The Dubious Benefits Of Ticket To Work

     From Effects of the Ticket to Work Program: Return on Investment and Overall Assessment of Outcomes Versus Design by Paul O'Leary and Emily Roessel:

The Ticket to Work (TTW) program was established by 1999 legislation to expand access to vocational rehabilitation services for beneficiaries of Social Security Administration (SSA) disability benefit programs. We evaluate TTW and compare its outcomes with the intentions of its authorizing legislation. We also compare the program's costs with the benefit savings resulting from the reemployment of successful program participants. We analyze unadjusted descriptive statistics, then consider potential participation bias among individuals who received employment services by devising an econometric analysis that accounts for the seriousness of a participant's interest in work. We find that TTW improved employment outcomes and generated net benefit savings to SSA for many employment-service clients, but the savings did not fully offset program costs. However, these estimates should be regarded as lower bounds of TTW's positive effects because they do not account for higher service needs of TTW program participants. ...

Ticket To Work Doesn't Work

      From a recent report by the Government Accountability Office (GAO):

Disability beneficiaries participate in the Social Security Administration’s (SSA) Ticket to Work and Self-Sufficiency program (Ticket to Work) by assigning a "ticket" to service providers who, in turn, provide help with employment. SSA compensates the service providers when Ticket to Work participants achieve designated levels of work and earnings. Using SSA data from 2002, when the program began, through 2018, the most recent year available, GAO estimated that 5 years after starting Ticket to Work, participants’ average earnings were $2,451 more per year than that of similar nonparticipants. However, the majority of participants remained unemployed 5 years after starting Ticket to Work. 

Based on GAO’s analysis, the costs of Ticket to Work exceeded the savings in disability benefits to SSA by an estimated $806 million from 2002 through 2015, the most recent year with reliable savings data. Savings accrue when Ticket to Work participants receive lower benefits or leave the disability rolls due to earnings from work. GAO estimates that participants were slightly more likely to leave the rolls (9.7 percent) than nonparticipants who are similar across a range of characteristics such as age, gender, disability type, and education level (8.6 percent). A greater percentage of participants left the disability rolls due to work rather than for other reasons, such as medical improvement ...

GAO estimates that SSA incurred an additional $133 million to $169 million in costs (above the $806 million) from disability benefit overpayments to Ticket to Work participants. Overpayments can occur when beneficiaries who work do not report earnings to SSA or SSA delays in adjusting their benefit amounts. ...

     This report ignores an important reality.  No one makes claimants participate in the Ticket to Work program. Those who do participate are saying they believe they may have some capacity for work, meaning that they have better prospects for returning to work than claimants generally. Comparing the results in this group to claimants generally makes the Ticket to Work results look better than they are. Some of those who volunteered for Ticket to Work would have returned to work with or without Ticket to Work. We can't tell how many were only able to return to work due to Ticket to Work. If there were a control group, it would be some who volunteered for Ticket to Work but were arbitrarily denied Ticket to Work help but there is no such control group because none were turned away.

     Note the ridiculous level of overpayments associated with Ticket to Work even among a group of beneficiaries who told Social Security they planned to return to work. Don't blame claimants for this. Social Security's system for handling reports of return to work just doesn't work. 

     I'll make a modest suggestion. Social Security should almost completely stop relying upon wage reports from claimants because they do a poor job of reporting and Social Security does a worse job of recording what they report. We should define Substantial Gainful Activity on a quarterly basis and base work deductions on quarterly wages reported by employers. This can mostly be done by the computers. Yes, there will be problems with "wages" that are reported for work done earlier (such as sick pay, vacation pay and residual commissions) and yes, there will be problems with self-employment income but we'd be in a much better place than we're in now if those are the only problems we have to deal with.

Maximus Loses Ticket To Work Contract

      From Washington Technology:

Maximus has lost an incumbent contract at the Social Security Administration after the company saw its protest denied by the Government Accountability Office.

The company has held the Ticket Program Manager contract since at least 2015. But this time around, Cognosante won the contract and Maximus took its challenge to GAO. Maximus argued that the evaluation of proposals was not conducted properly.

According to the GAO protest docket, the Maximus protest was denied Aug. 6. ...

The Ticket Program Manager contract is worth $79.6 million and runs for five years. Cognosante and Maximus were the only two bidders on the contract, according to the Federal Procurement Data System. ...

Issuing A Directive

      A press release:

Today, House Ways and Means Social Security Subcommittee Chairman John B. Larson (D-CT) and Worker and Family Support Subcommittee Chairman Danny K. Davis (D-IL) sent a letter directing the U.S. Department of Labor to halt consideration of a proposed transfer of the Ticket to Work program from the Social Security Administration to the U.S. Department of Labor. The Ticket to Work program provides services to help Social Security and Supplemental Security Income disability beneficiaries who are attempting to return to work.

“In 1999, Congress placed the new Ticket to Work and Self-Sufficiency program (Ticket program) under the Social Security Administration (SSA), because of the close coordination between SSA and program participants, including beneficiaries and service providers, that is essential to the operation of the Ticket Program. Nothing has changed to warrant a transfer to the Department of Labor (DOL),” wrote Larson and Davis.

