[Federal Register Volume 60, Number 28 (Friday, February 10, 1995)]
[Rules and Regulations]
[Pages 8140-8153]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-3369]
[[Page 8139]]
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Part X
Department of Health and Human Services
_______________________________________________________________________
Social Security Administration
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20 CFR Parts 404 and 416
Benefit Reforms for Individuals Disabled Based on Drug Addiction or
Alcoholism; Interim Final Rule
Federal Register / Vol. 60, No. 28 / Friday, February 10, 1995 /
Rules and Regulations
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[[Page 8140]]
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Social Security Administration
20 CFR Parts 404 and 416
[Regulations Nos. 4 and 16]
RIN 0960-AD96
Federal Old-Age, Survivors, and Disability Insurance and
Supplemental Security Income for the Aged, Blind, and Disabled; Benefit
Reforms for Individuals Disabled Based on Drug Addiction or Alcoholism
AGENCY: Social Security Administration, HHS.
ACTION: Interim final rules with request for comments.
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SUMMARY: The Social Security Independence and Program Improvements Act
of 1994 contains provisions affecting the payment of benefits under
titles II and XVI of the Social Security Act (the Act) to individuals
whose drug addiction or alcoholism is a contributing factor material to
the determination of disability. These interim final rules implement
certain provisions related to limitations on benefit payments and the
nonpayment and termination of benefits to these individuals.
DATES: These interim final rules are effective on March 1, 1995. To be
sure that your comments are considered, we must receive them no later
than April 11, 1995.
ADDRESSES: Comments should be submitted in writing to the Commissioner
of Social Security, Department of Health and Human Services, P.O. Box
1585, Baltimore, MD 21235, sent by telefax to (410) 966-2830, or
delivered to the Division of Regulations and Rulings, Social Security
Administration, 3-B-1 Operations Building, 6401 Security Boulevard,
Baltimore, MD 21235, between 8:00 a.m. and 4:30 p.m. on regular
business days. Comments received may be inspected during these hours by
making arrangements with the contact person shown below.
FOR FURTHER INFORMATION CONTACT: Regarding this Federal Register
document--Richard M. Bresnick, Legal Assistant, Division of Regulations
and Rulings, Social Security Administration, 6401 Security Boulevard,
Baltimore, MD 21235, (410) 965-1758; regarding eligibility or filing
for benefits--our national toll-free number, 1-800-772-1213.
SUPPLEMENTARY INFORMATION:
History
In 1972, Public Law (Pub. L.) 92-603 established the supplemental
security income (SSI) program under title XVI of the Act. Aside from
disability for children under age 18 and blindness, the Act provided
the same definition of disability for individuals under title XVI as it
does under title II. However, the SSI program included special
provisions for disabled persons medically determined to be drug addicts
or alcoholics. As implemented, those provisions applied to individuals
whose drug addiction or alcoholism (DAA) was a contributing factor
material to the determination that they were disabled (disabled based
on DAA). The SSI provisions stated that an individual determined to be
disabled based on DAA could receive SSI benefits only if he or she
underwent appropriate treatment for the substance addiction when it was
available and received payments through a representative payee.
The 1972 legislation also required the Secretary of Health and
Human Services (the Secretary) to provide for the monitoring and
testing of these individuals to assure compliance with treatment and to
determine how the imposition of the treatment requirement contributes
to the achievement of program purposes. The Secretary also was required
to submit an annual report to Congress on the treatment and compliance
of affected SSI recipients.
Prior to the passage of the Social Security Independence and
Program Improvements Act of 1994, Pub. L. 103-296, enacted on August
15, 1994, there were no special program rules for Social Security
beneficiaries whose medically determined drug addiction or alcoholism
was a contributing factor material to the determination of disability.
New Legislation
The amendments made to the Act by section 201 of Pub. L. 103-296
introduced several new requirements and limitations for SSI recipients
disabled based on DAA and applied similar requirements and limitations
to Social Security beneficiaries disabled based on DAA, as well. These
requirements and limitations are, in part, intended to discourage
individuals from using Social Security or SSI benefits to support an
addiction, as well as encourage the treatment and rehabilitation of
individuals disabled based on DAA.
Section 201(a) of Pub. L. 103-296 contains the title II provisions
related to DAA and section 201(b) contains the corresponding SSI
provisions. The new requirements and changes under both programs for
individuals disabled based on DAA include:
Paying benefits to a representative payee;
A preference for selecting certain types of organizational
payees, inclusion of certain State and local government agencies as
qualified organizations, making permanent the provision authorizing
certain qualified organizations to collect a fee from beneficiaries for
whom they serve as representative payees, and increasing the upper
limit of the fee that organizational payees can charge persons disabled
based on DAA;
Requiring both Social Security and SSI recipients who are
disabled based on DAA to undergo appropriate substance abuse treatment,
if available;
Suspending benefits for months in which there is a failure
to comply with appropriate, available treatment and requiring that
individuals must demonstrate compliance with that treatment for a
specified period of time before payments can resume;
Terminating benefits after 12 consecutive months of
suspension for noncompliance (the individual may reapply and receive
disability benefits based on DAA for the remainder of the 36-month
limit described below);
Monitoring and testing of individuals to assure
compliance;
Establishing at least one referral and monitoring agency
(RMA) in every State to identify appropriate treatment placements, to
refer individuals disabled based on DAA to treatment and to monitor
compliance with such treatment;
Paying past-due benefits in installments, with a limited
exception for individuals with outstanding debts related to housing who
are at a high risk of homelessness;
A 36-month limit on the payment of benefits beginning with
the March 1995 payment month, with some differences between the title
II and SSI programs as to how the months are counted (months of
suspension will not be counted in the 36 months for either program);
A ``sunset date'' of September 2004 for the 36-month limit
on the payment of benefits;
Continued Social Security benefit payments to auxiliaries
after a disabled wage earner's benefits are suspended for failure to
comply with treatment requirements or when entitlement is terminated
after the 36 months, as long as the wage earner continues to be
disabled; [[Page 8141]]
Continuation of beneficiary status for purposes of
Medicare and Medicaid coverage during periods of suspense for
noncompliance and after eligibility or entitlement is terminated after
36 months of benefits are paid, as long as the individual remains
disabled.
Many of these provisions are effective for benefits payable for
months beginning March 1, 1995. Implementing regulations for certain
statutory provisions must be issued by February 11, 1995, 180 days
after enactment, and are included in these interim final rules. For
those statutory provisions not requiring final regulations by February
1995, principally those concerning representative payment, we will
publish a separate notice of proposed rulemaking (NPRM) in the Federal
Register.
These interim final regulations affect all disabled individuals
whose drug addiction or alcoholism is a contributing factor material to
the determination of disability, including those who were found
eligible for title II or SSI benefits before March 1, 1995. By March 1,
1995, the Social Security Administration (SSA) will have sent notices
to these individuals of the changes in the Act which affect them, as
required by section 201 of Pub. L. 103-296. At the same time, SSA also
will have sent notices to the representative payees of these
individuals who have them.
Congressional Direction to Consult With Experts
Section 201 of Pub. L. 103-296 directed the Secretary to consult
with drug and alcohol treatment professionals in formulating
regulations defining appropriate treatment for individuals subject to
the new provisions and establishing guidelines for the review and
evaluation of compliance and progress. On August 24-25, 1994, SSA
convened a meeting in Hunt Valley, Maryland of substance abuse
treatment professionals from across the nation to gain their individual
views on devising the new and revised regulations. During this meeting,
a wide range of substance abuse-related topics was discussed, but the
focus was on the legislative requirements to treat and monitor this
disabled population. In addition, SSA has written directly to numerous
professional organizations, individual treatment professionals, public
advocacy organizations, RMAs, and others with knowledge of substance
abuse-related issues seeking their views on treatment and compliance
questions and issues to gain balanced input on general contemporary
treatment philosophies.
On October 17, 1994, SSA published in the Federal Register a Notice
of Intent with Request for Comments (59 FR 52380) to solicit public
comments about the legislative requirements imposed by Pub. L. 103-296
and the regulations SSA is required to promulgate. The comment period
closed on November 16, 1994.
The comments we have received from all of these varied sources have
proved to be invaluable in revising the rules relating to individuals
under a disability when drug addiction or alcoholism is a contributing
factor material to the determination of disability.
What the Experts and Other Public Commenters Told Us
We solicited the views of experts in the field of substance abuse
treatment, as required by Pub. L. 103-296. We received valuable input
from treatment professionals and administrators at the August 24-25
meeting and subsequently received written comments from many of the
attendees. While we were interested in receiving the views of the
experts and other members of the public on all issues related to the
DAA provisions, we sought specific input from the discussions and the
Notice of Intent published October 17, 1994, on the following issues:
The definition of ``appropriate'' treatment for DAA;
The definition of when treatment is ``available'';
How to define and evaluate ``progress'' in treatment;
How to evaluate ``compliance'' with treatment;
The frequency with which RMAs should monitor an
individual's compliance with his/her treatment plan;
The definition of ``good cause'' for an individual's
failure to comply with the treatment requirements; and
The costs and benefits to be realized from the provisions.
In response to the Notice of Intent, we received comments from 56
individuals and groups. Commenters from State and local governments
ranged from State RMAs to Social Service Agencies, Medicaid Agencies,
and county government offices. Two national associations of directors
of State governmental entities also provided comments. In addition,
several treatment facilities, legal services organizations, and
individual attorneys commented on the Notice of Intent.
We have carefully considered all of the comments in developing
these interim final regulations.
