Yes, I know that the following is not technology related, but it is fully
about giving more information about the new employment law for people with
disabilities. After all, one of the best uses for adaptive technology is
to increase employment options for the blind. Technology does not exist
in a vacuum. It has a purpose.
The summary was prepared by the consortium of Citizens with Disabilities,
a Washington, DC lobby shop of the disability industry. If you have
further interest for members of your local vicug, be sure to check out the
full text of the law at http://www.thomas.gov
kelly
URL: http://www.c-c-d.org/wiia_summary.html
The following summary is excerpted and modified from the Conference
Report (H. Rept. 106-478) submitted by the Committee on Ways and Means
to the House of Representatives on November 17, 1999. Prepared by
Marty Ford, Co-Chair of The CCD Social Security Task Force and
Assistant Director of The Arc of the United States Governmental
Affairs Office, (202)785-3388.
THE TICKET TO WORK AND WORK INCENTIVES IMPROVEMENT ACT OF 1999
SUMMARY OF SELECTED PROVISIONS
--------------------------------------
SELECTED TABLE OF CONTENTS
SECTION 1. Short Title; Table of Contents.
(a)
Short Title: This Act may be cited as the `Ticket to Work and Work
Incentives Improvement Act of 1999'.
(b) Table of Contents
SECTION 2. Findings and purposes.
TITLE I--TICKET TO WORK AND SELF-SUFFICIENCY AND RELATED PROVISIONS
Subtitle A--Ticket to Work and Self-Sufficiency
Sec. 101. Establishment of the Ticket to Work and Self-Sufficiency
Program.
Subtitle B--Elimination of Work Disincentives
Sec. 111. Work activity standard as a basis for review of an
individual's disabled status.
Sec. 112. Expedited reinstatement of disability benefits.
Subtitle C--Work Incentives Planning, Assistance, and Outreach
Sec. 121. Work incentives outreach program.
Sec. 122. State grants for work incentives assistance to disabled
beneficiaries.
TITLE II--EXPANDED AVAILABILITY OF HEALTH CARE SERVICES
Sec. 201. Expanding State options under the Medicaid program for
workers with disabilities.
Sec. 202. Extending Medicare coverage for OASDI disability benefit
recipients.
Sec. 203. Grants to develop and establish State infrastructures to
support working individuals with disabilities.
Sec. 204. Demonstration of coverage under the Medicaid program of
workers with potentially severe disabilities.
Sec. 205. Election by disabled beneficiaries to suspend Medigap
insurance when covered under a group health plan.
TITLE III--DEMONSTRATION PROJECTS AND STUDIES
Sec. 301. Extension of disability insurance program demonstration
project authority.
Sec. 302. Demonstration projects providing for reductions in
disability insurance benefits based on earnings.
Sec. 303. Studies and reports.
--------------------------------------
Findings and Purposes
This section includes a number of findings related to the importance
of health care for individuals with disabilities, the difficulties
they often experience in obtaining proper health care coverage under
current program rules, the resulting limited departures from benefit
rolls due to recipients' fears of losing coverage, and the potential
program savings from providing them better access to coverage if they
return to work.
The purposes of the act are to provide individuals with disabilities:
(1) health care and employment preparation and placement services to
reduce their dependency on cash benefits; (2) Medicaid coverage
(through incentives to States to allow them to purchase it) needed to
maintain employment; (3) the option of maintaining Medicare coverage
while working; and (4) return to work tickets allowing them access to
services needed to obtain and retain employment and reduce dependence
on cash benefits.
Title I. Ticket to Work and Self-Sufficiency and Related Provisions
Subtitle A--Ticket to Work and Self-Sufficiency
Section 101. Establishment of the Ticket to Work and Self-Sufficiency
Program
1. Ticket System
The act creates a Ticket to Work and Self-Sufficiency program. Under
the program, the Commissioner of Social Security is authorized to
provide SSDI and disabled SSI beneficiaries with a `ticket' which they
may use to obtain employment services, vocational rehabilitation (VR)
services, and other support services (e.g., assistive technology) from
an employment network (that is, provider of services) of their choice
to enable them to enter the workforce.
