[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