[Federal Register: December 5, 2005 (Volume 70, Number 232)]
[Proposed Rules]
[Page 72416-72419]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr05de05-25]
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SOCIAL SECURITY ADMINISTRATION
20 CFR Parts 404 and 416
[Regulation Nos. 4 and 16]
RIN 0960-AG19
Continuing Disability Review Failure To Cooperate Process
AGENCY: Social Security Administration.
ACTION: Notice of proposed rulemaking.
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SUMMARY: We propose to amend our regulations to provide that we will
suspend your disability benefits before we make a determination during
a continuing disability review (CDR) under title II and title XVI of
the Social Security Act (the Act) when you fail to comply with our
request for necessary information. Should you remain non-compliant for
a period of one year following your suspension, we will then terminate
your disability benefits. Although our current title XVI regulations
generally provide for the termination of payments after 12 months of
suspension, we are proposing to amend our regulations by adding this
policy to our title II regulations and by restating it in the title XVI
CDR regulatory provisions.
DATES: To be sure that your comments are considered, we must receive
them no later than February 3, 2006.
ADDRESSES: You may give us your comments by: using our Internet site
facility (i.e., Social Security Online) at http://policy.ssa.gov/erm/rules.nsf/Rules+Open+To+Comment
or the Federal eRulemaking Portal at http://www.regulations.gov; e-mail to regulations@ssa.gov; by telefax
telefax
to (410) 966-2830; or by 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, 100 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 our
Internet site, at http://policy.ssa.gov/erm/rules.nsf/Rules+Open+To+Comment
, or you may inspect them on regular business days
by making arrangements with the contact person shown in this preamble.
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.
It is also available on the Internet
site for SSA (i.e., Social Security Online) at http://www.policy.ssa.gov/erm/rules.nsf/Rules+Open+To+Comment
.
FOR FURTHER INFORMATION CONTACT: Don Harvey, Social Insurance
Specialist, Office of Program Development and Research, Social Security
Administration, 6401 Security Boulevard, Baltimore, MD 21235-6401,
(410) 597-1026 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.socialsecurity.gov.
SUPPLEMENTARY INFORMATION:
Statutory Background
Sections 221(i) and 1614(a)(3)(H)(ii)(I) of the Act and Sec. Sec.
404.1589, 416.987 and 416.989 of our regulations require that after we
find that you are disabled, we evaluate your impairment(s) from time to
time to determine if you remain disabled. We call this evaluation a
continuing disability review (CDR). If the medical and other evidence
shows that you are not disabled under the standards set out in sections
223(f) and 1614(a)(4) of the Act, we will end the
[[Page 72417]]
payment of cash benefits and terminate your period of disability.
Section 1614(a)(3)(H)(iii) of the Act and Sec. 416.987 of our
regulations require that if you are eligible for payments as a child
under title XVI by reason of disability, we redetermine that
eligibility during the one-year period beginning on your 18th birthday,
or, in lieu of a CDR, whenever we determine that your case is subject
to such a review. We call this evaluation an age-18 redetermination. If
the medical and other evidence shows that you are not disabled under
the standards set out in section 1614(a)(3)(A)-(B) of the Act, we will
end the payment of cash payments and terminate your period of
disability.
Sections 223(f) and 1614(a)(4) of the Act provide that, in general,
if you receive disability benefits under titles II and/or XVI of the
Act, we may find that you are no longer disabled if substantial
evidence shows that there has been medical improvement in your
impairment or combination of impairments, and you are now able to do
substantial gainful activity. Under title XVI, if you are a child (an
individual under age 18), substantial evidence must show that there has
been medical improvement in your impairment or combination of
impairments, and the impairment(s) must no longer cause marked and
severe functional limitations. We call this the medical improvement
review standard (MIRS), and we apply it whenever we do a CDR for an
adult or child. The statute also provides, however, for several
exceptions to the ``medical improvement'' requirement where we will not
apply the MIRS. One of those exceptions to applying the MIRS is the
situation where you fail, without good cause, to cooperate with us when
we do a CDR.
