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SSA Cost Reimbursement Webinar Series: Part 5. Monthly Electronic Reporting—Your Reimbursement Depends On It (January 2012). Presenters. Ana Morales VR Specialist OSM/MAXIMUS Sallie Rhodes Partnership Plus Team Lead OSM/MAXIMUS. Goals of Training.

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SSA Cost Reimbursement Webinar Series: Part 5


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ssa cost reimbursement webinar series part 5

SSA Cost Reimbursement Webinar Series: Part 5

Monthly Electronic Reporting—Your Reimbursement Depends On It(January 2012)

presenters
Presenters

Ana Morales

VR Specialist

OSM/MAXIMUS

Sallie Rhodes

Partnership Plus Team Lead

OSM/MAXIMUS

goals of training
Goals of Training
  • Quick overview of legislative/regulatory history leading to changes in process for reporting Cost Reimbursement (CR) cases
  • Highlight new “In-Use SVR” status and benefits of moving Tickets in and out of status
  • Identify data required for electronic reporting
  • Explore options for submitting electronic files
  • Review key information/rules related to electronic reporting, CDR protection and Ticket eligibility
ssa employment programs for beneficiaries with disabilities
SSA Employment Programs for Beneficiaries with Disabilities

Two Social Security program provide compensation for successfully assisting beneficiaries to enter and maintain employment

  • Cost Reimbursement program
    • State VR Agencies (SVRAs) only
    • Reimbursement for the cost of services provided
  • Ticket program
    • SVRAs and approved Employment Networks (ENs)
    • Payments based on milestones and outcomes related to work and earnings
legislative and regulatory history
Legislative and Regulatory History
  • 1981: Cost Reimbursement program began
  • 1998: Last reauthorization of the Rehabilitation Act
  • 1999: Ticket to Work and Work Incentives Improvement Act passed
  • 2000: Latest regulations for Public VR program issues
  • 2001: First Ticket regulations published
  • 2002: Ticket program implemented, phased over 3 years
  • 2008: Ticket regulations revised
ticket legislation and svras
Ticket Legislation and SVRAs
  • SVRAs were
    • Made automatic ENs
      • Simply submitted a letter of intent to SSA to serve beneficiaries under Ticket program
    • Given the choice on a case-by-case basis between serving a beneficiary under CR or under Ticket program
      • If planning to function as an EN, must elect Outcome or Outcome/Milestone Payment system
      • Exceptions
      • If SVRA received CR payment for a specific beneficiary in the past (since 2001) and the same beneficiary returns for services, SVRA can only choose CR payment option
      • If SVRA has sent a letter to SSA expressing intent to only use CR option
ticket program regulatory history
Ticket Program: Regulatory History
  • Original Ticket regulations (2001): SSA provided compensation on behalf of a particular beneficiary under either the CR program or the Ticket program, NOT BOTH
  • Revised Ticket regulations (2008): SSA given authority to compensate a SVRA under the CR program and an EN under the Ticket program on behalf of the same beneficiary using the same Ticket (Partnership Plus)
    • SVRA provides up-front services leading to employment and EN provides ongoing supports to assist beneficiary to maintain and advance in employment
      • Choice is made when IPE is signed
      • If SVRA provided services to a beneficiary under CR but never bill SSA, beneficiary returns for services and SVRA opens a new case, SVRA can choose either payment option, i.e., CR or Ticket
processes for notifying ssa of svra s choice
Processes for Notifying SSA of SVRA’s Choice
  • Original Ticket regulations (2001): SSA issued sub-regulatory guidance requiring SVRA to secure Ticket assignment for both CR and Ticket
    • Transmittal 17
  • Revised Ticket regulations (2008): SSA now uses different processes for Ticket program and CR program
    • When SVRA chooses to function as an EN, SVRA must submit a completed SSA 1365 form to MAXIMUS
    • When SVRA chooses to serve a beneficiary under the CR program, case must be reported to MAXIMUS via a monthly electronic file
slide9

