210.00P Social Security and Ticket Procedure

February 2003

See corresponding policy: 210.00 Serving Individuals who are SSDI/SSI Participants Policy

Note: Vocational Rehabilitation procedures provide internal guidance for VESID staff only and create no procedural or substantive rights for any individual or group.

 

Table of Contents

Serving Individuals who are SSDI/SSI Participants

VESID staff will:

  1. provide vocational rehabilitation services to all eligible SSDI/SSI participants who intend to achieve an employment outcome and complete the VESID application process.
  2. provide information about the SSA Section 301 (Continued Payment Under a Vocational Rehabilitation Program) provision;
  3. provide information about resources where consumers can get more detailed information and individualized assistance in using work incentives and managing benefits (see Benefits Counseling); and,
  4. inform all SSDI/SSI beneficiaries of the benefits of using their Ticket to Work, including the "Basic Facts About the Ticket to Work Program" brochure (See Appendix I - Basic Information about the Ticket to Work Program for an overview of the Ticket to Work Program).

The record of services will indicate that the above information was shared with consumers.

Orientation and Intake

VESID staff must encourage all Social Security Disability Insurance (SSDI)/Supplemental Security Income (SSI) beneficiaries to seek benefits counseling available through the Benefits Planning, Assistance and Outreach (BPA&O) projects, Independent Living Centers, the Social Security Administration and other available sources.

If an individual on SSDI/SSI is only interested in extended employment, VESID staff, upon case closure, must refer the individual to the Social Security Administration (SSA) and/or to the SSA-funded Benefits Planning Assistance and Outreach program when the individual wants information about work incentives available through SSA.

Starting at orientation/intake, VESID staff will provide information to SSDI/SSI applicants on the Ticket to Work program. VESID must provide the "Basic Facts about the Ticket to Work Program" brochure at the orientation and/or at intake that describes:

  1. the basic facts and options that are available under the Ticket to Work Program;
  2. a general list of resources that may assist in participation in the Ticket to Work Program; and,
  3. the services available through VESID as a provider of vocational rehabilitation services.

Note: Not all individuals on SSDI/SSI will receive Tickets from SSA. See Appendix I for a description of who is eligible to receive a Ticket.

Documentation for the Determination of Eligibility

The Information for Certification of Eligibility Case Note-SSI/SSDB is to be used for SSDI/SSI recipients. In this case note, statements of the impairment, impediments/functional limitations and requirement of services are not required and the eligibility determination must not be delayed to secure documentation of this information. The information for eligibility that is required can be summarized in the SSI/SSDB Verify header alone.

In certain instances, an individual may present documentation that would satisfy the information required on the Information for Certification of Eligibility Case Note. When this documentation is provided to VESID in advance of verification of SSDI/SSI status, this eligibility case note should be used and the decision should not be delayed to wait for Social Security verification. Otherwise, the Information for Certification of Eligibility Case Note-SSI/SSDB, which is designed to contain just that information needed for SSDI/SSI recipients, should be used. (See Eligibility Procedure)

As soon as an applicant has identified him/herself as an SSDI/SSI participant, they meet the VESID eligibility requirement. The only exception to this presumption of eligibility is if the VESID counselor demonstrates with clear and convincing evidence, through a trial work experience or extended evaluation, that the person cannot benefit from VR services, in terms of employment, because of the severity of the individual's disability.

Verification of SSDI/ SSI for Eligibility and Significance of Disability

Several methods can be used to verify that an individual receives either SSDI and/or SSI:

  1. An individual on SSDI/SSI can show VESID staff current proof of benefits such as an entitlement or award letter, a current benefit check stub, or a current ("assignable" or "assigned") Ticket to Work.
  2. An individual who is receiving 1619b Medicaid is still considered an SSI recipient under VESID policies. This can be verified for anyone who was previously receiving SSI cash benefits and now has 1619b status by asking a SSA claims representative to check the "SSID Query" on SSA's computers to get written verification of 1619b status.
  3. The Social Security Administration (SSA) provides a Social Security Benefit Statement (Form SSA-1099) for each tax year.  The benefit statements show the amount of Social Security benefits.

If the applicant is unable to provide evidence to support that they are receiving Social Security benefits, then VESID must obtain appropriate releases from the individual and verify the applicant’s SSDI/SSI status by contacting the Social Security Administration. This verification must be made within a reasonable period of time so that eligibility is not delayed.

