The contractor and contractor staff members who provide the services described in this chapter also must comply with Chapters 1–3 of the Vocational Rehabilitation Standards for Providers (VR-SFP) manual.
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Benefits and work incentives counseling consists of individualized services that provide detailed information on the impact of employment and other income on Social Security Administration (SSA) disability cash benefits, Medicaid and/or Medicare coverage, and other publicly and privately funded services.
Information provided through benefits and work incentives counseling services supports customers’ abilities to make informed decisions about earning a living wage. An important component to such services is identification and explanation of SSA and Health and Human Services Commission (HHSC) work incentives that the customer may qualify for when employed.
The benefits counselor must review the deliverable for the benefits and work incentives counseling service in detail with the customer and document the review with the benefits counselor’s signature and the date. Once the review has been completed and a copy of each deliverable has been sent to the VR counselor, the benefits counselor may submit an invoice for payment.
Customers who have an individualized plan for employment (IPE) and are participating in other VR services before engaging in employment-related services may be referred for Benefits Information and Referral (Benefits I&R) only.
Customers are eligible for benefits and work incentives counseling services if they are actively looking for work or already working and have an IPE and one or more of the following SSA benefits:
The following services may be provided through benefits and work incentives counseling services:
Completion of HHSC’s Medicaid Buy-In for people with disabilities who work application, including assistance gathering necessary documentation can be purchased for any customer regardless of receipt of SSA disability benefits.
Before any benefits and work incentives counseling services are provided to customers, the benefits counselor’s director must:
The VR3455, Provider Staff Information Form, must document the benefits counselor’s qualifications with evidence such as transcripts, diplomas, reference letters, credentials, and licenses.
The benefits counselor must meet one of the following qualifications, as determined by the program specialist for benefits and work incentives:
To qualify to provide benefits and work incentives counseling services to VR customers, a community work incentive coordinator (CWIC) must be in possession of the following:
Veterans’ benefits information may be provided by a CWIC who is a veteran or who has completed the Online Basic Training Course from the National Veterans Legal Services Program (NVLSP) and the VCU veterans supplemental training course. The CWIC must have a minimum of five years’ experience working with one of the following:
A BSA/WIP or revised BSA/WIP completed by a provisionally certified CWIC must be reviewed and cosigned by a certified CWIC.
To qualify to provide benefits and work incentives counseling services to VR customers, a CPWIC must be in possession of the following:
Veterans’ benefits information may only be provided by a fully certified CPWIC who is a veteran or who has completed the Online Basic Training Course from NVLSP and the VCU veterans supplemental training course and who has a minimum of five years’ experience working with one of the following:
A Veteran's BSA/WIP or Revision to Veteran's BSA/WIP written by a provisionally certified CPWIC must be reviewed and cosigned by a certified CPWIC.
To qualify to provide benefits and work incentives counseling services to VR customers, a WIP-C™ must be in possession of the following:
Veterans’ benefits information may only be provided by a WIP- C™ who is a veteran or who has completed the Online Basic Training Course from NVLSP and has a minimum of five years’ experience working with one of the following:
Benefits and work incentives counseling services are available to customers receiving one or more of the following:
A concurrent beneficiary is someone who is receiving both SSI and a Title II disability benefit.
The Medicaid Buy-In service is available to any customer who is working, including those receiving a Title II disability benefit.
The following benefits and work incentives counseling services are available to SSI and Title II disability recipients:
SSI and/or Title II Benefits I&R provides the customer with a high-level overview of SSA Title XVI, Title II, and/or concurrent cash benefits and health care programs and with general information regarding the impact of earned and unearned income on the programs. A written narrative record of the conversation is the deliverable.
Benefits I&R must be as specific to the customer as possible. Fact sheets and checklists may be provided but cannot substitute for individualized information.
The Benefits I&R deliverable may contain a proposal for more detailed benefits and work incentives counseling services via a BSA/WIP if there is supporting evidence for this recommendation.
The benefits counselor receives:
The benefits counselor schedules a meeting with the customer. The meeting should be scheduled within 10 working days from receipt of the TWS-VRS referral. If the customer does not respond to the benefits counselor’s phone, email, or text message to schedule an appointment within five business days of the date on the VR1512, the benefits counselor should request the referring VR counselor’s assistance in contacting the customer.
When the BPQY is submitted with the VR referral packet, the benefits counselor should make every effort to review the completed Benefits I&R packet with the customer within 15 business days after the date on the VR1512.
When the BPQY is not submitted with the VR referral packet and the benefits counselor must obtain the BPQY, the benefits counselor should make every effort to review the completed Benefits I&R packet with the customer within 45 business days after the date on the VR1512.
