individual have those cash payments and the medical insurance, while they are completing an educational program or a training program, that individual now has increased skills. If that individual becomes disabled again in the future, hopefully, he or she won't have to stop working and have to go back on the benefits again later. Good solid social policy. What this section 301 refers to, people who get section 301 payments, the name comes from the section of the Social Security act that authorizes it. And the next slide shows you the actual citation. I doubt that any of you would be so delighted and thrilled as to go look this up. But if you needed to, here is the section. It's section 225 B, and section 1631(a)(6)(A) of the Social Security Act. This is the original authority that created this opportunity for people to continue payments even after medical recovery. This is not a new provision. This has been around for a very long time. Unfortunately, it is an obscure provision. Most people don't know that it exists. We will talk about that later in the program. The original provision has been changed, and added to most recently as I indicated, in 2005. Those changes were delineated in June of '05. This is the original legislation that created it. What are the requirements to get section 301 payments? There are as you know in Social Security specific rules about everything. And for an individual to get section 301 payments, they have to meet these requirements. They have to meet all of them. Let's take a look. First of all, in order to need section 301 payments the beneficiary has to have medically recovered. Medically improved. Meaning they no longer meet that disability requirement, that disability standard, that Social Security has. If an individual continues to be disabled section 301 payments are not necessary. Number one, you have to be medically recovered, medically improved. The second critical piece is that you have to be participating in a certain type of program. We are going to go over and over this later in the program. But that program has to be a vocational rehabilitation or now, certain educational programs. It has to be approved. You will even see the wording in the legislation, there is places where it's in quotes, appropriate. That is critical. So, A, medically recovered or improved. B, you have to be participating in a certain type of program. The next one is participation in the program has to have begun before medical improvement occurred. Meaning, before the date that your disability ended. Fourth, Social Security has to look at the program that the individual is involved in, and say, you know, if this individual completes or continues in this program, then the likelihood is that the skills or education that this individual will gain will keep them off of the rolls in the future. Remember section 301 is all about investing in an individual, letting them have those cash benefits and medical insurance while they participate in the rehabilitation program with that thought being that if you finish this, you are going to have improved skills, improved abilities, so hopefully you won't have to go back on the benefits again. You are going to see this referred to later on in the program as, the likelihood decision, or the likelihood determination, because the word that is used in the phrase here. Remember that all of these requirements have to be met. All of them, in order for an individual to receive section 301 payments. Let's talk about some of the facts. How do these payments work? First of all, unlike most things in Social Security disability that either apply to SSI or those Title II disability programs, section 301 applies to both SSI which is title 16, and all of the Title II disability programs. Remember there is more than one. You have SSDI, Social Security disability insurance, you have CDB, which stands for childhood disability benefits or beneficiaries, and DWB, which is disabled widows or widowers' benefits. All of those programs can be afforded section 301 continued payments. Payments also when you get section 301, they would include any applicable state supplements. I work in region 4. None of the states in region 4 have a supplement. But I know we do have participants signed up for this program from other states. If you get section 301 payments, that will include that additional state supplement if your state offers one. And auxiliary benefits, many of you will remember that in the Title II program, there are other members of your family sometimes that can draw off of your work record. If that was your situation, when you medically improved, and you received section 301 payments, those payments also continue for any auxiliaries or the family members who would have been drawing off of your work record. What else? Don't forget that with section 301 payments, also goes that critical health insurance. If you are in the Title II programs, you get to continue your Medicare. If you are in the title 16 program, SSI, your Medicaid coverage will continue as well. Section 301 only waives the disability requirement meaning that you get to keep your payments because you have, when you have medically improved. But all of the other requirements for getting Social Security benefits are still in place. This really trips people up, especially in the SSI program, because they are not remembering things like, my resources have to remain below $2,000. Or, my unearned income has to remain below a certain limit. In order for you to get section 301 payments, you have to meet all of those other eligibility requirements. The only thing that is waived is that disability requirement. Something to always remember. Let's take a look at what Social Security considers to be an improved or approved program. So what is that thing that you have to be participating in? Well, this is