[Federal Register Volume 68, Number 51 (Monday, March 17, 2003)]
[Proposed Rules]
[Pages 12639-12641]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-6278]


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SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404 and 416

[Regulations Nos. 4 and 16]
RIN 0960-AF69


Revised Medical Criteria for Evaluating Mental Disorders

AGENCY: Social Security Administration.

ACTION: Advance notice of proposed rulemaking.

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SUMMARY: We are planning to update and revise the rules that we use to 
evaluate mental disorders of adults and children who apply for, or 
receive, disability benefits under title II and Supplemental Security 
Income (SSI) payments based on disability under title XVI of the Social 
Security Act (the Act). We invite you to send us comments and 
suggestions for updating and revising these rules.
    After we have considered your comments and suggestions, as well as 
information about advances in medical knowledge, treatment, and methods 
of evaluating mental impairments, and our program experience, we intend 
to publish for public comment a Notice of Proposed Rulemaking (NPRM) 
that will propose specific revisions to the rules.
    As part of our long-term planning for the disability programs, we 
are also interested in your ideas for how we may be able to improve our 
programs for people who have mental disorders, especially those who 
would like to work.

DATES: To be sure your comments are considered, we must receive them by 
June 16, 2003.

ADDRESSES: You may give us your comments using: our Internet site 
facility (i.e., Social Security Online) at: http://policy.ssa.gov/pnpublic.nsf/LawsRegs, e-mail to [email protected]; telefax to (410) 
966-2830; or, by letter to the Commissioner of Social Security, P.O. 
Box 17703, Baltimore, Maryland 21235-7703. You may also deliver them to 
the Office of Disability and Income Security Programs, Social Security 
Administration, 100 Altmeyer Building, 6401 Security Boulevard, 
Baltimore, Maryland 21235-6401, between 8 a.m. and 4:30 p.m. on regular 
business days. Comments are posted in our Internet site at http://policy.ssa.gov/pnpublic.nsf/LawsRegs, or you may inspect them on 
regular business days by making arrangements with the contact person 
shown below.
    Electronic Version: The electronic file of this document is 
available on the date of publication in the Federal Register at http://www.access.gpo.gov/su_docs/aces/aces140.html. It is also available on 
the Internet site for SSA (i.e., Social Security Online): http://www.ssa.gov/regulations/.

FOR FURTHER INFORMATION CONTACT: Cathy Lively, Office of Disability and 
Income Security Programs, Social Security Administration, 4422 Annex 
Building, 6401 Security Boulevard, Baltimore, Maryland 21235-6401, 
(410) 966-1180 or TTY (410) 966-5609. For information on eligibility or 
filing for benefits, call our national toll-free number 1-800-772-1213 
or TTY 1-800-325-0778, or visit our Internet web site, Social Security 
Online, at http://www.ssa.gov.

SUPPLEMENTARY INFORMATION:

What Is the Purpose of This Notice?

    We are planning to update and revise the rules that we use to 
evaluate mental disorders of adults and children who apply for, or 
receive, disability benefits under title II and SSI payments based on 
disability under title XVI of the Act. The purpose of this notice is to 
give you an opportunity to send us comments and

[[Page 12640]]

suggestions for updating and revising those rules as we begin the 
rulemaking process. We are also asking for your comments and ideas 
about how we can improve our disability programs in the future for 
people with mental disorders.

Who Should Send Us Comments and Suggestions?

    Anyone who has an interest in the rules that we use to evaluate 
mental disorders of adults and children should comment. We are 
interested in getting comments and suggestions from people who apply 
for or receive disability benefits from us, members of the general 
public, advocates and organizations who advocate for people who have 
mental disorders, experts in the evaluation of mental disorders, 
researchers, people who make disability determinations for us, and any 
other people who have ideas for us to consider.

Will We Respond to Your Comments From This Notice?

    No, we will not respond directly to comments you send us because of 
this notice. However, after we consider your comments in response to 
this notice, along with other information such as medical research and 
our program experience, we will decide how to revise the rules we use 
to evaluate mental disorders. When we propose specific revisions to the 
rules, we will publish an NPRM in the Federal Register. In accordance 
with the usual rulemaking procedures we follow, you will have a chance 
to comment on the revisions we propose when we publish the NPRM, and we 
will summarize and respond to the significant comments on the NPRM in 
the preamble to any final rules.

Which Rules Are We Considering for Updating and Revision?

