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Senate and House of Representatives Proposed Legislation on establishing Ticket to Work and Self-Sufficiency Program
[S. 331 Work Incentives Improvement Act of 1999; H.R. 1180 Work Incentives Improvement Act of 1999]
Thursday, January 28, 1999
By Mr. JEFFORDS (for himself, Mr. Kennedy, Mr. Roth, Mr. Moynihan, Mr. Chafee, Mr. Grassley, Mr. Hatch, Mr. Murkowski, Mr. Breaux, Mr. Graham, Mr. Kerrey, Mr. Robb, Mr. Rockefeller, Mr. Bingaman, Mrs. Boxer, Mr. Cleland, Ms. Collins, Mr. Daschle, Mr. DeWine, Mr. Dodd, Mr. Durbin, Mr. Enzi, Mrs. Feinstein, Mr. Grams, Mr. Harkin, Mr. Hollings, Mr. Hutchinson, Mr. Inouye, Mr. Johnson, Mr. Kerry, Ms. Mikulski, Mrs. Murray, Mr. Reed, Mr. Reid, Mr. Sarbanes, Ms. Snowe, Mr. Stevens, Mr. Torricelli, and Mr. Wellstone):
S. 331. A bill to amend the Social Security Act to expand the availability of health care coverage for working individuals with disabilities, to establish a Ticket to Work and Self-Sufficiency Program in the Social Security Administration to provide such individuals with meaningful opportunities to work, and for other purposes; to the Committee on Finance.
work incentives improvement act of 1999
Mr. JEFFORDS: Mr. President, today Senators Kennedy, Roth, Moynihan, and I, joined by many of our colleagues are introducing the Work Incentives Improvement Act of 1999. The reason for this broad bipartisan effort is both compelling and simple. Currently, individuals with disabilities must choose between working or getting health care. Such a choice is absurd. But, current federal law forces individuals with disabilities to make that choice. Our legislation addresses this fundamental flaw.
The federal government helps individuals with significant disabilities, who earn under $500 a month. Individuals, who have less than $2,000 in assets and have not paid into Social Security, receive Supplemental Security Income (SSI) cash payments and access to Medicaid. Individuals, who have worked and paid into Social Security, receive Social Security Disability Insurance (SSDI) cash payments and access to Medicare. Yet, the current system offers no incentive for SSI and SSDI recipients to work to their full potential, to be taxpayers, to contribute to their well-being and that of their families. The facts bear out this assertion. Less than one half of one percent of the 7.5 million individuals on the Social Security disability rolls leave them.
Do these individuals really want to work? The answer is a resounding, "Yes." Over the last 10 years, national surveys consistently confirm that people with disabilities of working age want to work, but only about one-third are working.
Are the numbers low because of discrimination or because of lack of skills? Congress has tackled these issues. We passed the Americans with Disabilities Act in 1990. It is against the law to discriminate against an individual on the basis of disability in employment as well as in all other contexts. The Individuals with Disabilities Education Act, the Rehabilitation Act, and most recently the Workforce Investment Act of 1998 contribute to the access of individuals with disabilities to the education and training they need to become qualified workers.
However, protection against discrimination is not enough. Access to education and training is not enough. Colleagues, the biggest remaining barrier is health insurance. Individuals with significant disabilities who meet the rigorous eligibility criteria of the Social Security disability programs cannot often get reasonably priced, appropriate health insurance coverage from the private sector. These individuals can only get health insurance from the government, and the government gives it to them only if they stay home, or at best, work a minimal amount.
It is difficult to measure fully the effect of having a job on an individual's life. It has a positive impact on a person's identity and sense of self-worth. Having a job results in satisfaction associated with supporting oneself and one's family or at least not being a burden on it. If only one percent of the 7.5 million SSI and SSDI recipients go to work and forgo cash payments from the Social Security Administration (SSA), this would result in a cash savings of $3.5 billion to the federal Treasury over the lifetimes of these individuals. If we factor in the income taxes these individuals would pay, their lack of need for food stamps, subsidized housing, and other forms of assistance, that $3.5 billion dollar figure would be even higher.
Beyond the individual, there is another factor. Recently we learned that our unemployment rate, 4.3 percent, is the lowest it has been since 1956. Our economy, to stay vibrant and strong, needs access to a qualified and enthusiastic pool of potential workers fro which to draw. SSI and SSDI recipients are an untapped resource. Many of the jobs that currently go unfilled, in the service sector and technology industry, are the very jobs that many SSI and SSDI recipients are ready and willing to fill, if only they could have access to health care.
The Work Incentives Improvement Act of 1999 is targeted, fiscally responsible legislation. It would enable individuals with significant disabilities to enter the work force for the first time, reenter the work force, or avoid leaving it in the first place. These individuals would need not worry about losing their health care if they choose to work a forty hour week, to put in overtime, to go for a career advancement or change with more income potential.
Under current law, a poor individual with a disability who has not worked and not paid into Social Security, who meets rigorous criteria, receives monthly SSI payments. Once eligible for SSI cash payments, these individuals have access to Medicaid. In some states these individuals may have coverage of personal assistance services and prescription drugs through Medicaid. An SSI recipient who chooses to earn income, and then exceeds his or her state's threshold for earned income for an SSI beneficiary, loses SSI cash payments and access to Medicaid.
Also under current law, an individual who has worked and paid into Social Security, has a disability, and meets rigorous criteria, receives SSDI payments. After 24 months, these individuals have access to Medicare. Medicare does not cover the cost of personal assistance services or prescription drugs, items an individual with a disability may need to work at all. To access coverage of these items, an individual must spend-down his or her resources until he or she has under $2,000. Then, the individual can become eligible for coverage of these items through Medicaid in states where they are offered. An SSDI recipient who chooses to work and earns $500 monthly in a 12 month period, loses SSDI cash payments. SSDI beneficiaries continue to receive Medicare coverage after returning to work throughout a 39-month extended period of eligibility, but afterwards must pay the full Medicare Part A premium, which is over $300 monthly.
The bill would allow states to expand Medicaid coverage to workers with disabilities. These options build on previous reforms including a recent provision enacted in the Balanced Budget Act of 1997 (BBA). The BBA provision permitted states to offer a Medicaid buy-in to those individuals with incomes below 250 percent of poverty who would be eligible for SSI disability benefits but for their income.
The first option in our legislation would build on the BBA provision. States may elect to offer a Medicaid buy-in to people with disabilities who work and have earnings above 250 percent of poverty. Even so, participating States may also set limits on an individual's unearned income, assets, and resources and may require cost-sharing and premiums on a sliding scale up to a full premium.
The second option in our legislation would allow states that elect to do so to cover individuals who continue to have a severe medically determinable impairment but lose eligibility for SSI or SSDI because of medical improvement. Although medical improvement for individuals with disabilities is inextricably linked to ongoing interventions made possible through insurance coverage, under current law improvement can jeopardize continued eligibility for that coverage.
The legislation requires that states not supplant existing state-only spending with Medicaid funding under either of these options and maintain current spending levels on eligible populations.
A state which elects to implement the first option or the first and second options would receive a grant to support the design, establishment and operation of infrastructures to support working individuals with disabilities. A total of $150 million would be
available for five years, and annual amounts would be increased at the
rate of inflation from 2004 through 2009. In 2009, the Secretary of
Health and Human Services would recommend whether the program is still
needed.
The bill includes a ten-year trial program that would permit SSDI beneficiaries to continue to receive Medicare coverage when they return to work. This option in effect extends the current 39-month extended period of eligibility.
The legislation includes a time-limited demonstration program that would allow states to extend Medicaid coverage to workers who have a disability which, without access to health care, would become severe enough to quality them for SSI or SSDI. This demonstration would provide new information on the cost effectiveness of early health care intervention in keeping people with disabilities from becoming too disabled to work. Funding of $300 million would be available for the demonstration, which would sunset at the end of FY 2004.
The legislation eliminates other programmatic disincentives. It would encourage SSDI and SSi beneficiaries to return to work by providing assurance that cash benefits remain available if employment proves unsuccessful. Specifically, the legislation would prohibit using employment as the sole basis for scheduling a continuing disability review and would expedite eligibility determinations for those individuals that need to return to SSDI benefits after losing such benefits because of work.
We estimate the total cost of these health care-related provisions to be a total of $1.2 billion over five years.
Recognizing that some SSI and SSDI recipients will need training and job placement assistance and that they seek choices related to these activities, in our bill we include provisions modeled on Senator Bunning's legislation that passed the House last year. These "ticket to work and self-sufficiency" provisions would give SSI and SSDI beneficiaries more choices in where to obtain vocational rehabilitation and employment services and would increase incentives to public and participating private providers serving these individuals. The "ticket" provisions would create a new payment system for employment services to SSI and SSDI beneficiaries the result in employment. For each beneficiary a provider assists, the provider would be reimbursed with a portion of benefits savings to the federal government that would occur when the beneficiary earns more than the current law Substantial Gainful Activity (SGA) standard of $500 per month. These ticket provisions have been estimated to cost a total of $17 million over five years.
To assist individuals with disabilities to understand the myriad options available to them and their interrelationship, the legislation would create a community-based outreach program to provide accurate information on work incentives programs to individuals with disabilities, and a state grant program to help people cut red tape to access work incentives. For the community-based work incentives outreach program, up to $23 million per year would be provided for grants to states or private organizations. SSA would have the authority to provide state grants ($7 million annually) to provide help to beneficiaries in accessing the "ticket to work" and other work incentives programs.
