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U.S. Code as of:
01/19/04
Section 1320b-19. The Ticket to Work and Self-Sufficiency Program
(a) In general
The Commissioner shall establish a Ticket to Work and
Self-Sufficiency Program, under which a disabled beneficiary may
use a ticket to work and self-sufficiency issued by the
Commissioner in accordance with this section to obtain employment
services, vocational rehabilitation services, or other support
services from an employment network which is of the beneficiary's
choice and which is willing to provide such services to such
beneficiary.
(b) Ticket system
(1) Distribution of tickets
The Commissioner may issue a ticket to work and
self-sufficiency to disabled beneficiaries for participation in
the Program.
(2) Assignment of tickets
A disabled beneficiary holding a ticket to work and
self-sufficiency may assign the ticket to any employment network
of the beneficiary's choice which is serving under the Program
and is willing to accept the assignment.
(3) Ticket terms
A ticket issued under paragraph (1) shall consist of a document
which evidences the Commissioner's agreement to pay (as provided
in paragraph (4)) an employment network, which is serving under
the Program and to which such ticket is assigned by the
beneficiary, for such employment services, vocational
rehabilitation services, and other support services as the
employment network may provide to the beneficiary.
(4) Payments to employment networks
The Commissioner shall pay an employment network under the
Program in accordance with the outcome payment system under
subsection (h)(2) of this section or under the outcome-milestone
payment system under subsection (h)(3) of this section (whichever
is elected pursuant to subsection (h)(1) of this section). An
employment network may not request or receive compensation for
such services from the beneficiary.
(c) State participation
(1) In general
Each State agency administering or supervising the
administration of the State plan approved under title I of the
Rehabilitation Act of 1973 (29 U.S.C. 720 et seq.) may elect to
participate in the Program as an employment network with respect
to a disabled beneficiary. If the State agency does elect to
participate in the Program, the State agency also shall elect to
be paid under the outcome payment system or the outcome-milestone
payment system in accordance with subsection (h)(1) of this
section. With respect to a disabled beneficiary that the State
agency does not elect to have participate in the Program, the
State agency shall be paid for services provided to that
beneficiary under the system for payment applicable under section
422(d) of this title and subsections (d) and (e) of section 1382d
of this title. The Commissioner shall provide for periodic
opportunities for exercising such elections.
(2) Effect of participation by State agency
(A) State agencies participating
In any case in which a State agency described in paragraph
(1) elects under that paragraph to participate in the Program,
the employment services, vocational rehabilitation services,
and other support services which, upon assignment of tickets to
work and self-sufficiency, are provided to disabled
beneficiaries by the State agency acting as an employment
network shall be governed by plans for vocational
rehabilitation services approved under title I of the
Rehabilitation Act of 1973 (29 U.S.C. 720 et seq.).
(B) State agencies administering maternal and child health
services programs
Subparagraph (A) shall not apply with respect to any State
agency administering a program under subchapter V of this
chapter.
(3) Agreements between State agencies and employment networks
State agencies and employment networks shall enter into
agreements regarding the conditions under which services will be
provided when an individual is referred by an employment network
to a State agency for services. The Commissioner shall establish
by regulations the timeframe within which such agreements must be
entered into and the mechanisms for dispute resolution between
State agencies and employment networks with respect to such
agreements.
(d) Responsibilities of the Commissioner
(1) Selection and qualifications of program managers
The Commissioner shall enter into agreements with 1 or more
organizations in the private or public sector for service as a
program manager to assist the Commissioner in administering the
Program. Any such program manager shall be selected by means of a
competitive bidding process, from among organizations in the
private or public sector with available expertise and experience
in the field of vocational rehabilitation or employment services.
(2) Tenure, renewal, and early termination
Each agreement entered into under paragraph (1) shall provide
for early termination upon failure to meet performance standards
which shall be specified in the agreement and which shall be
weighted to take into account any performance in prior terms.
Such performance standards shall include -
(A) measures for ease of access by beneficiaries to services;
and
(B) measures for determining the extent to which failures in
obtaining services for beneficiaries fall within acceptable
parameters, as determined by the Commissioner.
(3) Preclusion from direct participation in delivery of services
in own service area
Agreements under paragraph (1) shall preclude -
(A) direct participation by a program manager in the delivery
of employment services, vocational rehabilitation services, or
other support services to beneficiaries in the service area
covered by the program manager's agreement; and
(B) the holding by a program manager of a financial interest
in an employment network or service provider which provides
services in a geographic area covered under the program
manager's agreement.
