Lucy Miller Part 1 VCU-RRTC Transcript provided by: Caption First, Inc. **** >> We do have a great deal of information to share with you this morning. What I’d like to do is turn the call over to your trainers for today's call, and these trainers are Lucy Miller and Terry Uttermohlen, (sic) from our national training center at VCU. I will turn over to Terry now. Terry? >> Thank you Susan. Good morning everybody, I provide training and technical assistance to regions one, two and three and for the National Training Team and Lucy provides for region four, which is one of the largest regions in the country. Today's call is to give you an idea of how the new ticket regulations changed and how your role has changed. Or, actually what you're role is and Lucy will be talking about the meat of the call. By the time you are done with this call, I would like for you guys to take away at least a basic understanding of the advantages to the new ticket regulations over the old ones. The whole point of creating new regulations is to make ticket work and to help everything work together. You want to come away with an understanding of your role under the new regulations, and an understanding of what the current regulations have defined and use, and timely progress for use of the ticket. So let's get started. If you have the power point presentation open, I am going to start on the second slide, which is why all the changes. This is really important; I am really excited about these changes. When the ticket to work and work incentives Improvement Act was passed, the goal was to present alternatives for people to get rehabilitation services from different sources, from non-traditional sources. Figuring more options, more opportunities, perhaps more participation in the return to work. But under the first version of the ticket, the participation was not as enthusiastic as we hoped, or as anybody had hoped, and Social Security has spent literally years revising the ticket regulations to make them more equitable for employment networks so they would come in and if more employment networks come in that means there are more alternatives for beneficiaries, and hopefully more beneficiaries going back to work because the whole point is for all of us to work together as a team to increase self-sufficiency for beneficiaries. We want the ticket to work and work incentives planning to work along with the ticket to make it possible for people who have a lot of barriers to work to be successful, it's really exciting but it also means we have a lot of work ahead of us. So, how will the improvements increase employment? Hopefully, and just from reading the regulations I think this is really exciting that this can happen, hopefully it will increase the number of employment networks who are willing to sign up and are interested in accessing the funds available under ticket and interested in helping people have more options. Hopefully it will help beneficiaries have better access to employment networks so that they will be more likely to sign, and it will help employment networks not just sign up but take tickets and provide services and get people out there and help them be self-sufficient. The biggest changes to the employment network payment structure, we are not going to talk about this in any detail, just a little tiny bit, one of them is it allows payment before the person loses Social Security benefits and that's a huge difference. The old ticket regulations allowed some but not much incremental payments and this will allow because of the change in the timely progress regulation that Lucy is going to be talking about later, employment networks can get money earlier in the process and they can get more. Under the old regulations, individuals who received SSI paid employment networks less because of the way that the ticket regulation paid employment networks, based on the average benefit. Under the new regulation, it is much more comparable between the tiers. At least, in the beginning of ticket use, the milestone payments that employment networks used to get reimbursed and to get paid are based on gross earnings and are much lower than they used to be. Since it is based on gross earnings, it means that people who use work incentives are still going to be successful in using the ticket early in the process. Another thing that is very cool is that the employment networks are going to have an easier time verifying work activities that the beneficiaries perform. Other key changes, and this is a huge one, this is enormous, under the old ticket regulations when we started out, employment networks -- I'm sorry, state vocational rehabilitation agencies had to take the ticket assignment as soon as the person signed the papers saying that they were a VR client, this is an approved individualized plan for employment and they signed it, the assigned the ticket. Under the new regulations, that is not the case. If the state rehabilitation service seeks cost reimbursement for a ticket holder instead of an outcome payment, the ticket is not assigned even though it still protects the person from medical review; it is a win-win situation. The beneficiary gets to the protection, they have access to state VR services and they still have the ticket that they can use later with the community employment network. Beneficiaries who have a medical improvement expected diary, and those are people that when they applied to Social Security benefits, social security setup how soon the medical review is going to happen. And there are three different standards. One is medical improvement expected, which is they think they are going to get better and we're going to review you relatively soon. Medical