Social Security Disability Program Demonstration Project: Promoting Opportunity Demonstration (POD), 50214-50219 [2017-23521]
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average wage index for 2016
($48,664.73) to that for 1992
($22,935.42) produces $1,973.29. We
then round this amount to $1,970.
Because $1,970 exceeds the current
amount of $1,950, the monthly SGA
amount for statutorily blind individuals
is $1,970 for 2018.
SGA Amount for Non-Blind Disabled
Individuals
Multiplying the 2000 monthly SGA
amount for non-blind individuals ($700)
by the ratio of the national average wage
index for 2016 ($48,664.73) to that for
1998 ($28,861.44) produces $1,180.31.
We then round this amount to $1,180.
Because $1,180 exceeds the current
amount of $1,170, the monthly SGA
amount for non-blind disabled
individuals is $1,180 for 2018.
Trial Work Period Earnings Threshold
General
During a trial work period of 9
months in a rolling 60-month period, a
beneficiary receiving Social Security
disability benefits may test his or her
ability to work and still receive monthly
benefit payments. To be considered a
trial work period month, earnings must
be over a certain level. In 2018, any
month in which earnings exceed $850 is
considered a month of services for an
individual’s trial work period.
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Computation
The method used to determine the
new amount is set forth in our
regulations at 20 CFR 404.1592(b).
Monthly earnings in 2018, used to
determine whether a month is part of a
trial work period, is the larger of: (1)
The amount for 2001 ($530) multiplied
by the ratio of the national average wage
index for 2016 to that for 1999; or (2) the
amount for 2017. If the amount so
calculated is not a multiple of $10, we
round it to the nearest multiple of $10.
Trial Work Period Earnings Threshold
Amount
Multiplying the 2001 monthly
earnings threshold ($530) by the ratio of
the national average wage index for
2016 ($48,664.73) to that for 1999
($30,469.84) produces $846.49. We then
round this amount to $850. Because
$850 exceeds the current amount of
$840, the monthly earnings threshold is
$850 for 2018.
Domestic Employee Coverage
Threshold
General
The minimum amount a domestic
worker must earn so that such earnings
are covered under Social Security or
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Medicare is the domestic employee
coverage threshold. For 2018, this
threshold is $2,100. Section 3121(x) of
the Internal Revenue Code provides the
formula for increasing the threshold.
Computation
Domestic Employee Coverage Threshold
Amount
Multiplying the 1995 domestic
employee coverage threshold ($1,000)
by the ratio of the national average wage
index for 2016 ($48,664.73) to that for
1993 ($23,132.67) produces $2,103.72.
We then round this amount to $2,100.
Therefore, the domestic employee
coverage threshold amount is $2,100 for
2018.
Election Official and Election Worker
Coverage Threshold
General
The minimum amount an election
official and election worker must earn
so the earnings are covered under Social
Security or Medicare is the election
official and election worker coverage
threshold. For 2018, this threshold is
$1,800. Section 218(c)(8)(B) of the Act
provides the formula for increasing the
threshold.
Computation
Under the formula, the election
official and election worker coverage
threshold for 2018 is equal to the 1999
amount of $1,000 multiplied by the ratio
of the national average wage index for
2016 to that for 1997. If the amount we
determine is not a multiple of $100, it
we round it to the nearest multiple of
$100.
Election Official and Election Worker
Coverage Threshold Amount
Multiplying the 1999 coverage
threshold amount ($1,000) by the ratio
of the national average wage index for
2016 ($48,664.73) to that for 1997
($27,426.00) produces $1,774.40. We
then round this amount to $1,800.
Therefore, the election official and
election worker coverage threshold
amount is $1,800 for 2018.
(Catalog of Federal Domestic Assistance:
Program Nos. 96.001 Social SecurityDisability Insurance; 96.002 Social SecurityRetirement Insurance; 96.004 Social Security-
Frm 00099
Fmt 4703
Nancy A. Berryhill,
Acting Commissioner of Social Security.
[FR Doc. 2017–23522 Filed 10–27–17; 8:45 am]
BILLING CODE 4191–02–P
Under the formula, the domestic
employee coverage threshold for 2018 is
equal to the 1995 amount of $1,000
multiplied by the ratio of the national
average wage index for 2016 to that for
1993. If the resulting amount is not a
multiple of $100, we round it to the next
lower multiple of $100.
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Survivors Insurance; 96.006 Supplemental
Security Income)
Sfmt 4703
SOCIAL SECURITY ADMINISTRATION
[Docket No. SSA–2017–0032]
Social Security Disability Program
Demonstration Project: Promoting
Opportunity Demonstration (POD)
AGENCY:
ACTION:
Social Security Administration.
Notice.
We are announcing a
demonstration project for the Social
Security disability program under title II
of the Social Security Act (Act). Under
this project, we will modify program
rules applied to beneficiaries who work
and receive title II disability benefits.
We are required to conduct the
Promoting Opportunity Demonstration
(POD), in compliance with section 823
of the Bipartisan Budget Act (BBA) of
2015.
In this project, we will test simplified
work incentives and use a benefit offset
based on earnings as an alternative to
rules we currently apply to title II
disability beneficiaries who work.
Under the benefit offset, we will reduce
title II disability benefits by $1 for every
$2 that a beneficiary earns above a
certain threshold.
We will select beneficiaries and offer
them the opportunity to volunteer for
the project. When we make the
selection, we will include beneficiaries
who receive title II disability benefits
only as well as beneficiaries who
receive both title II disability benefits
and Supplemental Security Income
(SSI) based on disability or blindness
under title XVI of the Act. We are
modifying rules that apply to the title II
program and the Ticket to Work
program under title XI. We will
continue to apply the usual SSI program
rules for participants who receive SSI
payments in addition to title II disability
benefits.
SUMMARY:
We plan to begin this project in
November 2017 and end it in June 2021.
DATES:
FOR FURTHER INFORMATION CONTACT:
Jeffrey Hemmeter, Office of Retirement
and Disability Policy, Social Security
Administration, 6401 Security
Boulevard, Baltimore, MD 21235, (410)
597–1815.
SUPPLEMENTARY INFORMATION:
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Background
We are required to conduct this
demonstration under Social Security
Act section 234(f).1
In this section, we broadly outline our
usual rules for paying disability
benefits, how those benefits may
terminate, and the work incentives that
affect payments. Then, we discuss the
modified rules we will apply under the
demonstration project.
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Who may receive disability benefits?
Under title II of the Act, we pay the
following benefits to persons who meet
the Act’s definition of disability:
• Disability insurance benefits for a
worker insured under the Act;
• Widow’s and widower’s insurance
benefits based on disability for a widow,
widower, or surviving divorced spouse
of an insured worker; and
• Childhood disability benefits for a
child of an insured worker who is
entitled to retirement or disability
benefits or has died.
In the rest of this notice, we refer to
these benefits collectively as Social
Security Disability Insurance (SSDI)
benefits and refer to the beneficiaries
who receive them as SSDI beneficiaries.
Under title XVI of the Act, we pay SSI
to persons who are aged, blind, or
disabled, and who also have limited
income and resources. An SSDI
beneficiary with limited income and
resources may qualify for SSI payments.
A person must meet the definition of
disability under title II of the Act in
order to be eligible for SSDI benefits. A
person is disabled under title II if the
person has a physical or mental
impairment or combination of
impairments that has lasted or is
expected to last for at least 12 months
or can be expected to result in death and
that prevents the person from doing any
substantial gainful activity (SGA).2 This
definition also applies under title XVI of
the Act for persons age 18 or older who
receive payments based on disability.3
Continuing Disability Reviews
We periodically reevaluate a
disability beneficiary’s impairment(s) to
determine whether the person continues
to be under a disability.4 We call this
evaluation a continuing disability
review (CDR). We conduct CDRs at
regularly scheduled intervals. We may
begin a CDR at a time other than a
1 Section 823 of the Bipartisan Budget Act of
2015, Public Law 114–74, added this requirement.
2 Section 223(d)(1)(A) of the Act; 20 CFR
404.1505(a).
3 Section 1614(a)(3)(A) of the Act; 20 CFR
416.905(a).
4 Section 221(i), (m) of the Act; 20 CFR 404.1589,
404.1590, and 404.1594.
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regular interval if circumstances
warrant. There are two main types of
CDRs: (1) Medical CDRs, in which we
examine medical improvement, if any,
and (2) work CDRs, in which we
examine earnings. If we determine in a
CDR that the individual is no longer
under a disability, we will stop benefits
in most cases.
How do we help disability beneficiaries
to return to work?