Appropriate Treatment
Most commenters defined appropriate substance abuse treatment as a
continuum of services to individuals with alcohol and other drug
problems. Many commenters believed that appropriate treatment is that
which serves the individual's needs in the least restrictive setting
consistent with an individualized treatment plan. A significant number
of commenters expressed the view that appropriate treatment can be
defined only on an individualized basis by treatment professionals
since there is no one modality that will work for every client disabled
based on DAA. Accordingly, various commenters advised SSA to refrain
from promulgating specific regulatory guidelines. Rather, they
suggested that the determination of ``appropriate'' treatment should be
within the purview of treatment professionals, circumscribed by very
general guidelines provided by SSA. Many commenters stated that client
participation in 12-step programs such as Alcoholics Anonymous is not,
in and of itself, appropriate treatment. While such programs may be
part of an overall treatment plan, because of their nature, they are
not treatment.
Available Treatment
Many commenters believed that the definition of ``availability'' of
substance abuse treatment should be a broadly inclusive definition to
assure that the client can in fact avail himself or herself of
appropriate treatment. Many commenters offered a list of factors that
should be used in determining availability of treatment: location of
the facility, availability and affordability of transportation, child
care, the client's general health, particular condition and
circumstances, language and cultural appropriateness.
There was a division among commenters as to whether one component
of ``available'' should be whether the treatment was without cost to
the client. Some commenters were of the view that treatment must be
without cost in order to be ``available.'' Others thought that the
client should be required to make some investment in the treatment
program by paying for some or all of the cost of treatment, depending
upon the type of treatment and the client's circumstances.
Evaluating Progress in Treatment
Generally, commenters posited that it would be difficult to
construct one definition or method by which to measure individuals'
progress in treatment. A large organization of State
[[Page 8142]] program administrators and others commented that no
universally accepted tool existed to measure individuals' progress in
substance abuse treatment. Due to the lack of a universally acceptable
tool to measure progress, other commenters were of the view that
treatment professionals should evaluate whether progress is made
according to very general rules set out by SSA. A few commenters
provided suggestions for some of the elements in the measurement of
progress, including abstinence from alcohol and drug use, a reduction
in the use of emergency medical services, an increase in educational or
vocational rehabilitation activities, and avoidance of criminal
activity.
Evaluating Compliance With Treatment
The commenters favored general rather than specific rules governing
compliance with the treatment requirements. Several commenters were of
the view that compliance means that an individual follows his or her
individual treatment plan. Accordingly, the treatment professional is
in the best position to evaluate compliance. One legal services
organization was concerned that SSA retain the ultimate responsibility
for determining compliance. One aspect of compliance is the issue of
requiring alcohol and drug testing. A few commenters recommended that
SSA mandate drug tests for beneficiaries in treatment. Several
commenters, including one of the large national organizations of State
administrators, advised against mandatory drug testing. In their view,
the need for and frequency of drug testing should be determined by the
treatment professional in accordance with an individualized treatment
plan. Concern was expressed about the cost of mandatory drug testing
and inaccuracies inherent in drug testing results.
Good Cause for Failure to Comply With Treatment
Many commenters supported an expansive list of factors that would
be considered ``good cause'' for noncompliance with the treatment
requirements, such as medical problems, lack of transportation, or
personal or family tragedies. Some commenters thought that the
treatment provider was in the best position to evaluate if the client
had ``good cause'' for noncompliance. A minority of commenters
supported a very restrictive definition because of their concern that
``good cause'' factors could be manipulated by individuals in
treatment.
Costs and Benefits
Few commenters provided information on the potential costs and
benefits of the provisions. Commenters provided a range of estimated
costs for drug testing expenses.
Other Comments
Many commenters expressed concerns regarding a number of
operational issues which are not the subject of these regulations.
Although these concerns are not regulatory issues, they have been
considered carefully in the development of our operating procedures.
Explanation of Revisions
These interim final regulations amend Secs. 404.315, 404.316,
404.321, 404.332, 404.335, 404.337, 404.350, 404.352, 404.402, 404.902,
416.202, 416.213, 416.262, 416.265, 416.535, 416.542, 416.558, 416.601,
416.610, 416.935, 416.936, 416.937, 416.938, 416.939, 416.1123,
416.1326, 416.1331, 416.1335, 416.1402 and 416.1725 and create new
Secs. 404.470, 404.480, 404.1535, 404.1536, 404.1537, 404.1538,
404.1539, 404.1540, 404.1541, 416.544, 416.940 and 416.941 to reflect
the statutory changes.
Section 404.315 is revised to add a new paragraph explaining the
prohibition against reentitlement to disability benefits based on DAA
after receiving 36 months of disability benefits on the basis of that
impairment.
Sections 404.316 and 404.321 have been amended to include an
explanation of the 36-month benefit limit and the termination of
benefits for 12 consecutive months of noncompliance in cases in which
drug addiction or alcoholism is a contributing factor material to the
determination of disability.
Section 404.332 is revised to state that, if the insured person is
disabled based on DAA and benefits terminate because of noncompliance
with treatment or because of the 36-month benefit limit, benefits to
the spouse will continue, provided the insured person remains disabled.
Section 404.335 provides that, if benefits to a widow(er) who is
disabled based on DAA are terminated after 36 months of benefits, that
person cannot become entitled again to widow(er)'s benefits if drug
addiction or alcoholism is a contributing factor material to the later
determination of disability.
Section 404.337 explains that, if the widow(er)'s entitlement to
benefits is based on DAA, benefits will terminate after 12 consecutive
months of suspension for noncompliance with treatment or, unless
otherwise disabled without regard to drug addiction or alcoholism,
after having received 36 months of payment.
Section 404.350 is revised to state that, if the entitlement of a
disabled child age 18 or over whose disability was based on DAA
terminates because of the 36-month benefit limit, the child may not be
entitled again to benefits based on a disability if drug addiction or
alcoholism is a contributing factor material to the later determination
of disability.
Section 404.352 states that, if the disability of a disabled child
age 18 or over is based on DAA and his or her benefits have been
suspended for a period of 12 consecutive months for failure to comply
with treatment, those benefits will terminate with the month following
the 12-month period of suspension. Likewise, if, after receiving 36
months of benefits based on DAA, the child would not otherwise be
disabled without regard to drug addiction or alcoholism, benefits based
on disability will be terminated with the month following the 36th
month of payment. If the disabled child is receiving benefits on the
record of a wage earner whose disability was based on DAA and benefits
to the wage earner end because of noncompliance with treatment or 36
months of benefits have been paid, benefits to the child will continue,
provided the insured person would have remained entitled to benefits
but for the operation of this provision.
Section 404.402 is revised to include nonpayments because of drug
addiction or alcoholism in the list of deductions, reductions, and
adjustment events which are considered before computing any applicable
reduction for the family maximum.
Sections 404.470 and 416.1725 explain the nonpayment ramifications
for beneficiaries disabled based on DAA who fail to comply with the
rules regarding available treatment for drug addiction or alcoholism.
Benefits will be suspended beginning with the first month after we
notify the individual of a determination of noncompliance with the
treatment requirements. Benefits will be terminated after 12
consecutive months of suspension for noncompliance.
Sections 404.480 and 416.544 explain that past-due benefits must be
paid in installments. Accrued unpaid benefits must be paid in
installments so that the total monthly payment including the
installment generally does not exceed two times the monthly benefit
amount. These sections also explain the exception to the limitation if
the [[Page 8143]] beneficiary has unpaid housing debts which put him or
her at high risk of homelessness. We consider an individual to be at
high risk of homelessness if continued nonpayment of housing expenses
is likely to result in the individual losing a place to live. We also
consider an individual who is already homeless to be among those at
high risk of homelessness.
Section 404.902 is revised to expand the list of administrative
actions that are initial determinations to include determinations about
drug addiction or alcoholism.
Sections 404.1535 and 416.935 explain the process by which a
determination is made that drug addiction or alcoholism is a
contributing factor material to the determination of disability.
Sections 404.1536 and 416.936 explain the treatment requirements
and the consequences of noncompliance with these requirements for
individuals disabled based on DAA. For consistency between programs,
especially for individuals who receive concurrent title II and SSI
benefits, we extend to title II beneficiaries the current SSI policy
that individuals referred for treatment generally are not expected to
pay for the treatment.
Sections 404.1537 and 416.937 explain what we mean by appropriate
treatment for these individuals and give examples of appropriate
treatment modalities.
Sections 404.1538 and 416.938 explain what we mean by approved
institutions or facilities for providing the appropriate treatment.
Sections 404.1539 and 416.939 describe the factors we will consider
in determining the availability of treatment.
Sections 404.1540 and 416.940 explain how we intend to assess
compliance with prescribed treatment, including measuring progress with
the treatment.
Based upon our contact with treatment professionals and
administrators, we deemed it best that our regulations not attempt to
provide exhaustive guidelines for determining what constitutes
appropriate treatment and definitive methods of measuring progress.
These particular concepts are inherent parts of the treatment program,
which must be developed by the treatment professional for each
individual. Thus, in these regulatory sections, we have provided broad
rather than narrow guidelines in these areas.
Sections 404.1541 and 416.941 delineate the functions and
responsibilities of the RMAs. The RMAs' duties include making treatment
referrals and monitoring compliance with prescribed treatment. The
contractual agreements with the RMAs will set forth their functions and
responsibilities in much more detail.
In carrying out their functions and responsibilities, the RMAs will
work closely with State alcohol and other drug abuse agencies, which
often are the focal point for the delivery of publicly funded services
to SSI beneficiaries.
Section 416.202 has been revised to reflect the new provision that
an individual disabled based on DAA is not eligible for SSI benefits if
he or she has previously received 36 months of Social Security benefits
when treatment was available or 36 months of SSI benefits based on DAA.