(4) Selection of employment networks
(A) In general
The Commissioner shall select and enter into agreements with
employment networks for service under the Program. Such
employment networks shall be in addition to State agencies
serving as employment networks pursuant to elections under
subsection (c) of this section.
(B) Alternate participants
In any State where the Program is being implemented, the
Commissioner shall enter into an agreement with any alternate
participant that is operating under the authority of section
422(d)(2) of this title in the State as of December 17, 1999,
and chooses to serve as an employment network under the
Program.
(5) Termination of agreements with employment networks
The Commissioner shall terminate agreements with employment
networks for inadequate performance, as determined by the
Commissioner.
(6) Quality assurance
The Commissioner shall provide for such periodic reviews as are
necessary to provide for effective quality assurance in the
provision of services by employment networks. The Commissioner
shall solicit and consider the views of consumers and the program
manager under which the employment networks serve and shall
consult with providers of services to develop performance
measurements. The Commissioner shall ensure that the results of
the periodic reviews are made available to beneficiaries who are
prospective service recipients as they select employment
networks. The Commissioner shall ensure that the periodic surveys
of beneficiaries receiving services under the Program are
designed to measure customer service satisfaction.
(7) Dispute resolution
The Commissioner shall provide for a mechanism for resolving
disputes between beneficiaries and employment networks, between
program managers and employment networks, and between program
managers and providers of services. The Commissioner shall afford
a party to such a dispute a reasonable opportunity for a full and
fair review of the matter in dispute.
(e) Program managers
(1) In general
A program manager shall conduct tasks appropriate to assist the
Commissioner in carrying out the Commissioner's duties in
administering the Program.
(2) Recruitment of employment networks
A program manager shall recruit, and recommend for selection by
the Commissioner, employment networks for service under the
Program. The program manager shall carry out such recruitment and
provide such recommendations, and shall monitor all employment
networks serving in the Program in the geographic area covered
under the program manager's agreement, to the extent necessary
and appropriate to ensure that adequate choices of services are
made available to beneficiaries. Employment networks may serve
under the Program only pursuant to an agreement entered into with
the Commissioner under the Program incorporating the applicable
provisions of this section and regulations thereunder, and the
program manager shall provide and maintain assurances to the
Commissioner that payment by the Commissioner to employment
networks pursuant to this section is warranted based on
compliance by such employment networks with the terms of such
agreement and this section. The program manager shall not impose
numerical limits on the number of employment networks to be
recommended pursuant to this paragraph.
(3) Facilitation of access by beneficiaries to employment
networks
A program manager shall facilitate access by beneficiaries to
employment networks. The program manager shall ensure that each
beneficiary is allowed changes in employment networks without
being deemed to have rejected services under the Program. When
such a change occurs, the program manager shall reassign the
ticket based on the choice of the beneficiary. Upon the request
of the employment network, the program manager shall make a
determination of the allocation of the outcome or
milestone-outcome payments based on the services provided by each
employment network. The program manager shall establish and
maintain lists of employment networks available to beneficiaries
and shall make such lists generally available to the public. The
program manager shall ensure that all information provided to
disabled beneficiaries pursuant to this paragraph is provided in
accessible formats.
(4) Ensuring availability of adequate services
The program manager shall ensure that employment services,
vocational rehabilitation services, and other support services
are provided to beneficiaries throughout the geographic area
covered under the program manager's agreement, including rural
areas.
(5) Reasonable access to services
The program manager shall take such measures as are necessary
to ensure that sufficient employment networks are available and
that each beneficiary receiving services under the Program has
reasonable access to employment services, vocational
rehabilitation services, and other support services. Services
provided under the Program may include case management, work
incentives planning, supported employment, career planning,
career plan development, vocational assessment, job training,
placement, follow-up services, and such other services as may be
specified by the Commissioner under the Program. The program
manager shall ensure that such services are available in each
service area.
(f) Employment networks
(1) Qualifications for employment networks
(A) In general
Each employment network serving under the Program shall
consist of an agency or instrumentality of a State (or a
political subdivision thereof) or a private entity, that
assumes responsibility for the coordination and delivery of
services under the Program to individuals assigning to the
employment network tickets to work and self-sufficiency issued
under subsection (b) of this section.