We offer certain work incentives to
encourage disability beneficiaries to
attempt to work. We also administer the
Ticket to Work program and other
employment support programs to help
disability beneficiaries become as selfsufficient as possible through work and
to promote their economic
independence. Under certain provisions
of the Act, such as the title II provision
for a trial work period, beneficiaries
may test their ability to work while
keeping their cash and medical benefits.
The Trial Work Period
We provide a trial work period (TWP)
that allows SSDI beneficiaries 5 to test
their ability to work for at least nine
months and not have that work
considered for disability purposes
during that period.6 During this period,
beneficiaries continue to receive full
SSDI benefits, regardless of how much
money they earn, as long as they report
the work activity and continue to have
a disabling impairment. The TWP ends
when a beneficiary has completed nine
trial work months (which do not have
to be consecutive) within a rolling 60month period. (The TWP may end
earlier if we determine that the
beneficiary’s disability ended based on
medical factors.7) We count as a trial
work month any month in which a
beneficiary’s gross earnings are above a
specified amount ($840 a month in
2017) or in which the beneficiary works
more than 80 hours in selfemployment.8
What happens if a beneficiary works
after the TWP?
If a beneficiary works after the TWP
ends, we review the beneficiary’s work
and earnings to decide if the work is
SGA. Work is ‘‘substantial’’ if it involves
doing significant physical or mental
activities. Work activity may be
5 The SSI program under title XVI of the Act does
not provide a TWP. The performance of SGA by a
recipient of SSI payments based on disability or
blindness does not affect the recipient’s disability
or blindness status under the SSI program. Section
1619 of the Act; 20 CFR 416.260–416.269.
6 Sections 222(c) and 223(d)(4) of the Act; 20 CFR
404.1592.
7 Id.
8 20 CFR 404.1592(b).
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‘‘substantial’’ even if it is performed on
a part-time basis. Work activity is
‘‘gainful’’ if it is performed for pay or
profit or is the kind of work usually
performed for pay or profit, whether or
not a profit is realized.9
In deciding whether work is SGA, we
consider the nature of the person’s job
duties, the skills and experience the
person needs to do the job, and how
much the person actually earned.10
Usually, we consider a person’s work to
be substantial and gainful if monthly
earnings, after allowable deductions,
average more than the monthly SGA
amount (in 2017, $1,170 a month for a
person who is not blind, or $1,950 a
month for a person who is blind). If the
person is self-employed, we may give
more consideration to the kind and
value of the work, including the
person’s part in the management of the
business, than to the person’s income
alone.11
When we decide whether work is
SGA and figure earnings, we deduct the
reasonable costs of certain ‘‘impairmentrelated work expenses’’ (IRWEs), that is,
items and services that enable a person
to work.12 We will decide that an SSDI
beneficiary’s disability has ended in the
first month the person performs SGA
after completion of the TWP.13 We pay
benefits for the month disability ended
and the following two months, no
matter how much the beneficiary
earns.14 We call this three-month period
the ‘‘grace period.’’ 15
The Reentitlement Period
Immediately after an SSDI beneficiary
completes the TWP, the reentitlement
period begins. The reentitlement period
is also called the extended period of
eligibility. The reentitlement period
typically lasts for 36 months, but it may
end earlier if we determine that the
beneficiary ceases to have a disabling
impairment for medical reasons.16 The
reentitlement period allows an SSDI
beneficiary with a disabling impairment
an additional period to test the ability
to work.17 If the beneficiary performs
SGA during the reentitlement period,
we will determine that the beneficiary’s
disability has ended, and we will stop
9 20
CFR 404.1572.
CFR 404.1571–404.1576.
11 20 CFR 404.1575.
12 Section 223(d)(4)(A) of the Act; 20 CFR
404.1576.
13 20 CFR 404.1592a(a)(1) and 404.1594(d)(5).
14 20 CFR 404.401a and 404.1592a(a)(2).
15 Program Operations Manual System, DI
13010.210.
16 20 CFR 404.1592a(b).
17 Sections 202(d)(1), (d)(6), (e)(1), and (f)(1) and
223(a)(1) of the Act; 20 CFR 404.316(d), 404.337(d),
404.352(e), 404.401a, and 404.1592a(a).
10 20
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benefits, subject to the grace period.
After the grace period, we will not pay
benefits to the disability beneficiary or
anyone receiving benefits on the
earnings record for any month during
the reentitlement period in which the
disability beneficiary performs SGA.18
However, if the beneficiary does not
perform SGA in a subsequent month in
the reentitlement period, we will pay
benefits again. The beneficiary does not
need to file a new application for the
benefits to start again.
State vocational rehabilitation agency.24
We pay these providers for certain
outcomes achieved by the beneficiary.25
We may pay an outcome payment for
each month for which SSDI benefits and
Federal SSI payments are not payable to
the beneficiary because of the
performance of SGA or by reason of
earnings from work activity.26 If the
beneficiary is an SSDI-only or
concurrent SSDI/SSI beneficiary, we
may make up to 36 outcome
payments.27
Expedited Reinstatement
The Promoting Opportunity
Demonstration (POD)
Expedited reinstatement is an
employment support available under
both the SSDI and SSI programs.19 We
provide expedited reinstatement for 60
months after we terminate entitlement
to disability benefits due to work
activity.20 Rather than filing a new
application for a new period of
entitlement, individuals can, during this
60-month period, request reinstatement
of their prior entitlement to disability
benefits. An individual may receive up
to six consecutive months of provisional
cash benefits and Medicare while we
make a determination about whether the
individual’s prior entitlement will be
reinstated.21 The provisional cash
benefits may be equal to the last
monthly benefit payable during the
prior entitlement. After we approve
reinstatement, the initial reinstatement
period (IRP) begins.22 During the IRP,
the TWP and reentitlement provisions
discussed above do not apply; if a
beneficiary performs SGA in a month
during the IRP, we will not pay benefits
for that month. The IRP ends after a
beneficiary has 24 months of payable
benefits; the months do not have to be
consecutive. At that point, the TWP and
reentitlement provisions discussed
above apply to the beneficiary.
Ticket to Work Program
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In addition to the work incentives
policies discussed above, we also
administer the Ticket to Work program,
which can help disability beneficiaries
access employment services, vocational
rehabilitation services, and other
support services.23 A beneficiary
participates in the program by assigning
a ticket to a qualified provider, which
may be an employment network or a
18 Section 223(e) of the Act; 20 CFR 404.401a and
404.1592a(a)(2).
19 20 CFR 404.1592c.
20 Section 223(i) of the Act; 20 CFR 404.1592b–
404.1592f.
21 Section 223(i)(7) of the Act; 20 CFR 404.1592e.
22 Section 223(i)(6) of the Act; 20 CFR 404.1592f.
23 Section 1148 of the Act; 20 CFR part 411.
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Description of the POD
Under the POD, we will modify title
II disability program rules that we
currently apply to SSDI beneficiaries
who work. We will test alternate rules
to determine their effectiveness in
encouraging SSDI beneficiaries to return
to work or increase their earnings. We
will test simplified work incentives and
use a monthly benefit offset based on
earnings. Under the benefit offset, we
will reduce SSDI benefits by $1 for
every $2 of a beneficiary’s earnings that
are above a certain threshold. The POD
threshold is equal to the greater of (1)
the applicable monthly TWP amount for
the calendar year or (2) itemized IRWEs
up to the SGA amount for the calendar
year.
We have contracted with Abt
Associates to implement the POD and
Mathematica Policy Research to conduct
evaluation activities. We will evaluate
the impact of the benefit offset on work
activity, earnings, and continued receipt
of cash benefits.
Where will we conduct the POD?
We expect to conduct this project in
eight sites across the country:
• Alabama (all counties);
• California (Los Angeles, Orange,
and San Diego counties);
• Connecticut (all counties);
• Maryland (Anne Arundel,
Baltimore, Harford, Howard,
Montgomery, and Prince George’s
counties; Baltimore City);
• Michigan (Barry, Berrien, Branch,
Calhoun, Cass, Kalamazoo, Kent, St.
Joseph, and Van Buren counties);
• Nebraska (Adams, Buffalo, Douglas,
Hall, Lancaster, and Sarpy counties);
• Texas (Bexar, Dallas, and Tarrant
counties); and
24 Section 1148(c) and (f) of the Act; 20 CFR
411.300–411.435.
25 Section 1148(h) of the Act; 20 CFR part 411,
subpart H.
26 Section 1148(h) of the Act; 20 CFR 411.500,
411.525, and 411.575.
27 20 CFR 411.500 and 411.525.
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• Vermont (all counties).
Abt Associates is subcontracting with
the State vocational rehabilitation
agencies or Work Incentive Planning
and Assistance providers in each site to
work directly with the beneficiaries in
this project.