District Offices can use the Verification of Public Assistance standard letter in CAMS for this process or a form letter that the District Office may have developed with the local SSA Office.

Significance of Disability

Individuals on SSI and/or SSDI are considered to have at least a significant disability. Eligible individuals are also assessed for meeting the criteria for most significant disability. When serious limitations exist in three or more functional capacities, then a most significant disability exists.

Benefits Counseling

VESID staff will work with referral agencies and SSDI/SSI recipients to encourage the use of benefits counseling prior to a referral to VESID or to another EN so that the recipient is able to make an informed choice about work. At the point an individual is referred to VESID, VESID will offer all SSDI/SSI recipients benefits counseling during the vocational rehabilitation process. Consistent with VESID policy on consumer involvement, VESID will only support the most cost-effective option for benefits counseling that leads to the individual's employment goal and that is required to meet the individual's needs.

When to Refer an Individual for Benefits Counseling

VESID will provide benefits counseling when it will enable the individual to achieve and sustain an employment goal. Prior to engaging in employment, individuals who are on SSDI/SSI and/or who are receiving Medicare or Medicaid will require counseling on the impact of earnings on their benefits and to maximize the use of work incentives.

Benefits counseling services are provided by many independent living centers, SSA-funded Benefits Planning Assistance and Outreach (BPA&O) providers and some other community-based organizations, such as housing or vocational service providers.

Benefits counseling can assist a consumer in making informed choices regarding work.  When pursuing employment, benefits counseling should enable the individual with a disability to obtain or maintain supports necessary to achieve their employment outcome.

VESID can provide for benefits counseling for the purposes of benefits screening and assessment of current situation and advisement, planning and utilizing specific benefits and work incentive options. Benefits counseling is not contingent on economic need.

Benefits Planning, Assistance and Outreach (BPA&O) Projects

Under the Ticket to Work and Work Incentives Improvement Act of 1999, the Social Security Administration has funded benefits planning, assistance and outreach to SSA beneficiaries through community providers.  In each region of New York State, a project is available to assist SSDI/SSI participants who need to understand how working will affect benefits (including Medicaid or Medicare).  The BPA&O will also help recipients understand how to make use of the work incentives available under SSA rules.  For BPA&O contact information in your region of the state, call the State Work Incentives Support Center, toll free, at 1-888-224-3272 or link to the list on VESID's Ticket to Work web site http://www.vesid.nysed.gov/tickettowork/who.htm

Documentation in the Record of Services

If individuals are referred for benefits counseling, whether or not it is authorized for payment by VESID, the referral and the results of the service should be documented in the record of services.

Making an Informed Choice Regarding the Ticket to Work Program

Most, but not all, SSDI/SSI recipients will also be eligible to participate in SSA's Ticket to Work Program. (See Who Is Eligible to Receive Tickets? for more information.) Some individuals with Tickets will come to VESID directly to obtain services. They will be informed that by choosing VESID for obtaining vocational rehabilitation services, they will be using their Ticket to Work. Others may opt for services with an employment network (EN) and may come to VESID for services after assigning their Ticket to another EN. The "Basic Facts About the Ticket to Work Program" brochure will be provided and explained to all Ticket holders. This must be documented in the record of services.

The following points cover some basic considerations related to VESID's involvement with the Ticket to Work program.

  1. To assure that individuals are making an informed choice under the Ticket program, VESID staff will explain to individuals who have a Ticket to Work from SSA:
    1. the individual’s choice regarding participation in the Ticket program and the option not to participate in the Ticket Program at all;
    2. the right to choose a vocational service provider prior to engaging in a plan for going to work, and to reassign the Ticket if necessary;
    3. the advantages of assigning the Ticket to VESID, particularly the scope of vocational rehabilitation services available for achieving an employment outcome;
    4. when a Ticket holder signs a plan to go to work with either VESID or an Employment Network, the Ticket is assigned to that provider;
    5. protection from SSA medical Continuing Disability Review when a Ticket is assigned;
    6. the Ticket Program timely progress requirements; and,
    7. the period of "using" a Ticket begins on the effective date of the Ticket assignment (usually the original IPE date). 
  2. VESID and the EN are required to coordinate services when an individual has assigned the Ticket to the EN and is requesting VR services. A written agreement between VESID and the EN must be in effect.
  3. If the individual decides to rescind and re-assign the Ticket to an EN while receiving services from VESID, the individual may continue to receive services from VESID in coordination with the EN. In this situation, VESID will provide services in accordance with the agreement. When necessary, VESID will request a three-way discussion with the individual and the EN to determine what services will be provided by the EN and what services will be provided by VESID in accordance with VESID policy on comparable benefits and services.
  4. If the individual needs high cost services, VESID will request a three-way discussion with the individual and the EN to determine the best way to pay for the services requested. The VESID/EN agreements include a mechanism for re-assigning Tickets to VESID depending on the scope and cost of services that are necessary for the individual to achieve an employment outcome.

