[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4136 Introduced in House (IH)]

103d CONGRESS
  2d Session
                                H. R. 4136

   To amend title II of the Social Security Act to institute certain 
  reforms relating to the provision of disability insurance benefits 
based on substance abuse and relating to representative payees, and for 
                            other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 24, 1994

Mr. Herger (for himself, Mr. Kleczka, Mr. McDade, Mr. Condit, Mr. Lewis 
of Florida, Mr. Poshard, Mr. Emerson, Mr. Moran, Mr. Buyer, Mr. McHugh, 
 Mr. Oxley, Mr. Hansen, Mr. Hefley, Mr. Ewing, Mr. Pombo, Mr. Bonilla, 
  Mr. DeLay, Mr. Hastert, Mr. Doolittle, Mr. Baker of California, Mr. 
Fawell, Mr. Baker of Louisiana, and Mr. Mann) introduced the following 
      bill; which was referred to the Committee on Ways and Means

_______________________________________________________________________

                                 A BILL


 
   To amend title II of the Social Security Act to institute certain 
  reforms relating to the provision of disability insurance benefits 
based on substance abuse and relating to representative payees, and for 
                            other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Social Security Disability and 
Rehabilitation Act of 1994''.

SEC. 2. REFORM OF MONTHLY INSURANCE BENEFITS BASED ON DISABILITY 
              INVOLVING SUBSTANCE ABUSE.

    (a) Social Security Disability Insurance.--
            (1) In general.--Section 223 of the Social Security Act (42 
        U.S.C. 423) is amended by adding at the end the following new 
        subsection:

    ``Limitation on Payment of Benefits by Reason of Substance Abuse

    ``(j)(1)(A) Notwithstanding any other provision of this title, no 
individual whose disability is based in whole or in part on a medical 
determination that the individual is a drug addict or alcoholic shall 
be entitled to benefits under this title based on such disability with 
respect to any month, unless such individual--
            ``(i) is undergoing, or on a waiting list for, any medical 
        or psychological treatment that may be appropriate for such 
        individual's condition as a drug addict or alcoholic (as the 
        case may be) and for the stage of such individual's 
        rehabilitation at an institution or facility approved for 
        purposes of this paragraph by the Secretary (so long as access 
        to such treatment is reasonably available, as determined by the 
        Secretary), and
            ``(ii) demonstrates in such manner as the Secretary 
        requires, including at a continuing disability review not later 
        than one year after such determination, that such individual is 
        complying with the terms, conditions, and requirements of such 
        treatment and with the requirements imposed by the Secretary 
        under subparagraph (B).
    ``(B) The Secretary shall provide for the monitoring and testing of 
all individuals who are receiving benefits under this title and who as 
a condition of such benefits are required to be undergoing treatment 
and complying with the terms, conditions, and requirements thereof as 
described in subparagraph (A), in order to assure such compliance and 
to determine the extent to which the imposition of such requirements is 
contributing to the achievement of the purposes of this title. The 
Secretary may retain jurisdiction in the case of a hearing before the 
Secretary under this title to the extent the Secretary determines 
necessary to carry out the preceding sentence. The Secretary shall 
annually submit to the Congress a full and complete report on the 
Secretary's activities under this paragraph.
    ``(C) The representative payee and the referral and monitoring 
agency for any individual described in subparagraph (A) shall report to 
the Secretary any noncompliance with the terms, conditions, and 
requirements of the treatment described in subparagraph (A) and with 
the requirements imposed by the Secretary under subparagraph (B).
    ``(D)(i) If the Secretary finds that an individual is not complying 
with the terms, conditions, and requirements of the treatment described 
in subparagraph (A), or with the requirements imposed by the Secretary 
under subparagraph (B), or both, the Secretary, in lieu of termination, 
may suspend such individual's benefits under this title until 
compliance has been reestablished, including compliance with any 
additional requirements determined to be necessary by the Secretary.
    ``(ii) Any period of suspension under clause (i) shall be taken 
into account in determining any 24-month period described in 
subparagraph (E) and shall not be taken into account in determining the 
36-month period described in such subparagraph.
    ``(E)(i) Except as provided in clause (ii), no individual described 
in subparagraph (A) shall be entitled to benefits under this title for 
any month following the 24-month period beginning with the 
determination of the disability described in such subparagraph.
    ``(ii) If at the end of the 24-month period described in clause 
(i), the individual furnishes evidence in accordance with subsection 
(d)(5) that the individual continues to be under a disability based in 
whole or in part on a medical determination that the individual is a 
drug addict or alcoholic, such individual shall continue to be entitled 
to benefits under this title based on such disability.
    ``(iii) Subject to clause (iv), if such an individual continues to 
be entitled to such benefits for an additional 24-month period 
following a determination under clause (ii), clauses (i) and (ii) shall 
apply with regard to any further entitlement to such benefits following 
the end of such additional period.
    ``(iv) In no event shall such an individual be entitled to benefits 
under this title for more than a total of 36 months, unless upon the 
termination of the 36th month such individual furnishes evidence in 
accordance with subsection (d)(5) that the individual is under a 
disability which is not related in part to a medical determination that 
the individual is a drug addict or alcoholic.
    ``(2)(A) Any benefits under this title payable to any individual 
referred to in paragraph (1), including any benefits payable in a lump 
sum amount, shall be payable only pursuant to a certification of such 
payment to a qualified organization acting as a representative payee of 
such individual pursuant to section 205(j).
    ``(B) For purposes of subparagraph (A) and section 205(j)(4), the 
term `qualified organization'--
            ``(i) shall have the meaning given such term by section 
        205(j)(4)(B), and
            ``(ii) shall mean an agency or instrumentality of a State 
        or a political subdivision of a State.
    ``(3) Monthly insurance benefits under this title which would be 
payable to any individual (other than the disabled individual to whom 
benefits are not payable by reason of this subsection) on the basis of 
the wages and self-employment income of such a disabled individual but 
for the provisions of paragraph (1), shall be payable as though such 
disabled individual were receiving such benefits which are not payable 
under this subsection.''.
            (2) Conforming amendments.--
                    (A) Section 205(j)(1) of such Act (42 U.S.C. 
                405(j)(1)) is amended by inserting ``, or in the case 
                of any individual referred to in section 223(j)(1)(A)'' 
                after ``thereby''.
                    (B) Section 205(j)(2)(D)(ii)(II) of such Act (42 
                U.S.C. 405(j)(2)(D)(ii)(II)) is amended by striking 
                ``legally incompetent or under the age of 15'' and 
                inserting ``legally incompetent, under the age of 15, 
                or a drug addict or alcoholic referred to in section 
                223(j)(1)(A)''.
    (b) Supplemental Security Income.--Paragraph (3) of section 1611(e) 
of the Social Security Act (42 U.S.C. 1382(e)) is amended to read as 
follows:
    ``(3)(A)(i) No person who is an aged, blind, or disabled individual 
solely by reason of disability (as determined under section 1614(a)(3)) 
