Benefits Training

and Consulting


November 23, 2010


EN Report Card


Social Security announced the initiation of the Employment Network Report Card.


When the final Ticket to Work Program regulations were published on December 28, 2001, Social Security stated they would evaluate the performance of Employment Networks (EN), in part, based on the views of the participants who had or are receiving services from an EN.  Congress and Social Security felt customer satisfaction would be a driving force behind the success of an EN in the program.  If previous and current customers are satisfied with the services received, other beneficiaries would use this information as part of their selection criteria of an EN.


Maximus, one of the Ticket to Work Managers, has been collecting administrative data annually  on each Employment Network’s performance (called the Annual Performance and Outcome Report (APOR)).  Now, Social Security will begin asking beneficiaries to evaluate their experience with the EN to whom they assigned their ticket.  Beneficiaries will have the opportunity to complete the survey either in paper-format or online.  Social Security intends to combine the two data sources in the form of an Employment Network Report Card.  They will launch the Report Card in California and then nationally.  The results of the EN Report Card will be available on the Beneficiary Access and Support Services Web site of a new Ticket to Work Manager (it is not currently available).  Social Security also announced the new web site will also include a monitored user comments section where beneficiaries will be able to post comments about their experiences with ENs (social network?).


My comment: I am often asked by beneficiaries to recommend an Employment Network in their area, and must often I can not, because I do not know the quality of their direct services. For too long, people have used national accreditations as an indicator of quality services, but we all know that this is a weak indicator of quality services.  Now, people receiving services will have a very significant role in measuring quality of services.  I sincerely hope they participate in this opportunity.


Pre-publication Sale of Publications


Each year, at this time, I offer a Pre-publication Sale of the upcoming edition of “THE GUIDE: Social Security Benefits and Work Incentives.”   The 2011 version will be the 19th Edition of this popular reference manual.  The 2011 version will have more examples of the application of work incentives and the implementation of new rules and projects which effect a working beneficiary.


The Pre-publication Sale will last until December 31st.  Shipment of orders placed now will begin on December 26th.  During this sale the normal price is reduced 1/3, and greater if multiple copies are ordered.  Go to the publication section to order..


While They Last.


I am clearing inventory of the 2010 editions of “THE GUIDE”, the “Managing Your SSI Benefit and Income” handbook, and the “Managing Your SSDI benefit and Income” handbook.  A set of books (one each) is now available for $30 plus $5 shipping. (Regular price $92.00 per set)  This offer is not available at the website, call 610-696-1551 to order.  Payment only by credit card.  This offer ends when the inventory is gone.


2011 Medicare Rates


On November 4th, The Centers for Medicare and Medicaid released the Medicare rate changes for 2011.


Part A: (Hospital Insurance) Premium

  • No monthly Part A premium for people (and spouse) who have 40 or more quarters of Medicare-covered employment.

  • $248.00 per month Part A premium for people having 30-39 quarters of Medicare-covered employment.

  • $450.00 per month Part A premium for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.

Part B: (Medical Insurance) Premium

  •  Most beneficiaries will continue to pay the same $96.40 or $110.50 premium amount in 2011.

  • Beneficiaries who currently have Social Security  withhold their Part B premium and have incomes of $85,000 or less (or $170,000 or less for joint filers) will not have an increase in their Part B premium in 2011.

  • For all others, the standard Medicare Part B monthly premium will be $115.40 in 2011, which is a 4.4% increase over the 2010 premium. The Medicare Part B premium is increasing in 2011 due to possible increases in Part B costs. If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $115.40 per month.

                         This last change applies to anyone who becomes entitled to Medicare during 2011.


Medicare Deductible and Coinsurance Amounts for 2011:


Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care)

For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2011 = $1,132) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.


     For each benefit period you pay:

  • A total of $1,132 for a hospital stay of 1-60 days.

  • $283 per day for days 61-90 of a hospital stay.

  • $566 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).

  • All costs for each day beyond 150 days.

           Skilled Nursing Facility Coinsurance

                        $141.50 per day for days 21 through 100 each benefit period.


Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home

health services, durable medical equipment)

  •  $162.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $162.00 deductible.)


Thank you, South Dakota


October completed my ninth year of doing workshops for the State of South Dakota. I would like to thank the staff of the Freedom to Work Project (FTW) for their attention to details in coordinating over 15 workshops conducted throughout South Dakota in April, August, and October.  THANK YOU to Shelly Phaif, FTW Consumer Involvement Coordinator, Brooke Lusk, FTW Program Manager, Dan Rounds, FTW Training Coordinator, Colette Wagoner, FTW Program Specialist, and Faith Ellis, Administrative Assistant.