where some very exciting changes occurred in 2005. First of all, on the slides, you can see here, it needs to be or can be a program carried out under an IPE, that stands for individualized plan for employment, with an improved EN, that stands for employment network, under the ticket to work initiative. Let's say you've got your beneficiary, you have assigned your ticket, you are receiving vocational services, employment services, preparatory services, whatever they might be. You have an individualized plan for employment with an employment network. You will be considered to be in an approved program. The second bullet there, what else? How about a program carried out under an IPE, individualized plan for employment, with a state VR agency? That is totally approved. If you are involved with your state voc rehab, in our state we have separate blind services that would count as well, this slide also points out for some of you in states where you might have Indian reservations, it can also be the organization administering a VR services project for American Indians with disabilities. I do know that at least the state of Mississippi, in region 4, also has BPAOs working on the Choktaw nation and participating in that VR program would be an approved program for section 301 as well. What else? Any federal program carried out under that individualized plan. You can see the pattern here. There needs to be that individualized plan for employment. This can be any other federal agency. Let's think about what that might be or who you might run into. Veterans organizations, you are going to run into people who are working through a veterans affairs programs or other types of disabled veterans programs. How about a one- stop center? Those are funded by Department of Labor, located all over the country. As long as there is that individualized plan, participation in one of these programs will also be approved. Here are more things that are allowable. The appropriate program of vocational rehabilitation services, employment services or other support services provided under, again, an individualized plan, and that can be provided by a private or public community organization or agency. Think about all the private rehab agencies that are out there. Community rehabilitation agencies. As long as there is the individualized plan for employment, that would be acceptable by Social Security for section 301 purposes as well. Here is a different one. Public, private or parochial schools. Again, the issue has to do with, is it an employment program? Is it a vocational rehabilitation program provided by the school? Is there that individualized plan for employment? Those are the critical pieces. Now, here is something new. This was not in section 301 prior to the changes that occurred in June of '05. For beneficiaries aged 18 to 21, an IEP, all these IEPs, that is an individualized education program, developed under the policies and procedures approved by the U.S. secretary of education for assistance to states for the education of individuals with disabilities under the IDEA. That is the legislation that created this, is considered an approved program. Think about what this means for transition age use. They can be participating in regular public education, from the ages of 18 all the way up to 21, and not be, maybe have an open case with your state VR agency but simply be in school with an individualized education plan that would meet the requirements of Idea and that would be an allowed program, that would allow for those continued section 301 payments to be made. What does Social Security mean by participation? You have been doing this long enough to know that Social Security has very specific meanings for the words that they use. And their policies operating manual system, the POMs, as everyone knows them, describe what these words mean in great detail. For the purposes of section 301, participation has a very specific meaning. It means, and this is a quote right out of the legislation, it means: Taking part in the activities and services as outlined in that individualized plan, whatever that is, whether it's an individualized work plan, an individualized plan for employment, or an individualized education plan, or other similar individualized plans. So, participation is just taking part. You will have goals and objectives outlined in that plan, as long as the entity providing those services can verify, yes, this individual is participating, meaning taking part, then you should be able to pass that test. Many of you will remember that the prior language in section 301 didn't talk about just taking part. It actually used the quoted phrase there, "actively involved." And it got very difficult for a determination to be made about, what is actively involved? And yes, this person is taking part in the services and activities outlined in their plan, but are they actively involved or not? This made it much easier for a section 301 determination to be made, that value judgment of actively involved has been removed, and that is a very positive thing. Makes life a lot easier for everyone. Now, before the changes were made to section 301, there was no provision for an interruption in participating in that program. You know, you think about working with people with disabilities. Life gets pretty real sometimes, and interruptions occur. People get sick. People have family emergencies. All of us have worked with enough people with disabilities to know that things like this happen. Before the new rule, if you had an interruption, in participating in what your approved program, you just lost your section 301 payments. They were going to stop. The rule was you had to continuously be actively involved in that program of that individualized program. Fortunately, Social Security heard the public comments that were made, and