Ticket to Work Payment & COS Updates

Transcription

1 Ticket to Work Payment & COS Updates Kimberly Cutler & Jenni Purdum Ticket Program Manager (TPM) NENA s 8 th Annual National Training Conference Louisville, KY September 2018

2 Ticket to Work Policy Updates E-PAY CHANGES

3 Introduction The Ticket Program Agreement (TPA) mandates that ENs provide Services and Supports to beneficiaries in order to qualify for payment. This presentation introduces changes to E-Pay based on the Services and Support review.

4 Services and Supports Reviews (1 of 2) The Services and Supports Review has replaced the previous Individual Work Plan (IWP) audit process. The annual review addresses both IWPs and Certification of Services (COS) by random sampling an EN s assigned Tickets. ENs will receive a request from the Program Integrity department to submit an IWP, COS, and any relevant case notes.

5 Services and Supports Reviews (2 of 2) The Services and Supports Reviews began in September All ENs are expected to be reviewed by October 1, Effective October 1, 2018, the results of the services and support review will impact E-Pay eligibility.

6 Services and Supports Reviews and E-Pay Effective October 1, 2018, the results of the services and support review will impact E-Pay eligibility based on the following: If an EN is found to be non-compliant after a review, the EN will be removed from E-Pay and will have to submit all payment requests via the portal After 6 months the EN can request an additional review to prove compliance The EN must make the request directly to their EN Specialist The EN must provide all requested information to show all identified issues have been resolved. After the EN is determined to be in compliance, the EN will be eligible for the next E-Pay file.

7 E-Pay Schedule There will not be another E-Pay file until all ENs have completed a Services and Support review. The next E-Pay file will not be created until the 4 th quarter of In the meantime, ENs should request payments via the Ticket Portal.

8 Changes to E-Pay Unassigned Tickets will not be included in E-Pay. ENs must request these payments via the Ticket Portal. Phase 1 Milestones will no longer be paid via E-Pay. Government Trusted Partners (VRENs and WIBs/AJCs) will continue to receive Phase 1 Milestone payments via E-Pay.

9 Ticket to Work Policy Updates PHASE 1 MILESTONE RELATIONSHIP REQUIREMENT (PMRR)

10 Phase 1 Milestones Relationship Requirement (PMRR) (1 of 3) Effective August 1, 2018 all ENs must prove a relationship with the beneficiary in order to receive payment, in addition to having proof of earnings. ENs must request Phase 1 Milestones 1-4 via the Ticket Portal. ENs can submit either paystubs or a Certification of Services (COS) as proof of a relationship with the beneficiary during the Phase 1 Milestone phase. Paystubs are the preferred proof of a relationship. Payment requests that include a paystub will not require additional evaluation.

11 Phase 1 Milestones Relationship Requirement (PMRR) (2 of 3) To prove Beneficiary/EN relationship Submit a paystub when requesting a Phase 1 Milestone. If an EN is unable to provide a paystub for any month(s) requested, then a Certification of Services (COS) is required. Even if the earnings are in SSA s records and the Ticket Portal displays the message Earnings Already Proven evidence must be provided in the form of a paystub or COS. TPM will adjust the claim month if necessary to ensure that these four payments are evaluated for the correct attainment month. There are no changes to current policy to determine acceptable evidence of earnings.

12 Phase 1 Milestones Relationship Requirement (PMRR) (3 of 3) Phase 1 Milestone (1-4) payments will continue to use the same policy for determining acceptable evidence of earnings. However, a new verification requirement has been established, entitled the Phase 1 Milestones Relationship Requirement (PMRR) to ensure program payment integrity. Please refer to the chart below to see all acceptable forms of evidence for proof of earnings and proof of relationship requirements. Acceptable Proof of Earnings Paystubs The Work Number Employer Prepared Earnings Statement Required Proof of a Relationship None Paystub or Certification of Services (COS) Paystub or Certification of Services (COS)

13 Use of EN COS when requesting Phase 1 Milestones ENs are required to submit proof of a relationship with every Phase 1 Milestone payment request. Both the proof of earnings and the proof of a relationship must cover the entire Phase 1 Milestone period (i.e. all nine months for a Phase 1 Milestone 4 payment request). The EN COS form must list the date and description of services that were provided for all of the months in the Phase 1 Milestone period. This form is available on the Your Ticket to Work website at EN developed COS forms are not permissible

14 EN selects a claim month for a Phase 1 Milestone via the Ticket Portal EN submits evidence of a relationship: either a paystub or COS YES Are sufficient earnings in SSA s system? NO EN submits evidence of earnings YES Does the EN submit a paystub? NO EN has satisfied both the earnings and relationship requirements EN submits a COS to satisfy the relationship requirement

15 Ticket to Work Policy Updates PAYMENTS CHANGES

16 Interim Changes From August 1 st October 1 st TPM will not assess additional available payments for ENs based on a single payment request. TPM will only process (pay, diary or deny) the claim month submitted. Example: Beneficiary has SGA-level earnings for 1/2017, 2/2017, and 3/2017. EN submits payment request for a Phase 2 Milestone for claim month: 1/2017. TPM will process the requested claim month of 1/2017. EN will have to submit a payment request separately for 2/2017 & 3/2017 in order to receive the additional payments.

