Evaluation of the Ticket to Work Program, Implementation ...

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104case, the counselor selects the outcome-only option. Staff had determined that$10,000 is the average cost reimbursement.• In Vermont, SVRA staff select the outcome-only system for beneficiaries whoare on DI, under age 55, and will likely require less than $10,000 in services. Inaddition, the agency attempts to clinically appraise the likelihood that theindividual is capable of working above the SGA for some period that willgenerate enough payments for the agency to recoup its service costs.• In Massachusetts, SVRA staff select the milestone-outcome payment system forclients served exclusively through state funds. The Massachusetts legislaturesupplements the SVRA’s federal case service monies with funds beyond therequired match. One official indicated that SSA could not reimburse the agencyfor these additional state funds because the traditional payment system appliesonly to cases served through federal/state matched monies.D. SVRA-EN RELATIONSHIPSIn our initial evaluation report, we made the point that, while TTW regulations alloweach EN to negotiate an individualized agreement with an SVRA, most SVRAs have simplydeveloped a standard agreement for use with all ENs. Furthermore, because SVRAs andRSA have interpreted TTW as a “comparable benefit,” 5 SVRAs have typically craftedagreements requiring ENs to reimburse them for most or all services provided by SVRAs toa beneficiary whose Ticket was assigned to an EN. If a resource is identified as acomparable benefit, the SVRA views that resource as a “first dollar” expenditure, meaningthat the comparable benefit funds (i.e., the Ticket) are applied first before accessing SVRAfunds. Unfortunately, in crafting SVRA-EN agreements, SVRAs have interpreted the notionof comparable benefit broadly. If an EN indicated that it could provide a specific service inits application to the PM, then that service was viewed as a comparable benefit for all Ticketholders, and the agreement required the EN to reimburse the SVRA for the service.Informal guidance from RSA (Stafford 2003) has directed SVRAs to apply the concept ofcomparable benefits at the level of the individual consumer. If a specific service matches aservice in an individual’s IPE and is available in a timely manner, then the service should beconsidered a comparable benefit. If the service is not in the individual’s IPE or not readilyavailable at the time the individual requires it, the service should not be considered acomparable benefit. The latter approach to interpreting comparable benefits would requireENs to reimburse SVRAs for services much less frequently.5 Comparable services and benefits are defined in the Rehabilitation Act of 1973 as amended by theWorkforce Investment Act of 1998 as follows: “(A) Services and benefits that are provided or paid for, inwhole or in part, by other Federal, State, or local public agencies, by health insurance, or by employee benefits;(B) Available to the individual at the time needed to ensure the progress of the individual toward achieving theemployment outcome in the individual’s individualized plan for employment; and (C) Commensurate to theservices that the individual would otherwise receive from the designated State vocational rehabilitation agency.”Section 101 (a) (8), 34 CFR Part 361.5.VI: State Vocational Rehabilitation Agency Participation in Ticket to Work
The findings described above were based on an analysis of SVRA-EN agreementsobtained during site visits conducted in 2002 as a part of the preliminary process evaluation.To determine whether the agreements changed as TTW was rolled out, we analyzed 27agreements obtained in 2004 from the 34 Phase 1 and 2 SVRAs (not all states had developedagreements at the time of the analysis). We also supplemented the analysis with data frominterviews we conducted for this report with the 8 SVRAs.We found that little had changed. SVRA-EN agreements still generally require ENs toreimburse SVRAs for most or all of the services provided by the latter to beneficiaries whohave assigned their Ticket to an EN. In many states, it appears that few ENs are signingagreements. This section reviews the core components of SVRA-EN agreements, describesthe status of RSA guidance, and details why, in the eight states we examined, few individualsare jointly served under the terms of an agreement.1. Core Components of SVRA-EN AgreementsSVRA-EN agreements describe the terms and conditions under which the SVRA willprovide services to a beneficiary referred by an EN. For instance, the agreements coverissues such as referral and information-sharing procedures, the financial responsibilities ofboth parties, the terms under which the EN will reimburse the SVRA for services provided,and dispute resolution procedures. Below, we discuss how agreements vary with respect totheir core components: how reimbursable services are defined, conditions under which ENsare expected to reimburse SVRAs, SVRA incentive payments, and the sharing of SSAreimbursements.Definition of Reimbursable Services. In most of the 27 agreements we reviewed,ENs are required to reimburse the SVRA only for direct services such as assessment,placement, or job-accommodation services. In 5 of the agreements, however, SVRAsrequire ENs to reimburse the SVRA for administrative and counseling/guidance services.In addition, nearly half of the agreements stipulate that SVRAs will not provide or pay forservices that the EN has indicated it can provide in its application to the Program Managerand/or on the beneficiary’s IWP.Conditions Under Which ENs Will Reimburse the SVRA. The conditions can varyconsiderably depending on the agreement.• Of the 27 agreements, 24 do not require the EN to reimburse the SVRA forservices until the beneficiary is employed at a level that will bring in milestone oroutcome payments. However, 3 agreements require the EN to reimburse theSVRA immediately after services are provided regardless of whether the EN hasbegun to receive payments from SSA.• While most agreements allow the EN to retain a portion of payments receivedfrom SSA beginning with the first payment, six of the agreements require theEN to reimburse the SVRA completely before the EN is allowed to keep anyportion of the payment from SSA.105VI: State Vocational Rehabilitation Agency Participation in Ticket to Work
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A CKNOWLEDGMENTSThe Ticket To Work
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viiiChapterVI(CONTINUED)PageF. SUMM
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xChapterPageAPPENDIX A: TICKET TO W
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xiiTableVIII.3IX.1IX.2IX.3IX.4IX.5I
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xivFigureIII.5III.6III.7III.8III.9P
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xviIX.3EARNINGS OF BENEFICIARIES WI
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xviiiMIENBSNPRMOAGPABSSPSUSGASSASSI
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xxIn Phase 3, which began in Novemb
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xxiigroups of beneficiaries that Co
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xxivimprove TTW, therefore, is to f
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2of disability beneficiaries, and i
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4country. Phase 2 began in November
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Page Is Intentionally Left Blank to
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8Only a few beneficiary characteris
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10Figure II.2.Participation Rate, b
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12Figure II.4.First Assignments at
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14before Ticket, it is perhaps surp
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16was selected for Phase 3. This ma
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18All of the statistics in this sec
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Table II.2. Beneficiary Groups with
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22In all Phase 1 and Phase 2 states
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24Figure II.8. Ticket Participation
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26Adjustments for all other charact
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28In general, provider and payment
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30next report, we will conduct more
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32Figure III.2.Living Arrangements
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34• Less likely to have reported
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36Figure III.7.Prevalence of Diffic
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38are more likely than all benefici
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40Table III.1.Income and Program Pa
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42coverage through their own employ
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44sizable percentage of TTW partici
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46Overall, 9 percent of working-age
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48leave the rolls in the next year,
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50next year and in the next five ye
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52in their characteristics, levels
Page 78 and 79: 54percentage points to 3.7 percent.
