American Congress of Community Supports and Employment Services
Washington, DC 20006
February 14, 2002

House Committee on Ways and Means
The Honorable E. Clay Shaw, Jr., Chairman
Subcommittee on Social Security
B-316 Rayburn House Office Building
Washington, DC 20515-6353

House Committee on Ways and Means
The Honorable Wally Herger, Chairman
Subcommittee on Human Resources
B-317 Rayburn House Office Building
Washington, DC 20515-6351

Chairman Shaw and Chairman Herger:

Thank you for giving me the opportunity to submit my written statement on the challenges facing the Social Security Administration (SSA) and new Commissioner.  As chairmen of your respective subcommittees, I am sure that you can appreciate that the lives of individuals with disabilities are greatly impacted by the programs administered by SSA.

I am submitting my statement on behalf of the American Congress of Community Support and Employment Services (ACCSES).  ACCSES is a national, nonprofit organization of providers of vocational rehabilitation and community supports committed to maximizing employment opportunities and independent living for individuals with mental and/or physical disabilities.

I will focus my statement on the ongoing implementation of the Ticket to Work and Self-Sufficiency Program (hereafter referred to as the Ticket program), which is part of the historic Ticket to Work and Work Incentives Improvement Act (TWWIIA) of 1999.  Considering that many individuals with disabilities want to work, but do not for fear of losing their Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI), the Ticket program presents a clear opportunity for success. The success of the Ticket program will undoubtedly be measured in many ways, such as the number of beneficiaries discontinuing their Federal disability benefits, community rehabilitation programs (CRPs) providing quality services, and the potential savings to the Social Security Trust Fund.

The Ticket program embodies the desire that individuals with disabilities have in wanting to forego disability benefits and become self-sufficient. Since currently less than one half of one percent of SSDI beneficiaries and approximately one percent of SSI beneficiaries ever realize the dream of becoming self-sufficient, it is crucial that the legislative intent of the TWWIIA is maintained during the implementation process. Removing disincentives to work and barriers to access quality health care are the cornerstones of this landmark piece of legislation. Anything short of SSA achieving these goals will result in lost confidence in the system by both beneficiaries and community providers alike.

Despite congressional intent, in publishing its final regulations on the Ticket program SSA has created new and distinct barriers to employment for SSDI and SSI beneficiaries.  ACCSES feels that the exclusion of beneficiaries who have impairments that are expected to improve and for whom SAA has not yet conducted at least one continuing disability review (CDR) is troublesome.  The “medical improvement expected” (MIE) designation is ambiguous.  Reliable evaluations are hard to obtain and subject to interpretation by disability determination officials.  SSA’s decision is clearly based more on administrative convenience than sound public policy since many beneficiaries remain on the rolls well after their first CDR. All beneficiaries deserve an equal opportunity to participate in the Ticket program and access the services being offered by community providers that will enable them to gain self-supporting employment.

In fact, SSA acknowledges the weakness of its standard in its own response to comments under Section 411.125.  In its response, SSA stated, “…we plan to conduct an evaluation of the methodology for the classification system to assess possible ways to improve the system for use in identifying those beneficiaries for whom near-term medical improvement should preclude the immediate receipt of a Ticket.”

In maintaining the MIE exclusion in the final regulations, SSA stated that using “the medical improvement diary system is the most practical and efficient means available to identify those beneficiaries with impairments that are expected to improve within a relatively short period of time so as to permit the individual to engage in SGA <Substantial Gainful Activity>.”  The diary system, however, will not assist beneficiaries who have been improperly classified as MIE but continue to need ongoing rehabilitative support services (i.e. there were 2200 individuals with diagnosed schizophrenia in 1994 – a medical condition that often involves relapses).  Clearly these individuals need more than a diary to benefit from the resources available under the Ticket program.  Instead of being fearful that some beneficiaries with near-term medical improvements might use such resources to obtain employment and engage in SGA, SSA should focus their attention on granting beneficiaries maximum access to them.

Changing the final regulations to reflect the intent of the legislation is also consistent with the purpose of the Rehabilitation Act of 1973, as amended.  Both the Ticket-to-Work program and the Rehabilitation Act of 1973, as amended, aim to offer the needed resources and opportunities for individuals with disabilities who want to enter or reenter the workforce.  More importantly though, both stress the importance of informed consumer choice and self-determination in accessing rehabilitative and support services.  By denying beneficiaries designated as MIE, SSA is essentially denying beneficiaries from exercising their right to choose the best and most appropriate options available in ending their dependency on cash benefits.

Along the same lines as the MIE exclusion, SSA has created an additional disincentive with its timely progress standards toward self-supporting employment.  Though ACCSES recognizes that these standards only apply to CDR protection (and not participation in the Ticket program), beneficiaries will be wary of participating if they fear a negative CDR determination will end their cash benefits prior to obtaining self-supporting employment.  Basically, there is no incentive for beneficiaries to participate in the Ticket program without an unambiguous CDR protection.

The standards in the final regulations are clearly too rigid and do not take into consideration the different abilities of beneficiaries who have different disabilities.  In other words, a “one-size-fits-all” approach to the timely progress standards assumes that beneficiaries with physical and mental disabilities require the same rehabilitative services and supports.  This approach may be easier to administer and monitor, but it will make it harder for beneficiaries with severe, persistent, and complex disabilities to enter or re-enter the workforce.  Individuals with psychiatric, developmental, physical, and/or multiple disabilities require different services and supports and, therefore increased flexibility not only recognizes individual differences, but also accommodates them, thus assuring an increased opportunity for success.

