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Protection and Advocacy

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					     PABSS
 Protection and
    Advocacy
for Beneficiaries
of Social Security   1
      Program Administration
   Established by the Ticket To Work and
    Work Incentives Improvement Act of
    1999
   Administered by the Social Security
    Administration through a grant to Guam
    Legal Services Corporation


                                         2
Program Purposes
   Provide information and advice about
    obtaining vocational rehabilitation and
    employment services
   Provide advocacy and other services
    needed to secure or regain gainful
    employment


                                              3
Fund Purposes
   To serve individuals who are currently
    entitled or eligible beneficiaries for
    Social Security Disability Benefits




                                             4
          Program Priorities
   Investigate and review any complaint of
    improper or inadequate services
    provided by a service provider,
    employer or other entity, except SSA,
    involved in the effort to return to work




                                           5
Program Priorities
   Provide information and referral about
    work incentives and
    employment,including employment
    under the Ticket to Work Program




                                             6
Program Priorities
   Provide information and assistance on
    work incentives to individuals,
    government agencies, employment
    networks and other service providers




                                            7
Program Priorities
   Provide consultation and, when
    necessary, legal representation to
    protect the rights of beneficiaries in
    their efforts to return to work




                                             8
Program Priorities
   Identify and correct deficiencies in the
    provision of VR, employment and other
    support services, including those related
    to the Ticket to Work Program.




                                            9
Program Priorities
   Assist beneficiaries with disabilities in
    disputes before SSA involving work-
    related program decisions and benefits
    overpayments that are clearly a
    barrier to obtaining employment.
   (overpayment due to excess earnings)


                                                10
Program Priorities
   Pursue appeals of continuing disability
    review determinations based on
    substantial gainful activity
   Advice on consideration of potential
    subsidies, impairment related work
    expenses and plans for achieving self
    support (PASS)

                                              11
SOCIAL SECURITY DISABILITY
INSURANCE (SSDI)
   The SSDI program has several work
    incentives, designed to encourage
    people with disabilities to work.
   “all or nothing” program ..you’re either
    eligible to receive the entire SSDI check
    or none of it.


                                            12
TICKET TO WORK PROGRAM
   Created by the Ticket to Work
    Incentives Improvement Act, 1999.
   For beneficiaries age 18-64 who are
    receiving SSDI and/or SSI
   Key to unlocking vocational
    rehabilitation, training, job referrals,
    and other support services
   Voluntary program
                                               13
    TICKET TO WORK PROGRAM
   Beneficiary and the Employment Network
    (EN) or Vocational Rehabilitation (VR) agency
    agree to work together and develop an
    Individual Work Plan (IWP)
   IWP must be approved by MAXIMUS
   The Ticket can be assigned to an EN or a VR
    agency so that the EN or VR agency provides
    employment services and support

                                                14
         WORK INCENTIVES
   Special SSA rules
   Allow you to keep your $$ benefits and
    Medicare or Medicaid while you test
    your ability to work




                                             15
         WORK INCENTIVES
   Work Incentive programs are meant to
    assist individuals with obtaining gainful
    employment, increase independence,
    and acquire self-support. To help
    beneficiaries return to work.




                                                16
WORK INCENTIVES
   Trial Work Period
   Extended Period of Eligibility
   Deductions during SGA Determination
   Cessation
   Expedited Reinstatement
   Delay of Continuing Disability Reviews
    (CDRs)
                                             17
Trial Work Period (TWP)
   9 months when you can earn $$ and still
    receive your SSDI check.
   9 months don’t have to be consecutive.
   TWP month=earnings over $720 or 80hours
    in self employment
   1 TWP per disability
   Must continue to meet disability standards
   If unsure how many TWP months remaining,
    do query with SS.

                                             18
       TRIAL WORK PERIOD
   If you aren’t sure how many TWP
    months remaining, do query with SS,
    seek information from Work Incentives
    Program Assistance (WIPA).




                                            19
       EXTENDED PERIOD OF
         ELIGIBILITY (EPE)
   Starts month after TWP ends
   Lasts at least 36 consecutive months
   Benefits paid for any month earnings
    are below SGA, plus 1 month SGA and
    next month grace
   No benefits paid for months over SGA
   Medicare (if eligible) continues all
    months
                                           20
              “THE CLIFF”
   Benefits can terminate the first time
    beneficiary performs SGA after the EPE
    is completed




                                             21
    Expedited Reinstatement of
             Benefits
   Expedited Reinstatement of Benefits – if
    perform SGA after Extended Period of
    Eligibility and have benefits terminated,
    but later have wages reduced below
    SGA because of disability, can be
    reinstated to SSDI benefits without new
    application if certain conditions are met.