The benefits counselor outlines the basics of the customer’s Title XVI, Title II, or concurrent cash and health care benefits and answers the customer’s basic questions. If the customer wants information on how specific amounts of income affect benefits and health care, a BSA/WIP must be purchased. The Benefits I&R conversation is recorded in a written narrative. Generic fact sheets on the customer’s SSA disability program may be offered for additional information.
The benefits counselor compiles the Benefits I&R packet, mails it to the customer, and contacts the customer to review the packet. All questions and concerns in the VR1512 Benefits and Work Incentives Planning Supports and Services Requested section must be addressed in the Benefits I&R documentation.
The benefits counselor submits a copy of the Benefits I&R packet to the requesting VR counselor with an invoice.
Any request to change the Benefits I&R Service Description, Process and Procedure, or Outcomes Required for Payment must be documented and approved by the VR director using the VR3472, Contracted Service Modification Request form, before the change is implemented. For more information, refer to VR-SFP 3.4.11 Contracted Services Modification Request.
The benefits counselor documents in descriptive terms in the Benefits I&R packet all information required in the Service Description and Process and Procedure, demonstrating that the following are covered or included:
Note that any service provided by a provisionally certified CPWIC must be cosigned by a supervising certified CPWIC.
Payment for Benefits I&R is made when the VR counselor approves a complete, accurate, signed, and dated invoice and Benefits I&R packet (reviewed with the customer, as documented).
For information on benefits and work incentives counseling services fees, refer to VR-SFP 26.7 Benefits and Work Incentives Counseling Services Fee Schedule.
An SSI and/or Title II BSA/WIP is a written document that provides both general and individualized information about a customer's verified Title II and/or Title XVI cash benefits, health care, and other benefits and how working will affect all publicly and privately funded benefits.
The BSA section must provide the customer with:
The source of verification of all benefits and programs must be documented on the BSA/WIP. Verification must come from the SSA, HHSC, or another funding entity.
The WIP section details current and future actions, including timelines, that must be taken by the customer and others involved in the customer’s case in relation to SSA disability benefits and other publicly or privately funded benefits.
A BSA/WIP must include recommendations for any work incentives under Title XVI or Title II for which the customer may qualify.
Assistance with completion of the application process for specific work incentives is purchased separately from the BSA/WIP.
The benefits counselor receives:
The benefits counselor schedules a meeting with the customer. The meeting should be scheduled within 10 working days from receipt of the TWS-VRS referral. If the customer does not respond to the benefits counselor’s phone, email, or text message to schedule an appointment within five business days of the date on the VR1512, the benefits counselor should request the referring VR counselor’s assistance in contacting the customer.
When the BPQY is submitted with the VR referral packet, the benefits counselor should make every effort to review the completed BSA/WIP packet with the customer within 30 business days after the date on the VR1512.
When the BPQY is not submitted with the VR referral packet and the benefits counselor must obtain the BPQY, the benefits counselor should make every effort to review the completed BSA/WIP packet with the customer within 60 business days after the date on the VR1512.
At the BSA/WIP meeting, the benefits counselor provides an overview of the customer’s SSA disability benefit program and associated health care, as well as detailed information on how anticipated or current earned income will affect SSA disability cash and other benefits. Generic fact sheets about the customer’s SSA disability program, Medicaid/Medicare, and other benefits programs may be offered for additional information. All questions and concerns in the VR1512 Benefits and Work Incentives Planning Supports and Services Requested section must be specifically addressed in the BSA/WIP documentation.
The use of HotDocs is required for work incentives planning and assistance (WIPA) BSA/WIPs.
CPWIC– and WIP-C™–generated BSA/WIP documentation must contain each of the following seven sections in the order listed. Each section must contain the information listed.
The benefits counselor:
Any request to change the BSA/WIP Service Description, Process and Procedure, or Outcomes Required for Payment must be documented and approved by the program specialist assigned to benefits planning and the VR director using the VR3472, Contracted Service Modification Request form, before the change is implemented. For more information, refer to VR-SFP 3.4.11 Contracted Services Modification Request.
The benefits counselor documents in descriptive terms in the BSA/WIP all information required in the Service Description and Process and Procedure, demonstrating that the following are covered or included:
Note that any service provided by a provisionally certified CPWIC must be cosigned by the supervising certified CPWIC. Payment for a BSA/WIP is made when the VR counselor approves a complete, accurate, signed, and dated invoice and BSA/WIP (reviewed with the customer, as documented).
For information on benefits and work incentives counseling services fees, refer to VR-SFP 26.7 Benefits and Work Incentives Counseling Services Fee Schedule.
A Veteran’s SSI and/or Title II BSA/WIP is a written document that provides both general and individualized information about a customer’s verified Title II or Title XVI cash benefits, health care, and other benefits. A Veteran’s BSA/WIP includes detailed information on the impact of employment on a veteran’s cash benefits, health care, housing, and participation in other veterans’ programs.
