[Federal Register Volume 72, Number 146 (Tuesday, July 31, 2007)]
[Proposed Rules]
[Pages 41649-41651]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E7-14686]


=======================================================================
-----------------------------------------------------------------------

SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404, 405, and 416

[Docket No. SSA 2007-0053]
RIN 0960-AG54


Compassionate Allowances

AGENCY: Social Security Administration (SSA).

ACTION: Advance notice of proposed rulemaking.

-----------------------------------------------------------------------

SUMMARY: Under titles II and XVI of the Social Security Act (the Act), 
we pay benefits to individuals who meet our rules for entitlement and 
have medically determinable physical or mental impairments that are 
severe enough to meet the definition of disability in the Act. The 
rules for determining disability can be very complicated, but some 
individuals have such serious medical conditions that their conditions 
obviously meet our disability standards. To address these individuals' 
needs, we strive to provide not only responsive, but also 
compassionate, public service that ensures the most severely disabled 
in our society who meet the Act's requirements are awarded benefits 
quickly. To that end, we are investigating methods of making 
``compassionate allowances'' by quickly identifying individuals with 
obvious disabilities. The purpose of this notice is to give you an 
opportunity to send us comments about what standards we should use for 
compassionate allowances, methods we might use to identify 
compassionate allowances, and suggestions for how to implement those 
standards and methods.

DATES: To be sure that your comments are considered, we must receive 
them by October 1, 2007.

ADDRESSES: You may give us your comments by: Internet through the 
Federal eRulemaking Portal at http://www.regulations.gov; e-mail to 
[email protected]; telefax to (410) 966-2830; or letter to the 
Commissioner of Social Security, P.O. Box 17703, Baltimore, MD 21235-
7703. You may also deliver them to the Office of Regulations, Social 
Security Administration, 960 Altmeyer Building, 6401 Security 
Boulevard, Baltimore, MD 21235-6401, between 8 a.m. and 4:30 p.m. on 
regular business days. Comments are posted on the Federal eRulemaking 
Portal, or you may inspect them on regular business days by making 
arrangements with the contact person shown in this preamble.

FOR FURTHER INFORMATION CONTACT: James Julian, Director, Office of 
Compassionate Allowances and Listings Improvements, Social Security 
Administration, 4470 Annex Building, 6401 Security Boulevard, 
Baltimore, MD 21235-6401, (410) 965-4015. 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.socialsecurity.gov.

SUPPLEMENTARY INFORMATION:

Electronic Version

    The electronic file of this document is available on the date of 
publication in the Federal Register at http://www.gpoaccess.gov/fr/index.html.

Sequential Evaluation Process for Determining Disability

    We use a five-step ``sequential evaluation process'' to decide 
whether an individual is disabled, but will stop at any point in the 
process at which we are able to make a disability determination. At 
step one, we determine whether an individual is currently engaged in 
substantial gainful activity. If not, we then move to step two and 
determine whether the individual has a ``severe'' impairment or 
combination of impairments significantly limiting the ability to 
perform basic work activities. At step three, we compare the 
individual's impairment(s) to those in the Listing of Impairments in 
appendix 1 of subpart P of part 404 of our regulations (listing). If 
the impairment does not meet or equal in severity a listing, at step 
four, we assess the individual's residual functional capacity to 
determine if the individual can do any past relevant work. Finally, at 
step five, we determine whether other work exists in significant 
numbers that such an individual can perform, considering the 
individual's residual functional capacity, age, education, and work 
experience. We use different sequential evaluation processes for 
children and for individuals already receiving benefits when we 
determine whether they are still disabled. See Sec. Sec.  404.1594, 
416.924, 416.994, and 416.994a of our regulations.

