20 C.F.R. § 411.545

Current through November 30, 2024

Section 411.545 - How are the outcome payments calculated under the outcome-milestone payment system?

The amount of each monthly outcome payment under the outcome-milestone payment system is calculated as follows:

(a) For title II disability beneficiaries (including concurrent title II/title XVI disability beneficiaries), an outcome payment is equal to 36 percent of the payment calculation base as defined in § 411.500(a)(1) for the calendar year in which the month occurs, rounded to the nearest whole dollar;

(b) For title XVI disability beneficiaries (who are not concurrently title II/title XVI disability beneficiaries), an outcome payment is equal to 36% of the payment calculation base as defined in § 411.500(a)(2) for the calendar year in which the month occurs, rounded to the nearest whole dollar.

(c) The following chart provides an example of how an EN could receive milestone and outcome payments:

Outcome-Milestone Payment Table

Chart I-New Outcome-Milestone Payment Table

[2008 figures for illustration only]

Payment type	Beneficiary earnings	Title II amount of payment	Title XVI amount of payment
Phase 1 (120% of Title II PCB)
Milestone 1	$335/mo. $670/mo. * 3 mo. work in a 6-month period	$1,177	$1,177
Milestone 2	$1,177	$1,177
Milestone 3	$670/mo. * 6 mo. work in a 12-month period	$1,177	$1,177
Milestone 4	$670/mo. * 9 mo. work in an 18-month period	$1,177	$1,177
Total Phase 1 milestones		$4,708	$4,708
Phase 2 (36% of PCB)	Gross Earnings[GREATER THAN]SGA
Title II milestones 1-11	$353 * 11 = $3,883
Title XVI milestones 1-18	$203 * 18 = $3,654
Total Phase 1 + 2	$8,591	$8,362
	Outcome payments (36% of PCB)
Title II = 1-36	Monthly cash benefit not payable due to SGA	$353 * 36 = $12,708
Title XVI = 1-60	Sufficient earnings for federal cash benefits = "0"	203 * 60 = $12,180
Total milestone and outcome payments	$21,299	$20,542

Definitions and amounts: Payment Calculation Base (PCB)-The average title II disability insurance benefit payable under section 223 of the Social Security Act for all beneficiaries for months during the preceding calendar year; and the average payment of supplemental security income benefits based on disability payable under title XVI (excluding State supplementation) for months during the preceding calendar year to all beneficiaries who have attained 18 years of age but have not attained 65 years of age. (2008 title II = $981.17, title XVI = $563.35).

Gross earnings requirements for Phase 1 are based on Trial Work level amounts.

For Phase 1 milestones only, the payments are calculated for both title XVI and title II beneficiaries using the higher title II payment calculation base. All other payments are based on a percentage of the Payment Calculation Base (PCB) for the respective program (title XVI or title II). See § 411.535 for a discussion of the circumstances under which we will pay milestones.

Phase 1 milestones = 120% of PCB.

Phase 2 milestones = 36% of PCB.

Outcome payments (under the outcome-milestone payment system) = 36% of PCB Earnings used to meet the first, second, or third Phase 1 milestone may be counted again when determining if a later milestone is met, provided the earlier earnings fall within the relevant time period for meeting the later Phase 1 milestone (see 411.525(a)(2) for the relevant time period for each milestone).

20 C.F.R. §411.545