The Veteran’s BSA section must provide the customer with:
The source of verification of all benefits and programs must be documented on the Veteran’s BSA/WIP. Verification must come from the VA, SSA, HHSC, or another funding entity.
The Veteran’s WIP section details current and future actions, with timelines, that must be taken by the customer and others involved in the customer’s case in relation to SSA, VA, and other disability benefits.
A Veteran’s BSA/WIP must include recommendations for any work incentives under Title XVI or Title II for which the customer may qualify.
Assistance with completion of the application process for specific work incentives is purchased separately from the Veteran’s BSA/WIP.
The benefits counselor receives:
The benefits counselor schedules a meeting with the customer. The meeting should be scheduled within 10 working days from receipt of the TWS-VRS referral. If the customer does not respond to the benefits counselor’s phone, email, or text message to schedule an appointment within five business days of the date on the VR1512, the benefits counselor should request the referring VR counselor’s assistance in contacting the customer.
When a BPQY is submitted with the VR referral packet, the benefits counselor should make every effort to review the completed Veteran’s BSA/WIP packet with the customer within 30 business days after the date on the VR1512.
When a BPQY is not submitted with the VR referral packet and the benefits counselor must obtain the BPQY, the benefits counselor should make every effort to review the completed Veteran’s BSA/WIP packet with the customer within 60 business days after the date on the VR1512.
At the Veteran’s BSA/WIP meeting, the benefits counselor provides an overview of the customer’s SSA disability benefit program and associated health care, as well as detailed information on how anticipated or current earned income will affect SSA disability, VA, and other benefits. Generic fact sheets about the customer’s SSA disability program, Medicaid/Medicare, VA, and other benefits programs may be offered for additional information. All questions and concerns in the VR1512 Benefits and Work Incentives Planning Supports and Services Requested section must be specifically addressed in the Veteran’s BSA/WIP documentation.
The use of HotDocs is required for WIPA Veteran’s BSA/WIPs.
CPWIC– and WIP-C™–generated Veteran’s BSA/WIPs must contain each of the following seven sections in the order listed. Each section must contain the information listed:
In addition to the sections above, detailed information on how employment will affect the following veterans’ benefits, if applicable, must be addressed in the Veteran’s BSA/WIP:
The following may also be provided:
The benefits counselor compiles the Veteran’s BSA/WIP packet, mails the packet to the customer, and reviews the packet with the customer. All questions and concerns in the VR1512 Benefits and Work Incentives Planning Supports and Services Requested section must be addressed in the Veteran’s BSA/WIP documentation.
Veteran’s BSA/WIPs produced by a provisionally certified CPWIC must be cosigned by the supervising certified CPWIC.
Any request to change the Veteran’s BSA/WIP Service Description, Process and Procedure, or Outcomes Required for Payment must be documented and approved by the VR director using the VR3472, Contracted Service Modification Request form, before the change is implemented. For more information, refer to VR-SFP 3.4.11 Contracted Services Modification Request.
The benefits counselor documents in descriptive terms in the Veteran’s BSA/WIP all information required in the Service Description and Process and Procedure, demonstrating that the following are covered or included:
Note that any service provided by a provisionally certified CPWIC must be cosigned by the supervising certified CPWIC.
Payment for the Veteran’s BSA/WIP is made when the VR counselor approves a complete, accurate, signed, and dated invoice and Veteran’s BSA/WIP (reviewed with the customer, as documented).
For information on benefits and work incentives counseling services fees, refer to VR-SFP 26.7 Benefits and Work Incentives Counseling Services Fee Schedule.
To make changes to an SSI and/or Title II BSA/WIP or Veteran’s BSA/WIP, a Revision to BSA/WIP or Veteran’s BSA/WIP packet is necessary. Revisions to a BSA/WIP or Veteran’s BSA/WIP must be employment related and can occur when a customer with an open VR case has a change in the earned income documented in Section 2 of the original BSA/WIP or Veteran’s BSA/WIP.
The benefits counselor receives:
The benefits counselor schedules a meeting with the customer. The meeting should be scheduled within 10 working days from receipt of the TWS-VRS referral. If the customer does not respond to the benefits counselor’s phone, email, or text message to schedule an appointment within five business days of the date on the VR1512, the benefits counselor should request the referring VR counselor’s assistance in contacting the customer.
When the BPQY is submitted with the VR referral packet, the benefits counselor should make every effort to review the completed Revision to BSA/WIP or Veteran’s BSA/WIP packet with the customer within 30 business days after the date on the VR1512.
