We have noted in past evaluation reports that TTW has had a relatively minor impact on the SVRAs, but that the SVRAs have had an overwhelming impact on TTW because of the number and percent of Tickets assigned to the SVRAs. This continues to be the case.1 SVRAs have accepted 89 percent to 92 percent of Ticket assignments since TTW rolled out. Like other providers, SVRAs can be paid for providing services through either the milestone-outcome or the outcome-only payment system, but unlike any other providers, SVRAs can also opt to be paid under the traditional system. Most SVRAs continue to use that system only, and, consistent with findings from previous evaluations, approximately 93 percent of Tickets assigned to SVRAs are assigned under that system. Thus, most beneficiaries who assign Tickets are receiving services from SVRAs under the traditional payment system, just as they could have done had TTW never been implemented.
SVRAs serve a broad array of people with disabilities, including SSI and DI beneficiaries. The number of SSA beneficiaries served by SVRAs has risen over the past few years to 175,000 cases closed in 2003; these cases made up about one-fourth to one-third of all recent case closures. Since 1981, SSA has reimbursed SVRAs for their costs (up to a limit) to serve an SSA beneficiary after the client completes nine consecutive months of work at the SGA level. This traditional cost reimbursement system has generated $80 million to $100 million annually for SVRAs in recent years. These funds are used primarily to supplement the federal and state funds used by SVRAs to purchase services for clients. While SSA beneficiaries account for 25 percent to 30 percent of SVRA clients, funds from SSA account for less than 10 percent of case-service dollars. Thus, SVRAs have served SSA beneficiaries through their primary funding source with a small but important supplement provided by SSA.2
This chapter describes the experience of SVRAs under TTW and the important role they play in implementing the program. As context for SVRA implementation of TTW, we describe recent financial constraints stemming from rising service demand and shrinking state budgets. We describe Ticket assignment behavior, payments to SVRAs, service delivery, and SVRA/EN relationships.
Over the past three years, we have conducted telephone interviews and site visits with 21 SVRA officials in Phase 1 and Phase 2 states. For this report, we interviewed officials from four SVRAs in Phase 3 states as well as staff at the Council of State Administrators for Vocational Rehabilitation (CSAVR). Our interviews with the SVRAs generally included the person designated as the Ticket coordinator and the person responsible for processing payment claims to SSA. We interviewed the director of external relations and the director of policy and research at CSAVR.
A. Resource Constraints
SVRAs operate with funding from the U.S. Department of Education’s RSA and from each state according to a formula that adjusts for population and per capita income. Federal funding, which totals about $2.6 billion, supports the vocational rehabilitation program, the network of Centers for Independent Living, and other related programs. SVRAs use a large percentage of their state appropriation to purchase rehabilitation services that help clients identify and reach their vocational goals; the services include assessment and evaluation, educational and medical services, job placement, and assistive technology. In many cases, the SVRA counselors purchase services for their clients through a network of community rehabilitation providers, many of which participate in TTW as ENs.
Financial constraints appear to have curbed both the resources that SVRAs can devote to TTW and their interest in recruiting new clients. Although federal funds have remained relatively constant throughout the last few years, state funding for SVRAs has been cut as a result of lower state tax revenues and higher unemployment in 2004 and early 2005 as well as rising Medicaid expenditures. In addition, representatives of SVRAs we interviewed in 2005 reported that higher unemployment had created more applicants for their SVRA.
According to CSAVR officials, the number of SVRAs that must ration their resources by an “order of selection” has risen over the past few years to a high of 43 nationwide, as of July 15, 2005, including three of the four SVRAs we interviewed for this report. SVRAs initiate an order of selection when they do not have enough resources to meet the demand for services. Under such a policy, SVRAs enroll only those applicants in the highest priority category. The specific categories and who fits into each varies by state, but generally, individuals are classified into three categories according to the severity of their disability as described below in the order of selection classification for the Pennsylvania SVRA3:
Priority category one includes individuals who are the most significantly disabled, defined as having a physical, mental, or sensory impairment that seriously limits three or more functional capacities; also, the individual must be expected to require multiple vocational rehabilitation services over an extended period.
