Good afternoon, everybody and welcome to today's webinar.
My name is Karla Bell, from the California health incentives improvement project and I'd like to welcome you to today's webinar, entitled California department of rehab taition and the new ticket to work program brought to you by the California Health Incentives Improvement Project and San Diego State University inter work institute.
I'd like to take care of a bit of business first, before I introduce our presenters.
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Now, certification, excuse me, certified rehabilitation counselor or C R C credits, will be available for this webinar. So, to receive C R C credits, you need to complete a survey and short quiz. We will follow up with an e-mail on how to receive the credits, now this e-mail will also include the links to the C R C quiz and survey, also a link to the archive of this webinar, so you can listen to it again any time you'd like. And all of our webinars are always archived on our talent knows no limits web site. So that's where you go for the archives and the C R C quiz, like I said, we're going to be sending everybody a followup e-mail with all of this information.
Today, I am pleased to introduce our presenters, Abby Medina and Megan Hellam from the Social Security program section at the California department of rehabilitation.
Abby Medina is the manager for the Social Security program section, at the California department of rehabilitation. Ms. Medina is responsible for state wide coordination of Social Security programs, including program and policy development and the presentation of policy recommendations to executive management.
Her section is the lead in the implementation, monitoring and overseeing activities of the department, relative to Social Security programs, including the ticket to work and work in ten tivs improvement act, work in ten tivs training and technical assistance and physical over sight of the Social Security administration vocational rehabilitation cost reimbursement program.
She has a bachelor's of science degree in human development and physiology from the University of California Davis, and a master degree in C R C rehabilitation counseling from San Diego State University. And she's been with the California department of rehabilitation for 14 years. Megan Hellam is a Social Security specialist. Working in California department of rehabilitation Social Security program section.
She is responsible for developing and providing training and technical assistance to field staff regarding Social Security work incentives, the ticket to work and work improvement act and health benefit initiatives. She assisted in implementing and monitoring activities related to soshling security programs such as department of rehabilitation cost reimbursement program.
Grant opportunities and demonstration projects. She's an experienced trainer and presenter in the area of Social Security. And she's been with the department six of rehabilitation for two years. Abby and Megan will take questions at the very end of today's presentation. So, please, jot down any questions you have as we go through the presentation.
Now, we will open up the webinar chat window for questions once the presentation has been completed. At that time, please enter your question into the chat window, on the right side of the screen, and click enter.
Now, I'm going to turn it over to Abby and Megan to start the presentation. Take it away.

>> Thank you, for the introduction, Karla and first we want to thanks the California Health Incentives Improvement Project p San Diego State University for inviting us to present on this topic this afternoon. And today's presentation, Megan and I will cover the following topics. And if you would like to follow on the agenda, it's on slide two. And we realize we only have an hour and a half to cover, we have a lot to cover, in today's session. And, one one thing I would like to say is we will have 15 minutes for Q and A. And, if for whatever reason, we are not able to get to the questions, to all of your questions, we have about 220 registered, so I'm assuming there will be a lot of questions at the end of today's presentation. We will communicate to you another avenue that you can submit those questions to us, so that we can make sure to give you the answers.
And, so in today's presentation, we will cover the following topics. Overview of the rehab process, Social Security administration, vocational rehabilitation, cost reimbursement program. Overview of the new ticket to work program. Partnership plus and sequential services, new ticket status in use S D R and finally, a little bit on the timely progress reviews.
Before we begin, as I said earlier, we have different organizations who have registered for today's webinar. We have a variety of audience here today. A lot primarily, staff of the independent living centers, some department of rehabilitation staff and counselor's. Employment networks and other service providers, private and public entities.
So, what I would like to do is, start by communicating to everyone, what the California department of rehabilitation mission statement is. And the first couple of slides, I would also like to take an opportunity to give you information about our department, what we do, and along with some statistics on the clientele that we serve.
So, slide Number three, our department, the California department of rehabilitation has a three prong, a three prong mission statement. And our goal is to work in partnership with consumers and other stakeholders to provide services and advocacy resulting in one, employment, two, independent living and a quality for individuals with disabilities.
Our department carries out its mission by providing vocational re bill station and other necessary services that provide access and independence to eligible Californians with disabilities.
The D O R provides vocation national rehabilitation services to eligible individuals with every type and category of disability. And our vocational rehabilitation counselor's in 14 department of rehab districts, work directly with consumers.
Next slide.
Just a little bit on our authority here. The R S A or rehabilitation services administration, oversees the V R program at the national level. And it has the short and responsibility to assure that V R programs are provided in accordance with the federal rehabilitation act 1973 as amended as codified in CFR 34. Now, the department of rehabilitation is part of the California health and human services agency.
A little bit on the number of consumers that we serve. Which is slide five, California department of rehab statistics. We serve a hundred 20 cases annually, and one-third of these, or 40,000, are S S I, SSDI cases. Or supplemental security income, or Social Security disability insurance cases.