improvement possible, which means you might if everything lines up just perfectly, you might get better. And medical improvement not expected, which means this a permanent disability. Under the old regulations, people who had that first standard, medical improvement expected standards, did not get a ticket until they had a medical review. Under the new regulations, they are eligible for the ticket to work as soon as they are entitled to benefits. This is really great, because these are people who may get better and may be able to get back into the work force. >> Lucy, I am going to a interject something. This change July 21st, and I already got technical assistance calls, when are the old people who did not get the ticket before, these medical improvements expected folks, going to get the new ticket? Just because of the amount of time it takes to process these changes, Social Security has indicated that the MIE's, medical improvement expected folks, will be receiving their tickets beginning in November of 2008. So as you are counseling people, who never got a ticket before, who are medical improvement expected, they have not had their first medical continuing disability review, you can let them know to expect a response from Social Security sometime after or in November, 2008. To you, Terry. >> Additional changes. This is really cool. The timely progress can now include educational progress. So, previously for people to make timely progress they really had to be working, and under the new regulations there is actually a period of time where the individual can make progress in education, great. Another thing that changes is that the progress review periods are all 12 months, there is no 24 months beginning period, everything is twelve months. Lucy is going to be talking at length about what those various 12-month progress reviews are. OK, slide seven. Where do work incentives, planning and assistance projects fit into this process? This is where the collaboration comes in. Work incentive planning and assistance projects are all about supporting people to work, that is what the ticket is about. It’s part of the tool box that you as a work incentive Planning Assistance Project, or community work incentive coordinator, have to help people get everybody playing the same game to get the person what they want for self-sufficiency. So, it is a very good fit for what work incentive planning assistance projects do, and gives you more people that you could refer beneficiaries to for vocational training and services. Work incentive planners are really critical to help people understand how to use the tickets. And, it won't help everybody but it does offer the CVR protection. It also gives people flexibility, it is a really valuable, one more work incentive in your tool box, and you guys, when we do initial training, we talk about the tool box that claims representatives have when they do the [inaudible) activity determination. This is a bigger toolbox. One of the things under the new WIPA, instead of the benefits planning assistance, is that you guys are an integral part of a very complex services system. And this gives you one more connection and possibly, and hopefully actually, quite a few connections in your community for places that people can go to get services that they want. Your obligation to beneficiaries is to help people recognize when they might be a good candidate, when they might want to use their ticket. You are going to need to be able to explain how the ticket program function, and what benefits people get. You are going to have to help encourage people to use ticket if it is to their advantage; we are not about bullying -- if you force somebody to do something they are not going to keep doing it. But just know that it is part of the tool box, keep it on your radar screen as you're talking to people. Oh, yeah, you might be able to use the ticket, or here are these employment networks and this one could be really good for you. There are obligations you have -- you need to give beneficiaries a list of all the employment networks in your area, and not just the ones you like, but every employment network in the area; you should have a good understanding of which of those employment are taking tickets, which of those employment networks provide which services, and you should know that well enough to be able to describe to the beneficiaries so they can make informed choices about where to try to deposit the tickets or pay the ticket. Having a fire wall. A lot of you guys are either considering becoming employment networks or your agencies are considering becoming employment networks, or you are already a community work incentive coordinator with a project and an employment network. I can't stress enough how critical it that there be a firewall between the employment network part of your agency and the WIPA part of your agency. They cannot be meshed together because there has to be consumer choice on both sides. If you are an employment network, WIPAs can refer people to you, but -- or you can refer people to WIPAs. But it has to be consumer choice. It can't be forced. And if you are in a work incentive planning and assistance project, you have to make sure that the beneficiaries have access to all of the employment networks in the area because no one employment network would be best for everybody and the whole point of this is consumer choice and variety and creativity. So make sure there is a brick wall between those two halves of your agency if you do both. >> Lucy, I am going to jump in. These procedures, these firewall procedures really need to be in writing, and your staff need to be trained on them. It is not enough to just have