SSA 1365 Form must be completed for Ticket assignment

Ticket is assigned to SVRA the same as it would be to an EN

new ticket status created for cr
New Ticket Status Created for CR
  • 2008: MAXIMUS created an electronic reporting process to place Tickets “In-Use SVR”
    • Eliminated need to complete a form (SSA 1365) for each beneficiary being served under CR
    • Submission of electronic files has two purposes
      • When IPE is signed on a CR case, places Tickets “In-Use SVR”
      • When closing a CR case, takes Ticket out of “In-Use SVR”
in use svr status
“In-Use SVR” Status

Placing a Ticket “In-Use SVR”

  • Extends medical CDR protection to beneficiaries served under CR
  • Ticket cannot be assigned to another EN while VR CR case is open
  • If beneficiary wants to assign Ticket to an EN other than VR, VR counselor and beneficiary should discuss VR closing the case
in use svr status continued
“In-Use SVR” Status (continued)

Taking a Ticket out of “In-Use SVR”

  • Case closure date begins 90-day extension of medical CDR protection
    • If beneficiary assign Ticket to an EN within 90 days, CDR protection continues uninterrupted
  • Places Ticket in an “In-Use SVR Extended” status, which releases Ticket for assignment to an EN
  • Protects SVRA: Ticket cannot be assigned to another EN while CR case is open
  • If beneficiary wants to assign Ticket to an EN other than VR, VR counselor and beneficiary should discuss VR closing the case
the electronic reporting process
The Electronic Reporting Process
  • Starting April 1, 2012 each SVRA must submit electronic files to MAXIMUS to move Tickets in and out of the “In-Use SVR” status
      • Files can be sent monthly, biweekly or weekly
    • Processing timelines
      • Starting February 1, 2012 MAXIMUS will begin processing files on a daily basis
      • Files must be processed through both MAXIMUS and SSA systems
      • MAXIMUS prepares an analysis file on the data that was received and returns the analysis to the SVRAs. Analysis will be returned within 3-5 business days after file is processed. In case of delays, MAXIMUS will notify SVRAs of the new projected completion date
      • SVRAs compare analysis data with their database to match cases
submitting in use svr files
Submitting “In-Use SVR” Files

Required file

  • Comma delimited text file
  • Excel spreadsheet (CSV, comma delimited)

Required data

  • SSN (including dashes or all nine digits)
  • IPE signature date (MM/DD/CCYY format)
  • Case closure date (MM/DD/CCYY format)
  • Case closure status (are they employed?)

NOTE:

  • State VR Agencies can add identifier number as the fifth element
submitting in use svr files continued
Submitting “In-Use SVR” Files (continued)
  • When placing a Ticket “In-Use SVR”, submit only
    • SSN
    • IPE Date
    • SVRA Identifier (optional)
  • When taking a Ticket out of “In-Use SVR”, submit only
    • SSN
    • Case Closure Date
    • Case Closure Code
    • SVRA Identifier (optional)
options for submitting in use svr files
Options for Submitting In-Use SVR Files
  • Four options for submitting electronic files
  • Comma delimited text file or Excel comma delimited file (.csv). Both files should be sent via encrypted Winzip file
    • File and password should be sent in separate emails to svrticketdata@MAXIMUS.com
  • MOVEit, MAXIMUS’ Secure File Transfer System
  • The SVRA’s secured FTP site
  • Mail a CD to P.O. Box 25105, Alexandria, VA 22313
      • Email password to svrticketdata@MAXIMUS.com
moveit
MOVEit
  • User friendly and secure site to exchange In-Use SVR files through the web
  • No need to encrypt files
  • Two individuals per SVRA
    • Secured login
  • Automated email notifications every time a file is available
explanation of analysis
Explanation of Analysis
  • MAXIMUS will send one comma delimited text analysis file with a .txt extension
  • The file includes the data received by the SVRA plus the following data
    • DUNS number
    • Status code value
    • For Code 2, “In-Use SVR” date
    • For Code 3, name of EN/SVRA with Ticket assignment
submitting in use svr files1
Submitting “In-Use SVR” files
  • Required File Name
    • State, DUNS number, underscore, month, day, year (MM/DD/CCYY format), underscore, and the word “RAW” (raw data)
      • VA123456789_01242012_RAW.txt
    • Analysis File’s Name
      • VA123456789_01312012_SYS.txt
submitting in use svr files continued1
Submitting “In-Use SVR” files (continued)
  • No duplicate records should be sent, i.e., one record for each SSN
  • For “In-Use SVR” records before July 1, 2008 (only cases currently open) – Date listed for placing Tickets “In-Use SVR” will be 90 days before date file is processed
submitting in use svr files continued2
Submitting “In-Use SVR” files(continued)
  • Do not send full data dumps each month. Every month we should receive the previous month data only, with the exception of SSNs previously processed and returned in analysis as
    • Non Ticket Holders (Status Code Value 1)
    • Assigned to another EN or SVRA (Status Code Value 3)
    • Ticket is not currently assignable (Status Code Value 8)