Who is eligible to participate in the
POD?
To be eligible to participate in the
project, a beneficiary must:
• Be at least age 20 and be under age
62 throughout the project;
• Be entitled to title II benefits based
on disability as the insured worker 28
only;
• Receive title II disability cash
benefits, unless we are not paying cash
benefits because the beneficiary is
engaging in SGA after the grace period
and during the reentitlement period;
• Reside in one of the eight sites for
the project, according to our records;
and
• Not be a prior or current treatment
or control group participant in any of
our other demonstration projects.
How will we select participants and
assign them to control or treatment
groups?
We will select potential participants
for the POD from a pool of beneficiaries
who meet the requirements for
participation described above. We
expect to recruit about 15,000
beneficiaries to volunteer to participate
in the POD. We will randomly assign
the beneficiaries who have agreed to
participate in the POD to a control
group or one of two treatment groups, as
described below.
• Control Group—We will assign
approximately 5,000 SSDI beneficiaries
to this group, which will continue to be
subject to our usual program rules. We
will not test any alternate rules with this
group.
• Treatment Group 1—We will assign
approximately 5,000 SSDI beneficiaries
to this group, which will be eligible for
the benefit offset. For any month the
beneficiary’s SSDI benefits are reduced
to zero under the offset, benefits are
suspended for that month. The
beneficiary remains eligible for benefits
for months that the offset does not
reduce benefits to zero.
• Treatment Group 2—We will assign
approximately 5,000 SSDI beneficiaries
to this group, which will be eligible for
the benefit offset. If a beneficiary in this
group has the SSDI benefit reduced to
zero under the offset for 12 consecutive
28 Individuals receiving widow’s or widower’s
insurance benefits or childhood disability benefits
based on someone else’s status as an insured worker
at the time of enrollment are not eligible.
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What provisions of the Act and
regulations are we waiving to provide
alternate rules under the POD?
months, we will terminate the
beneficiary’s entitlement to SSDI.
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How will we conduct the POD?
The evaluation contractor,
Mathematica Policy Research, will
conduct outreach through mailings and
phone calls to recruit and enroll
beneficiaries into the POD, and
randomly assign participants into the
control and treatment groups.
Beneficiaries we recruit and who wish
to participate will sign a consent form
to indicate their agreement to
participate before being randomly
assigned to one of the three groups
described above. All enrolled
beneficiaries can withdraw from the
project at any time. Beneficiaries
randomly assigned to the control group
will receive a notice informing them of
their assignment and that the usual
program rules apply. Beneficiaries
randomly assigned to the treatment
groups will receive a notice informing
them of their assignment and that
alternate program rules will apply for
earnings. The notice will provide
contact information for Abt Associates,
which will be beneficiaries’ central
point of contact for the POD.
The notice will also inform
beneficiaries of the POD-related benefits
counseling available to all treatment
group members. Each site will have
benefits counselors dedicated to the
project who can help beneficiaries
understand the alternate rules under the
POD and how the offset will affect their
SSDI benefit.
Participation in the POD is voluntary,
and a beneficiary may withdraw the
consent to participate in the POD at any
time in writing. A beneficiary who
wishes to withdraw consent will inform
Abt Associates in writing and be offered
counseling on withdrawing from the
demonstration and returning to usual
rules. A beneficiary in a treatment group
who withdraws consent will no longer
be eligible for the alternate program
rules or any project services available
under the POD, but will have the option
to continue to participate in evaluation
activities, such as follow-up surveys. If
a beneficiary chooses not to participate
in the evaluation activities, we will
continue to track the beneficiary for the
project evaluation using program data.
We will apply our usual program rules
to the beneficiary beginning with the
month that withdrawal from the project
becomes effective. We will apply our
usual title II disability program rules for
all participants after the end of the
project, beginning July 2021.
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Alternate Title II Program Rules
The following alternate program rules
will apply to an SSDI beneficiary
assigned to a treatment group during
participation in the POD:
• Eligibility for the benefit offset will
begin after random assignment to a
treatment group and end at the close of
the project in June 2021;
• Payment of SSDI benefits will be
subject to reduction, potentially to zero,
under the benefit offset;
• Payment of benefits to any other
person entitled to benefits on the
earnings record of the SSDI beneficiary
will continue for any month for which
the beneficiary’s SSDI benefit is
partially reduced under the benefit
offset and will stop for months for
which the SSDI benefit is reduced to
zero under the offset;
• For months that SSDI benefits are
reduced to zero under the offset,
benefits are suspended for participants
in both treatment groups. If the
participants’ earnings decrease in a
subsequent month such that the offset
does not reduce the SSDI benefit to zero,
the beneficiary will again receive a
benefit, subject to the offset. If a
participant in treatment group 2 has the
SSDI benefit reduced to zero for 12
consecutive months, we will terminate
entitlement to benefits;
• The TWP will not apply to the
participant;
• The reentitlement period will not
apply to the participant;
• If a participant has entitlement
reinstated under expedited
reinstatement, the IRP will not apply to
the participant;
• If a participant was eligible for
Medicare Part A coverage because of
entitlement to SSDI and the SSDI
entitlement terminates as a result of the
POD’s benefit offset, the participant will
remain eligible for Medicare Part A
coverage for 93 additional months
provided that the person continues to
have the same disabling impairment(s)
that provided the basis for the prior
SSDI entitlement and meets the other
SSDI entitlement requirements;
• No work CDRs will be initiated or
completed during the POD
participation;
• We will continue to pay outcome
payments to qualified providers under
the Ticket to Work program for
participants who earn above SGA,
whether or not their SSDI benefit is
reduced to zero; and
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• Our usual program rules will apply
beginning with the month after
participation in the POD ends.
Applying these alternate rules
involves waiving or altering certain
provisions included in sections 222(c);
223(a)(1), (d)(4), (e), and (i); and 1148(h)
of the Act and 20 CFR 404.316(d),
404.325, 404.401a, 404.1571 through
404.1576, 404.1590, 404.1592,
404.1592a, 404.1592f, 404.1594,
411.500(b)–(e), 411.525(a)(1)(i), and
411.575(b)(1)(i)(A).
When will a participant in one of the
treatment groups be eligible for the
benefit offset?
A beneficiary who is in a treatment
group will be eligible for the benefit
offset after random assignment and
should begin to report earnings to Abt
Associates the month after random
assignment. Thus, if random assignment
is in November, the beneficiary should
report November earnings and IRWEs in
December, and the benefit offset, if any,
will begin with the December benefit,
which is paid in January. Participants
should report earnings and IRWEs
information to the POD through June
2021.
How will we apply the benefit offset?
We will apply the benefit offset on a
monthly basis to reduce SSDI benefits
based on a beneficiary’s report of
monthly earnings and IRWEs.
Participants who report their earnings
and IRWEs information for the prior
month on time in the current month
will have the benefit offset calculated
into the following month’s benefit. For
example, for a participant who reports
April 2018 earnings and IRWEs in May
2018, the offset will be calculated in the
May 2018 benefit, which is paid in June
2018.
In the example below, we show how
we will calculate the amount by which
monthly SSDI benefit payments will be
reduced under the offset for a
beneficiary whose earnings exceed the
POD threshold. In the example, we use
the POD threshold that would apply in
2017.
Example: A beneficiary reports
monthly earnings of $1,040. The POD
threshold is $840. The reported monthly
earnings exceed the threshold by $200.
We will reduce the beneficiary’s SSDI
benefit payment by $100. The
calculations for this example are as
follows:
First, we calculate the monthly
earnings that exceed the POD threshold.
$1,040 (monthly earnings report)
¥$840 (2017 POD threshold)
$200
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Second, we calculate the $1 for $2
benefit offset amount by dividing the
amount of earnings that exceeds the
POD threshold by 2.
$200 ÷ 2 = $100 (monthly $1 for $2
benefit offset amount)
For the purposes of the POD, we will
round the monthly benefit offset amount
resulting from the calculations down to
the nearest dime.
We consider monthly IRWEs in the
calculation only when the total is
greater than the POD threshold. If the
total monthly amount of itemized
IRWEs is greater than the POD
threshold, we will use the total monthly
amount of itemized IRWEs as the
monthly POD threshold for the offset.
However, if the total monthly amount of
itemized IRWEs equals or exceeds the
applicable SGA amount, we will use the
SGA amount as the monthly POD
threshold for the offset.
In the example below, we show how
we will calculate the amount by which
monthly SSDI benefit payments will be
reduced under the offset for a
beneficiary whose earnings and
itemized IRWEs exceed the POD
threshold. In the example, we use the
POD threshold that would apply in
2017.