We currently have approximately 25000 open S S I, SSDI cases. Of these, approximately a 4th are individuals with psychiatric disabilities, and after 25,000, approximately half fall into category one, otherwise known as most significantly disabled in our federal regulations, and approximately half are in category two, or significantly disabled.
Now, just to explain that a little bit here, on the categories, this has to do with order of selection. State vocational rehabilitation agency, what order of selection is, if a state vok rehab agency does fot have adequate funds to serve all eligible individuals right away, then we are required to serve the most significantly disabled first, and then significantly disabled, then disabled. We have those three categories.
Currently right now, the department of rehab has been fortunate enough to continue to serve our category one and two most significantly disabled, and disabled categories.
Next slide.
So, before we move on further, what I'd like to do is take a look at Social Security administration, definition of disability. In order for an individual to be determined eligible for S S I and/or SSDI, that individual has to meet S S A's disability criteria. And in your slide, we have the word for word definition of disability according to federal Social Security administration.
Basically, what that is, is the inability to engage in any substantial gainful activity, because of a medically determine able physical or mental impairment, and that impairment can be expected to result in death or that has lasted or expected to last for continuous period of not less than 12 months. So as you can see, Social Security has a very stringent definition of disability.
And, this definition of disability applies to individuals who are age 18 or over. Social Security has a separate definition of disability for children under age of 18, and also for individuals with a visual impairment.
We're not going to go through the under 18 definition of the disability because our topic today has to do with ticket to work and that's a program for S S I or SSDI beneficiaries who have 18 to 65.
Before I move on, I mentioned the inability to engage in any substantial gainful activity or S G A. Basically, what S G is A is according to Social Security, is that a person who is earning more than a certain monthly amount, and this year, it's a thousand dollars for non blind and 1640 for blind. This person is beings ordinarily considered by Social Security to be engaging in S G A.
So, that's basically the federal definition of disability for the eligibility criteria to qualify for S S I and SSDI.
So, slide No. 7 now, here, talks about the department of rehabilitation's basic eligibility criteria. Basically, for the department, an individual is determined eligible if they meet the following factors. This is our basic eligibility criteria as defined in our CCR seven '06 two. So an individual has to have a physical or mental impairment that No. 1, con stutsz or results in a substantial impediment to employment, and that individual must require vocational rehabilitation services to prepare for retain or regain employment consistent with their primary employment factors listed on the slide, and also, of course consistent with their informed choice. And finally, employment, they have to be interested in obtaining employment. That's the ultimate outcome.
Employment has to be the individuals goal.
Now, again, that's department of rehabilitation basic eligibility criteria that our counselor applies when an individual applies for department of rehab services.
The next slide talks about D O R presumptive eligibility. Now, this applies to S S I, SSDI applicants. And basically, under federal guidelines, remember, when I define Social Security's definition of disability earlier, I mentioned that they have a strict criteria for eligibility, based on their disability. So, the consumers who apply to D O R services and have been determined eligible for S S you I or SSDI have already been through an extensive review of their disability by the Social Security administration.
So for that reason, the public voek rehab program a firms that any individual who is receiving S S I or SSDI as a result of disability, is presumed eligible for V R services so long as they intend to achieve an employment outcome. The S S I, SSDI applicants are presumed eligible and also considered to be an individual with significant disability for the purposes of order of selection, unless of course the rehab counselor determine that that individual is not capable of benefitting in terms of an employment outcome from vok rehab, due to the severity of their disability.
And Megan will talk to you about that in a little bit. Actually, right now, right, Megan?
So, the next slide here, Megan will give you an overview of the rehabilitation process.

>> Thank you, Abby. We're going to look now at the rehabilitation process. And, this is a flow chart that really shows the rehabilitation process. And many of you who are counselor's are probably looking at this and thinking that little a ingts bit shorter than what I'm used to looking at. This is an abbreviated version of the rehabilitation process. We begin at the top, showing when the consumer applies for services.
After the application the counselor typically does an intake interview or orientation to D O R services before moving onto making a determination of eligibility. Now our S S I, SSDI beneficiaries who apply for services do fall under the presumptive eligibility. So the determination is made promptly in those cases.
For other consumers, if they don't meet D O R's basic eligibility criteria that Abby went over for us. They are not el eligible and the case is closed.
So in a case if a counselor has some doubt, due to the severity of their disability. A counselor may choose to do an extended evaluation, which usually takes the form of a trial work experience or a T W E.
This does happen from time to time with our S S I SSDI consumers as well. Basically what the trial work experience is, the consumer is placed into a work environment and observed. And the results of the trial work experience help the counselor to determine whether the consumer can benefit or not in terms of an employment outcome and makes a determination of eligibility from there.
So once a consumer is determined to be eligible or is presumed eligible. The next step is to determine the level of significance gans of disability. Now, this is also known as L sad. And this is a reference to what Abby was talking to you with our categories, category one, two, and three. So, a consumer is then placed into one of these three categories, depending on how many areas of their life are impacted by their disability.
Now, as Abby said, California is currently under an order of selection. So, at this current time, we move on to the order of selection box. And that means that we can continue to provide services for category one, most significantly disabled individuals, and category two, significantly disabled individuals.