    We are considering two regulations sections and two sections of our 
listings for revision. The two regulations sections are Sec. Sec.  
404.1520a and 416.920a, and are both titled, ``Evaluation of mental 
impairments.'' These rules discuss the special technique we use to 
evaluate all claims of adults who have mental disorders. The two 
sections of our listings are sections 12.00 and 112.00. These are the 
listings for mental disorders for adults (Part A, 12.00) and children 
(Part B, 112.00).

Where Can You Find These Rules on the Internet?

    You can find all of these rules on our Internet site.
    [sbull] Sec.  404.1520a is at http://www.ssa.gov/OP_Home/cfr20/404/404-1520a.htm.
    [sbull] Sec.  416.920a is at http://www.ssa.gov/OP_Home/cfr20/416/416-0920a.htm.
    [sbull] Sections 12.00 and 112.00 are in the Listing of Impairments 
in appendix 1 to subpart P of part 404 of our regulations at http://www.ssa.gov/OP_Home/cfr20/404/404-ap09.htm.
    [sbull] You can also look up sections 12.00 and 112.00 at this 
site: http://www.ssa.gov/disability/professionals/bluebook/.
    If you do not have Internet access, you can find the Code of 
Federal Regulations in some public libraries, Federal depository 
libraries, and public law libraries.

Why Are We Updating and Revising Our Rules for Evaluating Mental 
Disorders?

    [sbull] The current listings for mental disorders for adults 
(12.00) and children (112.00) will no longer be in effect on July 2, 
2003, unless we extend them or revise and promulgate them again, so we 
must consider now whether to update and revise them.
    [sbull] Although we have made some changes to the listings since we 
first published them, including changes to the listings in 2000 (65 FR 
50746, corrected at 65 FR 60584), we have not comprehensively revised 
the adult listings since 1985 and the childhood listings since 1990.
    [sbull] Many of our rules for adults are based on the American 
Psychiatric Association's Diagnostic and Statistical Manual of Mental 
Disorders, Third Edition (Washington, DC: APA, 1980), also called the 
DSM-III. That manual has been updated three times over the years since 
we first published comprehensive revisions of the adult mental 
disorders listings. Our childhood listings are based on the revision of 
the Third Edition (the DSM-III-R), which has been updated twice since 
we first published comprehensive revisions of those listings. We want 
to update the terms in our listings so they are consistent with current 
medical terminology. (The current edition is the Diagnostic and 
Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, 
Washington, DC, American Psychiatric Association, 2000, also called the 
DSM-IV-TR.)
    [sbull] There is also new information about mental retardation (MR) 
that we need to consider. We recently funded research through the 
National Research Council (NRC) that assessed our current criteria for 
evaluating MR in the context of state-of-the-art scientific knowledge 
and clinical practice. In its final report, Mental Retardation: 
Determining Eligibility for Social Security Benefits, the NRC made a 
number of recommendations to us for revising our rules, and we are 
considering the recommendations now. If you would like to review the 
report and send us comments on the recommendations, you can find it at 
http://www.nap.edu/books/0309083230/html/.
    [sbull] We will also be considering information from other sources, 
including the following recent documents, for relevance to our policy 
for evaluating MR:
    [sbull] Schroeder, Stephen R.; Gerry, Martin; Gertz, Gabrielle; and 
Velazques, Fiona, Usage of the Term ``Mental Retardation''; Language, 
Image, and Public Education (Kansas University Center on Developmental 
Disabilities, Center for the Study of Family, Neighborhood and 
Community Policy, The University of Kansas, June 14, 2002). You can 
find this report online at http://www.ssa.gov/disability/MentalRetardationReport.pdf.
    [sbull] Mental Retardation: Definition, Classification, and Systems 
of Supports, 10th Edition (American Association on Mental Retardation, 
Washington, DC, 2002).

What Should You Comment About?

    We are interested in any comments and suggestions you have for 
revising any or all parts of Sec. Sec.  404.1520a and 416.920a and 
sections 12.00 and 112.00 of our listings. For example, we are 
interested in knowing if:
    [sbull] You have concerns about any of the current listings 
provisions for adults or children; such as whether you think we should 
change any of our criteria or whether you think a listing is difficult 
to use or understand.
    [sbull] You would like to see our listings include something that 
they do not include now.
    You can also comment about the recommendations in the NRC report 
and about information in the other two sources we cite above and make 
any other comments or suggestions to help us improve our rules for 
evaluating whether adults and children who have mental disorders 
qualify for benefits.
    In addition to your comments about our regulations, we are also 
interested in any ideas you have about how the disability requirements 
of the Act and our regulations affect people who have mental disorders 
and:
    [sbull] Need access to treatment or rehabilitation,
    [sbull] Want to work, or
    [sbull] May benefit from some employment.