The legislation would reauthorize SSA's demonstration authority which expired June 10, 1996. In addition, through mandated demonstration projects SSA is to assess the effect of a gradual reduction in cash benefits a earnings increase. Under current law, SSI recipients have access to a gradual reduction in their cash payments, but SSDI recipients do not. SSDI recipients lose cash payments immediately after earning $500 monthly in a 12 month trial work period. SSDI recipients participating in the demonstration would lose one SSDI dollar for every $2 earned.
Finally, the legislation directs the General Accounting Office (GAO) to study three issues: (1) tax credits and other disability-related employment incentives under the Americans with Disabilities Act of 1990; (2) the coordination of SSI and SSDI benefits; and (3) the effects of the Substantial Gainful Activity (currently $500 monthly) standard on work incentives.
These provisions have been estimated to cost a total of $55 million over five years.
This legislation represents two years of work. It reflects what individuals with disabilities say they need. It was shaped by input across the philosophical spectrum. It was endorsed by the President in this State of the Union Address. It is an opportunity to bring responsible change to federal policy and eliminate a perverse dilemma for many Americans with disabilities--if you don't work, you get health care; if you do work, you don't.
This legislation is a vital link that will make the American dream a reality for many Americans with disabilities. Let's work together to make the Work Incentives Improvement Act of 1999 the first significant legislation enacted by the 106th Congress.
Ms. COLLINS: Mr. President, I am pleased to join Senators Jeffords, Kennedy, Roth, and Moynihan in introducing this historic, bipartisan initiative that will help tear down the barriers that prevent Americans with disabilities who want to work from reaching their full potential and achieving economic independence.
Eight million Americans receive more than $50 billion a year in cash disability benefits under the Supplemental Security Income and Social Security Disability programs. While surveys show that the overwhelming majority of adults with disabilities want to work, fewer than \1/2\ of 1 percent of them actually do.
Advances in medicine and technology coupled with tougher civil rights laws have made it possible for more and more people with physical and mental disabilities to enter the workforce. These are people who genuinely want to work. They have the skills and talents necessary to be productive members of the workforce. But they face a Catch-22. If they leave the disability rolls for a job, they risk losing the Medicare and Medicaid benefits that made it possible for them to enter the workforce in the first place. Moreover, many of these individuals' very lives depend on the prescription drugs, technology, personal assistance services, and medical care they receive.
Mr. President, no one should have to make a choice between a job and health care. The legislation we are introducing today will create and fund new options for States to encourage them to allow people with disabilities who enter the workforce to buy into the Medicaid program, so they can continue to receive the prescription drugs, personal assistance services, and medical care upon which they depend. It will also allow workers leaving the social Security Disability Insurance program to extend their Medicare coverage for ten years. This is tremendously important since many people returning to work after having been on SSDI either work part time and are therefore not eligible for employer-based insurance, or they work in jobs that do not offer health insurance. Allowing these disabled individuals to maintain their Medicare coverage will serve as a tremendous incentive for them to return to the workforce.
Other provisions of the legislation we are introducing today incorporate a more "user-friendly" approach in programs providing job training and placement assistance to individuals with disabilities who wants to work. Our bill gives disabled SSI and SSDI beneficiaries greater consumer choice by creating a "ticket" that enables them to choose whether they want to go to a public or private provider of vocational rehabilitation services. The bill also provides grants to States and organizations to help connect people with disabilities with appropriate services, and funds demonstrations and studies to better understand policies that will encourage and enable work.
Mr. President, the legislation we are introducing today is an investment in human potential that promises tremendous return. By ensuring that Americans with disabilities have access to affordable health insurance, we are removing the major barrier between them and the workplace. The Work Incentives Improvement Act of 1999 will both encourage and enable Americans with disabilities to be full participants in our nation's workforce and growing economy, and I urge all of my colleagues to join me in cosponsoring this important legislation.
Mr. KENNEDY: Mr. President, it is an honor to join my colleagues in introducing the Work Incentives Improvement Act to provide affordable and accessible health care for persons with disabilities so they can work and live independently.
Despite the extraordinary growth and prosperity the country is now enjoying, people with disabilities continue to struggle to live independently and become fully contributing members of their communities. We have made significant progress through special education programs that open new horizons for excellence in learning, and through rehabilitation programs that develop practical independent living skills.
Too often, however, the goal of independence is still out of reach. We need to do more to see that the benefits of our prosperous economy are truly available to all Americans, including those with disabilities. Disabled children and adults deserve access to the benefits and support they need to achieve their full potential.
Large numbers of the 54 million disabled Americans have the capacity to work and become productive citizens. But they are unable to do so because of the unnecessary barriers they face. For too long, people with disabilities have suffered from unfair penalties if they go to work. They are in danger of losing their cash benefits if they accept a paying job. They are in danger of losing the medical coverage, which may well mean the difference between life and death. Too often, they face a harsh choice between eating a decent meal and buying their needed medication.
The bipartisan legislation we are introducing today will help to remove these unfair barriers. It will make health insurance coverage more widely available, through opportunities to buy-in to Medicare and Medicaid at an affordable rate. It will phase out the loss of cash benefits as income rises--instead of the unfair sudden cut-off that so many workers with disabilities face today. It will bring greater access for people with disabilities to the services they need in order to become successfully employed.
Our goal is to restructure and improve existing disability programs so that they do more to encourage and support every disabled person's dream to work and live independently, and be productive and contributing members of their community. That goal should be the birthright of all Americans--and when we say all, we mean all.
This bill is the right thing to do, it is the cost effective thing to do, and now is the time to do it. For too long, our fellow disabled citizens have been left out and left behind. A new and brighter day is on the horizon for Americans with disabilities, and together we can make it a reality.
I especially commend Senator Jeffords, Senator Roth and Senator Moynihan for their impressive leadership on this issue. We look forward to working with all members of Congress to pass this landmark legislation that will give disabled persons across the country a better opportunity to fulfill their dreams and participate fully in the social and economic mainstream of the nation.
Mr. KERREY: Mr. President, it is with pleasure that I join Senators Moynihan, Roth, Kennedy and Jeffords on their significant initiative to expand work opportunities for Americans with disabilities. As Americans, we value the opportunity to support ourselves and our families to the best of our abilities. In fact, we refer to this right and this responsibility as the American dream. But today, millions of Americans who want to work remain on various forms of public assistance, because they can't access the supports they need to begin and continue working.
People with disabilities face unique barriers to self-sufficiency. Many of them need certain types of health services, such as home health care and personal care services, in order to work--yet these services are rarely available under employer-sponsored health insurance. Many of them find private health insurance unavailable or unaffordable. Some need vocational rehabilitation services and help finding employment. Others need assistive technology in order to do their job.
Currently, health care coverage and other services are linked to two cash programs--Social Security Disability (SSDI) and Supplemental Security Income. So people with disabilities must choose whether they want to reach self-sufficiency and risk losing their health coverage and other supportive services, or retain their health insurance but remain dependent on these safety-net programs. At the same time, without personal attendants or other supportive services, they may not be able to work in the first place, or no longer be able to work if their health status is threatened by the loss of the services they can access through health coverage.
I do not believe that people who wish to work and support themselves should face this kind of agonizing choice and take these types of risks. However, we can change this Catch-22. The Work Incentives Improvement Act will make several important changes. Most significantly,
it will provide new options for Medicaid and Medicare coverage for
disabled individuals who enter the workforce, and expand access to
employment services for disabled individuals who are building their
employment skills.
By enabling workers with disabilities to buy-in to the Medicaid program, this legislation will permit Americans with disabilities to enter the workforce without worrying about losing the prescription drug coverage, personal care services, and other health care services they need to work in the first place. It also allows States to establish sliding-scale premiums for workers with higher incomes, therefore ensuring that as workers' income increases, they maintain their health coverage but are less financially dependent on public programs. This proposal will also allow States to continue covering people whose health condition has improved through treatment made possible through Medicaid coverage. Finally, through a ten-year demonstration, the Work Incentives Improvement Act will determine whether permitting SSDI beneficiaries to continue their Medicare coverage is a cost-effective strategy for providing health insurance to individuals who lose SSDI when they return to work.
This legislation will also reduce barriers to employment for Americans with disabilities by providing new mechanisms for these individuals to receive the vocational rehabilitation and employment services they need from the providers they choose. In addition, it will encourage SSDI and SSI beneficiaries to develop their skills and venture into the workplace by providing a new assurance that their cash benefits will remain available, if necessary. These individuals may still lose their cash benefits, depending on their working income, but they can be assured that their SSDI and SSI eligibility application would be expedited if their work experience ultimately proves unsuccessful.
As we look towards the next century, we know that America's economic strength and sense of national community are dependent on the contributions of each and every American. We need to take the necessary steps to ensure that all Americans will have a chance to enjoy the American dream. Americans with disabilities have the same dreams as the rest of us--including a productive and rewarding working life that enables them to support their families and achieve economic self-
sufficiency. We should do our best to help make these dreams a reality.
Mr. MOYNIHAN: Mr. President, I join today with my colleagues Senators Roth, Kennedy and Jeffords to introduce The Work Incentives Improvement Act of 1999. This bill would address some of the barriers and disincentives that individuals enrolled in Federal disability programs face in returning to work.
Many persons with disabilities need the health coverage that accompanies their eligibility for cash benefits. (Social Security Disability Insurance (SSDI) beneficiaries are also covered under Medicare. Supplemental Security Income (SSI) beneficiaries receive Medicaid coverage). Disability is determined based on an inability to sustain gainful work activity, which is measured by an earned income threshold. Under current law, as they return to work and earn income, beneficiaries lose their cash benefits and, subsequently, their health coverage. The risk of losing health benefits may deter disabled individuals from returning to work and, instead, encourage them to
continue to receive cash benefits despite their ability to work.