Now, anyone who is in category three, which is the category of disabled, is currently being placed on the wait list. But you'll remember Abby mentioned that half of our S S I, SSDI consumers are in category one. The other half are in category two. So they are currently being served.
Now, once the eligibility has been determined, they've been to the L sad or the level of significance gans of disability. It's determined they're meeting the criteria for order of selection, we then move onto the individualized plan or I P E this is when the counselor and consumer sit down together to develop the plan.
Once the plan is signed and approved, we then move onto implementing the plan. Part of the implementation is providing the services that are authorized on I P E, such as training, provision of assistive technology, job seeking skills and so on. It is the goal of the department, of course, once the I P E is completed, and the services have been provided as outlined in the I P E, that that individual would be placed in employment.
Now, after placement, once that person is stabilized in employment for 90 days or more, they, the D O R case is closed successfully. So a successful close shush is closure is also referred to as a kloesh klosh sure status 26.
Now, if a consumer is not stabilized in employment or for any other reason is not successful or drops out of the I P E at any point for whatever reason, then that would be an unsuccessful closure or status 28 closure as it's referred to.
There is also an option for post employment services. You can see, the arrow pointing away from the box to successful closure to post employment services, and this is, these are services that can be provided to consumers who are employed who were successfully closed and they need some services that are limited in scope and duration, in order to help them to retain their employment. So post employment services are available to consumers when needed and approved by the counselor.
We're going to move on now to talk about, actually, before I do move on, let me go back. I want to pause for a moment and talk a little bit about the individualized plan for employment, the I P E development.
It is important to bear in mind that the development I P E is a separate process from the eligibility determination. The D O R counselor needs to do an assessment for rehabilitation needs of the consumer and this begins with both the counselor and the consumer having a clear understanding of the impact of the disability on their employment.
So if additional information is necessary, to determine the vocational goal, and the employment outcome and the nature and scope of services to be included in the I P E, the counselor con duingts a comprehensive assessment of the unique strengths, resources, the priorities, concerns, abilities and capabilities for the consumer based on informed choice. And I do pause here to emphasize this just so that you can understand that the I P E development is a process in and of itself. So it's not necessarily something that can happen overnight. It's something that takes time.
Okay. So now we'll move on. And talk a little bit about Social Security administration's partnerships with D O R. We have, we partner with the department, we partner with Social Security administration, in many demonstration projects and Grant opportunities. fwo of those are the I S S P or individual self sufficiency planning project. Grant and also the bridges Grant. And these are two grants focusing on two different populations. I S S P focuses on individuals with psychiatric disabilities, and the bridges granlt focused on transition age youth with disabilities.
And both involved intensive benefits planning and service coordination as an employment support. And as a result of these two demonstration projects, we actually saw a success rate in terms of their employment, between 59 and six five percent. That's compared to a national average of about 18 percent. So those were two very successful demonstration projects.
We also partner with Social Security in data exchange and that's something Abby will talk about later on today. We partner with Social Security in work incentives training, for our D O R staff and other community partners.
We participate also in the Social Security administration hiring initiative, and this is something that Social Security administration does to help to recruit qualified individuals with disabilities to work in Social Security administration offices.
And we also partner with Social Security administration in the V R cost reimbursement program. And that is what we're going to talk about next.
So the V R, vocational rehabilitation cost reimbursement program is a partnership that we've had with Social Security administration since 1981. And basically, the way it works, department of rehabilitation is eligible to have our costs reimbursed that are sosh jait ted with providing services to S S I, SSDI consumers. The qualification for that to happen, the beneficiary has to work for nine months at S G A level earnings, so $1,000 for this year. Within a 12 month period.
When that criteria is met, then department of rehabilitation is eligible to submit a claim to have our direct costs, our administrative costs and our tracking costs associated with helping to find that person employment, we're eligible to have those costs reimbursed.
Now, Social Security is currently looking at updating and re advising the cost reimbursement regulations. They recently released A N P R M. And they will be releasing in the beginning of 2011, a notice of proposed rule making N P R M as well.
So, let's talk now about the ticket to work and work incentives I am prove ment act, or the ticket act of 1999. This legislation was signed into law by president Clinton on December 17, 1999. The act has four purposes. So the first three bullets here, are work and health incentive improvement of. So the ticket act was written to provide health care and employment services to individuals with disabilities. To encourage states to enable beneficiaries to purchase Medicaid coverage. For California, for that second bullet, you are probably familiar with 250 percent Medi-Cal working disabled program, and that's how that second bullet has manifested in California.
The ticket act also was written to provide options of maintaining Medicare coverage while working. And this 4th bullet is the actual establishing the ticket to work and self sufficiency program. Or the ticket to work program.
So the first three bullets cover the work incentives and health incentive improvement, the 4th and last bullet is a ticket to work component. And that's what we'll be focusing on for the rest of today.
So, basic overview of the ticket to work program, all S S I, SSDI beneficiaries who are between the ages of 18 and 64, who are in a current cash pay status, have a ticket, or are at least ticket eligible.
