
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC1320b-19]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
   SUBCHAPTER XI--GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE 
                             SIMPLIFICATION
 
                       Part A--General Provisions
 
Sec. 1320b-19. The Ticket to Work and Self-Sufficiency Program


(a) In general

    The Commissioner shall establish a Ticket to Work and Self-
Sufficiency Program, under which a disabled beneficiary may use a ticket 
to work and self-sufficiency issued by the Commissioner in accordance 
with this section to obtain employment services, vocational 
rehabilitation services, or other support services from an employment 
network which is of the beneficiary's choice and which is willing to 
provide such services to such beneficiary.

(b) Ticket system

                     (1) Distribution of tickets

        The Commissioner may issue a ticket to work and self-sufficiency 
    to disabled beneficiaries for participation in the Program.

                      (2) Assignment of tickets

        A disabled beneficiary holding a ticket to work and self-
    sufficiency may assign the ticket to any employment network of the 
    beneficiary's choice which is serving under the Program and is 
    willing to accept the assignment.

                          (3) Ticket terms

        A ticket issued under paragraph (1) shall consist of a document 
    which evidences the Commissioner's agreement to pay (as provided in 
    paragraph (4)) an employment network, which is serving under the 
    Program and to which such ticket is assigned by the beneficiary, for 
    such employment services, vocational rehabilitation services, and 
    other support services as the employment network may provide to the 
    beneficiary.

                 (4) Payments to employment networks

        The Commissioner shall pay an employment network under the 
    Program in accordance with the outcome payment system under 
    subsection (h)(2) of this section or under the outcome-milestone 
    payment system under subsection (h)(3) of this section (whichever is 
    elected pursuant to subsection (h)(1) of this section). An 
    employment network may not request or receive compensation for such 
    services from the beneficiary.

(c) State participation

                           (1) In general

        Each State agency administering or supervising the 
    administration of the State plan approved under title I of the 
    Rehabilitation Act of 1973 (29 U.S.C. 720 et seq.) may elect to 
    participate in the Program as an employment network with respect to 
    a disabled beneficiary. If the State agency does elect to 
    participate in the Program, the State agency also shall elect to be 
    paid under the outcome payment system or the outcome-milestone 
    payment system in accordance with subsection (h)(1) of this section. 
    With respect to a disabled beneficiary that the State agency does 
    not elect to have participate in the Program, the State agency shall 
    be paid for services provided to that beneficiary under the system 
    for payment applicable under section 422(d) of this title and 
    subsections (d) and (e) of section 1382d of this title. The 
    Commissioner shall provide for periodic opportunities for exercising 
    such elections.

             (2) Effect of participation by State agency

        (A) State agencies participating

            In any case in which a State agency described in paragraph 
        (1) elects under that paragraph to participate in the Program, 
        the employment services, vocational rehabilitation services, and 
        other support services which, upon assignment of tickets to work 
        and self-sufficiency, are provided to disabled beneficiaries by 
        the State agency acting as an employment network shall be 
        governed by plans for vocational rehabilitation services 
        approved under title I of the Rehabilitation Act of 1973 (29 
        U.S.C. 720 et seq.).

        (B) State agencies administering maternal and child health 
                services programs

            Subparagraph (A) shall not apply with respect to any State 
        agency administering a program under subchapter V of this 
        chapter.

        (3) Agreements between State agencies and employment 
                                  networks

        State agencies and employment networks shall enter into 
    agreements regarding the conditions under which services will be 
    provided when an individual is referred by an employment network to 
    a State agency for services. The Commissioner shall establish by 
    regulations the timeframe within which such agreements must be 
    entered into and the mechanisms for dispute resolution between State 
    agencies and employment networks with respect to such agreements.

(d) Responsibilities of the Commissioner

        (1) Selection and qualifications of program managers

        The Commissioner shall enter into agreements with 1 or more 
    organizations in the private or public sector for service as a 
    program manager to assist the Commissioner in administering the 
    Program. Any such program manager shall be selected by means of a 
    competitive bidding process, from among organizations in the private 
    or public sector with available expertise and experience in the 
    field of vocational rehabilitation or employment services.

             (2) Tenure, renewal, and early termination

        Each agreement entered into under paragraph (1) shall provide 
    for early termination upon failure to meet performance standards 
    which shall be specified in the agreement and which shall be 
    weighted to take into account any performance in prior terms. Such 
    performance standards shall include--
            (A) measures for ease of access by beneficiaries to 
        services; and
            (B) measures for determining the extent to which failures in 
        obtaining services for beneficiaries fall within acceptable 
        parameters, as determined by the Commissioner.

      (3) Preclusion from direct participation in delivery of 
                        services in own service area

        Agreements under paragraph (1) shall preclude--
            (A) direct participation by a program manager in the 
        delivery of employment services, vocational rehabilitation 
        services, or other support services to beneficiaries in the 
        service area covered by the program manager's agreement; and
            (B) the holding by a program manager of a financial interest 
        in an employment network or service provider which provides 
        services in a geographic area covered under the program 
        manager's agreement.

                (4) Selection of employment networks

        (A) In general

            The Commissioner shall select and enter into agreements with 
        employment networks for service under the Program. Such 
        employment networks shall be in addition to State agencies 
        serving as employment networks pursuant to elections under 
        subsection (c) of this section.

        (B) Alternate participants

            In any State where the Program is being implemented, the 
        Commissioner shall enter into an agreement with any alternate 
        participant that is operating under the authority of section 
        422(d)(2) of this title in the State as of December 17, 1999, 
        and chooses to serve as an employment network under the Program.

       (5) Termination of agreements with employment networks

        The Commissioner shall terminate agreements with employment 
    networks for inadequate performance, as determined by the 
    Commissioner.