When the BPQY is not submitted with the VR referral packet and the benefits counselor must obtain the BPQY, the benefits counselor should make every effort to review the completed Revision to BSA/WIP or Veteran’s BSA/WIP packet with the customer within 60 business days after the date on the VR1512.
In the Revision to BSA/WIP or Veteran’s BSA/WIP meeting the benefits counselor reviews the overview of the customer’s SSA disability benefit program and associated health care, as well as the detailed information on how anticipated or current earned income will affect SSA disability, VA, and other benefits, as applicable. Generic fact sheets about the customer’s VA and SSA disability program, Medicaid or Medicare, TRICARE, and any other benefits programs, as applicable, may be offered for additional information. All questions and concerns in the VR1512 Specific Information Needed and Additional Comments section must be specifically addressed in the Revision to BSA/WIP or Veteran’s BSA/WIP documentation. After completing the BSA/WIP the benefits counselor mails the final packet to the customer and reviews the packet with the customer.
Any request to change the Revision to BSA/WIP or Veteran’s BSA/WIP Service Description, Process and Procedure, or Outcomes Required for Payment must be documented and approved by the program specialist assigned to benefits planning and the VR director using the VR3472, Contracted Service Modification Request form, before the change is implemented. For more information, refer to VR-SFP 3.4.11 Contracted Services Modification Request.
The benefits counselor documents in descriptive terms in the Revision to BSA/WIP or Veteran’s BSA/WIP all information required in the Service Description and Process and Procedure, demonstrating that the following are covered or included:
Note that any service provided by a provisionally certified CPWIC must be cosigned by the supervising certified CPWIC.
Payment for a Revision to BSA/WIP or Veteran’s BSA/WIP is made when the VR counselor approves a complete, accurate, signed, and dated invoice or Revision to BSA/WIP or Veteran’s BSA/WIP (reviewed with the customer, as documented).
For information on benefits and work incentives counseling services fees, refer to VR-SFP 26.7 Benefits and Work Incentives Counseling Services Fee Schedule.
The following SSI work incentives are available:
The SSI SEIE is an in-depth written explanation and application for this work incentive, which allows certain students under age 22 to retain more of their monthly SSI cash benefit when working.
The benefits counselor receives:
The benefits counselor schedules a meeting with the customer. The meeting should be scheduled within 10 working days from receipt of the TWS-VRS referral. If the customer does not respond to the benefits counselor’s phone, email, or text message to schedule an appointment within five business days of the date on the VR1512, the benefits counselor should request the referring VR counselor’s assistance in contacting the customer.
When the BPQY is submitted with the VR referral packet, the benefits counselor should make every effort to review the completed SEIE packet with the customer within five business days after the date on the VR1512.
When the BPQY is not submitted with the VR referral packet and the benefits counselor must obtain the BPQY, the benefits counselor should make every effort to review the completed SEIE packet with the customer within 35 business days after the date on the VR1512.
The SEIE packet consists of:
Generic fact sheets about the customer’s SSA disability program and SEIE may be offered for additional information.
An SEIE request letter must contain the following information:
The benefits counselor completes the SEIE application, mails it to the customer and reviews it with the customer. All questions and concerns in the VR1512 Benefits and Work Incentives Planning Supports and Services Requested section must be addressed in the SEIE documentation.
Any request to change the SEIE Service Description, Process and Procedure, or Outcomes Required for Payment must be documented and approved by the VR director using the VR3472, Contracted Service Modification Request form, before the change is implemented. For more information, refer to VR-SFP 3.4.11 Contracted Services Modification Request.
The benefits counselor documents in descriptive terms in the SEIE packet all information required in the Service Description and Process and Procedure, demonstrating that the following are covered or included:
Note that any service provided by a provisionally certified CPWIC must be cosigned by the supervising certified CPWIC.
Payment for an SEIE packet is made when the VR counselor approves a complete, accurate, signed, and dated invoice and SEIE packet (reviewed with the customer, as documented).
For information on benefits and work incentives counseling services fees, refer to VR-SFP 26.7 Benefits and Work Incentives Counseling Services Fee Schedule.
An SSI IRWE is a completed application with an in-depth written explanation for this work incentive, which allows customers to retain more of their SSI monthly cash benefit for items and/or services related to the customer’s disability if needed to maintain or advance in employment.
The benefits counselor receives:
The benefits counselor schedules a meeting with the customer. The meeting should be scheduled within 10 working days from receipt of the TWS-VRS referral. If the customer does not respond to the benefits counselor’s phone, email, or text message to schedule an appointment within five business days of the date on the VR1512, the benefits counselor should request the referring VR counselor’s assistance in contacting the customer.
When the BPQY is submitted with the VR referral packet, the benefits counselor should make every effort to review the completed IRWE packet with the customer within 10 business days after the date on the VR1512.
