Process for authorizing Benefits Asssessment and Benefits Planning Services 

1. Benefits Services provide vital information about how earned income will impact local, state, and/or federal benefits and how work incentives can be used to reduce lessen this impace and help the person to cchieve greater economic self-sufficiency.  A Benefits Orientation provides foundational information and familiarizes the client with basic terminology and aspects of Benefits Services.  (See Benefits Orientation chapter for additional information.) In collaboration with Benefits Services Providers and other community agencies, VR supports people to understand the impact of earned income on public benefits and how to use tools and incentives to attain greater financial independence while meeting their desired employment goals.  Provision of such information is key to ensure the person can make an informed choice about receiving Benefits Services.
2. The Benefits Services Providers Form attached to this chapter is provided to the client and documents choice of provider OR refusal of the service as verified by the client's signature.  The form is filed with releases and consents in the case file.  (See below for details about refusal of Benefits Services.)
3. A referral and authorization for Benefits Assessment is completed by the Benefits Orientation Specialist.  This service is authorized for all clients who receive local, state, and/or federal benefits and is completed before the IPE (in Assessment) so that the information gathered may be used to develop the IPE.  Elements of the Benefits Assessment service include, but are not limited to:

• Gathering of client's personal information for intake -- living situation, support system, possible work incentives, employment goals, past work history
• Reviewing VR Benefits Orientation, checking for understanding and comprehension of information to build client's knowledge / understanding of possible work incentives
• Requesting Benefits Planning Query (BPQY) for review (if applicable, as VR will forward copy if the one on file is less than 6 weeks old)
• Verifying all benefits [Social Security Administration (SSA), Department of Health and Human Services (DHHS)--Economic Assistance (EA), Medicaid, and Division of Developmental Disabilities (DDD) Medicaid waiver services, Housing subsidy, etc.]
• Addressing / correcting current benefits issues pertaining, but not limited to:
  • Loss of Social Security benefits
  • Medicaid case suspension or closure
  • Incorrect information on BPQY or indication of inaccurate reporting
  • Consideration of self-employment plan
• Connecting to other community resources, as needed
• Assisting in applying/becoming eligible for additional benefits, as applicable
• Addressing client's monthly budget and providing education as needed
• Identifying methods and tools to report earnings

      4.  Authorize $330.00 for Benefits Assessment.  The service is entered in QE2 as:  Service Category:  Assessment Support; Service: Benefits Assessment.

           NOTE:  See Pre-Employment Transition Services chapter for details about authorizing Benefits Assessment Services for students in pre-employment transition.

      5.  VR Benefits Orientation Specialist and VR Counselor receive and review Benefits Assessment report which includes:  types of assistance received, different levels of potential income, and work incentives that are options at each level, health insurance/coverage (Medicare/Medicaid/employer/parent) and guidelines for continued coverage.  This written report must be received before Benefits Planning can be authorized. 

    6.   The information in the Benefits Assessment report is used in developing the IPE, with information explained to the client by the VR Counselor.  

    7.   After the IPE is signed, the Benefits Orientation Specialist authorizes Benefits Planning for all clients who receive local, state, and/or federal benefits.  This service includes, though is not limited to, the following core elements:

• Review of Social Security Disability Benefits (SSI, SSDI, CDB, DAC, DWB)
• Review of other disability-related benefits (Medicaid, Medicare, VA, Railroad Retirement Benefits, Workers Compensation, Unemployment, State and Local benefits, such as housing, energy assistance, Supplemental Nutrition Assistance Program (SNAP), etc.)
• Documentation and resolution of errors or inaccuracies in the benefits records
• A summary of findings in a written Benefits Summary & Analysis / Work Incentives Plan (B S & A / WIP) using the VCU standard reporting format
• The delivery and review of B S & A and WIP at a meeting with required participants:  client, VR Counselor, authorized representative (if applicable).  Other participants may include representative payee, DD Service Coordinator, Supported Employment service provider, etc.

    8.   Authorize $550.00 for Benefits Planning.  The service is entered in QE2 as:  Service Category:  Miscellaneous Training; Service:  Benefits Planning.

    9.  Payment for this service may be made after the B S & A / WIP review meeting is completed and the B S & A / WIP and invoice are submitted to VR.

   10. Benefits Orientation Specialist reviews the earnings reporting requirements and tools for reporting when the person begins employment and provides reminders and assistance as needed to support accurate reporting.

Process for authorizing other types of Benefits Services

      PASS (Plan to Achieve Self-Sufficiency) Development

1. When identified in the B S & A / WIP as a viable work incentive option, PASS Development may be authorized.  This service may also be requested later by the client, VR staff, or the Benefits Services provider when a client's circumstances change and PASS is identified as a viable work incentive option.  Elements of the PASS Development service include, but are not limited to:

• Assistance with/preparation of PASS Form 545
• Submission of the PASS for approval
• Provision of training to client on PASS monitoring, including progress reviews, collection of receipts and bank statements, management of monthly deposits into PASS-dedicated account, and state benefits coordination
• Coordination and communication with the VR Counselor
• On-going coordination with the SSA PASS Cadre

       2.  Authorize $440.00 for PASS Development. The service is entered in QE2 as:  Service Category:  Miscellaneous Training; Service:  PASS Development.