Employment networks may include both State VR agencies and private and
other public providers. Employment networks would be prohibited from
seeking additional compensation from beneficiaries. The act provides
State VR agencies with the option of participating in the program as
an employment network or remaining in the current reimbursement
system, including the option to elect either payment method on a
case-by-case basis. Services provided by State VR agencies
participating in the program would be governed by plans for VR
services approved under Title I of the Rehabilitation Act. The
Commissioner would issue regulations regarding the relationship
between State VR agencies and other employment networks. It is
intended that the agreements would be broad-based, rather than
case-by-case agreements. The Commissioner is also required to issue
regulations to address other implementation issues, including
distribution of tickets to beneficiaries.
The act requires the program to be phased in at sites selected by the
Commissioner beginning no later than 1 year after enactment. The
program would be fully implemented as soon as practicable, but not
later than 3 years after the program begins.
2. Program Managers
The Commissioner is required to contract with `program managers,'
i.e., one or more organizations in the private or public sector with
expertise and experience in the field of vocational rehabilitation or
employment services, through a competitive bidding process, to assist
the Social Security Administration to administer the program.
Agreements between SSA and program managers shall include performance
standards, including measures of access of beneficiaries to services.
Program managers would be precluded from providing services in their
own service area.
Program managers would recruit and recommend employment networks to
the Commissioner, ensure adequate availability of services to
beneficiaries and provide assurances to SSA that employment networks
are complying with terms of their agreement. In addition, program
managers would provide for changes in employment networks by
beneficiaries.
3. Employment Networks
Employment networks consist of a single provider (public or private)
or an association of providers which would assume responsibility for
the coordination and delivery of services. Employment networks may
include a one-stop delivery system established under Title I of the
Workforce Investment Act of 1998. Employment networks are required to
demonstrate specific expertise and experience and provide an array of
services under the program. The Commissioner would select and enter
into agreements with employment networks, provide periodic quality
assurance reviews of employment networks, and establish a method for
resolving disputes between beneficiaries and employment networks.
Employment networks would meet financial reporting requirements as
prescribed by the Commissioner, and prepare periodic performance
reports which would be provided to beneficiaries holding a ticket and
made available to the public.
Employment networks and beneficiaries would together develop an
individual employment plan for each beneficiary that provides for
informed choice in selecting an employment goal and specific services
needed to achieve that goal. A beneficiary's written plan would take
effect upon written approval by the beneficiary or beneficiary's
representative.
4. Payment to Employment Networks
The act authorizes payment to employment networks for outcomes and
long-term results through one of two payment systems, each designed to
encourage maximum participation by providers to serve beneficiaries:
* The outcome payment system would provide payment to employment
networks up to 40 percent of the average monthly disability
benefit for each month benefits are not paid to the beneficiary
due to work, not to exceed 60 months.
* The outcome-milestone payment system is similar to the outcome
payment system, except it would provide for early payment(s) based
on the achievement of one or more milestones directed towards the
goal of permanent employment. To ensure the cost-effectiveness of
the program, the total amount payable to a service provider under
the outcome-milestone payment system must be less than the total
amount that would have been payable under the outcome payment
system.
The Commissioner is required to periodically review both payment
systems and may alter the percentages, milestones, or payment periods
to ensure that employment networks have adequate incentive to assist
beneficiaries in entering the workforce. In addition, the Commissioner
is required to submit a report to Congress with recommendations for
methods to adjust payment rates to ensure adequate incentives for the
provision of services to individuals with special needs (including
people who work below minimum wage, who require ongoing supports and
services, who require high-cost accommodations, and who receive
partial cash benefits (such as SSI).
The act requires the Commissioner to report to Congress within 3 years
on the adequacy of program incentives for employment networks to
provide services to `high risk' beneficiaries.
The bill authorizes transfers from the Social Security Trust Funds to
carry out these provisions for Social Security beneficiaries, and
authorizes appropriations to the Social Security Administration to
carry out these provisions for SSI recipients.
5. Evaluation
The Commissioner is required to provide for a series of independent
evaluations to assess the cost-effectiveness and outcomes of the
program. The Commissioner is required to periodically provide to the
Congress a detailed report of the program's progress, success, and any
modifications needed.