“By law, the Department of Labor does not administer the Ticket program,” continued Larson and Davis. “We do not intend to consider legislation to remove the administration of the Ticket program from SSA and place it at DOL. We therefore expect the Department to halt any further consideration of this inappropriate and detrimental proposal.”

Allsup Got Almost $4.5 Million In Ticket To Work Money In 2019

      Social Security has made a proactive disclosure of recipients of money under the Ticket To Work (TTW) program, which pays for rehabilitation to enables Social Security disability recipients to return to work. A rehabilitation provider gets paid based upon claimants returning to work. 

     Ranked in third place on the list of largest recipients of TTW money in 2019, at $4,467,810, is Allsup Employment Services, LLC. Yep, that's part of the Allsup non-attorney group that represents Social Security disability claimants before the agency.

     Doing this actually occurred to me years ago. Sometimes you help a claimant get on benefits but you know from their medical records that they're getting better and have a realistic chance of returning to work. It doesn't happen much but it does happen. Since you already have their medical records, you're in a great place to spot these cases and to profit from providing "rehabilitation" to people who need little help anyway. I never did it because it seemed like a conflict of interest or at least it didn't seem to smell quite right. It's not illegal, though, as far as I know. Of course, I don’t know how Allsup is coming by its TTW cases.

     I wonder if there are other affiliates of entities representing Social Security claimants on the TTW list, perhaps with names that can't be so easily connected.

Policy Proposals From President's Budget

     From the portions of  the President's proposed budget concerning Social Security:

• ... Reduce improper payments caused by barriers for beneficiaries to report income and assets. The Budget proposes to reduce improper payments in disability programs by targeting administrative resources to the development of a uniform system of reporting in mySocialSecurity. This is in addition to instituting a holistic view that provides all beneficiaries’ data, including income and assets, in one electronic location, while simultaneously developing a network of automated processes across other IT platforms for work-related benefit payment adjustments, work continuing disability reviews, redeterminations, and payments to Ticket to Work providers. In addition, future related legislative changes to address the root causes of these improper payments could include requiring suspension of benefits when beneficiaries neglect to report wages and resources, and instituting mandatory training for beneficiaries on reporting requirements prior to receipt of their first benefit checks. These administrative actions would result in $11 billion in outlay savings over 10 years. ... 

• Increase the overpayment collection threshold for OASDI. The Budget would change the mini-mum monthly withholding amount for recovery of Social Security benefit overpayments to reflect the increase in the average monthly benefit since SSA established the current minimum of $10 in 1960. By changing this amount from $10 to 10 percent of the monthly benefit payable, SSA would recover over-payments more quickly and better fulfill its stew-ardship obligations to the combined Social Security Trust Funds. ... 

• Simplify administration of the SSI program. The Budget proposes changes to simplify the SSI program by incentivizing support from recipients’ family and friends, reducing SSA’s administrative burden, and streamlining requirements for applicants. SSI benefits are reduced by the amount of food and shelter, or in-kind support and maintenance, a beneficiary receives. The policy is burdensome to administer and is a leading source of SSI improper payments. The Budget proposes to replace the complex calculation of in-kind support and maintenance with a flat rate reduction for adults living with other adults to capture economies of scale. The Budget also proposes to eliminate dedicated accounts for past due benefits and to eliminate the administratively burdensome consideration whether a couple is holding themselves out as married. This proposal costs $13 million over 10 years. ... 

• Exclude SSA debts from discharge in bankruptcy. Debts due to an overpayment of Social Security benefits are generally dischargeable in bankruptcy. The Budget includes a proposal to exclude such debts from discharge in bankruptcy, except when it would result in an undue hardship. ... 

• Establish replacement Social Security card fee. The Budget proposes to collect fees on replacement Social Security cards. First-time Social Security cards including cards issued at birth would not be subject to the fee....

Ticket To Work Not Working

     From the Washington Free Beacon:

The Social Security Administration has spent $3 billion on programs designed to incentivize disability recipients to go back to work over the past 16 years. So far, less than 3 percent of beneficiaries have signed up, with "no consistent evidence" the program has helped participants find a job. 

The inspector general for the agency released an audit last week calling for Congress to evaluate the "viability" of the programs 

including Ticket to Work and Self-Sufficiency (TTW) and Achieve Self-Support (PASS)."SSA has spent about $3 billion administering two ongoing congressionally mandated return-to-work programs and a time-limited demonstration project designed to determine whether a policy change would help beneficiaries return to work," the inspector general said. "However, these programs and demonstration project enticed a small percentage of disabled individuals to return to work." ...

Since it began in 2000, the TTW program has cost $2.8 billion and enrolled 1.2 million disabled welfare recipients, a participation rate of only 2.6 percent. Those beneficiaries have saved the government approximately $5.9 billion. For each beneficiary served, the government spent $2,300 through the program, as opposed to the average $5,000 benefits forgone. ...

      You might say that this shows that even though TTW is only minimally successful that it still more than pays for itself but the problem is that it is more than possible that the vast majority of those “helped” by TTW would have gone back to work on their own. To what extent are TTW providers helping people who wouldn’t otherwise get back to work and to what extend are TTW providers just profiting from people who don’t need their help? We just don’t know. Any advantage from TTW is, at best, unproven. The problem with all the efforts to get Social Security disability recipients back to work is that they are premised upon a deep seated belief that it’s easy to get on benefits. It’s not. It’s terribly difficult to get on disability benefits. As sick as people have to be to get on Social Security disability benefits, we shouldn’t expect many to go back to work.