Notes:

    • Status of Tickets with these codes can change in the future
    • Code 1, Code 3, and Code 8 can be resent each month
miscellaneous items
Miscellaneous Items
  • In-Use SVR Date
    • IPE date
    • Ticket mail date
    • Next available date
    • 90 days retroactively from the month the file is processed
  • Case Closure Code
    • Required since phase 1 milestone payments to ENs depend on the outcome of the closure
    • Failure to report a CR case (i.e., place Ticket “In-Use SVR”) or failure to include the closure code can result in Phase 1 overpayments to an EN
important reminders
Important Reminders
  • SSA/MAXIMUS no longer allows a beneficiary to remove his/her Ticket from “In-Use SVR” status without a Closure/Referral letter from the SVRA or through the electronic file process
  • Status code values may change as needed/indicated
  • Effective April 1, 2012, CR claims submitted on SSNs never listed as “In-Use SVR” or for which an attempt was never made to place them “In-Use SVR” will be denied
  • If SVRA reports at least monthly, SSA/MAXIMUS will provide a report indicating SGA-level earnings for the previous 8 quarters (i.e., a rolling 8 quarter period)
  • Taking Tickets out of the “In-Use SVR” status is necessary to facilitate Partnership Plus handoffs to ENs
clarification
Clarification

Three 90-day rules that are important to remember

  • Extension of Medical CDR Protection After VR Case Closure
    • A 90-day grace period for the medical CDR protection begins with the case closure date
    • If Ticket is assigned within 90 days, CDR protection is continuous
    • If Ticket is not reassigned after 90-day grace period, CDR protection will lapse until Ticket is assigned
    • If CDR protection ends, beneficiary goes back in queue for next regularly scheduled CDR
    • During these 90 days regardless of the Ticket status (assignable or not assignable, Ticket can be reassigned to a new provider
clarification continued
Clarification (continued)

Three 90-day rules that are important to remember

2. For “In-Use SVR” records before July 1, 2008 (only cases currently open) – Date listed for placing Tickets “In-Use SVR” will be 90 days before date file is processed

  • For example, if file is sent during the current month with an IPE dated 6/8/2007 and Ticket is still open the In-Use SVR date will be 10/1/2011
clarification continued1
Clarification (continued)

Three 90-day rules that are important to remember

3. Changing a CR Case to a Ticket Payment Case

  • For a particular beneficiary, SVRA has 90 days after IPE is signed to change from CR (In-Use SVR) to Ticket Payment (assignment)
  • Original CR decision must be communicated to MAXIMUS through electronic file and change must reported to MAXIMUS within 90 days of IPE signature date by submitting SSA 1365 form with a note to change case to Ticket assignment
slide32

Ana Morales

AnaLMorales@maximus.com

svrhelpdesk@maximus.com

(866) 949-3687 Extension 8013