Priority category two includes individuals who are significantly disabled, defined as a physical, mental, or sensory impairment that seriously limits one or more functional capacities; also, the individual must be expected to require multiple vocational rehabilitation services over an extended period.
Priority category three includes individuals who are not significantly disabled, defined as a physical, mental, or sensory impairment that does not meet the definition of most significantly disabled or significantly disabled.
“Functional capacities” are defined, for example, as physical mobility, dexterity and coordination, personal behaviors, repeat hospitalizations, and life planning.
According to SVRA officials we interviewed, SSI and most DI beneficiaries would fall into category one, but even that status does not guarantee that services will be provided. Some SVRAs have had to establish waiting lists even for individuals in category one, including two of the Phase 3 SVRAs we interviewed. One SVRA, which has been operating in an order of selection since 2001, had an 11-month waiting list for category one; the other had a waiting list of almost 500 category one clients and a total waiting list of over 13,000 across all three categories. Thus, order of selection can prevent SVRAs from serving beneficiaries quickly under TTW even if the agency expects to be reimbursed eventually by SSA.
As discussed later in this chapter, SVRA funding constraints and order of selection rules are forcing some SVRAs to urge beneficiaries to assign their Ticket to an ENs, the rationale being to both reduce demands on their own resources and help beneficiaries get services quickly. The SVRAs reported that such efforts have not yet generated much, if any, success because ENs are highly selective in their acceptance of Tickets, if they accept them at all.
B. Ticket Assignments
1. Assignments from New Clients
The officials from the four Phase 3 SVRAs we interviewed said they received a high volume of calls from potential clients during the initial Ticket rollout, but that these calls diminished considerably a few months after rollout was completed. These four SVRAs designated one staff person to field these calls, and, once the volume of calls diminished, that staff member was able to assume additional administrative responsibilities associated with administration of assigned Tickets. Officials reported that, when the TTW goal of moving beneficiaries off of the SSI or DI rolls is explained to them, most lose interest in TTW. (Even under the traditional payment system, SVRAs do not receive SSA reimbursements unless clients work at the SGA level for nine months or more. Thus, like ENs, SVRAs tell beneficiaries that the goal of TTW is to help them move off the rolls.) However, SVRA officials use this opportunity to describe the services they provide through other funding mechanisms, such as Title I of the Rehabilitation Act, which requires only that the client establish a vocational goal. The SVRA will serve the beneficiary without accepting the Ticket.
2. Assignments from Pipeline Cases
As discussed in Chapter III, the Phase 2 and Phase 3 SVRAs obtained Ticket assignments from far fewer “pipeline” cases (that is, existing clients) than did the Phase 1 SVRAs, but they obtained assignments from new clients at about the same rate as the Phase 1 SVRAs.4 This finding is consistent with the findings from the Phase 3 interviews we conducted for this report, which indicate that the Phase 3 SVRAs had much less of an incentive to obtain assignments from pipeline cases during their own rollout period.
Our initial evaluation report indicated that when TTW was first rolled out, Phase 1 SVRA officials anticipated a significant number of new applicants for vocational rehabilitation (VR) services as a result of the introductory Ticket mailing. They also felt they had to respond aggressively to TTW to safeguard their SSA funding stream, which had become increasingly important over the past few years. Phase 1 SVRA officials we interviewed were quite concerned that clients would refuse to assign their Tickets to the SVRA, receive services under Title I, and then assign their Ticket to an EN, making the SVRA ineligible for the traditional payment. Phase 1 officials were especially concerned that beneficiaries would assign their Ticket to AAATake Charge, which, after receiving a Ticket assignment, would essentially convert the Ticket to cash if the participant left the rolls by paying the beneficiary 75 percent of every outcome payment it received on the beneficiary’s behalf. Phase 1 SVRA officials were also concerned that beneficiaries who assign their Tickets must meet the TTW timely progress requirements and that such requirements would make it difficult to serve beneficiaries pursuing higher education or another lengthy rehabilitation process. (As of December 2005, SSA has suspended timely progress requirements; see Chapter 12 for further discussion.)