Continuing Disability Review and Age-18 Redetermination Processes Under
Our Current Regulations
When we begin a CDR or an age-18 redetermination, we notify you
that we are reviewing your eligibility for disability benefits and
explain why we are reviewing your eligibility; what standard will
apply, either the MIRS in a CDR or the initial claims criteria in an
age-18 redetermination; that our review could result in the termination
of your benefits; and that you have the right to submit medical and
other evidence for us to consider during the CDR or the age-18
redetermination. Before we determine whether you are still disabled, we
develop a complete medical history covering at least the 12 months
preceding the date that you complete a report about your continuing
disability status. If our review shows that we should stop your
benefits, we notify you in writing and give you the opportunity to
appeal. (See Sec. Sec. 404.1589 and 416.989 of our regulations.) We
explain when and how often we will do a CDR in Sec. Sec. 404.1590 and
404.1591 of our title II regulations and in Sec. Sec. 416.990 and
416.991 of our title XVI regulations. We explain when we will do an
age-18 redetermination in Sec. 416.987 of our title XVI regulations.
When we do a CDR, Sec. Sec. 404.1594(e)(2), 416.987(e)(3),
416.994(b)(4)(ii) and 416.994a(f)(2) of our regulations set out the
general principle that is reflected in sections 223(f) and 1614(a)(4)
of the Act; i.e., that you have the responsibility to cooperate with
us, or take any required action that we decide is necessary to allow us
to complete the CDR or age-18 redetermination. If you do not cooperate
with us, and you do not have good cause as defined in Sec. Sec.
404.911 and 416.1411 of our regulations for not cooperating, we will
find that your disability has ended.
We currently have no provision in our regulations that allows us to
suspend your benefits under title II of the Act if you fail to
cooperate with us when we request necessary information during a CDR.
However, Sec. 416.1322 of our title XVI regulations provides general
authority that allows us to suspend your payments under title XVI of
the Act, whenever you fail to cooperate with our requests for
information, including during a CDR.
When we suspend your title XVI payments for such failure to
cooperate under Sec. 416.1322, we follow Sec. 416.714(b) of our
regulations, which gives you thirty days from the date of our written
request to comply with the request for information. We also follow
Sec. 416.1336 of our regulations, which provides that before we
suspend, reduce, or terminate your title XVI payments, we will give you
advance notice of our intent and provide you with appeal rights and
payment continuation rights pending resolution of the appeal. When we
terminate your title XVI payments due to continuous suspension of
payments, we follow Sec. 416.1335 of our regulations, which provides
that we will terminate your eligibility for payments following 12
consecutive months of payment suspension.
Why Are We Proposing To Revise Our Regulations?
We are continually exploring ways to improve the disability
process. These proposed rule changes would allow us to make our rules
consistent for all beneficiaries under both titles II and XVI,
implement a more efficient CDR process, encourage beneficiaries to
cooperate during the CDR process, and make the process less burdensome.
As a result of the proposed revisions, your failure to cooperate in
the CDR process would result initially in a suspension rather than a
termination of benefits based on a determination that you are no longer
entitled to benefits. To have your benefits resumed, you would only
have to contact your local Social Security office and provide the
requested information and you would have up to 12 months to do so.
Accordingly, you would not have to file an appeal in order to have your
benefits resumed. In addition, you would not have to request, prepare
for, and attend a hearing for your benefits to be resumed.
How Are We Proposing To Change Our Regulations?
We propose to revise Sec. Sec. 404.1587 and 404.1596 of our title
II regulations and to add new Sec. 416.992 to our title XVI
regulations. With respect to Sec. 404.1587, we propose to revise the
title to reflect that your benefits may be terminated as well as
suspended. In addition, we propose to designate the current paragraph
as paragraph (a) and add a heading to it. We also propose to add new
paragraphs (b) and (c). Under proposed Sec. 404.1587(b), we would
suspend your benefits during a CDR when you do not cooperate with us by
failing to comply with our written request for any necessary
information. If you subsequently give us the information that we
requested, we would reinstate your benefits and continue with the CDR
process. We would reinstate your benefits for any previous month for
which they are otherwise payable. Under proposed Sec. 404.1587(c), we
would terminate your benefits following 12 consecutive months of
benefit suspension when you fail to comply with our written request for
any necessary information made during a CDR. This termination would be
effective with the start of the 13th month after your benefits were
stopped because you failed to cooperate. You would have the right to
appeal the termination, but you would not have benefit continuation
rights.