now there is a provision to allow for a temporary hold on your section 301 payments, or actively participating in your programs. Section 301 payments now may continue during a temporary interruption in participation in that program. Back to the rules again. Social Security is going to narrowly define what does temporary interruption mean? Very cut and dried. There is the next bullet. It can be no longer than three months. Let's say that you are an individual with a mental illness, who perhaps had to be hospitalized. If you are in, if your interruption lasted five months, your protection from section 301 would stop. If it's less than three months, your payments would continue during that interruption, and continue after the interruption stopped and you went back to participation. Third bullet there, you have to resume participation after the interruption is over. You can't have an interruption and then not go back to participating in your program or your educational program. You have to go back. This rule began on June 25, 2005. In that program operating manual system, you will see this date referred to. If the interruption occurred prior to when these rules took effect, it's not going to help anybody. This is really an important provision though. When you are explaining this to your clients, you need to make sure that they understand, there are now rules to protect them during this temporary interruption. But you need to make sure that they understand what the rules are. No more than three months, and you do have to get back into that program again when the interruption is over. The other item to think about here is, when did participation begin? You will remember from the first couple of slides we talked about, what the requirements are, the eligibility requirements are to be afforded section 301 protection. Well, I think it was the second or third bullet on those slides that said, you have to start participating in the approved program, whatever that might be, before the date of medical cessation. Now, I want to make sure you understand that medical cessation and the date of the CDR, and that stands for continuing disability review, are not the same thing. Keep in mind that sometimes, CDRs are delayed, and in some cases they can be significantly delayed. Let's say that someone was scheduled for a disability review, and it went for several years, and that individual did medically improve. Finally the continuing disability review is conducted. The individual is determined to be no longer disabled by Social Security rules. The DTS, disability termination services, is going to look backwards to see when exactly did medical improvement occur. It isn't just a date of when the review was done, but when exactly did you improve medically. And your participation in the program has to have started before the date at which you medically improve. Not when the CDR was conducted. How are you going to know when there is a difference? When you get your CDR results back, when your clients get those back, it will list date of recovery on there. You will have to look at that date and go back to see when did the participation in the program occur, and when did it begin, and it needs to be prior to that date of cessation. Very specific date. This is a major problem for people that have CDRs that are delayed. How do they measure when your participation began in that approved program? It's the date that your plan is signed. It's straightforward. This has implications with your state rehab agencies, your one-stop system, or your school system. That plan needs to be current. Your clients need to be told that their plan needs to be dated before the date of cessation. Sometimes the VR counselors are delayed in getting those plans done. This is an important date. If the date on the plan is after the date of medical cessation, section 301 is not going to apply, and a very helpful continuation of benefits is then going to be lost to that individual. It's very important that that plan be dated correctly. Section 301 is applicable to individuals who have that age 18 redetermination. Now, what's interesting with age 18 redetermination is that your review, your medical review, generally occurs at some point in that 18th year. But sometimes again, these can be delayed. What is interesting with age 18 redeterminations is, you all should know this, is that let's say you don't get your redetermination done until six months into your 18th year. Fortunately, Social Security does not penalize you for that. They are not going to make you pay back any disability payments that you received all the way back to your 18th birthday. That does not change in section 301. When you get your review done, if it's determined that you are medically improved, you don't have to pay anything back. The problem is that Social Security is looking to see if you participated in that approved program before you turned 18. Not just before your review was done. Because the review is going to occur at some point in that 18th year. So, what do we need to make sure our clients understand? We need to make sure that they understand that before that 18th birthday occurs, they must either be in that individualized education program, or the individualized rehabilitation program, meaning they have to have a plan signed with the state rehab agency, the one-stop center, whatever the program is, or that employment network, okay? So there is a bit of a difference there. If you are in the SSI program, everybody gets that age 18 redetermination, and remember that approximately one-third of all SSI recipients fail to meet the adult standards at the age of 18, when that review is done. So section 301 can be a critical importance to those SSI recipients who are turning 18, having to pass that different medical standard, the adult standard as opposed to the child