[Federal Register Volume 59, Number 206 (Wednesday, October 26, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-26508]
[[Page Unknown]]
[Federal Register: October 26, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Social Security Administration
20 CFR Parts 404 and 416
[Regulations Nos. 4 and 16]
RIN 0960-None Assigned
Federal Old-Age, Survivors, and Disability Insurance and
Supplemental Security Income for the Aged, Blind, and Disabled;
Signature Requirements for State Agency Medical and Psychological
Consultants in Disability Determinations
AGENCY: Social Security Administration, HHS.
ACTION: Proposed rules.
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SUMMARY: We propose to revise the requirements of the Social Security
and Supplemental Security Income (SSI) regulations regarding the
certifications required on disability determination forms.
Determinations of disability are generally made by disability
determination services (DDS), which are agencies of each State. Present
regulations require that, unless the disability determination is made
by a State agency disability hearing officer, disability determinations
made by a DDS will be made by a State agency medical or psychological
consultant and a State agency disability examiner, including those in
which the determination is made on technical, non-medical, rather than
medical, grounds. We propose to remove the requirement that a medical
or psychological consultant make the determination jointly with the
disability examiner when there is no medical evidence to be evaluated.
DATES: To be sure that your comments are considered, we must receive
them no later than December 27, 1994.
ADDRESSES: Comments should be submitted in writing to the Commissioner
of Social Security, Department of Health and Human Services, P. O. Box
1585, Baltimore, Maryland 21235, sent by telefax to (410) 966-0869, or
delivered to the Office of Regulations, Social Security Administration,
3-B-1 Operations Building, 6401 Security Boulevard, Baltimore, Maryland
21235, between 8:00 a.m. and 4:30 p.m. on regular business days.
Comments may be inspected during these same hours by making
arrangements with the contact person shown below.
FOR FURTHER INFORMATION CONTACT: Harry J. Short, Legal Assistant,
Office of Regulations, Social Security Administration, 6401 Security
Boulevard, Baltimore, Maryland 21235, (410) 965-6243.
SUPPLEMENTARY INFORMATION: The Social Security Act (the Act) provides,
in title II, for the payment of disability benefits to individuals
insured under the Act. Title II also provides for the payment of
child's insurance benefits based on disability and widow's and
widower's insurance benefits for disabled widows, widowers, and
surviving divorced spouses of insured individuals. In addition, the Act
provides, in title XVI, for SSI payments to persons who are aged,
blind, or disabled and who have limited income and resources. For
adults under both the title II and title XVI programs and for persons
claiming child's insurance benefits based on disability under the title
II program, ``disability'' means the inability to engage in any
substantial gainful activity by reason of any medically determinable
impairment. For a child under age 18 claiming SSI benefits based on
disability, ``disability'' means that the child's impairment(s) is of
comparable severity to one that would disable an adult (i.e., the
impairment(s) substantially reduces the child's ability to function
independently, appropriately, and effectively in an age-appropriate
manner such that the child's impairment(s) and resulting limitations
are comparable to those that would disable an adult). Under both title
II and title XVI, disability must be the result of a medically
determinable physical or mental impairment(s) which can be expected to
result in death or which has lasted or can be expected to last for a
continuous period of not less than 12 months.
Sections 404.1503 and 416.903 of the Social Security
Administration's regulations provide that State agencies make
disability and blindness determinations for the Secretary of Health and
Human Services for most persons living in the State. Sections
404.1615(c) and 416.1015(c) of the regulations provide that disability
determinations will be made by either: (1) A State agency medical or
psychological consultant and a State agency disability examiner or (2)
a State agency disability hearing officer. Sections 404.1615(e) and
416.1015(e) of the regulations require the State agency to certify each
determination of disability to the Social Security Administration (SSA)
on forms provided by SSA. The term ``determination of disability'' is
defined in Secs. 404.1602 and 416.1002 of the regulations to mean one
or more of the following decisions: whether or not a person is under a
disability; the date a person's disability began; or the date a
person's disability ended.
When a disability determination is made jointly by a State agency
medical or psychological consultant and a State agency disability
examiner, the medical or psychological consultant is responsible for
the medical portion of the determination and the disability examiner is
responsible for the remainder of the determination. Under our current
procedures, both the disability examiner and the medical or
psychological consultant must certify the determination on forms which
we provide as required in the regulations.