    VESID staff select the SSA payment system for services provided to individuals who assign the Ticket to VESID. In most situations, VESID will select the "Cost Reimbursement Payment System" on the SSA-1365 Ticket Assignment form.
  5. VESID staff must select the Employment Network payment option ("State VR agency’s employment network payment system of record"):
    1. for any individual for whom Maximus indicates that payments have already been made to an EN; and,
    2. under special Ticket pilot programs.

      (See VESID’s Use of the Employment Network Payment System below.)
  6. VESID staff should encourage the assignment of the Ticket to VESID through the SSA-1365 form and may discuss with the individual how the Ticket program allows VESID to recover from SSA the money spent on services, making it possible to serve more people.
  7. At plan development, VESID staff will confirm with Maximus:
    1. whether or not the individual has received a Ticket;
    2. whether or not it has been assigned to another EN; and,
    3. whether or not any payments under the Ticket program have been made to an EN or another state VR agency.

      If the individual receives the Ticket after an IPE is developed, the Ticket can then be assigned based on the existing plan.

      See Appendix I for Basic Information on the Ticket to Work Program.

      Note: If an individual is pursuing an employment goal of homemaker or unpaid family worker on the IPE, then it is not necessary to pursue Ticket assignment.

Choosing VESID as the Ticket Provider

The Ticket is assigned to VESID at the time an individual signs the IPE. VESID staff must complete the Ticket Assignment Form (SSA-1365) when VESID is serving under the "Cost Reimbursement Payment System" using the following steps.

  1. Determine if the Ticket is available to be assigned to VESID by calling Maximus at 1-866-968-7842 or 1-866-yourticket. Provide Maximus with VESID’s Employer Identification Number (EIN) # 14-6013200 and with the individual’s Social Security Number (SSN).
  2. If the Ticket is available, also ask Maximus if SSA has made any payments to an EN under the Ticket program. (If any payments have been made, do not select cost reimbursement, see VESID’s Use of the Employment Network Payment System below.)
  3. If the Ticket is available, obtain the individual’s signature and note date in Section B of the SSA-1365.
  4. Check the SSA-1365 Ticket Assignment form for accuracy. The CAMS version of the form will have most sections already completed (Items 1,2, 3, 4 a/b, 5 a/b, and 6).
    1. Item 4 a/b uses the current vocational goal.
    2. Item 5 a/b uses the date of the original IPE.
    3. Item 6 uses the current completion date.
  5. On SSA-1365, Item 7, select "Cost Reimbursement Payment System" if no Ticket payments have been previously made by SSA to an EN. (If payments have been made or if the individual is participating in a special Ticket pilot program, see VESID's Use of the Employment Network Payment System below.)
  6. In CaMS, access the case assignment tab, add "Ticket - assigned VESID" from the available special program options.
  7. Fax Ticket Assignment form to Maximus at 703-683-3289 or mail to the address on the top of the form.
  8. Give the individual a copy of the Ticket Assignment form.
  9. File Ticket Assignment form (or copy) in record of service with the IPE.

If VESID staff mail the IPE to the individual for signature, and if the Ticket is to be assigned to VESID, the Ticket Assignment form (SSA 1365) will be mailed simultaneously with the plan for the individual’s signature, to be returned to VESID. CAMS will contain a follow-up letter to use when individuals do not return the Ticket assignment forms.

NOTE: If the individual receives the Ticket after an IPE is developed, the Ticket can then be assigned, based on the existing plan by following the steps above.

