BASIC (03-86)

A. General

The Omnibus Budget Reconciliation Act of 1981 (P.L. 97-35), changed the method by which funds are paid to State VR agencies for rehabilitative services. Effective October 1, 1981, SSA must reimburse the State VR agencies each time their services result in a title II or title XVI beneficiary/recipient performing substantial gainful activity (SGA) for a continuous period of 9 months and certain other reimbursement conditions are met. Reimbursement will be on a case-by-case basis.

B. State VR Agency Claims for Reimbursement

If a State VR agency believes its services have resulted (or soon will result) in a beneficiary or recipient performing SGA for a continuous period of 9 months and it wants to be reimbursed for those services, it must file a claim for reimbursement. The State must file a claim within 12 months following the ninth month of SGA. Each claim must provide SSA with identifying information about the individual served. SSA will verify that the person was a beneficiary /recipient. SSA also will determine whether the person engaged in SGA for a continuous period of 9 months (VR continuous period of SGA).

C. The VR Continuous Period of SGA

An individual will be considered to have performed a VR continuous period if he or she has performed:

1. Nine consecutive months of SGA that meet the guidelines in DI 10501.015. (See DI 13510.010 for application of the SGA guidelines to the 9 month continuous period.)

2. Nine months of SGA within ten consecutive months and has monthly earnings in those 9 months that meet the guidelines in DI 10505.005 and DI 10505.015. (One month without SGA earnings may be disregarded, regardless of the reason for the individual not performing SGA.)

3. At least 9 months of SGA within twelve consecutive months and those 9 months meet the guidelines in DI 10505.005 and DI 10505.015 and the reason for not performing SGA in 2 or 3 of those months was circumstances beyond his/her control and unrelated to the medical impairment (e.g., the employer closed down for 3 months).

The VR continuous period of SGA should not be confused with other disability “periods” such as:

1. the trial work period (TWP)

2. extended period of eligibility (EPE)

3. continued payments of benefits to individuals under vocational rehabilitation plans (section 301)

The VR continuous period of SGA may, but need not, coincide with the TWP. For example, there is no time limit for completing the TWP, whereas the VR continuous period of SGA must be completed within 12 (or 9-12) months. Also, SGA is not a factor in counting TWP months; it is for the VR continuous period of SGA.

The VR continuous period of SGA may fall within the extended period of eligibility, or it may occur after disability ceased. The VR continuous period of SGA also applies to SSI blind recipients who are not subject to SGA or trial work provisions.

The VR continuous period of SGA described in these instructions pertains only to the State's right to receive reimbursement for rehabilitation services to beneficiaries/recipients. It does not pertain to the person's entitlement or eligibility for benefit payments.