Over 2,000 residents of South Dakota have taken part in the workshops and individually benefitted from the use of the information they have acquired.  I take personal pleasure in watching empowerment happen, when a person asks a question in the workshop and another audience member answers the question.  I have watched people schedule meetings with benefit counselors for personal counseling and I have listened to the successes of people who have properly used the work incentives in their effort to be self-sufficient. 


Initially, these workshops were sponsored by the Division of Rehabilitation Services ( Thank you, Grady Kickul, Division Director and Bernie Grimme for bring me into South Dakota)  and then funding shifted to the South Dakota Freedom to Work Project  in 2004.  The Freedom to Work Project is funded, in part, by a Medicaid Infrastructure Grant.  See what else they are doing at their website:


See you in the Spring!


Compassionate Allowances


During the past year, Social Security has expanded the list of medical conditions which can qualify for Compassionate Allowance (known as CAL) and they continue to hold hearings on additional medical conditions which may be added to the list.    This is part of Social Security’s effort to reduce the time it takes to process an application.  This month two hearings have been held for 1)  cardiovascular disease and multiple organ transplants, and 2) schizophrenia, to consider adding these conditions to the list.


The goal of the Compassionate Allowance process is to make a decision, within 20 days of receipt of the application, whether the applicant is disabled or not disabled.   Cases are put into this category based primarily on information provided by the applicant on the SSA-3368 Disability Report.   In other words, the computer system looks for the medical condition or appropriate abbreviation.  


The applicant is not told their case is identified for the CAL process.  But the disability examiner may ask the applicant to assist in obtaining necessary medical evidence to expedite the process.  If asked, the examiner can reveal the case is in CAL status.


DI 23022.080 List of Compassionate Allowance (CAL) Conditions

The following is the list of CAL conditions. To get to the impairment summary, go the POMS reference in “Section Number.”

Section Title

Section Number

Acute Leukemia

DI 23022.085

Adrenal Cancer – with distant metastases or inoperable, unresectable, or recurrent

DI 23022.090

Alexander Disease (ALX) – Neonatal and Infantile

DI 23022.095

Alstrom Syndrome

DI 23022.350

Amegakaryocytic Thrombocytopenia

DI 23022.355

Amyotrophic Lateral Sclerosis (ALS)

DI 23022.100

Anaplastic Adrenal Cancer – with distant metastases or inoperable, unresectable, or recurrent

DI 23022.105

Astrocytoma – GRADE III and IV

DI 23022.110

Ataxia Telangiectasia

DI 23022.360

Batten Disease

DI 23022.365

Bilateral Retinoblastoma

DI 23022.370

Bladder Cancer – with distant metastases or inoperable or unresectable

DI 23022.115

Bone Cancer – with distant metastases or inoperable or unresectable

DI 23022.120

Breast Cancer – with distant metastases or inoperable or unresectable

DI 23022.125

Canavan Disease (CD)

DI 23022.130

Cerebro Oculo Facio Skeletal (COFS) Syndrome

DI 23022.135

Chronic Myelogenous Leukemia – Blast Phase

DI 23022.140

Creutzfeldt-Jakob Disease (CJD) – Adult

DI 23022.145

Cri du Chat Syndrome

DI 23022.375

Degos Disease, Systemic

DI 23022.380

Early-Onset Alzheimer’s Disease

DI 23022.385

Edwards Syndrome (Trisomy 18)

DI 23022.390

Ependymoblastoma (Child Brain Tumor)

DI 23022.150

Esophageal Cancer

DI 23022.155

Farber’s Disease (FD) – Infantile

DI 23022.160

Fibrodysplasia Ossificans Progressiva

DI 23022.395

Friedreichs Ataxia (FRDA)

DI 23022.165

Frontotemporal Dementia (FTD) Picks Disease – Type A – Adult

DI 23022.170

Fukuyama Congenital Muscular Dystrophy

DI 23022.400

Gallbladder Cancer

DI 23022.175

Gaucher Disease (GD) – Type 2

DI 23022.180

Glioblastoma Multiforme (Brain Tumor)

DI 23022.185

Head and Neck Cancers – with distant metastasis or inoperable or uresectable

DI 23022.190

Hemophagocytic Lymphohistiocytosis

DI 23022.405

Hunter Syndrome

DI 23022.410

Hurler Syndrome

DI 23022.415

Idiopathic Pulmonary Fibrosis

DI 23022.420

Infantile Neuroaxonal Dystrophy (INAD)

DI 23022.195

Infantile Neuronal Ceroid-Lipofuscinoses

DI 23022.425

Inflammatory Breast Cancer (IBC)

DI 23022.200

Junctional Epidermolysis Bullosa Lethal Type

DI 23022.430

Kidney Cancer – inoperable or unresectable

DI 23022.205

Krabbe Disease (KD) – Infantile

DI 23022.210

Large Intestine Cancer – with distant metastasis or inoperable, unresectable, or recurrent