Less than one percent of SSDI and SSI beneficiaries leave the programs and return to work each year. A survey released by the National Organization on Disability showed that, currently, only 29 percent of all disabled adults are employed full-time or part-time, compared to 79 percent of the non-disabled adult population.
PAST INITIATIVES
Our former Majority Leader and Finance Committee Chairman, Senator Bob Dole, should be commended for pioneering legislation to address work disincentives for people with disabilities. On March 19, 1986, Senator Dole introduced The Employment Opportunities for Disabled Americans Act to permanently authorize an SSI demonstration that would allow SSI beneficiaries who return to work to continue to receive cash assistance and, most importantly, continue their Medicaid coverage. At a slightly higher income level, beneficiaries returning to work would have a phased down SSI benefit while maintaining their Medicaid coverage. I was an original cosponsor of that bill, which passed the Senate by a voice vote. On November 11, 1986, President Reagan signed the bill into law.
Most recently, under the Balanced Budget Act of 1997, states were given the option to provide Medicaid coverage on a sliding premium scale for disabled workers with net incomes up to 250 percent of poverty. This provision gave workers with disabilities an opportunity to buy into Medicaid coverage without leaving their job to qualify for SSI and Medicaid.
These initiatives were necessary first steps, yet several disincentives still exist.
THE WORK INCENTIVES IMPROVEMENT ACT OF 1999
The bill we introduce today would provide additional Medicare and Medicaid options for workers with disabilities, and would encourage SSI and SSDI beneficiaries to seek vocational rehabilitative services.
With regard to health coverage, the bill would allow states to lift the income and asset limits for the Medicaid buy-in program established in BBA. States would also have the option to continue Medicaid coverage for workers with disabilities that lose SSI benefits due to a medical improvement criteria. This bill would establish state demonstrations to provide the Medicaid buy-in for workers with disabilities that are not yet severe enough to end work but would be if they did not have comprehensive Medicaid coverage. In addition, as a ten-year trial period, SSDI beneficiaries who return to work may continue to receive Medicare coverage, despite losing SSDI benefits.
The bill would also create incentives for vocational rehabilitation providers to assist beneficiaries in finding work and achieving sufficient income. These providers would be paid a portion of the benefits saved by the beneficiaries returning to work. The bill would create several grant programs for outreach, advocacy, and planning and assistance for beneficiaries in work incentive programs.
Again, Senator Dole has offered his support for this legislation to continue the initiatives he began. My colleagues and I developed this proposal last year and would like to see it pass this year. Chairman Roth and I are committed to marking up the bill in the Committee on Finance in early spring. At that time, the Chairman's Mark will include offsets to the proposed spending. We urge all members to support this important legislation.
106th CONGRESS
1st Session
S. 331
To amend the Social Security Act to expand the availability of health
care coverage for working individuals with disabilities, to establish a
Ticket to Work and Self-Sufficiency Program in the Social Security
Administration to provide such individuals with meaningful
opportunities to work, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
January 28, 1999
Mr. Jeffords (for himself, Mr. Kennedy, Mr. Roth, Mr. Moynihan, Mr.
Chafee, Mr. Grassley, Mr. Hatch, Mr. Murkowski, Mr. Breaux, Mr. Graham,
Mr. Kerrey, Mr. Robb, Mr. Rockefeller, Mr. Bingaman, Mrs. Boxer, Mr.
Cleland, Ms. Collins, Mr. Daschle, Mr. DeWine, Mr. Dodd, Mr. Durbin,
Mr. Enzi, Mrs. Feinstein, Mr. Grams, Mr. Harkin, Mr. Hollings, Mr.
Hutchinson, Mr. Inouye, Mr. Johnson, Mr. Kerry, Ms. Mikulski, Mrs.
Murray, Mr. Reed, Mr. Reid, Mr. Sarbanes, Ms. Snowe, Mr. Stevens, Mr.
Torricelli, and Mr. Wellstone) introduced the following bill; which was
read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend the Social Security Act to expand the availability of health
care coverage for working individuals with disabilities, to establish a
Ticket to Work and Self-Sufficiency Program in the Social Security
Administration to provide such individuals with meaningful
opportunities to work, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Work Incentives
Improvement Act of 1999''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings and purposes.
TITLE I--EXPANDED AVAILABILITY OF HEALTH CARE SERVICES
Sec. 101. Expanding State options under medicaid for workers with
disabilities.
Sec. 102. Continuation of medicare coverage for working individuals
with disabilities.
Sec. 103. Grants to develop and establish State infrastructures to
support working individuals with
disabilities.
Sec. 104. Demonstration of coverage of workers with potentially severe
disabilities.
TITLE II--TICKET TO WORK AND SELF-SUFFICIENCY AND RELATED PROVISIONS
Subtitle A--Ticket to Work and Self-Sufficiency
Sec. 201. Establishment of the Ticket to Work and Self-Sufficiency
Program.
Sec. 202. Work Incentives Advisory Panel.
Subtitle B--Elimination of Work Disincentives
Sec. 211. Prohibition on using work activity as a basis for review of
an individual's disabled status.
Sec. 212. Expedited eligibility determinations for applications of
former long-term beneficiaries that
completed an extended period of
eligibility.
Subtitle C--Work Incentives Planning, Assistance, and Outreach
Sec. 221. Work incentives outreach program.
Sec. 222. State grants for work incentives assistance to disabled
beneficiaries.
TITLE III--DEMONSTRATION PROJECTS AND STUDIES
Sec. 301. Extension of disability insurance program demonstration
project authority.
Sec. 302. Demonstration projects providing for reductions in disability
insurance benefits based on earnings.
Sec. 303. Sense of Congress regarding additional demonstration
projects.
Sec. 304. Studies and reports.
TITLE IV--TECHNICAL AMENDMENTS
Sec. 401. Technical amendments relating to drug addicts and alcoholics.
Sec. 402. Treatment of prisoners.
Sec. 403. Revocation by members of the clergy of exemption from Social
Security coverage.
Sec. 404. Additional technical amendment relating to cooperative
research or demonstration projects under
titles II and XVI.
Sec. 405. Authorization for State to permit annual wage reports.
SEC. 2. FINDINGS AND PURPOSES.
(a) Findings.--Congress makes the following findings:
(1) Health care is important to all Americans.
(2) Health care is particularly important to individuals
with disabilities and special health care needs who often
cannot afford the insurance available to them through the
private market, are uninsurable by the plans available in the
private sector, and are at great risk of incurring very high
and economically devastating health care costs.
(3) Americans with significant disabilities often are
unable to obtain health care insurance that provides coverage
of the services and supports that enable them to live
independently and enter or rejoin the workforce. Personal
assistance services (such as attendant services, personal
assistance with transportation to and from work, reader
services, job coaches, and related assistance) remove many of
the barriers between significant disability and work. Coverage
for such services, as well as for prescription drugs, durable
medical equipment, and basic health care are powerful and
proven tools for individuals with significant disabilities to
obtain and retain employment.
(4) For individuals with disabilities, the fear of losing
health care and related services is one of the greatest
barriers keeping the individuals from maximizing their
employment, earning potential, and independence.
(5) Individuals with disabilities who are beneficiaries
under title II or XVI of the Social Security Act (42 U.S.C. 401
et seq., 1381 et seq.) risk losing medicare or medicaid
coverage that is linked to their cash benefits, a risk that is
an equal, or greater, work disincentive than the loss of cash
benefits associated with working.
(6) Currently, less than \1/2\ of 1 percent of social
security disability insurance and supplemental security income
beneficiaries cease to receive benefits as a result of
employment.
(7) Beneficiaries have cited the lack of adequate
employment training and placement services as an additional
barrier to employment.
(8) If an additional \1/2\ of 1 percent of the current
social security disability insurance (DI) and supplemental
security income (SSI) recipients were to cease receiving
benefits as a result of employment, the savings to the Social
Security Trust Funds in cash assistance would total
$3,500,000,000 over the worklife of the individuals.
(b) Purposes.--The purposes of this Act are as follows:
(1) To provide health care and employment preparation and
placement services to individuals with disabilities that will
enable those individuals to reduce their dependency on cash
benefit programs.
(2) To encourage States to adopt the option of allowing
individuals with disabilities to purchase medicaid coverage
that is necessary to enable such individuals to maintain
employment.
(3) To provide individuals with disabilities the option of
maintaining medicare coverage while working.
(4) To establish a return to work ticket program that will
allow individuals with disabilities to seek the services
necessary to obtain and retain employment and reduce their
dependency on cash benefit programs.
TITLE I--EXPANDED AVAILABILITY OF HEALTH CARE SERVICES
SEC. 101. EXPANDING STATE OPTIONS UNDER MEDICAID FOR WORKERS WITH
DISABILITIES.
(a) State Option To Eliminate Income, Assets, and Resource
Limitations for Workers With Disabilities Buying Into Medicaid.--
Section 1902(a)(10)(A)(ii) of the Social Security Act (42 U.S.C.
1396a(a)(10)(A)(ii)) is amended--
(1) in subclause (XIII), by striking ``or'' at the end;
(2) in subclause (XIV), by adding ``or'' at the end; and
(3) by adding at the end the following:
``(XV) who, but for earnings in
excess of the limit established under
section 1905(q)(2)(B), and subject to
limitations on assets, resources, or
unearned income that may be set by the
State, would be considered to be
receiving supplemental security income
(subject, notwithstanding section 1916,
to payment of premiums or other cost-
sharing charges (set on a sliding scale
based on income that the State may
determine and that may require an
individual with income that exceeds 250
percent of the income official poverty
line (as defined by the Office of
Management and Budget, and revised
annually in accordance with section
673(2) of the Omnibus Budget
Reconciliation Act of 1981) applicable
to a family of the size involved to pay
an amount equal to 100 percent of the
premium cost for providing medical
assistance to the individual), so long
as any such premiums or other cost-
sharing charges are the same as any
premiums or other cost-sharing charges
imposed for individuals described in
subclause (XVI));''.
