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Getting to Work with Assistive Technology - Implications for Assistive Technology Act Grantees: Increased Access to AT in the Work Incentives Legislation
Table of Contents
TICKET TO WORK AND WORK INCENTIVES IMPROVEMENT ACT (TWWIIA) OF 1999
Fact Sheet (from the Social Security Administration website: http://www.ssa.gov/work/factsheet.htm
President Clinton signed the Ticket to Work and Work Incentives Improvement Act of 1999 on December 17, 1999. This new law:
Establishment of the Ticket to Work and Self-Sufficiency Program
Expanded Availability of Health Care Services
The law also extends Medicare coverage for people with disabilities who return to work. It extends Part A premium-free coverage for 4 1/2 years beyond the current limit for Social Security disability beneficiaries who return to work.
Expedited Reinstatement of Benefits
If Social Security decides that the medical condition no longer prevents the individual from working, the provisional benefits paid would not be considered an overpayment.
Continuing Disability Reviews
Effective January 1, 2002, work activity by a Social Security disability beneficiary who has received Social Security disability benefits for at least 24 months could not be used as a basis for conducting a disability review. However, the individual would be subject to regularly scheduled medical reviews. Again, cash benefits may be subject to termination if earnings are substantial.
Work Incentives Advisory Panel
Work Incentives Outreach Program
The law also directs Social Security to establish a corps of work incentives specialists within Social Security.
Protection and Advocacy
Demonstration Projects and Studies
The implementation dates and locations for this demonstration will be announced.
Social Security Administration
From the web page http://www.ssa.gov/work/Q&A.htm;
Questions and Answers on the Ticket to Work and Work Incentives Improvement Act of 1999I. The Ticket to Work Program
III. Removal of Work Disincentives
IMPLEMENTATION OF THE TICKET TO WORK AND WORK INCENTIVES IMPROVEMENT ACT
In January 2000, SSA’s OESP office published a Redbook on Work Incentives: A Summary Guide to Social Security and Supplemental Security Income Work Incentives for People with Disabilities. Social Security Administration, SSA Pub. No. 64-030 ICN 436900. The Redbook is available online in both text and pdf formats.
It is intended to serve as a general reference source about the employment-related provisions of Social Security Disability Insurance and the Supplemental Security Income programs for educators, advocates, rehabilitation professionals, and counselors who serve people with disabilities. The guide also includes some case examples of various SSDI and SSI work incentives along with timelines of eligibility. The guide does not mention "assistive technology" specifically, but includes examples of Impairment-Related Work Expenses (IRWE), such as the cost of structural or operational modifications to your vehicle needed to travel to work, and wheelchairs, One-handed typewriters, typing aids (e.g., page-turning devices), measuring instruments, reading aids for visual impairments, electronic visual aids, Braille devices, telecommunications devices for hearing impairments and special work tools.
Opportunities for AT Act Grantees Under the Ticket to Work and Work Incentives Improvement Act (TWWIIA)
The TWWIIA presents a number of exciting opportunities for AT Act projects in programmatic involvement and in funding.
To address these opportunities, three key points must be reviewed. First, TWWIIA creates and empowers a whole new set of participants in the vocational rehabilitation process. Second, TWWIIA creates new funding streams and new kinds of financial incentives for participants in the rehabilitation and job placement process. Third, the role of assistive technology (AT) in the vocational aspirations of people with disabilities, while remaining centrally important, is not addressed with much specificity by TWWIIA.
How Do These Three Points Apply to the AT Act Projects?
New Set of Participants
Protection and Advocacy (P&A) Programs and Others. Among the institutions empowered and funded under TWWIIA, some are familiar and some are new. The AT Act projects are all familiar with state P&A programs, but these programs have an important new role and significant new funding under TWWIIA. They, along with other entities providing technical assistance, benefits counseling, and related monitoring activities, will play a critical role on what could be called the consumer side of the equation. To a significant degree, the work of these entities will determine whether people with disabilities are successful in negotiating the perilous complexities of work incentives and disincentives that make up the law.