Social Security Seeks Input

     From a notice published by Social Security in the Federal Register (footnotes omitted):

This request for information (RFI) seeks public input on strategies for improving the adult economic outcomes of youth ages 14 to 25 with disabilities receiving SSI. ...

While studies have shown that transition-age SSI recipients are at risk of poor economic outcomes--lower earnings and employment--when they become adults, it is not clear what supports could improve these outcomes or who should provide them. ...

This RFI offers interested parties, including States, community-based and other non-profit organizations, philanthropic organizations, researchers, and members of the public, the opportunity to provide information and recommendations on effective approaches for improving adult outcomes for youth receiving SSI. ...

SSA's redetermination of SSI eligibility at age 18 also generally results in 30-40 percent of youth losing SSI eligibility (and the accompanying automatic Medicaid access that most SSI recipients receive) because their condition does not meet the adult standard for disability. The Government Accountability Office (GAO) has noted that these issues contribute to the difficulties many child SSI recipients experience transitioning to adulthood. 

Several studies of transition-age SSI recipients suggest significant gaps exist in the awareness and use of services and policies currently available to youth. For example, prior to age 18, less than one quarter of SSI recipients received vocational training. About 40 percent of 16- and 17-year-old SSI recipients work, but only about 3 percent of eligible SSI recipients (of all ages) use the student earned income exclusion, a work incentive that excludes a certain amount of earned income from the SSI calculation. ...

SSA has recognized the difficult transition to adulthood and that many of these youth return to the SSI program in early adulthood. ...

We ask respondents to address the following questions, where possible, considering the context discussed in this document. You do not need to address every question and should focus on those that relate to your expertise or perspectives. To the extent possible, please clearly indicate which question(s) you address in your response.

Questions:

     1. What specific programs or practices have shown promise at the Federal, State, or local level in improving the adult economic outcomes of youth with disabilities receiving SSI?

     2. Given the requirement of VR agencies to serve transition-age individuals, the availability of Individualized Education Programs (IEP) and Section 504 plans in school settings, and the availability of services and supports elsewhere available to youths, what should SSA's role be in assisting the transition of youths to adulthood?

     3. How might SSA better support other agencies' youth transition-related activities?
          a. What SSA policies interact with other agencies' services and supports?
         b. Do SSA's and other agencies' policies need to be modified (technically or administratively) to improve utilization of these services and supports? How?

     4. Are there aspects of SSA's publications, mailings, and online information that SSA can improve to better support successful transitions to adulthood of youths receiving SSI?

     5. How can SSA improve its existing work incentive policies, such as the Student Earned Income Exclusion (SEIE) and Impairment-Related Work Expenses (IRWE), to better support and increase SSI youth engagement in work? Are there alternative models that SSA should consider to replace existing work incentives?

     6. How can SSA enhance and better target its existing service infrastructure including its Work Incentive Planning and Assistance (WIPA) program and Plan to Achieve Self Support (PASS), to increase SSI youth engagement in work and work activities?

     7. What lessons from SSA's youth demonstration projects, in particular the Youth Transition Demonstration (YTD) and the Promoting Readiness of Minors in SSI (PROMISE) project, should SSA apply to new policies and demonstrations? What partners were not included in those demonstrations that should have been? Why?

     8. If SSA were to conduct a new demonstration project related to youth, which populations should SSA consider targeting, if any? How can SSA identify these populations? How many individuals enter these populations per year?

     9. Are there entities (for example, State VR agencies, medical practices, local education and training agencies, etc.) we could look to as exemplars based on current practices for serving youth with disabilities? What evidence exists to suggest these sites are effectively providing services that would lead to the increased self-sufficiency of youths with disabilities?

     10. In the absence of legislation renewing SSA's ability to refer Social Security Disability Insurance (SSDI) beneficiaries and SSI recipients directly to VR, how can SSA help connect youth to VR services?

     11. Should SSA expand the Ticket to Work (Ticket) program to include children or create a separate program for children with a similar mission (i.e., reimbursing service providers whose services result in increased employment and reduced need on cash benefits)?
         a. What services should such a program provide over and above the services youth with disabilities receiving SSI are already eligible for?
         b. What types of service providers should be allowed to participate in a youth Ticket program? Should such a program include all types of existing employment network providers or should it be limited organizations with existing providers that serve the broader youth population?
         c. Is there a lower age limit the Ticket program (either the current program or a new child-specific program) should include that is consistent with other common Federal, State, and local policies that promote self-sufficiency?
        d. Since most children are in school, what outcomes or milestones should a
program that included payments for child outcomes be tied to?
         e. How effective are such incentive payments to service providers likely to be when serving youth? Are there alternatives to current incentive payment structures that SSA should consider (e.g., a payment structure based on state-wide youth employment or youth SSI participation metrics)?
         f. How should the age-18 redetermination and the fact that over one-third of age-18 redeterminations result in the cessation of benefits because they do not have a condition that meets the adult standard for disability factor into such a program?
          g. Are there specific populations among SSI youth, such as youth in foster care, that such a program should consider for allowable services, providers, and expenditures?
         h. Would such a program be duplicative of the services provided by State VR agencies, which are already required to support the transition of youth with disabilities? Why or why not?