(b) State Option To Expand Opportunities for Workers With
Disabilities To Buy Into Medicaid.--
(1) Eligibility.--Section 1902(a)(10)(A)(ii) of the Social
Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)), as amended by
subsection (a), is amended--
(A) in subclause (XIV), by striking ``or'' at the
end;
(B) in subclause (XV), by adding ``or'' at the end;
and
(C) by adding at the end the following:
``(XVI) who are working individuals
with disabilities described in section
1905(v) (subject, notwithstanding
section 1916, to payment of premiums or
other cost-sharing charges (set on a
sliding scale based on income) that the
State may determine so long as any such
premiums or other cost-sharing charges
are the same as any premiums or other
cost-sharing charges imposed for
individuals described in subclause
(XV)), but only if the State provides
medical assistance to individuals
described in subclause (XV);''.
(2) Definition of working individuals with disabilities.--
Section 1905 of the Social Security Act (42 U.S.C. 1396d) is
amended by adding at the end the following:
``(v)(1) The term `working individuals with disabilities' means
individuals ages 16 through 64 who--
``(A) by reason of medical improvement, cease to be
eligible for benefits under section 223(d) or 1614(a)(3) at the
time of a regularly scheduled continuing disability review but
who continue to have a severe medically determinable
impairment; and
``(B) are employed.
``(2) An individual is considered to be `employed' if the
individual--
``(A) is earning at least the applicable minimum wage
requirement under section 6 of the Fair Labor Standards Act (29
U.S.C. 206) and working at least 40 hours per month; or
``(B) is engaged in a work effort that meets substantial
and reasonable threshold criteria for hours of work, wages, or
other measures, as defined by the State and approved by the
Secretary.''.
(3) Conforming amendment.--Section 1905(a) of the Social
Security Act (42 U.S.C. 1396d(a)) is amended in the matter
preceding paragraph (1)--
(A) in clause (x), by striking ``or'' at the end;
(B) in clause (xi), by adding ``or'' at the end;
and
(C) by inserting after clause (xi), the following:
``(xii) individuals described in subsection (v),''.
(c) Prohibition Against Supplantation of State Funds; Maintenance
of Effort Requirement; Condition for Approval of State Plan
Amendment.--
(1) No supplantation of state funds.--Federal funds paid to
a State for medical assistance provided to an individual
described in subclause (XV) or (XVI) of section
1902(a)(10)(A)(ii) of the Social Security Act (42 U.S.C.
1396a(a)(10)(A)(ii)) must be used to supplement but not
supplant the level of State funds expended as of October 1,
1998 for programs to enable working individuals with
disabilities to work.
(2) Maintenance of effort.--With respect to a fiscal year
quarter, no Federal funds may be paid to a State for medical
assistance provided to an individual described in subclause
(XV) or (XVI) of section 1902(a)(10)(A)(ii) of the Social
Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) for such fiscal
year quarter if the Secretary of Health and Human Services
determines that the total of the State expenditures for
programs to enable working individuals with disabilities to
work for the preceding fiscal year quarter is less than the
total of such expenditures for the same fiscal year quarter of
the preceding fiscal year.
(3) Condition for approval of state plan amendments.--No
State plan amendment that proposes to provide medical
assistance to an individual described in subclause (XV) or
(XVI) of section 1902(a)(10)(A)(ii) of the Social Security Act
(42 U.S.C. 1396a(a)(10)(A)(ii)) may be approved unless the
chief executive officer of the State certifies to the Secretary
of Health and Human Services that the plan, as so amended, will
satisfy the requirements of paragraphs (1) and (2) of this
subsection.
(d) Effective Date.--
(1) In general.--The amendments made by this section shall
apply on and after October 1, 1999.
(2) Extension of effective date for state law amendment.--
In the case of a State plan under title XIX of the Social
Security Act which the Secretary of Health and Human Services
determines requires State legislation in order for the plan to
meet the additional requirements imposed by the amendments made
by this section, the State plan shall not be regarded as
failing to comply with the requirements of this section solely
on the basis of its failure to meet these additional
requirements before the first day of the first calendar quarter
beginning after the close of the first regular session of the
State legislature that begins after the date of enactment of
this Act. For purposes of the previous sentence, in the case of
a State that has a 2-year legislative session, each year of the
session is considered to be a separate regular session of the
State legislature.
SEC. 102. CONTINUATION OF MEDICARE COVERAGE FOR WORKING INDIVIDUALS
WITH DISABILITIES.
(a) Continuation of Coverage.--Section 1818A of the Social Security
Act (42 U.S.C. 1395i-2a) is amended by adding at the end the following:
``(e)(1) During the 10-year period beginning with the first month
that begins after the date of enactment of this subsection, this
section shall apply--
``(A) in subsection (a), by inserting--
``(i) in paragraph (2)(C), ``on or after the date
of enactment of the Work Incentives Improvement Act of
1999'' after ``ends''; and
``(ii) ``without being subject to a premium''
before the period; and
``(B) without regard to subsections (c)(2)(D) and (d).
``(2) Any individual who, as of the date of enactment of this
subsection is enrolled in the medicare program under this section and
would, without regard to paragraph (1), otherwise satisfy the
eligibility requirements for enrollment set forth in subsection (a)
shall be deemed to satisfy the requirement of subsection (a)(2)(C) of
that section after the application of paragraph (1)(A)(i) for purposes
of not being subject to a premium for enrollment in the medicare
program under this section.
``(3) Notwithstanding paragraph (1), paragraph (1) shall continue
to apply after the termination of the 10-year period described in that
paragraph in the case of any individual who is enrolled in the medicare
program under this section for the month that ends such 10-year
period.''.
(b) GAO Report.--Not later than 8 years after the date of enactment
of this Act, the Comptroller General of the United States shall submit
a report to Congress that--
(1) examines the effectiveness and cost of section 1818A of
the Social Security Act (42 U.S.C. 1395i-2a) as amended by
subsection (a); and
(2) recommends whether that section should continue to be
applied, as so amended, beyond the 10-year period described in
subsection (e) of that section.
SEC. 103. GRANTS TO DEVELOP AND ESTABLISH STATE INFRASTRUCTURES TO
SUPPORT WORKING INDIVIDUALS WITH DISABILITIES.
(a) Establishment.--
(1) In general.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') shall award
grants described in subsection (b) to States to support the
design, establishment, and operation of State infrastructures
that provide items and services to support working individuals
with disabilities. A State may submit an application for a
grant authorized under this section at such time, in such
manner, and containing such information as the Secretary may
determine.
(2) Definition of state.--In this section, the term
``State'' means each of the 50 States, the District of
Columbia, Puerto Rico, Guam, the United States Virgin Islands,
American Samoa, and the Commonwealth of the Northern Mariana
Islands.
(b) Grants for Infrastructure and Outreach.--
(1) In general.--Out of the funds appropriated under
subsection (e), the Secretary shall award grants to States to--
(A) support the establishment, implementation, and
operation of the State infrastructures described in
subsection (a); and
(B) conduct outreach campaigns regarding the
existence of such infrastructures.
(2) Eligibility for grants.--
(A) In general.--No State may receive a grant under
this subsection unless--
(i) the State has an approved amendment to
the State plan under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) that--
(I) provides medical assistance
under such plan to individuals
described in section
1902(a)(10)(A)(ii)(XV) of the Social
Security Act (42 U.S.C.
1396a(a)(10)(A)(ii)(XV)); or
(II) provides medical assistance
under such plan to individuals
described in subclauses (XV) and (XVI)
of section 1902(a)(10)(A)(ii) of the
Social Security Act (42 U.S.C.
1396a(a)(10)(A)(ii)); and
(ii) the State demonstrates to the
satisfaction of the Secretary that the State
makes personal assistance services available
under the State plan under title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.) to
the extent necessary to enable individuals
described in subclause (I) or (II) of clause
(i) to remain employed (as determined under
section 1905(v)(2) of the Social Security Act
(42 U.S.C. 1396d(v)(2)).
(B) Definition of personal assistance services.--In
this paragraph, the term ``personal assistance
services'' means a range of services, provided by 1 or
more persons, designed to assist an individual with a
disability to perform daily activities on and off the
job that the individual would typically perform if the
individual did not have a disability. Such services
shall be designed to increase the individual's control
in life and ability to perform everyday activities on
or off the job.
(3) Determination of awards.--
(A) In general.--Subject to subparagraph (B), the
Secretary shall determine a formula for awarding grants
to States under this section that provides special
consideration to States that provide medical assistance
under title XIX of the Social Security Act to
individuals described in section
1902(a)(10)(A)(ii)(XVI) of that Act (42 U.S.C.
1396a(a)(10)(A)(ii)(XVI)).
(B) Award limits.--
(i) Minimum awards.--No State that submits
an approved application for funding under this
section shall receive a grant for a fiscal year
that is less than $500,000.
(ii) Maximum awards.--No State that submits
an approved application for funding under this
section shall receive a grant for a fiscal year
that exceeds 15 percent of the total
expenditures by the State (including the
reimbursed Federal share of such expenditures)
for medical assistance for individuals eligible
under subclause (XV) or (XVI) of section
1902(a)(10)(A)(ii), whichever is greater, as
estimated by the State and approved by the
Secretary.