standard. Okay. Let's talk about the likelihood determination. It's an odd situation. For section 301 payments to be afforded to somebody, Social Security has to determine that continuing in that program, whatever it is, that educational program, that vocational program, whatever it is, it has to increase the likelihood that that individual will not return to the disability or the blindness roles again in the future. Remember section 301 is about investing in a beneficiary now, keeping them on the benefits, even though they actually are not disabled, and do not meet that criteria, because Social Security understands that if they can get them through that educational program, get them through the rehab program, the likelihood is they won't come back. It's all an investment. If you look at this likelihood determination, how in the world would a claims representative or an office of disability operations, ODO employee, make this determination? Again, there are specific tests and rules. And there is a huge change in the way that Social Security does likelihood determinations now, after the 2005 changes, as opposed to how they did them before. Here is how they decide it. They look at a couple different criterion. Number one, if the program is expected to provide work experience, such that the individual would be more likely to be able to perform past relevant work in spite of future possible future reduction in residual functional capacity. Wow, that's pure Social Security speak. But basically, it's common sense. It says if this program is going to provide relevant work experience, something that the individual will be able to use in the future, to get better jobs, better-paying jobs, that will enable them to do any type of work perhaps that the, the past relevant work they were doing before their injury, that is one test. The work has to last long enough, that the person is able to, A, learn to do it, and B, provide earnings of at least SGA level, SGA is substantial gainful activity, everybody knows what that is, currently $860 for nonblind individual. And it must have physical or mental requirements that could still be met if the disabling condition got worse. What Social Security is looking at here is the experience that is being gained or that will be gained by completion of or continuation in this educational program, this training program, this rehabilitation program, whatever it is that is preparing this individual to do work in the future. It has to afford a better opportunity for that individual, and the last bullet I think is interesting because it's talking about, will this lead to substantial gainful activity level work? Is it going to give this person enough experience, enough exposure, enough training, to get better work, even if the disability gets worse? That is a critical point there at the bottom. The completion of the program should also be expected to result in an improvement in any of the vocational factors of education, or skilled or semi-skilled work experience, which would make the individual more likely to be able to adjust to other work in the national economy, in spite of a reduction in residual functional capacity. More Social Security talk here. Basically, this is a common sense approach. Social Security will be looking at the training program, the educational program and making a very eyeballing it, a decision to say, this training will result in better opportunity for enhanced work and that work is going to result in SGA level earnings in the future, is going to broaden the opportunities for work within the national economy for this individual, even if the individual becomes more disabled. That is all that they are doing. I wanted to go back on one slide, because I wanted to talk about the likelihood determination before the changes in section 301. They were onerous. Social Security was really trying to make predictive evaluations, or predict the outcome of a specific program of rehabilitation. Social Security employees are not rehabilitation professionals. The old rules put them in a position where they would actually have to determine the vocational outcome that was likely to occur from completing the program. Very difficult task. These new rules are much less stringent, easier for Social Security employees to make that likelihood determination. Very common sensical. You can take a look at this opportunity and say yes, this will help this person improve their skills, increase the likelihood of getting a good-paying job and even if their disability becomes worse in the future, the likelihood is they would not need to come back on those rolls. This is a very positive change. Here is another exciting change. This is another new rule for 18 to 21-year-olds, that critical transition piece. Social Security, for students, 18 to 22, Social Security will assume and that is underlined, they will assume that continuation in or completion of the educational program provided under the individualized education plan will increase the likelihood that there would be no need to return to the disability role. This means that students who cease to be, to meet the medical standard for Social Security, or students who have that adverse age 18 redetermination, meaning that they didn't meet the adult definition of disability in the SSI program, they are not going to have to deal with this case by case likelihood determination at all. It is an assumption. Social Security simply says, we believe that you completing your plan of education, your individualized educational program in the public school system, we assume that that will increase the likelihood that you will not need to go back on benefits again in the future. So, there is no test required here. It is wonderful. Nothing to be looked at, it takes all the guesswork out of everything. 