The Social Security
Cost Reimbursement Program:
Submitting a Claim
For Cost Reimbursement
Introductions, Federal
• Ken McGill, Moderator, Ticket to Work
Operations Support Manager
• Nate Arnold, Vocational
Rehabilitation/Partnership Plus Lead, SSA Office
of Employment Support Programs
• Kathy Schriver, Senior Analyst, SSA office of
Employment Support Programs
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Introductions, State Partners
• Abygail Medina, Chief, Social Security Programs
Section, California Department of Rehabilitation
• Eugenia Cox, Ticket to Work Program
Coordinator, Oregon Office of Vocational
Rehabilitation Services
• Ann Lynn Banton, SSA/Ticket to Work
Coordinator, Virginia Department for the Blind
and Vision Impaired
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Submitting
Cost Reimbursement Claims
• The State VR Agency must file a claim for payment
for each individual case for which it is seeking
reimbursement
• A claim is submitted by completing an SSA-199 or on
a paper copy of an electronic facsimile of the SSA199 and sending it to SSA
• SSA is responsible for determining
– Whether each claim meets all of the requirements for
payment; and
– The amount to be paid
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Completing the SSA-199
State VR Agencies should submit their claims directly
to SSA
*Claims that are being mailed should be sent to:
Social Security Administration
Office of Employment Support Programs
P.O. Box 17714
Baltimore, MD 21235-7714
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Completing the SSA-199 (continued)
Claims that are being sent by UPS or FEDEX should be
addressed to:
Social Security Administration
Office of Employment Support Programs
VRA Operations Team
6401 Security Blvd., 2-M-21 Robert Ball Bldg.
Baltimore, MD 21135
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Benefits Status
• One of the requirements for payment is that the VR
consumer be a disability beneficiary (SSDI or SSI) at
any time during the period where VR services are
provided
• State VR agencies should verify an individual’s benefit
status before filing a reimbursement claim with SSA
• The electronic process established by OSM/MAXIMUS
to place the Tickets of beneficiaries being served
under the CR program “In-Use SVR” is one of the ways
for a SVRA to verify benefit status
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Earnings
As discussed in Part 2 of this webinar series, a State VR
Agency has two options for establishing evidence of
earnings to qualify for a CR claim:
• Submit documentation of the beneficiary’s earnings
with the claim, or
• Request that SSA investigate the earnings
• Remember to consider the appropriate tolerance
levels, if appropriate (2011 rates)
$1000 + $200 =$1200 (non-blind)
$1640 + $100 = $1740 (blind)
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Transitional Work
When looking for earnings, we may find earnings below
the SGA level for a long period of time and then the
earnings eventually leads to SGA. These earnings are
called “transitional work”
• If the Continuous Period of SGA begins more than one
year after VR case closure, we will evaluate the claim
• If we determine that additional information is needed,
we will send a letter requesting clarification of how the
services provided lead to completion of SGA
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Direct Cost Services
• Direct costs are costs incurred between the VR case
opening and VR closure dates
• The VR agency should include a month-by-month
breakdown of such costs on the SSA-199 (Vocational
Rehabilitation Provider Claim)
• If this documentation is missing, and the payment
period does not cover all of the months between VR
case opening and closure, SSA will send the VR agency
a C7 letter requesting a monthly breakdown of direct
costs during the period of VR services. This can occur
in the following instances:
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Direct Cost Services (continued)
• The individual's entitlement or eligibility to benefits
started later than the VR case opening;
• The individual's entitlement or eligibility to benefits
ended before the period of VR services ended; or
• The individual's continuous period of SGA ended
earlier than the period of VR services ended
Type of service codes are no long required, but service
description is still required.
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Cost Formulas
Costs for administration, counseling and placement
(ACP) incurred in the rehabilitation of beneficiaries are
computed based on a cost formula.
• The cost formula is computed each year by the State
VR Agency based on expenditures and case counts in
the preceding fiscal year
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Cost Formulas (continued)
There are two cost formula options for SVRAs to select
from. Both cost formulas use a calculation of:
– Administration
– Services provided by the State VR Agency
– Grants for the establishment/development of community
rehabilitation programs
– Funds to establish a Business Enterprise Program
This data is obtained from the RSA-2 and RSA-113 reports.
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Cost Formulas (continued)
Option A – Using the aforementioned calculation and
the number of clients served for the fiscal year, we
apply a calculation to determine the ACP and the
Tracking cost formulas.
Option B – Using the aforementioned calculation and
the number of newly accepted clients and clients open
at the end of the quarterly period for the fiscal year, we
apply a calculation to determine the ACP and Tracking
cost formulas.
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Pre-Payment Validation Review
• The Pre-Payment validation review process is used by
OESP to ensure that payments made are accurate.
This review is done by looking at a small sample of
claims
• OESP will send a letter requesting that the VR agency
submit the IPE and all direct cost documents related
to the cases being reviewed
• OESP will validate all direct costs charged
• If any direct cost item is not validated, that direct
cost item will not be paid
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SSA Cost Reimbursement
Payment Period
• The payment period (for which ACP and Direct Costs
can be claimed) starts with the VR start date or
when SS benefits began, whichever comes later
• The payment period ends with the last month of SS
benefits or the 9th month of SGA, whichever comes
earlier
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Tracking Period
• The Tracking period (for which tracking costs up to 9
months can be claimed) begins with the month after
the VR payment period ended
• The Tracking period ends with the last month of SGA
or the 9th month after VR case closure, whichever
comes earlier
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Period of Services
for the State VR Agencies
• Begins with the first day of the month the beneficiary
entered into or started VR services
• Ends the last day of the month in which the VR
agency finished providing services to the individual,
i.e., closed the case
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Payment Period/Period of VR
•
•
•
•
The date client entered VR
Date IPE signed
Date employment began
Date of final closure
3/5/08
3/25/08
4/10
7/10
• SGA was 5/10 – 3/11
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SSA Cost Reimbursement
Payment Period
• Payment period begins when benefits began
(3/1982) or VR start date (03/2008). (Use the later of the two
dates)
• Payment period ends with the last month of benefits
(benefits in current pay) or the 9th month of SGA
(3/2011). (Use the earlier of the two dates)
• The date the payment period begins will be (3/2008)
and the date the payment period ends will be
(3/2011)
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Period of VR for the
State VR Agencies
• The period of VR is the period during which the
beneficiary received VR services and the VR receives
direct cost payment
• It begins with the Date Client Entered VR
• It ends with the Date of Final VR Closure
• The period of VR began (3/2008)
• The period of VR ended (7/2010)
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Click the
Attachments button
to download
associated files
QUESTIONS?
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QUESTIONS?
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Click the
Attachments button
to download
associated files
QUESTIONS?
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QUESTIONS?
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QUESTIONS?
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QUESTIONS?
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