The work of these entities will also be important to assist ENs in effectively conducting their job. From the standpoint of assisting job seekers or ENs, or both, AT Act projects are well positioned to play a major role.
Employment Networks (ENs).ENs is a new concept under the Act. Essentially these networks are the various groupings of contractors who will be created or who will come together to provide vocational services to ticket holders (SSI or SSDI beneficiaries) participating in the program. Since ticket holders are free to obtain vocational services from any eligible employment network, the likelihood is that there will be considerable competition among ENs for ticket holders’ business. But just as competition among managed care providers in the health field does not ensure comprehensive service, the structure within which ENs will work does not guarantee that AT will be fully utilized.
Two barriers exist to maximize the use of AT. First, AT services and resources for evaluation, selection, interface of appropriate devices and systems, training, and technical support are all too scarce. If TWWIIA results in any appreciable increase in the number of people seeking or needing AT in order to pursue vocational goals, this scarcity may become an even greater problem, at least in the short-term. Obviously, AT Act projects can be a major resource in this area.
To the extent they can provide expertise and point the way to other resources, they can play a critical role in making AT available to ENs and to those the networks serve.
New Funding Streams
Employment Networks. The second barrier to effective utilization of AT by the ENs under TWWIIA is potentially even more serious. TWWIIA uses funding models to compensate service providers that again are reminiscent of managed care. The amount of money that ENs can receive for their work with any individual, while it will vary depending on how long they work with the individual and, of course, depending on the outcome of that work, is not subject to significant increase for work with program participants who need costly or complicated services.
So putting a project in the position of an EN, who would a project rather serve for the same money: someone who needs assistive technology in order to work at highest potential or even at all, or someone who needs little or no technology for evaluation, training or placement?
Working with or as part of ENs, AT Acts can once more make all the difference. To whatever extent they can facilitate appropriate technology inputs at the lowest possible cost, they can contribute immeasurably to the ability and willingness of EN partners to incorporate AT into their services and to reach out to ticket holders who want and need AT.
Financial Self Interest. Obviously, AT Act projects will expect to be paid for their expertise and their work, whether they participate on the consumer side of the equation, the provider end, or both. Numerous approaches to this type of financial participation are available. AT Acts can work on a fee-for-service basis, under retainer agreements, as subcontractors (with or without outcome-based payment differentials), and under a host of other models. How a particular AT Act project will finance and, in turn, be financed by its participation in one or more TWWIIA program components or funding streams will depend upon many factors including the project’s overall approach to funding and its status as a public or nonprofit entity.
State VR Agencies. Because 15 AT Act projects are affiliated with or housed in state vocational rehabilitation agencies, and because many others work closely with such agencies, unique opportunities are available to these projects under TWWIIA. TWWIIA does not change the basic VR program, but it does present state VR agencies with new opportunities such as authorization to provide services under the TWWIIA model if they wish. AT Act projects will vary in their response to this opportunity, but the role of AT may be as important as any other single factor in VR agencies’ decisions on how to proceed.
Why? TWWIIA provides a very different reimbursement structure and timetable than traditional VR. Most state agencies that review this reimbursement structure are likely to decide that providing certain services under the TWWIIA model and other services (including AT) under the traditional VR model will be the approach that makes the most sense. Integrating the two program models, especially where AT is concerned, will be neither simple nor easy. Affiliated AT Act projects are likely to be in a good position to play a facilitating role.
Technology Acquisition. Even after AT Act projects have done all they can to assist ENs and state VR agencies to make the greatest possible use of AT, and even after they have worked with the P&As to ensure that every opportunity for using work incentives to obtain work-related AT has been taken, one grimly inescapable fact remains. There will not be enough money in the system to meet the AT funding needs of all beneficiaries who participate in TWWIIA. For this reason, the expertise and experience of AT Act projects in technology funding will become even more valuable than before.
