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Case Closure

CR Cases

A State VR agency must notify MAXIMUS when the case of a beneficiary being served under CR is being closed. This information should also be submitted on a monthly basis in the same format as the information on opened cases. This would include the same four data elements that were reported upon opening the case:

The case closed status is necessary so that MAXIMUS will know whether the Phase 1 Milestone payments would be available to an EN that subsequently gets the beneficiary’s Ticket assignment.

Upon receipt of this information, MAXIMUS will

The beneficiary has 90 days within which to assign his/her Ticket to another EN to ensure the continuation of the protection against a medical CDR. The beneficiary can still assign his/her Ticket after 90 days, but SSA may initiate a medical CDR during the period between the 90th day and the day the beneficiary assigns his/her Ticket to an EN. If SSA does initiative a medical CDR, the subsequent assignment of the Ticket will not stop the CDR from proceeding to completion.

Referring Beneficiaries to ENs after Case Closure

When VR has been serving a beneficiary under CR, the VR Counselor needs to inform the beneficiary of several things.

The VR Counselor should also provide the following information to the beneficiary.

Check out the “Sample Talking Points” (DOC) that VR Counselors can use in explaining the Ticket to beneficiaries at various points in the rehabilitation process.

Some VR agencies are exploring a beneficiary’s post-employment needs prior to case closure by having the beneficiary complete a questionnaire (DOC).

Some State VR agencies have formalized a process for referring beneficiaries to ENs by creating an EN Referral Form (DOC).

Ticket Cases

(under development)

Filing a CR Claim

A State VR agency can file a CR claim when a beneficiary that the State VR agency is serving under CR attains 9 months of earnings above SGA within a 12 month period.  There is no requirement that this occur within 12 months of the VR case being closed.  In fact, this could occur several years after the State VR agency closes the case and the VR agency could submit a CR claim s long as it can demonstrate that the services VR provided contributed to the beneficiary’s successful outcome. 

The same is true in a Partnership Plus situation, i.e., a State VR agency can submit a CR claim when a beneficiary, who has assigned his/her Ticket to an EN after VR closes the CR case, attains 9 months of earnings above SGA within a 12 month period. Again, this does not need to occur within 12 months of the State VR agency closing the case.  If it occurs several years after the State VR agency closes the case, VR agency must demonstrate that the VR services the beneficiary received contributed to the beneficiary’s successful outcome.

The requirements for filing a CR claim are found in the VR Providers Handbook which can be found at http://www.socialsecurity.gov/work/documents/VRProviderHandbook.doc.

Submitting for Ticket Payments

(under development)

CR and Ticket Payments Constitute Program Income

While SSA does not put any restrictions or requirements on how State VR agencies use funding received under the CR or the Ticket program, these funds represent program income for VR agencies. As a result, the amended governing regulation of the Rehabilitation Act of 1973 and the Department of Education’s General Administrative Requirements (referred to as EDGAR) determine how State VR agencies can use program income such as CR and Ticket payments.

The Role of the VR Counselor

The VR counselor has a critical role in making certain that beneficiaries understand their options under the Ticket program. The Ticket not only offers an option for beneficiaries that are wait-listed under an Order of Selection, but also provides access to a new source of funding for post-employment support to help beneficiaries maintain and advance in employment. A VR counselor’s success in helping beneficiaries make informed choices about their post-employment support needs depends, to some extent, on the counselor’s

Information and resources explaining the Ticket program can be found in at least four places:

Benefits Planning: A Key Step in the Rehabilitation Process

In addition to understanding the basics of the Ticket program and Partnership Plus, VR Counselors also need a basic understanding of Social Security disability benefits and the fact that work and earnings can impact a beneficiary’s continued access to disability benefits. SSA has a number of Work Incentive programs that beneficiaries can use to reduce their “countable” income and be able to temporarily keep their cash disability benefits while they explore work. Since these programs are often viewed as complex and confusing, beneficiaries should be encouraged to consult with benefits planners as they plan to enter the workforce. Thus, VR Counselors are encouraged to refer beneficiaries for Work Incentives assistance whenever possible.