Section 416.213 is revised to state that an individual disabled
based on DAA who refuses or does not follow available and appropriate
treatment for drug addiction or alcoholism will not receive SSI
benefits until he or she has demonstrated compliance with treatment
requirements for the period specified in the revised rules in
Sec. 416.1326. The section also explains in detail the eligibility
requirement that an individual cannot receive SSI benefits on the basis
of disability based on DAA if he or she has already received 36 months
of SSI or Social Security benefits on the same basis. The section
contains references to other SSI and Social Security regulatory
sections which explain how the 36 months are calculated for each of
those programs.
Sections 416.262 and 416.265 have been revised to explain that
individuals who are disabled based on DAA may be eligible for SSI
payments, including special SSI cash benefits, and special SSI
eligibility status for a total of 36 months.
Section 416.535 is revised to include cross-references to the SSI
regulatory sections which state the rules on the installment payment of
past-due benefits for individuals who are disabled based on DAA.
Section 416.542 is revised to explain that, if an underpaid
recipient disabled based on DAA is alive, the amount of any
underpayments due the recipient will be paid to his or her
representative payee. No underpayments may be paid to the recipient.
Section 416.558 is revised by adding to paragraph (a) a reference
to the new Sec. 416.544, and by adding a new paragraph (c) to explain
that, whenever a decision is made about the amount of any benefits due
for a past period that should be paid in installments, the written
notice which is sent to the individual and the individual's
representative payee will also explain the amount of the installment
payment and when an increased initial installment payment may be made.
The last sentence of paragraph (b)(1) of Sec. 416.601 and paragraph
(a)(3) of Sec. 416.610 are revised to update the language referring to
an individual ``medically determined to be a drug addict or an
alcoholic.'' We now refer to individuals for whom ``drug addiction or
alcoholism is a contributing factor material to the determination of
disability.'' This does not change the meaning in any way; it merely
makes the terminology consistent with that used throughout these
regulations.
Paragraph (d) of Sec. 416.1123, which discusses how we count
retroactive monthly Social Security benefits as unearned income, is
revised to address the counting of such benefits when they are paid in
installments. New installment requirements for past-due benefits for
individuals disabled based on DAA are explained in Sec. 416.544.
Because of those requirements, SSA generally will be precluded from
paying at one time all past-due benefits remaining after reimbursing a
State for interim assistance (when appropriate). Paragraph (d)(2)
explains that the total of retroactive Social Security benefits paid in
installments to individuals disabled based on DAA which is countable
income after the rules in paragraph (d)(1) are applied will be counted
as unearned income only in the first month they are paid.
In enacting section 201 of Pub. L. 103-296, Congress evidenced no
intent to change the manner in which past-due Social Security benefits
are counted for SSI purposes, but instead intended to reduce the
likelihood that the past-due benefits would be used by the beneficiary
in a way that would support continuing substance abuse. By counting
retroactive benefits paid in installments as if received in a lump sum
in the first month of payment, the SSI recipient will be at risk of
losing SSI (and possibly Medicaid) eligibility for at most 1 month
because of the receipt of those benefits, as is now the case. The
alternative method of counting these past-due benefits--month by month
as the installments are received--would result, in many cases, in the
loss of eligibility for both SSI and Medicaid for the entire period
during which the installments are paid. A loss of eligibility for
Medicaid could severely limit the accessibility of treatment for drug
addiction or alcoholism and thus undermine the intent of the
legislation. Accordingly, these regulations make no change in the way
past-due benefits are counted for SSI purposes; past-due benefits will
continue to be counted as [[Page 8144]] if received in a lump sum even
when received in installments.
Section 416.1326 has been revised to explain that SSI benefits for
individuals disabled based on DAA will be suspended for noncompliance
with treatment requirements effective the first month after
notification of noncompliance. Suspension of SSI benefits will continue
until the recipient demonstrates compliance with treatment for
specified periods; a minimum of 2 months, 3 months, and 6 months,
respectively, for the first, second, and third and additional
determinations of noncompliance. Suspension of benefits for 12
consecutive months, for any reason, will result in termination of
benefits.
Section 416.1331, which addresses termination of disability
benefits, has been revised. New paragraph (c) discusses termination
after 12 months of suspension for noncompliance. New paragraph (d)
describes the limit of 36 months on benefits and that this limit is no
longer effective for benefits for months beginning after September
2004. New paragraph (e) explains what months are counted in determining
the 36 months of benefits.
Section 416.1335, which discusses termination due to continuous
suspension for ineligibility, has been amended by changing the language
to explain that SSI benefits will be terminated after 12 months of
suspension, even when some or all of the suspension months are due to
suspense for noncompliance, as defined in Sec. 416.1326.
Paragraph (d) of Sec. 416.1402 is revised to update the language
referring to an individual ``determined to be a drug addict or an
alcoholic.'' We now refer to an individual for whom ``drug addiction or
alcoholism is a contributing factor material to the determination of
disability.'' This does not change the meaning in any way; it merely
makes the terminology consistent with that in the new legislation and
used throughout these regulations.
Regulatory Procedures
The Department of Health and Human Services, even when not required
by statute, as a matter of policy generally follows the Administrative
Procedure Act (APA) NPRM and public comment procedures specified in 5
U.S.C. 553 in the development of its regulations. The APA provides
exceptions to its notice and comment procedures when an agency finds
that there is good cause for dispensing with such procedures on the
basis that they are impracticable, unnecessary, or contrary to the
public interest. In the case of these interim final rules, we have
determined that under 5 U.S.C. 553(b)(B), good cause exists for waiving
the NPRM procedures.
Pub. L. 103-296 was signed into law on August 15, 1994. Sections
201(a)(3)(E)(i) and 201(b)(3)(E)(i) of Pub. L. 103-296 require the
Secretary to issue regulations necessary to carry out those amendments
made by section 201 which are the subject of these interim final rules
by February 11, 1995. In addition, the legislation requires that the
Secretary consult with drug and alcohol treatment professionals in
developing certain aspects of these regulations with regard to defining
appropriate substance abuse treatment and establishing guidelines to
review and evaluate compliance with treatment and measures of progress.
Accordingly, to undertake the required consultation process and also
issue these rules as an NPRM would have delayed issuance of final rules
until well past the statutory deadline of February 11, 1995. In light
of these constraints, we solicited public comments on the regulations
needed to implement certain aspects of this new legislation by
publishing a Notice of Intent with Request for Comments on October 17,
1994 (59 FR 52380), and allowed adequate time to give the comments
received in response to that notice our full consideration.
In addition, publishing interim final regulations will permit the
timely and effective implementation of the new provisions for
recipients whose drug addiction or alcoholism is a contributing factor
material to the determination of disability. Such implementation may
allow some recipients to get into available treatment for their
addictions sooner. This will benefit both the recipients and the public
at large.
In light of the Congressional mandate that we issue regulations
needed to carry out these statutory provisions no later than February
11, 1995, we believe that, under the APA, good cause exists for waiver
of the prior notice procedures since issuance of proposed rules would
be impracticable and contrary to the public interest. While we are
issuing these rules as interim final regulations, we are interested in
receiving public comments regarding the substance of these interim
rules.
Executive Order 12866
These interim final rules reflect and implement most of the
provisions of sections 201(a) and 201(b) of Pub. L. 103-296. The Office
of Management and Budget (OMB) has reviewed these interim final rules
and determined that they meet the criteria for a significant regulatory
action under E.O. 12866. Therefore, we prepared and submitted to OMB,
separately from the interim final rules, an assessment of the potential
costs and benefits of this regulatory action. This document also
contains an analysis of alternative policies we considered and chose
not to adopt. This assessment is available for review by members of the
public.
Regulatory Flexibility Act
We certify that these regulations will not have a significant
economic impact on a substantial number of small entities because they
affect individuals' eligibility for program benefits under the Social
Security Act. Therefore, a regulatory flexibility analysis as provided
in Pub. L. 96-354, the Regulatory Flexibility Act, is not required.
Paperwork Reduction Act
These interim final rules contain information collection
requirements in Secs. 404.480, 404.1540, 404.1541, 416.544, 416.940,
and 416.941. As required by the Paperwork Reduction Act of 1980, we
will submit a copy of these information collection requirements to OMB
for its review. Organizations and individuals desiring to submit
comments on these information collection requirements should direct
them to the Office of Information and Regulatory Affairs, OMB, New
Executive Office Building, Room 3208, Washington, D.C. 20503,
Attention: Desk Officer for HHS. The public reporting burden for the
collections of information in Secs. 404.480 and 416.544 is estimated to
average 4 minutes per response. The burden for Secs. 404.1540,
404.1541, 416.940, and 416.941 is estimated to average 5 minutes per
response for one form for each beneficiary annually, and 10 minutes per
response for another form for each beneficiary monthly. These include
the time it will take to read the instructions, gather the necessary
facts, and provide the information. For Secs. 404.480 and 416.544 we
expect approximately 2,400 beneficiaries or recipients to provide
responses and estimate the total annual burden to be 160 hours. For
Secs. 404.1540, 404.1541, 416.940, and 416.941 we expect responses from
treatment providers through approximately 52 RMAs on behalf of
approximately 184,000 beneficiaries or recipients and estimate the
total annual burden to be 395,600 hours. If you have any comments or
suggestions on these estimates, write to the Social Security
Administration, Attention: Reports Clearance Officer, 1-A-21 Operations
Building, 6401 [[Page 8145]] Security Boulevard, Baltimore, MD 21235.
(Catalog of Federal Domestic Assistance Program Nos. 93.802, Social
Security-Disability Insurance; 93.803, Social Security-Retirement
Insurance; 93.805, Social Security-Survivors Insurance; 93.807,
Supplemental Security Income)
List of Subjects
20 CFR Part 404
Administrative practice and procedure, Blind, Disability benefits,
Old-Age, Survivors, and Disability Insurance, Reporting and
recordkeeping requirements, Social Security.