(c) Availability of Funds.--
(1) Funds allocated to states.--Funds allocated to a State
under a grant made under this section for a fiscal year shall
remain available until expended.
(2) Funds not allocated to states.--Funds not allocated to
States in the fiscal year for which they are appropriated shall
remain available in succeeding fiscal years for allocation by
the Secretary using the allocation formula established by the
Secretary under subsection (c)(3)(A).
(d) Annual Report.--A State that receives a grant under this
section shall submit an annual report to the Secretary on the use of
funds provided under the grant. Each report shall include the
percentage increase in the number of title II disability beneficiaries,
as defined in section 1148(k)(3) of the Social Security Act (as amended
by section 201) in the State, and title XVI disability beneficiaries,
as defined in section 1148(k)(4) of the Social Security Act (as so
amended) in the State who return to work.
(e) Appropriation.--Out of any funds in the Treasury not otherwise
appropriated, there is authorized to be appropriated and there is
appropriated to make grants under this section--
(1) for fiscal year 2000, $20,000,000;
(2) for fiscal year 2001, $25,000,000;
(3) for fiscal year 2002, $30,000,000;
(4) for fiscal year 2003, $35,000,000;
(5) for fiscal year 2004, $40,000,000; and
(6) for fiscal years 2005 through 2010, the amount
appropriated for the preceding fiscal year increased by the
percentage increase (if any) in the Consumer Price Index for
All Urban Consumers (United States city average) for the
preceding fiscal year.
(f) Recommendation.--Not later than October 1, 2009, the Secretary
of Health and Human Services, in consultation with the Work Incentives
Advisory Panel established under section 202, shall submit a
recommendation to the Committee on Commerce and the Committee on Ways
and Means of the House of Representatives and the Committee on Finance
of the Senate regarding whether the grant program established under
this section should be continued after fiscal year 2010.
SEC. 104. DEMONSTRATION OF COVERAGE OF WORKERS WITH POTENTIALLY SEVERE
DISABILITIES.
(a) State Application.--A State may apply to the Secretary of
Health and Human Services (in this section referred to as the
``Secretary'') for approval of a demonstration project (in this section
referred to as a ``demonstration project'') under which up to a
specified maximum number of individuals who are workers with a
potentially severe disability (as defined in subsection (b)(1)) are
provided medical assistance equal to that provided under section
1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) to individuals
described in section 1902(a)(10)(A)(ii)(XV) of that Act (42 U.S.C.
1396a(a)(10)(A)(ii)(XV)).
(b) Worker With a Potentially Severe Disability Defined.--For
purposes of this section--
(1) In general.--The term ``worker with a potentially
severe disability'' means, with respect to a demonstration
project, an individual who--
(A) is at least 16, but less than 65, years of age;
(B) has a specific physical or mental impairment
that, as defined by the State under the demonstration
project, is reasonably expected, but for the receipt of
items and services described in section 1905(a) of the
Social Security Act, to become blind or disabled (as
defined under section 1614(a) of the Social Security
Act); and
(C) is employed (as defined in paragraph (2)).
(2) Definition of employed.--An individual is considered to
be ``employed'' if the individual--
(A) is earning at least the applicable minimum wage
requirement under section 6 of the Fair Labor Standards
Act (29 U.S.C. 206) and working at least 40 hours per
month; or
(B) is engaged in a work effort that meets
substantial and reasonable threshold criteria for hours
of work, wages, or other measures, as defined under the
demonstration project and approved by the Secretary.
(c) Approval of Demonstration Projects.--
(1) In general.--Subject to paragraph (3), the Secretary
shall approve applications under subsection (a) that meet the
requirements of paragraph (2) and such additional terms and
conditions as the Secretary may require. The Secretary may
waive the requirement of section 1902(a)(1) of the Social
Security Act (42 U.S.C. 1396a(a)(1)) to allow for sub-State
demonstrations.
(2) Terms and conditions of demonstration projects.--The
Secretary may not approve a demonstration project under this
section unless the State provides assurances satisfactory to
the Secretary that the following conditions are or will be met:
(A) Election of optional category.--The State has
elected to provide coverage under its plan under title
XIX of the Social Security Act of individuals described
in section 1902(a)(10)(A)(ii)(XV) of the Social
Security Act.
(B) Maintenance of state effort.--Federal funds
paid to a State pursuant to this section must be used
to supplement, but not supplant, the level of State
funds expended for workers with potentially severe
disabilities under programs in effect for such
individuals at the time the demonstration project is
approved under this section.
(C) Independent evaluation.--The State provides for
an independent evaluation of the project.
(3) Limitations on federal funding.--
(A) Appropriation.--Out of any funds in the
Treasury not otherwise appropriated, there is
authorized to be appropriated and there is appropriated
to carry out this section--
(i) for fiscal year 2000, $70,000,000;
(ii) for fiscal year 2001, $73,000,000;
(iii) for fiscal year 2002, $77,000,000;
and
(iv) for fiscal year 2003, $80,000,000.
(B) Limitation on payments.--In no case may--
(i) the aggregate amount of payment made by
the Secretary to States under this section
exceed $300,000,000; or
(ii) payment be provided by the Secretary
for a fiscal year after fiscal year 2005.
(C) Funds allocated to states.--The Secretary shall
allocate funds to States based on their applications
and the availability of funds. Funds allocated to a
State under a grant made under this section for a
fiscal year shall remain available until expended.
(D) Funds not allocated to states.--Funds not
allocated to States in the fiscal year for which they
are appropriated shall remain available in succeeding
fiscal years for allocation by the Secretary using the
allocation formula established under this section.
(E) Payments to states.--Subject to the succeeding
provisions of this section, the Secretary shall pay to
each State with a demonstration project approved under
this section, from its allocation under subparagraph
(C), an amount for each quarter equal to the Federal
medical assistance percentage (as defined in section
1905(b) of the Social Security Act (42 U.S.C. 1395d(b))
of expenditures in the quarter for medical assistance
provided to workers with a potentially severe
disability.
(d) State Defined.--In this section, the term ``State'' has the
meaning given such term for purposes of title XIX of the Social
Security Act.
TITLE II--TICKET TO WORK AND SELF-SUFFICIENCY AND RELATED PROVISIONS
Subtitle A--Ticket to Work and Self-Sufficiency
SEC. 201. ESTABLISHMENT OF THE TICKET TO WORK AND SELF-SUFFICIENCY
PROGRAM.
(a) In General.--Part A of title XI of the Social Security Act (42
U.S.C. 1301 et seq.) is amended by adding after section 1147 (as added
by section 8 of the Noncitizen Benefit Clarification and Other
Technical Amendments Act of 1998 (Public Law 105-306; 112 Stat. 2928))
the following:
``ticket to work and self-sufficiency program
``Sec. 1148. (a) In General.--The Commissioner shall establish a
Ticket to Work and Self-Sufficiency Program, under which a disabled
beneficiary may use a ticket to work and self-sufficiency issued by the
Commissioner in accordance with this section to obtain employment
services, vocational rehabilitation services, or other support services
from an employment network which is of the beneficiary's choice and
which is willing to provide such services to the beneficiary.
``(b) Ticket System.--
``(1) Distribution of tickets.--The Commissioner may issue
a ticket to work and self-sufficiency to disabled beneficiaries
for participation in the Program.
``(2) Assignment of tickets.--A disabled beneficiary
holding a ticket to work and self-sufficiency may assign the
ticket to any employment network of the beneficiary's choice
which is serving under the Program and is willing to accept the
assignment.
``(3) Ticket terms.--A ticket issued under paragraph (1)
shall consist of a document which evidences the Commissioner's
agreement to pay (as provided in paragraph (4)) an employment
network, which is serving under the Program and to which such
ticket is assigned by the beneficiary, for such employment
services, vocational rehabilitation services, and other support
services as the employment network may provide to the
beneficiary.
``(4) Payments to employment networks.--The Commissioner
shall pay an employment network under the Program in accordance
with the outcome payment system under subsection (h)(2) or
under the outcome-milestone payment system under subsection
(h)(3) (whichever is elected pursuant to subsection (h)(1)). An
employment network may not request or receive compensation for
such services from the beneficiary.
``(c) State Participation.--
``(1) In general.--Each State agency administering or
supervising the administration of the State plan approved under
title I of the Rehabilitation Act of 1973 may elect to
participate in the Program as an employment network with
respect to a disabled beneficiary. If the State agency does
elect to participate in the Program, the State agency also
shall elect to be paid under the outcome payment system or the
outcome-milestone payment system in accordance with subsection
(h)(1). With respect to a disabled beneficiary that the State
agency does not elect to have participate in the Program, the
State agency shall be paid for services provided to that
beneficiary under the system for payment applicable under
section 222(d) and subsections (d) and (e) of section 1615. The
Commissioner shall provide for periodic opportunities for
exercising such elections (and revocations).
``(2) Effect of participation by state agency.--
``(A) State agencies participating.--In any case in
which a State agency described in paragraph (1) elects
under that paragraph to participate in the Program, the
employment services, vocational rehabilitation
services, and other support services which, upon
assignment of tickets to work and self-sufficiency, are
provided to disabled beneficiaries by the State agency
acting as an employment network shall be governed by
plans for vocational rehabilitation services approved
under title I of the Rehabilitation Act of 1973.
``(B) State agencies administering maternal and
child health services programs.--Subparagraph (A) shall
not apply with respect to any State agency
administering a program under title V of this Act.