(B) One-stop delivery systems
An employment network serving under the Program may consist
of a one-stop delivery system established under subtitle B of
title I of the Workforce Investment Act of 1998 (29 U.S.C. 2811
et seq.).
(C) Compliance with selection criteria
No employment network may serve under the Program unless it
meets and maintains compliance with both general selection
criteria (such as professional and educational qualifications,
where applicable) and specific selection criteria (such as
substantial expertise and experience in providing relevant
employment services and supports).
(D) Single or associated providers allowed
An employment network shall consist of either a single
provider of such services or of an association of such
providers organized so as to combine their resources into a
single entity. An employment network may meet the requirements
of subsection (e)(4) of this section by providing services
directly, or by entering into agreements with other individuals
or entities providing appropriate employment services,
vocational rehabilitation services, or other support services.
(2) Requirements relating to provision of services
Each employment network serving under the Program shall be
required under the terms of its agreement with the Commissioner
to -
(A) serve prescribed service areas; and
(B) take such measures as are necessary to ensure that
employment services, vocational rehabilitation services, and
other support services provided under the Program by, or under
agreements entered into with, the employment network are
provided under appropriate individual work plans that meet the
requirements of subsection (g) of this section.
(3) Annual financial reporting
Each employment network shall meet financial reporting
requirements as prescribed by the Commissioner.
(4) Periodic outcomes reporting
Each employment network shall prepare periodic reports, on at
least an annual basis, itemizing for the covered period specific
outcomes achieved with respect to specific services provided by
the employment network. Such reports shall conform to a national
model prescribed under this section. Each employment network
shall provide a copy of the latest report issued by the
employment network pursuant to this paragraph to each beneficiary
upon enrollment under the Program for services to be received
through such employment network. Upon issuance of each report to
each beneficiary, a copy of the report shall be maintained in the
files of the employment network. The program manager shall ensure
that copies of all such reports issued under this paragraph are
made available to the public under reasonable terms.
(g) Individual work plans
(1) Requirements
Each employment network shall -
(A) take such measures as are necessary to ensure that
employment services, vocational rehabilitation services, and
other support services provided under the Program by, or under
agreements entered into with, the employment network are
provided under appropriate individual work plans that meet the
requirements of subparagraph (C);
(B) develop and implement each such individual work plan, in
partnership with each beneficiary receiving such services, in a
manner that affords such beneficiary the opportunity to
exercise informed choice in selecting an employment goal and
specific services needed to achieve that employment goal;
(C) ensure that each individual work plan includes at least -
(i) a statement of the vocational goal developed with the
beneficiary, including, as appropriate, goals for earnings
and job advancement;
(ii) a statement of the services and supports that have
been deemed necessary for the beneficiary to accomplish that
goal;
(iii) a statement of any terms and conditions related to
the provision of such services and supports; and
(iv) a statement of understanding regarding the
beneficiary's rights under the Program (such as the right to
retrieve the ticket to work and self-sufficiency if the
beneficiary is dissatisfied with the services being provided
by the employment network) and remedies available to the
individual, including information on the availability of
advocacy services and assistance in resolving disputes
through the State grant program authorized under section
1320b-21 of this title;
(D) provide a beneficiary the opportunity to amend the
individual work plan if a change in circumstances necessitates
a change in the plan; and
(E) make each beneficiary's individual work plan available to
the beneficiary in, as appropriate, an accessible format chosen
by the beneficiary.
(2) Effective upon written approval
A beneficiary's individual work plan shall take effect upon
written approval by the beneficiary or a representative of the
beneficiary and a representative of the employment network that,
in providing such written approval, acknowledges assignment of
the beneficiary's ticket to work and self-sufficiency.
(h) Employment network payment systems
(1) Election of payment system by employment networks
(A) In general
The Program shall provide for payment authorized by the
Commissioner to employment networks under either an outcome
payment system or an outcome-milestone payment system. Each
employment network shall elect which payment system will be
utilized by the employment network, and, for such period of
time as such election remains in effect, the payment system so
elected shall be utilized exclusively in connection with such
employment network (except as provided in subparagraph (B)).
(B) No change in method of payment for beneficiaries with
tickets already assigned to the employment networks
Any election of a payment system by an employment network
that would result in a change in the method of payment to the
employment network for services provided to a beneficiary who
is receiving services from the employment network at the time
of the election shall not be effective with respect to payment
for services provided to that beneficiary and the method of
payment previously selected shall continue to apply with
respect to such services.