When the BPQY is not submitted with the VR referral packet and the benefits counselor must obtain the BPQY, the benefits counselor should make every effort to review the completed IRWE packet with the customer within 40 business days after the date on the VR1512.
The IRWE packet consists of a completed application for IRWE and a copy of SSA Form 795 with instructions on reporting income to the SSA. Generic fact sheets about the customer’s SSA disability program and IRWE may be offered for additional information.
There is no SSA form for IRWE. The benefits counselor can create a template IRWE request letter for the customer.
Requests for IRWE must include the following information:
The benefits counselor completes the IRWE packet, ensuring that pay stubs and receipts are included, mails the packet to the customer, and reviews the packet with the customer. All questions and concerns in the VR1512 Benefits and Work Incentives Planning Supports and Services Requested section must be addressed in the IRWE packet.
The benefits counselor submits a copy of the IRWE packet to the requesting VR counselor with an invoice.
Any request to change the IRWE Service Description, Process and Procedure, or Outcomes Required for Payment must be documented and approved by the VR director using the VR3472, Contracted Service Modification Request form, before the change is implemented. For more information, refer to VR-SFP 3.4.11 Contracted Services Modification Request.
The benefits counselor documents in descriptive terms in the IRWE packet all information required in the Service Description and Process and Procedure, demonstrating that the following are covered or included:
Note that any service provided by a provisionally certified CPWIC must be cosigned by the supervising certified CPWIC.
Payment for an IRWE packet is made when the VR counselor approves a complete, accurate, signed, and dated invoice and IRWE packet (reviewed with the customer, as documented).
For information on benefits and work incentives counseling services fees, refer to VR-SFP 26.7 Benefits and Work Incentives Counseling Services Fee Schedule.
The SSI BWE is a written or electronic in-depth explanation and application for this work incentive, which allows customers who are statutorily blind, by SSA’s definition, to retain more of their SSI monthly cash benefit when working.
The benefits counselor receives:
The benefits counselor schedules a meeting with the customer. The meeting should be scheduled within 10 working days from receipt of the TWS-VRS referral. If customer does not respond to the benefits counselor’s phone, email, or text message to schedule an appointment within five business days of the date on the VR1512, the benefits counselor should request the referring VR counselor’s assistance in contacting the customer.
When the BPQY is submitted with the VR referral packet, the benefits counselor should make every effort to review the completed BWE packet with the customer within 10 business days after the date on the VR1512.
When the BPQY is not submitted with the VR referral packet and the benefits counselor must obtain the BPQY, the benefits counselor must review the completed BWE packet with the customer within 40 business days after the date on the VR1512.
The BWE packet consists of a completed application for BWE and a copy of SSA Form 795, with instructions on reporting income to the SSA. Generic fact sheets about the customer’s SSA disability program and BWE may be offered for additional information.
The completed written BWE application must contain the following information:
The benefits counselor completes the BWE packet, mails the packet to the customer and reviews the packet with the customer. All questions and concerns in the VR1512 Benefits and Work Incentives Planning Supports and Services Requested section must be addressed in the BWE packet.
Any request to change the BWE Service Description, Process and Procedure, or Outcomes Required for Payment must be documented and approved by the VR director using the VR3472, Contracted Service Modification Request form, before the change is implemented. For more information, refer to VR-SFP 3.4.11 Contracted Services Modification Request.
The benefits counselor documents in descriptive terms in the BWE packet all information required in the Service Description and Process and Procedure, demonstrating that the following are covered or included:
Note that any service provided by a provisionally certified CPWIC must be cosigned by the supervising certified CPWIC.
Payment for a BWE packet is made when the VR counselor approves a complete, accurate, signed, and dated invoice and BWE packet (reviewed with the customer, as documented).
For information on benefits and work incentives counseling services fees, refer to VR-SFP 26.7 Benefits and Work Incentives Counseling Services Fee Schedule.
An SSI PASS is a completed application on SSA Form 545 with budgets and an in-depth written explanation for this SSI work incentive, which allows customers to set aside money to pay for items and/or services needed to achieve a work goal. Money deposited in the customer’s PASS account will increase the amount of the monthly SSI cash benefit and not be counted towards the SSI $2,000/$3,000 monthly resource limit.
Customers are not required to be working to have a PASS but must have a work goal that will result in a living wage.
The benefits counselor receives:
The benefits counselor schedules a meeting with the customer. The meeting should be scheduled within 10 working days from receipt of the TWS-VRS referral. If the customer does not respond to the benefits counselor’s phone, email, or text message to schedule an appointment within five business days of the date on the VR1512, the benefits counselor should request the referring VR counselor’s assistance in contacting the customer.
When the BPQY is submitted with the VR referral packet, the benefits counselor should make every effort to review the completed PASS packet with the customer within 30 business days after the date on the VR1512.