20 CFR Part 416
Administrative practice and procedure, Aged, Blind, Disability
benefits, Public assistance programs, Supplemental Security Income
(SSI), Reporting and recordkeeping requirements.
Dated: December 22, 1994.
Shirley S. Chater,
Commissioner of Social Security.
Approved: February 2, 1995.
Donna E. Shalala,
Secretary of Health and Human Services.
For the reasons set forth in the preamble, part 404, subparts D, E,
J, and P of chapter III of title 20 of the Code of Federal Regulations
are amended as set forth below.
PART 404--FEDERAL OLD-AGE, SURVIVORS, AND DISABILITY INSURANCE
(1950- )
1. The authority citation for subpart D of part 404 is revised to
read as follows:
Authority: Secs. 202, 203(a) and (b), 205(a), 216, 223, 225,
228(a) through (e), and 1102 of the Social Security Act; 42 U.S.C.
402, 403 (a) and (b), 405(a), 416, 423, 425, 428(a) through (e), and
1302.
2. Section 404.315 is amended by redesignating the introductory
test as paragraph (a) and adding a heading to it, redesignating former
paragraphs (a) through (d) as paragraphs (a)(1) through (a)(4), and
adding a new paragraph (b) to read as follows:
Sec. 404.315 Who is entitled to disability benefits.
(a) General. * * *
* * * * *
(b) Prohibition against reentitlement to disability benefits if
drug addiction or alcoholism is a contributing factor material to the
determination of disability. You cannot be entitled to a period of
disability payments if drug addiction or alcoholism is a contributing
factor material to the determination of disability and your earlier
entitlement to disability benefits on the same basis terminated after
you received benefits for 36 months during which treatment was
available.
3. Section 404.316 is amended by adding paragraphs (e) and (f) to
read as follows:
Sec. 404.316 When entitlement to disability benefits begins and ends.
* * * * *
(e) If drug addiction or alcoholism is a contributing factor
material to the determination of disability as described in
Sec. 404.1535, you may receive disability benefits on that basis for no
more than 36 months regardless of the number of entitlement periods you
may have. Not included in these 36 months are months in which treatment
for your drug addiction or alcoholism is not available, months before
March 1995, and months for which your benefit payments were suspended
for any reason. Benefits to your dependents may continue after the 36
months of benefits if, but for the operation of this paragraph, you
would otherwise be entitled to benefits based on disability. The 36-
month limit is no longer effective for benefits for months beginning
after September 2004.
(f) If drug addiction or alcoholism is a contributing factor
material to the determination of disability as described in
Sec. 404.1535 and your disability benefits are suspended for 12
consecutive months because of your failure to comply with treatment
requirements, your disability benefits will be terminated effective the
first month after such 12-month period. Benefits to your dependents may
continue after the 12-month period if, but for the operation of this
paragraph, you would otherwise be entitled to benefits based on
disability.
4. Section 404.321 is amended by adding paragraph (d) to read as
follows:
Sec. 404.321 When a period of disability begins and ends.
* * * * *
(d) When drug addiction or alcoholism is a contributing factor
material to the determination of disability. (1) Your entitlement to
receive disability benefit payments ends the month following the month
in which, regardless of the number of entitlement periods you may have
had based on disability where drug addiction or alcoholism is a
contributing factor material to the determination of disability (as
described in Sec. 404.1535)--
(i) You have received a total of 36 months of disability benefits.
Not included in these 36 months are months in which treatment for your
drug addiction or alcoholism is not available, months before March
1995, and months for which your benefits were suspended for any reason;
or
(ii) Your benefits have been suspended for 12 consecutive months
because of your failure to comply with treatment requirements.
(2) For purposes other than payment of your disability benefits,
your period of disability continues until the termination month as
explained in Sec. 404.325.
5. Section 404.332 is amended by adding a sentence to the end of
paragraph (b)(5) to read as follows:
Sec. 404.332 When wife's and husband's benefits begin and end.
* * * * *
(b) * * *
(5) * * * Exception: Your benefits will continue if the insured
person was entitled to disability benefits based on a finding that drug
addiction or alcoholism was a contributing factor material to the
determination of his or her disability (as described in Sec. 404.1535),
the insured person's benefits ended after 36 months of benefits (see
Sec. 404.316(e)) or 12 consecutive months of suspension for
noncompliance with treatment (see Sec. 404.316(f)), and but for the
operation of these provisions, the insured person would remain entitled
to benefits based on disability.
* * * * *
6. Section 404.335 is amended by removing the word ``and'' at the
end of paragraph (c)(2), adding the word ``and'' after the semicolon at
the end of paragraph (c)(3), and adding a new paragraph (c)(4) to read
as follows:
Sec. 404.335 Who is entitled to widow's or widower's benefits.
* * * * *
(c) * * *
* * * * *
(4) You have not previously received 36 months of payments based on
disability when drug addiction or alcoholism was a contributing factor
material to the determination of disability (as described in
Sec. 404.1535), regardless of the number of entitlement periods you may
have had, or your current application for widow(er)'s benefits is not
based on a disability where drug addiction or alcoholism is a
contributing factor material to the determination of disability.
* * * * *
7. Section 404.337 is amended by adding a new sentence at the end
of paragraph (b)(2) to read as follows: [[Page 8146]]
Sec. 404.337 When widow's and widower's benefits begin and end.
* * * * *
(2) * * * If your widow's or widower's benefit is based on a
finding that drug addiction or alcoholism is a contributing factor
material to the determination of disability as described in
Sec. 404.1535, your entitlement to benefits will terminate the month
after the 12th consecutive month of suspension for noncompliance with
treatment or after 36 months of benefits on that basis when treatment
is available regardless of the number of entitlement periods you may
have had, unless you are otherwise disabled without regard to drug
addiction or alcoholism.
* * * * *
8. Section 404.350 is amended by redesignating the introductory
text as paragraph (a) and adding a heading to it, redesignating former
paragraphs (a) through (e) as paragraphs (a)(1) through (a)(5), and
adding a new paragraph (b) to read as follows:
Sec. 404.350 Who is entitled to child's benefits.
(a) General. * * *
* * * * *
(b) Entitlement preclusion for certain disabled children. If you
are a disabled child as referred to in paragraph (a)(5) of this
section, and your disability was based on a finding that drug addiction
or alcoholism was a contributing factor material to the determination
of disability (as described in Sec. 404.1535) and your benefits ended
after your receipt of 36 months of benefits, you will not be entitled
to benefits based on disability for any month following such 36 months
regardless of the number of entitlement periods you have had if, in
such following months, drug addiction or alcoholism is a contributing
factor material to the later determination of disability (as described
in Sec. 404.1535).
9. Section 404.352 is amended by adding a new sentence to the end
of paragraph (b)(3), redesignating paragraphs (c) and (d) as paragraphs
(d) and (e), and adding a new paragraph (c) to read as follows:
Sec. 404.352 When child's benefits begin and end.
* * * * *
(b) * * *
(3) * * * Exception: Your benefits will continue if the insured
person was entitled to disability benefits based on a finding that drug
addiction or alcoholism was a contributing factor material to the
determination of his or her disability (as described in Sec. 404.1535),
the insured person's benefits ended after 36 months of payment (see
Sec. 404.316(e)) or 12 consecutive months of suspension for
noncompliance with treatment (see Sec. 404.316(f)), and the insured
person remains disabled.
(c) If you are entitled to benefits as a disabled child age 18 or
over and your disability is based on a finding that drug addiction or
alcoholism was a contributing factor material to the determination of
disability (as described in Sec. 404.1535), your benefits also will
terminate under the following conditions:
(1) If your benefits have been suspended for a period of 12
consecutive months for failure to comply with treatment, your benefits
will terminate with the month following the 12 months unless you are
otherwise disabled without regard to drug addiction or alcoholism (see
Sec. 404.470(c)).
(2) If you have received 36 months of benefits on that basis when
treatment is available, regardless of the number of entitlement periods
you may have had, your benefits will terminate with the month following
such 36-month payment period unless you are otherwise disabled without
regard to drug addiction or alcoholism.
* * * * *
10. The authority citation for subpart E of part 404 is revised to
read as follows:
Authority: Secs. 202, 203, 204(a) and (e), 205(a) and (c),
222(b), 223(e), 224, 225, 227, and 1102 of the Social Security Act;
42 U.S.C. 402, 403, 404(a) and (e), 405(a) and (c), 422(b), 423(e),
424, 425, 427, and 1302.
11. Section 404.402 is amended by revising paragraph (a),
introductory text, to read as follows:
Sec. 404.402 Interrelationship of deductions, reductions, adjustments,
and nonpayment of benefits.
(a) Deductions, Reductions, Adjustment. Deductions because of
earnings or work (see Secs. 404.415 and 404.417); failure to have a
child ``in her care'' (see Sec. 404.421); refusal to accept
rehabilitation services (see Sec. 404.422); as a penalty for failure to
timely report noncovered work outside the United States, failure by a
woman to report that she no longer has a child ``in her care,'' or
failure to timely report earnings (see Secs. 404.451 and 404.453);
because of unpaid maritime taxes (see Sec. 404.457); or nonpayments
because of drug addiction and alcoholism to individuals other than an
insured individual who are entitled to benefits on the insured
individual's earnings record are made:
* * * * *
12. A new Sec. 404.470 is added to read as follows:
Sec. 404.470 Nonpayment of disability benefits due to noncompliance
with rules regarding treatment for drug addiction or alcoholism.
(a) Suspension of monthly benefits. (1) For an individual entitled
to benefits based on a disability (Sec. 404.1505) and for whom drug
addiction or alcoholism is a contributing factor material to the
determination of disability (as described in Sec. 404.1535), monthly
benefits will be suspended beginning with the first month after we
notify the individual in writing that he or she has been determined not
to be in compliance with the treatment requirements for such
individuals (Sec. 404.1536).
