Evaluation of the Ticket to Work Program Initial Evaluation Report

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ENs may periodically elect to change their payment systems. They may change their
initial payment system within 12 months after selecting it or within 12 months after TTW is
rolled out in the state, whichever is later. Thereafter, ENs can switch payment systems no
more frequently than every 18 months. However, payments made to ENs with respect to a
particular beneficiary are always based on the payment system in place when the beneficiary’s
Ticket was assigned. Consequently, ENs that select to switch payment systems may receive
payments under both systems simultaneously.
SVRAs can choose whether to serve a given beneficiary under either of the two new
payment systems or under the traditional payment system. If acting as an EN, the SVRA
will be paid under the EN payment system it has elected (the outcome-only or milestoneoutcome
system). If acting as a traditional vocational rehabilitation provider, the SVRA will
be reimbursed under the traditional payment system. This system is also used when SVRAs
serve beneficiaries who have not been issued Tickets or beneficiaries who were receiving
services from the SVRA before they became eligible for a Ticket and subsequently decide
not to assign the Ticket to the SVRA.
B. PROGRAM CONTEXT
The success of the TTW program will be strongly influenced by the context in which it
is implemented. This section provides background information on SSA’s traditional
vocational rehabilitation payment system that TTW is replacing, describes the variety of
private organizations that provide work-related services to disability beneficiaries, and
discusses several public initiatives that help disability beneficiaries find and maintain
employment. A number of the initiatives were designed specifically for individuals served by
the TTW program.
1. Traditional Vocational Rehabilitation System
Since 1981, under SSA’s Vocational Rehabilitation Reimbursement Program (which we
refer to as the traditional payment system), SSA has reimbursed SVRAs for services
provided to SSA beneficiaries that result in specified employment outcomes. This payment
system, which replaced an earlier block grant program, was designed to improve program
outcomes and accountability. Under this system, the state Disability Determination Service
applied a set of criteria to individuals awarded SSI or DI benefits. Individuals who appeared
to be good candidates for rehabilitation were referred to the SVRA and were then required
to participate in the program or risk losing their benefits. (While legally binding, however,
this provision was seldom enforced.) Beneficiaries could also apply on their own, without
being referred. SSA reimburses SVRAs for reasonable and necessary costs of services
provided to disability beneficiaries if such services result in the person’s achieving work at
the level of SGA for 9 months in a 12-month period.
For reimbursement, SVRAs must submit evidence that the beneficiary has returned to
work at a level exceeding SGA for 9 months in a 12-month period. SVRAs typically track
beneficiary earnings through state administrative data systems rather than through contact
with the beneficiary or the beneficiary’s employer. They commonly use quarterly state
II: Structure and Background of the Ticket to Work Program