However, Phase 3 SVRAs are now less concerned that beneficiaries will assign their Tickets to ENs and have relaxed their efforts to obtain Ticket assignments. The early experience with TTW suggests that there is little risk that SVRA pipeline cases would assign their Tickets to ENs, making the SVRA ineligible for a traditional payment. Phase 1 SVRAs reported that they did not lose many pipeline cases to ENs, and ENs we have interviewed tend to refer cases to the SVRAs, not take cases from them. SVRAs can wait to obtain a Ticket until they know whether the client will be eligible for cost reimbursement or payment under one of the new TTW payment systems.5
Still, the Phase 3 SVRAs interviewed recently appear to be devoting some resources to contacting Ticket holders in their existing caseloads, explaining the program to these individuals and encouraging them to assign their Tickets to the SVRA. Some SVRAs, particularly the smaller ones, had their central office canvass their existing caseloads to identify beneficiaries, sending the names of these individuals to counselors to discuss Ticket assignment. The larger SVRAs asked their counselors to go through their existing caseloads to identify beneficiaries. One large SVRA sent a letter to all of its clients asking them to contact their counselor and discuss Ticket assignment, but the results were disappointing—less than 30 percent of beneficiaries responded to this request.
Once TTW beneficiaries have been identified, counselors use the same process to accept Ticket assignments from new and pipeline cases. They explain the Ticket program, provide clients with lists of ENs (when they are available), and sometimes refer beneficiaries for benefits planning. Officials from one of the four SVRAs we interviewed said their agency has developed a script for counselors to use when explaining TTW.
3. Promoting Consumer Choice in the SVRA Application Process
Counselors must explain to beneficiaries that they have a choice in what to do with their Ticket: they can assign it to an SVRA or to an EN, or they can leave it unassigned. If a beneficiary assigns the Ticket to an SVRA, the agency can use either the traditional payment system or one of the two new payment systems. If a beneficiary leaves the Ticket unassigned, an SVRA can continue to serve the individual under the traditional payment system if the SVRA submits an unsigned Ticket Assignment Form (Form 1365) and a signed IPE to the Program Manager.
Although Transmittal 17 of the Social Security Provider’s Handbook allows SVRAs to submit a Ticket Assignment Form without a beneficiary signature if the form is accompanied by the signed IPE,6 SVRA officials we interviewed for this and earlier reports expressed serious concern about this practice because it de-emphasizes consumer choice in services—a concept emphasized in the Rehabilitation Act. Officials said that this policy has created conflicts within the agency; agency administrators tell counselors it is particularly important to obtain Ticket assignments so the SVRA can be reimbursed but then stress the importance of clients playing an active role in choosing where they will go for services.
To address these opposing goals, counselors tie discussions of Ticket assignment to the development, review, or revisions of the client’s IPE. Additionally, some SVRAs are amending IPEs to include language that specifies what signing the IPE implies for Ticket assignment. For example, the Maine SVRA has revised its IPE form to include the following language:
“I agree and understand that by signing this IPE, my Ticket will be assigned to DVR if I am eligible to participate in the Social Security Administration’s Ticket to Work Program. In order for DVR to get paid by SSA for services provided to me, DVR will track my SSI/SSDI benefits and earnings and exchange information related to my work and vocational plan with SSA and Maximus, SSA’s Program Manager.”
“I also understand that I can inactivate my Ticket or assign it to a different Employment Network by contacting Maximus, toll-free at 1-866-968-7842
(1-866-833-2967 TTY). While my Ticket is in use and I am making progress on my IPE, I also understand that SSA will not do any Continuing Disability Reviews on my case.”
In this way, SVRAs can incorporate the informed choice discussion about Ticket assignment into the IPE process.