     12. Since the implementation of WIOA, are there specific examples of effective services that are funded through the PROMISE grants but not funded through State VR agencies or other Federal and State funding sources?...

     I can talk about something that I used to see that I don't see anymore even though it seemed effective. In the past, workers for the state Vocational Rehabilitation (VR) agency were in regular contact with school guidance counselors to identify disabled high school age children.  These children were offered VR help in making the transition to work. As appropriate, VR offered counseling, VR paid for post-high school training, VR offered sheltered workshops, VR used contacts with sympathetic employers to help at risk young people find employment, and VR offered job coaches. This has almost completely ended in North Carolina. It especially troubles me that there are no more sheltered workshops. You don't need a Ph.D. in VR to figure out that these sorts of services can be invaluable to disabled young people. Why did they stop? It's lack of operating funds for VR. The Social Security Administration can't solve this problem but Congress certainly can and should.
     I can and do refer disabled young people to VR. Every time I do, the parents tell me that they can't understand why no one at the school ever told them about VR. However, even after the young person gets to VR, it seems that they now receive only very limited help. It's nothing like it used to be.
     Please, let's give adequate funding to VR. They can do good work if we'll let them have enough funding.

Festival of Acronyms: CCD Worried About TTW

     The Coalition for Citizens with Disabilities (CCD) has expressed concern over language in the pending appropriations bill for Social Security concerning the Ticket To Work (TTW) program. The bill would require a report on TTW effectiveness.

     I think there is good reason to question TTW's effectiveness. However, I'm also aware that some Republicans want a more coercive approach to return to work, as in something like time limited disability benefits. That would cause enormous distress for large numbers of very sick people and it wouldn't save money but it wouldn't be all bad. It would create plenty of business for me. There would be lots and lots of people cast off benefits only to get right back on benefits after an appeal or two.

Kentucky DDS Issues Report

     From WTVQ:

A new report issued Tuesday shows an increase of staggering proportions in the number of Kentucky adults and children receiving disability benefits. The report was prepared by Kentucky’s Disability Determination Services (DDS) ...

The groundbreaking study of outcomes covers a 35-year timeframe between 1980-2015. During that time, Kentucky's population grew by 21 percent while its combined disability enrollment grew exponentially by 249 percent. Childhood enrollment growth was an astounding 449 percent.

In 2015, 11.2 percent of Kentuckians were receiving some form of disability benefit payment, which is the second highest percentage in the country. ...

As the rolls have increased, so has the rate of controlled substance prescriptions. Per capita opioid prescriptions for SSI/Medicaid adult recipients have increased from 47.58 doses in 2000 to 147.29 doses in 2015, a 210 percent increase. Per capita psychotropic prescriptions SSI/Medicaid children have increased from 272.61 doses in 2000 to 456.87 doses in 2015, an increase of 168 percent. ...

The report states Social Security disability benefit dependence should be created by genuinely disabling conditions which permanently preclude individuals from ever performing remunerative work. For people so afflicted, the integrity and solvency of the system must be preserved. Tragically, some individuals in Kentucky have never experienced life without public assistance. The culture within the Social Security Administration (SSA) is described as a bureaucratic institution, the SSA is motivated to protect and, if possible, expand the scope of its activities across the full horizon of its operational domain. For the SSA, claims and beneficiaries equal budget. This simple equation drives the SSAs internal culture thereby making it a significant obstacle to long-term change. 

An outline for SSA reforms is laid out in the report and includes a recommendation for an overhaul of the SSA Program Operations Manual System (POMS) to include:

1) Mandate the use of objective medical evidence using best practices in forensic evaluation to determine benefit eligibility. Objective evidence of injury or illness must be paired with objective functional capacity evaluations that include cross-validation and intra-test reliability protocols which measure the legitimacy of demonstrated physical effort and limitation.

2) Mandate the use of best practices in forensic psychological evaluation to include symptom and performance validity tests such as the Miller Forensic Assessment of Symptoms Test (M-FAST), the Structured Inventory of Malingered Symptomatology (SIMS), the Test of Memory and Malingering (TOMM), and the Rey 15 Item Memory Test. These tests should be accompanied with the application of clinical thresholds of benefit eligibility.

3) Remove all subjective non-severe conditions from the listing of eligible conditions and require mandatory termination reviews for all recoupable conditions based on clinically accepted recovery timelines.

4) Eliminate the SSAs Medical Improvement evidentiary standard of continuing disability review in favor of an Objective Functionality review founded upon objective forensic evaluation standards.

5) Cease payment of benefits upon CDR termination pending the outcome of an appeal to an ALJ.

6) Eliminate the SSAs Lost Folder policy which restricts the re-evaluation of a beneficiary whose file has been lost. This policy is referred to as the Golden Ticket because the individual whose file is lost will likely receive benefits for the rest of his/her life without any prospect of termination. ...

