[Federal Register Volume 80, Number 88 (Thursday, May 7, 2015)]
[Notices]
[Pages 26314-26317]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-10993]
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SOCIAL SECURITY ADMINISTRATION
[Docket No. SSA-2015-0023]
Request for Information on Early Intervention Strategies for
Serving Individuals With Disabilities
AGENCY: Social Security Administration.
ACTION: Request for information.
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SUMMARY: The Consolidated and Further Continuing Appropriations Act,
2015 (Pub. L. 113-235), provided us with money under section 1110 of
the Social Security Act to begin the design, development, and
implementation of an early intervention demonstration to test
innovative strategies aimed at helping people with disabilities remain
in the workforce. The President's FY 2016 Budget requested additional
funds to support a complete demonstration project. In order to inform
the development of that demonstration, this request for information
(RFI) seeks recommendations on targeted design features related to
improving employment and earnings outcomes for people with
disabilities, specifically individuals with mental impairments. The
input we receive will inform and complement ongoing interagency
deliberations about the best use of funds for an initial demonstration
project relevant to future policy discussions for the Social Security
Disability Insurance (DI) and Supplemental Security Income (SSI)
programs.
DATES: Comments must be received by June 8, 2015.
ADDRESSES: You may submit comments by any one of three methods--
Internet, fax, or mail. Do not submit the same comments multiple times
or by more than one method. Regardless of which method you choose,
please state that your comments refer to Docket No. SSA-2015-0023 so
that we may associate your comments with the correct docket.
Caution: You should be careful to include in your comments only
information that you wish to make publicly available. We strongly urge
you not to include in your comments any personal information, such as
Social Security numbers or medical information.
1. Internet: We strongly recommend that you submit your comments
via the Internet. Please visit the Federal eRulemaking portal at http://www.regulations.gov. Use the Search function to find docket number
SSA-2015-0023. The system will issue a tracking number to confirm your
submission. You will not be able to view your comment immediately
because we must post each comment manually. It may take up to a week
for your comment to be viewable.
2. Fax: Fax comment to (410) 966-2830.
3. Mail: Mail your comments to the Office of Regulations and
Reports Clearance, Social Security Administration, 3100 West High Rise
Building, 6401 Security Boulevard, Baltimore, Maryland 21235-6401.
Comments are available for public viewing on the Federal
eRulemaking portal at http://www.regulations.gov or in person, during
regular business hours, by arranging with the contact person identified
below.
FOR FURTHER INFORMATION CONTACT: Susan Wilschke, Office of Retirement
and Disability Policy, Social Security Administration, 6401 Security
Boulevard, Baltimore, Maryland 21235-6401, (410) 966-8906. For
information on eligibility or filing for benefits, call our nation
toll-free number, 1-800-772-1213 or TTY 1-800-325-0778, or visit our
Internet site, Social Security online, at http://www.socialsecurity.gov.
SUPPLEMENTARY INFORMATION:
Purpose
The DI program provides benefits for disabled workers and their
families. We paid more than $141 billion in DI benefits to almost 11
million people in 2014. The SSI program guarantees a
[[Page 26315]]
minimum level of income support to financially needy individuals who
are aged, blind, or disabled. In 2014, we paid nearly $54 billion in
Federal SSI benefits to more than 8 million people. Given the large
number of individuals who rely on the DI and SSI programs to make ends
meet and the interest in supporting employment efforts of those with
disabilities, it is helpful for policymakers to have an evidentiary
base from which to consider potential program improvements and
innovations that can strengthen the ability of individuals with
disabilities to work.
This request for information offers States, community-based and
other non-profit organizations, philanthropic organizations,
researchers, and other interested members of the public the opportunity
to provide recommendations on effective approaches for improving
employment and earnings outcomes for individuals with disabilities,
specifically individuals with mental impairments. For the purposes of
this RFI, ``early intervention'' means serving an individual with
impairment before the individual is determined eligible for benefits in
either the DI or SSI programs.
In light of research indicating that health problems often begin in
advance of complete disability onset, and data showing that earnings
often begin to decline well before benefits are awarded, we believe
demonstrations on early intervention are merited and may lead to
innovative approaches for assisting people with disabilities to succeed
in the workforce. Our past demonstrations have identified certain
interventions after the point of complete disability onset that can
yield positive outcomes for beneficiaries, but earlier interventions,
before an individual begins to receive DI or SSI benefits, may be more
effective. While several demonstrations for existing DI and SSI
beneficiaries have yielded positive results, such as increased
earnings, they have not identified interventions that would return
beneficiaries to substantial and sustained employment.
Public input responding to this notice will inform ongoing
deliberations of a Federal interagency workgroup and a Federal
Technical Advisory Panel--including representatives from SSA, the
Department of Health and Human Services, the Department of Education,
the Department of Labor, and the Office of Management and Budget--about
the design and parameters of the demonstration funded by our FY 2015
Appropriation.\1\ This demonstration project will help the agencies
develop an evidentiary base for future potential DI and SSI program
reforms. Responses to the RFI will also inform how SSA and its
interagency partners could deploy additional resources for early
interventions that were requested in the FY 2016 President's Budget.