Example: A beneficiary reports
monthly earnings of $1,040. The
beneficiary also reports monthly
itemized IRWEs of $940 and all are
approved. Since the total monthly
amount of itemized IRWEs is greater
than $840, we use the IRWEs amount as
the POD threshold. The reported
monthly earnings exceed the threshold
by $100. We will reduce the
beneficiary’s SSDI benefit payment by
$50. The calculations for this example
are as follows:
First, we calculate the monthly
earnings that exceed the POD threshold.
continue to report monthly, the prior
reported earnings will carry forward for
subsequent months until the beneficiary
reports earnings again, or until the end
of the project. If the beneficiary is late
in reporting earnings for a month, we
will make appropriate adjustments to
future benefit payments if we determine
that we paid the beneficiary too much
or too little in benefits under the offset
for the months when we carried over
prior earnings. We will send the
beneficiary a written notice of our
determination that will provide appeal
rights.
We will perform an end-of-year
reconciliation after the close of each
calendar year. We will determine the
actual amount of the beneficiary’s
earnings for each month in the calendar
year to decide if the person was paid
more or less in benefits than was due
under the offset. We will make
appropriate adjustments to future
benefit payments if we determine that
we paid the beneficiary too much or too
little in benefits under the offset. We
will send the beneficiary a written
notice of our determination that will
provide appeal rights.
$1,040 (monthly earnings report)
¥$940 (POD threshold is equal to the total
monthly itemized IRWEs)
What options do we provide to
beneficiaries whose entitlement to
disability benefits terminates during the
POD due to work activity?
Participants whose entitlement to
disability benefits terminates due to
work activity during the POD can apply
for expedited reinstatement, as under
current rules. Participants can request
expedited reinstatement of their prior
entitlement for a 60-month period. We
will apply the same criteria used under
current rules to determine whether a
beneficiary meets the requirements for
reinstatement. As under current rules,
an individual may receive up to six
consecutive months of provisional cash
benefits while we make a determination.
Participants in treatment group 2 who
are reinstated will remain in the
demonstration. They will continue in
sradovich on DSK3GMQ082PROD with NOTICES
$100
Second, we calculate the $1 for $2
benefit offset amount by dividing the
amount of earnings that exceeds the
POD threshold by 2.
$100 ÷ 2 = $50 (monthly $1 for $2
benefit offset amount)
For the purposes of the POD, we will
round the monthly benefit offset amount
resulting from the calculations down to
the nearest dime.
What happens if a beneficiary does not
report earnings on a monthly basis?
It is very important that beneficiaries
in the treatment groups report earnings
and IRWEs. If a beneficiary reports
earnings for a month, but does not
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17:59 Oct 27, 2017
Jkt 244001
What happens to beneficiaries whose
benefit is reduced to zero for 12
consecutive months?
When a beneficiary’s earnings are
high enough that the offset amount
equals or exceeds the beneficiary’s SSDI
monthly benefit payment, the
beneficiary will not receive a benefit
payment for that month. That is, the
SSDI benefit is reduced to zero under
the offset, and the benefit is suspended
for that month. Beneficiaries in
treatment group 2 only will have
entitlement terminated after their
benefit is reduced to zero (that is,
suspended) for 12 consecutive months.
PO 00000
Frm 00103
Fmt 4703
Sfmt 4703
the POD treatment group 2 and will be
subject to the applicable alternate rules
for that treatment group. Under current
rules, after we reinstate entitlement
through expedited reinstatement, the
IRP begins. Under POD rules, the IRP
will not apply. See the following section
for further details on the IRP.
A participant whose entitlement is
terminated under the POD will remain
in this terminated status (unless the
person is reinstated as discussed above),
even if the person withdraws from the
project.
What happens to the IRP of a
beneficiary in the POD?
The IRP will not apply to
beneficiaries in treatment groups during
POD participation. When a beneficiary
in a treatment group stops participating
in the POD, the status of the IRP will be
the same as when the beneficiary began
participating in the POD. That means
that if a beneficiary enters the POD
during the beneficiary’s IRP, the IRP
will pick up at the same point after the
beneficiary’s participation in the POD
ends and the beneficiary returns to our
usual rules. If a beneficiary in treatment
group 2 has entitlement terminated
because of the offset but then has
entitlement reinstated under expedited
reinstatement, the beneficiary will
return to participation in treatment
group 2. When the beneficiary’s
participation ends and the beneficiary
returns to usual rules, the beneficiary
will begin the IRP.
What happens to the POD participation
for beneficiaries whose entitlement to
disability benefits terminates for any
reason?
Participants must maintain all SSDI
eligibility requirements to continue
receiving SSDI. For example,
participants will still be subject to
medical CDRs, which could result in a
termination of entitlement on medical
grounds. If a participant’s entitlement
terminates for any reason and we
subsequently approve reinstatement, the
participant will return to the same
treatment group the participant was in
before termination until the participant
withdraws from the project or the
project ends.
What happens to the payment of
benefits to other persons entitled on the
earnings record of a beneficiary whose
SSDI benefit is subject to the offset?
If any other person is entitled to
benefits on the earnings record of a
beneficiary whose SSDI benefit is
subject to the offset, we will pay the
other person the full amount of monthly
cash benefits that the person is
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otherwise due for any month for which
the beneficiary is eligible for payment of
a reduced SSDI benefit under the offset.
However, we will not pay benefits to the
other person for any month for which
the beneficiary’s SSDI benefit is reduced
to zero under the offset. For example, a
beneficiary in a POD treatment group
could have earnings above SGA, and if
the earnings do not result in full offset,
other persons entitled on the
beneficiary’s record will continue to
receive their full amount of benefits for
as long as the beneficiary is
participating in the POD. By contrast,
under current rules, if a beneficiary has
earnings above SGA during the 36month reentitlement period following
the TWP, other persons entitled on the
beneficiary’s record would not continue
to receive benefits.29
sradovich on DSK3GMQ082PROD with NOTICES
What happens to the TWP of a
beneficiary in the POD?
The TWP will not apply to
beneficiaries in treatment groups during
their participation in the POD. A month
during which the participant works and
earns above the TWP amount will not be
considered a trial work month for any
purpose. Once the beneficiary’s
participation in the POD ends, the
beneficiary will, from that point
forward, be subject to our usual rules,
but the work and earnings accumulated
during the POD participation will not be
counted toward a TWP. Upon return to
our usual rules, the beneficiary’s TWP
status will be equal to the TWP status
before participating in the POD. We
will, however, count the period of the
POD participation as part of the rolling
60-month TWP window. For example, if
a beneficiary in a treatment group has
completed four trial work months before
enrolling in the POD, the first month the
beneficiary earns above the TWP
amount after the beneficiary’s
participation in the POD ends will be
the beneficiary’s fifth trial work month.
What happens to the reentitlement
period of a beneficiary in the POD?
The reentitlement period will not
apply to beneficiaries in treatment
groups during POD participation. There
is also no reentitlement-related
assessment to determine whether a
beneficiary’s disability ended during a
reentitlement period because the person
performed SGA. Once the beneficiary’s
participation in the POD ends, the
beneficiary will, from that point
forward, be subject to our usual rules.
Upon return to usual rules, the
beneficiary’s reentitlement status will be
equal to the reentitlement status before
participating in the POD. No work or
earnings during POD participation will
be considered in determining the
reentitlement period upon return to
usual rules.
Will we conduct work continuing
disability reviews during the POD?
We will not initiate work CDRs for
participants in the POD treatment
groups while they are participating in
the POD. If a participant in a POD
treatment group has a work CDR in
progress when POD participation
begins, we will not complete the work
CDR while the person is participating in
the POD.
Will the alternate rules under the POD
affect a beneficiary’s Medicare
coverage?
A beneficiary who is under age 65 and
who has been entitled to SSDI benefits
for 24 months is entitled to Hospital
Insurance (Medicare Part A) under the
Medicare program.30 Entitlement to
Medicare coverage generally continues
as long as a beneficiary’s entitlement to
SSDI benefits continues. However, a
beneficiary whose entitlement to SSDI
benefits terminates due to the
performance of SGA may be entitled to
extended Medicare coverage for a period
of at least 93 months following the end
of the TWP, provided that disability
continues. Under the Act, the period of
extended Medicare coverage is
determined as if the beneficiary had a
15-month reentitlement period
following the end of the TWP.31
Section 234(f)(2)(D) of the Act, created
by section 823 of the BBA of 2015,
provides special rules on Medicare Part
A coverage for some POD participants.