       3.  Invoice for this service may be paid upon receipt of a copy of the PASS Plan and identification of training and on-going support activities to be arranged for and/or provided to the client.

      Benefits Management

      1.  Benefits Management may be authorized when unforeseen problems or crises arise, or critical transition points are reached after the provision of Benefits Planning or PASS Development have been completed.  Any issues or concerns present while Benefits Planning or PASS Development services are in progress will be addressed under those authorizations without a separate Benefits Management authorization. Benefits Management may be authorized prior to VR closure (if Benefits Planning has been completed) or as a Post-Employment service.  There is a limit of one authorization for Benefits Management before VR closure and one authorization during the Post-Employment period.  Elements of the Benefits Management service include, though are not limited to:

• Authorized when circumstances such as these exist:
  • Need for PASS monitoring due to disability-related impairments and/or lack of natural supports for monitoring/reporting
  • To access additional work incentives, address issues with federal, state, and/or local benefits (including SSA, housing subsidy, SNAP, Medicaid, etc.) or to institute the use of an ABLE (Achieving a Better Life Experience) account
  • To address specialized orientation, such as that needed for Self-Employment
  • To problem-solve circumstances such as:
    • Loss of / reduction in SSA benefits
    • Loss of Medicaid / Share of Cost (SOC) notification
    • Problems with PASS Plan use
    • Failure to report or inaccurate reporting of earnings
  • Critical transition points have been reached, including:
    • FOR SSI RECIPIENTS
      • Starting or ending employment
      • Changes in earned or unearned income
      • Reaching the Break-Even Point (BEP) with earned income
      • Transition to 1619(b) status
      • Changes in student status or attainment of age 22 for Student Earned Income Exclusion (SEIE)
      • Reaching insured status for Title II benefits (SSDI, CDB, DWB, Retirement Insurance Benefits [RIB])
      • Changes in living arrangement, marital status, or resources
    • FOR TITLE II BENEFICIARIES
      • Completion of the Trial Work Period (TWP)
      • Beginning and end of the Extended Period of Eligibility (EPE)
      • Identification and use of Impairment-Related Work Expense (IRWE), Subsidy, or Un-incurred Business Expenses and Unpaid Help (if self-employed)
      • Substantial Gainful Activity Determinations
      • Beginning and end of Extended Period of Medicare Coverage
      • Attainment of dual entitlement (Childhood Disability Beneficiary [CDB] becomes insured on own record)
      • Transition to retirement benefits (early or full retirement age)
    • FOR DUAL ELIGIBLES (SSI and TITLE II)
      • Cessation of benefits due to medical improvement
      • Expedited Reinstatement of eligibility 
      • Overpayments or underpayments

         2.  Authorize $330.00 for Benefits Management.  The service is entered in QE2 as:  Service Category:  Miscellaneous Training; Service:  Benefits Management.

         3.  Invoice for this service may be paid when a written report is submitted and identifies how issues were resolved.

         NOTE ABOUT REFUSAL OF BENEFITS SERVICES FOLLOWING BENEFITS ORIENTATION:

As noted in the Benefits Orientation Chapter:  During the Benefits Orientation, discussion of the importance of receiving Benefits Services is vital. A client who does not understand work incentives may be limiting their ability to maximize income and benefits to reach greater economic self-sufficiency.  The Benefits Orientation Specialist and VR Counselor play a key role in educating clients on the importance of accessing Benefits Services.  VR staff should discuss that Benefits Services, among other things:  1) identify work incentives and other tools so that needed benefits are retained while maximizing earnings; 2) provide basic support for budgeting earnings and income; 3) address concerns with Social Security records found to be incorrect or incomplete; and, 4) provide training and information on the importance of properly reporting earnings.  If, given all of this information, the client refuses a Benefits Services referral, the client's signature will denote such refusal on the Benefits Services Providers form.  The form will be filed in the client record with other consents/releases.  The refusal will also be documented in a Customized Task note, titled, "Benefits Services Refusal."  The note will include the reasons why the person refused the service. 

Clients who receive local, state, and/or federal benefits will be referred and authorized for Benefits Services in accordance with standard procedures so they may make an informed choice about earning income by working. 

Benefits Services provide a comprehensive review of the client's information to assess real or potential impact of employment on the client's local, state and federal benefits, and the Ticket to Work program.

The client can get further information about the Ticket program by visiting www.choosework.net. For questions, the client can call the Ticket to Work Help Line at 1.866.968.7842/866.833.2967 (TTY/TDD) Monday through Friday from 8 a.m. to 8 p.m. EST or send an e-mail support@chooseworkttw.net.