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\1\ FY 2016 President's Budget, Appendix Volume--Supplemental
Security Income Program, p. 1206 (see http://www.whitehouse.gov/sites/default/files/omb/budget/fy2016/assets/ssa.pdf#Page=2.
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Background
SSA and other Federal agencies have begun to outline the basic
parameters of an early intervention demonstration project for
individuals with mental impairments. This discussion provides
background on those broad parameters and potential models under
consideration, and the next section requests information on a series of
program design issues.
Early interventions may be warranted in light of research
indicating that health problems begin in advance of complete disability
onset and data showing that earnings begin to decline well before DI
benefits are awarded. Some evidence suggests that intervening before an
individual fully detaches from the labor market may be more effective
than providing services after disability benefit receipt. For example,
the Centers for Medicare and Medicaid Services Demonstration to
Maintain Independence and Employment (DMIE) found that health and
employment supports for working adults with potentially disabling
conditions lowered the likelihood of receiving payments from our
disability programs. The National Institute of Mental Health's Recovery
After an Initial Schizophrenia Episode (RAISE) project is testing
whether intervening at the point of first diagnosis and using early and
aggressive treatment will reduce the symptoms and prevent the gradual
deterioration of functioning that is characteristic of chronic
schizophrenia. However, a broader, more extensive research base would
help policymakers design programs and policies that improve outcomes
for individuals and reduce program costs.
A key challenge for early interventions is to identify individuals
at risk of becoming long-term DI beneficiaries or SSI recipients who
would also have the potential to benefit from the intervention methods.
For an initial demonstration, we are considering targeting intervention
services towards prime-working-age people with disabilities to keep
them in the labor market. Specifically, we are interested in developing
an intervention model for workers with mental impairments between the
ages of 18 and 50 which would allow them to remain in the labor force.
By providing medical and/or vocational services prior to benefit
receipt in a demonstration, we will be able to test whether such
services help individuals with these impairments remain and succeed in
the workforce.
We are considering a design in which individuals will be identified
as early as possible after a first episode of mental illness. Our
initial focus for target populations is potentially on two groups: (1)
Individuals receiving services from a State Vocational Rehabilitation
(VR) agency who are not DI or SSI disability beneficiaries; and (2)
individuals who have recently applied for SSI or DI disability benefits
and whose claims were denied. Both of these groups include individuals
who are on the margin between employment and receiving disability
benefits. Prior research estimates that 40 percent of DI claimants
denied at the appeals level become DI beneficiaries within 10 years.\2\
One goal of the demonstration is to determine whether some of those
individuals would be able to remain in the labor market if they are
provided appropriate health care and employment supports. People who
seek VR services may hold an interest in employment despite a
documented impairment. We are considering focusing on applicants whose
claims have been denied as well as VR participants because they are a
population that can be easily identified, and the intervention, if
successful, could be scaled up. The ideal target population has both a
likelihood of receiving SSA disability benefits in the future and yet
maintains a recent or strong enough connection to the labor market that
they are likely to respond to the offer of employment services.
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\2\ French, Eric, and Jae Song. 2014. ``The Effect of Disability
Insurance Receipt on Labor Supply.'' American Economic Journal:
Economic Policy, 6(2): 291-337. https://www.aeaweb.org/articles.php?doi=10.1257/pol.6.2.291.
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We are considering an approach that includes some of the features
of the successfully implemented Mental Health Treatment Study (MHTS).
The MHTS demonstration found that employment supports, along with
medical support and coordinated care, were successful in improving
health, lowering hospitalizations, and increasing employment for DI
beneficiaries with schizophrenia and affective disorders. The MHTS
followed the evidence-based Individual
[[Page 26316]]
Placement and Support (IPS) model, a supported employment model
designed for rapid placement of individuals into competitive
employment. In the new early intervention demonstration being
developed, we are considering providing participants with a team of
mental health providers and employment specialists who would coordinate
and provide services that would optimize that individual's ability to
obtain and retain employment.
The demonstration could provide participants with an intensive set
of behavioral health and related services beyond what is available
through the individual's existing health plan and long-term employment
services, to help them remain in or return to the labor market rather
than seek SSA disability benefits. For example, IPS services are
delivered by supported employment teams that operate within community
mental health agencies and other medical providers, with a key
differentiator from other interventions being the linkage between
employment and medical services.
The MHTS is one of several studies using the IPS model to show
increases in employment rates for persons with severe mental
impairments.\3\ The health-related treatment could include behavioral
health and related services, medication, and disease management
services.\4\ The employment-related services could include job
training, job placement, and pre- and post-placement support services.
We would likely require service providers to have strong employer
contacts and demonstrate the ability to place participants in
sustainable, paid, competitive employment. Support services could
include: Help with incidentals necessary to secure and maintain
employment (for example, work clothes or transportation) and with
navigating other available supports, such as systematic medication
management and nurse-care coordinator services; and low intensity,
long-term services that would focus on employment retention once a job
is secured (for example, providing an employment retention coach).