                                            22
      SUBSTANTIAL GAINFUL
         ACTIVITY (SGA)
   Performance of significant physical
    and/or mental activities in work for pay
    or profit, or in work of a type generally
    performed for pay or profit
   Earnings over $1010 gross monthly, but
    for those eligible based on blindness -
    $1690

                                            23
              EXAMPLE 1
   Bruno receives SSDI and works 25 hrs
    per week at $10/hr
   25 hrs x $10= $250/wk
   Should SSA presume that Bruno is
    performing SGA
   How will earnings be counted? E.g.
    4.333 X $250 = $1082.50

                                           24
     Countable Earnings above SGA
    Threshold = Presumption of SGA

   An individual may appeal an SGA
    determination
   SSA’s work incentives include
    considerations that can rebut the
    presumptions of SGA
   The policy behind this is to prevent
    premature work related benefit
    terminations
                                           25
Employment Supports (Rebutting
the SGA Presumption)
   Apply to SGA – do not apply to TWP
   Averaging
   Unsuccessful Work Attempt (UWA)
   Impairment-Related Work Expenses (IRWE)
   Unincurred Business Expenses (self-
    employed)
   Subsidy
   Special Conditions
                                              26
                    AVERAGING
   Way to rebut SGA Presumption
   Does not apply after disability has been
    ceased because SGA, when determining TWP
   Use when
      -earnings vary
      - Pattern of work is continuous, no
        significant change, and no change of SGA
        levels
20 CFR 404.1574(a), 416.974(a)                 27
Unsuccessful Work Attempt
   allows for continuation of benefits if,
    within a certain period of time, work
    ends because of disability




                                              28
Key Elements of Unsuccessful
Work Attempts
   Countable earnings appear to be SGA
   Work stopped or was reduced due to
    impairment or removal of special conditions
   Significant break
   NOT UWA if work effort lasted over 6
    months and ended for any reason
   If UWA proven, none of the SGA work counts,
    even if it was at SGA level
20 CFR 404.1574(c), 416.974(c)
                                             29
Impairment-Related Work
Expenses (IRWE)
   Expense for an item or service which is
    directly related to enabling an impaired
    individual to work and is incurred by the
    individual because of a physical or mental
    impairment. The person must pay for the
    item or services and not be reimbursed.
   Not applicable during TWP
20 CFR 404.1576, 416.976, POMS DI 10520.000 et seq.


                                                      30
          Examples of IRWE
   Medications prescribed to treat the
    impairment
   Attendant care services
   Medical devices
   Work-related assistive devices
   Modifications to vehicle/residence
   Some transportion costs
                                          31
                        SUBSIDY
   Only the actual value of the work is
    counted when determining SGA
   Provided by employer
   Specific
   Non-specific
20 CFR 404.1574(a)(2), 416.976 (a)(2)




                                           32
Unincurred Business Expenses
    For Self-employed only
   Contributions made by others to the
    business
   Provided by someone other than
    individual receiving benefits



                                          33
   Application of Tools to Rebut
       Presumption of SGA
Can We apply:   When          For EPE        For EPE
                determining   Months, Before Months, After
                TWP Months    Cessation      Cessation
Averaging       No            Yes            No


UWA             No            Yes            No


Subsidy         No            Yes            Yes


IRWE            No            Yes            Yes




                                                             34
          Cessation Month and
              Grace Period
   The Cessation month is the first month of SGA after
    TWP
    -“Cessation” not the same as termination
    - Benefits are paid for 1st SGA month and the two
    following months – grace period
    - If SGA after the grace period and still in the
    EPE re-entitlement period-benefits suspended
    - Benefits reinstated for nonSGA months in
     EPE
   If first SGA month after the EPE, benefits
    terminate after the grace period                  35
          Extended Medicare
   Medicare continues during TWP
   Medicare continues during the EPE
   Extended Medicare is a Work Incentive that
    continues coverage even after SGA
    termination
   Extended Medicare may provide coverage for
    at least 93 months after the TWP
   Note: Extended Medicare DOES NOT apply to
    medical terminations after a CDR
                                             36
    Extended Medicare After SGA
           Termination
   To maintain Extended Medicare coverage after an
    SGA termination one must:
    - Continue to meet the medical disability standard,
    and
    -Pay the Medicare premiums (Medicare Part A
    remains premium free)
   The potential period of Extended Medicare after SGA
    termination depends mostly on when the first SGA
    month occurs after the TWP


                                                      37
Work Incentives Planning and
 Assistance Project (WIPA)
  For information on how returning to work may affect
   your SSDI or SSI benefits, contact your assigned
   WIPA agency:
   Imagine Enterprises
   3234 Ivy
   Abilene, TX 79603
   Toll Free - PACIFIC ONLY 888-844-3608
 www.imagineenterprises.com
   Rosemary Burks
   Areas served: Guam,American Samoa and the
   Northern Mariana Islands                          38
       Protection and Advocacy for
      Beneficiaries of Social Security
                  (PABSS)
   For more information on protecting your rights
    during your effort to return to work, contact
    your local PABSS office at

    GUAM LEGAL SERVICES CORPORATION –
    DISABILITY LAW CENTER




                                                     39
   GUAM LEGAL SERVICES
CORPORATION-DISABILITY LAW
         CENTER
   Hours: 8am – 5pm, Monday – Friday
       (closed on holidays)
   113 BRADLEY PLACE, HAGATNA (across Ace
    Hardware, behind Chode’s)
   Tel: 477-9811/12
   Fax: 477-1320
   TDD/TTY: 477-7356
   Email: information@guamlsc.org
   If you have specific questions or concerns, please do
    not hesitate to contact us.

                      THANK YOU!!!
                                                            40

				
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