Now, they are, there are two options for a ticket holder to use their ticket to receive employment services. If they come to the Department of Rehab or another state vocational rehabilitation agency, that is functioning under the cost reimbursement program, their ticket will be placed in use SVR status. If they choose to use their ticket with an employment network, their ticket is assigned.
To that employment network. And employment networks are paid differently than a state V R agency who is functioning under the cost reimbursement program. They're paid on an outcome milestone payment system.
So these two ticket statuses will come into play later on in the presentation. The thing I want you to come away with at this point is to understand that there are two different ticket statuses and a ticket can be placed in use SVR status or assigned to E N. But they cannot be, it has to be sequential, it cannot be in use and assigned at the same time.
So, as many of you know, Social Security administration does issue the beneficiary an actual paper ticket. But it's important to remember that this paper ticket is not required in order for that person to use the ticket. A ticket status can be verified by Maximus and Maximus is the program manager for the ticket to work program. And their phone number is here on this slide. '86 six, '96 eight, '78 42.
So that's the number that can be referred to if a person does not have the actual paper ticket. Or if you need to verify whether it is available for assignment.
There are several key players in the ticket to work program. One of them is of course the Social Security administration. Maximus is, as I said, the program manager for the ticket to work program. CESSI is responsible for the recruitment and outreach of employment networks and CESSI will continue to fulfill that role until the end of this month, end of November, and a a different contractor will take that on in December.
Beneficiaries are a very key player in the ticket to work program. And we also have employment networks which we began to mention and also state V R. State vocational rehabilitation agencies such as Department of Rehab.
So, we have basic idea of who is involve nd the ticket to work program, and how it works. I'm going to turn it back over to Abby now, who is going to talk about some of the benefits of the tickets to work program.

>> Thank you, Megan.
A lot of you are wondering, what if the benefit of the ticket to work program, what's in it for me? If you're an employment network, what's in it for you, if you're a beneficiary, what's in it for you, or a state V R act see, what's in it for you. So basically, m the next three slides, I'm going to discuss what the benefits of the ticket to work program, in all three areas.
So the first is, as a beneficiary, what is the benefit of the tinkt to work program?
The new ticket to work program offers choice of service providers for beneficiaries who do not want V R services. Now, we have a lot of beneficiaries here in California, we can't serve all of them. And for those who do not want to go with the California department of rehabilitation or want V R services, now have additional choice of service providers in the form of employment networks or E Ns.
The ticket to work program also offers choice for beneficiaries to receive services from V R and E N sequentially. And the sequential services has to do with the new service delivery model which Megan will discuss later on, called partner plus service delivery model. So basically the beneficiary can also, you know, choose to first come to vok rehab, to get the intensive services that they need, such as training, and provision of assistive technology, job seeking skills and when the V R case is lowestd, they can can choose to assign their ticket to an employment network of their choice.
The ticket to work program also then provides ongoing support services for the beneficiaries, so that they can maintain work efforts. In the case of a consumer who is working with Department of Rehab, once their case is closed successfully, they may need additional ongoing support services, because the department of rehabilitation is not the end all and be all, and do not provide services forever.
So, therefore, follow along services, ongoing support services, would be available through the employment network of their choice. And finally, the other benefit to the beneficiary is, while that individual is either using the ticket with the department of rehabilitation, or have their ticket assigned to an employment network, now, remember, if either in use with SVR, state vok rehab agency or assigned to an employment network. But not both.
Either way, while they have a ticket assignment or while the ticket is in use and they're makesing satisfactory progress defined by S S A, defined by timely progress reviews.
These individuals are protected from medical konlting reviews, what that means is sushl security administration will suspend their regularly scheduled medical continuing disability reviews, for those of you who are not aware of that terminology, medical konlting disability review, let's define that.
Next slide.
So, what is a medical CD R or medical continuing disability review? This is a periodic review that the Social Security administration conducts in order to determine the continued eligibility for disability benefits, based on that individual or that beneficiary's medical or disabling condition. Some of the consumers that you serve might have what Social Security calls a diary date where they conduct their medical review every year.
Some every three years.
Some every seven years. Depending on the expectation of their medical recovery.
So, that's basically what a medical konlting disability review is. It's important to know that the ticket to work program, participation in the ticket to work program suspends that individual's medical review, not work review or any other type of review that Social Security does. We get a lot of questions on that. Suspension of medical review, has to do with the ikt, ticket use or ticket to work.
Okay, so I've communicated the benefits to the S S I SSDI beneficiaries. Now, what is the benefit to the employment network? I know we have some employment networks who are on this webinar today, and so, the first benefit that the ticket to work program offers to employment networks is money. Additional revenue source.
In the form of E N payments or outcome milestone payments.
Now, we have a lot of employment networks here in California. Some of you are, many of you are vendors of the California Department of Rehab. Many of you are already providing services to individuals with disabilities before you became an employment network. And you are funded by a variety of sources. The ticket to work program is yet now another source of revenue for the employment networks. tn beauty of it is that, Social Security allows the employment networks to use the payments however they choose.
