The Ticket to Work and Work Incentives Improvement Act of 1999

December 1999

Prepared by Joy Johnson Wilson
Director, AFI Health Committee

Provision	P.L. 106-170
Title I- Ticket to Work and Self-sufficiency and Related Provisions
Sec. 101 - Establishment of the Ticket to Work and Self-Sufficiency Program	Establishment Authorizes the Commissioner of Social Security to provide Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) disability beneficiaries with a ticket which they may use to obtain services of their choice from an employment network of their choice to enable them to enter the workforce. State vocational rehabilitation agencies would be provided the option of participating in the program as an employment network or remaining in the current reimbursement system, with the ability to elect payment on a case-by-case basis. The ticket program would be implemented on a graduated basis beginning within one year at sites selected by the Commissioner and within a total of four years in every State. Program Managers Directs the Commissioner to contract with program managers (one or more public or private organizations with expertise and experience in the field of vocational rehabilitation or employment services) through a competitive bidding process to help the Social Security Administration (SSA) administer the program. Program managers would have to recruit and recommend employment networks to the Commissioner, ensure adequate choices of services are available to beneficiaries, ensure beneficiary access to services, and provide assurances to SSA that employment networks are complying with agreement terms. Agreements with program managers would include performance standards, and program managers would be precluded from delivering services in their own service area. Employment Networks Employment networks would have to consist of a single public or private provider or an association of providers combined into a single entity which assumes responsibility for the coordination and delivery of services. Employment networks would have to have experience providing relevant employment services and supports for individuals with disabilities and would have to provide an array of such services under the program. Employment networks and beneficiaries would have to develop an individual employment plan so that the beneficiary can exercise informed choice in selecting an employment goal and specific services needed to achieve that goal. Employment networks would prepare and provide periodic performance reports to beneficiaries holding a ticket and would make the reports available to the public. The Commissioner would have to provide periodic quality assurance reviews of employment networks and would have to establish a method for resolving disputes between beneficiaries and employment networks. Payment to Employment Networks Authorizes payment to employment networks through one of two payment systems designed to ensure maximum choice of providers to serve consumers with disabilities: an outcome payment system providing up to 40 percent of the average monthly disability benefit for each month benefits are not payable to the beneficiary due to work (but not for more than 60 months), and an outcome-milestone payment system providing early payments based on the achievement of one or more milestones towards permanent employment. Authorizes transfers from the Social Security Trust Funds and appropriations to SSA to carry out these provisions with regard to SSDI and SSI beneficiaries, respectively. Evaluation and Reports. Requires the Commissioner to design and conduct a series of evaluations to assess the cost-effectiveness and effects of the program, and would have to report to Congress his findings. Requires the Commissioner to report to Congress on program implementation and suggested refinements. Creates and Advisory Panel consisting of experts representing consumers, providers of services, employers, and employees to advise the Commissioner.
Sec. 111 -Work Activity Standard as a Basis for Review of an Individual's Disabled Status	Effective January 1, 2002, for long-term SSDI beneficiaries (i.e., those receiving benefits for at least 24 months), SSA would continue to evaluate work activity to determine whether eligibility for cash benefits continued, but a return to work would not trigger an unscheduled continuing disability review.
Sec. 112 - Expedited Reinstatement of Benefits	Provides for reinstatement of benefits without filing a new application for certain individuals whose entitlement to SSDI or SSI benefits terminated due to work, to reassure disabled beneficiaries that benefits would be swiftly reestablished should their work efforts fall short. Effective one year after the date of enactment The individual would have to have become unable to continue working on the basis of his or her medical condition and would have to file a reinstatement request within the 60-month period following the month of termination. Pending the Commissioner's decision regarding a reinstatement request, the individual would be eligible for provisional cash and health benefits for up to six months.
Sec. 121 - Work Incentives Outreach Program	Establishes a community-based work incentives planning and assistance program to disseminate information on work incentives. Authorizes up to $23 million for each of fiscal years 2000-2004 for this purpose.