DI 23022.215

Late Infantile Neuronal Ceroid-Lipofuscinoses

DI 23022.435

Leigh’s Disease

DI 23022.440

Lesch-Nyhan Syndrome (LNS)

DI 23022.220

Liver Cancer

DI 23022.225

Mantle Cell Lymphoma (MCL)

DI 23022.230

Maple Syrup Urine Disease

DI 23022.445

Merosin Deficient Congenital Muscular Dystrophy

DI 23022.450

Metachromatic Leukodystrophy – Late Infantile

DI 23022.235

Mixed Dementia

DI 23022.455

Mucosal Melanoma

DI 23022.460

Neonatal Adrenoleukodystrophy

DI 23022.465

(Neonatal) Glutaric Acidemia

DI 23022.470

Niemann-Pick Disease (NPD) – Type A

DI 23022.240

Niemann-Pick Disease Type C

DI 23022.475

Non-Small Cell Lung Cancer – with metastases to, or beyond, the hilar nodes or inoperable, unresectable, or recurrent

DI 23022.245

Ornithine Transcarbamylase (OTC) Deficiency

DI 23022.250

Osteogenesis Imperfecta (OI) – Type II

DI 23022.255

Ovarian Cancer – with distant metastases or inoperable or unresectable

DI 23022.260

Pancreatic Cancer

DI 23022.265

Patau Syndrome (Trisomy 13)

DI 23022.480

Peritoneal Mesothelioma

DI 23022.270

Pleural Mesothelioma

DI 23022.275

Pompe Disease – Infantile

DI 23022.280

Primary Progressive Aphasia

DI 23022.485

Progressive Multifocal Leukoencephalopathy

DI 23022.490

Rett (RTT) Syndrome

DI 23022.285

Salivary Tumors

DI 23022.290

Sandhoff Disease

DI 23022.295

Sanfilippo Syndrome

DI 23022.495

Small Cell Cancer of the Large Intestine

DI 23022.300

Small Cell Cancer of the Ovary

DI 23022.305

Small Cell Cancer of the Prostate

DI 23022.310

Small Cell Cancer of the Uterus

DI 23022.315

Small Cell Lung Cancer

DI 23022.320

Small Intestine Cancer – with distant metastases or inoperable, unresectable, or recurrent

DI 23022.325

Spinal Muscular Atrophy (SMA) – Types 0 and 1

DI 23022.330

Spinocerebellar Ataxia

DI 23022.500

Stomach Cancer – with distant metastases or inoperable, unresectable, or recurrent

DI 23022.335

Subacute Sclerosing Panencephalitis

DI 23022.505

Tay Sachs Disease, Infantile Type

DI 23022.510

Thanatophoric Dysplasia, Type 1

DI 23022.515

Thyroid Cancer

DI 23022.340

Ullrich Congenital Muscular Dystrophy

DI 23022.520

Ureter Cancer – with distant metastases or inoperable, unresectable, or recurrent

DI 23022.345

Walker Warburg Syndrome

DI 23022.525

Wolman Disease

DI 23022.530

Zellweger Syndrome

DI 23022.535


Updated 03/12/2010


Questions I’ve Received


Addressing real-life questions and issues is an excellent way to learn new information about benefit programs.  And, you may find a solution to a problem you are dealing with.


Question:  I have a client who is considering marriage. She receives SSDI along with Medicaid from the Aquired/Traumatic Brain injury waiver. Her fiancé is also receiving SSDI and is residing in a Residential Care home. Both are conserved financially.
Will their income from SSDI be affected by marriage?


Answer: No, if both people are receiving benefits from their own work record, the amounts will not change upon marriage.  This would also apply, if one or both are drawing Childhood Disability Benefits from their respective parent’s insured status.   I would recommend you talk with the waiver program administrator to determine if the future spouse’s income (SSDI) will effect eligibility for the waiver program.


Question:  I have several questions about Tim’s situation, (I’m) faxing a copy of the calendar work sheet I’ve been operating from, the 18-month look back period, as well as a recent letter from SSA about wages and questions about eligibility. I just received a BPQY dated today and his Trial Work months are still listed as zero. His SSDI benefit is $1912 and his next medical review was 9/10.


Tim’s disability started March 2009 and his Ticket was assigned 9/24/2009 to this Employment Network (EN). He worked from April to October 2009 earning up to $2800 during those months then started a high paying job in April 2010. Using the calendar sheet I counted out the 9 Trial Work months ending May 2010 followed by cessation, grace and grace (ending August 2010). I advised him in September he may have to turn the September check back to SSA.  On 10/4/2010, I submitted his wage records for July thru October 2009 and April thru August 2010 to SSA as requested by the local SSA office. Trying to get this guy to submit his wage records to me in a timely manner has been a challenge.


On 10/22/2010, I talked with a Maximus representative (Ticket to Work Manager) who indicated the EN would not be eligible for any phase 1 milestone payments but we would be eligible for some phase 2 payments (October 2009 and April thru August 2010). We have submitted the request for phase 2 payments.