(2) This rule applies to all individuals entitled to disability
benefits (Sec. 404.315), widow(er)'s benefits (Sec. 404.335), and
child's benefits based on a disability (Sec. 404.350) effective with
benefits paid in months beginning on or after March 1, 1995.
(3) Benefit payments to any other person who is entitled on the
basis of a disabled wage earner's entitlement to disability benefits
are payable as though the disabled wage earner were receiving benefits.
(b) Resumption of monthly benefits. The payment of benefits may be
resumed only after an individual demonstrates and maintains compliance
with appropriate treatment requirements for:
(1) 2 consecutive months for the first determination of
noncompliance;
(2) 3 consecutive months for the second determination of
noncompliance; and
(3) 6 consecutive months for the third and all subsequent
determinations of noncompliance.
(c) Termination of benefits. (1) A suspension of benefit payments
due to noncompliance with the treatment requirements for 12 consecutive
months will result in termination of benefits effective with the first
month following the 12th month of suspension of benefits.
(2) Benefit payments to any other person who is entitled on the
basis of a disabled wage earner's entitlement to disability benefits
are payable as though the disabled wage earner were receiving benefits.
13. A new Sec. 404.480 is added to read as follows:
Sec. 404.480 Paying benefits in installments: Drug addiction or
alcoholism.
(a) General. For disabled beneficiaries who receive benefit
payments through a representative payee because drug
[[Page 8147]] addiction or alcoholism is a contributing factor material
to the determination of disability (as described in Sec. 404.1535),
certain amounts due the beneficiary for a past period will be paid in
installments. The amounts subject to payment in installments include:
(1) benefits due but unpaid which accrued prior to the month
payment was effectuated;
(2) benefits due but unpaid which accrued during a period of
suspension for which the beneficiary was subsequently determined to
have been eligible; and
(3) any adjustment to benefits which results in an accrual of
unpaid benefits.
(b) Installment formula. Except as provided in paragraph (c) of
this section, the amount of the installment payment in any month is
limited so that the sum of (1) the amount due for a past period (and
payable under paragraph (a) of this section) paid in such month and (2)
the amount of any benefit due for the preceding month under such
entitlement which is payable in such month, does not exceed two times
the amount of the beneficiary's benefit payment for the preceding
month. In counting the amount of the beneficiary's benefit payment for
the previous month, no reductions or deductions under this title are
taken into account.
(c) Exception to installment limitation. An exception to the
installment payment limitation in paragraph (b) of this section can be
granted for the first month in which a beneficiary accrues benefit
amounts subject to payment in installments if the beneficiary has
unpaid housing expenses which result in a high risk of homelessness for
the beneficiary. In that case, the benefit payment may be increased by
the amount of the unpaid housing expenses so long as that increase does
not exceed the amount of benefits which accrued during the most recent
period of nonpayment. We consider a person to be at risk of
homelessness if continued nonpayment of the outstanding housing
expenses is likely to result in the person losing his or her place to
live or if past nonpayment of housing expenses has resulted in the
person having no appropriate personal place to live. In determining
whether this exception applies, we will ask for evidence of outstanding
housing expenses that shows that the person is likely to lose or has
already lost his or her place to live. For purposes of this section,
homelessness is the state of not being under the control of any public
institution and having no appropriate personal place to live. Housing
expenses include charges for all items required to maintain shelter
(for example, mortgage payments, rent, heating fuel, and electricity).
(d) Payment through a representative payee. If the beneficiary does
not have a representative payee, payment of amounts subject to
installments cannot be made until a representative payee is selected.
(e) Underpaid beneficiary no longer entitled. In the case of a
beneficiary who is no longer currently entitled to monthly payments,
but to whom amounts defined in paragraph (a) are still owing, we will
treat such beneficiary's monthly benefit for the last month of
entitlement as the beneficiary's benefit for the preceding month and
continue to make installment payments of such benefits through a
representative payee.
(f) Beneficiary currently not receiving Social Security benefits
because of suspension for noncompliance with treatment. If a
beneficiary is currently not receiving benefits because his or her
benefits have been suspended for noncompliance with treatment (as
defined in Sec. 404.1536), the payment of amounts under paragraph (a)
will stop until the beneficiary has demonstrated compliance with
treatment as described in Sec. 404.470 and will again commence with the
first month the beneficiary begins to receive benefit payments.
(g) Underpaid beneficiary deceased. Upon the death of a
beneficiary, any remaining unpaid amounts as defined in paragraph (a)
will be treated as underpayments in accordance with Sec. 404.503(b).
14. The authority citation for subpart J of part 404 is revised to
read as follows:
Authority: Secs. 201(j), 205(a), (b), and (d) through (h),
221(d), 225, and 1102 of the Social Security Act; 31 U.S.C. 3720A;
42 U.S.C. 401(j), 405(a), (b), and (d) through (h), 421(d), 425, and
1302; sec. 5 of Pub. L. 97-455, 96 Stat. 2500; sec. 6 of Pub. L. 98-
460, 98 Stat. 1802.
15. Section 404.902 is amended by revising paragraph (o),
redesignating paragraphs (p) through (v) as paragraphs (q) through (w),
and adding a new paragraph (p) to read as follows:
Sec. 404.902 Administrative actions that are initial determinations.
* * * * *
(o) Whether the payment of your benefits will be made, on your
behalf, to a representative payee, unless you are under age 18, legally
incompetent, or you are disabled and drug addiction or alcoholism is a
contributing factor material to the determination of disability (as
described in Sec. 404.1535);
(p) Your drug addiction or alcoholism;
* * * * *
16. The authority citation for subpart P of part 404 is revised to
read as follows:
Authority: Secs. 202, 205(a), (b), and (d) through (h), 216(i),
221(a) and (i), 222(c), 223, 225, and 1102 of the Social Security
Act; 42 U.S.C. 402, 405 (a), (b), and (d) through (h), 416(i),
421(a) and (i), 422(c), 423, 425, and 1302.
17. A new Sec. 404.1535 is added to read as follows:
Sec. 404.1535 How we will determine whether your drug addiction or
alcoholism is a contributing factor material to the determination of
disability.
(a) General. If we find that you are disabled and have medical
evidence of your drug addiction or alcoholism, we must determine
whether your drug addiction or alcoholism is a contributing factor
material to the determination of disability.
(b) Process we will follow when we have medical evidence of your
drug addiction or alcoholism.
(1) The key factor we will examine in determining whether drug
addiction or alcoholism is a contributing factor material to the
determination of disability is whether we would still find you disabled
if you stopped using drugs or alcohol.
(2) In making this determination, we will evaluate which of your
current physical and mental limitations, upon which we based our
current disability determination, would remain if you stopped using
drugs or alcohol and then determine whether any or all of your
remaining limitations would be disabling.
(i) If we determine that your remaining limitations would not be
disabling, we will find that your drug addiction or alcoholism is a
contributing factor material to the determination of disability.
(ii) If we determine that your remaining limitations are disabling,
you are disabled independent of your drug addiction or alcoholism and
we will find that your drug addiction or alcoholism is not a
contributing factor material to the determination of disability.
18. A new Sec. 404.1536 is added to read as follows:
Sec. 404.1536 Treatment required for individuals whose drug addiction
or alcoholism is a contributing factor material to the determination of
disability.
(a) If we determine that you are disabled and drug addiction or
alcoholism is a contributing factor [[Page 8148]] material to the
determination of disability (as described in Sec. 404.1535), you must
avail yourself of appropriate treatment for your drug addiction or
alcoholism at an institution or facility approved by us when this
treatment is available and make progress in your treatment. Generally,
you are not expected to pay for this treatment. You will not be paid
benefits for any month after the month we have notified you in writing
that--
(1) You did not comply with the terms, conditions and requirements
of the treatment which has been made available to you; or
(2) You did not avail yourself of the treatment after you had been
notified that it is available to you.
(b) If your benefits are suspended for failure to comply with
treatment requirements, your benefits can be reinstated in accordance
with the rules in Sec. 404.470.
19. A new Sec. 404.1537 is added to read as follows:
Sec. 404.1537 What we mean by appropriate treatment.
By appropriate treatment, we mean treatment for drug addiction or
alcoholism that serves the needs of the individual in the least
restrictive setting possible consistent with your treatment plan. These
settings range from outpatient counseling services through a variety of
residential treatment settings including acute detoxification, short-
term intensive residential treatment, long-term therapeutic residential
treatment, and long-term recovery houses. Appropriate treatment is
determined with the involvement of a State licensed or certified
addiction professional on the basis of a detailed assessment of the
individual's presenting symptomatology, psychosocial profile, and other
relevant factors. This assessment may lead to a determination that more
than one treatment modality is appropriate for the individual. The
treatment will be provided or overseen by an approved institution or
facility. This treatment may include (but is not limited to)--
(a) Medical examination and medical management;
(b) Detoxification;
(c) Medication management to include substitution therapy (e.g.,
methadone);
(d) Psychiatric, psychological, psychosocial, vocational, or other
substance abuse counseling in a residential or outpatient treatment
setting; or
(e) Relapse prevention.
20. A new Sec. 404.1538 is added to read as follows:
Sec. 404.1538 What we mean by approved institutions or facilities.