                        (6) Quality assurance

        The Commissioner shall provide for such periodic reviews as are 
    necessary to provide for effective quality assurance in the 
    provision of services by employment networks. The Commissioner shall 
    solicit and consider the views of consumers and the program manager 
    under which the employment networks serve and shall consult with 
    providers of services to develop performance measurements. The 
    Commissioner shall ensure that the results of the periodic reviews 
    are made available to beneficiaries who are prospective service 
    recipients as they select employment networks. The Commissioner 
    shall ensure that the periodic surveys of beneficiaries receiving 
    services under the Program are designed to measure customer service 
    satisfaction.

                       (7) Dispute resolution

        The Commissioner shall provide for a mechanism for resolving 
    disputes between beneficiaries and employment networks, between 
    program managers and employment networks, and between program 
    managers and providers of services. The Commissioner shall afford a 
    party to such a dispute a reasonable opportunity for a full and fair 
    review of the matter in dispute.

(e) Program managers

                           (1) In general

        A program manager shall conduct tasks appropriate to assist the 
    Commissioner in carrying out the Commissioner's duties in 
    administering the Program.

               (2) Recruitment of employment networks

        A program manager shall recruit, and recommend for selection by 
    the Commissioner, employment networks for service under the Program. 
    The program manager shall carry out such recruitment and provide 
    such recommendations, and shall monitor all employment networks 
    serving in the Program in the geographic area covered under the 
    program manager's agreement, to the extent necessary and appropriate 
    to ensure that adequate choices of services are made available to 
    beneficiaries. Employment networks may serve under the Program only 
    pursuant to an agreement entered into with the Commissioner under 
    the Program incorporating the applicable provisions of this section 
    and regulations thereunder, and the program manager shall provide 
    and maintain assurances to the Commissioner that payment by the 
    Commissioner to employment networks pursuant to this section is 
    warranted based on compliance by such employment networks with the 
    terms of such agreement and this section. The program manager shall 
    not impose numerical limits on the number of employment networks to 
    be recommended pursuant to this paragraph.

     (3) Facilitation of access by beneficiaries to employment 
                                  networks

        A program manager shall facilitate access by beneficiaries to 
    employment networks. The program manager shall ensure that each 
    beneficiary is allowed changes in employment networks without being 
    deemed to have rejected services under the Program. When such a 
    change occurs, the program manager shall reassign the ticket based 
    on the choice of the beneficiary. Upon the request of the employment 
    network, the program manager shall make a determination of the 
    allocation of the outcome or milestone-outcome payments based on the 
    services provided by each employment network. The program manager 
    shall establish and maintain lists of employment networks available 
    to beneficiaries and shall make such lists generally available to 
    the public. The program manager shall ensure that all information 
    provided to disabled beneficiaries pursuant to this paragraph is 
    provided in accessible formats.

           (4) Ensuring availability of adequate services

        The program manager shall ensure that employment services, 
    vocational rehabilitation services, and other support services are 
    provided to beneficiaries throughout the geographic area covered 
    under the program manager's agreement, including rural areas.

                  (5) Reasonable access to services

        The program manager shall take such measures as are necessary to 
    ensure that sufficient employment networks are available and that 
    each beneficiary receiving services under the Program has reasonable 
    access to employment services, vocational rehabilitation services, 
    and other support services. Services provided under the Program may 
    include case management, work incentives planning, supported 
    employment, career planning, career plan development, vocational 
    assessment, job training, placement, follow-up services, and such 
    other services as may be specified by the Commissioner under the 
    Program. The program manager shall ensure that such services are 
    available in each service area.

(f) Employment networks

             (1) Qualifications for employment networks

        (A) In general

            Each employment network serving under the Program shall 
        consist of an agency or instrumentality of a State (or a 
        political subdivision thereof) or a private entity, that assumes 
        responsibility for the coordination and delivery of services 
        under the Program to individuals assigning to the employment 
        network tickets to work and self-sufficiency issued under 
        subsection (b) of this section.

        (B) One-stop delivery systems

            An employment network serving under the Program may consist 
        of a one-stop delivery system established under subtitle B of 
        title I of the Workforce Investment Act of 1998 (29 U.S.C. 2811 
        et seq.).

        (C) Compliance with selection criteria

            No employment network may serve under the Program unless it 
        meets and maintains compliance with both general selection 
        criteria (such as professional and educational qualifications, 
        where applicable) and specific selection criteria (such as 
        substantial expertise and experience in providing relevant 
        employment services and supports).

        (D) Single or associated providers allowed

            An employment network shall consist of either a single 
        provider of such services or of an association of such providers 
        organized so as to combine their resources into a single entity. 
        An employment network may meet the requirements of subsection 
        (e)(4) of this section by providing services directly, or by 
        entering into agreements with other individuals or entities 
        providing appropriate employment services, vocational 
        rehabilitation services, or other support services.

         (2) Requirements relating to provision of services

        Each employment network serving under the Program shall be 
    required under the terms of its agreement with the Commissioner to--
            (A) serve prescribed service areas; and
            (B) take such measures as are necessary to ensure that 
        employment services, vocational rehabilitation services, and 
        other support services provided under the Program by, or under 
        agreements entered into with, the employment network are 
        provided under appropriate individual work plans that meet the 
        requirements of subsection (g) of this section.

                   (3) Annual financial reporting

        Each employment network shall meet financial reporting 
    requirements as prescribed by the Commissioner.

                   (4) Periodic outcomes reporting

        Each employment network shall prepare periodic reports, on at 
    least an annual basis, itemizing for the covered period specific 
    outcomes achieved with respect to specific services provided by the 
    employment network. Such reports shall conform to a national model 
    prescribed under this section. Each employment network shall provide 
    a copy of the latest report issued by the employment network 
    pursuant to this paragraph to each beneficiary upon enrollment under 
    the Program for services to be received through such employment 
    network. Upon issuance of each report to each beneficiary, a copy of 
    the report shall be maintained in the files of the employment 
    network. The program manager shall ensure that copies of all such 
    reports issued under this paragraph are made available to the public 
    under reasonable terms.