We're Doing A Poor Job Of Helping Disabled Young People Make The Transition From School To Work

     From a recent report by the Government Accountability Office (GAO):

The Social Security Administration’s (SSA) primary approach for encouraging employment for transition-age youth (ages 14 to 17) with disabilities who receive Supplemental Security Income (SSI) is work incentives that allow them to keep at least some of their SSI benefits and Medicaid coverage while they work. But few transition-age youth benefit from these incentives. ... The work incentive targeted specifically to younger SSI recipients is the Student Earned Income Exclusion (SEIE), which allows income to be excluded from benefits calculations if a recipient is a student under age 22. However, less than 1.5 percent of all transition-age youth — and generally less than half of those with earnings —benefited from SEIE in 2012 through 2015. ... Data also show that almost no youth benefited from other incentives that allow them to exclude earnings used for specific purposes, such as the Impairment-Related Work Expenses incentive. The effectiveness of SSA-administered work incentives may be further limited because, according to SSA and other officials, youth and their families are often unaware of or do not understand them, and may fear that work will negatively affect their benefits or eligibility. ... 

SSA does not have a systematic way to connect transition-age youth on SSI to state Vocational Rehabilitation (VR) agencies that provide training and employment services under the VR State Grants program administered by the Department of Education (Education). Although youth receiving SSI are generally presumed to be eligible for VR services, GAO found that less than 1 percent had an open VR service record in 2015 in four of the five states from which GAO collected VR data. ...

We recommend that the Acting Commissioner of the Social Security Administration take the following actions: 

1. Analyze the SEIE data to determine why a large proportion of transition- age youth on SSI with reported earnings did not benefit from the SEIE and, if warranted, take actions to ensure that those eligible for the incentive benefit from it. 
2. Analyze options to improve communication about SSA-administered work incentives and the implications of work on SSI benefits, with a goal of increasing understanding of SSI program rules and work incentives among transition-age youth and their families. This should include, but not necessarily be limited to, updating SSAs procedures for staff meeting with SSI applicants, recipients, and their families to regularly and consistently discuss – when applicable—how work incentives can prevent reductions in benefit levels and how work history is considered during eligibility redeterminations. 
3. Work with the Secretary of Education to determine the extent to which youth on SSI are not receiving transition services through schools that can connect them to VR agencies and services. 
4. Explore various options for increasing connections to VR agencies and services , including their potential costs and benefits. One option, among others, could be to expand the Ticket to Work program to include youth.

     The report addresses an important topic. I have a few thoughts on this:

• Transition services are vitally important to disabled youths who are about to leave school. I have seen far too many cases where young people who urgently needed VR had no idea that VR exists. When I see clients in this situation, I tell them and their parents about VR but, of course, most disabled young people never see a Social Security attorney.
• Some years ago, at least in North Carolina, schools worked with VR to identify disabled young people in need of help and made sure they were offered that help. That seemed extremely effective. That's not happening now. (What about other states?) I'm pretty sure the problem is lack of VR funding. I'm not sure why the school systems don't at least give the disabled young people and their families the phone number for VR although as I discuss below state Vocational Rehabilitation may be of only limited value at this point.
• Sheltered workshops are a vital part of vocational rehabilitation for disabled young people trying to make the transition from school to work. Sheltered workshops have almost completely disappeared in North Carolina. I'm pretty sure it's due to lack of funding. (What about other states?)
• What I've seen over the last decade or two is declining effectiveness of North Carolina VR. They seem to be able to do little other than pay for community college courses. Disabled young people trying to make the transition from school to work typically need far more help. (What about other states?)
• Social Security's work incentives are far, far too complicated. That's not the agency's fault. Congress wrote the work incentives, not Social Security, but don't expect simplification to help much. There's plenty of evidence that work incentives have little value.
• Social Security lacks funding to do much to help disabled young people making the transition from school to work. I suppose the agency could send out mailings but they would need additional appropriations to do anything more. I think the money might be better spent elsewhere.
• I think additional funding for VR along with provisions requiring VR to coordinate with school systems would work better than anything the Social Security Administration can do.
• Finally, don't expect miracles. Most disabled children won't work on a regular basis no matter what anyone does. Many people who work at the Office of Disability Adjudication and Review (ODAR) or who represent claimants get the mistaken impression that almost all children receiving SSI benefits have psychiatric or cognitive impairments that are of less than overwhelming severity. That's because that group is vastly over-represented in the population requesting hearings on SSI child disability claims. Most disabled children on SSI have physical problems and most of those problems are so overwhelming that the disability claims are approved quickly. Work is unlikely to ever be in the picture for most of these children. Many of those suffering from psychiatric disability have schizophrenia. While Social Security is denying too many schizophrenics, it's still a fact that most schizophrenia claims are being approved fairly quickly. The vast majority of schizophrenics won't be able to work no matter what anyone does for them.