6. Advisory Panel
The bill establishes a Ticket to Work and Work Incentives Advisory
Panel consisting of experts representing consumers, providers of
services, employers, and employees, at least one-half of whom are
individuals with disabilities or representatives of individuals with
disabilities. The Advisory Panel is to be composed of twelve members
appointed as follows:
* Four by the President, not more than two of whom may be of the
same political party;
* Two by the Speaker of the House of Representatives, in
consultation with the Chairman of the Committee on Ways and Means;
* Two by the Minority Leader of the House of Representatives, in
consultation with ranking minority member of the Committee on Ways
and Means;
* Two by the Majority Leader of the Senate, in consultation with the
Chairman of the Committee on Finance; and
* Two members would be appointed by the Minority Leader of the
Senate, in consultation with the ranking minority member of the
Committee on Finance.
The Panel is to advise the Commissioner and report to the Congress on
work incentives programs, planning, and assistance and program
implementation, including such issues as the establishment of pilot
sites, refinements to the program, and the design of program
evaluations.
All 12 Panel members would be required to have experience or expert
knowledge as a recipient, provider, employer, or employee. The terms
of initial appointment would be set by the individual making the
appointment, with each individual making appointments designating
one-half of appointees for a term of 4 years and the other half for a
term of 2 years. The Director of the Panel would be appointed by the
Chairperson of the Advisory Panel.
Subtitle B--Elimination of Work Disincentives
Section 111. Work Activity Standard as a Basis for Review of an
Individual's Disabled Status
The act establishes the standard that continuing disability reviews
(CDRs) for long-term SSDI beneficiaries (i.e., those receiving
disability benefits for at least 24 months) be limited to periodic
CDRs. SSA would continue to evaluate work activity to determine
whether eligibility for cash benefits continued, but a return to work
would not trigger a review of the beneficiary's impairment to
determine whether it continued to be disabling. This provision is
effective January 1, 2002.
Section 112. Expedited Reinstatement of Disability Benefits
The act establishes that an individual: (1) whose entitlement to SSDI
benefits had been terminated on the basis of work activity following
completion of an extended period of eligibility; or (2) whose
eligibility for SSI benefits (including special SSI eligibility status
under section 1619(b) of the Social Security Act) had been terminated
following suspension of those benefits for 12 consecutive months on
account of excess income resulting from work activity, may request
reinstatement of those benefits without filing a new application. The
individual must have become unable to continue working due to his or
her medical condition and must file a reinstatement request within the
60-month period following the month of such termination.
While the Commissioner is making a determination pertaining to a
reinstatement request, the individual would be eligible for
provisional benefits (cash benefits and Medicare or Medicaid, as
appropriate) for a period of not more than 6 months. If the
Commissioner makes a favorable determination, such individual's prior
entitlement to benefits would be reinstated, as would be the prior
benefits of his or her dependents who continue to meet the entitlement
criteria. If the Commissioner makes an unfavorable determination,
provisional benefits would end, but the provisional benefits already
paid would not be considered an overpayment. This provision is
effective one year after enactment.
Subtitle C--Work Incentives Planning, Assistance, and Outreach
Section 121. Work Incentives Outreach Program
The Commissioner of Social Security is required to establish a
community-based work incentives planning and assistance program for
the purpose of disseminating accurate information to individuals on
work incentives. Under this program, the Commissioner is required to:
* Establish a program of grants, cooperative agreements, or
contracts to provide benefits planning and assistance (including
protection and advocacy services) to individuals with disabilities
and outreach to individuals with disabilities who are potentially
eligible for work incentive programs; and
* Establish a corps of work incentive specialists located within the
Social Security Administration.
The Commissioner is required to determine the qualifications of
agencies eligible for grants, cooperative agreements, or contracts.
Social Security Administration field offices and State Medicaid
agencies are deemed ineligible. Eligible organizations may include
Centers for Independent Living, protection and advocacy organizations,
and client assistance programs (established in accordance with the
Rehabilitation Act of 1973, as amended); State Developmental
Disabilities Councils (established in accordance with the
Developmental Disabilities Assistance and Bill of Rights Act); and
State welfare agencies (funded under Title IV-A of the Social Security
Act).