Under the proposed revisions to Sec. 404.1596, we would revise the
title to reflect that your benefits may be terminated as well as
suspended. We also would remove current paragraphs (c)(1) and (c)(2)
and add new paragraphs (d) and (e) to explain that we would not make a
medical determination when you do not cooperate with us by failing to
comply with our written request for
[[Page 72418]]
any necessary information. We would suspend your benefits only after we
give you advance notice. (See Sec. 404.1595.) The advance notice would
tell you what you need to do so that your benefits are not suspended as
outlined in Sec. 404.1595(b)(3) of our regulations.
Under the proposed revisions to Sec. 404.1596(d), we are adding
language to explain that if we suspend your benefits because you fail
to cooperate and you subsequently give us the information that we
requested, we would reinstate your benefits and continue with the CDR
process. We would reinstate your benefits for any previous months for
which they are otherwise payable.
With respect to Sec. 404.1596(e), we propose to explain that if we
suspend your benefits because you do not give us the information that
we need and you fail to respond during the subsequent 12-month period,
we would terminate your benefits. The termination would be effective
with the start of the 13th month after your benefits were stopped
because you failed to cooperate. You would have the right to appeal the
termination, but you would not have benefit continuation rights.
We are proposing to add a new Sec. 416.992 to explain what would
happen if you fail to comply with our request for information during a
CDR or age-18 redetermination. We would suspend your payments before we
make a determination regarding your continuing eligibility for
disability payments if you fail to comply with our request for
information for your CDR or age-18 redetermination. We would suspend
your payments only after we give you advance notice as described in
Sec. 416.995. The advance notice would tell you what you need to do so
that your payments are not suspended as outlined in Sec. 416.1336 of
our regulations. If we suspend your payments because you fail to
cooperate and you subsequently give us the information that we
requested, we would reinstate your payments and continue with the CDR
or age-18 redetermination process. We would reinstate your payments for
any previous month for which they are otherwise payable. If we suspend
your payments because you do not give us the information that we need
and you fail to respond during the subsequent 12-month period, we would
terminate your payments. The termination would be effective with the
start of the 13th month after your payments were stopped because you
failed to cooperate. You would have the right to appeal the
termination, but you would not have payment continuation rights.
Clarity of These Proposed Rules
Executive Order (E.O.) 12866, as amended by E.O.13258, requires
each agency to write all rules in plain language. In addition to your
substantive comments on these proposed rules, we invite your comments
on how to make these proposed rules easier to understand. For example:
Have we organized the material to suit your needs?
Are the requirements in the rules clearly stated?
Do the rules contain technical language or jargon that is not
clear?
Would a different format (grouping and order of sections, use
of headings, paragraphing) make the rules easier to understand?
Would more (but shorter) sections be better?
Could we improve clarity by adding tables, lists, or diagrams?
What else could we do to make the rules easier to understand?
Regulatory Procedures
Executive Order 12866
We have consulted with the Office of Management and Budget (OMB)
and determined that these proposed rules would meet the criteria for a
significant regulatory action under E.O. 12866, as amended by E.O.
13258. Thus they were subject to OMB review.
Regulatory Flexibility Act
We certify that these proposed rules would not have a significant
economic impact on a substantial number of small entities because they
affect only individuals. Thus, a regulatory flexibility analysis as
provided in the Regulatory Flexibility Act, as amended, is not
required.
Paperwork Reduction Act
These proposed regulations impose no reporting requirements subject
to OMB clearance.
(Catalog of Federal Domestic Assistance Program Nos. 96.001, Social
Security--Disability Insurance; 96.002, Social Security--Retirement
Insurance; 96.004; Social Security--Survivors Insurance; 96.006;
Supplemental Security Income.)
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, Blind, Disability
benefits, Public assistance programs, Reporting and recordkeeping
requirements, Supplemental Security Income (SSI).
Dated: November 28, 2005.
Jo Anne B. Barnhart,
Commissioner of Social Security.
For the reasons set out in the preamble, we propose to amend
subpart P of part 404 and subpart I of part 416 of chapter III of title
20 of the Code of Federal Regulations, as set forth below:
PART 404--FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE
(1950-)
Subpart P--[Amended]
1. The authority citation for subpart P of part 404 continues to
read as follows:
Authority: Sections 202, 205(a), (b), and (d)-(h), 216(i),
(221(a) and (i), 222(c), 223, 225, and 702(a)(5) of the Social
Security Act (42 U.S.C. 402, 405(a), (b), and (d)-(h), 416(i),
421(a) and (i), 422(c), 423, 425, and 902(a)(5)); section 211(b),
Pub. L. 104-193, 110 Stat. 2105, 2189.