``(3) Special requirements applicable to cross-referral to
certain state agencies.--
``(A) In general.--In any case in which an
employment network has been assigned a ticket to work
and self-sufficiency by a disabled beneficiary, no
State agency shall be deemed required, under this
section, title I of the Workforce Investment Act of
1998, title I of the Rehabilitation Act of 1973, or a
State plan approved under such title, to accept any referral of such
disabled beneficiary from such employment network unless such
employment network and such State agency have entered into a written
agreement that meets the requirements of subparagraph (B). Any
beneficiary who has assigned a ticket to work and self-sufficiency to
an employment network that has not entered into such a written
agreement with such a State agency may not access vocational
rehabilitation services under title I of the Rehabilitation Act of 1973
until such time as the beneficiary is reassigned to a State vocational
rehabilitation agency by the Program Manager.
``(B) Terms of agreement.--An agreement required by
subparagraph (A) shall specify, in accordance with
regulations prescribed pursuant to subparagraph (C)--
``(i) the extent (if any) to which the
employment network holding the ticket will
provide to the State agency--
``(I) reimbursement for costs
incurred in providing services
described in subparagraph (A) to the
disabled beneficiary; and
``(II) other amounts from payments
made by the Commissioner to the
employment network pursuant to
subsection (h); and
``(ii) any other conditions that may be
required by such regulations.
``(C) Regulations.--The Commissioner and the
Secretary of Education shall jointly prescribe
regulations specifying the terms of agreements required
by subparagraph (A) and otherwise necessary to carry
out the provisions of this paragraph.
``(D) Penalty.--No payment may be made to an
employment network pursuant to subsection (h) in
connection with services provided to any disabled
beneficiary if such employment network makes referrals
described in subparagraph (A) in violation of the terms
of the agreement required under subparagraph (A) or
without having entered into such an agreement.
``(d) Responsibilities of the Commissioner.--
``(1) Selection and qualifications of program managers.--
The Commissioner shall enter into agreements with 1 or more
organizations in the private or public sector for service as a
program manager to assist the Commissioner in administering the
Program. Any such program manager shall be selected by means of
a competitive bidding process, from among organizations in the
private or public sector with available expertise and
experience in the field of vocational rehabilitation and
employment services.
``(2) Tenure, renewal, and early termination.--Each
agreement entered into under paragraph (1) shall provide for
early termination upon failure to meet performance standards
which shall be specified in the agreement and which shall be
weighted to take into account any performance in prior terms.
Such performance standards shall include--
``(A) measures for ease of access by beneficiaries
to services; and
``(B) measures for determining the extent to which
failures in obtaining services for beneficiaries fall
within acceptable parameters, as determined by the
Commissioner.
``(3) Preclusion from direct participation in delivery of
services in own service area.--Agreements under paragraph (1)
shall preclude--
``(A) direct participation by a program manager in
the delivery of employment services, vocational
rehabilitation services, or other support services to
beneficiaries in the service area covered by the
program manager's agreement; and
``(B) the holding by a program manager of a
financial interest in an employment network or service
provider which provides services in a geographic area
covered under the program manager's agreement.
``(4) Selection of employment networks.--
``(A) In general.--The Commissioner shall select
and enter into agreements with employment networks for
service under the Program. Such employment networks
shall be in addition to State agencies serving as
employment networks pursuant to elections under
subsection (c).
``(B) Alternate participants.--In any State where
the Program is being implemented, the Commissioner
shall enter into an agreement with any alternate
participant that is operating under the authority of
section 222(d)(2) in the State as of the date of
enactment of this section and chooses to serve as an
employment network under the Program.
``(5) Termination of agreements with employment networks.--
The Commissioner shall terminate agreements with employment
networks for inadequate performance, as determined by the
Commissioner.
``(6) Quality assurance.--The Commissioner shall provide
for such periodic reviews as are necessary to provide for
effective quality assurance in the provision of services by
employment networks. The Commissioner shall solicit and
consider the views of consumers and the program manager under
which the employment networks serve and shall consult with
providers of services to develop performance measurements. The
Commissioner shall ensure that the results of the periodic
reviews are made available to beneficiaries who are prospective
service recipients as they select employment networks. The
Commissioner shall ensure that the periodic surveys of
beneficiaries receiving services under the Program are designed
to measure customer service satisfaction.
``(7) Dispute resolution.--The Commissioner shall provide
for a mechanism for resolving disputes between beneficiaries
and employment networks, between program managers and
employment networks, and between program managers and providers
of services. The Commissioner shall afford a party to such a
dispute a reasonable opportunity for a full and fair review of
the matter in dispute.
``(e) Program Managers.--
``(1) In general.--A program manager shall conduct tasks
appropriate to assist the Commissioner in carrying out the
Commissioner's duties in administering the Program.
``(2) Recruitment of employment networks.--A program
manager shall recruit, and recommend for selection by the
Commissioner, employment networks for service under the
Program. The program manager shall carry out such recruitment
and provide such recommendations, and shall monitor all
employment networks serving in the Program in the geographic
area covered under the program manager's agreement, to the
extent necessary and appropriate to ensure that adequate
choices of services are made available to beneficiaries.
Employment networks may serve under the Program only pursuant
to an agreement entered into with the Commissioner under the
Program incorporating the applicable provisions of this section
and regulations thereunder, and the program manager shall
provide and maintain assurances to the Commissioner that
payment by the Commissioner to employment networks pursuant to
this section is warranted based on compliance by such
employment networks with the terms of such agreement and this
section. The program manager shall not impose numerical limits
on the number of employment networks to be recommended pursuant
to this paragraph.
``(3) Facilitation of access by beneficiaries to employment
networks.--A program manager shall facilitate access by
beneficiaries to employment networks. The program manager shall
ensure that each beneficiary is allowed changes in employment
networks for good cause, as determined by the Commissioner,
without being deemed to have rejected services under the
Program. The program manager shall establish and maintain lists
of employment networks available to beneficiaries and shall
make such lists generally available to the public. The program
manager shall ensure that all information provided to disabled
beneficiaries pursuant to this paragraph is provided in
accessible formats.
``(4) Ensuring availability of adequate services.--The
program manager shall ensure that employment services,
vocational rehabilitation services, and other support services
are provided to beneficiaries throughout the geographic area
covered under the program manager's agreement, including rural
areas.
``(5) Reasonable access to services.--The program manager
shall take such measures as are necessary to ensure that
sufficient employment networks are available and that each
beneficiary receiving services under the Program has reasonable
access to employment services, vocational rehabilitation
services, and other support services. Services provided under
the Program may include case management, work incentives
planning, supported employment, career planning, career plan
development, vocational assessment, job training, placement,
followup services, and such other services as may be specified
by the Commissioner under the Program. The program manager
shall ensure that such services are available in each service
area.
``(f) Employment Networks.--
``(1) Qualifications for employment networks.--
``(A) In general.--Each employment network serving
under the Program shall consist of an agency or
instrumentality of a State (or a political subdivision
thereof) or a private entity that assumes
responsibility for the coordination and delivery of
services under the Program to individuals assigning to
the employment network tickets to work and self-
sufficiency issued under subsection (b).
``(B) One-stop delivery systems.--An employment
network serving under the Program may consist of a one-
stop delivery system established under subtitle B of
title I of the Workforce Investment Act of 1998.
``(C) Compliance with selection criteria.--No
employment network may serve under the Program unless
it meets and maintains compliance with both general
selection criteria (such as professional and
educational qualifications (where applicable)) and
specific selection criteria (such as substantial expertise and
experience in providing relevant employment services and supports).
``(D) Single or associated providers allowed.--An
employment network shall consist of either a single
provider of such services or of an association of such
providers organized so as to combine their resources
into a single entity. An employment network may meet
the requirements of subsection (e)(4) by providing
services directly, or by entering into agreements with
other individuals or entities providing appropriate
employment services, vocational rehabilitation
services, or other support services.
``(2) Requirements relating to provision of services.--Each
employment network serving under the Program shall be required
under the terms of its agreement with the Commissioner to--
``(A) serve prescribed service areas; and
``(B) take such measures as are necessary to ensure
that employment services, vocational rehabilitation
services, and other support services provided under the
Program by, or under agreements entered into with, the
employment network are provided under appropriate
individual work plans meeting the requirements of
subsection (g).
``(3) Annual financial reporting.--Each employment network
shall meet financial reporting requirements as prescribed by
the Commissioner.
``(4) Periodic outcomes reporting.--Each employment network
shall prepare periodic reports, on at least an annual basis,
itemizing for the covered period specific outcomes achieved
with respect to specific services provided by the employment
network. Such reports shall conform to a national model
prescribed under this section. Each employment network shall
provide a copy of the latest report issued by the employment
network pursuant to this paragraph to each beneficiary upon
enrollment under the Program for services to be received
through such employment network. Upon issuance of each report
to each beneficiary, a copy of the report shall be maintained
in the files of the employment network. The program manager
shall ensure that copies of all such reports issued under this
paragraph are made available to the public under reasonable
terms.