Did I misguide this guy or does this situation all look okay? I wonder if this SSA alert all came about because of the high wages he earned for sales and commission.


Answer: Yes, the SSA alert came because of the high wages.  The Benefit Planning Query (BPQY) probably was not complete because this case is now in a Continuing Disability Review (CDR).  A BPQY is ususally updated after the work portion of the CDR is completed.


The main problem is Tim went to work shortly after being found disabled by Social Security.  He was awarded the benefit on a presumption his medical condition would not permit him to perform Substantial Gainful Activity (SGA) for twelve months.  In 2009, SGA was $980 or more of countable earned income, and in 2010, SGA is $1,000 or more of countable earned income.  It is obvious from the reported wages (I reviewed each month), he was over SGA in 2009 and 2010.  If he can not reduce the countable earned income below SGA by claiming Impairment-related Work Expenses or documenting the value of Special Work Conditions (Subsidies), Social Security will find that he was never disabled.  He will be found in overpayment for all of the cash payments received since March 2009.


If the EN receives the Phase II milestone payment, this payment will have to be returned to Social Security.  


Question:  I have a question for you. I have a client who works 30 hours a week and just received a Disability Information letter from SS outlining her Trial work months. From what I understand, the letter is saying that she is meeting these 9 months soon. She has assigned her ticket to us, does this conflict with that? Thank you so much for your help!


Answer:   Completion of the Trial Work Period is part the process of title II benefits a beneficiary must complete before moving into the Reentitlement Period of the Extended Period of Eligibility. Assignment of the ticket does not inhibit the completion of the Trial Work Period.   Assignment of the ticket only inhibits Social Security from conducting a Medical Review of the case, unless the Medical Review was scheduled prior to assigning the ticket.  When someone completes their Trial Work Period, Social Security may conduct a Continuing Disability Review (CDR) of the case and a medical review is typically part of the CDR.  Since this medical review was not previously scheduled, Social Security is not permitted to do the medical review portion of the CDR.


Upcoming Workshops

The specific location for each workshop is posted at my web site.  Registration can also be completed at the site.  Go to WORKSHOPS    


Nov. 29, 2010  Manchester, NH          Benefits and Employment in 2011

Nov. 30, 2010  Portland, ME               Benefits and Employment in 2011

Dec. 1, 2010     Lexington, MA            Benefits and Employment in 2011

Dec. 2, 2010     Worcester MA            Benefits and Employment in 2011

Dec. 6, 2010     Farmington, CT           Benefits and Employment in 2011

Dec. 7, 2010     New Haven, CT          Benefits and Employment in 2011


Jan. 12, 2011  Jacksonville, FL           Benefits and Employment in 2011

Jan. 13, 2011  Jacksonville, FL           Medicare and Medicaid for Individuals with Disability

Jan. 18, 2011  Fort Myers, FL            Benefits and Employment in 2011

Jan. 19, 2011  Fort Myers, FL            Medicare and Medicaid for Individuals with Disability

Jan. 20, 2011  Fort Lauderdale, FL     Benefits and Employment in 2011

Jan. 21, 2011  Fort Lauderdale, FL     Medicare and Medicaid for Individuals with Disability

Jan. 24, 2011  Brandon, FL                Benefits and Employment in 2011

Jan. 25, 2011  Brandon, FL                Medicare and Medicaid for Individuals with Disability

Jan. 26, 2011  Tallahassee, FL            Benefits and Employment in 2011

Jan. 27, 2011  Tallahassee, FL            Medicare and Medicaid for Individuals with Disability

February         California

March             Oregon and Washington


 Would You Like to Host a Workshop?


By serving as the host organization for a workshop, the organization has ten free seats at the workshop.   This certainly reduces staff training costs, particularly when your program is on a tight budget.


We ask the host organization to provide meeting space, for approximately 40 people in a classroom setting.  The host organization is responsible for providing light refreshments (coffee, soda, snack foods).  We also ask the host organization to distribute an advertisement of the workshop to local contacts, as they have a better mailing list of contacts in the local area.   Benefits Training and Consulting provides the training materials and audio-visual equipment.


The host organization’s distribution of the advertisement is an important role in suburban and rural areas. This usually assures a minimum registration of people to conduct the workshop.  We supply the master copy of the ad for your distribution to local contacts.


Host organizations have used a variety of free meeting space when their own facility was inadequate to accommodate the workshop.  The meeting site must be accessible to individuals with disability.


We maintain a list of interested organizations and contact them approximately 3 months prior to the week I will be in their area. Contact me if you would like to host a workshop during 2011.  You can reach me by phone: (610) 696-1551, fax (610) 932-0428, or by e-mail:


We are now planning for Spring and Summer of 2011


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