VESID's Use of the Employment Network Payment System

The Ticket is assigned to VESID at the time an individual signs an IPE. VESID staff must complete the Ticket Assignment Form (SSA-1365) when VESID is serving as an Employment Network. VESID will serve as an employment network:

  • for any individual for whom Maximus indicates that payments have already been made to an EN; and,
  • under special Ticket pilot programs.
  1. After contacting Maximus, if the Ticket is available, obtain the individual’s signature and note date in Section B of the SSA-1365.
  2. Check the SSA-1365 Ticket Assignment form for accuracy. The CAMS version of the form will have most sections already completed. (See Step 4 above.)
  3. On SSA-1365 Item 7, Select "State VR agency’s employment network payment system of record".
  4. In CaMS, access the case assignment tab. Add "Ticket - VESID as EN " from the available special program options.
  5. Fax the Ticket Assignment form SSA-1365 to Maximus at 703-683-3289 or mail to the address on the top of the form.
  6. Give the individual a copy of the Ticket Assignment form SSA-1365.
  7. File Ticket Assignment form (or copy) in record of service with the IPE.

CAMS will contain a follow-up letter to use when individuals do not return the Ticket assignment forms.

What to do if an individual does not want to assign Ticket

If an individual does not want to assign their Ticket to VESID or another EN, VESID staff should encourage the assignment of the Ticket to VESID. VESID staff may discuss with the individual how the Ticket program allows VESID to recover from SSA the money spent on services, making it possible to serve more people. Protection from CDR should also be stressed.

After a thorough discussion, if the individual wishes to proceed with the IPE but is unwilling to sign the SSA-1365 Ticket Assignment form, VESID will ask the individual to explore more fully their options for employment services under the Ticket program prior to signing, initiating or continuing the IPE. This is not to delay provision of services but to assure that the individual understands their options before choosing VR services

VESID will refer to resources that can assist the individuals to look at options under the Ticket to Work program. Individuals who want to explore other options under the Ticket program should contact the Protection and Advocacy for Beneficiaries of Social Security (PABSS) Coordinator for NYS (Tom Gilbert) at the Commission on Quality Care at 1-800-624-4143. These resources include local advocacy and consumer organizations that have agreed to assist Ticket holders in exploring options under the Ticket program and services available for achieving employment goals.

VESID staff will also discuss the IPE with the individual to address any concerns the individual may have about committing to the services outlined in the plan.

After exploring options under the Ticket program, the VESID counselor and the individual will re-examine the IPE. If, due to the complexity of the Ticket program, the individual has serious concerns about use of the Ticket, then the individual can sign the IPE without signing the SSA-1365 Ticket Assignment form. Proceeding with the IPE without assigning the Ticket is considered an exception and requires the approval of the senior counselor.

The VESID counselor will continue to request Ticket assignment to VESID when the plan is periodically reviewed or when changes in status occur. Ticket assignment will also be pursued at closure. The individual' decision to not assign the Ticket will be noted in the record of services. In CAMS, access the case assignment tab. Add "Ticket - not assigned." If the individual assigns the Ticket to VESID, delete "Ticket - not assigned" and add appropriate code.

If an individual has already assigned a Ticket to an Employment Network

An SSDI/SSI beneficiary who has assigned a Ticket to an employment network (EN) may obtain vocational rehabilitation services from VESID under a written agreement between the EN and VESID.  The agreement will outline what services are to be provided by the EN, those services provided by VESID and the financial responsibilities of each.

  1.  An Employment Network must create an Individualized Work Plan (IWP) with each consumer outlining specific services needed to reach an agreed upon vocational goal and who will deliver services. 
  2. VESID policy and procedures on IPE development are to be followed with the IWP being considered similarly to a plan developed with technical assistance from other sources. (See VR Manual Section on IPE Development.) 
  3. Those services identified in the consumer's Individualized Work Plan (IWP) as provided by the employment network are considered comparable services.

    If an EN refers an individual to VESID and an agreement is not in place, the District Manager should be notified.   VESID and the EN are required to establish an agreement in order to coordinate services to the individual. The individual also has the option to reassign the Ticket to VESID. If the delay of services while agreement issues are resolved will interrupt the individual’s progress toward an employment outcome, delay an immediate job placement, or create serious hardship, then services should be initiated, in accordance with the above process for IPE development, with the approval of the District Office Manager.