When the BPQY is not submitted with the VR referral packet and the benefits counselor must obtain the BPQY, the benefits counselor should make every effort to review the completed PASS packet with the customer within 60 business days after the date on the VR1512.
The benefits counselor:
All questions and concerns in the VR1512 Benefits and Work Incentives Planning Supports and Services Requested section must be addressed in the PASS documentation. Any request to change the PASS Service Description, Process and Procedure, or Outcomes Required for Payment must be documented and approved by the VR director using the VR3472, Contracted Service Modification Request form, before the change is implemented. For more information, refer to VR-SFP 3.4.11 Contracted Services Modification Request.
The benefits counselor documents in descriptive terms in the PASS packet all information required in the Service Description and Process and Procedure, demonstrating that the following are covered or included:
Note that any service provided by a provisionally certified CPWIC must be cosigned by the supervising certified CPWIC.
Payment for PASS is made when the VR counselor approves a complete, accurate, signed, and dated invoice and PASS packet (reviewed with the customer, as documented).
For information on benefits and work incentives counseling services fees, refer to VR-SFP 26.7 Benefits and Work Incentives Counseling Services Fee Schedule.
SSI PESS is an in-depth written explanation and application on SSA Form 795 and accompanying documents, such as a tax return, a deed, or documents proving the base value of livestock or tools. This work incentive allows customers receiving SSI who own property, livestock, or tools used in a trade or business or as an employee to exclude all or a portion of those items from resources. PESS only applies to unincorporated for-profit businesses that produce net earnings from self-employment in the trade or business exclusion, such as sole proprietorships, partnerships, and limited liability companies.
The benefits counselor receives:
The benefits counselor schedules a meeting with the customer. The meeting should be scheduled within 10 working days from receipt of the TWS-VRS referral. If the customer does not respond to the benefits counselor’s phone, email, or text message to schedule an appointment within five business days of the date on the VR1512, the benefits counselor should request the referring VR counselor’s assistance in contacting the customer.
When the BPQY is submitted with the VR referral packet, the benefits counselor should make every effort to review the completed PESS packet with the customer within 15 business days after the date on the VR1512.
When the BPQY is not submitted with the VR referral packet and the benefits counselor must obtain the BPQY, the benefits counselor should make every effort to review the completed PESS packet with the customer within 45 business days after the date on the VR1512.
The benefits counselor:
The SSA Form 795 PESS request must have attached or contain the following information:
Any request to change the PESS Service Description, Process and Procedure, or Outcomes Required for Payment must be documented and approved by the VR director using the VR3472, Contracted Service Modification Request form, before the change is implemented. For more information, refer to VR-SFP 3.4.11 Contracted Services Modification Request.
The benefits counselor documents, in descriptive terms in the PESS packet, all information required in the Service Description and Process and Procedure, demonstrating that the following are covered or included:
Note that any service provided by a provisionally certified CPWIC must be cosigned by the supervising certified CPWIC. Payment for PESS is made when the VR counselor approves a complete, accurate, signed, and dated invoice and PESS packet (reviewed with the customer, as documented).
For information on benefits and work incentives counseling services fees, refer to VR-SFP 26.7 Benefits and Work Incentives Counseling Services Fee Schedule.
The following Title II services are available:
A Title II PASS is a completed application on SSA Form 545 with budgets and an in-depth written explanation for this Title II work incentive, which allows customers to set aside money to pay for items and/or services needed to achieve a work goal.
Customers on Title II disability benefits who have an approved PASS will always get some amount of SSI disability monthly cash benefit and Medicaid while the PASS is active.
A PASS application packet for a Title II disability beneficiary must include instructions on how to report income to the Title II claims representative and a note that, as long as the customer is receiving Medicaid, he or she must have no more than $2,000/$3,000 in monthly resources.
Customers are not required to be working to have a PASS but must have a work goal that will result in a living wage.
The benefits counselor receives:
The benefits counselor schedules a meeting with the customer. The meeting should be scheduled within 10 working days from receipt of the TWS-VRS referral. If the customer does not respond to the benefits counselor’s phone, email, or text message to schedule an appointment within five business days of the date on the VR1512, the benefits counselor should request the referring VR counselor’s assistance in contacting the customer.
When the BPQY is submitted with the VR referral packet, the benefits counselor should make every effort to review the completed PASS packet with the customer within 30 business days after the date on the VR1512.
When the BPQY is not submitted with the VR referral packet and the benefits counselor must obtain the BPQY, the benefits counselor should make every effort to review the completed PASS packet with the customer within 60 business days after the date on the VR1512.
The benefits counselor completes the PASS application on SSA Form 545, the PASS budget, and other documentation, educates the customer on how to track and report PASS savings to the SSA, mails the packet to the customer, and reviews the packet with the customer.