[[Page 41650]]

Current Examples of Compassionate Allowances

    In making disability determinations, we already apply screening 
methods that identify and assist some of the most obviously disabled 
individuals. Some of our current screening methods include:
    1. Presumptive Disability/Presumptive Blindness. Under the Act, an 
individual, including a child, applying for supplemental security 
income (SSI) based on disability or blindness, may receive up to 6 
months of payments before we make a formal determination of disability 
or blindness if we determine that he or she is presumptively disabled 
or blind (PD/PB) and meets all other eligibility requirements. 
Generally, our field offices are authorized to make a PD/PB finding 
only for certain impairments that are readily observable or that can be 
easily confirmed; however, the State agencies that make initial 
disability determinations for us may make a PD/PB finding in any case 
where there is a strong likelihood that the claim will be allowed on 
formal determination.
    2. Terminal Illness. We expedite the determinations of all 
disability cases in which there is an indication of a terminal illness 
(TERI). We may identify a claim as a TERI case when an individual 
alleges a terminal illness, when there is an allegation or diagnosis of 
AIDS, when an individual is receiving hospice care, or when medical 
records indicate that an individual has an impairment that is 
untreatable.
    3. Quick Disability Determinations (QDD). Through the QDD process, 
we screen claims for special assignment within the State agencies so 
that they may allow the claims quickly, often within less than 10 days. 
We use a complex computer screening tool at the time an individual 
files his or her application for disability benefits to identify some 
cases that are likely to qualify with evidence we can obtain quickly. 
The screening tool searches the application and other documents for key 
words in identifying a claim as a likely QDD.
    4. The Listing of Impairments. As described above, at the third 
step of the ``sequential evaluation process'' that we use for 
determining disability, we consider whether an individual's impairment 
meets or medically equals the criteria of a listing. When an 
individual's impairment meets or medically equals the criteria of any 
listed impairment, we find the individual disabled without considering 
residual functional capacity, age, education, or work experience.
    Examples of some listing-level impairments that qualify for 
favorable determinations with minimal medical evidence establishing the 
diagnosis include:
     Hemipelvectomy (sections 1.05D and 101.05D),
     Non-mosaic Down syndrome (sections 10.06 and 110.06),
     Catastrophic congenital anomalies, such as anencephaly and 
cri du chat (deletion 5p) syndrome (section 110.08),
     Amyotrophic lateral sclerosis (section 11.10),
     Acute leukemia (sections 13.06A and 113.06A),
     Small-cell carcinoma of a lung (section 13.14B),
     Carcinoma (except islet cell carcinoma) of the pancreas 
(section 13.20A), and
     Major organ transplants, such as heart, liver, or lungs 
(various sections).
    There are also some impairments that qualify for favorable 
determinations under a listing based solely on objective medical 
evidence but with criteria for clinical or laboratory findings 
demonstrating the severity of the impairment. However, this evidence is 
also generally minimal. For example:
     Impairment of visual acuity (statutory blindness) with 
remaining vision in the better eye after best correction of 20/200 or 
less (section 2.02 and 102.02A),
     Cystic fibrosis with specified levels of forced expiratory 
volume (FEV1) (sections 3.04A and 103.04A),
     Any symptomatic congenital heart disease with cyanosis at 
rest and a specified hematocrit or arterial oxygen level (sections 
4.06A and 104.06A),
     Any chronic renal (kidney) disease requiring chronic 
hemodialysis or peritoneal dialysis (sections 6.02A and 106.02A), and
     Many inoperable cancers and cancers with distant 
metastases (various provisions in sections 14.00 and 114.00).