Institutions or facilities that we may approve include--
(a) An institution or facility that furnishes medically recognized
treatment for drug addiction or alcoholism in conformity with
applicable Federal or State laws and regulations;
(b) An institution or facility used by or licensed by an
appropriate State agency which is authorized to refer persons for
treatment of drug addiction or alcoholism;
(c) State licensed or certified care providers;
(d) Programs accredited by the Commission on Accreditation for
Rehabilitation Facilities (CARF) and/or the Joint Commission for the
Accreditation of Healthcare Organizations (JCAHO) for the treatment of
drug addiction or alcoholism;
(e) Medicare or Medicaid certified care providers; or
(f) Nationally recognized self-help drug addiction or alcoholism
recovery programs (e.g., Alcoholics Anonymous or Narcotics Anonymous)
when participation in these programs is specifically prescribed by a
treatment professional at an institution or facility described in
paragraphs (a) through (e) of this section as part of an individual's
treatment plan.
21. A new Sec. 404.1539 is added to read as follows:
Sec. 404.1539 How we consider whether treatment is available.
Our determination about whether treatment is available to you for
your drug addiction or your alcoholism will depend upon--
(a) The capacity of an approved institution or facility to admit
you for appropriate treatment;
(b) The location of the approved institution or facility, or the
place where treatment, services or resources could be provided to you;
(c) The availability and cost of transportation for you to the
place of treatment;
(d) Your general health, including your ability to travel and
capacity to understand and follow the prescribed treatment;
(e) Your particular condition and circumstances; and
(f) The treatment that is prescribed for your drug addiction or
alcoholism.
22. A new Sec. 404.1540 is added to read as follows:
Sec. 404.1540 Evaluating compliance with the treatment requirements.
(a) General. Generally, we will consider information from the
treatment institution or facility to evaluate your compliance with your
treatment plan. The treatment institution or facility will:
(1) Monitor your attendance at and participation in treatment
sessions;
(2) Provide reports of the results of any clinical testing (such
as, hematological or urinalysis studies for individuals with drug
addiction and hematological studies and breath analysis for individuals
with alcoholism) when such tests are likely to yield important
information;
(3) Provide observational reports from the treatment professionals
familiar with your individual case (subject to verification and Federal
confidentiality requirements); or
(4) Provide their assessment or views on your noncompliance with
treatment requirements.
(b) Measuring progress. Generally, we will consider information
from the treatment institution or facility to evaluate your progress in
completing your treatment plan. Examples of milestones for measuring
your progress with the treatment which has been prescribed for your
drug addiction or alcoholism may include (but are not limited to)--
(1) Abstinence from drug or alcohol use (initial progress may
include significant reduction in use);
(2) Consistent attendance at and participation in treatment
sessions;
(3) Improved social functioning and levels of gainful activity;
(4) Participation in vocational rehabilitation activities; or
(5) Avoidance of criminal activity.
23. A new Sec. 404.1541 is added to read as follows:
Sec. 404.1541 Establishment and use of referral and monitoring
agencies.
We will contract with one or more agencies in each of the States,
Puerto Rico and the District of Columbia to provide services to
individuals whose disabilities are based on a determination that drug
addiction or alcoholism is a contributing factor material to the
determination of disability (as described in Sec. 404.1535) and to
submit information to us which we will use to make decisions about
these individuals' benefits. These agencies will be known as referral
and monitoring agencies.
Their duties and responsibilities include (but are not limited
to)--
(a) Identifying appropriate treatment placements for individuals we
refer to them;
(b) Referring these individuals for treatment;
(c) Monitoring the compliance and progress with the appropriate
treatment of these individuals; and [[Page 8149]]
(d) Promptly reporting to us any individual's failure to comply
with treatment requirements as well as failure to achieve progress
through the treatment.
For the reasons set forth in the preamble, part 416, subparts B, E,
F, I, K, M, N, and Q of chapter III of title 20 of the Code of Federal
Regulations are amended as set forth below.
PART 416--SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND
DISABLED
24. The authority citation for subpart B of part 416 continues to
read as follows:
Authority: Secs. 1102, 1110(b), 1602, 1611, 1614, 1615(c),
1619(a), 1631, and 1634 of the Social Security Act; 42 U.S.C. 1302,
1310(b), 1381a, 1382, 1382c, 1382d(c), 1382h(a), 1383, and 1383c;
secs. 211 and 212 of Pub. L. 93-66, 87 Stat. 154 and 155; sec.
502(a) of Pub. L. 94-241, 90 Stat. 268; and sec. 2 of Pub. L. 99-
643, 100 Stat. 3574.
25. Section 416.202 is amended by redesignating paragraph (e) as
paragraph (f) and adding a new paragraph (e) to read as follows:
Sec. 416.202 Who may get SSI benefits.
* * * * *
(e) You are disabled, drug addiction or alcoholism is a
contributing factor material to the determination of disability (see
Sec. 416.935), and you have not previously received a total of 36
months of Social Security benefit payments when appropriate treatment
was available or 36 months of SSI benefits on the basis of disability
where drug addiction or alcoholism was a contributing factor material
to the determination of disability.
* * * * *
26. Section 416.213 is revised to read as follows:
Sec. 416.213 You are disabled and drug addiction or alcoholism is a
contributing factor material to the determination of disability.
(a) If you do not comply with treatment requirements. If you
receive benefits because you are disabled and drug addiction or
alcoholism is a contributing factor material to the determination of
disability (see Sec. 416.935), you must avail yourself of any
appropriate treatment for your drug addiction or alcoholism at an
approved institution or facility when this treatment is available and
make progress in your treatment. You are not eligible for SSI benefits
beginning with the month after the month you are notified in writing
that we determined that you have failed to comply with the treatment
requirements. If your benefits are suspended because you failed to
comply with treatment requirements, you will not be eligible to receive
benefits until you have demonstrated compliance with treatment for a
period of time, as specified in Sec. 416.1326. The rules regarding
treatment for drug addiction and alcoholism are in subpart I of this
part.
(b) If you previously received 36 months of SSI or Social Security
benefits. You are not eligible for SSI benefits by reason of disability
on the basis of drug addiction or alcoholism as described in
Sec. 416.935 if--
(1) You previously received a total of 36 months of SSI benefits on
the basis of disability and drug addiction or alcoholism was a
contributing factor material to the determination of disability for
months beginning March 1995, as described in Sec. 416.935. Not included
in these 36 months are months before March 1995 and months for which
your benefits were suspended for any reason. The 36-month limit is no
longer effective for months beginning after September 2004; or
(2) You previously received a total of 36 months of Social Security
benefits counted in accordance with the provisions of Sec. 404.316,
404.337, and 404.352 by reason of disability on the basis of drug
addiction or alcoholism as described in Sec. 404.1535.
27. Section 416.262 is amended by removing the word ``and'' at the
end of paragraph (c), redesignating paragraph (d) as paragraph (e), and
adding a new paragraph (d) to read as follows:
Sec. 416.262 Eligibility requirements for special SSI cash benefits.
* * * * *
(d) If your disability is based on a determination that drug
addiction or alcoholism is a contributing factor material to the
determination of disability as described in Sec. 416.935, you have not
yet received SSI cash benefits, special SSI cash benefits, or special
SSI eligibility status for a total of 36 months, or Social Security
benefit payments when treatment was available for a total of 36 months;
and
* * * * *
28. Section 416.265 is amended by revising paragraph (a) to read as
follows:
Sec. 416.265 Requirements for the special SSI eligibility status.
* * * * *
(a) You are blind or you continue to have a disabling impairment
which, if drug addiction or alcoholism is a contributing factor
material to the determination of disability as described in
Sec. 416.935, has not resulted in your receiving SSI cash benefits,
special SSI cash benefits, or special SSI eligibility status for a
total of 36 months, or Social Security benefit payments when treatment
was available for a total of 36 months;
* * * * *
29. The authority citation for subpart E of part 416 is revised to
read as follows:
Authority: Secs. 1102, 1601, 1602, 1611(c), and (e), and 1631(a)
through (d) and (g) of the Social Security Act; 42 U.S.C. 1302,
1381, 1381a, 1382 (c) and (e), and 1383 (a) through (d) and (g).
30. Section 416.535 is amended by redesignating paragraphs (b) and
(c) as paragraphs (d) and (e) and adding a new paragraph (b) to read as
follows:
Sec. 416.535 Underpayments and overpayments.
* * * * *
(b) Additional rules for individuals whose drug addiction or
alcoholism is a contributing factor material to the determination of
disability. When an individual whose drug addiction or alcoholism is a
contributing factor material to the determination of disability, as
described in Sec. 416.935, receives less than the correct amount of SSI
benefits, adjustment is effected as described in Secs. 416.542 and
416.543 and the additional rule described in Sec. 416.544 applies.
* * * * *
31. Section 416.542 is amended by revising paragraph (a) to read as
follows:
Sec. 416.542 Underpayments--to whom underpaid amount is payable.
(a) Underpaid recipient alive--underpayment payable. (1) If an
underpaid recipient is alive, the amount of any underpayment due him or
her will be paid to him or her in a separate payment or by increasing
the amount of his or her monthly payment.
(2) If an underpaid recipient whose drug addiction or alcoholism is
a contributing factor material to the determination of disability (as
described in Sec. 416.935) is alive, the amount of any underpayment due
the recipient will be paid through his or her representative payee in
installment payments. No underpayment may be paid directly to the
recipient. If the recipient dies before we have paid all benefits due
through his or her representative payee, we will follow the rules which
apply to underpayments for the payment of any remaining amounts due to
any eligible survivor of a deceased recipient as described in paragraph
(b) of this section.
* * * * *
32. A new Sec. 416.544 is added to read as follows: [[Page 8150]]
Sec. 416.544 Paying benefits in installments: Drug addiction or
alcoholism.
(a) General. For disabled recipients who receive benefit payments
through a representative payee because drug addiction or alcoholism is
a contributing factor material to the determination of disability,
certain amounts due the recipient for a past period will be paid in
installments. The amounts subject to payment in installments include:
(1) benefits due but unpaid which accrued prior to the month
payment was effectuated;
(2) benefits due but unpaid which accrued during a period of
suspension for which the recipient was subsequently determined to have
been eligible; and
(3) any adjustment to benefits which results in an accrual of
unpaid benefits.