Status Of FY 2017 Appropriations

     Social Security and all other agencies are operating on continuing funding resolutions. This is likely to be the case until March. With news that the incoming Trump administration probably won't even submit a Fiscal Year (FY) 2018 budget much less a FY 2017 budget, the pending House and Senate appropriations bills become even more important than usual. Below is a summary of what the two bills provide. In each case, the bill has only passed at the committee level. There will be new bills in the next Congress which will be at the least similar but which may not be exactly the same as these bills. Each bill will have to pass at the committee level before going to the House and Senate floors. The two bills must then be reconciled. Note that the money differences between the two houses are small in the context of a total agency appropriation of more than $12 billion.
     I have bolded what I regard as the most important riders, that is provisions in appropriations bills  or at least in committee reports that affect not how much money the agency has to spend but try to affect what the Social Security Administration does with that money. Note that what I have bolded is only in the bill that one of the two appropriations committees passed, not both. The committees may become in some ways more cautious and in other ways less cautious in their demands of the agency with a President who is at least nominally Republican. Do they really want to see changes that would deny far more disability claims if a Republican is in the White House to catch the blame? We'll have to see.

House appropriations bill: $75 million less than FY 2016 

House Riders:

• The Committee is aware that some locations average twice the processing time of others and that it can take up to two years to process. This degree of differential processing times is a concern to the Committee. The Social Security Administration is directed to include in the fiscal year 2018 budget request steps taken to reduce the processing times at offices that average over 600 days.
• The Social Security Administration is requested to submit to the Committee an information technology (IT) modernization plan in the fiscal year 2018 budget request. The plan shall include: a complete list of any new systems and significant improvements of existing systems proposed for development; the projected cost of each development project each year to completion including the total estimated cost of development; the estimated annual operations and maintenance costs for each system once development is complete; and a timeline and estimated maintenance cost savings of any legacy systems that will no longer be necessary and are proposed to be eliminated. The plan should also include an assessment of SSA's IT management controls, including how the systems integrate into SSA's enterprise architecture; an analysis of SSA's project management capabilities; and a review of SSA's IT investment and human capital management practices. The requested plan shall address IT funding provided in this Act and any other spending authority planned for or proposed to be used for such purposes.
• The Committee is aware that SSA was added to the Muscular Dystrophy Coordinating Committee through the Muscular Dystrophy CARE Act Amendments enacted in September 2014. The Committee requests that the agency provide relevant data within the fiscal year 2018 budget request on the rate at which persons with Duchenne and Becker Muscular Dystrophy utilize SSA programs, particularly those focused on promoting employment and community independence such as the Ticket to Work program.
• SSA's National Hearing Centers (NHCs) provide the SSA with invaluable flexibility and support to address the hearings backlog. Understanding the value of this flexibility and support, the Committee directs SSA to ensure that its upcoming Administrative Law Judge (ALJ) hiring allocates no less than 25 percent of those newly hired ALJs to NHCs.
• The SSA has committed significant resources to fighting fraud in the Disability Insurance program. To understand if these efforts are effective, the Committee directs the SSA Commissioner to work with the Office of Inspector General to establish a disability fraud rate baseline no later than September 30, 2017.

Senate bill: $32 million more than FY 2016 

Senate Riders:

• The Committee supports SSA's efforts to reduce the backlog of disability claims hearings. Given the successful implementation of the Disability Hearing Pilot Program in Region 1, the Committee encourages SSA to implement the changes on a nationwide level. The changes should include providing advance notice of a hearing date, and requiring claimants to inform SSA or submit written evidence within a certain period in advance of the hearing, subject to the good cause exception. Furthermore, as recommended in the pilot, SSA should consider removing ``new and material evidence'' as a basis for reopening any decision made at the hearing of Appeals Council levels for benefits based on disability. The Committee requests a report on plans for implementation no later than 60 days after the enactment of this act.
• The Committee is dedicated to ensuring that the disabled have access to needed benefits, and strongly encourages SSA to work with us to achieve that goal. The Committee continues to be concerned that SSA uses outdated rules to determine whether or not a claimant meets SSA's definition of disability. The Committee is encouraged by SSA's indication that they are beginning the regulatory process, having already received input from the National Disability Forum, the National Institute of Medicine, as well as various aging and employment experts. These initial steps are well received by the Committee as we continue to work with the Administration to modernize the outdated vocational guidelines into a structure that reflects the 21st century labor market. As this is the first significant overhaul of the grid in nearly 40 years, the Committee requests SSA to submit, no later than 60 days after the enactment of this act, a report on its ongoing efforts to update the grid. In addition, the report shall include a study assessing the feasibility of maintaining a continuous update of the medical vocational guidelines every 10 years.
• The Committee is aware that the Social Security Administration is included in the Muscular Dystrophy Coordinating Committee under the Muscular Dystrophy CARE Act Amendments enacted in September 2014. The Committee expects the agency to make data available on the rate at which persons with Duchenne and Becker Muscular Dystrophy utilize SSA programs, particularly those focused on promoting employment and community independence such as the Ticket to Work Program.
•  While the Committee commends SSA on its continued Program Integrity efforts towards becoming current with regards to the Continuing Disability Review [CDR] backlog, a recent GAO report found that SSA's CDR prioritization models fail to maximize potential cost savings to the trust funds and the Treasury. Within 1 year, and every 3 years thereafter, the Committee directs SSA to review and update the models for prioritization of CDRs with the primary intent of efficiently and effectively maximizing lifetime cost savings to the Federal Government, both for the DI trust fund and Treasury. A detailed, cost-based explanation for the model's prioritization of different CDR types and justification for any updates made should be included in the annual CDR Report to Congress.
• The Committee commends SSA for its work to improve program integrity. However, the Committee is concerned, per previous GAO testimony and report findings from the SSA Office of the Inspector General, that confusion still exists about the Medical Improvement Standard (MIRS) and its exceptions. The Committee directs SSA to submit a report no later than 60 days after the enactment of this act on its progress in educating Disability Determinations Services in the proper application of the MIRS and its exceptions.
• The Committee expects that in resolving claims for disability insurance, SSA's consideration of medical evidence should reflect the degree of relevance and familiarity each medical source has with the effect of an individual's medically determinable impairment(s) on his or her ability to perform Substantial Gainful Activity [SGA]. Since the Treating Physician rule was first published in the Federal Register in 1991, healthcare delivery in the United States has changed significantly and the Treating Physician rule no longer reflects the present reality of the medical personnel with greatest knowledge of an individual's physical and/or mental condition. The Committee encourages SSA to consider revising the controlling weight doctrine in the Treating Physician rule and revising its Acceptable Medical Sources to reflect the new degree of familiarity with their patients, and rigorous training of, nurse practitioners, physician assistants, licensed clinical social workers, audiologists, and speech and language pathologists for the particular impairments that they are well-equipped to treat.
•  The Committee notes that the SSA's OIG has recommended that SSA periodically determine whether VE fees are appropriate to obtain the required level of VE service. The Committee understands that SSA plans to conduct such a review, including benchmark studies of VE fees paid in the national economy and those paid by other governmental and non-governmental organizations, during SSA's acquisition planning process for the contracts to be awarded in fiscal year 2018. The Committee looks forward to an update in the fiscal year 2018 CJ regarding these studies.