SSA provides three free sources of information on Work Incentives.

  1. The Social Security “Red Book” provides a summary of the various employment supports that SSA offers for individuals with disabilities under the SSDI and SSI programs. The “2010 Red Book” can be down loaded at www.socialsecurity.gov/redbook.
  2. General questions about the various Work Incentives programs that SSA offers should be directed to the Work Incentive Information and Referral Center (WIIRC) at MAXIMUS by calling 1-866-968-7842 (voice) or 1-866-833-2967 (TDD).
  3. If a beneficiary has questions about how a job will likely affect his/her disability benefits, he/she should be encouraged to contact the local Work Incentives Planning and Assistance (WIPA) program. A beneficiary can find the WIPA serving his/her area by visiting www.socialsecuritya.gov/work, and clicking on “Service Provider Directory.”

VR Case Closure and Access to Post-Employment Services

As VR counselors have daily contact with beneficiaries with disabilities, they can play a key role in informing beneficiaries about the Ticket program. While there is no “mandate” to discuss the Ticket with beneficiaries, VR counselors are required to consider a consumer’s need for post-employment services within the context of the IPE [34 CFR 361.46(c)]. VR counselors are also required to inform consumers about the availability of post-employment services. VR’s governing regulations define “post-employment services” as one or more of the services that are provided subsequent to the achievement of an employment outcome and that are necessary for an individual to maintain, regain, or advance in employment, consistent with the individual’s strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice.” [Section 34 CFR 361.5(b) (42)] Post-employment services are to be available to meet rehabilitation needs that do not require a complex and comprehensive provision of services and thus, should be limited in scope and duration. If more comprehensive services are required, the regulations state that a new rehabilitation effort should be considered. This would require opening a new case and establishing a new IPE.

The Ticket program and the new Partnership Plus service delivery option provide new opportunities for beneficiaries who need more intensive or long-term post-employment supports. Partnership Plus provides an alternative to opening a new case when a beneficiary needs ongoing support services for individuals participating in supported employment services or when a beneficiary needs more intensive services after being placed in employment. Partnership Plus can also come into play when a beneficiary needs post-employment services to advance in employment to a level that is consistent with the individual’s strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice.

Under VR’s governing regulations [34 CFR 361.46(c)], the IPE or each individual must contain, as appropriate based on the individual’s needs, a statement of how post-employment services will be provided or arranged through other entities. This section of the regulations refers to arrangements made pursuant to the comparable services or benefits requirements outlined in Sec. 361.53.

Facilitating Informed Choice

Under VR’s governing regulations [34 CFR 361.56], one of the requirements for closing the record of services of a VR consumer who has achieved an employment outcome is to inform the consumer through appropriate modes of communication of the availability of post-employment services. Based on this regulatory provision, VR Counselors should be routinely providing information on the Ticket program and a beneficiary’s options for using the Ticket after VR case closure.

To make an informed choice, a beneficiary needs to know that his/her Ticket still has value after VR services are completed and the VR case is closed. Many beneficiaries will need assistance in finding an EN that can address his/her post-employment support needs. Beneficiaries can access information on ENs serving the areas in a number of ways. 

Some VR Counselors will simply refer beneficiaries to MAXIMUS’ Ticket to Work web site (www.yourtickettowork.com) to obtain a list of approved ENs in the area. MAXIMUS maintains a directory of ENs that can be searched by ZIP code, city, county, or state. The directory includes information on the services and supports the EN provides under the Ticket program and any qualifying factors (e.g., some ENs only serve individuals with certain types of disabilities).

Some VR Counselors provide additional guidance to help beneficiaries choose among different ENs. Some provide a list that has been narrowed down to only those ENs that offer the type of post-employment services and supports identified in the post-closure discussion. Some provide more detailed information about ENs serving the area and some will make a formal referral to a specific EN. In some cases, beneficiaries are referred to VR vendors that are approved ENs and that have been serving the beneficiary under contract while the VR case was open. Some VR agencies have formal referral mechanisms that are clearly spelled out in written interagency agreements, while others will make a referral to a specific EN based on the informed consent of the beneficiary.

