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statement, and the statements of Bridges staff noted below, suggests that this EN, and
perhaps others in the future, may switch to the outcome-only system if greater experience
and data-driven analysis show it to be financially viable.
Two of the ENs changed their payment systems after initial selection. Initially IDR
planned to use the outcome-only payment system with the expectation that the bulk of its
Ticket assignments would come from its existing caseload. This population posed little risk
because IDR was already receiving payments for serving these individuals. As it became
obvious that the majority of its TTW customers would be retail clients, IDR switched to the
milestone-outcome payment system. IDR perceives the outcome-only payment system to be
riskier than the milestone-outcome system, and with no outside funding sources for these
clients, IDR was hesitant to assume any more risk than was absolutely necessary.
The Marriott Bridges program initially chose the outcome-only system, but switched to
the milestone-outcome system prior to the first interview in fall 2002. Program officials
came to believe that the young beneficiaries they serve (all are ages 18 to 21) generally would
not have enough employment stability to generate the full number of outcome payments—
that is, they would not remain employed above the SGA level for five years. For example,
some early clients moved away and stopped working relatively soon, and the program
collected no payments on them. Realizing they could have collected milestone payments on
those clients (and on others like them in the future), EN officials changed their selection to
the milestone-outcome payment system, which they figured would produce more revenue.
As a result of the switch, Bridges currently receives payments under both systems, depending
on which was in place when a client assigned his or her Ticket. Now, however, the EN
would like to switch back to the outcome-only system, because, officials said, they would like
to collect the larger monthly payments on behalf of some two dozen clients who are working
consistently over SGA. The EN will have to wait, however, until the required time period
passes before it can change its payment plan a second time.
For Oklahoma’s DRS, the milestone-outcome payment system was a natural choice,
officials said. Ten years earlier the agency had developed a milestone system for paying
community rehabilitation programs. Under that system, community rehabilitation programs
received up to eight milestone payments totaling $9,000 ($11,000 if the consumer was highly
challenged) for each successful rehabilitation. The staff member who manages SSA
reimbursement for the SVRA decides on a case-by-case basis whether to use the milestoneoutcome
option or the traditional payment system for each new Ticket assignment,
depending on the agency’s past experience assisting individuals with similar characteristics.
For clients who are expected to receive services totaling less than $5,000, DRS elects to be
paid as an EN under the milestone-outcome payment system; for other, more-expensive
cases they choose the traditional system. According to DRS staff, this flexibility has enabled
DRS, acting as an EN, to receive payment for services that the agency would historically not
have received under SSA’s traditional payment system. For example, by selecting the
milestone-outcome payment system for individuals with mental retardation or
developmental disabilities in supported employment, DRS might secure three or four
milestone payments. The agency would likely not be able to receive traditional payments for
V: Case Studies of Eight Experienced TTW Providers