Examples of Other Compassionate Allowances That We Are Considering

    In addition to these methods of identifying compassionate 
allowances, we are considering the creation of an extensive list of 
impairments that we can allow quickly with minimal objective medical 
evidence that is based on clinical signs or laboratory findings or a 
combination of both. We believe that we could use certain listed 
impairments, such as those described above, as a starting point for a 
much longer list of impairments that could be allowed based on 
established diagnoses alone (supported by objective medical evidence) 
or based on diagnoses that have reached certain points in their 
progression that would be considered disabling. We would not limit, 
however, the compilation of conditions to those already covered by our 
listing. We would incorporate any conditions that should be allowed 
quickly with minimal, but sufficient, objective medical evidence. As 
such, the list of qualifying conditions would be specific and 
extensive.
    Additionally, although we already have some policies and procedures 
for identifying the most obviously disabled individuals quickly, we are 
investigating methods for identifying compassionate allowances by 
perhaps starting with a specific allegation or through the use of a 
computer system that is able to search key words included in an 
electronic disability folder. Because the health care industry is 
capturing more and more clinical information in structured electronic 
formats using standardized codesets, we also are interested in your 
ideas about whether and how we can use that information for identifying 
compassionate allowances.
    Many, although by no means all, of the individuals who would 
qualify for a compassionate allowance will have impairments that are 
expected to result in death and need immediate decisions on their 
claims. It is our hope that compassionate allowances will not only 
bring faster benefits to individuals in need, but that they will also 
help to quicken the processing time of those claims that must be 
processed through our existing procedures.

Request for Comments

    Please provide us with any comments and suggestions you have about 
new standards and identification methods for compassionate allowances. 
The following questions raise issues that you may wish to consider. 
Feel free to raise other questions, thoughts, or comments.
     Do you have any ideas for how we can better identify 
impairments that can quickly be allowed without going through the 
entire disability determination process?
     Do you have any ideas for different standards we should be 
using in our effort to provide compassionate assistance to individuals 
with the most serious impairments?
     What is the minimum amount of medical evidence we should 
accept to support a compassionate allowance finding?
     What procedures should we follow in our Social Security 
field offices, the State agencies, and the Office of Disability 
Adjudication and Review to identify compassionate allowances?

[[Page 41651]]

     How can we best take advantage of clinical information 
captured electronically using standardized codes to specify the nature 
of the impairment?
     What do you think about our idea of a more extensive and 
specific list of impairments based on established diagnoses?
     What should the general criteria for inclusion on such a 
list be?
     What specific impairment(s) or kinds of impairments do you 
believe we should include on such a list, and what specific criteria 
for inclusion should we use for those impairments (including specific 
standardized codes if appropriate)?
     How should the rules or procedures for such a list be 
structured; for example, should we include a list of all of the 
diagnoses in the regulations, or should we have the list on SSA's 
Internet site or somewhere else?
     What sources should we consult to create such a list; for 
example, our Listing of Impairments, the latest edition of the World 
Health Organization's International Classification of Diseases (ICD), 
and the latest edition of the American Psychiatric Association's 
Diagnostic and Statistical Manual of Mental Disorders (DSM)? Are there 
individuals and organizations we should also be consulting?
     How should we keep the list up to date?
     We intend to undertake special outreach efforts in order 
to encourage public discussion regarding potential methods and 
standards for identifying compassionate allowances, including periodic 
quarterly hearings. What methods should we use for community outreach, 
and where should the outreach take place?
    We will not respond directly to comments you send us because of 
this notice. After we consider your comments in response to this 
notice, we will decide whether and how to revise the rules we use to 
determine disability. If we propose specific revisions to the rules, we 
will publish a notice of proposed rulemaking (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.

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 405

    Administrative practice and procedure; Blind, Disability benefits; 
Old-Age, Survivors, and Disability Insurance, Public assistance 
programs, Reporting and recordkeeping requirements, Social Security, 
Supplemental Security Income (SSI).

20 CFR Part 416

    Administrative practice and procedure, Aged, Blind, Disability 
benefits, Public assistance programs, Reporting and recordkeeping 
requirements, Supplemental Security Income (SSI).

    Dated: July 24, 2007.
Michael J. Astrue,
Commissioner of Social Security.
 [FR Doc. E7-14686 Filed 7-30-07; 8:45 am]
BILLING CODE 4191-02-P