Preparing for the Ticket to Work: Market Leadership - It’s Our’s to Lose

Dan O’Brien

Oklahoma Dept of Rehabilitation Services

VR Thinking Like a Business

• We have prime positioning in an $80 B Market

• Analyze the Market and Competition

• GROWING our business using the Ticket:

– Market our services to customers - Assertive Engagement

– Develop and use choice based self-screening

– Develop expandable networks of sub-contractors

– Collaboratively plan with Vendors and Customers

– Create incentives for VR staff to serve SSA beneficiaries

Ticket to Work Basics

• TWWIIA Signed into Law Dec. 1999

• Enhances Work Incentives, EZ Back On, 7 ^1/2 years Medicare, Limits CDR’s, Medicaid Buy-in

• Sets up vocational voucher – the Ticket to Work

• National Program Manager will manage Tickets and Employment Networks - Maximus, Inc.

• Employment Networks (EN) - the direct service providers - must be approved by SSA

• Some EN’s pre-selected-VR, One Stops ,AP’s

• Includes Milestone Payments during 1^st 9 Mos.

• Only VR can choose the existing reimbursement system or the Ticket payment by individual

Ticket Implementation

• Fall 2000 National Program Manager - Maximus, Inc.

• November –13 Ticket States, Oklahoma, Colorado, etc.

• Dec. 2000 – Draft Ticket Regulations

• April 2001 - RFP for EN’s released

• Summer 2001– Final Ticket Regulations

• Summer 2001 – Implemented in 13 Pilot States

• Oklahoma - 82,000 Tickets, 30% MH, 20% DD

• Jan 2002 – 20 additional states

• Jan 2003 – Remaining States and Territories

Ticket Under-funded

• Voucher worth 40% of estimated savings over 5 years off benefits

– $16,620/14,127 for SSDI

– $10,560/8,976 for SSI

– Outcome Only/Milestones+outcome payments

• SSI Ticket Under-funded – ave. VR SSA Claim $11,000 (1999)

• VR may be the only willing Provider for SSI recipients

Proposed Ticket Milestone Payment

• SSA needs program to at least break even - that point is 2-4 years off of SSA rolls

• Milestone Payments = $1410 SSDI/$900 SSI

– 3 months Job Retention - $470 SSDI/$300 SSI

– 7 months of work at SGA - $940 SSDI/$600 SSI

– Proposed - Blind will have same SGA ($740) for Milestone payments ONLY

• Job Retention (Outcome) Payments for 60 months

– SSDI = $90 1^st 12 mo., 222/mo. if over SGA ($740/1240), check=$0

– SSI = $57/$141 per month at $0 Benefit Level, earnings over $1145 per month

Vendor Risk Management Options

• Employment Network has Deferred Payment Risk

• Option 1 - Profile/Cream the $1,500 Clients

• Option 2 - Forward Fund - risk assessment

• Option 3 - Only accept Ticket for individuals you intend to hire - ex. NISH, Blind Vendors

• Option 4 - Bill Medicaid for part of the cost of getting to 9 months, ex. HCB Waiver – and/or regular Medicaid - personal assistance, case management

• Option 5 - Join a publicly financed Employment Network – One Stops, VR, MH, DD

Forming a VR Funded Network

• VR/VS Agencies are positioned as the Market Leaders

• Oklahoma DRS is piloting a VR sponsored Employment Network

• Potential 200% growth of Case Service Funds at 3%-4% Ticket use rate

• Need a system for Choice based Screening

Okla. SSA funded Voucher Pilot

• To Inform consumers, advocates and MH Staff on the value of work in recovery and use of Work Incentives

• Facilitate Medicaid buy-in Oklahoma

• Pilot Ticket Implementation Issues:

– Started issuing Vocational Vouchers Sept. 1999

– Response Rate - 35-40% attended Work incentive meeting and 8-10% got on caseload

– Equitable provider payment rates - $3500-$10,000

– Facilitating Consumer Choice - Vendor Report Card

– Work out methodology for a VR sponsored Employment Network

OKLA DRS Pilot Structure

• VR Contracts with competing Vendors

• Issue OK Vocational Voucher at Work Incentive Meeting

• Issue Vendor Performance Report Card

• Consumer has choice of 2 Models (Clubhouse and IPS model) & 4 Vendors

• Consumer Assigns Voucher to Vendor

• Enrolled by VR – 6 Milestones total=$6,500 ave. for SE

• SSA funds used for Quarterly Ongoing Support Payments

– Plus incentive payments to provider for reaching SGA, Medical Benefits

Marketing to the SSA Beneficiary: Selling Work

• Four contacts before each meeting

• Two by mail and two by phone

• If they can’t or don’t attend, invite to next meeting or arrange a home visit

• Held at an All you can eat Buffet

• Consumer Trainers and Exemplars/Role Models explain value of work as part of recovery

• Consumer Trainers review SSI/SSDI work incentives

• IF we provide World Class service and choice why would anyone go anywhere else?

State Agencies Need a Contingency Plan

• If 10% (8,200) of Ticket Holders in Oklahoma apply for services this will double the number of applications we have to process

• As many as 30,000 may call for information

• How can we take more applications

– Hire VR Clients as Temporary Work Incentive Staff

– Streamline application and eligibility process

Choice Based Self Screening

• We must have a system to handle a huge increase in SSA Beneficiary interest

– 4 Step Self Screening Process

– Recruiting by advocacy organizations by mail and phone – 100% of Ticket Holders

– Work Incentive Meeting to brief beneficiaries on benefits of working and Work Incentives – 20-30% of beneficiaries choose to attend

– Facilitated use of the One-Stops Core Services – Screening of Ticket Holders - 10% complete

– VR Application and referral to CRP under Milestone contract for Short Term Job Coaching or Supported Employment - 5%

Subcontracting: Vendors as Partner

• Vendors will bring Tickets to VR if they are full partners paid at Market based rates

• We need them

– We don’t have the capability to JC with our staff, most SSA beneficiaries will need a JC or Personal Assistant

– Cheaper, faster with better quality to contract out

– May have longstanding relationships - DD/MR/MH

• They need us

– They don’t have risk tolerance we do - RSA funds

– Under Ticket we can manage the risk better

– We can choose by individual whether to bill under existing reimbursement system or Ticket system

DRS Ticket Implementation

• Create a Unit/work group charged with Ticket Implementation and tracking, add staff to 2 units

• Identify current clients who are SSI/SSDI

• Educate Staff on purchasing supports for success - Supported Employment & Short JCing

• Set rates for services for Ticket Holders

• Expand provider network - sub-contracts (SE+)

• Actively recruit Ticket holders

• Pilot Screening with One-Stop/Workforce

• Track services provided and SSA payments

• Create incentives to encourage staff

Website Address:

www.milestonemanagement.com

Email:

deobrien@aol.com (Dan O’Brien)

or

Rfcook@drs.state.ok.us (Becky Cook)