a procedure that the manager of the WIPA project knows and nobody else knows. This is very important for avoiding a conflict of interest. And this is required by Social security. This isn't sort of, gee whiz, it's optional, I don't really need to do that. Oh yes you do. Written procedures, staff is trained, and that you follow them, so that there is clearly choice and fairness offered in terms of assisting beneficiaries select in the end, where you are clearly not directing every beneficiary to your own agency for services. This is critically important. >> It is also critical that you do not mesh the files. You have a WIPA file, and the individuals who are receiving service with the community work incentive coordinator has specifically given community work incentive coordinator information and signed a release. That is private information and that can only be seen in your agency by people who have passed the security clearance that Work Incentive Planning Assistance Projects have to go through. The files have to be completely separate. Even if you say, oh man, this would be so much easier if we had one file cabinet, it would be easier but it would be wrong. It would be a violation of confidentiality. So I cannot stress this enough. And the reason I am so passionate about this is because I have seen projects not do it the right way, and it's scary for me. You want people to make sure that the beneficiaries’ privacy is respected and that their ability to choose is respected. OK more obligations to beneficiaries. I think we kind of hit this. You really need to know everybody, all the employment networks in your area, and that includes the national employment networks. Sometimes national networks like Triple A take charge of the right answer for beneficiaries. Sometimes it is going to be Joe's Bar & Grill down the street. Joe has decided to become an employment network so that he can help people with disabilities enter the restaurant business. You want to make sure that they get everybody. What are your obligations to the Employment Network? The first one is basic outreach. This is the stuff that you do with any community agency. You need to make sure that employment networks know who you are, know what you do, and know who is a appropriate to refer for specifically WIPA services. You have to do outreach to the employment networks so they know who you are and they know that you are a partner. You are going to provide individualized Work incentive Planning and assistance to people who are accessing the services of employment network. This is really important because if people understand what is going to happen there more likely to pursue work. If they go to work it helps everybody; it helps the beneficiary, it helps the employment network, and it helps the Social Security trust fund. The second bullet on this is important. You can help employment networks understand the documentation that you use if a beneficiary gives you permission to share it. Even though we are all on the team you cannot pass anything over to another team member unless the beneficiary specifically gives you permission. If they do, you can help the employment network understand that particular beneficiary information so they can anticipate what is available to help the person go to work, what impact work is going to have on that individual. Another thing that is really important is to work collaboratively with employment when problems arise. You may be aware of support in the community, or work incentive support that may help the employment network help the individual. This is about collaboration, working together to reach one goal. Another thing that you need to do is to coordinate with the employment networks to help the beneficiary to make reports, to make sure that work reviews happen at the right time so that the beneficiary does not get any surprises in. You can help employment networks by assisting beneficiaries and knowing when they have a ticket to assign, and having -- making changes, putting the ticket in inactive status, the basic stuff. You guys aren't going to be helping employment networks get payment, that is not your job. Your job is to help the beneficiary get back to work. But you can help that beneficiary with his or her understanding of assignments, taking tickets out of assignment, reassigning. You have some limits in the role that you have. You are not there to provide training and technical assistance on general information to employment networks. Your job instead is to support individual beneficiaries in their return to work and provide specific, individual information as people go back to work. You do not help employment networks with getting paid, that's not your job. We are not giving you that information. There's lots and lots and lots of resources for employment networks to learn how to get paid back for the services that they provide. You are not going to provide vocational services. One of the things in the manual and we talked about it how important it is that you are part of a vocational team, and that you keep the vocational goal in mind, it is really important that your understand that your piece is to refer people to individuals who can help them develop an appropriate vocational goal, who can support them in achieving that vocational goal, and that you are part of that picture. But it is not your job to help somebody come up with it, because there are people with other skills sets that have the time and energy and the funding to do that. OK, so there are a couple of new eligibility rules. >>Lucy, I want to jump in before we leave that topic. I want to remind everybody that you have a short -- I don't even want to call it a briefing