Annual appropriations would not exceed $23 million for fiscal years
2000-2004. The provision would be effective on enactment. The grant
amount in each State would be based on the number of beneficiaries in
the State, subject to certain limits.
Section 122. State Grants for Work Incentives Assistance to Disabled
Beneficiaries
The Commissioner of Social Security is authorized to make grants to
existing protection and advocacy programs authorized by the States
under the Developmental Disabilities Assistance and Bill of Rights
Act. Services would include information and advice about obtaining
vocational rehabilitation, employment services, advocacy, and other
services a Social Security Disability Insurance (SSDI) or Supplemental
Security Income (SSI) beneficiary may need to secure or regain gainful
employment, including applying for and receiving work incentives.
Appropriation would not exceed $7 million for each of the fiscal years
2000-2004. The provision would be effective upon enactment.
Title II. Expanded Availability of Health Care Services
Section 201. Expanding State Options Under the Medicaid Program for Workers
with Disabilities
The act allows States to establish one or two new optional Medicaid
eligibility categories:
* States would have the option to cover individuals with
disabilities (aged 16-64) who, except for earnings, would be
eligible for SSI. In addition, States could establish limits on
assets, resources and earned or unearned income that differ from
the federal requirements.
* If States provide Medicaid coverage to individuals described
above, they may also provide coverage to the following: Employed
persons with disabilities whose medical condition has improved,
but who continue to have a severe medically determinable
impairment as defined by regulations by the Secretary of HHS.
Individuals covered under these options could `buy in' to Medicaid
coverage by paying premiums or other cost-sharing charges on a
sliding-fee scale based on income. The State would be required to make
premium or other cost-sharing charges the same for both these two new
eligibility groups. States may require individuals with incomes above
250 percent of the federal poverty level to pay the full premium cost.
In the case of individuals with incomes between 250 percent and 450
percent of the poverty level, premiums may not exceed 7.5 percent of
income. States must require individuals with incomes above $75,000 per
year to pay all of the premium costs. States may choose to subsidize
premium costs for such individuals, but they may not use federal
matching funds to do so.
The effective date is October 1, 2000. [Some advocates believe
technical corrections will be necessary prior to implementation to
ensure that the provision operates as intended.]
Section 202. Extending Medicare Coverage for OASDI Disability Benefit
Recipients
Social Security Disability Insurance (SSDI) beneficiaries are
currently allowed to test their ability to work for at least nine
months without affecting their disability or Medicare benefits.
Disability payments stop when a beneficiary has monthly earnings at or
above the substantial gainful activity level ($700) after the 9-month
trial work period. If the beneficiary remains disabled but continues
working, Medicare can continue for an additional 39 months, for a
total of 48 months of coverage. Beyond that point, the individual (if
still disabled) may continue Medicare coverage by paying the premium.
Effective October 1, 2000, the act provides for continued Medicare
Part A coverage for 4 ½ additional years beyond the current limit,
resulting in a total limit of 7 ¾ years of Medicare continuation after
the TWP. When the full Medicare Part A coverage period runs out, the
individual (if still disabled) may continue Medicare coverage by
paying the premium.
The General Accounting Office (GAO) must submit a report to Congress
(no later than 5 years after enactment) that examines the
effectiveness and cost of extending Medicare Part A coverage to
working disabled persons without charging them a premium; the
necessity and effectiveness of providing the continuation of Medicare
coverage to disabled individuals with incomes above the Social
Security taxable wage base ($72,600); the use of a sliding-scale
premium for high-income disabled individuals; the viability of an
employer buy-in to Medicare in lieu of coverage under private health
insurance; the interrelation between the use of continuation of
Medicare coverage and private health insurance coverage; and that
recommends whether the Medicare coverage extension should continue
beyond the extended period provided under the bill.
Section 203. Grants to Develop and Establish State Infrastructures to
Support Working Individuals with Disabilities
The bill requires the Secretary of HHS to award grants to States to
design, establish and operate infrastructures that provide items and
services to support working individuals with disabilities, and to
conduct outreach campaigns to inform them about the infrastructures.