In some instances, however, the requirement for the medical or
psychological consultant's certification is unnecessary because the
decision is made on technical, non-medical grounds alone, without
consideration of any medical evidence. Many medical and psychological
consultants who work with the State agencies do so on a part-time basis
and are not always available to sign disability determination forms.
This can result in delays of cases that are otherwise complete because
no medical input or expertise is necessary.
This happens, for example, when an individual who has no history of
medical treatment or examination--and, hence, no existing medical
records that we can obtain--refuses to attend a consultative
examination purchased at our expense. In such a case, the State agency
makes its determination on technical, non-medical, rather than medical,
grounds. It denies such a claim because, without the individual's
cooperation, the evidence needed to determine whether the individual is
disabled cannot be obtained. Nevertheless, our current rules require
that a medical or psychological consultant sign the standard disability
determination form in such a case, even though there is no medical
evidence and consequently, no medical finding can be made.
We propose to address this issue by revising Secs. 404.1615 and
416.1015 of the regulations to provide, in a new paragraph (c)(2), that
a State agency disability examiner alone may make the disability
determination when there is no medical evidence to be evaluated, such
as when there is no existing medical evidence and the individual
refuses to attend a consultative examination. We also propose to
redesignate current paragraph (c)(2), which provides that a State
agency disability hearing officer may also make disability
determinations, as paragraph (c)(3).
Regulatory Procedures
Executive Order 12866
We have consulted with the Office of Management and Budget (OMB)
and determined that these rules do not meet the criteria for a
significant regulatory action under Executive Order 12866. Therefore
they are not subject to OMB review.
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 is not
required.
Paperwork Reduction Act
These proposed regulations will, if promulgated, impose no
additional reporting or recordkeeping requirements necessitating
clearance by OMB.
(Catalog of Federal Domestic Assistance Program No. 93.802, Social
Security-Disability Insurance; and 93.807, Supplemental Security
Income)
List of Subjects
20 CFR Part 404
Administrative practice and procedure, Blind, Death Benefits,
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: September 9, 1994.
Shirley S. Chater,
Commissioner of Social Security.
Approved: October 20, 1994.
Donna E. Shalala,
Secretary of Health and Human Services.
PART 404--FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE
(1950- )
For the reasons set out in the preamble, chapter III, part 404,
subpart Q, of Title 20, Code of Federal Regulations, is proposed to be
amended as set forth below:
1. The authority citation for subpart Q of part 404 continues to
read as follows:
Authority: Secs. 205(a), 221, and 1102 of the Social Security
Act; 42 U.S.C. 405(a), 421, and 1302.
2. Section 404.1615 is amended by removing the ``or'' in paragraph
(c)(1) and adding a semicolon in its place; by redesignating paragraph
(c)(2) as paragraph (c)(3); and by adding a new paragraph (c)(2) to
read as follows:
Sec. 404.1615 Making disability determinations.
* * * * *
(c) * * *
(2) A State agency disability examiner alone when there is no
medical evidence to be evaluated, e.g., when there is no existing
medical evidence and the individual refuses to attend a consultative
examination; or
* * * * *
PART 416--SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND
DISABLED
For the reasons set out in the preamble, chapter III, part 416,
subpart J, of Title 20, Code of Federal Regulations, is proposed to be
amended as set forth below:
3. The authority citation for subpart J continues to read as
follows:
Authority: Secs. 1102, 1614, 1631, and 1633 of the Social
Security Act; 42 U.S.C. 1302, 1382c, 1383, and 1383b.
4. Section 416.1015 is amended by removing the ``or'' in paragraph
(c)(1); by redesignating paragraph (c)(2) as paragraph (c)(3); and by
adding a new paragraph (c)(2) to read as follows:
Sec. 416.1015 Making disability determinations.
* * * * *
(c) * * *
(2) A State agency disability examiner alone when there is no
medical evidence to be evaluated, e.g., when there is no existing
medical evidence and the individual refuses to attend a consultative
examination; or
* * * * *
[FR Doc. 94-26508 Filed 10-25-94; 8:45 am]
BILLING CODE 4190-29-P
