Referral Agreements

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 6 of the EN Request for Application (RFA) 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 State VR agency and the EN have a signed agreement that specifies the conditions under which services will be provided by the State VR agency.

The EN RFA further clarifies the requirement, stating that "without an agreement with the State VR agency, the EN shall arrange for the beneficiary to make the Ticket available to the State VR agency temporarily by unassigning the Ticket". The EN RFA also states that if an EN disregards this protocol, SSA may withhold Phase 1 payments to the EN or implement improper payment procedures if payment was already made.

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 Cost 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 State VR agency and the EN prior to the EN referring any beneficiaries to the State VR agency. The RFA 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 unassigning the beneficiary's Ticket in conjunction with the referral to VR, or if the beneficiary is planning to unassign his/her Ticket and place it in use with the State VR agency.

If an EN is making referrals to a State VR agency without unassigning Tickets or having a referral agreement in place, the agency should notify the TPM by emailing the TPM's Program Integrity team at 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).