Transcript Slide 1

Ticket 101: Integrating the NEW Ticket –to-Work to
Maximize PROS' Employment Outcomes
1
Welcome to the webinar
FOR AUDIO 
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or 1 (847) 944-7361 (US Toll)
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Kevin Nickerson,
NYMWP
Oscar Jimenez, MPH
NYAPRS
Chacku Mathai, CPRP
NYAPRS
David Bucciferro
NYSOMH
Elizabeth Jennings
NYMWP
2
Today’s Presenters
Kevin Nickerson
NYMWP Consultant
Elizabeth Jennings
NYMWP Program Associate
Oscar Jimenez, MPH
NYAPRS Director of Community and
Economic Development
Chacku Mathai, CPRP
NYAPRS Associate Executive Director
David Bucciferro
Director of Rehabilitation Services at
NYS Office of Mental Health
3
How to participate in the webinar
Mute/ un-mute
• All attendees will be automatically muted during webinar
• During Q & A you may un-mute yourself by pressing: # 6
• To mute yourself: * 6 (star and then the number 6)
Sending questions via chat function:
Go to upper left corner to “attendees.” Look for
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Chat with Lara…. to send questions or technical issues
Technical problems?
Call (518) 436-0008 and ask for Kizzi Casale
4
2010 Ticket-to-Work Training and TA Series for MH Providers
• Ticket 101: Integrating Ticket to Maximize PROS’ Employment Outcomes
• Ticket 201: Employment Network Application Walk-Through Webinars
These webinars organized by CESSI and NYAPRS will review the Request for
Proposal and application requirements. The next session will be on:
– October 14th, 2:00 – 3:30pm Register here:
http://www.surveymonkey.com/s/NYAPRS-CESSI-Application-walk-thruwebinar-8-13-10
•
•
Ticket 301: Operating an Employment Network
Four one-day regional trainings will be held this fall to assist with operating
Employment Networks. Locations: NYC, Buffalo, Long Island and Albany
areas (Dates TBD).
5
2010 Ticket-to-Work Training and TA Series for MH Providers
• EN Café at the NYAPRS Conference
David Jones (CESSI) and NYAPRS staff will hold individual
consultations during the NYAPRS Conference (Sept 22nd-24th) to
assist with completing the Employment Network RFP. Please contact
Mira Bowin to get more information or set up an appointment at
[email protected]
•
Individualized Technical Assistance
NYAPRS, NYMWP and CESSI staff are available to provide
individualized TA in becoming and operating an EN. Contact Oscar
Jimenez or Mira Bowin at: [email protected] or [email protected]
to access these services.
6
Learning Objectives
• Overview of PROS’ funding of employment services
• Overview of TtW basics
• The NEW Ticket to Work Program!
• EN models and partnerships
• What’s my next step? How do we apply?
7
Personalized Recovery-Oriented Services…
A quick review• Employment services funded under PROS
• How to integrate Ticket-to-Work funding
8
Opportunities for Braided-funding of
Employment Services within
Personalized Recovery-Oriented Services
(PROS)
9
Allowable Medicaid service types under PROS:
1. Community Rehabilitation and Support (CRS)
2. Intensive Rehabilitation (IR)
3. Ongoing Rehabilitation and Support (ORS)
4. Clinical Treatment
10
Community Rehabilitation & Support (CRS) Services
• Pre-Admission Screening
• Engagement
• Assessment (Note: Health Assessment & Psychiatric
Assessment fall under Clinical Services)
• Individualized Recovery Planning
• Basic Living Skills Training
• Benefits and Financial Management
• Community Living Exploration
• Crisis Intervention
• Information and Education Regarding Self-Help
• Structured Skill Development and Support
• Wellness Self-Management
11
Intensive Rehabilitation (IR)
IR Services: “Evidence-Based Practices”
• These services are evidence-based practices
and require specially trained staff:
• Family Psycho-education
• Integrated Dual Disorder Treatment (IDDT)
12
Intensive Rehabilitation (IR)
IR Services: “Immediate Need”
• The intensity and frequency of these two IR
services distinguish them from CRS services:
– Intensive Relapse Prevention – To prevent relapse
or loss of a life role (imminent risk)
– Intensive Rehabilitation Goal Acquisition – To
attain a desired life role or goal (short term and
targeted)
13
Ongoing Rehabilitation and Support (ORS)
• Designed to assist individuals to maintain and
retain integrated, competitive employment.
• Participant must receive at least two 30-minute
services per month on separate days. (One service
may be with a collateral.)
• Services are not provided at the PROS site.
Services can be rendered at the worksite, the
participant’s residence or some other location in
the community.