Officials from one SVRA we interviewed have established a policy under which the agency does not attempt to obtain a client’s Ticket unless the Ticket Assignment Form has been signed. From the agency’s perspective, the risk that a beneficiary will learn that the Ticket has been assigned without formal consent and subsequently believe that the agency is usurping the right to informed choice in Ticket assignment is simply too great. SVRA officials stated that the trusting relationship between the client and the rehabilitation counselor must be preserved, even at the expense of losing payments under the traditional system. The SVRA has an agreement with SSA that if an individual is identified for reimbursement under the traditional program but has not assigned his or her Ticket to the SVRA, then SSA will hold the reimbursement submission and allow the SVRA to contact the individual one more time to attempt to obtain Ticket assignment. This process gives the SVRA every opportunity to obtain the assignment while protecting beneficiary choice.
4. Administrative Effort Associated with Ticket Assignments
All four SVRA officials we interviewed agree that the Ticket assignment process is one of TTW’s most time-consuming administrative burdens. From a counselor’s perspective, the process has little or no added value, especially relative to the burden it imposes. For instance, counselors must first become conversant in the TTW program and then devise a simple and straightforward way to explain it to new clients. They feel that the requirement to discuss complex program concepts at the initiation of services often confuses clients and delays more important service-related discussions. In their eyes, the time is not well spent because TTW appears to have little to no impact on service provision. Counselors must also expend energy tracking down existing clients to obtain Ticket assignments from them. Although these clients may be receiving services from the SVRA, the counselors may actually have little direct in-person contact with them because, for example, the SVRA is purchasing services through another agency or paying for college, in which case counselors may only check in with the client quarterly by telephone. So the process of tracking down pipeline cases adds another layer to an already heavy administrative burden with little value added, particularly for counselors with typical caseloads of 150 or more.
From the SVRA perspective, the need to explain basic aspects of TTW to new callers adds another administrative function and increases the costs of participating in the program. Although SVRA staff use this opportunity to explain services that can be provided under other funding sources, staff members report receiving few applicants they would not have otherwise received. SVRA officials also said that obtaining current, accurate information on TTW eligibility and assignment status from the Program Manager is problematic. Although the Program Manager sends the SVRA monthly CDs with lists of TTW beneficiaries in the state, the officials we interviewed did not see the CDs as helpful because they did not contain Social Security numbers through which beneficiaries could be matched to SVRA clients. Communication with the Program Manager on Ticket assignments takes place by fax, which SVRA officials see as extremely inefficient when multiple Ticket assignments are being requested. SVRA officials also noted several instances of conflicting and inaccurate information on beneficiaries’ benefit and Ticket assignment status, requiring multiple phone calls and faxes between the SVRA and the Program Manager. SVRAs have had to move staff from other duties to build new data management systems to track Ticket assignments and requests for reimbursement. The four SVRAs we interviewed said they designated one to two individuals for Ticket-related activities—not an insignificant change given periods of resource shortages and staff layoffs. These officials could not point to many compensating benefits to the SVRA or its clients.
These findings reflect findings in previous interviews in which SVRA officials reported that TTW has increased their administrative burden and therefore their administrative costs. They indicated that central office staff and local rehabilitation counselors spend a substantial amount of time explaining the program to beneficiaries, encouraging them to assign their Ticket to the SVRA, and trying to ensure that they exercise informed choice in assigning their Ticket. This change in the SVRAs’ approach to their clients is significant because any increase in SVRA administrative costs will reduce the funds available to provide services.
C. Payments to SVRAs
Each SVRA must select either the milestone-outcome or outcome only system under TTW. Once an SVRA accepts a Ticket assignment, it must specify whether it will be paid under the system they have selected or under the traditional payment system.
All four Phase 3 SVRAs we interviewed currently accept all new Ticket assignments under the traditional payment option. Although they had selected the milestone-outcome payment system, they had accepted only a few Tickets under this system. They provided two reasons for preferring the traditional payment system. First, beneficiaries need only work 9 months at the SGA level for the SVRA to qualify for payment under the traditional system. To obtain the full payment amount under the new TTW payment options, the beneficiary must remain off cash benefits for 60 months. Even though the full amount under the new payment systems may be greater than the full amount of payment under the traditional system, the SVRA officials we interviewed did not want to risk not being paid if their clients remained off cash benefits for fewer than 60 months. Second, the payment process under the traditional system is substantially simpler than the process under either of the two new systems. Specifically, an SVRA submits only one request in the traditional system and receives one lump-sum payment; under the new TTW payment options, an SVRA must track the beneficiary for 60 or more months and submit up to 64 requests for payment.
