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Ticket to Work: Payment Rules and Application

Learn about the payment rules and application process for Phase 1 and Phase 2 milestones, including earnings, lookback rules, state VR agency involvement, EN certification of services, outcome payments, and recent policy changes.

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Ticket to Work: Payment Rules and Application

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  1. Ticket to Work: All EN Payments Call Part IITuesday, July 30, 2013

  2. EN Payment Rules and Application Part I Part II Part III Phase 1/Phase 2Milestones • Earnings • 18-Month Lookback Rule • State VR agency involvement • EN Certification of Services • Outcome • Recent Policy Changes Phase 1/Phase 2Milestones • Benefits • Attainment Month • Payment Request Form

  3. Phase 1/Phase 2 Milestones -Earnings

  4. Phase 1/Phase 2 Milestones - Earnings (cont.) EN submits a PR for an SSDI (T2) beneficiary for a PH2/M1 for the claim month 01/2011. The pay stubs (2) submitted show: Pay stub # 1 Pay Period Beginning:01/10/2011 Pay Period Ending:01/23/2011 Pay Date:01/28/2011 Gross amount:$530.20 Pay stub # 2 Pay Period Beginning:01/24/2011 Pay Period Ending:02/06/2011 Pay Date:02/11/2011 Gross amount:$660.80 Determination: The P2M1 claim is denied. Denial Reason: Earnings Amounts Do Not Meet Criteria for Payment Comments: Evidence of earnings submitted are below SGA for 2011= $1,000

  5. Phase 1/Phase 2 Milestones- Earnings (cont.) Explanation: SSDI (T2) If an EN submits a PR for a Beneficiary receiving SSDI (T2), we will determine the amount of earnings earned in the month (from the 1st day of the month to the last day of the month) for Ph1/Ph2 Milestones and for Outcome payments. If the evidence of earnings for the claim month requested is overlapping the following month, we will prorate the earnings for each month. $660.80 / 14 (days in the pay period) = $47.20 X 8 (days 01/24-01/31) = $377.60 Then: $530.20 (pay stub #1) + $377.60 (8 days in 01/2011, pay stub # 2) = 907.80 The PR submitted by the EN for Ph2/M1 for the claim month of 01/2011 will be denied due to total earnings amount is below SGA (SGA for 2011=$1000.00).

  6. Phase 1/Phase 2 Milestones - Earnings (cont.) • SSI (If beneficiary was SSI or T16) • If an EN submits a PR for a beneficiary receiving T16, we will determine the amount of earnings paid in the month (pay dates may fall on any day of the month) for Ph1/Ph2 Milestones and for Outcome payments. Even if a pay stub shows that the days are overlapping the following month, we will consider only the pay date.

  7. Phase 1/Phase 2 Milestones - 18-MLB Rule

  8. Phase 1/Phase 2 Milestones - 18-MLB Rule (cont.) EN submits a PR for a P1M1 with an attainment date of 01/2013. The beneficiary’s Ticket was assigned 12/10/2012. The EN supplied copies of pay stubs with earnings that met were above TWL to meet the criteria for a Phase 1 milestone. The EN also submitted a Look Back form and indicated the beneficiary had earnings at or above TWL for 10/2012 and 11/2012. Determination: The P1M1 claim is denied. Denial Reason: Not Eligible for Payment Due to Look Back Earnings Comments: Earnings above TWL exist prior to the Ticket assignment date. EN is not entitled to receive P1M1 payment. The timeframe use to calculate Phase 1 Milestones that may be unavailable is listed below: Phase 1 Milestone #Timeframe of TWL Earnings 1 1 Month before Ticket assignment 2 3 out of 6 Months 3 6 out of 12 Months 4 9 out of 18 Months

  9. Phase 1/Phase 2 Milestones - 18-MLB Rule (cont.) In the example above, 18 months prior to 12/2012 is 06/2011. If the beneficiary has earnings ≥ TWL: 3 months between 06/12 and 12/12 ; Phase 1 milestone 2 would be excluded; 6 months between 12/11 and 12/12; Phase 1 milestone 3 would be excluded; 9 months between 06/11 and 12/12; Phase 1 milestone 4 would be excluded

  10. Phase 1/Phase 2 Milestones – SVR Involvement

  11. Phase 1/Phase 2 Milestones – SVR Involvement (cont.) EN submitted a PR for Phase 1 Milestones 1-3. The Ticket assignment date was 01/10/2011. The attainment dates were 03/11, 05/11 and 08/11. The EN supplied pay stubs with earnings above Substantial Gainful Activity (SGA) for the 6 months and filled out Section V of the PR with a summary of services and dates of services between each Phase 1 milestone. Determination: Phase 1 Milestones 1-4 were denied. Phase 2 Milestones 1-6 paid. Denial Reason: Due to VR Services Phase 1 Milestone Can’t Be Paid Comments: Ticket assignment to a SVR was closed successfully. No Phase 1 Milestone payments can be made.

  12. Phase 1/Phase 2 Milestones – SVR Involvement (cont.) According to §411 Code of Federal Regulations: (iii) If a beneficiary had a ticket that otherwise was available for assignment and chose to receive services under an IPE from a State VR agency that elected the VR cost reimbursement option, payment of Phase 1 Milestones to an EN or a different VR agency acting as an EN with respect to the same ticket is precluded if the State VR Agency that elected the VR cost reimbursement option achieved an employment outcome (as described in 34 CFR 361.56) before case closure.

  13. Phase 1/Phase 2 Milestones – EN COS

  14. Phase 1/Phase 2 Milestones – EN COS (cont.) EN submitted a PR for a Phase 2 Milestone 11 claim with an attainment month of 03/13. The beneficiary was in a current pay payment status and earnings posted in Social Security’s system were above SGA for 03/13. Phase 2 Milestone 10 had been paid for attainment month 02/13. Determination:The P2M11 is paid. EN Payments staff request PHD to submit a request to the EN for an EN COS for P2M11. Explanation: The beneficiary met the criteria for payment of the P2 M11; however, ENs should submit an EN COS when submitting PRs for: Phase 1 Milestone 4 Phase 2 Milestone 11 Outcome 11 Outcome 22

  15. Join us next month for Part III Phase 1/Phase 2 Milestones – PART II Part III • Outcome • Recent Policy Changes

  16. Contact Us Website:www.yourtickettowork.com Email: ENOperations@yourtickettowork.com Payments Helpdesk • Toll Free Line: 1-800-949-3687 • Email: ENPaymentsHelpdesk@maximus.com

  17. Questions

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