All questions and concerns in the VR1512 Benefits and Work Incentives Planning Supports and Services Requested section must be addressed in the PASS documentation.
Any request to change the PASS Service Description, Process and Procedure, or Outcomes Required for Payment must be documented and approved by the VR director using the VR3472, Contracted Service Modification Request form, before the change is implemented. For more information, refer to VR-SFP 3.4.11 Contracted Services Modification Request.
The benefits counselor documents in descriptive terms in the PASS packet all information required in the Service Description and Process and Procedure, demonstrating that the following are covered or included:
Note that any service provided by a provisionally certified CPWIC must be cosigned by the supervising certified CPWIC.
Payment for PASS is made when the VR counselor approves a complete, accurate, signed, and dated invoice and PASS packet (reviewed with the customer, as documented).
For information on benefits and work incentives counseling services fees, refer to VR-SFP 26.7 Benefits and Work Incentives Counseling Services Fee Schedule.
A Title II IRWE is a completed application with an in-depth written explanation for this work incentive, which allows customers to retain their Title II monthly cash benefit if expenses for items and/or services related to the customer’s disability are needed to maintain employment. Title II IRWEs can only be ordered if the customer has finished a trial work period and is earning above substantial gainful activity.
The benefits counselor receives:
The benefits counselor schedules a meeting with the customer. The meeting should be scheduled within 10 working days from receipt of the TWS-VRS referral. If the customer does not respond to the benefits counselor’s phone, email, or text message to schedule an appointment within five business days of the date on the VR1512, the benefits counselor should request the referring VR counselor’s assistance in contacting the customer.
When the BPQY is submitted with the VR referral packet, the benefits counselor should make every effort to review the completed Title II IRWE packet with the customer within 10 business days after the date on the VR1512.
When the BPQY is not submitted with the VR referral packet and the benefits counselor must obtain the BPQY, the benefits counselor should make every effort to review the completed Title II IRWE packet with the customer within 45 business days after the date on the VR1512.
The Title II IRWE packet consists of:
Generic fact sheets about the customer’s Title II disability benefits and Title II IRWE may be offered for additional information.
There is no SSA form for Title II IRWE. The benefits counselor can create a template IRWE request letter for the customer. The Title II IRWE letter must contain the following information:
The benefits counselor completes the Title II IRWE packet, mails the packet to the customer and reviews the packet with the customer. All questions and concerns in the VR1512 Benefits and Work Incentives Planning Supports and Services Requested section must be addressed in the Title II IRWE documentation.
Any request to change the Title II IRWE Service Description, Process and Procedure, or Outcomes Required for Payment must be documented and approved by the VR director using the VR3472, Contracted Service Modification Request form, before the change is implemented. For more information, refer to VR-SFP 3.4.11 Contracted Services Modification Request.
The benefits counselor documents in descriptive terms in the Title II IRWE packet all information required in the Service Description and Process and Procedure, demonstrating that the following are covered or included:
Note that any service provided by a provisionally certified CPWIC must be cosigned by the supervising certified CPWIC.
Payment for a Title II IRWE is made when the VR counselor approves a complete, accurate, signed, and date invoice and Title II IRWE packet (reviewed with the customer, as documented).
For information on benefits and work incentives counseling services fees, refer to VR-SFP 26.7 Benefits and Work Incentives Counseling Services Fee Schedule.
A Subsidy or Special Condition service consists of a completed application on SSA Form 3033 signed by the customer’s employer and an in-depth written explanation. This work incentive allows customers to keep their monthly Title II cash benefit after completion of the trial work period when working above substantial gainful activity and receiving natural or paid on-the-job supports.
The benefits counselor receives:
The benefits counselor schedules a meeting with the customer. The meeting should be scheduled within 10 working days from receipt of the TWS-VRS referral. If the customer does not respond to the benefits counselor’s phone, email, or text message to schedule an appointment within five business days of the date on VR1512, the benefits counselor should request the referring VR counselor’s assistance in contacting the customer.
When the BPQY is submitted with the VR referral packet, the benefits counselor should make every effort to review the completed Subsidy or Special Condition packet with the customer within 30 business days after the date on the VR1512.
When the BPQY is not submitted with the VR referral packet and the benefits counselor must obtain the BPQY, the benefits counselor should make every effort to review the completed Subsidy or Special Condition packet with the customer within 60 business days after the date on the VR1512.
The Subsidy or Special Condition packet consists of a completed application for Subsidy or Special Condition on SSA Form 3033 and instructions on reporting income to the SSA. Generic fact sheets about the customer’s SSA disability program and Subsidy or Special Condition may be offered for additional information.