If a participant is entitled to Medicare
Part A coverage because of entitlement
to SSDI benefits and the SSDI
entitlement is terminated as a result of
the POD’s benefit offset, the participant
is entitled to extended Medicare
coverage for a period of 93 months
following the SSDI entitlement
termination, as long as the participant
continues to have the same disabling
impairment(s) that provided the basis
for the prior SSDI entitlement and the
participant meets the other SSDI
entitlement requirements.
What are the alternate rules under the
Ticket to Work program?
We will apply an alternate rule for
paying outcome payments to a qualified
service provider that has been assigned
a ticket by an SSDI-only or concurrent
SSDI/SSI beneficiary in a POD treatment
29 20
CFR 404.1592a.
VerDate Sep<11>2014
17:59 Oct 27, 2017
group. As noted above, under our usual
rules, we may pay outcome payments to
service providers for months in which
SSDI benefits are not payable to a
beneficiary because earnings are at or
above the SGA level. Under the POD’s
offset, however, a beneficiary’s earnings
may be at or above the SGA level and
yet still not be high enough to reduce
the SSDI benefit to zero. Thus, applying
our normal Ticket to Work program
rules could unduly burden these service
providers, since they would not receive
the outcome payments that they would
otherwise be eligible for if the
beneficiary was not participating in the
POD. Therefore, for the POD, we will
pay an outcome payment to the provider
for each month the participant earns
above SGA, whether or not the SSDI
benefit is reduced to zero. This process
will occur only during a beneficiary’s
POD participation period.
We will apply our usual rules for
paying outcome payments beginning
with the first month after a beneficiary’s
POD participation period ends. We will
continue to limit the number of months
for which outcome payments may be
made based on the same ticket to a
maximum of 36 months. We will count
any month for which we pay an
outcome payment under the alternate
rule or our usual rule toward this 36month limit.
What is our authority for conducting the
POD?
Section 234 of the Act authorizes
experiments and demonstration projects
designed to promote attachment to the
labor force, including projects that test
alternative methods of treating work
activity of SSDI beneficiaries and that
involve the waiver of certain program
rules. Section 234(f) of the Act, added
by section 823 of the BBA of 2015,
specifically requires that we conduct the
POD. We are conducting the POD
consistent with the requirements in
section 234(e) of the Act that
participation in a demonstration project
must be voluntary and based on
informed written consent, and that the
voluntary agreement to participate may
be withdrawn by the volunteer at any
time.
Authority: Section 234 of the Act.
Nancy A. Berryhill,
Acting Commissioner of Social Security.
[FR Doc. 2017–23521 Filed 10–27–17; 8:45 am]
BILLING CODE 4191–02–P
30 Section
226(b) of the Act; 42 CFR 406.12.
31 Id.
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]]>Agencies
[Federal Register Volume 82, Number 208 (Monday, October 30, 2017)]
[Notices]
[Pages 50214-50219]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-23521]
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SOCIAL SECURITY ADMINISTRATION
[Docket No. SSA-2017-0032]
Social Security Disability Program Demonstration Project:
Promoting Opportunity Demonstration (POD)
AGENCY: Social Security Administration.
ACTION: Notice.
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SUMMARY: We are announcing a demonstration project for the Social
Security disability program under title II of the Social Security Act
(Act). Under this project, we will modify program rules applied to
beneficiaries who work and receive title II disability benefits. We are
required to conduct the Promoting Opportunity Demonstration (POD), in
compliance with section 823 of the Bipartisan Budget Act (BBA) of 2015.
In this project, we will test simplified work incentives and use a
benefit offset based on earnings as an alternative to rules we
currently apply to title II disability beneficiaries who work. Under
the benefit offset, we will reduce title II disability benefits by $1
for every $2 that a beneficiary earns above a certain threshold.
We will select beneficiaries and offer them the opportunity to
volunteer for the project. When we make the selection, we will include
beneficiaries who receive title II disability benefits only as well as
beneficiaries who receive both title II disability benefits and
Supplemental Security Income (SSI) based on disability or blindness
under title XVI of the Act. We are modifying rules that apply to the
title II program and the Ticket to Work program under title XI. We will
continue to apply the usual SSI program rules for participants who
receive SSI payments in addition to title II disability benefits.
DATES: We plan to begin this project in November 2017 and end it in
June 2021.
FOR FURTHER INFORMATION CONTACT: Jeffrey Hemmeter, Office of Retirement
and Disability Policy, Social Security Administration, 6401 Security
Boulevard, Baltimore, MD 21235, (410) 597-1815.
SUPPLEMENTARY INFORMATION:
[[Page 50215]]
Background
We are required to conduct this demonstration under Social Security
Act section 234(f).\1\
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\1\ Section 823 of the Bipartisan Budget Act of 2015, Public Law
114-74, added this requirement.
---------------------------------------------------------------------------
In this section, we broadly outline our usual rules for paying
disability benefits, how those benefits may terminate, and the work
incentives that affect payments. Then, we discuss the modified rules we
will apply under the demonstration project.
Who may receive disability benefits?
Under title II of the Act, we pay the following benefits to persons
who meet the Act's definition of disability:
Disability insurance benefits for a worker insured under
the Act;
Widow's and widower's insurance benefits based on
disability for a widow, widower, or surviving divorced spouse of an
insured worker; and
Childhood disability benefits for a child of an insured
worker who is entitled to retirement or disability benefits or has
died.
In the rest of this notice, we refer to these benefits collectively
as Social Security Disability Insurance (SSDI) benefits and refer to
the beneficiaries who receive them as SSDI beneficiaries.
Under title XVI of the Act, we pay SSI to persons who are aged,
blind, or disabled, and who also have limited income and resources. An
SSDI beneficiary with limited income and resources may qualify for SSI
payments.
A person must meet the definition of disability under title II of
the Act in order to be eligible for SSDI benefits. A person is disabled
under title II if the person has a physical or mental impairment or
combination of impairments that has lasted or is expected to last for
at least 12 months or can be expected to result in death and that
prevents the person from doing any substantial gainful activity
(SGA).\2\ This definition also applies under title XVI of the Act for
persons age 18 or older who receive payments based on disability.\3\
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\2\ Section 223(d)(1)(A) of the Act; 20 CFR 404.1505(a).
\3\ Section 1614(a)(3)(A) of the Act; 20 CFR 416.905(a).
---------------------------------------------------------------------------
Continuing Disability Reviews
We periodically reevaluate a disability beneficiary's impairment(s)
to determine whether the person continues to be under a disability.\4\
We call this evaluation a continuing disability review (CDR). We
conduct CDRs at regularly scheduled intervals. We may begin a CDR at a
time other than a regular interval if circumstances warrant. There are
two main types of CDRs: (1) Medical CDRs, in which we examine medical
improvement, if any, and (2) work CDRs, in which we examine earnings.
If we determine in a CDR that the individual is no longer under a
disability, we will stop benefits in most cases.
---------------------------------------------------------------------------
\4\ Section 221(i), (m) of the Act; 20 CFR 404.1589, 404.1590,
and 404.1594.
---------------------------------------------------------------------------
How do we help disability beneficiaries to return to work?
We offer certain work incentives to encourage disability
beneficiaries to attempt to work. We also administer the Ticket to Work
program and other employment support programs to help disability
beneficiaries become as self-sufficient as possible through work and to
promote their economic independence. Under certain provisions of the
Act, such as the title II provision for a trial work period,
beneficiaries may test their ability to work while keeping their cash
and medical benefits.
The Trial Work Period
We provide a trial work period (TWP) that allows SSDI beneficiaries
\5\ to test their ability to work for at least nine months and not have
that work considered for disability purposes during that period.\6\
During this period, beneficiaries continue to receive full SSDI
benefits, regardless of how much money they earn, as long as they
report the work activity and continue to have a disabling impairment.
The TWP ends when a beneficiary has completed nine trial work months
(which do not have to be consecutive) within a rolling 60-month period.
(The TWP may end earlier if we determine that the beneficiary's
disability ended based on medical factors.\7\) We count as a trial work
month any month in which a beneficiary's gross earnings are above a
specified amount ($840 a month in 2017) or in which the beneficiary
works more than 80 hours in self-employment.\8\
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\5\ The SSI program under title XVI of the Act does not provide
a TWP. The performance of SGA by a recipient of SSI payments based
on disability or blindness does not affect the recipient's
disability or blindness status under the SSI program. Section 1619
of the Act; 20 CFR 416.260-416.269.
\6\ Sections 222(c) and 223(d)(4) of the Act; 20 CFR 404.1592.
\7\ Id.
\8\ 20 CFR 404.1592(b).
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What happens if a beneficiary works after the TWP?