shall be an eligible individual or eligible spouse for purposes of this 
title with respect to any month if such individual's disability is 
based in whole or in part on a medical determination that the 
individual is a drug addict or alcoholic, unless such individual--
            ``(I) is undergoing, or on a waiting list for, any medical 
        or psychological treatment that may be appropriate for such 
        individual's condition as a drug addict or alcoholic (as the 
        case may be) and for the stage of such individual's 
        rehabilitation at an institution or facility approved for 
        purposes of this paragraph by the Secretary (so long as access 
        to such treatment is reasonably available, as determined by the 
        Secretary), and
            ``(II) demonstrates in such manner as the Secretary 
        requires, including at a continuing disability review not later 
        than one year after such determination, that such individual is 
        complying with the terms, conditions, and requirements of such 
        treatment and with the requirements imposed by the Secretary 
        under clause (ii).
    ``(ii) The Secretary shall provide for the monitoring and testing 
of all individuals who are receiving benefits under this title and who 
as a condition of such benefits are required to be undergoing treatment 
and complying with the terms, conditions, and requirements thereof as 
described in clause (i), in order to assure such compliance and to 
determine the extent to which the imposition of such requirements is 
contributing to the achievement of the purposes of this title. The 
Secretary may retain jurisdiction in the case of a hearing before the 
Secretary under this title to the extent the Secretary determines 
necessary to carry out the preceding sentence. The Secretary shall 
annually submit to the Congress a full and complete report on the 
Secretary's activities under this subparagraph.
    ``(iii) The representative payee and the referral and monitoring 
agency for any individual described in clause (i) shall report to the 
Secretary any noncompliance with the terms, conditions, and 
requirements of the treatment described in clause (i) and with the 
requirements imposed by the Secretary under clause (ii).
    ``(iv)(I) If the Secretary finds that an individual is not 
complying with the terms, conditions, and requirements of the treatment 
described in clause (i), or with the requirements imposed by the 
Secretary under clause (ii), or both, the Secretary, in lieu of 
termination, may suspend such individual's benefits under this title 
until compliance has been reestablished, including compliance with any 
additional requirements determined to be necessary by the Secretary.
    ``(II) Any period of suspension under subclause (I) shall be taken 
into account in determining any 24-month period described in clause (v) 
and shall not be taken into account in determining the 36-month period 
described in such clause.
    ``(v)(I) Except as provided in subclause (II), no individual 
described in clause (i) shall be entitled to benefits under this title 
for any month following the 24-month period beginning with the 
determination of the disability described in such clause.
    ``(II) If at the end of the 24-month period described in subclause 
(I), the individual furnishes evidence in accordance with section 
223(d)(5) that the individual continues to be under a disability based 
in whole or in part on a medical determination that the individual is a 
drug addict or alcoholic, such individual shall be entitled to benefits 
under this title based on such disability.
    ``(III) Subject to subclause (IV), if such an individual continues 
to be entitled to such benefits for an additional 24-month period 
following a determination under subclause (II), subclauses (I) and (II) 
shall apply with regard to any further entitlement to such benefits 
following the end of such additional period.
    ``(IV) In no event shall such an individual be entitled to benefits 
under this title for more than a total of 36 months, unless upon the 
termination of the 36th month such individual furnishes evidence in 
accordance with section 223(d)(5) that the individual is under a 
disability which is not related in part to a medical determination that 
the individual is a drug addict or alcoholic.
    ``(B)(i) Any benefits under this title payable to any individual 
referred to in subparagraph (A), including any benefits payable in a 
lump sum amount, shall be payable only pursuant to a certification of 
such payment to a qualified organization acting as a representative 
payee of such individual pursuant to section 1631(a)(2)(A)(ii).
    ``(ii) For purposes of clause (i) and section 1631(a)(2)(D), the 
term `qualified organization'--
            ``(I) shall have the meaning given such term by section 
        1631(a)(2)(D)(ii), and
            ``(II) shall mean an agency or instrumentality of a State 
        or a political subdivision of a State.''
    (c) Effective Dates; Authorizations.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by this section shall apply to benefits payable 
        for determinations of disability made 90 or more days after the 
        date of the enactment of this Act.
            (2) Current determinations.--
                    (A) In general.--With respect to any individual 
                described in subparagraph (B), the Secretary of Health 
                and Human Services shall provide during the 3-year 
                period beginning after the date of the enactment of 
                this Act for the application of the amendments made by 
                this section to such individual with the time periods 
                described in such amendments to begin upon such 
                application.
                    (B) Individual described.--An individual is 
                described in this subparagraph if such individual is 
                entitled to benefits under title II or XVI of the 
                Social Security Act based on a disability determined 
                before the date described in paragraph (1) to be based 
                in whole or in part on a medical determination that the 
                individual is a drug addict or alcoholic.
            (3) Authorization of appropriations.--There are authorized 
        to be appropriated such sums as may be necessary to carry out 
        the purposes of the provisions of, and the amendments made by, 
        this section.