    In CaMS, access the case assignment tab. Add "Ticket - assigned other EN" from the available special program options.

How to assist a consumer who wants to RESCIND the Ticket

If an individual decides that they no longer want to keep the Ticket with VESID, they must contact Maximus in writing and request that the Ticket be "rescinded". In this situation, VESID staff should inform the individual that if the Ticket is assigned to another EN, it can affect VESID services.

  1. Encourage the individual to consider options before making any changes.
  2. Discuss the potential impact with the individual and how VESID can continue working with the individual toward the work goal, even if through a counseling and guidance plan. This discussion should be documented in the record of services.
  3. If the individual rescinds the Ticket, access the case assignment tab in CaMS. Add "Ticket - rescinded" from the available special program options.

If the individual wants to work with VESID rather than the Employment Network that currently holds the Ticket Assignment:

  1. Inform the individual that they may rescind their Ticket by writing to Maximus at MAXIMUS SSA Ticket To Work, P.O. Box 25105, Alexandria, VA. 22313. The individual must include his/her name, address, SS # and signature and date with the request.
  2. Inform the individual that the Ticket will be available for reassignment to VESID or another EN 30 days after the notice is received and processed by Maximus.

Program Codes

  1. Enter appropriate Ticket to Work program code into CAMS.
  2. When the IPE is completed, or when other circumstances necessitate a change, the correct code should be added.
  3. Incorrect/former codes should be changed or deleted.

Ticket to Work Program Codes

Program Code CASE ASSIGNMENT
TAB/SPECIAL PROGRAM OPTIONS		 Meaning
Ticket - assigned to VESID The consumer has decided to assign the Ticket to VESID.
Ticket - not assigned Prior to plan development or when consumer chooses not to assign or does not respond to contacts.
Ticket - not received by consumer Consumer is SSA beneficiary, but did not receive Ticket - perhaps not eligible for Ticket
Ticket - assigned other EN Ticket is assigned to some other Employment Network. Client is being referred to VESID for some specific service
Ticket - VESID as EN Ticket is assigned to VESID and VESID is serving as an EN.
Ticket - reassigned to other Employment Network Ticket is re-assigned to an employment network.
Ticket - rescinded The Ticket is rescinded from VESID by the consumer with Maximus.

Copy of SSA-1365 State Agency Ticket Assignment Form

Form Approved OMB No. 0860-0641

STATE AGENCY TICKET ASSIGNMENT FORM
TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM
Instructions - This form must be completed to record that a beneficiary who is a ticket holder has decided to assign the ticket to a State Vocational Rehabilitation (VR) Agency. The form must be completed by both the State VR agency representative and the ticket holder or, as appropriate, the ticket holder's representative. The State VR agency will submit this form in lieu of submitting the Individualized Plan for Employment. The ticket holder or his/her representative, as appropriate must sign this form to confirm the decision to assign the ticket to the State VR Agency. The State VR agency will either send or fax the completed and signed form to:

Mail - MAXIMUS Ticket to Work
ATTN: Ticket Assignment
P.O. Box 25105
Alexandria, VA 22313

Fax - (703) 683-3289

A. To be Completed by State VR Agency (after verifying the beneficiary has a ticketwhich may be assigned to the State VR agency)

1. Enter the State VR Agency's name

Enter the State VR Agency's Employer Identification

2. Ticket Holder's Name (Last, First, Middle Initial)

3. Ticket Holder Number (This is the Social Security Number on the ticket with the TW suffix.)

4. (a) What vocational objective or employment outcome is outlined in the ticket holder's Individualized Plan for Employment?

4. (b) What is the expected type of job? (Check one EEOC Classification below):

□ Executive/Managerial
□ Professional
□ Sales
□ Technical/Paraprofessional

□ Skilled Craft
□ Secretarial/Office/Clerical
□ Service Worker
□ Operative
□ Laborer

5. (a) Date the Individualized Plan for Employment was signed by tecket holder or his/her representative (month, day, year)

5. (b) Date the Individualized Plan for Employment was signed by the State VR agency counselor (month, day, year)

6. In the Individualized Plan for Employment, date established for meeting the vocational objective chosed (month, year)

7. What SSA Payment System is the State VR agency selecting with respect to this ticket holder? (Place an X in the appropriate box).