Proposed Change To Unsuccessful Work Attempt Rules

     The Social Security Administration has asked the Office of Management and Budget (OMB) to approve a set of amendments to its regulations concerning unsuccessful work attempts and expedited reinstatement. Social Security does not have to release the proposal at this point. However, it does have to post a regulatory agenda in the Federal Register twice a year. Here's how the agency described this proposal last fall:

We propose to remove the additional requirements for evaluation of a Unsuccessful Work Attempt (UWA) in employment or self-employment that last between 3 and 6 months and use the current 3 month standards for all work attempts that are 6 months or less. We also propose to change the calculation for determining the amount adjusted for national wage growth for both employees and the self-employed from $530 to $700, the amount currently being used to calculate Substantial Gainful Activity (SGA). In order to avoid any unintended consequences for Ticket to Work (Ticket) holders as a result of our change to the calculation of the Trial Work Period (TWP) service month amount, we propose to change how we calculate timely progress toward self-supporting employment for the Ticket program to earnings equal to or greater than the amount representing 72 percent of SGA. Finally, we propose to allow beneficiaries to apply for Expedited Reinstatement (EXR) Eligibility in the same month they stop performing SGA. These changes would align our policies, make them easier for the public to understand, and simplify our processing procedures, thereby allowing for faster determinations.

     This proposal isn't going to be official for a long time. OMB must approve it. The proposal is then posted in the Federal Register for comments. Social Security must consider the comments. The agency may modify the proposal. If it still wants to go ahead with the proposal, it submits the final version to OMB again. If OMB approves the proposal, it is again published in the Federal Register and becomes official. The normal time frame for something like this is one to two years.

When Will They Ever Learn?

     From a "Policy Futures" paper by Kathleen Romig for the Center on Budget and Policy Priorities (CBPP):

The October 2015 budget agreement extended the solvency of the Social Security Disability Insurance (DI) trust fund into 2022 and renewed the Social Security Administration’s (SSA’s) authority to conduct demonstration projects, allowing the agency to test ideas to encourage work among DI beneficiaries and applicants.  This creates an opportunity to build further evidence on the efficacy of various ideas to encourage work among this population. 

New demonstrations will likely produce only limited results, however.  SSA has conducted many work-incentive experiments over the past 25 years, and none has led to a significant number of beneficiaries earning enough to support themselves and leave DI.  This result should not come as a surprise.  DI’s eligibility criteria are strict.  Few DI beneficiaries are able to work.  Still fewer are likely to be able to return to self-supporting work on a sustained basis. ...