• Individual must be scheduled to work 10 hours per
week to qualify for ORS
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Clinical Treatment
• Focuses on symptom management
• Addresses a functional barrier related to a life
role
• Provided by staff with specific clinical credentials
and skills (and with clinical supervision)
• Includes the integration of improved physical
health with mental health recovery
• Integrated with rehabilitation service components
15
BRAIDED FUNDING STRATEGIES FOR PROS PROGRAMS
Clinical IR
Overcoming clinical barriers to employment X
Overcoming family barriers to employment
Overcoming SA barriers to employment
Engagement on employment
Assessing employment readiness
Developing employment readiness
Goal exploration and development
Benefits management
Financial education and management
X
X
CRS
ORS State
Aid
X
X
X
X
X
X
X
X
Job development
Job placement
Job coaching
Peer employment support
Maintaining employment
X
X
X
X
X
X
X
Ticket to
Work
X
X
X
X
X
X
X
X
X
X
X
X
X
X
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PROS Medicaid Funding & TtW
• Braiding Medicaid funded services and Ticket to
Work funds is not “double dipping”
• The Centers for Medicare & Medicaid Services (CMS)
clarified this recently in a State Medicaid Director
Letter (SMD #10-002), See:
www.cessi.net/ttw/docs/CMS_Letter.pdf
• Choose Work Quarterly Newsletter of the Ticket to
Work Program, Summer 2010 issue also reviews this
concept:
http://www.cessi.net/ttw/docs/CW_newsletter_Summ
er2010_r1.pdf
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The New Ticket-to-Work Program
Kevin Nickerson
Consultant, NYMWP
18
The Challenge Experience
•
•
•
•
EN since 2001
Consistent with Challenge Mission
First Ticket assigned in NYS to private EN
Knowledge of SSA benefits increased Ticket
holder confidence in services
• 2nd EN in Nation to achieve 60th Outcome
payment (achieved March, 2007)
• Increasing Ticket assignments now due to
changes in regulations
19
The Ticket to Work and Work Incentives Improvement Act was passed
in 1999 and provided several benefits to SSA Disability
beneficiaries, including:
• Yearly cost of living increases for Ticket Payments
• Two new work incentives
– Extended Medicare benefits
– Expedited Reinstatement of Benefits
• Medicaid Buy In Programs
– New York: Medicaid Buy-In Program for Working People with Disabilities
• Work Incentive Planning and Assistance projects
• Ticket to Work and Self-Sufficiency employment program
20
In 2008, SSA made several improvements to the Ticket to Work
employment program to increase participation.
Today you will learn about these improvements and…….
•
•
•
•
Ticket to Work program basics
New payment structure
Why VESID and Medicaid Providers should participate
Next Steps to becoming an Employment Network
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Ticket to Work Basics
• Creates an opportunity for any entity (other than a Federal Department) to
become a Ticket to Work ‘Employment Network’ and begin receiving payments
for supporting ‘Ticket Holders’ as they work at increasing levels of wages.
– Ticket Holders are qualified Social Security Disability Beneficiaries ages 18 to 64,
receiving Title XVI and/or Title II benefits (SSI or SSDI)
– Now both Medical Improvement Expected (MIE) and Medical Improvement Not
Expected (MINE) groups are eligible due to changes in TtW regulations from 2008
• Offers long-term funding to ensure Ticket Holders receive ongoing return to
work support.
• Increases choice for Ticket Holders and Employment Networks allowing both to
choose who they work with under the program.
22
Ticket to Work – Provider basics
• This is a voluntary program (you do not have to participate)
• Provides additional monetary support to approved providers
(Employment Networks) who assist Social Security beneficiaries
with disabilities in obtaining and maintaining employment
** The dollars you will receive are IN ADDITION to the funds you
receive under VESID and Medicaid **
http://www.cessi.net/ttw/CMS_Medicaid.html
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Ticket to Work – Ticket Holder basics
• This is a voluntary program - as a Ticket Holder, I do not have to participate.
• Provides Ticket Holders with CHOICE – as a Ticket Holder, I decide who I assign
my Ticket to based upon who I feel can best provide the services I need.
• Ensures continued employment support – as a Ticket Holder, I know you will
continue to provide me support beyond the time that VESID or Medicaid funding
permits.
• Actively participating in the Ticket to Work program suspends a Ticket Holder’s
medical Continuing Disability Review – as a Ticket Holder, I can return to work
without fear that I will medically improve before I am gainfully employed.
24
Goal of the Ticket to Work program….
Self-sufficiency.
Decrease the Ticket Holder’s dependence on their cash
benefits by increasing their work effort to substantial
gainful activity level and beyond.