If a beneficiary works after the TWP ends, we review the
beneficiary's work and earnings to decide if the work is SGA. Work is
``substantial'' if it involves doing significant physical or mental
activities. Work activity may be ``substantial'' even if it is
performed on a part-time basis. Work activity is ``gainful'' if it is
performed for pay or profit or is the kind of work usually performed
for pay or profit, whether or not a profit is realized.\9\
---------------------------------------------------------------------------
\9\ 20 CFR 404.1572.
---------------------------------------------------------------------------
In deciding whether work is SGA, we consider the nature of the
person's job duties, the skills and experience the person needs to do
the job, and how much the person actually earned.\10\ Usually, we
consider a person's work to be substantial and gainful if monthly
earnings, after allowable deductions, average more than the monthly SGA
amount (in 2017, $1,170 a month for a person who is not blind, or
$1,950 a month for a person who is blind). If the person is self-
employed, we may give more consideration to the kind and value of the
work, including the person's part in the management of the business,
than to the person's income alone.\11\
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\10\ 20 CFR 404.1571-404.1576.
\11\ 20 CFR 404.1575.
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When we decide whether work is SGA and figure earnings, we deduct
the reasonable costs of certain ``impairment-related work expenses''
(IRWEs), that is, items and services that enable a person to work.\12\
We will decide that an SSDI beneficiary's disability has ended in the
first month the person performs SGA after completion of the TWP.\13\ We
pay benefits for the month disability ended and the following two
months, no matter how much the beneficiary earns.\14\ We call this
three-month period the ``grace period.'' \15\
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\12\ Section 223(d)(4)(A) of the Act; 20 CFR 404.1576.
\13\ 20 CFR 404.1592a(a)(1) and 404.1594(d)(5).
\14\ 20 CFR 404.401a and 404.1592a(a)(2).
\15\ Program Operations Manual System, DI 13010.210.
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The Reentitlement Period
Immediately after an SSDI beneficiary completes the TWP, the
reentitlement period begins. The reentitlement period is also called
the extended period of eligibility. The reentitlement period typically
lasts for 36 months, but it may end earlier if we determine that the
beneficiary ceases to have a disabling impairment for medical
reasons.\16\ The reentitlement period allows an SSDI beneficiary with a
disabling impairment an additional period to test the ability to
work.\17\ If the beneficiary performs SGA during the reentitlement
period, we will determine that the beneficiary's disability has ended,
and we will stop
[[Page 50216]]
benefits, subject to the grace period. After the grace period, we will
not pay benefits to the disability beneficiary or anyone receiving
benefits on the earnings record for any month during the reentitlement
period in which the disability beneficiary performs SGA.\18\ However,
if the beneficiary does not perform SGA in a subsequent month in the
reentitlement period, we will pay benefits again. The beneficiary does
not need to file a new application for the benefits to start again.
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\16\ 20 CFR 404.1592a(b).
\17\ Sections 202(d)(1), (d)(6), (e)(1), and (f)(1) and
223(a)(1) of the Act; 20 CFR 404.316(d), 404.337(d), 404.352(e),
404.401a, and 404.1592a(a).
\18\ Section 223(e) of the Act; 20 CFR 404.401a and
404.1592a(a)(2).
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Expedited Reinstatement
Expedited reinstatement is an employment support available under
both the SSDI and SSI programs.\19\ We provide expedited reinstatement
for 60 months after we terminate entitlement to disability benefits due
to work activity.\20\ Rather than filing a new application for a new
period of entitlement, individuals can, during this 60-month period,
request reinstatement of their prior entitlement to disability
benefits. An individual may receive up to six consecutive months of
provisional cash benefits and Medicare while we make a determination
about whether the individual's prior entitlement will be
reinstated.\21\ The provisional cash benefits may be equal to the last
monthly benefit payable during the prior entitlement. After we approve
reinstatement, the initial reinstatement period (IRP) begins.\22\
During the IRP, the TWP and reentitlement provisions discussed above do
not apply; if a beneficiary performs SGA in a month during the IRP, we
will not pay benefits for that month. The IRP ends after a beneficiary
has 24 months of payable benefits; the months do not have to be
consecutive. At that point, the TWP and reentitlement provisions
discussed above apply to the beneficiary.
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\19\ 20 CFR 404.1592c.
\20\ Section 223(i) of the Act; 20 CFR 404.1592b-404.1592f.
\21\ Section 223(i)(7) of the Act; 20 CFR 404.1592e.
\22\ Section 223(i)(6) of the Act; 20 CFR 404.1592f.
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Ticket to Work Program
In addition to the work incentives policies discussed above, we
also administer the Ticket to Work program, which can help disability
beneficiaries access employment services, vocational rehabilitation
services, and other support services.\23\ A beneficiary participates in
the program by assigning a ticket to a qualified provider, which may be
an employment network or a State vocational rehabilitation agency.\24\
We pay these providers for certain outcomes achieved by the
beneficiary.\25\ We may pay an outcome payment for each month for which
SSDI benefits and Federal SSI payments are not payable to the
beneficiary because of the performance of SGA or by reason of earnings
from work activity.\26\ If the beneficiary is an SSDI-only or
concurrent SSDI/SSI beneficiary, we may make up to 36 outcome
payments.\27\
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\23\ Section 1148 of the Act; 20 CFR part 411.
\24\ Section 1148(c) and (f) of the Act; 20 CFR 411.300-411.435.
\25\ Section 1148(h) of the Act; 20 CFR part 411, subpart H.
\26\ Section 1148(h) of the Act; 20 CFR 411.500, 411.525, and
411.575.
\27\ 20 CFR 411.500 and 411.525.
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The Promoting Opportunity Demonstration (POD)
Description of the POD
Under the POD, we will modify title II disability program rules
that we currently apply to SSDI beneficiaries who work. We will test
alternate rules to determine their effectiveness in encouraging SSDI
beneficiaries to return to work or increase their earnings. We will
test simplified work incentives and use a monthly benefit offset based
on earnings. Under the benefit offset, we will reduce SSDI benefits by
$1 for every $2 of a beneficiary's earnings that are above a certain
threshold. The POD threshold is equal to the greater of (1) the
applicable monthly TWP amount for the calendar year or (2) itemized
IRWEs up to the SGA amount for the calendar year.
We have contracted with Abt Associates to implement the POD and
Mathematica Policy Research to conduct evaluation activities. We will
evaluate the impact of the benefit offset on work activity, earnings,
and continued receipt of cash benefits.
Where will we conduct the POD?
We expect to conduct this project in eight sites across the
country:
Alabama (all counties);
California (Los Angeles, Orange, and San Diego counties);
Connecticut (all counties);
Maryland (Anne Arundel, Baltimore, Harford, Howard,
Montgomery, and Prince George's counties; Baltimore City);
Michigan (Barry, Berrien, Branch, Calhoun, Cass,
Kalamazoo, Kent, St. Joseph, and Van Buren counties);
Nebraska (Adams, Buffalo, Douglas, Hall, Lancaster, and
Sarpy counties);
Texas (Bexar, Dallas, and Tarrant counties); and
Vermont (all counties).
Abt Associates is subcontracting with the State vocational
rehabilitation agencies or Work Incentive Planning and Assistance
providers in each site to work directly with the beneficiaries in this
project.
Who is eligible to participate in the POD?
To be eligible to participate in the project, a beneficiary must:
Be at least age 20 and be under age 62 throughout the
project;
Be entitled to title II benefits based on disability as
the insured worker \28\ only;
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\28\ Individuals receiving widow's or widower's insurance
benefits or childhood disability benefits based on someone else's
status as an insured worker at the time of enrollment are not
eligible.
---------------------------------------------------------------------------
Receive title II disability cash benefits, unless we are
not paying cash benefits because the beneficiary is engaging in SGA
after the grace period and during the reentitlement period;
Reside in one of the eight sites for the project,
according to our records; and
Not be a prior or current treatment or control group
participant in any of our other demonstration projects.
How will we select participants and assign them to control or treatment
groups?
We will select potential participants for the POD from a pool of
beneficiaries who meet the requirements for participation described
above. We expect to recruit about 15,000 beneficiaries to volunteer to
participate in the POD. We will randomly assign the beneficiaries who
have agreed to participate in the POD to a control group or one of two
treatment groups, as described below.
Control Group--We will assign approximately 5,000 SSDI
beneficiaries to this group, which will continue to be subject to our
usual program rules. We will not test any alternate rules with this
group.
Treatment Group 1--We will assign approximately 5,000 SSDI
beneficiaries to this group, which will be eligible for the benefit
offset. For any month the beneficiary's SSDI benefits are reduced to
zero under the offset, benefits are suspended for that month. The
beneficiary remains eligible for benefits for months that the offset
does not reduce benefits to zero.
