[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]


=======================================================================
-----------------------------------------------------------------------

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.

-----------------------------------------------------------------------

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.
---------------------------------------------------------------------------

    \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.
---------------------------------------------------------------------------

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.
---------------------------------------------------------------------------

    \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.
---------------------------------------------------------------------------

    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).
---------------------------------------------------------------------------

    \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.
---------------------------------------------------------------------------

    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?

[[Page 26317]]

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]
BILLING CODE 4191-02-P