□ Cost Reimbursement Payment System
□ State VR agency's employment network payment system of record
(if this option is selected, submit Form SSA-1366, "State Vocational Rehabilitation Ticket to Work Information Sheet" or equivalent information with this SSA-1365)

B. to be completed by the ticket holder or ticket holder's representative

Check the appropriate box and sign your name in the space provided below:
□ I am the ticket holder to whom the information on this form applies.
□ I am the representative of the ticket holder to whom the information on this form applies and am acting on his/her behalf.

I understand that once my ticket is assigned to the State VR agency, I have the right to retrieve my ticket for any reason. I acknowledge that the information contained on this form relating to the ticket holder is correct, and that I do willingly agree to assign my ticket to the State VR agency shown above.

I understand that if I make, or cause to be made, a representation which I know is false concerning the requirements of the Ticket to Work and Self-Sufficiency program, I could be punished by a fine, or imprisonment, or both.

Ticket Holder or Representative Signature

State VR Agency Representative Signature

Date

Date

Form SSA-1365 (10-2001)

 

Appendix I - Basic Information About the Ticket to Work Program

Description of the Ticket to Work Program

The Ticket to Work and Self-Sufficiency Program is a Social Security Administration (SSA) initiative that allows Social Security Disability and SSI beneficiaries to seek the employment services, vocational rehabilitation services and other support services needed to obtain, regain or maintain employment and reduce their dependence on cash benefit programs.  This program is intended to provide employment services and supports so that the individual can return to work and eliminate the need for cash benefits from Social Security.

The "Ticket" is a document that provides evidence of SSA's commitment to pay an employment network or a State VR agency to which a disabled beneficiary’s ticket is assigned, for providing employment services, vocational rehabilitation services, and other support services to the beneficiary.

Who is eligible to receive Tickets?

SSA has established that individuals who meet the following criteria are eligible to participate in the Ticket to Work Program:

  1. The individual is an SSDI/SSI participant between the ages of 18 and 64, in current pay status for monthly cash benefits; and
  2. The individual has a permanent impairment (no medical improvement expected), or the individual has a nonpermanent impairment (with medical improvement expected) and has had at least one continuing disability review.

Note:  SSI recipients must meet the SSI eligibility standard for adults.

SSDI/SSI Individuals who are not Eligible to Receive a Ticket

It is likely that there will be some SSDI/SSI participants served by VESID who are not eligible to receive a Ticket.  For example, individuals who are SSI recipients on 1619b Medicaid are not eligible to receive a Ticket. For those individuals where it is verified with Maximus that they are not eligible to receive a Ticket, enter program code for "Ticket - not received".

How is the Ticket Program Administered?

The Social Security Administration has contracted with a "Program Manager" to assist SSA in administering the Ticket to Work program. Maximus, a private contractor, is the SSA approved Program Manager for the Ticket to Work program.  Beneficiaries will receive Tickets to Work in the mail and will be told to call Maximus for information. Maximus will provide beneficiaries with contact information for VESID services and for Employment Networks (EN) serving the region.

Informing Participants of the SSA Ticket Timely Progress Requirements

One important advantage to SSA beneficiaries using Ticket to Work is the suspension of medical Continuing Disability Review (CDR) for participants who meet timely progress in demonstrating an increasing ability to work at levels which will reduce or eliminate dependence on Social Security entitlements. SSA has established "timely progress" criteria for the Ticket to Work program.

NOTE:  Maintaining SSA's "timely progress," as defined by SSA, is not a condition of obtaining services from VESID.  The IPE outlines the services and time required to achieve the chosen employment goal.  Also, work-triggered CDR has been eliminated for all SSDI beneficiaries (who have received SSDI benefits for at least 24 months), regardless of Ticket status.  However, all SSDI/SSI beneficiaries may be subject to a loss of benefits if their earned income exceeds the levels established by SSA regulations.