We know that some employment networks that have been operating for a while have received enough payments so that they can hire additional staffing for their organization. Some employment networks are using, in addition to the services that they're providing, real services that they provide, recently have been using some of the payments as financial incentive, and for their beneficiary, meaning that they are, they could be sharing a percentage of the payment that they receive. As a financial incentive for that consumer.
So that is also allow able understand Social Security administration. The E Ns can also choose to accept or decline a ticket assignment from a beneficiary. So what that means is that, the E N has ank opingts whether to serve that beneficiary or not, for whatever reason
( An option.)
So these are the nain benefits.
Finally, what is the benefit of the ticket to work, to the state V R agency. We talked about options earlier, the first bullet again talks about new options. So, for state V R agencies, the ticket provides a new option for assisting your consumers to obtain and advance in employment in dayses where we have closed their cases successfully. In the past, once we closed the case successfully, we do provide post employment services, if necessary. But now, we have additional support an option in the form of an employment network to help that individual retain, maintain or advance in employment. And of course, it is the beneficiary's choice to assign that ticket.
And for those cases where the counselor is not successful or consumer is not successful with D O R and the V R counselor closes the case unsuccessfully for whatever reason, whether it's the client asking them to close the case, or whether the consumer did not follow through with their I P E, the ticket program provides another option for these beneficiaries to go to employment network of their choice.
And this third bullet doesn't so much apply currently to California department of rehabilitation, because we are I believe to serve all S S I, SSDI eligible beneficiaries. But it applies to other state V R agencies who are currently on an order of selection, and have their categories closed and cannot serve some consumers that are eligible.
This, the ticket provides an alternative for beneficiaries who are on the waiting list or status '04, in rehab language.
So, these individuals that are placed on the waiting list now have an option rather than just staying on the waiting list, waiting for V R to serve them. They have an option to go to an employment network to pursue their work efforts or get assistance also, the counselor now has an option to refer that particular consumer who is on the waiting list to, for information and referral according to our federal regulations, to refer that individual to an appropriate employment network of their choice.
Finally, the ticket to work program reduces the need for re opening cases, when beneficiaries need additional assistance after V R closure. One thing I forgot to put on this slide is the other benefits that the state V R agency is cost reimbursement.
The E Ns have a invested interest to see that's these consumers maintain their work efforts and maybe even increase their earnings because that's how they will be paid by Social Security administration, through outcome milestone.
So the E N provision of ongoing support and retention services is a benefit to Department of Rehab or state V R agencies because it may likely result in increasing numbers of S S I, SSDI consumers to achieve the nine months of level of earnings which then can allow the Department of Rehab or any state agency operating under cost reimbursement to submit more cases for cost reimbursement, while E Ns can also submit for E N milestone payment.
So, the idea, the intent is for this to be a win/win situation for all parties involved.
The next slide talks about the state V R agency option. Now, as defined in the Social Security regulations, the state R R agency has two options. We have an option to choose whether to serve beneficiary under the traditional cost reimbursement program, or we as a state V R agency have an option to function or operate as an employment network under the ticket program.
Now, currently right now, just like the majority of state V R agencies, California D O R is cost reimbursement only. We are not functioning as an employment network. So we are strictly cost reimbursement only.
Now, let's talk about partnership plus. I mentioned earlier sequential services. So I will turn you over to Megan to give you information on partnership plus and sequential services.

>> Okay. So, under the old ticket to work regulations, Social Security administration paid beneficiaries, paid for beneficiary success under either the V R cost reimbursement program or under the ticket to work program but not both.
With the new regulations that went into effect in July of 2008, it permits payments to vocational rehabilitation agencies under the cost reimbursement program and also to the employment network under the ticket program or the milestone payment system, on behalf of the same beneficiary for the same ticket, in certain circumstances.
So when a consumer comes to the Department of Rehab, and we function as accost reimbursement program, after the D O R case is closed the employment network has the opportunity to take that ticket assignment, serve that consumer, help them to retain their employment and be paid under the E N milestone payment system. And we will talk in more detail later on about how exactly that works under partnership plus. This is essentially, what the partnership plus service delivery model includes.
The payments are based on the provision of the sequential, not concurrent services.
So let's talk for a second about how this impacts, how partnership plus impacts payment to employment networks. The partnership plus service delivery model does increase the likelihood that the ticket holder will continue working, will retain employment, it increases the likelihood that the V R agency will receive the cost reimbursement payment from Social Security. And it also increases the likelihood that the employment network will receive the ticket payments, the milestone and outcome payments.
The one note to make here is that when a ticket holder's V R case is closed successfully, that is status 26, the Phase I milestones are not available to the E N. And that is because the Phase I milestones are associated with the level of earnings that's consistent with just beginning employment, since the beneficiary is already employed when they come to the employment network for continued services in this example, then the Phase I milestone payments are not available.
But it is important to remember that nearly $17,000 in the Phase II milestones and the outcome payments are still available to the employment network.
