By Sarah Lyngdal (Geller), NENA Director
Ticket to Work Program Manager
Employment Resources, Inc.
At the 2017 NENA conference in San Antonio, Social Security provided data that showed they plan to complete more medical continuing disability reviews in 2018 than ever before. A key benefit to participating in the Ticket to Work program is that it can provide medical review protection if the Ticket Holder is making “Timely Progress.” Timely Progress is a set of educational and employment goals broken down by year of program participation in the Ticket to Work program. Someone with their ticket in-use with their state vocational rehabilitation agency (SVR, DVR, VR), or assigned to an Employment Network (EN) is considered to be participating in the Ticket to Work Program.
Social Security contracted MAXIMUS, now known as the Ticket Program Manager (TPM), to manage and implement the Ticket to Work Program. Sometime in 2015, MAXIMUS determined their process for completing Timely Progress Reviews (TPR) wasn’t effective. They put a moratorium on Timely Progress Reviews (TPR) until they could come up with a better system for doing the reviews. In the meantime, Ticket Holders maintain the TPR status they held at the time the moratorium was put into place. If they passed their last review, they have medical review protection. If they failed their last review, they don’t have medical review protection and could have a medical review initiated on their normal medical review schedule.
What ENs need to know: ENs have access to their assigned Ticket Holders’ TPR statuses. If a Ticket Holder is now meeting the Timely Progress requirements for the review year they previously failed, the EN can request they be re-entered in medical review protection by submitting documentation to support their progress to MAXIMUS. For example, if the Ticket Holder failed their Timely Progress Review for year 2 in 2013-2014, and this year they’ve worked 6 months above the Trial Work Level, the EN can submit those pay stubs to MAXIMUS and request re-entry in medical review protection for that Ticket Holder. MAXIMUS will review the evidence and make a decision. The EN will be informed of the decision, and their TPR status on the portal will be updated if re-entry is granted. The Ticket Holder will get a letter with the decision as well.
I encourage you to look at your Ticket Holders’ TPR statuses in the portal. Try to proactively fix any issues that you find. In my experience, it saves a lot of time and work in the long run to fix the issues before Social Security initiates a medical review. It’s also important to know that Social Security will stop a medical continuing disability review if it turns out they shouldn’t have started it in the first place because of medical review protection with Timely Progress in the Ticket to Work program. I’ve been able to work with MAXIMUS to proactively fix TPR statuses for several Ticket Holders, and I was able to stop medical reviews in the works with for a few as well.
Ticket Holders who are assigning or using their ticket for the first time will have medical review protection effective the date they assign their ticket, or sign their work plan with VR. This cannot stop a medical review that was initiated prior to ticket assignment, or in-use status with VR.
When the moratorium ends, and Timely Progress Reviews (TPR) start up again, all Ticket Holders using their tickets will need to be meeting the Timely Progress requirements to keep medical review protection.