We examined payments made on all Tickets assigned by December 2003 to SVRAs under one of the new payment systems. As of that date, which precedes the Phase 3 rollout, 43 of the 75 SVRA offices had accepted at least one assignment under one of the new payment systems, for a total of 2,705. Of these assignments, 6.4 percent had generated at least one payment by July 2005. (We excluded more recent assignments because of the long period that can elapse before any payment is made.) Payments were highly concentrated in a few SVRAs—only 10 of them had received any payments under the new systems. The total amount paid was only $373,000, and one SVRA received 56 percent of that amount.
The number of claims paid under the traditional payment system in each phase of the Ticket rollout is shown in Exhibit XI.1. It is problematic to compare these paid claims to claims paid under the new payment systems because of substantial differences between the new and the old payment and reporting systems. The delay from Ticket assignment to payment under the traditional system can be even longer than under the new systems, but full payment is typically made in one transaction, not stretched out over many months. Nonetheless, these statistics provide useful information on SSA payments to SVRAs under the traditional payment system.
|Source: Tabulations of SSA’s Vocational Rehabilitation Reimbursement Management System data.|
The number of beneficiaries for whom SSA made a payment under the traditional system dropped significantly in all phases after fiscal year (FY) 2002. The vertical scale for Exhibit XI.1 is in logarithms (that is, it is a “ratio” scale), so the vertical distance from one year to the next represents the percentage change in claims paid. The large decline from FY2002 to FY2003 is approximately the same for all phases. Changes after FY2003 vary across the phases, but not in a manner that would suggest that TTW played a role in the changes. In FY2005, claims paid in all three phases remained well below the FY2002 peak.
The value of payments also dropped substantially, from about $131 million in 2002 to about $76 million in FY 2005 (Exhibit XI.2), although the reasons for this change are not entirely clear. While probably not a major factor, the design of TTW could have reduced payments in the short term. In particular, although SSA makes a single lump-sum payment for eligible beneficiaries through the traditional payment system, milestone payments can occur over 12 months and outcome payments, over 60 months or more for beneficiaries who stop receiving cash benefits. This difference between payment schedules would cause payments to fall in the short-term and rise in the long-term. But payments to SVRAs under the new payment systems—under $1 million to date—make up only a tiny fraction of the $55 million decline.
|Source: Social Security Administration, 2005.|
If the introduction of TTW were the cause of the $55 million drop, we would have expected the drop to occur later, and later in Phase 2 than in Phase 1, and still later in Phase 3. Instead, the most likely explanation for the drop may be the 2001 recession and state revenue constraints that dissuaded SVRAs from joining the program. Because SVRAs submit claims to SSA only after an individual has worked at the SGA level for nine consecutive months, payments in any given year largely reflect beneficiaries enrolled and served in previous years. This long delay from placement to closure along with administrative delays from closure to payment mean that many payment claims processed in FY 2003, and even later, were for cases closed during the 2001-2002 recession. The recession constricted the job market in many states, making it difficult for SVRA counselors to help their clients find jobs. It also put a heavy strain on state budgets and caused many states to reduce their funding for SVRAs. Faced with fewer resources, the SVRAs had to restrict services, which made it more difficult for SSA beneficiaries to find jobs. The drop in the number of SSA beneficiaries who found jobs during this period reduced SSA payments to SVRAs.
The number of claims has increased somewhat in the past two years, though not to the pre-2002 level. This might well be because employment grew very slowly during the early years of the recovery (particularly for the lower end of the wage distribution where many beneficiaries are likely to be looking for employment). By 2005, the percentage of the working-age population that was employed, 62.7 percent, was still below its 2000 peak, 64.4 percent (President’s Council of Economic Advisors 2006).