[[Page 12641]]

    For example, we know that many people who have mental disorders 
might not need benefits from us if they could get treatment before 
their disorders make them unable to work. Others may be disabled and 
unable to work, but may not need to remain unemployed, if they receive 
treatment or other interventions. Many people with permanent disorders 
can work if they have a supporting safety net (including title II 
disability benefits and SSI payments). Work can also be therapeutic for 
some people. Although the Act and our regulations include some access 
to health care through Medicare and Medicaid, some provision for 
vocational rehabilitation, and a number of work incentives, these 
provisions are generally for people who already qualify for benefits 
under our disability programs.
    We are interested in your ideas for how we may be able to improve 
our programs for people who have mental disorders, especially those who 
would like to work full-time or part-time with supports. Your ideas can 
address our existing rules and regulations or suggest changes to the 
law. We will consider your ideas as we develop the NPRM we intend to 
publish for public comment, and, where applicable, as part of our long-
term planning for the disability program.

Other Information

Who Can Get Disability Benefits?

    Under title II of the Act, we provide for the payment of disability 
benefits if you are disabled and belong to one of the following three 
groups:
    [sbull] Workers insured under the Act,
    [sbull] Children of insured workers, and
    [sbull] Widows, widowers, and surviving divorced spouses (see 20 
CFR 404.336) of insured workers.
    Under title XVI of the Act, we provide for Supplemental Security 
Income (SSI) payments on the basis of disability if you are disabled 
and have limited income and resources.

How Do We Define Disability?

    Under both the title II and title XVI programs, disability must be 
the result of any medically determinable physical or mental impairment 
or combination of impairments that is expected to result in death or 
which has lasted or is expected to last for a continuous period of at 
least 12 months. Our definitions of disability are shown in the 
following table:

------------------------------------------------------------------------
                                                    Disability means you
                                                      have a medically
 If you file a claim under . .                          determinable
               .                And you are . . .     impairment(s) as
                                                    described above and
                                                   that results in . . .
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Title II......................  an adult or a      the inability to do
                                 child.             any substantial
                                                    gainful activity
                                                    (SGA).
Title XVI.....................  a person age 18    the inability to do
                                 or older.          any SGA.
Title XVI.....................  a person under     marked and severe
                                 age 18.            functional
                                                    limitations.
------------------------------------------------------------------------

What Are the Listings?

    The listings are examples of impairments that we consider severe 
enough to prevent a person from doing any gainful activity, or that 
result in ``marked and severe functional limitations'' in children 
seeking SSI payments under title XVI of the Act. Although we publish 
the listings only in appendix 1 to subpart P of part 404 of our rules, 
we incorporate them by reference in the SSI program in Sec.  416.925 of 
our regulations, and apply them to claims under both title II and title 
XVI of the Act.

How Do We Use the Listings?

    The listings are in two parts. There are listings for adults (part 
A) and for children (part B). If you are a person age 18 or over, we 
apply the listings in part A when we assess your claim, and we never 
use the listings in part B.
    If you are a person under age 18, we first use the criteria in part 
B of the listings. If the listings in part B do not apply, and the 
specific disease process(es) has a similar effect on adults and 
children, we then use the criteria in part A. (See Sec. Sec.  404.1525 
and 416.925.)
    If your impairment(s) does not meet any listing, we will also 
consider whether it medically equals any listing; that is, whether it 
is as medically severe. (See Sec. Sec.  404.1526 and 416.926.)
    We use the listings only to decide that people are disabled or that 
they are still disabled. We will never deny your claim or decide that 
you no longer qualify for benefits simply because your impairment(s) 
does not meet or medically equal a listing. If you have a severe 
impairment(s) that does not meet or medically equal any listing, we may 
still find you disabled based on other rules in the ``sequential 
evaluation process'' that we use to evaluate all disability claims. 
(See Sec. Sec.  404.1520, 416.920, and 416.924.)

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, Bind, Disability 
benefits, Public assistance programs, Supplemental Security Income 
(SSI), Reporting and recordkeeping requirements.

    Dated: February 14, 2003.
Jo Anne B. Barnhart,
Commissioner of Social Security.
[FR Doc. 03-6278 Filed 3-14-03; 8:45 am]
BILLING CODE 4191-02-U