(b) Installment formula. Except as provided in paragraph (c) of
this section, the amount of the installment payment in any month is
limited so that the sum of (1) the amount due for a past period (and
payable under paragraph (a) of this section) paid in such month and (2)
the amount of any current benefit due cannot exceed twice the Federal
Benefit Rate plus any federally-administered State supplementation
payable to an eligible individual for the preceding month.
(c) Exception to installment limitation. An exception to the
installment payment limitation in paragraph (b) of this section can be
granted for the first month in which a recipient accrues benefit
amounts subject to payment in installments if the recipient has unpaid
housing expenses which result in a high risk of homelessness for the
recipient. In that case, the benefit payment may be increased by the
amount of the unpaid housing expenses so long as that increase does not
exceed the amount of benefits which accrued during the most recent
period of nonpayment. We consider a person to be at risk of
homelessness if continued nonpayment of the outstanding housing
expenses is likely to result in the person losing his or her place to
live or if past nonpayment of housing expenses has resulted in the
person having no appropriate personal place to live. In determining
whether this exception applies, we will ask for evidence of outstanding
housing expenses that shows that the person is likely to lose or has
already lost his or her place to live. For purposes of this section,
homelessness is the state of not being under the control of any public
institution and having no appropriate personal place to live. Housing
expenses include charges for all items required to maintain shelter
(for example, mortgage payments, rent, heating fuel, and electricity).
(d) Payment through a representative payee. If the recipient does
not have a representative payee, payment of amounts subject to
installments cannot be made until a representative payee is selected.
(e) Underpaid recipient no longer eligible. In the case of a
recipient who is no longer currently eligible for monthly payments, but
to whom amounts defined in paragraph (a) of this section are still
owing, we will continue to make installment payments of such benefits
through a representative payee.
(f) Recipient currently not receiving SSI benefits because of
suspension for noncompliance with treatment. If a recipient is
currently not receiving SSI benefits because his or her benefits have
been suspended for noncompliance with treatment (as defined in
Sec. 416.936), the payment of amounts under paragraph (a) of this
section will stop until the recipient has demonstrated compliance with
treatment as described in Sec. 416.1326 and will again commence with
the first month the recipient begins to receive benefits.
(g) Underpaid recipient deceased. Upon the death of a recipient,
any remaining unpaid amounts as defined in paragraph (a) of this
section will be treated as underpayments in accordance with
Sec. 416.542(b).
33. Section 416.558 is amended by revising paragraph (a) and adding
a new paragraph (c) to read as follows:
Sec. 416.558 Notice relating to overpayments and underpayments.
(a) Notice of overpayment and underpayment determination. Whenever
a determination concerning the amount paid and payable for any period
is made and it is found that, with respect to any month in the period,
more or less than the correct amount was paid, written notice of the
correct and incorrect amounts for each such month in the period will be
sent to the individual against whom adjustment or recovery of the
overpayment as defined in Sec. 416.537(a) may be effected or to whom
the underpayment as defined in Secs. 416.536 and any amounts subject to
installment payments as defined in Sec. 416.544 would be payable,
notwithstanding the fact that part or all of the underpayment must be
withheld in accordance with Sec. 416.543. When notifying an individual
of a determination of overpayment, the Social Security Administration
will, in the notice, also advise the individual that adjustment or
recovery is required, as set forth in Sec. 416.571, except under
certain specified conditions, and of his or her right to request waiver
of adjustment or recovery of the overpayment under the provisions of
Sec. 416.550.
* * * * *
(c) Notice relating to installment payments to individuals whose
drug addiction or alcoholism is a contributing factor material to the
determination of disability. Whenever a determination is made
concerning the amount of any benefits due for a period that must be
paid in installments, the written notice will also explain the amount
of the installment payment and when an increased initial installment
payment may be made (as described in Sec. 416.544). This written notice
will be sent to the individual and his or her representative payee.
34. The authority citation for subpart F of part 416 continues to
read as follows:
Authority: Secs. 1102 and 1631(a)(2) and (d)(1) of the Social
Security Act; 42 U.S.C. 1302 and 1383(a)(2) and (d)(1).
35. Section 416.601 is amended by revising the last sentence of
paragraph (b)(1) to read as follows:
Sec. 416.601 Introduction.
* * * * *
(b) Policy used to determine whether to make representative
payment. * * * However, we must select a representative payee for an
individual who is eligible for benefits solely on the basis of
disability if drug addiction or alcoholism is a contributing factor
material to the determination of disability.
* * * * *
36. Section 416.610 is amended by revising paragraph (a)(3) to read
as follows:
Sec. 416.610 When payment will be made to a representative payee.
(a) * * *
(3) Eligible for benefits solely on the basis of disability and
drug addiction or alcoholism is a contributing factor material to the
determination of disability.
* * * * *
37. The authority citation for subpart I of part 416 is revised to
read as follows:
Authority: Secs. 1102, 1611, 1614(a), 1619, 1631 (a), (c), and
(d)(1), and 1633 of the Social Security Act; 42 U.S.C. 1302, 1382,
1382c(a), 1382h, 1383 (a), (c), and (d)(1), and 1383b; secs. 2, 5,
6, and 15 of Pub. L. 98-460, 98 Stat. 1794, 1801, 1802, and 1808.
38. Section 416.935 is revised to read as follows: [[Page 8151]]
Sec. 416.935 How we will determine whether your drug addiction or
alcoholism is a contributing factor material to the determination of
disability.
(a) General. If we find that you are disabled and have medical
evidence of your drug addiction or alcoholism, we must determine
whether your drug addiction or alcoholism is a contributing factor
material to the determination of disability, unless we find that you
are eligible for benefits because of your age or blindness.
(b) Process we will follow when we have medical evidence of your
drug addiction or alcoholism.
(1) The key factor we will examine in determining whether drug
addiction or alcoholism is a contributing factor material to the
determination of disability is whether we would still find you disabled
if you stopped using drugs or alcohol.
(2) In making this determination, we will evaluate which of your
current physical and mental limitations, upon which we based our
current disability determination, would remain if you stopped using
drugs or alcohol and then determine whether any or all of your
remaining limitations would be disabling.
(i) If we determine that your remaining limitations would not be
disabling, we will find that your drug addiction or alcoholism is a
contributing factor material to the determination of disability.
(ii) If we determine that your remaining limitations are disabling,
you are disabled independent of your drug addiction or alcoholism and
we will find that your drug addiction or alcoholism is not a
contributing factor material to the determination of disability.
39. Section 416.936 is revised to read as follows:
Sec. 416.936 Treatment required for individuals whose drug addiction
or alcoholism is a contributing factor material to the determination of
disability.
(a) If we determine that you are disabled and drug addiction or
alcoholism is a contributing factor material to the determination of
disability, you must avail yourself of appropriate treatment for your
drug addiction or alcoholism at an institution or facility approved by
us when this treatment is available and make progress in your
treatment. Generally, you are not expected to pay for this treatment.
You will not be paid benefits for any month after the month we have
notified you in writing that--
(1) You did not comply with the terms, conditions and requirements
of the treatment which has been made available to you; or
(2) You did not avail yourself of the treatment after you had been
notified that it is available to you.
(b) If your benefits are suspended for failure to comply with
treatment requirements, your benefits can be reinstated in accordance
with the rules in Sec. 416.1326.
40. Section 416.937 is revised to read as follows:
Sec. 416.937 What we mean by appropriate treatment.
By appropriate treatment, we mean treatment for drug addiction or
alcoholism that serves the needs of the individual in the least
restrictive setting possible consistent with your treatment plan. These
settings range from outpatient counseling services through a variety of
residential treatment settings including acute detoxification, short-
term intensive residential treatment, long-term therapeutic residential
treatment, and long-term recovery houses. Appropriate treatment is
determined with the involvement of a State licensed or certified
addiction professional on the basis of a detailed assessment of the
individual's presenting symptomatology, psychosocial profile, and other
relevant factors. This assessment may lead to a determination that more
than one treatment modality is appropriate for the individual. The
treatment will be provided or overseen by an approved institution or
facility. This treatment may include (but is not limited to)--
(a) Medical examination and medical management;
(b) Detoxification;
(c) Medication management to include substitution therapy (e.g.,
methadone);
(d) Psychiatric, psychological, psychosocial, vocational, or other
substance abuse counseling in a residential or outpatient treatment
setting; or
(e) Relapse prevention.
41. Section 416.938 is revised to read as follows:
Sec. 416.938 What we mean by approved institutions or facilities.
Institutions or facilities that we may approve include--
(a) An institution or facility that furnishes medically recognized
treatment for drug addiction or alcoholism in conformity with
applicable Federal or State laws and regulations;
(b) An institution or facility used by or licensed by an
appropriate State agency which is authorized to refer persons for
treatment of drug addiction or alcoholism;
(c) State licensed or certified care providers;
(d) Programs accredited by the Commission on Accreditation for
Rehabilitation Facilities (CARF) and/or the Joint Commission for the
Accreditation of Healthcare Organizations (JCAHO) for the treatment of
drug addiction or alcoholism;
(e) Medicare or Medicaid certified care providers; or
(f) Nationally recognized self-help drug addiction or alcoholism
recovery programs (e.g., Alcoholics Anonymous or Narcotics Anonymous)
when participation in these programs is specifically prescribed by a
treatment professional at an institution or facility described in
paragraphs (a) through (e) of this section as part of an individual's
treatment plan.
42. Section 416.939 is revised to read as follows:
Sec. 416.939 How we consider whether treatment is available.