18 to 21-year-old, it's an assumption if you are continuing to participate in that special education program, you have that individualized educational plan, likelihood determination is already made for you. It's for the positive. Think about this for a minute. Really when you think about this exciting rule, this is a dropout prevention issue. A lot of kids in special education, I know in my home state of Kentucky, they drop out between the ages of 18 to 21. They don't want to be in school that long. They don't see it being a benefit or unfortunately, the family does not see there being a benefit in that. So they drop out. Now, what we can offer beneficiaries to say, if you can stay in there until the age of 21, hang in to your special education program, even if you medically improve, even if you are one of those one-third of the SSI individuals who fails to meet the adult disability standard, your benefits and your Medicaid are going to be continued, all the way up through the end of your individualized educational program. That is incentive to stay in school and staying in school is to the benefit of that individual. They complete their education. Hopefully, they get community-based work experience. It is all good stuff. Again, this is an investment in this individual. Hopefully, if you can keep the benefits for a little bit longer, continue your educational program, get better skills, you won't need to go back on the benefits later in life. This is a very exciting change. Well, what do you do if section 301 is denied? This is a determination that's made. It isn't automatic. It isn't waving a magic wand and section 301 payments just happen. You have to ask for them. And then someone at Social Security has to review your case to see if you meet all of those eligibility requirements that we talked about early in the broadcast. If extended payments are allowed, the medical cessation decision is not processed, meaning that it doesn't get pushed through the regular system within Social Security. Now, the medical cessation decision was made by the disability determination service, or section 301 payments wouldn't be necessary. But it isn't processed. The check doesn't stop. If extended payments are not allowed, meaning that the individual did not meet all the requirements, the cessation decision proceeds as normal, and the benefit payments and the associated health insurance will stop. Decisions to deny or discontinue benefits under section 301 requirements are subject to the administrative and judicial review process. That is the basic appeals process, that you have available to you with most decisions within the Social Security Administration. Appeals are processed in the usual manner. First step is a reconsideration in that local office. The next step is to go to the administrative law judge or the ALJ, and the process remains. Remember that the appeals process is described in your BPAO manual, so if you are forgetting how that works, you can review that in your manual. Section 301 appeals are no different from any other type of appeal and you do have appeal rights with section 301. Beneficiaries may get section 301 payments and simultaneously appeal that original medical cessation decision. A lot of people don't understand that. They think that those two things are mutually exclusive. And absolutely not. Let's say that you had a medical cessation, you had a mental illness, and Social Security or DBS rather determines that you medically improved, you don't agree with that decision. You can seek section 301 continued payments, and pursue an appeal on that original cessation decision simultaneously. One does not preclude the other. Unfortunately, sometimes people get told that. But that is not correct. The outcome of the appeal is unrelated to the section 301 status. They have no interaction whatsoever. So if your client disagree with the actual medical cessation, they should pursue an appeal on that and that should proceed as normal with no problems just because section 301 payments are being received in the meantime. Regular payments can be retained. Remember how this works. If you appeal your medical determination within ten days, the problem with that is that if you are found no longer disabled, meaning it's the original, if the original medical decision is upheld, those payments that you would receive would have to be paid back. However, if you had pursued section 301 status, and you were receiving continued payments under section 301, those payments do not have to be paid back. If it turns out that that original medical determination is correct. So, if you don't pursue section 301 and you continue those benefits while you pursue an appeal of the medical cessation, the possibility exists that you could have to pay back some benefits. If you meet the requirements for section 301, there definitely is an advantage for pursuing that route, because those payments are not recoverable if the original decision is still withheld. So, when does section 301 payments stop? It almost sounds too good to be true, doesn't it? There has to be an end. When one of the following occurs, any one of the following occurs, the section 301 payments will stop. And with the payment, the stopping of the payment, also would stop Medicare, if you are on Title II, or Medicaid if you are on title 16. The first one is obvious. If you complete your approved program, you meet your goals and objectives, you have finished your program, section 301 stops. The whole reason for continuing the benefits is to give you some cash in your pocket so you can complete the program. When you complete the program, the payments will stop. Beneficiaries stops participating in the approved program. Well, let's say that you drop out of school. Or you decide you don't want to be involved with the VR program. Or you don't want your ticket and assignment with that employment