paper, but you've got maybe a fact sheet in the materials we sent you about the role that you would have been working collaborative with employment networks on this new and improved ticket program, and I think that paper is really important for you to read it. It is not long. You need to read that thing from beginning to end, you need to save it. I think it is an important piece of information perhaps to share with employment networks, because they are not going to know what your role is with them. And my guess is that in the past, under the old ticket, most of the benefits counseling folks out there didn't see that they had a role in coordinating and collaborating with EN. This is kind of a brave new world for us. And for many of us who have been doing this for a long time, just looking at that paper or looking at the slides you might be sitting up in your chair saying wait a minute, the ENs were in their own little world and we were in our own little world before and we really didn't work together, this is new. And it is critically important that you understand that you aren't in your little bubble working in isolation. You have a very important role in supporting EN towards our shared mission. And our shared mission, promoting work and enhancing self-sufficiency, that is what the ticket is all about. We are all pulling in the same direction, so you need to be available to support the ENs in achieving this goal, and you have a very, very valuable role to play and that, but you can't sit in your office and never work with EN and have this thing all work. So, we have to recognize that there is a very important role. We have to get together with the EN, work in a collaborative partnership kind of way, pull towards that shared vision and goal that we have. In promoting employment and enhancing self-sufficiency. Alright, my rant is over, Cary. >> I am glad you're in -- that's good. (laughter). Similar to the old ticket regulations, there are people who are not going to be eligible for a ticket, and there are fewer of them. Largely, these are people who are about to have some kind of review, or have had some kind of review or for some other reason they're not eligible for benefits. The first one is going to be a beneficiary who is under the age of 18, or beneficiaries who are of full retirement age. People who are under age 18, as a child, they are going to have to go through the Age 18 redetermination if they are on SSI. If they are under the Title II program, they are not receiving a disability benefit. They are just getting a child benefit. People who are at full retirement age don't have any earnings limits at all, so they're not going to get a ticket because the whole point of the ticket is a short-term investment in helping a person achieve greater self-sufficiency for the long-term benefit of having them not need benefits. A childhood SSI beneficiary who has attained age 18 but hasn't had a review yet is not going to get a ticket until they have been a review and are determined to meet the adult standard of disability for SSI. Individuals who are receiving payment continuation under Section 301, now in initial training we talked about this a little and a lot of you guys may not remember what this is, but if an individual has a medical review, and the medical review says you are medically improved, normally benefits stop. They do not meet the disability standards anymore and the checks stop. But if the individual is in an approved rehabilitation plan they can continue their payments under Section 301. SSI or Social Security disability benefits, any of the three categories that we talked about. And the person to get benefits until the plan is over, they’ve done what they said there were going to do or until the Social Security Administration determines that it is unlikely to result in they're not needing benefits in the future. So the bottom line is that these folks already have been determined to have a medical improvement, so they're not going to get a ticket because Social Security knows the benefits are going to stop. Similarly, individuals who have a medical improvement determination and are appealing, if they make a request within 10 days they can have payments continue throughout the appeal. And these individuals are not going to get a ticket because become again, the benefits are going to stop once the determination is made that they're not disabled or they're going to start up again and they will now get a ticket if they hearing comes up that the individual still has a disability. Individuals who received provisional payments while waiting for expedited reinstatement are not going to get a ticket until it is determined that their medical condition continues. I know we've got people from community departments, we have a lot of folks who have been through training and possibly some who haven't, but expedited reinstatement is a work incentive that came through with the ticket to work and work incentive Improvement Act; the person does not have to be using a ticket to access expedited reinstatement. In fact, they do not have one at that moment. But it allows someone to get back on benefits, they have up to [inaudible) payments while the Social Security Administration is determining that their medical condition is the same or related to the earlier one, and it still is substantial, severe enough to preclude performance of substantial work. So the provisional payments we come up until six months, the person is not going to get a ticket while they are getting that money. They will get a ticket as soon as their benefits are reinstated, if Social Security says you are not better, you are still due payments, pay you as a reinstated