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\3\ See MHTS Final Report at http://socialsecurity.gov/disabilityresearch/documents/MHTS_Final_Report_508.pdf.
\4\ See Nuechterlein, et al. for example of an adaptation of the
IPS model at http://www.ncbi.nlm.nih.gov/pubmed/18407884. The
Demonstration to Maintain Independence and Employment provided
enhanced medical care and employment services. See http://www.sciencedirect.com/science/article/pii/S1936657413001179.
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We intend to issue a contract solicitation for demonstration
implementation later in FY 2015 with an award in early calendar year
2016. SSA and collaborating agencies are considering a multi-site
demonstration, an approach on which we solicit feedback in this RFI. A
multi-site demonstration would likely include a 1-year design
refinement phase, during which one or two sites would begin enrollment
to inform implementation of any additional sites during calendar year
2016. The demonstration would then transition to a five-year
implementation phase. Over that period, we would evaluate impacts on
outcomes such as employment, earnings, health, and DI and SSI
applications and benefit receipt.
Request for Information
Through this RFI, we are soliciting feedback from a broad range of
stakeholders on the initial design of an early intervention
demonstration focused on improving outcomes related to employment and
earnings for individuals with mental impairments, including services
that could optimize an individual's ability to obtain and retain
employment. Responses to this RFI will inform the work of SSA and its
interagency partners in designing a new demonstration project and
potentially future projects.
This RFI is for planning purposes only and should not be construed
as a solicitation or as an obligation on our part or on the part of
participating Federal agencies.
We ask respondents to address the following questions, where
possible, in the context of the discussion in this document. You do not
need to address every question and should focus on those where you have
relevant expertise or perspectives. To the extent possible, please
clearly indicate which question(s) you address in your response.
Key Questions
1. What early intervention programs or practices have shown promise
at the State or local level to assist workers with mental health
impairments to remain in the workforce?
2. In the context of this demonstration project, what programs and
practices might be especially applicable to individuals who might
qualify for DI or SSI benefits in the absence of interventions?
3. What are the outcomes of interest that an evaluation should
capture?
Detailed Questions
I. Population and Sites
1. Should we focus on specific types of mental impairments in
establishing the parameters for this demonstration? If so, which ones,
and why those?
2. Would individuals with non-mental impairments benefit from
similar services? If so, would the intervention look different and how?
3. We are considering focusing on individuals who are ages 18 to 50
for services in this demonstration. How appropriate is this age range?
4. We are considering focusing on individuals who are receiving
services from a State VR agency but who are not SSA disability
beneficiaries. Is this an appropriate population from which to draw a
sample? If so, how can we identify those VR clients who are likely to
apply for DI or SSI benefits in the future without inducing an
application?
5. We are considering focusing on individuals who have applied for
DI or SSI benefits and whose claims were denied. Is this an appropriate
population from which to draw a sample?
6. Are there other populations on which we should consider
focusing? How can we identify these populations?
7. What types of sites would be the most beneficial for us to
consider including?
8. Are there sites we could look to as exemplars based on current
practices? What evidence suggests these sites effectively address early
intervention services for workers with mental impairments?
9. At how many sites should we consider implementing this
demonstration?
10. How might we best consider structuring the demonstration to
investigate the potential for screening workers for both their
likelihood of receiving disability benefits and their likelihood of
responding to employment supports?
II. Mental Health Services
11. What types of mental health services should we consider as an
early intervention for workers with mental impairments?
12. What variations in timing should we consider for early
interventions?
13. To what extent should certain mental health services be
prioritized, whether behavioral health and related services,
medication, or disease management services?
14. What are the best ways to involve workers with disabilities in
planning and implementation in order to ensure that demonstration
services will be effective in meeting their needs?
15. What mental health service program designs and interventions
demonstrate promise for improving long-term employment outcomes for
workers with disabilities? What evidence supports these interventions?
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III. Employment and Job-Related Services
16. What specific employment-related interventions related to skill
development, job training, job placement, or pre- and post-placement
services should we consider?
17. What employment program designs and interventions demonstrate
promise for improving long-term employment outcomes for workers with
disabilities? What evidence supports these interventions?
Guidance for Submitting Documents
We ask that each respondent include the name and address of his or
her institution or affiliation, and the name, title, mailing and email
addresses, and telephone number of a contact person for his or her
institution or affiliation, if any.
Rights to Materials Submitted
By submitting material in response to this RFI, you agree to grant
us a worldwide, royalty-free, perpetual, irrevocable, nonexclusive
license to use the material, and to post it publicly. Further, you
agree that you own, have a valid license, or are otherwise authorized
to provide the material to us. You should not provide any material you
consider confidential or proprietary in response to this RFI. We will
not provide any compensation for material submitted in response to this
RFI.
Dated: April 29, 2015.
Carolyn W. Colvin,
Acting Commissioner of Social Security.
[FR Doc. 2015-10993 Filed 5-6-15; 8:45 am]
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