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

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]

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