TN 1 (10-02)

Citations:

Soc. Sec. Act as Amended in 1999, §§ 1148(b)(4), (c)(1), (h)(1) through (4), and (k)(2) through (5); P.L. 106-107, 101(a) and (e)(2)(H); 20 CFR 411.355, 411.365, 411.370, and 411.500 through 411.587

A. Process – field office (FO) and program center (PC) role in the EN payment process

FOs and PCs will not be involved directly in making decisions on requests for payment that Employment Networks (ENs) (or State Vocational Rehabilitation (VR) Agencies serving as ENs) submit. However, FOs and PCs play an important role in the EN payment process because they review and process reports of earnings for beneficiaries/recipients with tickets that come to SSA from ENs via MAXIMUS, SSA's Program Manager (PM). The processing of these third-party earnings reports and any resulting adjustments to benefits ultimately dictate whether and how timely EN payment requests can be approved.

B. Process – MAXIMUS and the Office of Employment Support Program’s (OESP's) role in the EN payment process

MAXIMUS and OESP share responsibility for processing claims for payments from ENs (and State VR agencies serving beneficiaries/recipients as an EN) under the Ticket to Work Program. The EN payment process involves:

• recording each EN's (or State VR agency's) choice of EN payment systems and any subsequent changes in that choice;

• recording a State VR agency's payment choice with respect to a specific ticket beneficiary/recipient (see DI 55060.005C.4.);

• certifying reports of earnings and inputting them to the Disability Control File (DCF) so that FOs can develop and process the reports (see DI 55030.001);

• inputting payment recommendations to an automated EN payment system; and

• resolving disagreements with ENs over payment decisions.

NOTE: OESP has a claims unit that reviews and processes those EN payment decisions that cannot be fully automated. This unit also makes decisions on requests from State VR agencies under the VR cost reimbursement payment system. (Other than recording a State VR agency's payment election, MAXIMUS is not involved in the VR cost reimbursement payment process.)

C. Procedure – handling EN and state VR agency payment questions

1. Questions about payment system elections

Operating components should refer any questions about payment system elections that ENs and State VR agencies have to MAXIMUS. MAXIMUS' toll free numbers are:

• 1-866-968-7842 (1-866-YOUR TICKET); or

• TTY/TDD 1-866-833-2967 (1-866-TDD 2WORK).

2. Questions about EN payment decisions

Operating components should refer any questions about EN payment decisions (i.e., decisions about requests for outcome or milestone payments), including disputes about EN payment decisions to MAXIMUS.

3. Questions about VR cost reimbursement payment decisions

Operating components should tell State VR agencies that call with questions about or disagreements with VR cost reimbursement payment decisions to contact OESP's claim unit directly. (State VR agencies have been given a set of phone numbers and should follow their established protocol for such contacts with OESP.)