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2008 Improvements of Importance
• Ticket payments have increased and allow for payments before the Ticket
Holder works at SGA level
• Ticket payment structure encourages the use of available work incentives
with new Phase 2 payment structure
• Tickets are now available to all beneficiaries with disabilities, ages 18
through 64 (with a few exceptions)
• Timely progress reviews are now one time per year
• Partnership with VESID is more clearly defined, now called Partnership
Plus
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EN & Ticket Holder Connect
EN & Ticket Holder discuss
needs/services & Ticket Holder gets
benefits planning.
EN & Ticket Holder Negotiate the
Individual Work Plan (IWP)
IWP is sent to Maximus – once
approved, Ticket is assigned to EN
(7 days +/-)
EN provides
agreed upon
services and
supports
Ticket Holder Goes
to Work
& EN Collects
Evidence of Earnings
EN submits
Payment Request
to Maximus &
receives Ticket
Payment
(30 days +/-)
EN continues to
provides services &
supports in
accordance with
Ticket Holder’s IWP
27
2010 Payments At A Glance
2010 OUTCOME PAYMENT METHOD
Payment Type
Outcome
Beneficiary Earnings Required After Ticket Assignment
Earnings sufficient for “zero” cash benefits status
Total of Outcome Payments Available
SSI Ticket-Holder
SSDI Ticket-Holder
Up to 60 payments of
$409/month
Up to 36 payments of
$711/month
$24,540.
$25,596.
2010 MILESTONE-OUTCOME PAYMENT METHOD
Payment Type
Beneficiary Earnings Required After Ticket Assignment
SSI Ticket-Holder
SSDI Ticket-Holder
Phase 1
Milestone 1
Milestone 2
Milestone 3
Milestone 4
$360/ month x 1 month
$720/ month x 3 months within 6 months
$720/ month x 6 months within 12 months
$720/ month x 9 months within 18 months
Total for Phase 1
$1275
$1275
$1275
$1275
$1275
$1275
$1275
$1275
$5,100
$5,100
Phase 2
Milestones
Outcome
Gross earnings at or over $1,000(non-blind)/month (SGA)
Gross earnings at or over $1,640 (blind)/month (SGA)
Up to 18 payments of
$220/ month
Up to 11 payments of
$382/ month
Total for Phase 2
$3,960
$4,202
Total Phase 1 + 2 Milestones Payments
$9,060
$9,302
Earnings sufficient for “zero cash benefit” status
Up to 60 payments of
$220/ month
Up to 36 payments of
$382/ month
Total of Outcome Payments Available
$13,200
$13,752
Total of Milestones + Outcome Payments
$22,260
$23,054
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Outcome Payment System
Type
Outcome
Total Possible
Outcome Payments
Ticket Holder
Earnings
EN Payment
for SSDI
EN Payment
for SSI
Earnings sufficient
for “zero” cash
benefits status
$711/mo. for up
to 36 months
$409/mo.
for up to 60
months
$25,596
$24,540
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Milestone-Outcome Payment System: Phase 1 Milestones
Type
Ticket Holder Earnings
EN Payment EN Payment
for SSDI
for SSI
Phase 1
Milestone 1
$720/mo for 1 month (or
$360 within a two week
period)*
$1,275
$1,275
Milestone 2
$720/mo for 3 months
within 6 months (cumulative)
$1,275
$1,275
Milestone 3
$720/mo for 6 months
within 12 months (cumulative)
$1,275
$1,275
Milestone 4
$720/mo for 9 months
within 18 months (cumulative)
$1,275
$1,275
Total Potential Phase I Milestone Payments
$5,100
$5,100
2010 Rates
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Recent Work Rule
• Work at or above applicable Trial Work level earnings
($720 in 2010) within 18 months “prior to Ticket
assignment” can impact EN’s access to Phase 1 Milestones
• Does not apply to Tickets assigned prior to July 21, 2008
• MAXIMUS has created a tool to explore a beneficiary
recent work history
> Check out the 18-Month Prior Earnings Tool at
www.yourtickettowork.com.
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New Opportunities for EN-VR Partnerships
• VR Cost Reimbursement payments and EN Milestone and
Outcome payments both possible for same beneficiary
– SSA will pay for sequential, but not concurrent, services
• When VR chooses to serve a beneficiary under Cost
Reimbursement, beneficiary’s Ticket is
-- Not assigned to VR, and
-- Cannot be assigned to another EN while VR case is open
• New “in-use SVR” status extends Continuing Disability Review
(CDR) protection to beneficiary while receiving VR services
under Cost Reimbursement
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VR Case Closure
• Beneficiary can assign Ticket to an EN after VR case
closure
• Phase 1 Milestones not available to EN if VR closed case
with beneficiary employed
-- VR provided services leading to initial
efforts at self-supporting employment
-- SSA pays EN for Milestones & Outcomes
achieved after Ticket assignment
33
Milestone-Outcome Payment System: Phase 2 Payments
Type
Phase 2
Ticket Holder
Earnings
Gross > SGA
EN Payment EN Payment
for SSDI
for SSI
$382/mo. (up
$220/mo.
to 11 mos.)