Sec. 122 - State Grants for Work Incentives Assistance to Disabled Beneficiaries	Authorizes the Commissioner to make grants of up to $7 million for each of fiscal years 2000-2004 to protection and advocacy organizations providing information and advice about obtaining vocational rehabilitation and employment services and advocacy and other services a beneficiary may need to secure or regain employment.
Title II - expanded availability of health care services
Sec. 201 - Expanding Options Under Medicaid for Workers with Disabilities	Allows states to establish new Medicaid eligibility categories effective October 1, 2000, for persons with disabilities whose income or resources would make them ineligible for SSI, or for working-age individuals who would lose eligibility due to medical improvement but who still have a severe impairment and are employed. Under either option, individuals would be able to "buy into" Medicaid on a sliding fee scale (but with limits on the use of Federal funds for those with higher incomes).
Sec. 202 - Extending Medicare Coverage for SSDI Beneficiaries	Extends Medicare coverage for an additional four and one-half year period beyond current law for SSDI beneficiaries (thus for a total of eight and one-half years once work activity begins), effective October 1, 2000,
Sec. 203 - Grants to Develop and Establish State Infrastructures to Support Working Individuals with Disabilities	Authorizes the Secretary of Health and Human Services (HHS) to award grants effective October 1, 2000, to eligible States to design, establish, and operate infrastructures providing items and services to support working individuals with disabilities, and to conduct outreach campaigns to inform them about these new benefits. Authorizes $20 million, $25 million, $30 million, $35 million, and $40 million for fiscal years 2001-2005, respectively, for this purpose; for fiscal years 2006-2011, it would authorize the prior year's amount adjusted for inflation.
Section 204: Demonstrations of Coverage under the Medicaid Program of Workers with Potentially Severe Disabilities	Authorizes the Secretary of HHS to establish State demonstration programs that would provide, under certain terms, medical assistance equivalent to Medicaid for disabled persons age 16-64 who are "workers with a potentially severe disability." A total of $250 million would be authorized for the period fiscal year 2001-2006 for this purpose.
Sec.205 - Election by Disabled Beneficiaries to Suspend Medigap Insurance When Covered under a Group Health Plan	Requires Medigap supplemental insurance plans to provide that benefits and premiums be suspended at the request of the policyholder 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.
TITLE III--DEMONSTRATION PROJECTS AND STUDIES
Sec. 301 - Extension of Disability Insurance Program Demonstration Authority	SSDI demonstration project authority (for projects involving applicants as well as beneficiaries) would be renewed for five years.
Sec. 302 - Demonstration Projects Providing for Reductions in Disability Insurance Benefits Based on Earnings	Requires the Social Security Administration (SSA) to conduct a demonstration project on the effects of gradually reducing SSDI benefits $1 for every $2 in earnings over a level determined by the Commissioner.
Sec. 303 - Studies and Reports	Requires the U.S. General Accounting Office (GAO) to conduct four studies assessing: the effectiveness of current tax and other incentives to encourage employers to hire individuals with disabilities, the effectiveness of SSA work incentives for individuals who are entitled to both Social Security and SSI disability benefits; the impact of the substantial gainful activity limit as a disincentive to work, and (4) SSA's efforts to conduct disability demonstrations. Requires the Commissioner to report on all SSI and SSDI income disregards and recommend changes.
TITLE IV-Miscellaneous and TECHNICAL AMENDMENTS
Sec. 401 - Technical Amendments Relating to Drug Addicts and Alcoholics	Makes several technical and clarifying changes pertaining to restrictions on eligibility for disability benefits based on alcoholism and drug addiction
Sec. 402 - Treatment of Prisoners	The 1996 welfare reform law provided for payments to State and local institutions reporting lists of inmates resulting in the termination of SSI benefits (for which prisoners are ineligible). Provides for similar payments of up to $400 for each prisoner found to be receiving Old Age, Survivor and Disability benefits as a result of such reports. Make several technical changes to conform this new provision with current law, and requires the Commissioner to provide, on a reimbursable basis, inmate lists to any Federal or Federally-assisted cash, food, or medical aid program for use in determining eligibility. Further restricts payment of OASDI benefits to prisoners who are convicted of a criminal offense and are confined (for more than 30 days) to (1) a penal institution, (2) a public institution if found guilty but insane, or (3) a public institution upon completion of a prison term for a sex offense, pursuant to a court finding that they remain a danger to others.