``(g) Individual Work Plans.--
``(1) Requirements.--Each employment network shall--
``(A) take such measures as are necessary to ensure
that employment services, vocational rehabilitation
services, and other support services provided under the
Program by, or under agreements entered into with, the
employment network are provided under appropriate
individual work plans that meet the requirements of
subparagraph (C);
``(B) develop and implement each such individual
work plan in partnership with each beneficiary
receiving such services in a manner that affords the
beneficiary the opportunity to exercise informed choice
in selecting an employment goal and specific services
needed to achieve that employment goal;
``(C) ensure that each individual work plan
includes at least--
``(i) a statement of the vocational goal
developed with the beneficiary;
``(ii) a statement of the services and
supports that have been deemed necessary for
the beneficiary to accomplish that goal;
``(iii) a statement of any terms and
conditions related to the provision of such
services and supports; and
``(iv) a statement of understanding
regarding the beneficiary's rights under the
Program (such as the right to retrieve the
ticket to work and self-sufficiency if the
beneficiary is dissatisfied with the services
being provided by the employment network) and
remedies available to the individual, including
information on the availability of advocacy
services and assistance in resolving disputes
through the State grant program authorized
under section 1150;
``(D) provide a beneficiary the opportunity to
amend the individual work plan if a change in
circumstances necessitates a change in the plan; and
``(E) make each beneficiary's individual work plan
available to the beneficiary in, as appropriate, an
accessible format chosen by the beneficiary.
``(2) Effective upon written approval.--A beneficiary's
individual work plan shall take effect upon written approval by
the beneficiary or a representative of the beneficiary and a
representative of the employment network that, in providing such
written approval, acknowledges assignment of the beneficiary's ticket
to work and self-sufficiency.
``(h) Employment Network Payment Systems.--
``(1) Election of payment system by employment networks.--
``(A) In general.--The Program shall provide for
payment authorized by the Commissioner to employment
networks under either an outcome payment system or an
outcome-milestone payment system. Each employment
network shall elect which payment system will be
utilized by the employment network, and, for such
period of time as such election remains in effect, the
payment system so elected shall be utilized exclusively
in connection with such employment network (except as
provided in subparagraph (B)).
``(B) No change in method of payment for
beneficiaries with tickets already assigned to the
employment networks.--Any election of a payment system
by an employment network that would result in a change
in the method of payment to the employment network for
services provided to a beneficiary who is receiving
services from the employment network at the time of the
election shall not be effective with respect to payment
for services provided to that beneficiary and the
method of payment previously selected shall continue to
apply with respect to such services.
``(2) Outcome payment system.--
``(A) In general.--The outcome payment system shall
consist of a payment structure governing employment
networks electing such system under paragraph (1)(A)
which meets the requirements of this paragraph.
``(B) Payments made during outcome payment
period.--The outcome payment system shall provide for a
schedule of payments to an employment network in
connection with each individual who is a beneficiary
for each month during the individual's outcome payment
period for which benefits (described in paragraphs (3)
and (4) of subsection (k)) are not payable to such
individual because of work or earnings.
``(C) Computation of payments to employment
network.--The payment schedule of the outcome payment
system shall be designed so that--
``(i) the payment for each of the 60 months
during the outcome payment period for which
benefits (described in paragraphs (3) and (4)
of subsection (k)) are not payable is equal to
a fixed percentage of the payment calculation
base for the calendar year in which such month
occurs; and
``(ii) such fixed percentage is set at a
percentage which does not exceed 40 percent.
``(3) Outcome-milestone payment system.--
``(A) In general.--The outcome-milestone payment
system shall consist of a payment structure governing
employment networks electing such system under
paragraph (1)(A) which meets the requirements of this
paragraph.
``(B) Early payments upon attainment of milestones
in advance of outcome payment periods.--The outcome-
milestone payment system shall provide for 1 or more
milestones with respect to beneficiaries receiving
services from an employment network under the Program
that are directed toward the goal of permanent
employment. Such milestones shall form a part of a
payment structure that provides, in addition to
payments made during outcome payment periods, payments
made prior to outcome payment periods in amounts based
on the attainment of such milestones.
``(C) Limitation on total payments to employment
network.--The payment schedule of the outcome-milestone
payment system shall be designed so that the total of
the payments to the employment network with respect to
each beneficiary is less than, on a net present value
basis (using an interest rate determined by the
Commissioner that appropriately reflects the cost of
funds faced by providers), the total amount to which
payments to the employment network with respect to the
beneficiary would be limited if the employment network
were paid under the outcome payment system.
``(4) Definitions.--In this subsection:
``(A) Payment calculation base.--The term `payment
calculation base' means, for any calendar year--
``(i) in connection with a title II
disability beneficiary, the average disability
insurance benefit payable under section 223 for
all beneficiaries for months during the
preceding calendar year; and
``(ii) in connection with a title XVI
disability beneficiary (who is not concurrently
a title II disability beneficiary), the average
payment of supplemental security income
benefits based on disability payable under
title XVI (excluding State supplementation) for
months during the preceding calendar year to
all beneficiaries who have attained age 18 but
have not attained age 65.
``(B) Outcome payment period.--The term `outcome
payment period' means, in connection with any
individual who had assigned a ticket to work and self-
sufficiency to an employment network under the Program,
a period--
``(i) beginning with the first month,
ending after the date on which such ticket was
assigned to the employment network, for which
benefits (described in paragraphs (3) and (4)
of subsection (k)) are not payable to such
individual by reason of engagement in
substantial gainful activity or by reason of
earnings from work activity; and
``(ii) ending with the 60th month
(consecutive or otherwise), ending after such
date, for which such benefits are not payable
to such individual by reason of engagement in
substantial gainful activity or by reason of
earnings from work activity.
``(5) Periodic review and alterations of prescribed
schedules.--
``(A) Percentages and periods.--The Commissioner
shall periodically review the percentage specified in
paragraph (2)(C), the total payments permissible under
paragraph (3)(C), and the period of time specified in
paragraph (4)(B) to determine whether such percentages,
such permissible payments, and such period provide an
adequate incentive for employment networks to assist
beneficiaries to enter the workforce, while providing
for appropriate economies. The Commissioner may alter
such percentage, such total permissible payments, or
such period of time to the extent that the Commissioner
determines, on the basis of the Commissioner's review
under this paragraph, that such an alteration would
better provide the incentive and economies described in
the preceding sentence.
``(B) Number and amounts of milestone payments.--
The Commissioner shall periodically review the number
and amounts of milestone payments established by the
Commissioner pursuant to this section to determine
whether they provide an adequate incentive for
employment networks to assist beneficiaries to enter
the workforce, taking into account information provided
to the Commissioner by program managers, the Work
Incentives Advisory Panel established under section 202
of the Work Incentives Improvement Act of 1999, and
other reliable sources. The Commissioner may from time
to time alter the number and amounts of milestone
payments initially established by the Commissioner
pursuant to this section to the extent that the
Commissioner determines that such an alteration would
allow an adequate incentive for employment networks to
assist beneficiaries to enter the workforce. Such
alteration shall be based on information provided to
the Commissioner by program managers, the Work
Incentives Advisory Panel established under section 202
of the Work Incentives Improvement Act of 1999, or
other reliable sources.
``(i) Suspension of Disability Reviews.--During any period for
which an individual is using, as defined by the Commissioner, a ticket
to work and self-sufficiency issued under this section, the
Commissioner (and any applicable State agency) may not initiate a
continuing disability review or other review under section 221 of
whether the individual is or is not under a disability or a review
under title XVI similar to any such review under section 221.
``(j) Allocation of Costs.--
``(1) Payments to employment networks.--Payments to
employment networks (including State agencies that elect to
participate in the Program as an employment network) shall be
made from the Federal Old-Age and Survivors Insurance Trust
Fund or the Federal Disability Insurance Trust Fund, as
appropriate, in the case of ticketed title II disability beneficiaries
who return to work, or from the appropriation made available for making
supplemental security income payments under title XVI, in the case of
title XVI disability beneficiaries who return to work. With respect to
ticketed beneficiaries who concurrently are entitled to benefits under
title II and eligible for payments under title XVI who return to work,
the Commissioner shall allocate the cost of payments to employment
networks to which the tickets of such beneficiaries have been assigned
among such Trust Funds and appropriation, as appropriate.
``(2) Administrative expenses.--The costs of administering
this section (other than payments to employment networks) shall
be paid from amounts made available for the administration of
title II and amounts made available for the administration of
title XVI, and shall be allocated among those amounts as
appropriate.
``(k) Definitions.--In this section:
``(1) Commissioner.--The term `Commissioner' means the
Commissioner of Social Security.
``(2) Disabled beneficiary.--The term `disabled
beneficiary' means a title II disability beneficiary or a title
XVI disability beneficiary.
``(3) Title ii disability beneficiary.--The term `title II
disability beneficiary' means an individual entitled to
disability insurance benefits under section 223 or to monthly
insurance benefits under section 202 based on such individual's
disability (as defined in section 223(d)). An individual is a
title II disability beneficiary for each month for which such
individual is entitled to such benefits.
``(4) Title xvi disability beneficiary.--The term `title
XVI disability beneficiary' means an individual eligible for
supplemental security income benefits under title XVI on the
basis of blindness (within the meaning of section 1614(a)(2))
or disability (within the meaning of section 1614(a)(3)). An
individual is a title XVI disability beneficiary for each month
for which such individual is eligible for such benefits.
``(5) Supplemental security income benefit under title
xvi.--The term `supplemental security income benefit under
title XVI' means a cash benefit under section 1611 or 1619(a),
and does not include a State supplementary payment,
administered federally or otherwise.
``(l) Regulations.--Not later than 1 year after the date of
enactment of this section, the Commissioner shall prescribe such
regulations as are necessary to carry out the provisions of this
section.
``(m) Sunset of Program.--The Program established under this
section shall terminate on September 30, 2004.''.
(b) Conforming Amendments.--
(1) Amendments to title ii.--
(A) Section 221(i) of the Social Security Act (42
U.S.C. 421(i)) is amended by adding at the end the
following:
``(5) For suspension of reviews under this subsection in the case
of an individual using a ticket to work and self-sufficiency, see
section 1148(i).''.