The benefits counselor mails the customer SSA Form 3033, along with the information needed for the employer to complete and sign SSA Form 3033, and reviews the packet with the customer. All questions and concerns in the VR1512 Benefits and Work Incentives Planning Supports and Services Requested section must be addressed in the Subsidy or Special Condition documentation.
Any request to change the Subsidy or Special Condition Service Description, Process and Procedure, or Outcomes Required for Payment must be documented and approved by the VR director using the VR3472, Contracted Service Modification Request form, before the change is implemented. For more information, refer to VR-SFP 3.4.11 Contracted Services Modification Request.
The benefits counselor assists the customer in getting the SSA Form 3033 completed and signed by the employer and attaches pay stubs and any other documentation, as described in the Subsidy or Special Condition Service Description.
Note that any service provided by a provisionally certified CPWIC must be cosigned by the supervising certified CPWIC.
Payment for a Subsidy or Special Condition is made when the VR counselor approves a complete, accurate, signed, and dated invoice and Subsidy or Special Condition packet (reviewed with the customer as documented).
For information on benefits and work incentives counseling services fees, refer to VR-SFP 26.7 Benefits and Work Incentives Counseling Services Fee Schedule.
The Medicaid Buy-In service consists of a completed application on HHSC Form 1200/MBI, pay stubs and other required documentation, and an in-depth written explanation for this work incentive, which allows any qualifying customer who is working and needs health insurance to purchase Medicaid and earn a living wage.
If the customer also receives Title II disability benefits, a BSA/WIP must be purchased simultaneously or before purchasing the Medicaid Buy-In service.
The benefits counselor receives:
The benefits counselor schedules a meeting with the customer. The meeting should be scheduled within 10 working days from receipt of the TWS-VRS referral. If the customer does not respond to the benefits counselor’s phone, email, or text message to schedule an appointment within five business days of the date on the VR1512, the benefits counselor should request the referring VR counselor’s assistance in contacting the customer.
If a BPQY is necessary and submitted with the VR referral packet or was previously provided within the past year, the benefits counselor should make every effort to review the completed Medicaid Buy-In packet with the customer within 30 business days after the date on the VR1512.
If a BPQY is necessary but not submitted with the VR Referral Packet and the benefits counselor must obtain the BPQY, the benefits counselor should make every effort to review the completed Medicaid Buy-In packet with the customer within 60 business days after the date on the VR1512.
The Medicaid Buy-In packet consists of a completed application on HHSC Form H-1200/MBI and instructions on reporting income to HHSC. Generic fact sheets about Medicaid Buy-In and the customer’s SSA disability program, if applicable, may be offered for additional information.
The benefits counselor assists the customer in completing the HHSC H-1200/MBI and gathering pay stubs and other necessary documentation, mails the packet to the customer, and reviews the packet with the customer. All questions and concerns in the VR1512 Benefits and Work Incentives Planning Supports and Services Requested section must be addressed in the Medicaid Buy-In documentation.
Any request to change the Medicaid Buy-In Service Description, Process and Procedure, or Outcomes Required for Payment must be documented and approved by the VR director using the VR3472, Contracted Service Modification Request form, before the change is implemented. For more information, refer to VR-SFP 3.4.11 Contracted Services Modification Request.
The benefits counselor completes and submits a Medicaid Buy-In packet to the requesting VR counselor with an invoice.
Note that any service provided by a provisionally certified CPWIC must be cosigned by the supervising certified CPWIC.
Payment for Medicaid Buy-In is made when the VR counselor approves the invoice and the completed MBI packet (reviewed with the customer as documented).
For information on benefits and work incentives counseling services fees, refer to VR-SFP 26.7 Benefits and Work Incentives Counseling Services Fee Schedule.
A benefits counselor cannot collect money from a VR customer or the customer’s family for any service.
Services |
Proposed New Rates |
Comment |
Benefits I&R |
$100 |
May be purchased one time for a customer |
BSA/WIP |
$550 |
May be purchased one time for a customer |
Veteran’s BSA/WIP |
$1,000 |
May be purchased one time for a customer |
Revision to BSA/WIP or Veteran’s BSA/WIP |
$300 |
May be purchased multiple times for a customer |
PASS |
$450 |
May be purchased one time for a customer |
IRWE |
$100 |
May be purchased one time for each job a customer obtains |
BWE (SSI only) |
$100 |
May be purchased one time for each job a customer obtains |
PESS (SSI only) |
$100 |
May be purchased one time for each job a customer obtains |
SEIE (SSI only) |
$100 |
May be purchased one time for each job a customer obtains |
Subsidy or Special Condition (Title II only) |
$100 |
May be purchased one time for each job a customer obtains |
Medicaid Buy-In Application (Any customer) |
$260 |
May be purchased one time for each job a customer obtains |