Some VR agencies have created tools that are used in discussing post-employment options under the Ticket program. One such tool, “EN Selection Form – Things to Consider in Selecting an EN” (DOC), simply asks a series of questions to help a beneficiary identify the services and supports he/she is likely to need after job placement, to think about his/her preferred methods for receiving services, and to explore approved ENs in the area. Some VR agencies have developed forms to make formal referrals to ENs after discussing beneficiary’s options for securing post-employment services (read more below).

There Is a Delay

State VR agencies are required to report to MAXIMUS when a service plan has been signed with someone receiving SSI and/or SSDI. The procedures for accepting a beneficiary for services under the Ticket program are different than those for accepting a beneficiary under the Cost Reimbursement (CR) program. To serve a person under the Ticket program, the VR agency must submit a signed SSA 1365 to MAXIMUS and abide by the rules of the Ticket program, e.g., regarding requesting Milestone and Outcome payments. To serve a person under the CR program, a State VR agency is asked to submit an electronic data file to MAXIMUS, preferably once a month, to report when each beneficiary has signed an IPE with VR and when VR closes each beneficiary’s CR cases. [See the Partnership Plus Toolkit section on Ticket and the VR Process for details.]

When VR submits electronic files on the opening of CR cases, MAXIMUS takes the names of these beneficiaries off the list of beneficiaries with Tickets available for assignment and places them in the new “in-use SVR” status.  This status extends the protection against medical CDRs to these beneficiaries. While a Ticket is classified as “in-use SVR” it is not available for assignment to an EN. This status is also associated with the period for which a State VR agency can submit a CR claim for a beneficiary.

When VR submits electronic files on the closing of CR cases, MAXIMUS puts the names of these beneficiaries back on the list of beneficiaries with Tickets available for assignment. Although the beneficiary’s Ticket is taken out of the “in-use SVR” status, the CDR protection remains in place during a 90-day grace period. Each ticket-eligible beneficiary whose VR case is being closed has the option of going to an EN and assigning his/her Ticket and receive ongoing support services, job retention services, benefits planning services, etc., or to receive additional education and training to advance in employment.

When MAXIMUS receives the electronic files that record VR’s opening and closing of beneficiary cases, the information must be loaded into the MAXIMUS data base. There is an inherent delay between the date that VR reports that an IWP has been signed or that a beneficiary’s case has been closed, the date VR submits its monthly report to MAXIMUS, and the date this information is transferred to the MAXIMUS database which triggers the reclassification of the beneficiaries’ Ticket, i.e., as “in-use SVR” or as “assignable.” 

Depending on when the case was closed, this delay can be anywhere from two to seven weeks. Since this can be such a critical time for beneficiaries who continue to need ongoing employment supports after VR closes the case, two methods have been identified to significantly reduce the delay between case closure and the reclassification of a Ticket as “assignable.” Either a VR case closure letter or an EN Referral Form can be used as evidence of VR case closure as long as the letter or form includes, at a minimum, the following information: 

Since many people have the same name, the process of identifying a particular individual in the MAXIMUS database can be further simplified by including the last four digits of the beneficiary’s Social Security Number. While an EN Referral Form (DOC) can be created to include this information most VR case closure letters do not include both the person’s name and the last four digits of the SSN. To simplify the process, the VR counselor can ask the beneficiary to write his/her SSN on the letter prior to giving it to an EN to use as evidence of case closure. If an EN has access to either a referral form or a case closure letter, the Ticket can be assigned without waiting for the reporting and recording processes associated with taking a Ticket out of the “in-use SVR” status and reclassifying it as “assignable.” These relatively simply processes can go a long way in facilitating a smooth handoff from VR to an EN and facilitating improved coordination of pre- and post-employment services.