Two important consequences flow from this fact. First, there may be opportunities of getting paid for funding expertise that did not exist before. ENs that cannot or do not choose to fund technology may be eager to find additional funding sources. Moreover, since the ticket holder may be fully aware that AT provision is not an automatic part of the service purchased with the ticket, the law does not prevent ENs and ticket holders from reaching out for such additional funding.
Second, the leverage value of allowing beneficiaries to maintain Medicare or Medicaid while working may be far greater than widely supposed. This is so because Medicare and Medicaid, in addition to providing health insurance, are important potential funding sources for AT.
The last several years have been a time of major advocacy and encouraging successes in establishing the principle that these publicly sponsored health insurance programs have a role in the provision of AT. The key conceptual barrier to using these insurance programs, as a source of funding under TWWIIA, is that the equipment TWWIIA participants seek is work-related equipment, while these medical programs are not designed or available to meet vocational needs. State AT projects can help bridge this gap by providing program participants and AT advocates with the understanding that functional considerations often transcend the distinctions between so-called medical and vocational objectives. Those who are familiar with AT can help make the case that even the most traditional medical definitions of improvement or of therapeutic benefit can be stated and restated in the functional terms that so often describe what AT does.
A project’s expertise in developing justifications, knowing how to document need, identifying evaluators, assessing cost effectiveness and determining appropriateness (to name but a few of the skills AT projects have) can likewise prove useful in the efforts of beneficiaries, ENs, and advocates to access a broad range of other potential AT funding sources. Having done this sort of work and amassed this sort of expertise over a decade, it is high time that your skills receive the appreciation they deserve. The decision to market and package those skills in a way understandable and responsive to the needs and the situation of the participants in the TWWIIA environment is the choice of the AT Act project.
Role of AT with TWIIA
Finally, TWIIA is not very specific about the range of services that ENs will provide. It is expected that some requirement will emerge in SSA’s regulations. However, it is also likely that ENs and job seekers will have an opportunity to negotiate the content of services. What is important here for the AT community is that SSI/SSDI recipients will have no guarantees that the average participating EN can or will provide a level of AT services. Therefore, the AT Act projects may find an important new dimension for their consumer outreach in identifying and describing the kinds of AT services that various networks are prepared to offer.
TWWIIA AT Act Project Self-Assessment Checklist
Should your project decide to meet and respond to the TWWIIA opportunities, your project may wish to address the following questions:
___ Yes ___ No
___ General technical assistance (education, staff training, I&R)
___ New ENs
___ Monitoring activities and performance networks
___ Specialized technical assistance (job analysis, worksite assessment, etc.)
___ Direct service providers
___ Interagency coordination with other private/public entities
List specific resources
___ Technical assistance ____________________________________
___ Consulting services ____________________________________
___ Direct services ______________________________________
___ Interagency coordination _________________________________
___ Others _____________________________________
___ Technical assistance ____________________________________
___ Consulting services ____________________________________
___ Direct services ____________________________________
___ Interagency coordination _________________________________
List Names & Contact Information
___ VR officials ____________________________________
___ One-Stop Center officials ____________________________________
___ Workforce Investment Act officials ______________________________
___ Others ____________________________________
___ Consumer-controlled management structure
___ Other advisory monitoring and evaluation structures such as ___________
___ Total number of individuals with disabilities served through TWWIIA
___ Number of technical assistance activities for TWWIIA
___ Number of trainings and trainees
___ Number of interagency TWWIIA collaborations generated
___ Number of TWWIIA job analyses/worksite assessments
___ Income generated for the project through TWWIIA opportunities
may offer in TWWIIA activities?
___ Yes ___ No
Questions and Answers about TWWIIA from the AT Act Grantees
What interfaces are occurring at federal levels between WIA, Voc Rehab, DOL, and Ticket to Work?
In its second report recommended that the Department of Labor develop a proposal for consideration in the FY 2001 budget process for an Office of Disability Policy, Evaluation and Technical Assistance (ODPET) to be headed by an Assistant Secretary of Labor.