beneficiary, here is your ticket. Individuals who get presumptive disability payments are not going to be eligible for a ticket. Presumptive disability only applies to the SSI program and it is for people who have really severe, on the face of it, disabilities. For example, somebody who alleges profound deafness, somebody who has amputations, someone who is totally blind, there is a list of very specific conditions that allow the Social Security Administration, SSI claims representative, to pay benefits for a few months while the Social Security Administration is deciding if indeed that person is medically eligible for payments. So they’re not been a beneficiary yet, really. They are just getting this money while they're waiting for the decision so they don't get a ticket. OK, so what are the benefits of assigning and using a ticket? The simplest one is that you have better access to services and support. You have a broader range of services that you can choose from to get rehabilitation services. And what is incredibly cool about these new regulations is that you are not choosing VR or another program unless you want to. You can assign your ticket to the state VR agency but if you are using your cost reimbursement, you still have the ticket and you can use it. So it allows people a full range of rehabilitation services. While the ticket is assigned and used, the individual is protected from having a medical continuing disability review; it is not going to be initiated while the person is using their ticket. And it is also not going to be initiated even if they have not assigned a ticket to the state VR agency, but it is not going to be initiated if the individual is receiving services from the state VR agency, so this is really a larger protection. >> I'd like to clarify with people, I anticipate questions about this issue. When a beneficiary is working with the state vocational rehabilitation agency, there are two different ways now that those services can be delivered through the ticket program. One way is where the state VR agency actually acts like an EN, they have signed up to be like an EN, they are accepting a ticket, they are being paid for their services the same way that all other ENs are paid. My guess is that that will be the minority, it won’t be the most frequently that people are served by a state VR agency, but we can't assume that your state VR agency isn’t going down that road. They can even opt to do that for some people that they serve, some beneficiaries but not for others. So when an individual is involved in receiving services from your state VR agency, it’s very important that the WIPA personnel know, OK, are you being served by your VR agency as an EN, are they collecting payments on the ticket, or are you being served under the cost reimbursement methodology or the option? Now that is the second option, that state VR agencies have become and when they do that they're just serving the individual the way that they always have if that individual meets certain employment guidelines for a certain period of time, the state VR agency is able to submit an invoice for Social Security and say here are the costs that we incurred to “rehabilitate this individual” and they are reimbursed for that. And this has been a relationship that Social Security has had with state VR agencies for years, years and years. And when that is occurring for a beneficiary, the get a wonderful new advantage. They get medical CDR protection. But their ticket is not in assignment. They can use it after voc rehab has provided services and closed the case. It is like having your cake and eating it to. This is an amazing change in the regulations and it is a tremendous benefit to those with server, it is critically important that [inaudible) understand how this works if we are going to help beneficiaries use this important work incentive in a strategic fashion, which is our value added, that is what we do for our job, helping people use work incentives in a strategic fashion. So there is a big difference, and I know you can't ask questions yet but if you're still a little muddled on that two different ways that a beneficiary can now get services from a state VR agency, you jot that down, and when the call is over we’ll beat that with a stick and make sure that you understand it because it is something that is new, and you need to understand when you are counseling people about how they want to use their ticket and how the voc rehab agency could serve this individual and what that means for the person. Back to you, Terry. >> Ok, this is pretty much the beginning piece, we talked about what your role is, and your role is to help beneficiaries understand when to assign a ticket, where they can assign their ticket, what employment networks are in the area, and your job is to help employment networks work with individual beneficiaries to utilize resources in a planful, kind of resource mapping kind of way. Somebody comes and they need something, and you go, oh well, let's see, the community employment network can provide this, and maybe you can write a path plan, or a use impairment related work expenses or other work incentives to fund part of the rehabilitation effort. Your job is to support the beneficiary, but as part of a big puzzle. There are additional resources in the handouts that we gave you, the role of the Work incentive Planning and assistance projects, you've got that and the power point slides themselves on the socialsecurity.gov/work website, there are some very we come very good resource documents about the differences between the old ticket regulations, and the new ticket regulations. They would be very helpful for you to review. [End]