States would be eligible for these grants only if they provide
personal assistance services through Medicaid to assist individuals
with disabilities to remain employed (that is, earn at least the
Federal minimum wage and work at least 40 hours per month, or engage
in work that meets criteria for work hours, wages, or other measures
established by the State and approved by the Secretary of HHS).
Personal assistance services refers to a range of services provided by
one or more persons to assist individuals with disabilities to perform
daily activities on and off the job. These services would be designed
to increase individuals' control in life.
The Secretary of HHS is required to develop a formula for the award of
infrastructure grants. The formula must provide special consideration
to States that extend Medicaid coverage to persons who cease to be
eligible for SSDI and SSI because of an improvement in their medical
condition, but who still have a severe medically determinable
impairment and are employed.
States that do not choose to take up the optional Medicaid eligibility
category permitting expansion to individuals with disabilities with
incomes up to 250 percent of poverty would be subject to a maximum
grant award established by a methodology developed by the Secretary
consistent with the limit applied to states that do take up the
option. For those states who do take up the option, the maximum will
be 10 percent of the federal and state Medicaid expenditures for such
individuals. These provisions would be effective October 1, 2000, with
funding of: FY2001, $20 million; FY2002, $25 million; FY2003, $30
million; FY2004, $35 million; FY2005, $40 million; and FY2006-11, the
amount of appropriations for the preceding fiscal year plus the
percent increase in the CPI for All Urban Consumers for the preceding
fiscal year.
While election of the Medicaid buy-in option is not a condition of
eligibility for infrastructure grants under this section, the
conference report urges the Secretary to award such grants with
preference for states exercising the buy-in option. Such grants may be
used to help finance other State programs facilitating a return to
work by disabled individuals, thereby supplementing the Medicaid
buy-in benefit as well as other work incentives provided by the act.
States would be required to submit an annual report to the Secretary
on the use of grant funds. In addition, the report must indicate the
percent increase in the number of SSDI and SSI beneficiaries who
return to work.
The Secretary of HHS, in consultation with the Ticket to Work and Work
Incentives Advisory Panel established by the bill, is required to make
a recommendation by October 1, 2010, to the Committee on Commerce in
the House and the Committee on Finance in the Senate regarding whether
the grant program should be continued after FY 2011.
Section 204. Demonstration of Coverage under the Medicaid Program of
Workers with Potentially Severe Disabilities
The Secretary of HHS is required to approve applications from States
to establish demonstration programs that would provide medical
assistance equal to that provided under Medicaid for disabled persons
age 16-64 who are `workers with a potentially severe disability.'
These are individuals who meet a State's definition of physical or
mental impairment, who are employed, and who are reasonably expected
to meet SSI's definition of blindness or disability if they did not
receive Medicaid services. States' definitions of workers with
potentially severe disabilities can include individuals with a
potentially severe disability that can be traced to congenital birth
defects as well as diseases or injuries developed or incurred through
illness or accident in childhood or adulthood.
The Secretary is required to approve demonstration programs if the
State meets the following requirements:
* The State has elected to provide Medicaid coverage to individuals
with disabilities whose income does not exceed 250 percent of the
Federal poverty level and who would be eligible for SSI, except
for their earnings;
* Federal funds are used to supplement the level of State funds used
for workers with potentially severe disabilities at the time the
demonstration is approved; and
* The State conducts an independent evaluation of the demonstration
program.
The act allows the Secretary to approve demonstration programs that
operate on a sub-State basis.
For purposes of the demonstration, individuals would be considered to
be employed if they earn at least the Federal minimum wage and work at
least 40 hours per month, or are engaged in work that meets threshold
criteria for work hours, wages, or other measures as defined by the
demonstration project and approved by the Secretary.
Unexpended funds from previous years may be spent in subsequent years.
The Secretary is required to allocate funds to States based on their
applications and the availability of funds. Funds awarded to States
would equal their Federal medical assistance percentage (FMAP) of
expenditures for medical assistance to workers with a potentially
severe disability.
The Secretary of HHS is required to make a recommendation by October
1, 2004, to the Committee on Commerce in the House and the Committee
on Finance in the Senate regarding whether the grant program should be
continued after FY2006.