Page 80 and 81: 56Figure IV.2. Phase 1 Ticket Recip
Page 82 and 83: 58situation described in the preced
Page 84 and 85: 60the end of the follow-up period w
Page 86 and 87: 62Figure IV.6. Average Monthly Bene
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Page 90 and 91: 66ENs were reluctant to expand serv
Page 92 and 93: 68As of July 2004, there were about
Page 94 and 95: 70But most EN representatives saw T
Page 96 and 97: 72Figure V.2. Number of EN Terminat
Page 98 and 99: 74received a total of just about $2
Page 100 and 101: 76Relatively few ENs have received
Page 102 and 103: 78According to their representative
Page 104 and 105: 80Five EN officials recognized that
Page 106 and 107: 82This was particularly true for so
Page 108 and 109: 84• Another EN representative fou
Page 110 and 111: 86• A third EN received 50 calls
Page 112 and 113: 88resolve administrative issues suc
Page 114 and 115: 90• Raise payments for SSI benefi
Page 116 and 117: 92Finally, the real and perceived w
Page 118 and 119: 94efforts to obtain Ticket assignme
Page 120 and 121: 96SSA payments to SVRAs under the T
Page 122 and 123: 98Figure VI.3. Total SSA Payments t
Page 124 and 125: 100assigning their Tickets to ENs (
Page 126 and 127: 102Table VI.1. SVRA Ticket Assignme
Page 130 and 131: 106• Most of the agreements requi
Page 132 and 133: 108needs of SSA beneficiaries and,
Page 134 and 135: 110to the SVRA under the traditiona
Page 136 and 137: 112Tickets each month from November
Page 138 and 139: 114about submitting virtually ident
Page 140 and 141: 116To make EN recruiting efforts mo
Page 142 and 143: 118E. EN ENROLLMENTThe Program Mana
Page 144 and 145: 120beneficiaries who have achieved
Page 146 and 147: 122quarterly basis if they have rec
Page 148 and 149: 124SSA’s approval of systems spec
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Page 152 and 153: 128have accepted. But even at that
Page 154 and 155: 130For beneficiaries who express an
Page 156 and 157: 132rehabilitation counselors (Burea
Page 158 and 159: 134generated a payment to an EN gen
Page 160 and 161: 136the milestone-outcome payment ge
Page 162 and 163: 138system is used so infrequently t
Page 164 and 165: 140One option is for ENs to try to
Page 166 and 167: 142approximations. Our planned anal
Page 168 and 169: 144Figure IX.1. Ticket-Eligible Ben
Page 170 and 171: 146Table IX.2.TTW Participation Rat
Page 172 and 173: 148Figure IX.3. Earnings of Benefic
Page 174 and 175: 150Compared with other beneficiarie
Page 176 and 177: 152Like all other beneficiaries who
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This kind of mixed success in the e
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C. SVRA PARTICIPATION REMAINS STRON
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serving beneficiaries who are simil
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observe changes in their employment
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Mashaw, Jerry L., and Virginia P. R
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A-2Table A.1 (continued)Time Period
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Table B.1. DefinitionsB-2Variable D
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Table B.1 (continued)B-4Variable De
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Table B.1 (continued)Variable Defin
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B-8Table B.3. Participation Rate by
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B-10C. PARTICIPATION RATES BY BENEF
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Table B.6. Participation Rates by C
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Table B.6 (continued)Group Definiti
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Table B.6 (continued)B-16Group Defi
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C-2survey. Whenever possible, the i
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C-4given the large number of benefi
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C-6• Young SSI recipients who are
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C-8beneficiary may have had with EN
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C-10Table C.2. Overview of the Nati
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C-12Sample completes (n=1,178) and
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C.14Table C.3 (continued)AllIntervi
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C.16Table C.5. Final Weighted and U
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C.18Table C.7. Sociodemographic Cha
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C.20Table C.9. Health Status (Figur
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C.22Table C.11. Program Participati
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C.24Table C.14. Awareness of TTW (F
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C.26Table C.16. Employment Expectat
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D-2Table D.1. Selected Characterist
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D-4information from two pretest int
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