Treatment Group 2--We will assign approximately 5,000 SSDI
beneficiaries to this group, which will be eligible for the benefit
offset. If a beneficiary in this group has the SSDI benefit reduced to
zero under the offset for 12 consecutive
[[Page 50217]]
months, we will terminate the beneficiary's entitlement to SSDI.
How will we conduct the POD?
The evaluation contractor, Mathematica Policy Research, will
conduct outreach through mailings and phone calls to recruit and enroll
beneficiaries into the POD, and randomly assign participants into the
control and treatment groups. Beneficiaries we recruit and who wish to
participate will sign a consent form to indicate their agreement to
participate before being randomly assigned to one of the three groups
described above. All enrolled beneficiaries can withdraw from the
project at any time. Beneficiaries randomly assigned to the control
group will receive a notice informing them of their assignment and that
the usual program rules apply. Beneficiaries randomly assigned to the
treatment groups will receive a notice informing them of their
assignment and that alternate program rules will apply for earnings.
The notice will provide contact information for Abt Associates, which
will be beneficiaries' central point of contact for the POD.
The notice will also inform beneficiaries of the POD-related
benefits counseling available to all treatment group members. Each site
will have benefits counselors dedicated to the project who can help
beneficiaries understand the alternate rules under the POD and how the
offset will affect their SSDI benefit.
Participation in the POD is voluntary, and a beneficiary may
withdraw the consent to participate in the POD at any time in writing.
A beneficiary who wishes to withdraw consent will inform Abt Associates
in writing and be offered counseling on withdrawing from the
demonstration and returning to usual rules. A beneficiary in a
treatment group who withdraws consent will no longer be eligible for
the alternate program rules or any project services available under the
POD, but will have the option to continue to participate in evaluation
activities, such as follow-up surveys. If a beneficiary chooses not to
participate in the evaluation activities, we will continue to track the
beneficiary for the project evaluation using program data. We will
apply our usual program rules to the beneficiary beginning with the
month that withdrawal from the project becomes effective. We will apply
our usual title II disability program rules for all participants after
the end of the project, beginning July 2021.
What provisions of the Act and regulations are we waiving to provide
alternate rules under the POD?
Alternate Title II Program Rules
The following alternate program rules will apply to an SSDI
beneficiary assigned to a treatment group during participation in the
POD:
Eligibility for the benefit offset will begin after random
assignment to a treatment group and end at the close of the project in
June 2021;
Payment of SSDI benefits will be subject to reduction,
potentially to zero, under the benefit offset;
Payment of benefits to any other person entitled to
benefits on the earnings record of the SSDI beneficiary will continue
for any month for which the beneficiary's SSDI benefit is partially
reduced under the benefit offset and will stop for months for which the
SSDI benefit is reduced to zero under the offset;
For months that SSDI benefits are reduced to zero under
the offset, benefits are suspended for participants in both treatment
groups. If the participants' earnings decrease in a subsequent month
such that the offset does not reduce the SSDI benefit to zero, the
beneficiary will again receive a benefit, subject to the offset. If a
participant in treatment group 2 has the SSDI benefit reduced to zero
for 12 consecutive months, we will terminate entitlement to benefits;
The TWP will not apply to the participant;
The reentitlement period will not apply to the
participant;
If a participant has entitlement reinstated under
expedited reinstatement, the IRP will not apply to the participant;
If a participant was eligible for Medicare Part A coverage
because of entitlement to SSDI and the SSDI entitlement terminates as a
result of the POD's benefit offset, the participant will remain
eligible for Medicare Part A coverage for 93 additional months provided
that the person continues to have the same disabling impairment(s) that
provided the basis for the prior SSDI entitlement and meets the other
SSDI entitlement requirements;
No work CDRs will be initiated or completed during the POD
participation;
We will continue to pay outcome payments to qualified
providers under the Ticket to Work program for participants who earn
above SGA, whether or not their SSDI benefit is reduced to zero; and
Our usual program rules will apply beginning with the
month after participation in the POD ends.
Applying these alternate rules involves waiving or altering certain
provisions included in sections 222(c); 223(a)(1), (d)(4), (e), and
(i); and 1148(h) of the Act and 20 CFR 404.316(d), 404.325, 404.401a,
404.1571 through 404.1576, 404.1590, 404.1592, 404.1592a, 404.1592f,
404.1594, 411.500(b)-(e), 411.525(a)(1)(i), and 411.575(b)(1)(i)(A).
When will a participant in one of the treatment groups be eligible for
the benefit offset?
A beneficiary who is in a treatment group will be eligible for the
benefit offset after random assignment and should begin to report
earnings to Abt Associates the month after random assignment. Thus, if
random assignment is in November, the beneficiary should report
November earnings and IRWEs in December, and the benefit offset, if
any, will begin with the December benefit, which is paid in January.
Participants should report earnings and IRWEs information to the POD
through June 2021.
How will we apply the benefit offset?
We will apply the benefit offset on a monthly basis to reduce SSDI
benefits based on a beneficiary's report of monthly earnings and IRWEs.
Participants who report their earnings and IRWEs information for the
prior month on time in the current month will have the benefit offset
calculated into the following month's benefit. For example, for a
participant who reports April 2018 earnings and IRWEs in May 2018, the
offset will be calculated in the May 2018 benefit, which is paid in
June 2018.
In the example below, we show how we will calculate the amount by
which monthly SSDI benefit payments will be reduced under the offset
for a beneficiary whose earnings exceed the POD threshold. In the
example, we use the POD threshold that would apply in 2017.
Example: A beneficiary reports monthly earnings of $1,040. The POD
threshold is $840. The reported monthly earnings exceed the threshold
by $200. We will reduce the beneficiary's SSDI benefit payment by $100.
The calculations for this example are as follows:
First, we calculate the monthly earnings that exceed the POD
threshold.
$1,040 (monthly earnings report)
-$840 (2017 POD threshold)
------------------------------------------------------------------------
$200
[[Page 50218]]
Second, we calculate the $1 for $2 benefit offset amount by
dividing the amount of earnings that exceeds the POD threshold by 2.
$200 / 2 = $100 (monthly $1 for $2 benefit offset amount)
For the purposes of the POD, we will round the monthly benefit
offset amount resulting from the calculations down to the nearest dime.
We consider monthly IRWEs in the calculation only when the total is
greater than the POD threshold. If the total monthly amount of itemized
IRWEs is greater than the POD threshold, we will use the total monthly
amount of itemized IRWEs as the monthly POD threshold for the offset.
However, if the total monthly amount of itemized IRWEs equals or
exceeds the applicable SGA amount, we will use the SGA amount as the
monthly POD threshold for the offset.
In the example below, we show how we will calculate the amount by
which monthly SSDI benefit payments will be reduced under the offset
for a beneficiary whose earnings and itemized IRWEs exceed the POD
threshold. In the example, we use the POD threshold that would apply in
2017.
Example: A beneficiary reports monthly earnings of $1,040. The
beneficiary also reports monthly itemized IRWEs of $940 and all are
approved. Since the total monthly amount of itemized IRWEs is greater
than $840, we use the IRWEs amount as the POD threshold. The reported
monthly earnings exceed the threshold by $100. We will reduce the
beneficiary's SSDI benefit payment by $50. The calculations for this
example are as follows:
First, we calculate the monthly earnings that exceed the POD
threshold.
$1,040 (monthly earnings report)
-$940 (POD threshold is equal to the total monthly itemized IRWEs)
------------------------------------------------------------------------
$100
Second, we calculate the $1 for $2 benefit offset amount by
dividing the amount of earnings that exceeds the POD threshold by 2.
$100 / 2 = $50 (monthly $1 for $2 benefit offset amount)
For the purposes of the POD, we will round the monthly benefit
offset amount resulting from the calculations down to the nearest dime.
What happens if a beneficiary does not report earnings on a monthly
basis?
It is very important that beneficiaries in the treatment groups
report earnings and IRWEs. If a beneficiary reports earnings for a
month, but does not continue to report monthly, the prior reported
earnings will carry forward for subsequent months until the beneficiary
reports earnings again, or until the end of the project. If the
beneficiary is late in reporting earnings for a month, we will make
appropriate adjustments to future benefit payments if we determine that
we paid the beneficiary too much or too little in benefits under the
offset for the months when we carried over prior earnings. We will send
the beneficiary a written notice of our determination that will provide
appeal rights.
We will perform an end-of-year reconciliation after the close of
each calendar year. We will determine the actual amount of the
beneficiary's earnings for each month in the calendar year to decide if
the person was paid more or less in benefits than was due under the
offset. We will make appropriate adjustments to future benefit payments
if we determine that we paid the beneficiary too much or too little in
benefits under the offset. We will send the beneficiary a written
notice of our determination that will provide appeal rights.