Table 1
SSA Timely Progress Criteria
Time Period Criteria
Initial 24 Months Actively Participate in the IPE.
Next Twelve Months - "the first 12-month work review period" Must work for at least 3 of the 12 months at Substantial Gainful Activity (SGA) level (for non-blind beneficiaries).  Note:  Any months worked at SGA during the Initial 24 months can count toward this first work review period requirement.
Second 12-Month Work Review Period Consumer must work for at least 6 of the 12 months at SGA level.  Does not need to be consecutive.
Third and for all subsequent 12-month work review periods. Consumer must work for at least 6 of the 12 months at an earnings level where SSDI or SSI (Federal portion) cash benefits are not payable.  Does not need to be consecutive

Consequences of Not Meeting Timely Progress Criteria

Maximus, or the designated Program Manager, will conduct progress reviews at the end of each time period. If the consumer does not meet the timely progress guidelines, the consumer will no longer be considered to be using a ticket and CDR protection will cease. In about 3 years, if a consumer does not meet timely progress , SSA will inform individuals that they are again subject to Continuing Disability Reviews and that the Ticket is inactive. However, the consumer can continue to pursue their employment goal with VESID. The individual may still be able to participate in the Ticket to Work program and be reinstated to "in use" status if they meet certain criteria established by SSA.

Appendix II - Definitions

"Assigning" a Ticket - A beneficiary has the choice of obtaining employment services from approved providers through the Ticket to Work program by "assigning" the Ticket to either a State VR Agency or an Employment Network. The Ticket is available for assignment, or "assignable", when an eligible individual wants to assign the ticket to VESID and it is not already assigned to an EN or other state VR agency.

Benefits Planning, Assistance and Outreach - The Social Security Administration has awarded funding to seven projects that offer services in specific catchment areas throughout all of New York State. These projects will assist beneficiaries of SSI and SSDI in determining the impact of earnings on benefits.

Continuing Disability Review (CDR) - A Continuing Disability Review (CDR) is a review conducted by SSA to determine if a beneficiary is still disabled under SSA's rules. Under the Ticket provisions, an individual will not be subject to medical CDRs during the period for which he or she is meeting SSA's "timely progress" criteria while using a Ticket. VESID consumers, who participate in the Ticket to Work program, are protected from medical CDR's if they meet the timely progress criteria.

Cost Reimbursement Payment System - Under the Social Security Act, Sections 222(d) and 1645 (1983), state VR agencies will be reimbursed for the cost of services (plus administrative and tracking fees) that lead to an SSDI/SSI recipient at substantial gainful activity (SGA) or above for 9 (out of 12) months. Under the Ticket program, state VR agencies will only receive cost reimbursement when the Ticket is assigned to the state VR agency.

Employment Network (EN)- Any qualified entity that has entered into an agreement with SSA to deliver employment, vocational rehabilitation and support services to beneficiaries of SSI and/or SSDI who have assigned their Tickets to them.

Individualized Work Plan (IWP) - An Employment Network is required to develop a written plan outlining the specific services necessary to reach an agreed upon employment goal and indicate who will deliver those services.

Maximus - Maximus tracks Ticket status of beneficiaries, recruits for and monitors Employment Networks (EN), facilitates access to Employment Networks by beneficiaries, gathers data necessary for payments to ENs, and other administrative requirements outlined by the Social Security Administration (SSA). 

Section 301 - Section 301 of the Social Security Disability Amendments of 1980 establishes that SSDI and SSI benefits can continue to be paid to a beneficiary whose impairment is determined to be no longer disabling if:

  1. the individual is participating in an approved vocational rehabilitation program before the disability ends under SSA rules; and,
  2. if SSA determines that completion of the VR program will increase the likelihood that the individual may be permanently removed from the disability benefit rolls.

If SSA determines that a consumer has medically improved and is therefore no longer eligible for benefits, the consumer should be able to continue to receive benefits while participating in vocational rehabilitation if they are pursuing an employment outcome that will enable them to leave the benefit rolls. VESID may need to verify to SSA an individual’s participation in vocational rehabilitation services. This enables the consumer to maintain income while completing their vocational rehabilitation program.

This protection extends to child’s SSI beneficiaries who, at age 18, will have their claims reviewed for eligibility under adult disability criteria. Although age 18 re-determinations are to be based on adult criteria, the SSI beneficiary under review must be afforded the same right to continued benefits as other persons being reviewed for medical improvement under a CDR.

Appendix III - Employment Network Agreement

Link to Employment Network Agreement: http://www.vesid.nysed.gov/tickettowork/enagreement.html

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