(g) Individual work plans

                          (1) Requirements

        Each employment network shall--
            (A) take such measures as are necessary to ensure that 
        employment services, vocational rehabilitation services, and 
        other support services provided under the Program by, or under 
        agreements entered into with, the employment network are 
        provided under appropriate individual work plans that meet the 
        requirements of subparagraph (C);
            (B) develop and implement each such individual work plan, in 
        partnership with each beneficiary receiving such services, in a 
        manner that affords such beneficiary the opportunity to exercise 
        informed choice in selecting an employment goal and specific 
        services needed to achieve that employment goal;
            (C) ensure that each individual work plan includes at 
        least--
                (i) a statement of the vocational goal developed with 
            the beneficiary, including, as appropriate, goals for 
            earnings and job advancement;
                (ii) a statement of the services and supports that have 
            been deemed necessary for the beneficiary to accomplish that 
            goal;
                (iii) a statement of any terms and conditions related to 
            the provision of such services and supports; and
                (iv) a statement of understanding regarding the 
            beneficiary's rights under the Program (such as the right to 
            retrieve the ticket to work and self-sufficiency if the 
            beneficiary is dissatisfied with the services being provided 
            by the employment network) and remedies available to the 
            individual, including information on the availability of 
            advocacy services and assistance in resolving disputes 
            through the State grant program authorized under section 
            1320b-21 of this title;

            (D) provide a beneficiary the opportunity to amend the 
        individual work plan if a change in circumstances necessitates a 
        change in the plan; and
            (E) make each beneficiary's individual work plan available 
        to the beneficiary in, as appropriate, an accessible format 
        chosen by the beneficiary.

                 (2) Effective upon written approval

        A beneficiary's individual work plan shall take effect upon 
    written approval by the beneficiary or a representative of the 
    beneficiary and a representative of the employment network that, in 
    providing such written approval, acknowledges assignment of the 
    beneficiary's ticket to work and self-sufficiency.

(h) Employment network payment systems

        (1) Election of payment system by employment networks

        (A) In general

            The Program shall provide for payment authorized by the 
        Commissioner to employment networks under either an outcome 
        payment system or an outcome-milestone payment system. Each 
        employment network shall elect which payment system will be 
        utilized by the employment network, and, for such period of time 
        as such election remains in effect, the payment system so 
        elected shall be utilized exclusively in connection with such 
        employment network (except as provided in subparagraph (B)).

        (B) No change in method of payment for beneficiaries with 
                tickets already assigned to the employment networks

            Any election of a payment system by an employment network 
        that would result in a change in the method of payment to the 
        employment network for services provided to a beneficiary who is 
        receiving services from the employment network at the time of 
        the election shall not be effective with respect to payment for 
        services provided to that beneficiary and the method of payment 
        previously selected shall continue to apply with respect to such 
        services.

                     (2) Outcome payment system

        (A) In general

            The outcome payment system shall consist of a payment 
        structure governing employment networks electing such system 
        under paragraph (1)(A) which meets the requirements of this 
        paragraph.

        (B) Payments made during outcome payment period

            The outcome payment system shall provide for a schedule of 
        payments to an employment network, in connection with each 
        individual who is a beneficiary, for each month, during the 
        individual's outcome payment period, for which benefits 
        (described in paragraphs (3) and (4) of subsection (k) of this 
        section) are not payable to such individual because of work or 
        earnings.

        (C) Computation of payments to employment network

            The payment schedule of the outcome payment system shall be 
        designed so that--
                (i) the payment for each month during the outcome 
            payment period for which benefits (described in paragraphs 
            (3) and (4) of subsection (k) of this section) are not 
            payable is equal to a fixed percentage of the payment 
            calculation base for the calendar year in which such month 
            occurs; and
                (ii) such fixed percentage is set at a percentage which 
            does not exceed 40 percent.

                (3) Outcome-milestone payment system

        (A) In general

            The outcome-milestone payment system shall consist of a 
        payment structure governing employment networks electing such 
        system under paragraph (1)(A) which meets the requirements of 
        this paragraph.

        (B) Early payments upon attainment of milestones in advance of 
                outcome payment periods

            The outcome-milestone payment system shall provide for 1 or 
        more milestones, with respect to beneficiaries receiving 
        services from an employment network under the Program, that are 
        directed toward the goal of permanent employment. Such 
        milestones shall form a part of a payment structure that 
        provides, in addition to payments made during outcome payment 
        periods, payments made prior to outcome payment periods in 
        amounts based on the attainment of such milestones.

        (C) Limitation on total payments to employment network

            The payment schedule of the outcome milestone payment system 
        shall be designed so that the total of the payments to the 
        employment network with respect to each beneficiary is less 
        than, on a net present value basis (using an interest rate 
        determined by the Commissioner that appropriately reflects the 
        cost of funds faced by providers), the total amount to which 
        payments to the employment network with respect to the 
        beneficiary would be limited if the employment network were paid 
        under the outcome payment system.

                           (4) Definitions

        In this subsection:

        (A) Payment calculation base

            The term ``payment calculation base'' means, for any 
        calendar year--
                (i) in connection with a title II disability 
            beneficiary, the average disability insurance benefit 
            payable under section 423 of this title for all 
            beneficiaries for months during the preceding calendar year; 
            and
                (ii) in connection with a title XVI disability 
            beneficiary (who is not concurrently a title II disability 
            beneficiary), the average payment of supplemental security 
            income benefits based on disability payable under subchapter 
            XVI of this chapter (excluding State supplementation) for 
            months during the preceding calendar year to all 
            beneficiaries who have attained 18 years of age but have not 
            attained 65 years of age.

        (B) Outcome payment period

            The term ``outcome payment period'' means, in connection 
        with any individual who had assigned a ticket to work and self-
        sufficiency to an employment network under the Program, a 
        period--
                (i) beginning with the first month, ending after the 
            date on which such ticket was assigned to the employment 
            network, for which benefits (described in paragraphs (3) and 
            (4) of subsection (k) of this section) are not payable to 
            such individual by reason of engagement in substantial 
            gainful activity or by reason of earnings from work 
            activity; and
                (ii) ending with the 60th month (consecutive or 
            otherwise), ending after such date, for which such benefits 
            are not payable to such individual by reason of engagement 
            in substantial gainful activity or by reason of earnings 
            from work activity.