TABLE 1

SSA Work-Incentive Experiments Have Shown Only Limited Results
Demonstration	Years	Description	Effects
Benefit Offset National Demonstration (BOND)	2009-2017	Testing a $1-for-$2 benefit offset for earnings above SGA level, with additional work supports for “Phase 2” beneficiaries	Small effects on earnings (Phase 2 only) Increased benefit payments
Accelerated Benefits Demonstration	2004-2011	Provided health care to DI beneficiaries during 24-month waiting period for Medicare, with additional medical and work supports for “AB Plus” beneficiaries	Improved health outcomes Negligible effect on employment For AB Plus, greater use of return-to-work services, but some evidence employment effects are temporary
Mental Health Treatment Study	2003-2011	Provided medical and employment supports to beneficiaries with schizophrenia or affective disorders	Improved employment and earnings Improved mental health status No impact on earnings above SGA No impact on benefits
Benefit Offset: Four-State Pilot	2003-2009	Replaced “cash cliff” with a $1-for-$2 offset for earnings above SGA level, with additional work supports	Small increase in earnings above SGA No effect on mean earnings No effect on employment Effects varied by participant subgroup
Youth Transition Demonstration	2001-2014	Waived SSI income and asset rules, provided state-designed employment and education supports for young DI and SSI beneficiaries	Little to no effect on employment and earnings SSA periodically revisiting outcomes
Ticket to Work	1999-present	Provides vocational rehabilitation and work support from employment networks (Ticket to Work is a change in law, not a demonstration)	Increased use of return-to-work services Little effect on employment Little effect on benefits
State Partnership Initiative	1998-2006	Tested variety of state-designed interventions, including Medicaid waivers and employment services for DI and SSI beneficiaries	Small and mixed effects on employment No effect — or negative effect — on earnings
Project NetWork	1991-1999	Offered intensive outreach, work-incentive waivers, and case management services to DI and SSI applicants and recipients	Small short-term effect on earnings No effect on benefits

Social Security Seeks Ticket To Work Input

     From today's Federal Register:

We are soliciting public input on whether and how we might revise the current Ticket to Work program rules. The Ticket to Work and Work Incentives Improvement Act of 1999 established the Ticket to Work program to allow individuals with disabilities to seek services to obtain and retain employment in order to reduce dependency on cash benefit programs. In creating the program, Congress found that eliminating barriers to work and providing individuals with real choice in obtaining services and technology to find, enter, and maintain employment can greatly improve the short and long-term financial independence and personal well-being of our beneficiaries. We want to explore improving our Ticket to Work program as part of our ongoing effort to help our beneficiaries find and maintain employment that leads to increased independence and enhanced productivity. If we propose specific revisions to our regulations, we will publish a notice of proposed rulemaking (NPRM) in the Federal Register.

Ticket To Work Is A Failure

     From the Social Security Bulletin (emphasis added):

The Social Security Administration (SSA) rolled out the Ticket to Work (TTW) program between 2002 and 2004, with goals of expanding employment-related services for disability program beneficiaries and increasing program exits for work. Provider and beneficiary participation were initially low and the program did not measurably increase the extent to which beneficiaries achieved earnings sufficient to forgo benefits. In 2008, SSA revised the regulations in order to make participation more attractive to service providers, but the revisions also reduced provider incentives to help beneficiaries give up their benefits for work. Using administrative data from SSA, we find that provider and beneficiary participation increased substantially after the regulations changed, but the percentage of participants forgoing benefits for work declined. The extent to which that decline reflects the effects of the recession versus an increase in TTW program use by those with a relatively low chance of forgoing benefits for work remains unclear.

Continuing Disability Reviews Study

     The Social Security Advisory Board convened the 2014 Disability Policy Panel to study Continuing Disability Reviews. Here are the Panel's recommendations:

• Provide Continuing Disability Review (CDR) Funding that is adequate, predictable, and sustained
• Retain the Medical Improvement Review Standard (MIRS) and strengthen its implementation
• Strengthen other payment integrity tools
• Strengthen links between CDRs and support for return to work
• CDRS for Supplemental Security Income (SSI) children and youth: 1) SSA should communicate expectations of independence to youth beneficiaries whose medical improvement is expected or possible. 2) As with the adult population, the Panel recommends that Congress continue the employment support services of the Ticket to Work program for one additional year. 3) The training recommended for the medical review standard should be extended to include examples unique to children.

This Discussion Should Really Set The Stage For The Disability Trust Fund Debate

      From the Atlanta Journal Constitution:

Roswell [GA] Republican U.S. Rep. Tom Price intends to tackle big-ticket entitlement programs as the new chairman of the House Budget Committee — including Social Security.

In a speech at the Heritage Action for America “Conservative Policy Summit” on Monday, Price said he was excited to work with a GOP-led Senate to end the “muddled mess” of the last few years. ...

“So all the kinds of things you know about – whether it’s means testing, whether it’s increasing the age of eligibility. The kind of choices — whether it’s providing much greater choices for individuals to voluntarily select the kind of manner in which they believe they ought to be able to invest their working dollars as they go through their lifetime. All those things ought to be on the table and discussed.”

 Price consistently framed entitlement changes as Republican desires to “save, secure and strengthen” the programs, given their rising costs that are a big driver of future deficit projections. ...

He said Republicans should not fear the politics of such changes — pointing out that the Romney-Ryan ticket won seniors in 2012, despite Democrats’ “Mediscare” tactics around the Ryan proposal for a voucher-like premium support program for Medicare. ...

Interesting

     Maximus, a corporation that has a major contract with the U.S. Social Administration to administer the Ticket to Work program, has just been awarded a major contract to do disability determination for the United Kingdom's version of Social Security, the Department for Work and Pensions. Maximus is replacing a prior contractor which was having major problems.

Want To Save Some Real Money At Social Security?

     Even researchers at Mathematica, Social Security's prime contractor for the Ticket to Work program, could find "no consistent evidence of impacts [of Ticket to Work mailings] on the number of months in which beneficiaries did not receive benefits because of work, or on other outcomes." The researchers try to blame the failure of Ticket to Work on the recession.