17 ENs not on E-Pay must submit ALL claims via the Ticket Portal Effective October 1 st ENs excluded from E-Pay must submit claims via the Ticket Portal. TPM will only process (pay, diary or deny) the claim month submitted. TPM will not assess additional available payments for ENs not eligible for E-Pay. If EN submits a claim and requirements are not met for the claim month submitted, TPM will deny the claim and will NOT process payments for any other months that meet payment requirements.

18 Example EN submits payment request for an Outcome for Claim Month: 4/2017, but earnings submitted are below SGA SSA Records show the beneficiary has SGA-level earnings for 5/2017, 6/2017, and 7/2017 The payment request for 4/2017 will be denied due to Earnings Amounts Do Not Meet Criteria for Payment. TPM will not make additional payments for months where beneficiary has SGA-level earnings on SSA records (5/2017, 6/2017 and 7/2017) In order to get paid, the EN must request each month via the Ticket Portal

19 TPM Phone & Resources Phone Monday thru Friday 9 a.m. 5 p.m. ET Toll Free: /TTY: Option 1: Payments Help Desk Option 2: Systems Help Desk For payment issues: enpaymentshelpdesk@yourtickettowork.ssa.gov For questions and issues related to Ticket assignment, the service provider website and the Ticket Portal: ensystemshelp@yourtickettowork.ssa.gov

20 Ticket to Work Policy Updates SERVICES AND SUPPORTS REVIEWS

21 Reminder Policy Changes (1 of 2) ENs are required to maintain regular contact with all assigned Ticketholders For Ticketholders who are currently in the Initial Support Phase, contact should be made at least monthly If you are unable to make contact, leave a phone message and document the process using the Telephone Message Documentation form After 3 months without contact, send a certified letter and document the process using the Certified Letter Documentation form

22 Reminder Policy Changes (2 of 2) For Ticketholders who are in the Ongoing Support Phase, contact should be made at least quarterly If you are unable to make contact, leave a phone message and document the process using the Telephone Message Documentation form After 6 months without contact, send a certified letter and document the process using the Certified Letter Documentation form

23 What is a Services and Supports Review? (1 of 2) Review of EN documentation to verify that the EN is actively working with Ticketholders and providing the services and supports agreed upon in the signed Individual Work Plans (IWP) Previously TPM conducted only IWP audits, now TPM will review both IWPs and Certification of Services (COS) documentation Every EN will go through a services and supports review on a yearly basis

24 What is a Services and Supports Review? (2 of 2) The Ticket Program Manager (TPM) will send a request for documentation from a random sampling of Social Security Numbers (SSNs) currently assigned to the EN Documentation required includes: IWPs COS statements Case notes with proof of ongoing contact and services and supports provided

25 What is an EN COS? ENs must occasionally complete an EN Certification of Services (COS) Statement to provide proof that the services and supports provided to Ticketholders align with the services agreed upon in an IWP The form must be submitted: During random reviews of IWPs and documentation of services To determine the number of claims eligible for ENs following a Ticketholder s unassignment of a Ticket To perform Quality Assurance (QA) reviews as stated in the Ticket Program Agreement (TPA) Remember to submit all 3 pages of the COS form Page 3 of the COS form must be signed and dated

26 Why Include Case Notes? When responding to the request, be sure to include any case notes that: Provide proof of ongoing contact or documented contact attempts Demonstrate services and supports provided, including dates Provide evidence for information requested on the EN COS Make references to case notes on page 2 of the COS form instead of duplicating content Only use references if the notes are clearly labeled by page number or file name Include where on the page you are referencing (if applicable)

27 Outcome Summary Report After reviewing the documentation, TPM will provide ENs with a summary report form with a result for each SSN Each COS review will receive one of the following results: Compliant Incomplete Documentation IWP Amendments Service Related Problems Noncompliant If IWPs were reviewed, a result will be listed as: Compliant Noncompliant No technical assistance session (TAS) required Noncompliant TAS Required

28 Services and Supports Best Practices ENs should regularly review Ticket assignment lists Unassign Tickets for those Ticketholders you are not actively working with Open the review as soon as you receive it to avoid a last minute rush to meet the 9 business-day timeline Double check to ensure all requested documents are submitted for each Ticketholder To simplify the review process, organize documents so that it is clear which documents apply to which SSNs Maintain thorough records and properly file documents to ensure quick retrieval of IWPs and case notes as well as completion of COS statements

29 IWP Best Practices Services and supports provided should match what is agreed upon in the IWP If the services and supports required have changed, it is important to amend the IWP An IWP is a living document that should grow and adapt to the changing needs of each individual Ticketholder Both the EN and Ticketholder should sign or initial any IWP amendments Services should be individualized to a Ticketholder IWPs should be written collaboratively between Ticketholders and ENs using language from the EN s perspective If you are not using the current IWP template, be sure to add: Business model Method of completion Missing terms and conditions

30 Questions During the Process Find more information about IWPs at For help with IWPs, contact the Provider Support Help Line Hours: Monday Friday, 9 a.m. 5 p.m. ET specific questions about your EN s Services and Supports review to ProgramIntegrity@yourtickettowork.ssa.gov All other questions regarding the services and supports review process can be directed to Ticket.QA@ssa.gov