     (5) Periodic review and alterations of prescribed schedules

        (A) Percentages and periods

            The Commissioner shall periodically review the percentage 
        specified in paragraph (2)(C), the total payments permissible 
        under paragraph (3)(C), and the period of time specified in 
        paragraph (4)(B) to determine whether such percentages, such 
        permissible payments, and such period provide an adequate 
        incentive for employment networks to assist beneficiaries to 
        enter the workforce, while providing for appropriate economies. 
        The Commissioner may alter such percentage, such total 
        permissible payments, or such period of time to the extent that 
        the Commissioner determines, on the basis of the Commissioner's 
        review under this paragraph, that such an alteration would 
        better provide the incentive and economies described in the 
        preceding sentence.

        (B) Number and amounts of milestone payments

            The Commissioner shall periodically review the number and 
        amounts of milestone payments established by the Commissioner 
        pursuant to this section to determine whether they provide an 
        adequate incentive for employment networks to assist 
        beneficiaries to enter the workforce, taking into account 
        information provided to the Commissioner by program managers, 
        the Ticket to Work and Work Incentives Advisory Panel 
        established by section 101(f) of the Ticket to Work and Work 
        Incentives Improvement Act of 1999, and other reliable sources. 
        The Commissioner may from time to time alter the number and 
        amounts of milestone payments initially established by the 
        Commissioner pursuant to this section to the extent that the 
        Commissioner determines that such an alteration would allow an 
        adequate incentive for employment networks to assist 
        beneficiaries to enter the workforce. Such alteration shall be 
        based on information provided to the Commissioner by program 
        managers, the Ticket to Work and Work Incentives Advisory Panel 
        established by section 101(f) of the Ticket to Work and Work 
        Incentives Improvement Act of 1999, or other reliable sources.

        (C) Report on the adequacy of incentives

            The Commissioner shall submit to the Congress not later than 
        36 months after December 17, 1999, a report with recommendations 
        for a method or methods to adjust payment rates under 
        subparagraphs (A) and (B), that would ensure adequate incentives 
        for the provision of services by employment networks of--
                (i) individuals with a need for ongoing support and 
            services;
                (ii) individuals with a need for high-cost 
            accommodations;
                (iii) individuals who earn a subminimum wage; and
                (iv) individuals who work and receive partial cash 
            benefits.

        The Commissioner shall consult with the Ticket to Work and Work 
        Incentives Advisory Panel established under section 101(f) of 
        the Ticket to Work and Work Incentives Improvement Act of 1999 
        during the development and evaluation of the study. The 
        Commissioner shall implement the necessary adjusted payment 
        rates prior to full implementation of the Ticket to Work and 
        Self-Sufficiency Program.

(i) Suspension of disability reviews

    During any period for which an individual is using, as defined by 
the Commissioner, a ticket to work and self-sufficiency issued under 
this section, the Commissioner (and any applicable State agency) may not 
initiate a continuing disability review or other review under section 
421 of this title of whether the individual is or is not under a 
disability or a review under subchapter XVI of this chapter similar to 
any such review under section 421 of this title.

(j) Authorizations

                 (1) Payments to employment networks

        (A) Title II disability beneficiaries

            There are authorized to be transferred from the Federal Old-
        Age and Survivors Insurance Trust Fund and the Federal 
        Disability Insurance Trust Fund each fiscal year such sums as 
        may be necessary to make payments to employment networks under 
        this section. Money paid from the Trust Funds under this section 
        with respect to title II disability beneficiaries who are 
        entitled to benefits under section 423 of this title or who are 
        entitled to benefits under section 402(d) of this title on the 
        basis of the wages and self-employment income of such 
        beneficiaries, shall be charged to the Federal Disability 
        Insurance Trust Fund, and all other money paid from the Trust 
        Funds under this section shall be charged to the Federal Old-Age 
        and Survivors Insurance Trust Fund.

        (B) Title XVI disability beneficiaries

            Amounts authorized to be appropriated to the Social Security 
        Administration under section 1381 of this title shall include 
        amounts necessary to carry out the provisions of this section 
        with respect to title XVI disability beneficiaries.

                     (2) Administrative expenses

        The costs of administering this section (other than payments to 
    employment networks) shall be paid from amounts made available for 
    the administration of subchapter II of this chapter and amounts made 
    available for the administration of subchapter XVI of this chapter, 
    and shall be allocated among such amounts as appropriate.

(k) Definitions

    In this section:

                          (1) Commissioner

        The term ``Commissioner'' means the Commissioner of Social 
    Security.

                      (2) Disabled beneficiary

        The term ``disabled beneficiary'' means a title II disability 
    beneficiary or a title XVI disability beneficiary.

                 (3) Title II disability beneficiary

        The term ``title II disability beneficiary'' means an individual 
    entitled to disability insurance benefits under section 423 of this 
    title or to monthly insurance benefits under section 402 of this 
    title based on such individual's disability (as defined in section 
    423(d) of this title). An individual is a title II disability 
    beneficiary for each month for which such individual is entitled to 
    such benefits.

                (4) Title XVI disability beneficiary

        The term ``title XVI disability beneficiary'' means an 
    individual eligible for supplemental security income benefits under 
    subchapter XVI of this chapter on the basis of blindness (within the 
    meaning of section 1382c(a)(2) of this title) or disability (within 
    the meaning of section 1382c(a)(3) of this title). An individual is 
    a title XVI disability beneficiary for each month for which such 
    individual is eligible for such benefits.

              (5) Supplemental security income benefit

        The term ``supplemental security income benefit under subchapter 
    XVI of this chapter'' means a cash benefit under section 1382 or 
    1382h(a) of this title, and does not include a State supplementary 
    payment, administered federally or otherwise.

(l) Regulations

    Not later than 1 year after December 17, 1999, the Commissioner 
shall prescribe such regulations as are necessary to carry out the 
provisions of this section.