And it's also possible that when the department of rehabilitation consumer is closed successfully, that they are already working at levels of substantial gainful activities. So their earnings are already pretty high. $1,000 or more. And in those cases, when the individual assigns their ticket to an employment network, the employment network may be able to immediately start receiving some of those Phase II milestone payments, because they are hinging on the individual earning substantial gainful activity levels.
Now, you've heard me talk about milestone payments and outcome payments. This is the 2010 E N payments at a glance. This is basically how E Ns are paid. I'm not going to spend much time on this, because those of you who are employment networks who are tuning in I'm sure are quite familiar with this. But it does just emphasize that the E N payment system is outcome based. That is, it is dependent on the ticket holder's performance, their out comes and earning levlts in order for an employment level to submit for these payments for services they're providing.
Again, I'm sure many of you are familiar with this. If you are an employment network currently. But it is important to note that Maximus the program manager for ticket to work program does provide detailed trainks on the employment network payment system, along with many other topics. But I did want to at least reference it here today.
So, I've got another flow chart for you. This is the partnership plus flow chart. And this may look familiar to some of you. This is something that Sally roads with CESSI has developed. It does a really nice job of putting everything that we've been talking about today into a context of the big picture. In the upper left-hand corner, we start with the beneficiary goes to the vocational rehab agency and applies for services. If you remember back to the previous chart we looked at you know there are several different steps in terms of eligibility, et cetera, et cetera. Before we get to the next box on this flow chart, which is with when the beneficiary and the V R agency develop the I P E.
Now, when that I P E is signed and approved, that is what notifies us to let Maximus know to place that ticket into in use SVR status. That's when the period of vocational rehabilitation for that individual begins, with the I P E approval date. From there we move to the third box on the top from the left. The vocational rehab agency provides services as outline nd the I P E.
There is an interesting note here, V R may purchase services from vendors on a fee for service basis. And those vendors may be approved E Ns and we will be talksing about that relationship between D O R vendor and E N later on today. But kind of an interesting note there.
So, V R closes the case. And when that person is successfully or unsuccessfully employed, in this example successfully employed, and we notify Maximus after the beneficiary has been stabilized in employment for at least 90 days.
We move to the second row, far right, and at case closure the counselor advicees the beneficiary of the options of assigning their ticket to an E N for ongoing support services and Abby is going to talk more about the counselor role as we go throughout the presentation today.
So then the beneficiary would connect with the employment network and discuss the need for ongoing support services. The E N and the beneficiary develop an I W P, this is an individuals liesd work plan and that is sent to Maximus for approval. And that is what triggers the ticket assignment to that E N. So it was originally in use SVR for the duration of the D O R case and then that at case closure that notifies Maximus to take that ticket and make it available for assignment. When they receive the I W P is what triggers the ticket to be placed into an assigned status to the E N.
So of course the E N provides the services outline nd the I W P to help the individual maintain or advance in employment. And as the consumer or the beneficiary continues to work TTW E N, earnings increase and they become more self sufficient, the E N can submit for the Phase II milestones payment. Once the beneficiary is khaeving S G A level earnings and the beneficiary and E N keep working together. When the disability checks stop, that's when the E N can submit for the outcome payments.
So, this flow chart also shows the E Ns have a vested interest in helping con suments ering to retain employment. And it's important to remember that throughout this process, department of rehabilitation or any other state V R agency is tracking the earnings of that individual. And when they have met the criteria for cost reimbursement, that is, when they have reached nine months of S G A within a 12 month period, D O R can then submit for the cost reimbursement claim on that individual.
So in this partnership plus service model it's a win/win win situation. Department of rehabilitation is able to seek the cost reimburse. The E N is getting paid through the milestone payment system. And also, and most importantly, the beneficiary is receiving intensive up front services from D O R and also receiving the retention benefits and the career advancement services that are offered by the employment network.
Okay: So the E N out reach efforts. Often with the partnership plus service delivery option, we see many employment networks reaching out to D O R or beneficiaries to know about the services they offer. For D O R counselor's, I'm sure that at local offices and district offices you may have been contacted by E Ns, saying we would like to start a partnership plus or E N agreement with you. What that means is they want to outreach to D O R and beneficiaries to let them know what services they can provide, and what services that they can offer to help individuals retain their employment.
So, we do ask that D O R consider the possibility of allowing employment networks to do short presentations at D O R unit meetings. This is something that has been happening on an informal basis currently and we've seen some great success with it. And also, consider E N presentations at D O R group orientations and other opportunities like that. Employment networks have expressed that they are more than willing to come in and provide just a basic overview of the ticket to work program at an orientation for consumers and things like that.
So just something to consider.
And what this does, is it really reinforces the idea that consumers will have this ongoing support, and the services after the D O R case is closed. So this, these outreach efforts can be in everybody's best interest.
Okay. So that begins to wrap up our discussion of partnership plus directly. I'm going to turn it back over to Abby who is going to start talking about the ticket to work procedures at the California Department of Rehab.

>> Okay. Thank you, Megan. So earlier today, Megan's outline of the vocational re bill or V R process. So what I want to do now, is talk about the California Department of Rehab ticket to work procedures.