2. Section 404.1587 is revised to read as follows:
Sec. 404.1587 Circumstances under which we may suspend and terminate
your benefits before we make a determination.
(a) We will suspend your benefits if you are not disabled. We will
suspend your benefits if all of the information we have clearly shows
that you are not disabled and we will be unable to complete a
determination soon enough to prevent us from paying you more monthly
benefits than you are entitled to. This may occur when you are blind as
defined in the law and age 55 or older and you have returned to work
similar to work you previously performed.
(b) We will suspend your benefits if you fail to comply with our
request for necessary information. We will suspend your benefits
effective with the month in which it is determined in accordance with
Sec. 404.1596(b)(2)(i) that your disability benefits should stop due
to your failure, without good cause, to comply with our request for
necessary information. When we have received the information, we will
continue with the CDR process and reinstate your benefits for any
previous month for which they are otherwise payable.
(c) We will terminate your benefits. We will terminate your
benefits following 12 consecutive months of benefit suspension because
you did not comply with our request for information
[[Page 72419]]
in accordance with Sec. 404.1596(b)(2)(i). We will count the 12-month
suspension period from the start of the first month that you stopped
receiving benefits (see paragraph (b) of this section). This
termination is effective with the start of the 13th month after the
suspension began because you failed to cooperate.
3. Section 404.1596 is amended by revising the section heading,
removing paragraphs (c)(1) and (c)(2), redesignating paragraphs (c)(3)
and (c)(4) as paragraphs (c)(1) and (c)(2), and adding new paragraphs
(d) and (e) to read as follows:
Sec. 404.1596 Circumstances under which we may suspend and terminate
your benefits before we make a determination.
* * * * *
(d) When the suspension is effective. We will suspend your benefits
effective with the month in which it is determined in accordance with
Sec. 404.1596(b)(2)(i) that your disability benefits should stop due
to your failure, without good cause, to comply with our request for
necessary information for your continuing disability review. This
review is to determine whether or not you continue to meet the
disability requirements of the law. When we have received the
information, we will continue with the CDR process and reinstate your
benefits for any previous month for which they are otherwise payable.
(e) When we will terminate your benefits. We will terminate your
benefits following 12 consecutive months of benefit suspension because
you did not comply with our request for information in accordance with
Sec. 404.1596(b)(2)(i). We will count the 12-month suspension period
from the start of the first month that you stopped receiving benefits
(see paragraph (d) of this section). This termination is effective with
the start of the 13th month after the suspension began because you
failed to cooperate.
PART 416--SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND
DISABLED
Subpart I--[Amended]
4. The authority citation for subpart I of part 416 continues to
read as follows:
Authority: Sections 702(a)(5), 1611, 1614, 1619, 1631(a), (c),
and (d)(1), and 1633 of the Social Security Act (42 U.S.C.
902(a)(5), 1382, 1382c, 1382h, 1383(a), (c), and (d)(1), and
1383(b); secs. 4(c) and (5), 6(c)-(e), 14(a), and 15, Pub. L. 98-
460, 98 Stat. 1794, 1801, 1802, and 1808 (42 U.S.C. 421 note, 1382h
note).
5. Section 416.992 is added to read as follows:
Sec. 416.992 What happens if you fail to comply with our request for
information.
We will suspend your payments before we make a determination
regarding your continued eligibility for disability payments if you
fail to comply with our request for information for your continuing
disability review or age-18 redetermination. The suspension is
effective with the month in which it is determined in accordance with
Sec. 416.1322 that your eligibility for disability payments has ended
due to your failure to comply with our request for necessary
information. When we have received the information, we will continue
with the CDR or age-18 redetermination process, and reinstate your
payments for any previous month for which they are otherwise payable.
We will terminate your eligibility for payments following 12
consecutive months of payment suspension as discussed in Sec.
416.1335.
[FR Doc. 05-23615 Filed 12-2-05; 8:45 am]
BILLING CODE 4191-02-P