(Aug. 14, 1935, ch. 531, title XI, Sec. 1148, as added Pub. L. 106-170, 
title I, Sec. 101(a), Dec. 17, 1999, 113 Stat. 1863.)

                       References in Text

    The Rehabilitation Act of 1973, referred to in subsec. (c)(1), 
(2)(A), is Pub. L. 93-112, Sept. 26, 1973, 87 Stat. 355, as amended. 
Title I of the Act is classified generally to subchapter I (Sec. 720 et 
seq.) of chapter 16 of Title 29, Labor. For complete classification of 
this Act to the Code, see Short Title note set out under section 701 of 
Title 29 and Tables.
    The Workforce Investment Act of 1998, referred to in subsec. 
(f)(1)(B), is Pub. L. 105-220, Aug. 7, 1998, 112 Stat. 936, as amended. 
Subtitle B of title I of the Act is classified generally to subchapter 
II (Sec. 2811 et seq.) of chapter 30 of Title 29, Labor. For complete 
classification of this Act to the Code, see Short Title note set out 
under section 9201 of Title 20, Education, and Tables.
    Section 101(f) of the Ticket to Work and Work Incentives Improvement 
Act of 1999, referred to in subsec. (h)(5)(B), (C), is section 101(f) of 
Pub. L. 106-170, which is set out as a note below.


                             Effective Date

    Pub. L. 106-170, title I, Sec. 101(c), 113 Stat. 1874, provided 
that: ``Subject to subsection (d) [set out as a note below], the 
amendments made by subsections (a) and (b) [enacting this section and 
amending sections 421, 422, 425, 1382d, 1383, and 1383b of this title] 
shall take effect with the first month following 1 year after the date 
of the enactment of this Act [Dec. 17, 1999].''


                               Regulations

    Pub. L. 106-170, title I, Sec. 101(e), Dec. 17, 1999, 113 Stat. 
1877, provided that:
    ``(1) In general.--The Commissioner of Social Security shall 
prescribe such regulations as are necessary to implement the amendments 
made by this section [enacting this section and amending sections 421, 
422, 425, 1382d, 1383, and 1383b of this title].
    ``(2) Specific matters to be included in regulations.--The matters 
which shall be addressed in such regulations shall include--
        ``(A) the form and manner in which tickets to work and self-
    sufficiency may be distributed to beneficiaries pursuant to section 
    1148(b)(1) of the Social Security Act [subsec. (b)(1) of this 
    section];
        ``(B) the format and wording of such tickets, which shall 
    incorporate by reference any contractual terms governing service by 
    employment networks under the Program;
        ``(C) the form and manner in which State agencies may elect 
    participation in the Ticket to Work and Self-Sufficiency Program 
    pursuant to section 1148(c)(1) of such Act and provision for 
    periodic opportunities for exercising such elections;
        ``(D) the status of State agencies under section 1148(c)(1) of 
    such Act at the time that State agencies exercise elections under 
    that section;
        ``(E) the terms of agreements to be entered into with program 
    managers pursuant to section 1148(d) of such Act, including--
            ``(i) the terms by which program managers are precluded from 
        direct participation in the delivery of services pursuant to 
        section 1148(d)(3) of such Act;
            ``(ii) standards which must be met by quality assurance 
        measures referred to in paragraph (6) of section 1148(d) of such 
        Act and methods of recruitment of employment networks utilized 
        pursuant to paragraph (2) of section 1148(e) of such Act; and
            ``(iii) the format under which dispute resolution will 
        operate under section 1148(d)(7) of such Act;
        ``(F) the terms of agreements to be entered into with employment 
    networks pursuant to section 1148(d)(4) of such Act, including--
            ``(i) the manner in which service areas are specified 
        pursuant to section 1148(f)(2)(A) of such Act;
            ``(ii) the general selection criteria and the specific 
        selection criteria which are applicable to employment networks 
        under section 1148(f)(1)(C) of such Act in selecting service 
        providers;
            ``(iii) specific requirements relating to annual financial 
        reporting by employment networks pursuant to section 1148(f)(3) 
        of such Act; and
            ``(iv) the national model to which periodic outcomes 
        reporting by employment networks must conform under section 
        1148(f)(4) of such Act;
        ``(G) standards which must be met by individual work plans 
    pursuant to section 1148(g) of such Act;
        ``(H) standards which must be met by payment systems required 
    under section 1148(h) of such Act, including--
            ``(i) the form and manner in which elections by employment 
        networks of payment systems are to be exercised pursuant to 
        section 1148(h)(1)(A) of such Act;
            ``(ii) the terms which must be met by an outcome payment 
        system under section 1148(h)(2) of such Act;
            ``(iii) the terms which must be met by an outcome-milestone 
        payment system under section 1148(h)(3) of such Act;
            ``(iv) any revision of the percentage specified in paragraph 
        (2)(C) of section 1148(h) of such Act or the period of time 
        specified in paragraph (4)(B) of such section 1148(h) of such 
        Act; and
            ``(v) annual oversight procedures for such systems; and
        ``(I) procedures for effective oversight of the Program by the 
    Commissioner of Social Security, including periodic reviews and 
    reporting requirements.''


