Evaluation of the Ticket to Work Program Initial Evaluation Report

59
• Are SVRAs permitted to require ENs to reimburse the SVRA for administrative
costs, including counseling and guidance, in addition to direct employment
support services? In at least one state, case management counseling services,
normally a part of an SVRA’s Individual Plan for Employment, become the
required responsibility of the EN.
• Can SVRAs collect a share of SSA payments to an EN over and above the actual
amount expended by the SVRA on behalf of a beneficiary? In at least two states,
the VR/EN agreement requires the EN to share payments with the SVRA even
after all costs have been repaid by the EN.
• Are SVRAs permitted to require ENs to reimburse the SVRA for its
expenditures, even before the EN begins to receive Ticket payments from SSA?
In at least one state, the VR/EN agreement requires the EN to reimburse the
SVRA for the total cost of all services, even if the EN stops receiving TTW
payments before being fully reimbursed.
In some states, dozens of ENs have signed VR/EN agreements with the SVRA. In
others, few, if any, ENs have entered into agreements. The lack of signed VR/EN
agreements in many states might be due to several factors. Some ENs, particularly national
ENs, may not see a need to sign an agreement with an SVRA. Other ENs may view the
terms of the agreements as financially unfavorable. In some instances, the SVRA may not
be aggressively pursuing the development of agreements with non-VR ENs, preferring to
encourage the assignment of all Tickets to the SVRA.
e. Summary
Despite initial concerns about the impact of TTW on existing funding streams and
administrative procedures, many SVRAs appear to have increased their emphasis on
providing services to SSA beneficiaries. In addition, SVRAs continue to receive the
overwhelming majority of Ticket assignments, in spite of their concerns about the
relationship between TTW and the SSA traditional payment system, Ticket assignment and
program implementation procedures, and SVRA relationships with other ENs. While many
SVRAs still have significant concerns about the future of TTW, it appears that the program
has not had the significant negative effect on SVRAs that many had feared.
4. Employment Networks
TTW represents a significant change in the business practices for ENs that are
traditional providers of rehabilitation services, as are most. The primary changes relate to
the nature of the payment system and to provider relationships with SVRAs.
With respect to the payment system, many traditional providers have relied on funding
from an SVRA and other sources that, while outcome-based in some respects (depending on
the state), typically finance services up-front and over shorter time periods. TTW payment is
wholly based on outcomes and is extended over a long period. For many providers, such a
III: TTW Early Implementation