Sec. 403 - Revocation by Members of the Clergy of Exemption from Social Security Coverage	Provides for a two-year "open season" beginning January 1, 2000, for members of the clergy to revoke their exemption from Social Security coverage.
Sec. 404 - Additional Technical Amendment Relating to Cooperative Research or Demonstration Projects	Clarifies that the current authority permitting SSA to make grants for cooperative research or demonstration projects relating to SSI also would apply to agreements or grants concerning SSDI.
Sec. 405 - Authorization for States to Permit Annual Wages Reports	To conform with the current (annual) reporting schedule for domestic service employers with respect to Social Security, Medicare, and Federal unemployment taxes, allows states to permit such employers to file annual (rather than quarterly) wage reports for purposes of the income and eligibility verification system.
Sec. 406 - Assessment on Attorneys Who Receive Their Fees Via the Social Security Act	Requires the GAO to study the costs of administering the attorney fee provisions (with specific estimates of the costs of determining and certifying fees), the feasibility and advisability of a fixed fee as opposed to an assessment based on a percentage of the attorney's fee, and whether the assessment impairs access to representation for applicants. Requires the GAO to make recommendations regarding efficiencies that the Commissioner could implement to reduce the cost of determining and certifying fees, the feasibility of linking the collection of the assessment to the timeliness of the payment of fees to attorneys, and the advisability of extending attorney fee disbursement to the SSI program.
Sec. 407 - Extension of Authority of State Medicaid Fraud Control Units	Permits Medicaid Fraud Control Units to investigate fraud related to any Federal health care program (subject to approval of the appropriate Inspector General) if related to Medicaid fraud.
Sec. 408 - Climate Database Modernization	Requires the National Oceanic and Atmospheric Administration to contract for its multi-year program for climate database modernization and utilization in accordance with certain existing contracts which were awarded as a result of fair and open competition.
Sec. 409 - Special Allowance Adjustment for Student Loans	Changes the index for the special allowance paid to lenders for participation in the Federal Family Education Loan Program from that for 91-day Treasury bills to that for 3-month commercial paper. This change would be applicable for payment with respect to any 3-month period beginning on or after January 1, 2000, for loans for which the first disbursement is made after such date.
Sec. 410 - Schedule for Payments Under SSI State Supplementation Agreements	Changes the date for remitting reimbursement by the States to the SSA for SSI State supplement payments administered by SSA. Effective for payments for months after September 2009, States would have to remit payments to SSA no later than the business day preceding the date SSA pays the monthly benefit. For the payment for the last month of the State's fiscal year, States shall remit the reimbursement by the fifth business day following the date SSA pays the monthly benefit.
Sec. 411 - Bonus Commodities	Applies provisions to fiscal years 2001-2009 incorporated in the U.S. Department of Agriculture appropriations laws for fiscal years 1999-2000 related to the amount of spending required on commodities under the School Lunch program.
Sec. 412 - Simplification of Definition of Foster Child Under the Earned Income Credit Program	Provides for a simplified definition of foster child for purposes of the EIC program. Under this provision, a foster child would be defined as a child who: is cared for by the taxpayer as if he or she were the taxpayer's own child, has the same principal place of abode as the taxpayer for the taxpayer's entire taxable year, and is either the taxpayer's brother, sister, stepbrother, stepsister, or descendant (including an adopted child) of any such relative, or was placed in the taxpayer's home by an authorized placement agency.
Sec. 413 - Delay Effective Date of Organ Procurement and Transplantation Network Final Rule	Delays implementation for 90 days, beginning on the date of enactment, the final rule entitled "Organ Procurement and Transplantation Network," promulgated by the Secretary of HHS on April 2, 1998, and the amendments to the rule promulgated on October 20, 1999.