The Office of Disability Policy, Evaluation and Technical Assistance will provide a long-term, permanent force to continue the work needed to ensure that persons with disabilities are integrated into mainstream employment and training programs within the Labor Department. The Presidential Task Force would continue to be responsible in the short-term for developing, refining, and monitoring the implementation of an aggressive, national employment strategy for persons with disabilities.
Pursuant to this recommendation, the DOL’s FY 2001 budget includes $43 million to address barriers that keep adults with disabilities out of the workforce by establishing the Office of Disability Policy, Evaluation and Technical Assistance within the Labor Department and improving access for adults with disabilities to employment services offered through the one-stop system.
The FY 2001 budget includes $20.556 million and 47 FTE’s for the Office of Disability Policy, Evaluation and Technical Assistance (ODPET). ODPET’S mission will be to implement a sustained, coordinated and aggressive strategy to eliminate barriers to employment for people with disabilities that result in meaningful employment opportunities and increase the employment rate of individuals with disabilities. (This office will subsume the President’s Committee on Employment of Adults with Disabilities).
First year activities will be to provide technical assistance for developing physical and programmatic accessibility for people with disabilities through the resources and opportunities provided by the One-Stop Career Centers (created under the Workforce Improvement Act of 1998 (WIA), including work incentive grants to help people with disabilities enter or re-enter the workforce.
The FY 2001 Budget also continues the competitive grants enacted in FY 2000, $20 million annually to be awarded, by DOL to partnerships of organizations to provide incentives for broader systems—building efforts involving coordinated service delivery through, and linkages across, the One-Stop Career Center system established under Title I of WIA of 1998.
Other Department of Labor resources, listed on the RESNA Technical Assistance Project website, focusing on coordination and partnership of WIA activities and TWWIIA activities are:
http://usworkforce.org/--This is a gateway site for information on the Work Force Improvement Act. It is designed to provide answers to current and emerging questions about the implementation of the Workforce Investment Act. It represents an unprecedented collaboration between public and private sector groups and individuals to provide access to workforce information and resources and to apply that information toward innovative and effective partnerships and programs.
http://www.ttrc.doleta.gov – This link is the main website for the DOL’s Employment and Training Administration.
http://www.ttrc.doleta.gov/onestop/--The link for DOL’s One Stop Centers.
Rehabilitation Services Administration
In December 1999, RSA issued an Information Memorandum.
RSA-IM-00-09, http://usworkforce.org/resources/rehab-mou.htm, to State Vocational Rehabilitation Agencies (general) State Vocational Rehabilitation Agencies (blind); State Rehabilitation Councils; Client Assistance Programs; Protection & Advocacy of Individual Rights Programs; Regional Rehabilitation Continuing Education Programs, American Indian Vocational Rehabilitation Programs; RSA senior management team, which was a Guide for Developing Memoranda Of Understanding with Local Workforce Investment Boards as Required by the Workforce Investment Act. The Workforce Investment Act (WIA) requires the local board, with the agreement of the chief local official, to develop and enter into a memorandum of understanding (MOU) concerning the operation of the one-stop delivery system in the local area. The Guide specifically states that it is recommended that MOU’s (See Section 101(a)(11)(i)(II) of the Act) ". . . may provide for the promotion of equal, effective and meaningful participation by individuals with disabilities…through program accessibility…reasonable accommodations, auxiliary aids and services…and rehabilitation technology."
If you have any questions concerning the MOU Guide, please call Ms. Roseann Ashby, Chief of Basic State Grants Branch, at 202-205-8719 or Mr. Charles Sadler at 202-205-9286.
A chart of the status of the State Plans under WIA is available at:
SSA is also working with HCFA, the Health Care Financing Administration (HCFA) to identify beneficiaries who will be eligible for the extension of Medicare entitlement in October 2000, and will notify these beneficiaries of their right to this extended entitlement. They are also working with HCFA to assist in their development of policies and grants to the states for increased Medicaid entitlement for persons with disabilities who are working to identify beneficiaries.