(2) Outcome payment system
(A) In general
The outcome payment system shall consist of a payment
structure governing employment networks electing such system
under paragraph (1)(A) which meets the requirements of this
paragraph.
(B) Payments made during outcome payment period
The outcome payment system shall provide for a schedule of
payments to an employment network, in connection with each
individual who is a beneficiary, for each month, during the
individual's outcome payment period, for which benefits
(described in paragraphs (3) and (4) of subsection (k) of this
section) are not payable to such individual because of work or
earnings.
(C) Computation of payments to employment network
The payment schedule of the outcome payment system shall be
designed so that -
(i) the payment for each month during the outcome payment
period for which benefits (described in paragraphs (3) and
(4) of subsection (k) of this section) are not payable is
equal to a fixed percentage of the payment calculation base
for the calendar year in which such month occurs; and
(ii) such fixed percentage is set at a percentage which
does not exceed 40 percent.
(3) Outcome-milestone payment system
(A) In general
The outcome-milestone payment system shall consist of a
payment structure governing employment networks electing such
system under paragraph (1)(A) which meets the requirements of
this paragraph.
(B) Early payments upon attainment of milestones in advance of
outcome payment periods
The outcome-milestone payment system shall provide for 1 or
more milestones, with respect to beneficiaries receiving
services from an employment network under the Program, that are
directed toward the goal of permanent employment. Such
milestones shall form a part of a payment structure that
provides, in addition to payments made during outcome payment
periods, payments made prior to outcome payment periods in
amounts based on the attainment of such milestones.
(C) Limitation on total payments to employment network
The payment schedule of the outcome milestone payment system
shall be designed so that the total of the payments to the
employment network with respect to each beneficiary is less
than, on a net present value basis (using an interest rate
determined by the Commissioner that appropriately reflects the
cost of funds faced by providers), the total amount to which
payments to the employment network with respect to the
beneficiary would be limited if the employment network were
paid under the outcome payment system.
(4) Definitions
In this subsection:
(A) Payment calculation base
The term "payment calculation base" means, for any calendar
year -
(i) in connection with a title II disability beneficiary,
the average disability insurance benefit payable under
section 423 of this title for all beneficiaries for months
during the preceding calendar year; and
(ii) in connection with a title XVI disability beneficiary
(who is not concurrently a title II disability beneficiary),
the average payment of supplemental security income benefits
based on disability payable under subchapter XVI of this
chapter (excluding State supplementation) for months during
the preceding calendar year to all beneficiaries who have
attained 18 years of age but have not attained 65 years of
age.
(B) Outcome payment period
The term "outcome payment period" means, in connection with
any individual who had assigned a ticket to work and
self-sufficiency to an employment network under the Program, a
period -
(i) beginning with the first month, ending after the date
on which such ticket was assigned to the employment network,
for which benefits (described in paragraphs (3) and (4) of
subsection (k) of this section) are not payable to such
individual by reason of engagement in substantial gainful
activity or by reason of earnings from work activity; and
(ii) ending with the 60th month (consecutive or otherwise),
ending after such date, for which such benefits are not
payable to such individual by reason of engagement in
substantial gainful activity or by reason of earnings from
work activity.
(5) Periodic review and alterations of prescribed schedules
(A) Percentages and periods
The Commissioner shall periodically review the percentage
specified in paragraph (2)(C), the total payments permissible
under paragraph (3)(C), and the period of time specified in
paragraph (4)(B) to determine whether such percentages, such
permissible payments, and such period provide an adequate
incentive for employment networks to assist beneficiaries to
enter the workforce, while providing for appropriate economies.
The Commissioner may alter such percentage, such total
permissible payments, or such period of time to the extent that
the Commissioner determines, on the basis of the Commissioner's
review under this paragraph, that such an alteration would
better provide the incentive and economies described in the
preceding sentence.
(B) Number and amounts of milestone payments
The Commissioner shall periodically review the number and
amounts of milestone payments established by the Commissioner
pursuant to this section to determine whether they provide an
adequate incentive for employment networks to assist
beneficiaries to enter the workforce, taking into account
information provided to the Commissioner by program managers,
the Ticket to Work and Work Incentives Advisory Panel
established by section 101(f) of the Ticket to Work and Work
Incentives Improvement Act of 1999, and other reliable sources.