Our determination about whether treatment is available to you for
your drug addiction or your alcoholism will depend upon--
(a) The capacity of an approved institution or facility to admit
you for appropriate treatment;
(b) The location of the approved institution or facility, or the
place where treatment, services or resources could be provided to you;
(c) The availability and cost of transportation for you to the
place of treatment;
(d) Your general health, including your ability to travel and
capacity to understand and follow the prescribed treatment;
(e) Your particular condition and circumstances; and
(f) The treatment that is prescribed for your drug addiction or
alcoholism.
43. A new Sec. 416.940 is added to read as follows:
Sec. 416.940 Evaluating compliance with the treatment requirements.
(a) General. Generally, we will consider information from the
treatment institution or facility to evaluate your compliance with your
treatment plan. The treatment institution or facility will--
(1) Monitor your attendance at and participation in treatment
sessions;
(2) Provide reports of the results of any clinical testing (such
as, hematological or urinalysis studies for individuals with drug
addiction and hematological studies and breath analysis for individuals
with [[Page 8152]] alcoholism) when such tests are likely to yield
important information;
(3) Provide observational reports from the treatment professionals
familiar with your individual case (subject to verification and Federal
confidentiality requirements); or
(4) Provide their assessment or views on your noncompliance with
treatment requirements.
(b) Measuring progress. Generally, we will consider information
from the treatment institution or facility to evaluate your progress in
completing your treatment plan. Examples of milestones for measuring
your progress with the treatment which has been prescribed for your
drug addiction or alcoholism may include (but are not limited to)--
(1) Abstinence from drug or alcohol use (initial progress may
include significant reduction in use);
(2) Consistent attendance at and participation in treatment
sessions;
(3) Improved social functioning and levels of gainful activity;
(4) Participation in vocational rehabilitation activities; or
(5) Avoidance of criminal activity.
44. A new Sec. 416.941 is added to read as follows:
Sec. 416.941 Establishment and use of referral and monitoring
agencies.
We will contract with one or more agencies in each of the States
and the District of Columbia to provide services to individuals whose
disabilities are based on a determination that drug addiction or
alcoholism is a contributing factor material to the determination of
disability (as described in Sec. 416.935) and to submit information to
us which we will use to make decisions about these individuals'
benefits. These agencies will be known as referral and monitoring
agencies. Their duties and responsibilities include (but are not
limited to)--
(a) Identifying appropriate treatment placements for individuals we
refer to them;
(b) Referring these individuals for treatment;
(c) Monitoring the compliance and progress with the appropriate
treatment of these individuals; and
(d) Promptly reporting to us any individual's failure to comply
with treatment requirements as well as failure to achieve progress
through the treatment.
45. The authority citation for subpart K of part 416 continues to
read as follows:
Authority: Secs. 1102, 1602, 1611, 1612, 1613, 1614(f), 1621,
and 1631 of the Social Security Act; 42 U.S.C. 1302, 1381a, 1382,
1382a, 1382b, 1382c(f), 1382j, and 1383; sec. 211 of Pub. L. 93-66,
87 Stat. 154.
46. Section 416.1123 is amended by revising paragraph (d) to read
as follows:
Sec. 416.1123 How we count unearned income.
* * * * *
(d) Retroactive monthly social security benefits. We count
retroactive monthly social security benefits according to the rule in
paragraph (d)(1) of this section, unless the exception in paragraph
(d)(2) of this section applies:
(1) Periods for which SSI payments have been made. When you file an
application for social security benefits and retroactive monthly social
security benefits are payable on that application for a period for
which you also received SSI payments (including federally-administered
State supplementary payments), we count your retroactive monthly social
security benefits as unearned income received in that period. Rather
than reducing your SSI payments in months prior to your receipt of a
retroactive monthly social security benefit, we will reduce the
retroactive social security benefits by an amount equal to the amount
of SSI payments (including federally-administered State supplementary
payments) that we would not have paid to you if your social security
benefits had been paid when regularly due rather than retroactively
(see Sec. 404.408b(b)). If a balance is due you from your retroactive
social security benefits after this reduction, for SSI purposes we will
not count the balance as unearned income in a subsequent month in which
you receive it. This is because your social security benefits were used
to determine the amount of the reduction. This exception to the
unearned income counting rule does not apply to any monthly social
security benefits for a period for which you did not receive SSI.
(2) Social security disability benefits where drug addiction or
alcoholism is a contributing factor material to the determination of
disability. If your retroactive social security benefits must be paid
in installments because of the limitations on paying lump sum
retroactive benefits to disabled recipients whose drug addiction or
alcoholism is a contributing factor material to the determination of
disability as described in Sec. 404.480, we will count the total of
such retroactive social security benefits as unearned income in the
first month such installments are paid, except to the extent the rule
in paragraph (d)(1) of this section would provide that such benefits
not be counted.
* * * * *
47. The authority citation for subpart M of part 416 continues to
read as follows:
Authority: Secs. 1102, 1611 through 1615, 1619, and 1631 of the
Social Security Act; 42 U.S.C. 1302, 1382 through 1382d, 1382h, and
1383.
48. Section 416.1326 is revised to read as follows:
416.1326 Suspension for failure to comply with treatment for drug
addiction or alcoholism.
(a) Basis for Suspension. If you are disabled and drug addiction or
alcoholism is a contributing factor material to the determination of
disability as described in Sec. 416.935, we will refer you to
appropriate treatment as defined in Sec. 416.937. You will not be an
eligible individual and we will suspend your benefits if you do not
comply with the terms, conditions and requirements of treatment
prescribed by the institution or facility. (See Sec. 416.940 which
explains how we evaluate compliance with treatment.)
(b) Date of Suspension. We will suspend your benefits for a period
starting with the first month after we notify you in writing that you
failed to comply with prescribed treatment.
(c) Resumption of Benefits. If you are complying with prescribed
treatment and are otherwise eligible for benefits, we will resume
benefits effective with the first day of the month after you
demonstrate and maintain compliance with appropriate treatment for
these periods--
(1) 2 consecutive months for the first determination of
noncompliance;
(2) 3 consecutive months for the second determination of
noncompliance; and
(3) 6 consecutive months for the third and all subsequent
determinations of noncompliance.
49. Section 416.1331 is amended by adding new paragraphs (c), (d),
and (e) to read as follows:
Sec. 416.1331 Termination of your disability or blindness payments.
* * * * *
(c) When benefits terminate due to 12 consecutive suspension months
for failure to comply with treatment for drug addiction or alcoholism.
If you are disabled and drug addiction or alcoholism is a contributing
factor material to the determination of disability as described in
Sec. 416.935, your benefits will terminate after 12 consecutive months
of suspension for [[Page 8153]] noncompliance with treatment
requirements as described in Sec. 416.1326.
(d) When benefits terminate due to payment of 36 months of benefits
based on disability when drug addiction or alcoholism is a contributing
factor material to the determination of disability. If you are disabled
and drug addiction or alcoholism is a contributing factor material to
the determination of disability as described in Sec. 416.935, your
benefits will terminate after you receive a total of 36 months of SSI
benefits. The 36-month limit is no longer effective for benefits for
months beginning after September 2004.
(e) Months we count in determining the 36 months of benefits when
drug addiction or alcoholism is a contributing factor material to the
determination of disability. Beginning March 1995, we will count all
months for which you were paid an SSI benefit, a federally-administered
State supplement, a special SSI cash benefit, or you were in special
SSI eligibility status, toward the 36 months described in paragraph (d)
of this section. Months for which you were not eligible for benefits
will not count toward the 36 months.
50. Section 416.1335 is revised to read as follows:
Sec. 416.1335 Termination due to continuous suspension.
We will terminate your eligibility for benefits following 12
consecutive months of benefit suspension for any reason beginning with
the first month you were no longer eligible for regular SSI cash
benefits, federally-administered State supplementation, special SSI
cash benefits described in Sec. 416.262, or special SSI eligibility
status described in Sec. 416.265. We will count the 12-month suspension
period either from the start of the first month you are no longer
receiving your cash benefits (see Sec. 416.1321(a)) or the start of the
month after the month your special SSI eligibility status described in
Sec. 416.265 ended. This termination is effective with the start of the
13th month after the suspension began.
51. The authority citation for subpart N of part 416 continues to
read as follows:
Authority: Secs. 1102, 1631, and 1633 of the Social Security
Act; 42 U.S.C. 1302, 1383, and 1383b.
52. Section 416.1402 is amended by revising paragraph (d) to read
as follows:
Sec. 416.1402 Administrative actions that are initial determinations.
* * * * *
(d) Whether payments will be made, on your behalf, to a
representative payee, unless you are under age 18, legally incompetent,
or you are disabled and drug addiction or alcoholism is a contributing
factor material to the determination of disability;
* * * * *
53. The authority citation for subpart Q of part 416 is revised to
read as follows:
Authority: Secs. 1102, 1611(e)(3), 1615, and 1631 of the Social
Security Act; 42 U.S.C. 1302, 1382(e)(3), 1382d, and 1383.
54. Section 416.1725 is revised to read as follows:
Sec. 416.1725 Effect of your failure to comply with treatment
requirements for your drug addiction or alcoholism.
(a) Suspension of benefits. Your eligibility for benefits will be
suspended beginning with the first month after we notify you in writing
that we have determined that you have failed to comply with the
treatment requirements for your drug addiction or alcoholism as defined
in Sec. 416.940. Your benefits will be suspended and reinstated in
accordance with the provisions in Sec. 416.1326.
(b) Termination of benefits. If your benefits are suspended for 12
consecutive months for failure to comply with treatment in accordance
with Sec. 416.1326, your eligibility for disability benefits will be
terminated in accordance with Sec. 416.1331.
[FR Doc. 95-3369 Filed 2-9-95; 8:45 am]
BILLING CODE 4190-29-P