How can Tech project service integrate into TWWIIA? And possible financial support for services?
See the RESNA TWWIIA Self-Assessment Checklist above.
An AT concern is: A provider will get reimbursed the same amount
whether he invests $100 or $10,000 in the case. In this environment how are such things as AT going to get provided?
How will consumers be assured that they can get the same range of services through the agency of their choice that they could receive through vocational Rehabilitation, i.e., technology-education?
Both of these questions concern how beneficiaries will be assured that they can continue to receive through the use of the ticket rehabilitation technology or assistive technology services that were and are available thru VR. In analyzing these two questions, there is both a short term and long term answer.
Long term –
The Commission is required to periodically review both payment systems and may alter the percentages, milestones, or payment periods to ensure that ENs have adequate incentives to assist beneficiaries in entering the workforce. Additionally, the Commissioner is required to submit a report to Congress with recommendations for methods to adjust payment rates to ensure adequate incentives for the provision of services to individuals with special needs (including people who work below minimum wage, who require ongoing supports and services, who require higher-cost accommodations, and who receive partial cash benefits, such as SSI).
The new law also gives SSA the authority for five years to conduct demonstration projects to improve Title II work incentives. In particular, the new law requires SSA to conduct a demonstration to evaluate the effects of withholding $1 of Social Security disability benefits for every $2 a beneficiary earns over a specified level. SSA is also authorized to conduct other demonstrations or studies of work incentives for beneficiaries. The new law requires SSA to submit periodic reports to Congress regarding the progress and effectiveness of these demonstration projects.
Chart of the Status of the State Plans under WIA
RSA’s December 1999 Information Memorandum.
RSA-IM-00-09, to State Vocational Rehabilitation Agencies (general) State Vocational Rehabilitation Agencies (blind); State Rehabilitation Councils; Client Assistance Programs; Protection & Advocacy of Individual Rights Programs; Regional Rehabilitation Continuing Education Programs, American Indian Vocational Rehabilitation Programs; RSA senior management team, which was a Guide for Developing Memoranda Of Understanding with Local Workforce Investment Boards as Required by the Workforce Investment Act.
DOL’s Employment and Training Administration
DOL’s One Stop Centers
Social Security Administration’s Gateway Site for Information on the Work Force Improvement Act
Designed to provide answers to current and emerging questions about the implementation of the Workforce Investment Act. It represents an unprecedented collaboration between public and private sector groups and individuals to provide access to workforce information and resources and to apply that information toward innovative and effective partnerships and programs.
Social Security Administration Fact Sheet on TWWIIA
Social Security Administration’s Office of Employment Support Programs (OESP) office Redbook on Work Incentives: A Summary Guide to Social Security and Supplemental Security Income Work Incentives for People with Disabilities. Social Security Administration, SSA Pub. No. 64-030 ICN 436900. The Redbook is available online in both text and pdf formats.
Medicare Coverage Expands For Beneficiaries With Disabilities
Many disability beneficiaries may no longer have to decide between working or keeping the health care coverage they need. Social Security beneficiaries with disabilities who are working, or thinking about working, may be eligible for expanded Medicare coverage. The coverage increases from 39 to 93 months after the end of the trial work period. http://www.ssa.gov/work/ResourcesToolkit/Health/qaextendcare.html
"Re-charting the Course - If Not Now When?" Report from the Presidential Task Force on Employment of Adults with Disabilities, November 1999.
The National Assistive Technology Technical Assistance Partnership is a cooperative agreement between the U.S. Department of Education and RESNA. The grant (Grant #H224B050003; CFDA 84.224B) is funded under the Assistive Technology Act of 1998, as amended and administered by the Rehabilitation Services Administration, Office of Special Education and Rehabilitative Services at the U.S. Department of Education.
This website is developed with grant funds. The information contained on these pages does not necessarily reflect the policy or position of the U.S. Department of Education or the Grantee and no official endorsement of the information should be inferred.