network anymore. If you stop participating in that approved program, and it's not a temporary interruption, which we covered earlier, your section 301 payments are going to stop. This means that your clients have got to be in close contact with their VR counselor, the VR counselor has to stay perhaps in contact with Social Security, so that if there is a stoppage, a completion or stoppage, that Social Security is aware of that and the individual will not get overpaid. Here is the third one. It is possible for section 301 payments to stop if Social Security determines that continuing to participate will not increase the likelihood that the person will be permanently removed from the disability rolls. There is that likelihood decision again. For whatever reason, if Social Security at one of your reviews, you get reviews on section 301 in that status, if they talk to your rehab counselor, look at your plan, the plan is changed, and it turns out that whatever your goals and objectives are now, Social Security does that likelihood test on them and it doesn't increase the likelihood, it is possible that your section 301 payments could stop because of this third point. I want to remind you that the likelihood determination is a much simpler, more common sense process now. So, the likelihood that this type of decision would be made midstream is slip. But it is possible. And it's something for you to be warning your clients about. If the plan changes midstream, that is something that probably should be communicated to Social Security. Okay. I mentioned that there are reviews. Well, you have to have checkups once in a while. You know how Social Security is. They have to find out how things are going. You know in the SSI program, you have an annual redetermination anyway. In section 301 reviews, they are diaried. You should all have soon that word before, meaning that there is a date that is marked in the computer system at which time you will be reviewed. I would say that this is typically once a year, but it might be sooner than that. Say that your rehab program is due to end in nine months. You are in a short-term training program. Social Security is going to want to review your section 301 case at the point at which they think your rehab program or educational program is going to end. The beneficiary and the VR program or educational program provide information to the FO, that stands for field office, the local Social Security office also known as district offices or DO, but ODO, the office of disability operations, actually makes the determination in a section 301 case. It isn't the local claims representative that is deciding yes or no on section 301. It goes to a larger office than that. These are more centrally made determinations. If your VR participation has ceased or your program has completed, has been completed, payments are going to stop. Just something to let your clients know about. If you participate, if your participation continues, the ODO will check other requirements like the likelihood issue. If the goals has changed, sometimes the likelihood decision can be changed as well. Not an extreme likelihood of this happening, but possible. And payments can be suspended if you or your client or your VR counselor, whoever, does not supply the information that is needed. Let's talk a little bit about section 301 and employment, because this is a very important issue. For the most part, if you have an individual receiving those extended payments on section 301, and that individual goes to work, section 301 payments are likely to terminate. Why is that? Let's think about it. Section 301 is intended as a way to help someone make it while they complete a program to prepare for employment. So if you get a job, you become employed, you are no longer preparing to become employed. You are employed. So section 301 payments are likely to stop if employment begins. Some things to remember about section 301. When you are getting those payments, you are actually not eligible for Social Security disability. Right? You no longer meet the medical standard. So, because you are not actually eligible, for those benefits, you are not afforded the protections of work incentives. So that second bullet here, you don't get a trial work period in the Title II program. You are not going to get an extended period of eligibility. If you are in section 301 status, you are receiving special extended payments even though you are not really eligible. So you are not going to be getting work incentives. Something to remember. It's all about the preparation. If you actually end up employed, Social Security feels that you don't need the payments anymore. There are some exceptions to that rule. But they are very specific. There are some paid internships, some work/study programs that may be permitted if they are part of, here we go again, the individualized plan. But it would have to be written in the plan. You can't just go get a part-time job, while you are going to school, or finishing your training program, whatever it is, and expect to continue those section 301 payments. So, if that's an internship, if it's a work/study program, something related to your educational or training program, then you need to give Social Security a heads up about that. They will have to make sure they make a notation of it. It's something to talk about during your section 301 review, so that you don't get a nasty surprise by losing those payments for a work opportunity related to your rehab program. Remember that for students 18 to 21, who are still in that high school program under that individualized education plan, that special education program, many of those folks we hope are participating in work transition programs, being taken by the teacher into the community, doing community-based work. Sometimes not for pay, but