What happens to beneficiaries whose benefit is reduced to zero for 12
consecutive months?
When a beneficiary's earnings are high enough that the offset
amount equals or exceeds the beneficiary's SSDI monthly benefit
payment, the beneficiary will not receive a benefit payment for that
month. That is, the SSDI benefit is reduced to zero under the offset,
and the benefit is suspended for that month. Beneficiaries in treatment
group 2 only will have entitlement terminated after their benefit is
reduced to zero (that is, suspended) for 12 consecutive months.
What options do we provide to beneficiaries whose entitlement to
disability benefits terminates during the POD due to work activity?
Participants whose entitlement to disability benefits terminates
due to work activity during the POD can apply for expedited
reinstatement, as under current rules. Participants can request
expedited reinstatement of their prior entitlement for a 60-month
period. We will apply the same criteria used under current rules to
determine whether a beneficiary meets the requirements for
reinstatement. As under current rules, an individual may receive up to
six consecutive months of provisional cash benefits while we make a
determination.
Participants in treatment group 2 who are reinstated will remain in
the demonstration. They will continue in the POD treatment group 2 and
will be subject to the applicable alternate rules for that treatment
group. Under current rules, after we reinstate entitlement through
expedited reinstatement, the IRP begins. Under POD rules, the IRP will
not apply. See the following section for further details on the IRP.
A participant whose entitlement is terminated under the POD will
remain in this terminated status (unless the person is reinstated as
discussed above), even if the person withdraws from the project.
What happens to the IRP of a beneficiary in the POD?
The IRP will not apply to beneficiaries in treatment groups during
POD participation. When a beneficiary in a treatment group stops
participating in the POD, the status of the IRP will be the same as
when the beneficiary began participating in the POD. That means that if
a beneficiary enters the POD during the beneficiary's IRP, the IRP will
pick up at the same point after the beneficiary's participation in the
POD ends and the beneficiary returns to our usual rules. If a
beneficiary in treatment group 2 has entitlement terminated because of
the offset but then has entitlement reinstated under expedited
reinstatement, the beneficiary will return to participation in
treatment group 2. When the beneficiary's participation ends and the
beneficiary returns to usual rules, the beneficiary will begin the IRP.
What happens to the POD participation for beneficiaries whose
entitlement to disability benefits terminates for any reason?
Participants must maintain all SSDI eligibility requirements to
continue receiving SSDI. For example, participants will still be
subject to medical CDRs, which could result in a termination of
entitlement on medical grounds. If a participant's entitlement
terminates for any reason and we subsequently approve reinstatement,
the participant will return to the same treatment group the participant
was in before termination until the participant withdraws from the
project or the project ends.
What happens to the payment of benefits to other persons entitled on
the earnings record of a beneficiary whose SSDI benefit is subject to
the offset?
If any other person is entitled to benefits on the earnings record
of a beneficiary whose SSDI benefit is subject to the offset, we will
pay the other person the full amount of monthly cash benefits that the
person is
[[Page 50219]]
otherwise due for any month for which the beneficiary is eligible for
payment of a reduced SSDI benefit under the offset. However, we will
not pay benefits to the other person for any month for which the
beneficiary's SSDI benefit is reduced to zero under the offset. For
example, a beneficiary in a POD treatment group could have earnings
above SGA, and if the earnings do not result in full offset, other
persons entitled on the beneficiary's record will continue to receive
their full amount of benefits for as long as the beneficiary is
participating in the POD. By contrast, under current rules, if a
beneficiary has earnings above SGA during the 36-month reentitlement
period following the TWP, other persons entitled on the beneficiary's
record would not continue to receive benefits.\29\
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\29\ 20 CFR 404.1592a.
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What happens to the TWP of a beneficiary in the POD?
The TWP will not apply to beneficiaries in treatment groups during
their participation in the POD. A month during which the participant
works and earns above the TWP amount will not be considered a trial
work month for any purpose. Once the beneficiary's participation in the
POD ends, the beneficiary will, from that point forward, be subject to
our usual rules, but the work and earnings accumulated during the POD
participation will not be counted toward a TWP. Upon return to our
usual rules, the beneficiary's TWP status will be equal to the TWP
status before participating in the POD. We will, however, count the
period of the POD participation as part of the rolling 60-month TWP
window. For example, if a beneficiary in a treatment group has
completed four trial work months before enrolling in the POD, the first
month the beneficiary earns above the TWP amount after the
beneficiary's participation in the POD ends will be the beneficiary's
fifth trial work month.
What happens to the reentitlement period of a beneficiary in the POD?
The reentitlement period will not apply to beneficiaries in
treatment groups during POD participation. There is also no
reentitlement-related assessment to determine whether a beneficiary's
disability ended during a reentitlement period because the person
performed SGA. Once the beneficiary's participation in the POD ends,
the beneficiary will, from that point forward, be subject to our usual
rules. Upon return to usual rules, the beneficiary's reentitlement
status will be equal to the reentitlement status before participating
in the POD. No work or earnings during POD participation will be
considered in determining the reentitlement period upon return to usual
rules.
Will we conduct work continuing disability reviews during the POD?
We will not initiate work CDRs for participants in the POD
treatment groups while they are participating in the POD. If a
participant in a POD treatment group has a work CDR in progress when
POD participation begins, we will not complete the work CDR while the
person is participating in the POD.
Will the alternate rules under the POD affect a beneficiary's Medicare
coverage?
A beneficiary who is under age 65 and who has been entitled to SSDI
benefits for 24 months is entitled to Hospital Insurance (Medicare Part
A) under the Medicare program.\30\ Entitlement to Medicare coverage
generally continues as long as a beneficiary's entitlement to SSDI
benefits continues. However, a beneficiary whose entitlement to SSDI
benefits terminates due to the performance of SGA may be entitled to
extended Medicare coverage for a period of at least 93 months following
the end of the TWP, provided that disability continues. Under the Act,
the period of extended Medicare coverage is determined as if the
beneficiary had a 15-month reentitlement period following the end of
the TWP.\31\
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\30\ Section 226(b) of the Act; 42 CFR 406.12.
\31\ Id.
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Section 234(f)(2)(D) of the Act, created by section 823 of the BBA
of 2015, provides special rules on Medicare Part A coverage for some
POD participants. If a participant is entitled to Medicare Part A
coverage because of entitlement to SSDI benefits and the SSDI
entitlement is terminated as a result of the POD's benefit offset, the
participant is entitled to extended Medicare coverage for a period of
93 months following the SSDI entitlement termination, as long as the
participant continues to have the same disabling impairment(s) that
provided the basis for the prior SSDI entitlement and the participant
meets the other SSDI entitlement requirements.
What are the alternate rules under the Ticket to Work program?
We will apply an alternate rule for paying outcome payments to a
qualified service provider that has been assigned a ticket by an SSDI-
only or concurrent SSDI/SSI beneficiary in a POD treatment group. As
noted above, under our usual rules, we may pay outcome payments to
service providers for months in which SSDI benefits are not payable to
a beneficiary because earnings are at or above the SGA level. Under the
POD's offset, however, a beneficiary's earnings may be at or above the
SGA level and yet still not be high enough to reduce the SSDI benefit
to zero. Thus, applying our normal Ticket to Work program rules could
unduly burden these service providers, since they would not receive the
outcome payments that they would otherwise be eligible for if the
beneficiary was not participating in the POD. Therefore, for the POD,
we will pay an outcome payment to the provider for each month the
participant earns above SGA, whether or not the SSDI benefit is reduced
to zero. This process will occur only during a beneficiary's POD
participation period.
We will apply our usual rules for paying outcome payments beginning
with the first month after a beneficiary's POD participation period
ends. We will continue to limit the number of months for which outcome
payments may be made based on the same ticket to a maximum of 36
months. We will count any month for which we pay an outcome payment
under the alternate rule or our usual rule toward this 36-month limit.
What is our authority for conducting the POD?
Section 234 of the Act authorizes experiments and demonstration
projects designed to promote attachment to the labor force, including
projects that test alternative methods of treating work activity of
SSDI beneficiaries and that involve the waiver of certain program
rules. Section 234(f) of the Act, added by section 823 of the BBA of
2015, specifically requires that we conduct the POD. We are conducting
the POD consistent with the requirements in section 234(e) of the Act
that participation in a demonstration project must be voluntary and
based on informed written consent, and that the voluntary agreement to
participate may be withdrawn by the volunteer at any time.
Authority: Section 234 of the Act.
Nancy A. Berryhill,
Acting Commissioner of Social Security.
[FR Doc. 2017-23521 Filed 10-27-17; 8:45 am]
BILLING CODE 4191-02-P