Some of the SVRA and CSAVR officials we interviewed pointed to three other changes that might have reduced the number of claims paid under the traditional payment:
In 1999, SSA raised the SGA limit from $500 to $700 per month and added an automatic annual increase based on the cost of living. The current SGA level is $860 for beneficiaries with disabilities other than blindness. Fewer SVRA clients who are SSA beneficiaries may achieve earnings above this new SGA level, and as a result, the SVRA may qualify for payments under the traditional system in fewer cases.
SSA initiatives and other efforts to help beneficiaries return to work have made beneficiaries more aware of work incentives that enable them to keep their benefits while working. As a result, more beneficiaries are seeking services with no intention of earning enough to generate payments.
SVRA staff is devoting more time to the administrative demands of the TTW program, as discussed earlier. These duties have been assumed, at least partially, by the person who is also responsible for submitting payment claims under the traditional payment system, diverting their attention away from the submission of claims.
The four SVRA representatives we interviewed said that their agencies are struggling to identify factors that would enable them to target certain beneficiaries to enroll in the milestone-outcome payment option. One SVRA experimented with the idea of having counselors choose clients for this option. The SVRA provided general guidance to its counselors, emphasizing its own eligibility for milestone payments for individuals who might not work for the full nine consecutive months of earnings at SGA as required to obtain payment under the traditional system but who might qualify for some milestone payments. However, counselors found this approach confusing and, according to SVRA officials, made erroneous choices. For example, one counselor assigned a Ticket under the milestone-outcome system for a person who was seeking agency funding for a four-year college degree, which the central office deemed inappropriate for the milestone-outcome system. Only about four Tickets were assigned under the milestone-outcome payment system, and the assignment responsibility was moved to the central office.
Of the 7,200 Tickets assigned to one of the four SVRAs we visited, 67 had been assigned under the milestone-outcome option. SVRA officials said that these assignments were “mistakes” either on the part of individual rehabilitation counselors or on the part of the Program Manager. When the SVRA attempted to change these assignments, it was told by the Program Manager that it was not possible to do so. The SVRA is using the 67 inadvertent Ticket assignments to “test” the milestone-outcome option. At present, one of the 67 individuals is working such that his earnings exceed the SGA, and only a small percentage are working at all. The SVRA is very concerned that staff time and costs involved in tracking individuals served under this payment system will be prohibitive in light of the large numbers of individuals served by the agency.
D. Effect of TTW on Service Delivery
Consistent with previous evaluation reports, staff of the four Phase 3 SVRAs we interviewed for this report sees the TTW program as having minimal impact on service delivery. The SVRA officials found some negative impact associated with diverting staff to administrative duties, particularly accepting Ticket assignments. Although the Phase 3 SVRAs had not held Tickets for 24 months and were not yet subject to the timely progress documentation requirements, they see them as another potential administrative burden.7
The only potential benefit that TTW may bring to service delivery is, according to SVRAs, the increased emphasis on work incentives planning. SVRA officials explained that TTW had raised an agency-wide awareness of the importance of work incentives planning early in the employment process. Counselors have a deeper understanding of the fact that, for beneficiaries, the possibility of losing benefits, particularly health care benefits, has the potential to derail employment goals; early referral to a BPAO program could position the beneficiary to make more informed choices about employment and earnings goals. One of the four SVRA representatives said the agency felt so strongly about the value of work incentives counseling that it is funding 10 work incentives counseling positions beyond the SSA-funded BPAO program. All representatives said that they frequently refer clients to the BPAO or have work incentives planning discussions with their clients.
In an encouraging development, one of the four SVRAs reported that it is focusing on improving wage outcomes for its clients and for SSI/SSDI beneficiaries in particular. This SVRA has instituted a fee schedule, which financially rewards providers who help clients find jobs in which the wages approximate TTW’s wage goals. For instance, providers receive a bonus 90 days after placement when clients earn $12 or more per hour, or, for SSI/DI beneficiaries, when their wages are above the SGA level. Although this approach was not initiated by the SVRA specifically in response to the TTW program, it demonstrates SVRA support for TTW’s emphasis on work and work incentives.
