How many payment options are available to Employment Networks (ENs)?
What's the difference between an outcome payment month and a milestone?
What's the SGA threshold amount?
Don't benefits stop automatically when a beneficiary earns more than the SGA threshold amount?
In terms of total payments, what is the difference between the two EN payment systems?
Are the payments under the two EN payment systems based on the individual`s benefit rate or on the costs an EN incurs?
What is the payment rate for the outcome payment system?
What are the payment rates for the outcome-milestone payment system?
Are there any other criteria for a milestone or outcome payment month?
When does a Ticket terminate?
Can an EN change its elected payment system?
Must a State vocational rehabilitation (VR) agency elect an EN payment system?
Is it possible to pay more than one EN?
How are payment requests processed?
SGA and Payment Tables

How many payment options are available to Employment Networks (ENs)?

Two. At the time an EN becomes an approved provider it can elect either the:

• Outcome payment system, under which it will receive payment for outcome payment months only; or
• Outcome-milestone payment system, under which it will receive reduced payments for outcome payment months in exchange for milestone payments in advance of the first outcome payment.

What's the difference between an outcome payment month and a milestone?

An outcome payment month is a month in which SSA pays no Federal cash disability benefits to a beneficiary because of work or earnings. Under both EN payment systems, the maximum number of outcome payment months for each Ticket is 60. These 60 outcome payment months do not have to be consecutive.

A milestone occurs after a beneficiary starts working and before Federal cash benefits stop because of work or earnings. There are four milestones for which an EN can be paid. A beneficiary attains a milestone when he/she has gross earnings from employment (or net earnings from self-employment) that exceed SSA's substantial gainful activity (SGA) threshold amount for the number of months specified in the following table.

What's the SGA threshold amount?

The SGA threshold amount refers to the level of earnings that SSA uses when it evaluates the work activity of an individual for disability entitlement purposes. Each year SSA calculates two SGA threshold amounts. One is for individuals who are statutorily blind and the other is for those who are not. View the actual SGA threshold amounts for calendar year 2008.

Don't benefits stop automatically when a beneficiary earns more than the SGA threshold amount?

• The Social Security Disability Insurance (SSDI) program provides benefits to "insured" workers, their adult children, and their widow(er)s.
• The Supplemental Security Income (SSI) program provides benefits to individuals with limited income and resources.

In terms of total payments, what is the difference between the two EN payment systems?

The difference in total payments lies in the fact that under the outcome-milestone payment system:

• the outcome payment rate is lower; and
• each outcome payment is reduced by an amount equal to 1/60th of the milestone payments received by an EN with respect to an individual.

Are the payments under the two EN payment systems based on the individual`s benefit rate or on the costs an EN incurs?

• SSDI PCB when computing the payment due an EN for serving an SSDI or a concurrent SSDI/SSI beneficiary; and
• SSI PCB when computing the payment due an EN for serving an SSI beneficiary, who is not concurrently an SSDI beneficiary.

View the actual PCBs for years beginning with 2002 here.

What is the payment rate for the outcome payment system?

View the actual outcome payment amounts under the outcome payment system for years beginning with 2002 here.

What are the payment rates for the outcome-milestone payment system?

The following chart summarizes the payment rates for the outcome-milestone payment system. They represent a percentage of the applicable PCB for the calendar year in which the beneficiary attains the milestone or outcome payment month.

View the actual milestone and outcome payment amounts under the outcome-milestone payment system for years beginning with 2002.

Are there any other criteria for a milestone or outcome payment month?

1. The milestones for which payment may be made must occur before the first outcome payment month. Thus, an EN may actually receive fewer than four milestone payments for a particular beneficiary it serves.
2. A month after disability-based benefits terminate for work or earnings can be an outcome payment month only if the individual:
   • earns more than the SGA threshold amount in the month; and
   • is not entitled to or eligible for any type of monthly cash benefits from SSA for that month.
3. An EN may be paid only for milestones or outcome payment months that a beneficiary attains:
   • after assigning the Ticket to the EN; and
   • before the Ticket terminates.

When does a Ticket terminate?

• the month in which disability benefits terminate for reasons other than work and earnings;
• the month an individual entitled to Social Security widow(er)`s benefits based on disability attains age 65; or
• the month following the month an individual receiving SSI benefits on account of disability or blindness attains age 65.

• the month the individual attains full retirement age (beginning in 2003 SSA`s full retirement age will increase gradually from age 65 to age 67);
• the month the individual dies;
• the month the individual becomes entitled to or eligible for a non-disability-based benefit from Social Security;
• the month SSA makes a subsequent unfavorable disability determination (i.e., the month SSA denies a subsequent application for disability benefits, or the month SSA decides not to approve a request to reinstate disability-based benefits); or
• the month the SSA makes a favorable disability determination (i.e., the month the individual again becomes entitled to or eligible for disability-based benefits based on a new application, or the month the individual is eligible to receive another Ticket because SSA approves a request to reinstate disability-based benefits).

Can an EN change its elected payment system?

Must a State vocational rehabilitation (VR) agency elect an EN payment system?

Is it possible to pay more than one EN?

• When two ENs request payment for the same milestone or same outcome payment month, the payment will be allocated based upon the services each EN provided.
• If SSA pays a State VR agency under the traditional cost reimbursement payment system with respect to a Ticket, such payment precludes any subsequent payment based on the same ticket to an EN (or another State VR agency) under one of the two EN payment systems.
• Conversely, if SSA pays an EN (or State VR agency) under one of the two EN payment systems with respect to a Ticket, such payment precludes any subsequent payment based on the same ticket to a State VR agency under the traditional cost reimbursement payment system.

How are payment requests processed?

ENs send requests for payment, evidence of a beneficiary`s work or earnings, and other information to SSA`s Ticket to Work Program Manager (PM), MAXIMUS, Inc. MAXIMUS, Inc. reviews the information and makes a recommendation for payment to SSA. SSA then determines all final approvals for payment.

SGA and Payment Tables
Substantial Gainful Activity (SGA) Threshold Amounts
Beginning With Calendar Year 2002

Payment Calculation Bases (PCBs)
Beginning With Calendar Year 2002

Payment Rates Under the Outcome Payment System
Beginning With Calendar Year 2002

Payment Rates Under the Outcome-Milestone
Payment System Beginning With Calendar Year 2002

II. Outcome Payment Rates