SEC. 3. PRIORITY OF TREATMENT.

    The Secretary of Health and Human Services, through the 
Administrator of the Substance Abuse and Mental Health Services 
Administration, shall assure that every individual receiving disability 
benefits under title II or XVI of the Social Security Act based in 
whole or in part on a medical determination that the individual is a 
drug addict or alcoholic be given high priority for treatment through 
entities supported by the various States through any substance abuse 
block grant authorized under law.

SEC. 4. ESTABLISHMENT OF REFERRAL MONITORING AGENCIES REQUIRED IN ALL 
              STATES.

    The Secretary of Health and Human Services shall, within 1 year of 
the date of the enactment of this Act, provide for the establishment of 
referral and monitoring agencies for each State for the purpose of 
carrying out the treatment requirements under sections 223(j)(1) and 
1611(e)(3)(A) of the Social Security Act (42 U.S.C. 423(j)(1) and 
1382(e)(3)(A)).

SEC. 5. PROCEEDS FROM CERTAIN CRIMINAL ACTIVITIES CONSTITUTE 
              SUBSTANTIAL GAINFUL EMPLOYMENT.

    (a) Social Security Disability Insurance.--Section 223(d)(4) of the 
Social Security Act (42 U.S.C. 423(d)(4)) is amended by inserting the 
following after the first sentence: ``If an individual engages in a 
criminal activity to support substance abuse, any proceeds derived from 
such activity shall demonstrate such individual's ability to engage in 
substantial gainful activity.''.
    (b) Supplemental Security Income.--Section 1614(a)(3)(D) of the 
Social Security Act (42 U.S.C. 1382(a)(3)(D)) is amended by inserting 
the following after the first sentence: ``If an individual engages in a 
criminal activity to support substance abuse, any proceeds derived from 
such activity shall demonstrate such individual's ability to engage in 
substantial gainful activity.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to disability determinations conducted on or after the date of 
the enactment of this Act.

SEC. 6. CONSISTENT PENALTY PROVISIONS FOR SSDI AND SSI PROGRAMS.

    (a) Felony Penalties for Fraud.--
            (1) In general.--Subsection (a) of section 1631 of the 
        Social Security Act (42 U.S.C. 1383a) is amended by striking 
        ``shall be guilty of a misdemeanor and upon conviction thereof 
        shall be fined not more than $1,000 or imprisoned for not more 
        than one year, or both'' and inserting ``shall be guilty of a 
        felony and upon conviction thereof shall be fined under title 
        18, United States Code, or imprisoned for not more than five 
        years, or both''.
            (2) Representative payees.--
                    (A) SSDI.--Subsections (b) and (c) of section 208 
                of such Act (42 U.S.C. 408) are amended to read as 
                follows:
    ``(b)(1) Any person or other entity who is convicted of a violation 
of any of the provisions of this section, if such violation is 
committed by such person or entity in his role as, or in applying to 
become, a certified payee under section 205(j) on behalf of another 
individual (other than such person's spouse or an entity described in 
section 223(j)(2)(B)(ii)), shall be guilty of a felony and upon 
conviction thereof shall be fined under title 18, United States Code, 
or imprisoned for not more than five years, or both.
    ``(2) In any case in which the court determines that a violation 
described in paragraph (1) includes a willful misuse of funds by such 
person or entity, the court may also require that full or partial 
restitution of such funds be made to the individual for whom such 
person or entity was the certified payee.
    ``(3) Any person or entity convicted of a felony under this section 
or under section 1632(b) may not be certified as a payee under section 
205(j).
    ``(c) For the purpose of subsection (a)(7), the terms `social 
security number' and `social security account number' mean such numbers 
as are assigned by the Secretary under section 205(c)(2) whether or 
not, in actual use, such numbers are called social security numbers.''
                    (B) SSI.--Subsection (b)(1) of section 1632 of such 
                Act (42 U.S.C. 1383a) is amended by striking ``(other 
                than such person's spouse)'' and all that follows 
                through the period and inserting ``(other than such 
                person's spouse or an entity described in section 
                1611(e)(3)(B)(ii)(II)), shall be guilty of a felony and 
                upon conviction thereof shall be fined under title 18, 
                United States Code, or imprisoned for not more than 
                five years, or both.''
    (b) Civil Administrative Penalties.--
            (1) SSDI.--Section 208 of the Social Security Act (42 
        U.S.C. 408) is amended by adding at the end the following new 
        subsections:
    ``(e) For administrative penalties for false claims and statements 
with respect to which an individual or other entity knows or has reason 
to know such falsity, see chapter 38 of title 31, United States Code.
    ``(f) In the case of the second or subsequent imposition of an 
administrative or criminal penalty on any person or other entity under 
this section, the Secretary may exclude such person or entity from 
participation in any program under this title and titles V, XVI, XVIII, 
and XX, and may direct that such person or entity be excluded from any 
State health care program (as defined in section 1128(h)) and any other 
Federal program as provided by law.''
            (2) SSI.--
                    (A) In general.--Section 1632 of such Act (42 
                U.S.C. 1383a) is amended by adding at the end the 
                following new subsections:
    ``(c) For administrative penalties for false claims and statements 
with respect to which an individual or other entity knows or has reason 
to know such falsity, see chapter 38 of title 31, United States Code.
    ``(d) In the case of the second or subsequent imposition of an 
administrative or criminal penalty on any person or other entity under 
this section, the Secretary may exclude such person or entity from 
participation in any program under this title and titles II, V, XVIII, 
and XX, and may direct that such person or entity be excluded from any 
State health care program (as defined in section 1128(h)) and any other 
Federal program as provided by law.''
                    (B) Conforming amendment.--The heading for section 
                1632 of such Act (42 U.S.C. 1383a) is amended by 
                striking ``for fraud''.
    (c) Effective Date.--The amendments made by this section shall be 
effective on or after the date of the enactment of this Act.

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HR 4136 IH----2