                          Findings and Purposes

    Pub. L. 106-170, Sec. 2, Dec. 17, 1999, 113 Stat. 1862, provided 
that:
    ``(a) Findings.--The Congress makes the following findings:
        ``(1) It is the policy of the United States to provide 
    assistance to individuals with disabilities to lead productive work 
    lives.
        ``(2) Health care is important to all Americans.
        ``(3) Health care is particularly important to individuals with 
    disabilities and special health care needs who often cannot afford 
    the insurance available to them through the private market, are 
    uninsurable by the plans available in the private sector, and are at 
    great risk of incurring very high and economically devastating 
    health care costs.
        ``(4) Americans with significant disabilities often are unable 
    to obtain health care insurance that provides coverage of the 
    services and supports that enable them to live independently and 
    enter or rejoin the workforce. Personal assistance services (such as 
    attendant services, personal assistance with transportation to and 
    from work, reader services, job coaches, and related assistance) 
    remove many of the barriers between significant disability and work. 
    Coverage for such services, as well as for prescription drugs, 
    durable medical equipment, and basic health care are powerful and 
    proven tools for individuals with significant disabilities to obtain 
    and retain employment.
        ``(5) For individuals with disabilities, the fear of losing 
    health care and related services is one of the greatest barriers 
    keeping the individuals from maximizing their employment, earning 
    potential, and independence.
        ``(6) Social Security Disability Insurance and Supplemental 
    Security Income beneficiaries risk losing medicare or medicaid 
    coverage that is linked to their cash benefits, a risk that is an 
    equal, or greater, work disincentive than the loss of cash benefits 
    associated with working.
        ``(7) Individuals with disabilities have greater opportunities 
    for employment than ever before, aided by important public policy 
    initiatives such as the Americans with Disabilities Act of 1990 (42 
    U.S.C. 12101 et seq.), advancements in public understanding of 
    disability, and innovations in assistive technology, medical 
    treatment, and rehabilitation.
        ``(8) Despite such historic opportunities and the desire of 
    millions of disability recipients to work and support themselves, 
    fewer than one-half of one percent of Social Security Disability 
    Insurance and Supplemental Security Income beneficiaries leave the 
    disability rolls and return to work.
        ``(9) In addition to the fear of loss of health care coverage, 
    beneficiaries cite financial disincentives to work and earn income 
    and lack of adequate employment training and placement services as 
    barriers to employment.
        ``(10) Eliminating such barriers to work by creating financial 
    incentives to work and by providing individuals with disabilities 
    real choice in obtaining the services and technology they need to 
    find, enter, and maintain employment can greatly improve their short 
    and long-term financial independence and personal well-being.
        ``(11) In addition to the enormous advantages such changes 
    promise for individuals with disabilities, redesigning government 
    programs to help individuals with disabilities return to work may 
    result in significant savings and extend the life of the Social 
    Security Disability Insurance Trust Fund.
        ``(12) If only an additional one-half of one percent of the 
    current Social Security Disability Insurance and Supplemental 
    Security Income recipients were to cease receiving benefits as a 
    result of employment, the savings to the Social Security Trust Funds 
    and to the Treasury in cash assistance would total $3,500,000,000 
    over the worklife of such individuals, far exceeding the cost of 
    providing incentives and services needed to assist them in entering 
    work and achieving financial independence to the best of their 
    abilities.
    ``(b) Purposes.--The purposes of this Act [see Tables for 
classification] are as follows:
        ``(1) To provide health care and employment preparation and 
    placement services to individuals with disabilities that will enable 
    those individuals to reduce their dependency on cash benefit 
    programs.
        ``(2) To encourage States to adopt the option of allowing 
    individuals with disabilities to purchase medicaid coverage that is 
    necessary to enable such individuals to maintain employment.
        ``(3) To provide individuals with disabilities the option of 
    maintaining medicare coverage while working.
        ``(4) To establish a return to work ticket program that will 
    allow individuals with disabilities to seek the services necessary 
    to obtain and retain employment and reduce their dependency on cash 
    benefit programs.''