sometimes for pay. This should not cause termination of section 301 payments if it is part of that individualized educational plan or in some cases it's called an individualized transition plan. But it has to be spelled out in that plan. If it's not part of the educational program, it's possible that Social Security could terminate your section 301 payments. Section 301, and the ticket to work is another sort of interesting phenomenon. People who are in section 301 status, you can't use or assign a ticket. Okay? So, it's a problem. If you were with an EN, during, prior to your section 301 eligibility determination, you are medically ceased, and you are afforded that section 301 continuation, you can no longer use your ticket while you were in section 301 status. Now, beneficiaries with a ticketing use, typically don't need section 301 protections anyway, because you know medical CDRs are suspended. They are not conducted after you have assigned your ticket or at least they are not supposed to be. It's a mutual exclusivity here and it works out nicely. If your ticket is an assignment, you should not receive a medical CDR. You shouldn't need to use extended payments from section 301. If a ticket is not in use, a medical CDR may occur, and that is a reason why people may want to think about assigning their ticket. And section 301 payments may be provided if the individual meets all of the criterion, but remember that's meet all of them. You have to know there would be special rules for self-employment too. Section 301 does apply to an individual whose goal is self-employment or it can apply. The beneficiary must be able to conduct the business considering all relevant physical or mental impairments. And, the business must be expected to result in SGA level earnings or above. But as we all know, you can be engaged in a vocational rehabilitation program, and that goal, that end goal can be self-employment. That is totally fine. But the likelihood determination is going to be a little different. Social Security will apply the self-employment rules as opposed to the wage employment rules that we reviewed earlier. All the other section 301 requirements must be met. Participating in that VR program or the educational program, and they would have to meet the likelihood test, meaning that completion of the program, attaining that goal, that rehabilitation goal, would be likely to keep the person off of the disability rolls in the future. Same likelihood rules. Nothing different there. What are the limits of section 301? This is not a do-all, end all, be all, panacea to every adverse medical determination. That is really important that you understand that. This section 301 is not a tool that we use to avoid termination due to medical recovery. It's only applicable in are a finite set of circumstances. Remember that to get section 301 payments, the individual has to be engaged in this approved program, this appropriate program, vocational rehabilitation or education, that participation has to have started prior to the medical cessation. So it isn't something that, my goodness, I've been determined no longer disabled, I better get the case open with VR. That will not work. This is an investment that Social Security is making to ensure that individuals who are already engaged in a program are afforded the safety net that they might need to complete it. Another problem we have or limit of section 301 is that the cases are rare. This is kind of interesting, because my guess is that there are many more people who would be eligible for section 301 than ever seek it, ask for it or apply for it. The reason for that is that it is an obscure provision. Most rehab counselors are not familiar with it. Education personnel, special education personnel, I can guarantee you, are not familiar with this. Social Security staff themselves are not going to be familiar, because the number of cases are so rare. They are not going to have a lot of experience with it. Now, that creates some problems, and one of the biggest problems is that when DDS is conducting those medical reviews, they are supposed to be asking about vocational rehabilitation involvement, and there's places that you actually tick that off on the forms that are completed during a medical CDR. But VR involvement continues to be missed. That we are human beings and we make mistakes and DDS workers don't always catch it. Now we have a change in the law, that occurred in June of '05 and making it more complex, we now have the educational program to watch for, so as a benefits planner, you need to be aware that this is out there. You need to be talking to your clients about this, particularly individuals who are at risk of that adverse medical determination, who might recover. I would talk about this with every 17-year-old on SSI that came through my door. Remember again one-third of those SSI recipients fall off the rolls at the age 18 redetermination because they are not meeting that more stringent medical requirement. Talk to your 17-year-olds about section 301. They need to stay in school. So that they can continue to receive the payments and the medical insurance that they need to continue that education program. Awareness of section 301, within the rehabilitation community, is minimal. It's something that we need to get out there and beat the bushes over. I hope that you are talking to your rehab counselors about this, I hope you will be talking to education providers about this, because it is such an important provision, and unfortunately it's heavily underutilized. That was a quick run-down. I'd say that we would spend 45 minutes on a section of the law that is probably only about a paragraph long. But as you can see, there is more to it than that. That concludes our program. I look forward to getting some great questions from all of you. Thanks. 1