Of course, the rehabilitation process remains the same. So, how does the ticket to work procedures fit within the Department of Rehab process?
And so the first bullet you've mentioned, you've heard me talk about presumptive eligibility. So when an individual comes to D O R for services, the counselor after orientation and intake makes a presumtive eligibility determination. So one note that I would like to say on here, is if you are an employment network or service provider who is referring that beneficiary to the counselor or to the local D O R office, the counselor is required to determine if, to verify if that individual is actually an S S I SSDI beneficiary.
So, if you are referring that individual and you have information or proof of S S I SSDI status of that individual, you may want to make sure that that beneficiary has that with them when they come to orientation, or meet with the counselor, because in order for the counselor to apply presumptive eligibility promptly, the counselor will need to verify their current S S I SSDI status. And some of the acceptable proof would be the actual ticket itself. We don't care whether it's a copy or original. That would be proof of, you know, presumptive eligibility or SSDI S S I eligibility, that would make the counselor determine presumptive eligibility. Benefits planning query report is also acceptable proof, verification, a current benefits report or B P Q Y.
That's another acceptable piece of documentation. Or, any documentation that verifies that that individual is a current S S I SSDI beneficiary, such as an award letter or paystub.
But, bottom line is the counselor has to verify the, that that individual is actually an S S I SSDI beneficiary. So the counselor goes through the typical rehab process, provides general ticket to work information. And I'm going to talk about the beneficiary fact sheet that is available in the Department of Rehab's web site that we have advised our counselor's to provide to the beneficiary, and I will talk a little bit about what that beneficiary fact sheet contains.
And, planned development, once the plan is signed, the Department of Rehab sends monthly I P E data files to Maximus and monthly closure data files to Maximus. And there's two reasons for that. Social Security or Maximus has to know the I P E date, because it's the I P E date that allows them to trigger in use SVR status. It's the I P E date that allows Maximus to move the sign able tickets to in use S D R status. Remember, in use S D R status applies to state V R agencies that are operating under cost reimbursement program.
The D O R provides services for approved I P E. And then, once the case is closed, the Maximus makes the ticket available for assignment to an employment network. And so, we also send, we, when I say we, it's department of rehabilitation central offices, we sev tral lizd this reporting office so oyr counselor's do not have to do it. In addition to the monthly I P E data files, we also send monthly closure files and this is how Maximus knows that the case has been closed either successfully or unsuccessfully.
In order for them to uncode it from SVR, in use SVR and make it available for an assignment for employment network.
I think you've heard me say three or four times term in use SVR status. Let's Dee define that.
The new regulations introduced this new sfat tus called in use SVR status and this again, only applies to state V R agencies operating understand state reimbursement fashion.
This status a forwards the S S I SSDI consumer the same medical CD R protection as a ticket assignment. So then there goes the first bullet. If the ticket is placed in use SVR status, they will receive the protection from medical continuing disability reviews. And I would like to stress that, that suspension of medical disability review means future medical disability review. So, I know we have some counselor's on line here, on the webinar, if your consumer, if Social Security already has initiated the medical review, before the case was put into plan or placed in in use SVR status, that medical continuing disability review will continue, and Social Security will make a favorable or unfavorable decision.
What will be suspended is any future medical continuing disability review that they have.
Okay. Again, this in use SVR status is triggerd when the beneficiary signs the individualized plan for employment. And D O R notifies Maximus via electronic data transfer file. And in our case, we report monthly. I know other state D R agencies report quarterly. So Social Security has given V R agencies the flexibility of how often to send the data files.
The third bullet, a note here, that the ticket cannot be in currently, in an assignment to an employment network, in order for Maximus to code the case as in use SVR status.
Okay. So, the ticket must be available for assignment in order for Maximus to allow an in use SVR status.
And the ticket is then available for assignment to an employment network, when the V R is closed successfully or unsuccessfully. So we added that, because there's a lot of, I guess questions there on, well, does the E N just want a ticket for cases that are closed successfully only? What about those unsuccessfully?
So, it doesn't matter whether a case is closed successfully or unsuccessfully, once Maximus receives the closure date file, indicating 26 or 28, that ticket will become available for assignment. Now, it will be, again, because it's an E N option to serve the beneficiary, it will be up the to that employment network if they want to serve an, that particular individual, depending on, you know, whether they're, irrespective of whether the case is closed successfully or unsuccessfully.
Okay. Next slide. Okay. This is a huge paragraph here. I'm not going to read it word for word. You have it there for reference. But what I would like to say about this is, with the ticket to work program, what the California department of rehabilitation has done is, and other V R agencies have done similar things, is to add a consumer's statement on the I P E or individualized plan for employment. And this basically, so that we can adhere to the concept of informed choice in notifying that individual.
And basically, two main things here: The information on here discusses that the counselor has provided the individual an information regarding timely progress. And there is a beneficiary fact sheet that our counselor's have been instructed to give to consumers or use as a guide when explaining the ticket to work program. And this two page fact sheet is available on D O R's web site at WWW Dot D O R Dot C A Dot gov. And the last page of the fact sheet basically, is the information on timely progress benchmarks from Social Security administration.