                   Graduated Implementation of Program

    Pub. L. 106-170, title I, Sec. 101(d), Dec. 17, 1999, 113 Stat. 
1874, provided that:
    ``(1) In general.--Not later than 1 year after the date of the 
enactment of this Act [Dec. 17, 1999], the Commissioner of Social 
Security shall commence implementation of the amendments made by this 
section [enacting this section and amending sections 421, 422, 425, 
1382d, 1383, and 1383b of this title] (other than paragraphs (1)(C) and 
(2)(B) of subsection (b) [amending sections 422 and 1382d of this 
title]) in graduated phases at phase-in sites selected by the 
Commissioner. Such phase-in sites shall be selected so as to ensure, 
prior to full implementation of the Ticket to Work and Self-Sufficiency 
Program, the development and refinement of referral processes, payment 
systems, computer linkages, management information systems, and 
administrative processes necessary to provide for full implementation of 
such amendments. Subsection (c) [set out as a note above] shall apply 
with respect to paragraphs (1)(C) and (2)(B) of subsection (b) without 
regard to this subsection.
    ``(2) Requirements.--Implementation of the Program at each phase-in 
site shall be carried out on a wide enough scale to permit a thorough 
evaluation of the alternative methods under consideration, so as to 
ensure that the most efficacious methods are determined and in place for 
full implementation of the Program on a timely basis.
    ``(3) Full implementation.--The Commissioner shall ensure that 
ability to provide tickets and services to individuals under the Program 
exists in every State as soon as practicable on or after the effective 
date specified in subsection (c) but not later than 3 years after such 
date.
    ``(4) Ongoing evaluation of program.--
        ``(A) In general.--The Commissioner shall provide for 
    independent evaluations to assess the effectiveness of the 
    activities carried out under this section [enacting this section, 
    amending sections 421, 422, 425, 1382d, 1383, and 1383b of this 
    title, and enacting provisions set out as notes under this section] 
    and the amendments made thereby. Such evaluations shall address the 
    cost-effectiveness of such activities, as well as the effects of 
    this section and the amendments made thereby on work outcomes for 
    beneficiaries receiving tickets to work and self-sufficiency under 
    the Program.
        ``(B) Consultation.--Evaluations shall be conducted under this 
    paragraph after receiving relevant advice from experts in the fields 
    of disability, vocational rehabilitation, and program evaluation and 
    individuals using tickets to work and self-sufficiency under the 
    Program and in consultation with the Ticket to Work and Work 
    Incentives Advisory Panel established under section 101(f) of this 
    Act [set out as a note below], the Comptroller General of the United 
    States, other agencies of the Federal Government, and private 
    organizations with appropriate expertise.
        ``(C) Methodology.--
            ``(i) Implementation.--The Commissioner, in consultation 
        with the Ticket to Work and Work Incentives Advisory Panel 
        established under section 101(f) of this Act, shall ensure that 
        plans for evaluations and data collection methods under the 
        Program are appropriately designed to obtain detailed employment 
        information.
            ``(ii) Specific matters to be addressed.--Each such 
        evaluation shall address (but is not limited to)--
                ``(I) the annual cost (including net cost) of the 
            Program and the annual cost (including net cost) that would 
            have been incurred in the absence of the Program;
                ``(II) the determinants of return to work, including the 
            characteristics of beneficiaries in receipt of tickets under 
            the Program;
                ``(III) the types of employment services, vocational 
            rehabilitation services, and other support services 
            furnished to beneficiaries in receipt of tickets under the 
            Program who return to work and to those who do not return to 
            work;
                ``(IV) the duration of employment services, vocational 
            rehabilitation services, and other support services 
            furnished to beneficiaries in receipt of tickets under the 
            Program who return to work and the duration of such services 
            furnished to those who do not return to work and the cost to 
            employment networks of furnishing such services;
                ``(V) the employment outcomes, including wages, 
            occupations, benefits, and hours worked, of beneficiaries 
            who return to work after receiving tickets under the Program 
            and those who return to work without receiving such tickets;
                ``(VI) the characteristics of individuals in possession 
            of tickets under the Program who are not accepted for 
            services and, to the extent reasonably determinable, the 
            reasons for which such beneficiaries were not accepted for 
            services;
                ``(VII) the characteristics of providers whose services 
            are provided within an employment network under the Program;
                ``(VIII) the extent (if any) to which employment 
            networks display a greater willingness to provide services 
            to beneficiaries with a range of disabilities;
                ``(IX) the characteristics (including employment 
            outcomes) of those beneficiaries who receive services under 
            the outcome payment system and of those beneficiaries who 
            receive services under the outcome-milestone payment system;
                ``(X) measures of satisfaction among beneficiaries in 
            receipt of tickets under the Program; and
                ``(XI) reasons for (including comments solicited from 
            beneficiaries regarding) their choice not to use their 
            tickets or their inability to return to work despite the use 
            of their tickets.
        ``(D) Periodic evaluation reports.--Following the close of the 
    third and fifth fiscal years ending after the effective date under 
    subsection (c), and prior to the close of the seventh fiscal year 
    ending after such date, the Commissioner shall transmit to the 
    Committee on Ways and Means of the House of Representatives and the 
    Committee on Finance of the Senate a report containing the 
    Commissioner's evaluation of the progress of activities conducted 
    under the provisions of this section and the amendments made 
    thereby. Each such report shall set forth the Commissioner's 
    evaluation of the extent to which the Program has been successful 
    and the Commissioner's conclusions on whether or how the Program 
    should be modified. Each such report shall include such data, 
    findings, materials, and recommendations as the Commissioner may 
    consider appropriate.
    ``(5) Extent of state's right of first refusal in advance of full 
implementation of amendments in such state.--
        ``(A) In general.--In the case of any State in which the 
    amendments made by subsection (a) [enacting this section] have not 
    been fully implemented pursuant to this subsection, the Commissioner 
    shall determine by regulation the extent to which--
            ``(i) the requirement under section 222(a) of the Social 
        Security Act (42 U.S.C. 422(a)) for prompt referrals to a State 
        agency; and
            ``(ii) the authority of the Commissioner under section 
        222(d)(2) of such Act (42 U.S.C. 422(d)(2)) to provide 
        vocational rehabilitation services in such State by agreement or 
        contract with other public or private agencies, organizations, 
        institutions, or individuals,
    shall apply in such State.
        ``(B) Existing agreements.--Nothing in subparagraph (A) or the 
    amendments made by subsection (a) [enacting this section] shall be 
    construed to limit, impede, or otherwise affect any agreement 
    entered into pursuant to section 222(d)(2) of the Social Security 
    Act (42 U.S.C. 422(d)(2)) before the date of the enactment of this 
    Act [Dec. 17, 1999] with respect to services provided pursuant to 
    such agreement to beneficiaries receiving services under such 
    agreement as of such date, except with respect to services (if any) 
    to be provided after 3 years after the effective date provided in 
    subsection (c).''