(up to 18 mos.)
Total Phase 2
Payments
$4,202
$3,960
Total Potential Ticket
Payments
Phases 1 and 2
$9,302
$9,060
($1000/non-blind;
$1,640 for blind)
2010 Rates
34
Milestone-Outcome Payment System: Outcome Payments (Phase 3)
Ticket Holder
Earnings
EN Payment
for SSDI
EN Payment
for SSI
Net > SGA
$382/mo. for up
to 36 months
$220/mo.
for up to 60
months
Total Outcome Phase
Payments
$13,752
$13,200
Total Potential Ticket
Payments
$23,054
$22,260
Type
Outcome Phase
($1000/non-blind;
$1,640 /blind) AND
0 cash benefit
2010 Rates
35
Will becoming an EN help me with individuals
that can only work part-time?
• The overall goal of the Ticket program continues to be
self-sufficiency
• Part-time work can increase an individuals self-sufficiency,
and in some cases, reduce benefits reliance
• Example: Joe works 20 hours/week and makes
$8.50/hour, monthly average wage=$736
• This example would qualify your EN for Milestone
payments
• NOTE: You should still develop your IWP indicating that
the Ticket holders goal is to achieve SGA level
employment
Milestone Reconciliation Payment
• Occurs when Beneficiary moves quickly into the Outcome
Payment Period
• Includes all Milestones “available” at time of first Ticket
assignment that remain “unpaid” due to the start of the
Outcome payment period
• Reconciliation payment made when 12th Outcome
payment is achieved
37
Requesting Ticket Payments
Three options for requesting payment:
1. Evidentiary Payment Request (EPR)
-- Requires primary evidence of earnings
2. Certification Payment Request (CPR)
-- Uses secondary evidence of earnings
3. Auto Pay
-- SSA gathers evidence of earnings starting at
Outcome payment #13 (less work for EN, takes longer
to get paid)
38
Ticket Payments in NYS
• 2008
$88,831.92
• 2009
$346,859.70
• 2010 (as of 4/9/10) $60,751.00
39
The Bottom Line…
Many entities are already placing customers with disabilities
in jobs that would qualify them for payments through the
Ticket to Work program
Why lose out on payments for work you’re already doing?
40
Benefits of becoming an EN include:
1. Increase your bottom line - Get paid for the work you
are already doing
2. Ticket payments are yours to use as you wish
3. Generous funding stream – between $23, 054 (SSDI)
and $22,260 (SSI) per successful beneficiary
41
Q&A
To UN-MUTE yourself, press # 6
After presenting your question/
comment, please MUTE your self by
pressing * 6
42
Possible EN Models
State Level Strategy
Partnership Plus
VESID
Contracted for Ticket
Administration
PROS Program
A
PROS Program
B
NYS Office
of
Mental Health
Example:
Private entity
For EN
Administration
PROS Program
C
PROS Program
D
Policy / Outreach / Reporting
Provide direct service to Ticket
holders / Follow-up supports /
data collection
PROS Program
E
PROS Program
F
PROS Program
G
43
Possible EN Models
Collaborative Agreement Strategy
VESID
Partnership Plus
Advantages: Sharing of
information &
resources, staffing and
community outreach
EN of record –
Has submitted RFP,
In this case, local
CRP
Ticket Holder
may discover
EN through
One Stop, or
through local
CRP which
is EN of record
Specific Advantage of
collaboration with OneStop: Access to database
of potential Ticket holders
who wish to return to
work
One Stop
Career Center –
Local
agreement
arranged
to serve mutual
Ticket holders
44
Possible EN Models
Local Level Strategy
Each EN completes a
separate application to
operate as an
independent EN
PROS Program
C
Community Rehab
Provider
A
Community Rehab
Provider
B
VESID
Partnership
Plus
PROS Program
A
VESID provides
information about all
EN options when
closing a case
PROS Program
B
Community Rehab
Provider
C
This example shows a
collaborative web
allowing for referral and
mentoring efforts
45
amongst separate EN’s
Becoming an Employment Network
Get the EN RFP at http://www.ssa.gov/work/enrfp.html
• Download and complete on your computer
• Cover letter provides information on how to contact SSA
• Advised not to mail your RFP, send by:
Email: [email protected] or
Fax number: 1-410-597-0429
46
RFP Basic Components
• Must have an Employer Identification Number (EIN), also known as the Tax
ID #
• Must have general business or professional liability insurance in effect
(minimum of $500,000 per occurrence)
• Must have a DUNS number (contact Dun & Bradstreet at 1-866-705-5711
or apply online at www.dnb.com)
• Must register your DUNS number through the Central Contractor
Registration (CCR) process (www.ccr.gov)
• Must complete forms for simple security clearance for all staff working with
beneficiaries or handling personally identifying information of beneficiaries
47
CESSI, the Program Manager for Recruitment and Outreach, will
assist you in completing the RFP….