So basically, just to highlight what, since you don't have a copy of that fact sheet right now with you, the fact sheet includes basic information on the toykt to work program, what is a ticket. And it also has information on what happens if you agree to work with the state V R agency such as the Department of Rehab. And it provides information on work incentives and benefits planning.
The rights, including protection and advocacy program. It provides information on the other projects and some important phone numbers for the beneficiary to consider, including our ticket to work toll free hotline and client assistance program. Again, the last page talks about the timely progress guidelines, word for word by Social Security administration under regulations.
The second half of the statement on the I P E discusses the department of rehabilitations good faith effort and commitment that if that individual was originally referred by an employment network to D O R, that, that individual, will be referred back to that referring employment network at the end of the D O R services.
Again, informed choice here, the last statement, you know, also states that it is the ultimate choice of that consumer who they want to assign the ticket to.
But the department of rehabilitation will take maximum efforts, that if that employment network refers to us, that we will refer that individual back to on that employment network.
Now, a lot of times this, it has not been happening a lot, we recognize that. And, or have not been happening consistently.
So, we have developed a D R referral form to help facilitate this process and I'm going to touch on that in a little bit here.
But, before I do that, I'd like to continue with a California D O R ticket to work procedures.
So, what is the departments of rehabilitation counselor's role at D O R case closure?
Now, the D O RV R agency counselor, not the CV O R, has a critical role in making sure that certain beneficiaries understand their options under the ticket to work program. The beneficiary needs to know that he or she has 90 days after V R case closure to assign his or her ticket to an employment network, in order to continue protection against medical CD R.
If that beneficiary's ticket is not assigned to an E N within 90 days, the CD R protection will be discontinued, however that beneficiary can continue participate anything the ticket program.
So once that consumer assigns his or her ticket to an employment network that CD R protection can be reinstated.
Again, but if the beneficiary receives a notice of medical CD R during the period that they have not assigned their ticket, that medical CD R will continue until it's completed. But then they will be protected from future medical CD Rs.
Under the V R governing regulations, specifically 24 CFR 361 point 56. One of the requirements foreclosing the record of services for a V R consumer who has achieved an employment outcome, meaning kloltion 26, is to inform that consumers of the availability of post employment services.
Now, based on this regulatory provision, the V R counselors should be routinely providing information on the consumers options for using the ticket after V R case closure.
To make an informed choice, a beneficiary needs to know that the his or her ticket still has value after V R services are completed and V R services is closed.
So, basically, encourage ticket assignment to the E N, not just to continue the medical CD R suspension, but then to allow that, that consumer the option or ability to obtain retention and ongoing support services. Once they're no longer with us.
Maximus web site, a lot of you you know, ask us how do I find or how does my consumer find an employment network in my area, in case this, that con sim err was never referred by that employment network in the first case.
The last bullet has Maximus's web site. WWW your ticket to work.Com, and on the left hand side, there's an E N directory link. So you click on that E N directory, and that directory also allows you to search employment networks by zip code or by county.
And of course, counselors, if you need any assistance in this, the Social Security program section is always available for technical assistance and guidance to you.
Okay. So, we talked about the monthly data file of I P E data and also the closure data that we send to Maximus. There is a delay in Maximus posting of beneficiary's name back on the list of beneficiaries with tickets available for assignment. You know, we closed the case throughout the month. We submit the data files once a month. And Zomax must has to load that so, Maximus has to load that data in their system. And depending on when the case was closed, the delay can be anywhere from two to seven weeks.
So, just just a time, a critical time for beneficiaries to continue to need ongoing support svts services, to be able to access employment network, Zomax must now allows a beneficiary or an E N to use other evidence of V R case closure, so they can assign that ticket right away to an employment network immediately after we close the case.
What that means is they don't have to wait until Maximus gets data and puts the data in the system.
And, the two acceptable pieces of information that beneficiary can use or an E N can use, as evidence of the V R closure is that V R case closure letter, signed by the counselor, and/or an employment network referral form or E N referral form.
Now, to facilitate this referral back to the employment network, well, not just referral back to the employment network, to facilitate the referral from an employment network to D O R, and from dor back to the employment network, the dor has to developed two forms, and in the form of, and we have a, we actually have a copy of that form on this power point presentation here and we'll let you know where you can actually access the form.
And it's the D R 343 A V R agency referral form, which is the here right now. And then on the next slide, which we're going to show you later, is the D O R 343 B referral, to employment network.
And this is to help facility tight the referrals back and forth between D O R and E Ns, more consistently and effectively. In the past, this is happening, not all the time, and not consistently, and so, in our effort to make sure that this is happening, this is the new referral form that we have introduced.
This is, to be printed front to back, meaning double sided. So that one side is the E N referring the D O R much, which is the form that you're seeing (inaudible) (inaudible) back to the employment network, which is the next slide.
Referral from the employment network.

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