            Ticket to Work and Work Incentives Advisory Panel

    Pub. L. 106-170, title I, Sec. 101(f), Dec. 17, 1999, 113 Stat. 
1878, provided that:
    ``(1) Establishment.--There is established within the Social 
Security Administration a panel to be known as the `Ticket to Work and 
Work Incentives Advisory Panel' (in this subsection referred to as the 
`Panel').
    ``(2) Duties of panel.--It shall be the duty of the Panel to--
        ``(A) advise the President, the Congress, and the Commissioner 
    of Social Security on issues related to work incentives programs, 
    planning, and assistance for individuals with disabilities, 
    including work incentive provisions under titles II, XI, XVI, XVIII, 
    and XIX of the Social Security Act (42 U.S.C. 401 et seq., 1301 et 
    seq., 1381 et seq., 1395 et seq., 1396 et seq.); and
        ``(B) with respect to the Ticket to Work and Self-Sufficiency 
    Program established under section 1148 of such Act [this section]--
            ``(i) advise the Commissioner of Social Security with 
        respect to establishing phase-in sites for such Program and 
        fully implementing the Program thereafter, the refinement of 
        access of disabled beneficiaries to employment networks, payment 
        systems, and management information systems, and advise the 
        Commissioner whether such measures are being taken to the extent 
        necessary to ensure the success of the Program;
            ``(ii) advise the Commissioner regarding the most effective 
        designs for research and demonstration projects associated with 
        the Program or conducted pursuant to section 302 of this Act 
        [set out as a note under section 434 of this title];
            ``(iii) advise the Commissioner on the development of 
        performance measurements relating to quality assurance under 
        section 1148(d)(6) of the Social Security Act [subsec. (d)(6) of 
        this section]; and
            ``(iv) furnish progress reports on the Program to the 
        Commissioner and each House of Congress.
    ``(3) Membership.--
        ``(A) Number and appointment.--The Panel shall be composed of 12 
    members as follows:
            ``(i) four members appointed by the President, not more than 
        two of whom may be of the same political party;
            ``(ii) two members appointed by the Speaker of the House of 
        Representatives, in consultation with the Chairman of the 
        Committee on Ways and Means of the House of Representatives;
            ``(iii) two members appointed by the minority leader of the 
        House of Representatives, in consultation with the ranking 
        member of the Committee on Ways and Means of the House of 
        Representatives;
            ``(iv) two members appointed by the majority leader of the 
        Senate, in consultation with the Chairman of the Committee on 
        Finance of the Senate; and
            ``(v) two members appointed by the minority leader of the 
        Senate, in consultation with the ranking member of the Committee 
        on Finance of the Senate.
        ``(B) Representation.--
            ``(i) In general.--The members appointed under subparagraph 
        (A) shall have experience or expert knowledge as a recipient, 
        provider, employer, or employee in the fields of, or related to, 
        employment services, vocational rehabilitation services, and 
        other support services.
            ``(ii) Requirement.--At least one-half of the members 
        appointed under subparagraph (A) shall be individuals with 
        disabilities, or representatives of individuals with 
        disabilities, with consideration given to current or former 
        title II [subchapter II of this chapter] disability 
        beneficiaries or title XVI [subchapter XVI of this chapter] 
        disability beneficiaries (as such terms are defined in section 
        1148(k) of the Social Security Act [subsec. (k) of this section] 
        (as added by subsection (a)).
        ``(C) Terms.--
            ``(i) In general.--Each member shall be appointed for a term 
        of 4 years (or, if less, for the remaining life of the Panel), 
        except as provided in clauses (ii) and (iii). The initial 
        members shall be appointed not later than 90 days after the date 
        of the enactment of this Act [Dec. 17, 1999].
            ``(ii) Terms of initial appointees.--Of the members first 
        appointed under each clause of subparagraph (A), as designated 
        by the appointing authority for each such clause--
                ``(I) one-half of such members shall be appointed for a 
            term of 2 years; and
                ``(II) the remaining members shall be appointed for a 
            term of 4 years.
            ``(iii) Vacancies.--Any member appointed to fill a vacancy 
        occurring before the expiration of the term for which the 
        member's predecessor was appointed shall be appointed only for 
        the remainder of that term. A member may serve after the 
        expiration of that member's term until a successor has taken 
        office. A vacancy in the Panel shall be filled in the manner in 
        which the original appointment was made.
        ``(D) Basic pay.--Members shall each be paid at a rate, and in a 
    manner, that is consistent with guidelines established under section 
    7 of the Federal Advisory Committee Act (5 U.S.C. App.).
        ``(E) Travel expenses.--Each member shall receive travel 
    expenses, including per diem in lieu of subsistence, in accordance 
    with sections 5702 and 5703 of title 5, United States Code.
        ``(F) Quorum.--Eight members of the Panel shall constitute a 
    quorum but a lesser number may hold hearings.
        ``(G) Chairperson.--The Chairperson of the Panel shall be 
    designated by the President. The term of office of the Chairperson 
    shall be 4 years.
        ``(H) Meetings.--The Panel shall meet at least quarterly and at 
    other times at the call of the Chairperson or a majority of its 
    members.
    ``(4) Director and staff of panel; experts and consultants.--
        ``(A) Director.--The Panel shall have a Director who shall be 
    appointed by the Chairperson, and paid at a rate, and in a manner, 
    that is consistent with guidelines established under section 7 of 
    the Federal Advisory Committee Act (5 U.S.C. App.).
        ``(B) Staff.--Subject to rules prescribed by the Commissioner of 
    Social Security, the Director may appoint and fix the pay of 
    additional personnel as the Director considers appropriate.
        ``(C) Experts and consultants.--Subject to rules prescribed by 
    the Commissioner of Social Security, the Director may procure 
    temporary and intermittent services under section 3109(b) of title 
    5, United States Code.
        ``(D) Staff of federal agencies.--Upon request of the Panel, the 
    head of any Federal department or agency may detail, on a 
    reimbursable basis, any of the personnel of that department or 
    agency to the Panel to assist it in carrying out its duties under 
    this Act [see Tables for classification].
    ``(5) Powers of panel.--
        ``(A) Hearings and sessions.--The Panel may, for the purpose of 
    carrying out its duties under this subsection, hold such hearings, 
    sit and act at such times and places, and take such testimony and 
    evidence as the Panel considers appropriate.
        ``(B) Powers of members and agents.--Any member or agent of the 
    Panel may, if authorized by the Panel, take any action which the 
    Panel is authorized to take by this section [enacting this section, 
    amending sections 421, 422, 425, 1382d, 1383, and 1383b of this 
    title, and enacting provisions set out as notes above].
        ``(C) Mails.--The Panel may use the United States mails in the 
    same manner and under the same conditions as other departments and 
    agencies of the United States.
    ``(6) Reports.--
        ``(A) Interim reports.--The Panel shall submit to the President 
    and the Congress interim reports at least annually.
        ``(B) Final report.--The Panel shall transmit a final report to 
    the President and the Congress not later than eight years after the 
    date of the enactment of this Act [Dec. 17, 1999]. The final report 
    shall contain a detailed statement of the findings and conclusions 
    of the Panel, together with its recommendations for legislation and 
    administrative actions which the Panel considers appropriate.
    ``(7) Termination.--The Panel shall terminate 30 days after the date 
of the submission of its final report under paragraph (6)(B).
    ``(8) Authorization of appropriations.--There are authorized to be 
appropriated from the Federal Old-Age and Survivors Insurance Trust 
Fund, the Federal Disability Insurance Trust Fund, and the general fund 
of the Treasury, as appropriate, such sums as are necessary to carry out 
this subsection.''

                  Section Referred to in Other Sections

    This section is referred to in sections 421, 425, 434, 1320b-20, 
1320b-21, 1320b-22, 1383, 1383b of this title.
