The only type of written agreement required under Ticket regulations is the EN to VR referral agreement. Section 411.400 of the regulations and Part III, Section 4 of the EN Request for Quotation (RFQ) address the conditions under which an EN can refer a beneficiary to a State VR agency for services and still keep the Ticket assignment. The regulations state that referrals can only be made if the VR agency and the EN have an agreement that specifies the conditions under which services will be provided by the State VR agency.
The EN RFQ further clarifies the requirement, stating that "without an agreement in place the EN shall not actively or passively refer a beneficiary to VR for services." A passive referral is defined by Social Security as any statement (written or verbal) understood by a beneficiary as directing him/her to the State VR agency for services. The EN RFQ also states that failure to comply with this provision may result in sanctions against the EN, including possible un-assignment of the Ticket once the VR agency accepts the beneficiary for services.
In most cases, these agreements address how the EN will compensate the VR agency for the services provided since the State VR agency cannot submit for reimbursement if the EN keeps the Ticket assignment. While these agreements are normally broadly worded to apply to all beneficiaries the EN is referring to VR, an EN and a State VR agency may enter into specific agreements to meet the needs of individual beneficiaries.
"Referral agreements" must be in writing and signed by both the VR agency and the EN prior to the EN referring any beneficiaries to the VR agency for services. The RFQ states that the EN shall submit a copy of the agreement to the Ticket Program Manager (TPM) within two weeks of the signing of the agreement.
A referral agreement is not necessary if the EN is un-assigning the beneficiary's Ticket in conjunction with the referral to VR, or if the beneficiary is planning to un-assign his/her Ticket and place it in use with the State VR agency.
If an EN is repeatedly making referrals to a State VR agency without unassigning tickets or having a referral agreement in place, the agency should notify the TPM by calling the Program Integrity Hotline at 1.888.407.4723 or by emailing the TPM's Program Integrity team at email@example.com. When using the hotline or email address, include the following information:
- A description of your concern,
- Information on the parties involved,
- Details on how and when the incident(s) occurred, and
- Your name and contact number (if you are willing to share this information).