The Commissioner may from time to time alter the number and
amounts of milestone payments initially established by the
Commissioner pursuant to this section to the extent that the
Commissioner determines that such an alteration would allow an
adequate incentive for employment networks to assist
beneficiaries to enter the workforce. Such alteration shall be
based on information provided to the Commissioner by program
managers, the Ticket to Work and Work Incentives Advisory Panel
established by section 101(f) of the Ticket to Work and Work
Incentives Improvement Act of 1999, or other reliable sources.
(C) Report on the adequacy of incentives
The Commissioner shall submit to the Congress not later than
36 months after December 17, 1999, a report with
recommendations for a method or methods to adjust payment rates
under subparagraphs (A) and (B), that would ensure adequate
incentives for the provision of services by employment networks
of -
(i) individuals with a need for ongoing support and
services;
(ii) individuals with a need for high-cost accommodations;
(iii) individuals who earn a subminimum wage; and
(iv) individuals who work and receive partial cash
benefits.
The Commissioner shall consult with the Ticket to Work and Work
Incentives Advisory Panel established under section 101(f) of
the Ticket to Work and Work Incentives Improvement Act of 1999
during the development and evaluation of the study. The
Commissioner shall implement the necessary adjusted payment
rates prior to full implementation of the Ticket to Work and
Self-Sufficiency Program.
(i) Suspension of disability reviews
During any period for which an individual is using, as defined by
the Commissioner, a ticket to work and self-sufficiency issued
under this section, the Commissioner (and any applicable State
agency) may not initiate a continuing disability review or other
review under section 421 of this title of whether the individual is
or is not under a disability or a review under subchapter XVI of
this chapter similar to any such review under section 421 of this
title.
(j) Authorizations
(1) Payments to employment networks
(A) Title II disability beneficiaries
There are authorized to be transferred from the Federal
Old-Age and Survivors Insurance Trust Fund and the Federal
Disability Insurance Trust Fund each fiscal year such sums as
may be necessary to make payments to employment networks under
this section. Money paid from the Trust Funds under this
section with respect to title II disability beneficiaries who
are entitled to benefits under section 423 of this title or who
are entitled to benefits under section 402(d) of this title on
the basis of the wages and self-employment income of such
beneficiaries, shall be charged to the Federal Disability
Insurance Trust Fund, and all other money paid from the Trust
Funds under this section shall be charged to the Federal
Old-Age and Survivors Insurance Trust Fund.
(B) Title XVI disability beneficiaries
Amounts authorized to be appropriated to the Social Security
Administration under section 1381 of this title shall include
amounts necessary to carry out the provisions of this section
with respect to title XVI disability beneficiaries.
(2) Administrative expenses
The costs of administering this section (other than payments to
employment networks) shall be paid from amounts made available
for the administration of subchapter II of this chapter and
amounts made available for the administration of subchapter XVI
of this chapter, and shall be allocated among such amounts as
appropriate.
(k) Definitions
In this section:
(1) Commissioner
The term "Commissioner" means the Commissioner of Social
Security.
(2) Disabled beneficiary
The term "disabled beneficiary" means a title II disability
beneficiary or a title XVI disability beneficiary.
(3) Title II disability beneficiary
The term "title II disability beneficiary" means an individual
entitled to disability insurance benefits under section 423 of
this title or to monthly insurance benefits under section 402 of
this title based on such individual's disability (as defined in
section 423(d) of this title). An individual is a title II
disability beneficiary for each month for which such individual
is entitled to such benefits.
(4) Title XVI disability beneficiary
The term "title XVI disability beneficiary" means an individual
eligible for supplemental security income benefits under
subchapter XVI of this chapter on the basis of blindness (within
the meaning of section 1382c(a)(2) of this title) or disability
(within the meaning of section 1382c(a)(3) of this title). An
individual is a title XVI disability beneficiary for each month
for which such individual is eligible for such benefits.
(5) Supplemental security income benefit
The term "supplemental security income benefit under subchapter
XVI of this chapter" means a cash benefit under section 1382 or
1382h(a) of this title, and does not include a State
supplementary payment, administered federally or otherwise.
(l) Regulations
Not later than 1 year after December 17, 1999, the Commissioner
shall prescribe such regulations as are necessary to carry out the
provisions of this section.
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