The act requires States with an approved demonstration to submit an
annual report to the Secretary, including data on the total number of
persons served by the project, and the number of each population who
are `workers with a potentially severe disability.' The aggregate
amount of payments to States for administrative expenses related to
annual reports may not exceed $2 million.
The act authorizes the demonstration at $250 million over 6 years.
These provisions would be effective October 1, 2000. No payments could
be made after FY 2009.
Section 205. Election by Disabled Beneficiaries to Suspend Medigap
Insurance when Covered under a Group Health Plan
The act requires Medigap supplemental insurance plans to provide that
benefits and premiums of such plans be suspended at the policyholder's
request if the policyholder is entitled to Medicare Part A benefits as
a disabled individual and is covered under a group health plan
(offered by an employer with 20 or more employees). If suspension
occurs and the policyholder loses coverage under the group health
plan, the Medigap policy is required to be automatically reinstituted
(as of the date of loss of group coverage) if the policyholder
provides notice of the loss of such coverage within 90 days of the
date of losing group coverage.
Title III. Demonstration Projects and Studies
Section 301. Extension of Disability Insurance Program Demonstration
Project Authority
The Commissioner of Social Security has authority to conduct certain
demonstration projects. The Commissioner may initiate experiments and
demonstration projects to test ways to encourage Social Security
Disability Insurance (SSDI) beneficiaries to return to work, and may
waive compliance with certain benefit requirements in connection with
these projects. This demonstration authority expired on June 9, 1996.
Effective as of the date of enactment, the act extends the
demonstration authority for 5 years, and includes authority for
demonstration projects involving applicants as well as beneficiaries.
Section 302. Demonstration Projects Providing for Reductions in Disability
Insurance Benefits Based on Earnings
The act requires the Commissioner of Social Security to conduct a
demonstration project under which payments to Social Security
disability insurance (SSDI) beneficiaries would be reduced $1 for
every $2 of beneficiary earnings. This demonstration will examine
allowing a gradual reduction in cash benefits as income rises. This is
particularly beneficial to low income workers for whom the loss of
cash benefit support is as much of a barrier to work as the loss of
health coverage. The Commissioner would be required to annually report
to the Congress on the progress of this demonstration project.
Section 303. Studies and Reports
1 GAO Report of Existing Disability-Related Employment Incentives.
The act would direct the General Accounting Office (GAO) to assess the
value of existing tax credits and disability-related employment
initiatives under the Americans with Disabilities Act and other
Federal laws. The report is to be submitted within 3 years to the
Senate Committee on Finance and the House Committee on Ways & Means.
2. GAO Report of Existing Coordination of the DI and SSI Programs as
They Relate to Individuals Entering or Leaving Concurrent Entitlement
The act would direct the General Accounting Office (GAO) to evaluate
the coordination under current law of work incentives for individuals
eligible for both Social Security disability insurance (SSDI) and
Supplemental Security Income (SSI). The report is to be submitted
within 3 years to the Senate Committee on Finance and the House
Committee on Ways & Means.
3. GAO Report on the Impact of the Substantial Gainful Activity Limit
on Return to Work.
The act would direct the General Accounting Office (GAO) to examine
substantial gainful activity limit as a disincentive for return to
work. The report is to be submitted within 2 years to the Senate
Committee on Finance and the House Committee on Ways & Means.
4. Report on Disregards Under the DI and SSI Programs.
The act would direct the Commissioner of Social Security to identify
all income disregards under the Social Security disability insurance
(SSDI) and Supplemental Security Income (SSI) programs; to specify the
most recent statutory or regulatory change in each disregard; the
current value of any disregard if the disregard had been indexed for
inflation; recommend any further changes; and to report certain
additional information and recommendations on disregards related to
grants, scholarships, or fellowships used in attending any educational
institution. The report is to be submitted within 90 days to the
Senate Committee on Finance and the House Committee on Ways & Means.
5. GAO Report on SSA's Demonstration Authority
The act would direct GAO to assess the Social Security
Administration's (SSA) efforts to conduct disability demonstrations
and to make a recommendation as to whether SSA's disability
demonstration authority should be made permanent. The report is to be
submitted within 5 years to the Senate Committee on Finance and the
House Committee on Ways and Means.
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