• Contact David Jones, Account Manager at CESSI, the Program Manager for
Recruitment and Outreach, toll-free at (703) 448-6155 ext. 201 or at
[email protected]
• Participate in an EN Application Walk-through Teleconference (register at
www.cessi.net/ttw)
 documentation requirements
 review forms
Q&A
• Additional help is available through SSA’s Employment Network Contracts
Team
 E-Mail: [email protected]
 Call: 1-866-584-5180
48
Once you become an Employment Network, MAXIMUS, the
Operations Support Manager for the Ticket to Work program
will:
– Handle the process for assigning & un-assigning Tickets
– Maintain the list of approved ENs
– Process Ticket payments
– Conduct timely progress reviews
– Staff an EN Help Desk
– Provide training & technical assistance to ENs
Visit the MAXIMUS website at www.yourtickettowork.com
49
Ticket to Work Program Resources:
Visit SSA’s Work Site at: www.socialsecurity.gov/work
Visit CESSI’s web site at: www.cessi.net/ttw
Visit the MAXIMUS web site at: www.yourtickettowork.com
or call: 1-866-949-ENVR (3687)
50
2010 Ticket-to-Work Training and TA Series for MH Providers
• Ticket 101: Integrating Ticket to Maximize PROS’ Employment Outcomes
• Ticket 201: Employment Network Application Walk-Through Webinars
These webinars organized by CESSI and NYAPRS will review the Request for
Proposal and application requirements. The next session will be on:
– October 14th, 2:00 – 3:30pm Register here:
http://www.surveymonkey.com/s/NYAPRS-CESSI-Application-walk-thruwebinar-8-13-10
•
•
Ticket 301: Operating an Employment Network
Four one-day regional trainings will be held this fall to assist with operating
Employment Networks. Locations: NYC, Buffalo, Long Island and Albany
areas (Dates TBD).
51
2010 Ticket-to-Work Training and TA Series for MH Providers
• EN Café at the NYAPRS Conference
David Jones (CESSI) and NYAPRS staff will hold individual
consultations during the NYAPRS Conference (Sept 22nd-24th) to
assist with completing the Employment Network RFP. Please contact
Mira Bowin to get more information or set up an appointment at
[email protected]
•
Individualized Technical Assistance
NYAPRS, NYMWP and CESSI staff are available to provide
individualized TA in becoming and operating an EN. Contact Oscar
Jimenez or Mira Bowin at: [email protected] or [email protected]
to access these services.
52
Questions about future trainings and
technical assistance?
For questions about future trainings regarding TTW and requests for
individualized TA for PROS programs:
Oscar Jimenez, MPH
NYAPRS Director of Community and Economic Development
518-436-0008, ext. 21
[email protected]
Mira Bowin
NYAPRS Employment and Economic Self-sufficiency
Coordinator
518-436-0008, ext. 18
[email protected]
53
NYS MIG Leadership Contact Information
• Michael Sereiter
MIG Director - New York State Office of Mental Health
[email protected] or 518.473.657
• Gary Shaheen
Co-Principal Investigator - Syracuse University Burton Blatt Institute
[email protected] or 315.443.9818
• Thomas Golden
Co-Principal Investigator - Cornell University ILR School
[email protected] or 607.255.2731
www.nymakesworkpay.com
54
New York Makes Work Pay
Partnering Organizations
New York Makes Work Pay is a Comprehensive Employment System Medicaid Infrastructure Grant
(Contract No. #1QACMS030318) from the U.S. Department of Health and Human Services, Center
for Medicare and Medicaid Services to the Office of Mental Health on behalf of New York
State. It is a joint effort of the Burton Blatt Institute at Syracuse University and the Employment and
Disability Institute at Cornell University with the collaborative support of the Employment Committee
of the New York State Most Integrated Setting Coordinating Council to develop pathways and
remove obstacles to employment for New Yorkers with disabilities.
55