E. SVRA/EN Agreements
One purpose of TTW is to promote coordination and collaboration between SVRAs and ENs; TTW regulations require that SVRAs negotiate agreements with ENs in the state to jointly serve beneficiaries. In earlier evaluation reports, we reported that in some instances, SVRAs may not be aggressively pursuing the development of agreements with other ENs, preferring to encourage the assignment of all Tickets to themselves. This trend appears to be changing in response to the fiscal restraints faced by SVRAs.
The Phase 3 SVRAs we interviewed, particularly those with waiting lists, encouraged providers to become ENs, viewing them as a potential “relief valve” in times of excess demand for services. They also hoped that in taking Tickets, the ENs would provide an additional choice for beneficiaries, but this has not happened. Some SVRAs sponsored Ticket information sessions for beneficiaries, giving ENs the opportunity to present their programs. However, ENs have neither accepted many Tickets and nor measurably reduced waiting lists for SVRA services. SVRA officials we interviewed noted that many beneficiaries who call them say they have called several ENs that would not accept their Ticket because the ENs were inactive, or they were not accepting Ticket assignments, or they would not accept an assignment from someone with a given disability or training needs. As a result, beneficiaries are, according to SVRA officials, highly frustrated by the time they approach the SVRA for assistance.
Reviews of SVRA/EN agreements for previous evaluation reports revealed that most SVRAs developed a standard agreement for use with all ENs. These agreements generally require ENs that hold Tickets and receive Ticket payments to share these payments with the SVRA until the SVRA recoups its service-delivery costs. Also under these agreements, the EN is generally paid for services it provides for a ticket holder who has assigned his Ticket to the SVRA. In general, the terms of these standard agreements have not been very favorable to ENs, especially for those to which a Ticket has been assigned. Previous interviews also revealed that few, if any beneficiaries are being served jointly by ENs and SVRAs when the EN is assigned the Ticket. Agreements developed by the four SVRAs and their experience in using these agreements follow the same pattern.
Before developing agreements with ENs, the Phase 3 SVRAs looked for guidance to the Phase 1 and 2 SVRAs in their region. In the Phase 3 state of Maine, for example, the SVRA-EN agreement includes a provision that the SVRA will share with the EN a portion of the administrative, counseling, and placement reimbursement if it receives payment under the traditional system—a feature in other New England area agreements between SVRAs and ENs. In another state, the SVRA negotiates the rate of reimbursement with each EN; that rate ranges from 20 percent to 50 percent of each payment the EN receives until the SVRA is fully reimbursed for its service costs. Officials from all four SVRAs we interviewed said that few, if any, beneficiaries are being served under these agreements. One of the four reported serving 14 individuals who assigned Tickets to ENs that have not signed an agreement with the agency.
Part 2 of this report has focused on the supply of service providers available to TTW participants. Part 3, Chapter XII, describes SSA and its contractors’ efforts to create and support the market and continue to implement the program.
1 See Thornton et al. 2004 and 2006. (back)
2 See Thornton et al. 2005, Chapter VI, for a fuller discussion of SSA payments to SVRAs. (back)
3 Pennsylvania Office of Vocational Rehabilitation Combined Agency State Plan 2006 Federal Fiscal Year Update, Attachment 4.12(c)(2)(A. www.dli.state.pa.us/landi/lib/landi/pdf/ovr/complete_2006_state_plan1.doc. Accessed April 11, 2006. (back)
4 VR agencies serve many more SSA beneficiaries than is reflected in Ticket assignments: Using SSA/RSA matched data, Phase 1 and Phase 2 state VR agencies have obtained Ticket assignments for only about 30 percent to 40 percent of the new SSA beneficiary clients they have served since TTW started. The assignment rate for beneficiary pipeline cases is even lower. (back)
5 See Thornton et al. 2004 for a discussion of Ticket assignment of new versus pipeline cases. (back)
6 The IPE is an official document that outlines the services the SVRA will provide and the client’s responsibilities, and it is signed by both counselor and client. (back)
7 See Chapter XII for a fuller discussion of the timely progress requirements. Also, the SVRA comments were collected before SSA suspended the timely progress provision in December 2005. (back)