The timely progress standards should be directly related to how beneficiaries are accomplishing their employment goals as outlined in their approved Individual Work Plans (IWPs).  Connecting the timely progress standards to the IWPs puts the beneficiaries in control of their own progress – thus, ensuring a greater probability of success.  This approach, if adopted by SSA, would, again, be consistent with the emphasis placed on informed consumer choice and self-determination by the Ticket program and the Rehabilitation Act of 1973, as amended.  As long as beneficiaries are actively engaged in working toward their employment goal, and the community providers are furnishing services (employment, vocational rehabilitation, or other support services as outlined in Subpart E in the final regulation) then their level of success should not be adversely measured using “administrative” standards.

It appears that SSA has sided, again, with administrative convenience in establishing its standards for CDR protection instead of the congressional intent to remove barriers and disincentives.  In responding to comment, SSA stated, “… if we allowed the individual and the EN or State VR agency to define timely progress, it would not be possible to develop a consistent and standardized method to determine timely progress for program administration and integrity purposes.”  Considering that the IWP is basically the contract between beneficiaries and community providers – with clearly required and defined components already approved by SSA Program Managers – SSA has the documentation needed to maintain the program administration and integrity it references.

The final regulations already show a willingness by SSA to recognize unforeseen events, which may cause beneficiaries to suspend their work efforts.  By granting an unassigned or inactive ticket status during the initial 24-month period, SSA is allowing beneficiaries to temporarily suspend their employment plan.  Also, the months in which their tickets are inactive do not count toward the time limitations for making timely progress toward self-supporting employment.  Clearly, if beneficiaries are working toward achieving their employment goals outlined in their IWPs, then it stands to reason that they are meeting the timely progress standards.  SSA should not penalize beneficiaries with inflexible standards.

SSA has also modified its standards in the final regulations to allow for “banking” of work during the initial 24-month period to meet work requirements of the first 12-month progress review period if the work was at the requisite level.  If SSA is willing to accommodate beneficiaries and their unique needs by allowing the banking of work, then SSA should also be willing to modify their standards to maximize beneficiaries’ self-determination.

Finally, the success of putting beneficiaries back to work will, in large part, depend on the availability of employment services, vocational rehabilitative services, and other support services in the community.  Most community providers fully recognize that the program does not come without risks and therefore will be looking for incentives to make their participation justifiable as an Employment Network (EN).  ACCSES is concerned that by only allowing community providers to change their desired payment system every 18 months, the final regulations will hinder the recruitment of ENs.  Community providers will be looking for flexibility to help ease their apprehension over the risks associated with their participation.

Granted, community providers are not obligated to accept tickets that they feel are beyond their service expertise.  However, since the Ticket program is outcome-based in nature, community providers will have to wait an extended period of time before seeing a return on their investment (i.e. furnishing services to beneficiaries).  And though community providers can elect to choose the milestone-outcome payment system – which begins making payments sooner once milestones are achieved – the total net worth of the payments is less than the outcome payment system.  By making what amounts to a simple infrastructure change, SSA will go a long way in appeasing provider apprehension.

In addition, many potential community providers are not-for-profit organizations that lack the resources to deliver services without some cost reimbursement prior to job placement. Few of these organizations can afford to wait for a year or longer before recovering at least some of their costs. The current payment system will prevent the majority of community providers from participating in the program and will result in a lack of choice for beneficiaries and in a service delivery system with insufficient capacity. Furthermore, by shifting all of the risk to community providers, it is reasonable to expect that beneficiaries with higher abilities will be targeted for services with the most in need viewed as to great a risk.

On a related issue, SSA decided not to narrow the gap in net payment amounts between the outcome and milestone-outcome payment systems.  Currently, under the milestone-outcome payment system in the final regulations, SSA will only pay 85 percent of the total payments under the outcome payment system.  The concept is in keeping with congressional intent and the statutory language, but the size of the gap is questionable.

The milestone-outcome payment system was added to the statute because community providers expressed their reluctance to participate in the Ticket program with the proposed outcome-only based payment system.  The addition of the milestone-outcome payments aimed to entice community providers to enroll as ENs and offer service to beneficiaries.  By only paying 85 percent, SSA essentially created a roadblock for community providers who are considering accepting the risk associated with the program.  Though community providers will receive some up-front monies, the total amount not materialized (15 percent) is a high price to pay.

Considering that to date SSA has had difficulties in recruiting community providers to enroll as ENs, the concerns expressed over the payment systems should be taken under advisement.

In closing, ACCSES appreciates the opportunity to submit its written statement to the House Ways and Means Subcommittees on Social Security and Human Resources.  ACCSES urges the new Commissioner of SSA to incorporate these important changes as the ongoing implementation of the Ticket program moves forward.  Thank you in advance for your consideration and attention to this issue.  Should you desire additional information, please feel free to contact me at 231-922-4886, or Brandon Macsata in our Washington, DC office at 202-466-3355.  I am

Sincerely,

Steve H. Perdue
President