(B) Section 222(a) of the Social Security Act (42
U.S.C. 422(a)) is repealed.
(C) Section 222(b) of the Social Security Act (42
U.S.C. 422(b)) is repealed.
(D) Section 225(b)(1) of the Social Security Act
(42 U.S.C. 425(b)(1)) is amended by striking ``a
program of vocational rehabilitation services'' and
inserting ``a program consisting of the Ticket to Work
and Self-Sufficiency Program under section 1148 or
another program of vocational rehabilitation services,
employment services, or other support services''.
(2) Amendments to title xvi.--
(A) Section 1615(a) of the Social Security Act (42
U.S.C. 1382d(a)) is amended to read as follows:
``Sec. 1615. (a) In the case of any blind or disabled individual
who--
``(1) has not attained age 16, and
``(2) with respect to whom benefits are paid under this
title,
the Commissioner of Social Security shall make provision for referral
of such individual to the appropriate State agency administering the
State program under title V.''.
(B) Section 1615(c) of the Social Security Act (42
U.S.C. 1382d(c)) is repealed.
(C) Section 1631(a)(6)(A) of the Social Security
Act (42 U.S.C. 1383(a)(6)(A)) is amended by striking
``a program of vocational rehabilitation services'' and
inserting ``a program consisting of the Ticket to Work
and Self-Sufficiency Program under section 1148 or
another program of vocational rehabilitation services,
employment services, or other support services''.
(D) Section 1633(c) of the Social Security Act (42
U.S.C. 1383b(c)) is amended--
(i) by inserting ``(1)'' after ``(c)''; and
(ii) by adding at the end the following:
``(2) For suspension of continuing disability reviews and other
reviews under this title similar to reviews under section 221 in the
case of an individual using a ticket to work and self-sufficiency, see
section 1148(i).''.
(c) Effective Date.--Subject to subsection (d), the amendments made
by subsections (a) and (b) shall take effect with the first month
following 1 year after the date of enactment of this Act.
(d) Graduated Implementation of Program.--
(1) In general.--Not later than 1 year after the date of
enactment of this Act, the Commissioner of Social Security
shall commence implementation of the amendments made by this
section (other than paragraphs (1)(C) and (2)(B) of subsection
(b)) in graduated phases at phase-in sites selected by the
Commissioner. Such phase-in sites shall be selected so as to
ensure, prior to full implementation of the Ticket to Work and
Self-Sufficiency Program, the development and refinement of
referral processes, payment systems, computer linkages, management
information systems, and administrative processes necessary to provide
for full implementation of such amendments. Subsection (c) shall apply
with respect to paragraphs (1)(C) and (2)(B) of subsection (b) without
regard to this subsection.
(2) Requirements.--Implementation of the Program at each
phase-in site shall be carried out on a wide enough scale to
permit a thorough evaluation of the alternative methods under
consideration, so as to ensure that the most efficacious
methods are determined and in place for full implementation of
the Program on a timely basis.
(3) Full implementation.--The Commissioner shall ensure
that the ability to provide tickets and services to individuals
under the Program exists in every State as soon as practicable
on or after the effective date specified in subsection (c) but
not later than 3 years after such date.
(4) Ongoing evaluation of program.--
(A) In general.--The Commissioner shall design and
conduct a series of evaluations to assess the cost-
effectiveness of activities carried out under this
section and the amendments made thereby, as well as the
effects of this section and the amendments made thereby
on work outcomes for beneficiaries receiving tickets to
work and self-sufficiency under the Program.
(B) Consultation.--The Commissioner shall design
and carry out the series of evaluations after receiving
relevant advice from experts in the fields of
disability, vocational rehabilitation, and program
evaluation and individuals using tickets to work and
self-sufficiency under the Program and consulting with
the Work Incentives Advisory Panel established under
section 202, the Comptroller General of the United
States, other agencies of the Federal Government, and
private organizations with appropriate expertise.
(C) Methodology.--
(i) Implementation.--The Commissioner, in
consultation with the Work Incentives Advisory
Panel established under section 202, shall
ensure that plans for evaluations and data
collection methods under the Program are
appropriately designed to obtain detailed
employment information.
(ii) Specific matters to be addressed.--
Each such evaluation shall address (but is not
limited to)--
(I) the annual cost (including net
cost) of the Program and the annual
cost (including net cost) that would
have been incurred in the absence of
the Program;
(II) the determinants of return to
work, including the characteristics of
beneficiaries in receipt of tickets
under the Program;
(III) the types of employment
services, vocational rehabilitation
services, and other support services
furnished to beneficiaries in receipt
of tickets under the Program who return
to work and to those who do not return
to work;
(IV) the duration of employment
services, vocational rehabilitation
services, and other support services
furnished to beneficiaries in receipt
of tickets under the Program who return
to work and the duration of such
services furnished to those who do not
return to work and the cost to
employment networks of furnishing such
services;
(V) the employment outcomes,
including wages, occupations, benefits,
and hours worked, of beneficiaries who
return to work after receiving tickets
under the Program and those who return
to work without receiving such tickets;
(VI) the characteristics of
providers whose services are provided
within an employment network under the
Program;
(VII) the extent (if any) to which
employment networks display a greater
willingness to provide services to
beneficiaries with a range of
disabilities;
(VIII) the characteristics
(including employment outcomes) of
those beneficiaries who receive
services under the outcome payment
system and of those beneficiaries who
receive services under the outcome-
milestone payment system;
(IX) measures of satisfaction among
beneficiaries in receipt of tickets
under the Program; and
(X) reasons for (including comments
solicited from beneficiaries regarding)
their choice not to use their tickets
or their inability to return to work
despite the use of their tickets.
(D) Periodic evaluation reports.--Following the
close of the third and fifth fiscal years ending after
the effective date under subsection (c), and prior to
the close of the seventh fiscal year ending after such
date, the Commissioner shall transmit to the Committee
on Ways and Means of the House of Representatives and
the Committee on Finance of the Senate a report
containing the Commissioner's evaluation of the
progress of activities conducted under the provisions
of this section and the amendments made thereby. Each
such report shall set forth the Commissioner's
evaluation of the extent to which the Program has been
successful and the Commissioner's conclusions on
whether or how the Program should be modified. Each
such report shall include such data, findings,
materials, and recommendations as the Commissioner may
consider appropriate.
(5) Extent of state's right of first refusal in advance of
full implementation of amendments in such state.--
(A) In general.--In the case of any State in which
the amendments made by subsection (a) have not been
fully implemented pursuant to this subsection, the
Commissioner shall determine by regulation the extent
to which--
(i) the requirement under section 222(a) of
the Social Security Act for prompt referrals to
a State agency, and
(ii) the authority of the Commissioner
under section 222(d)(2) of the Social Security
Act to provide vocational rehabilitation
services in such State by agreement or contract
with other public or private agencies,
organizations, institutions, or individuals,
shall apply in such State.
(B) Existing agreements.--Nothing in subparagraph
(A) or the amendments made by subsection (a) shall be
construed to limit, impede, or otherwise affect any
agreement entered into pursuant to section 222(d)(2) of
the Social Security Act before the date of enactment of
this Act with respect to services provided pursuant to
such agreement to beneficiaries receiving services
under such agreement as of such date, except with
respect to services (if any) to be provided after 3
years after the effective date provided in subsection
(c).
(e) Specific Regulations Required.--
(1) In general.--The Commissioner of Social Security shall
prescribe such regulations as are necessary to implement the
amendments made by this section.
(2) Specific matters to be included in regulations.--The
matters which shall be addressed in such regulations shall
include--
(A) the form and manner in which tickets to work
and self-sufficiency may be distributed to
beneficiaries pursuant to section 1148(b)(1) of the
Social Security Act;
(B) the format and wording of such tickets, which
shall incorporate by reference any contractual terms
governing service by employment networks under the
Program;
(C) the form and manner in which State agencies may
elect participation in the Ticket to Work and Self-
Sufficiency Program (and revoke such an election)
pursuant to section 1148(c)(1) of the Social Security
Act and provision for periodic opportunities for
exercising such elections (and revocations);
(D) the status of State agencies under section
1148(c)(1) at the time that State agencies exercise
elections (and revocations) under that section;
(E) the terms of agreements to be entered into with
program managers pursuant to section 1148(d) of the
Social Security Act, including--
(i) the terms by which program managers are
precluded from direct participation in the
delivery of services pursuant to section
1148(d)(3) of the Social Security Act;
(ii) standards which must be met by quality
assurance measures referred to in paragraph (6)
of section 1148(d) and methods of recruitment
of employment networks utilized pursuant to
paragraph (2) of section 1148(e); and
(iii) the format under which dispute
resolution will operate under section
1148(d)(7);
(F) the terms of agreements to be entered into with
employment networks pursuant to section 1148(d)(4) of
the Social Security Act, including--
(i) the manner in which service areas are
specified pursuant to section 1148(f)(2)(A) of
the Social Security Act;
(ii) the general selection criteria and the
specific selection criteria which are
applicable to employment networks under section
1148(f)(1)(C) of the Social Security Act in
selecting service providers;
(iii) specific requirements relating to
annual financial reporting by employment
networks pursuant to section 1148(f)(3) of the
Social Security Act; and
(iv) the national model to which periodic
outcomes reporting by employment networks must
conform under section 1148(f)(4) of the Social
Security Act;
(G) standards which must be met by individual work
plans pursuant to section 1148(g) of the Social
Security Act;
(H) standards which must be met by payment systems
required under section 1148(h) of the Social Security
Act, including--
(i) the form and manner in which elections
by employment networks of payment systems are
to be ex | |
