I

103D CONGRESS

2D SESSION H. R. 3814

To amend title II of the Social Security Act to institute certain reforms

relating to the provision of disability insurance benefits based on substance abuse and relating to representative payees, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

FEBRUARY 8, 1994

Mr. GEKAS (for himself, Mr. THOMAS of California, and Mr. ROTH) introduced the following bill; which was referred to the Committee on Ways

and Means

A BILL

To amend title II of the Social Security Act to institute

certain reforms relating to the provision of disability

insurance benefits based on substance abuse and relating

to representative payees, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Disability Insurance

5 Reform Act of 1994’’.
2

•HR 3814 IH

1 SEC. 2. REFORM OF MONTHLY INSURANCE BENEFITS

2 BASED ON DISABILITY INVOLVING SUB3 STANCE ABUSE.

4 (a) IN GENERAL.—Section 225 of the Social Security

5 Act (42 U.S.C. 425) is amended—

6 (1) by striking the heading and inserting the

7 following:

8 ‘‘ADDITIONAL RULES RELATING TO BENEFITS BASED ON

9 DISABILITY

10 ‘‘Suspension of Benefits’’;

11 (2) by inserting before subsection (b) the fol12 lowing new heading:

13 ‘‘Continued Payments During Rehabilitation Program’’;

14 and

15 (3) by adding at the end the following new sub16 section:

17 ‘‘Nonpayment of Benefits by Reason of Substance Abuse

18 ‘‘(c)(1)(A) Notwithstanding any other provision of

19 this title, no benefit based on disability under this title

20 shall be paid to any individual for any month during any

21 period of consecutive months beginning with a month in

22 which such individual is medically determined to be a drug

23 addict or an alcoholic and ending with a month as of the

24 end of which—

25 ‘‘(i) the person, through an outpatient rehabili26 tation program, has subsequently undergone treat-
3

•HR 3814 IH

1 ment appropriate for such condition for 3 months at

2 an institution or facility approved by the Secretary

3 for purposes of this subsection, and has complied

4 with the terms, conditions, and requirements of such

5 treatment and with the requirements imposed under

6 paragraph (4); and

7 ‘‘(ii) the Secretary determines that—

8 ‘‘(I) the person has made progress towards

9 recovery, or has recovered; or

10 ‘‘(II) if the person has not made progress

11 towards recovery, the person meets such re12 quirements established in regulations as the

13 Secretary deems appropriate to effectuate the

14 purposes of this title.

15 ‘‘(B) In any case in which an individual’s disability

16 is based in whole or in part on a medical determination

17 that the individual is a drug addict or alcoholic, such indi18 vidual’s benefits based on disability under this title which

19 are otherwise payable for any month preceding the month

20 in which application for such benefits is made (pursuant

21 to section 202(j)(1) or the last sentence of section 223(b))

22 shall be payable only pursuant to a certification of such

23 payment to a representative payee of such individual pur24 suant to section 205(j).
4

•HR 3814 IH

1 ‘‘(2) If, after the 3-month treatment period referred

2 to in paragraph (1)(A), the Secretary determines that the

3 person has not recovered from the condition treated, then,

4 as a condition of receiving benefits based on disability

5 under this title for any month after such period, the per6 son must continue to comply with the terms, conditions,

7 and requirements of such treatment and with the require8 ments imposed under paragraph (4), until the month in

9 which the Secretary determines that the person has recov10 ered from such condition.

11 ‘‘(3)(A) Notwithstanding any other provision of this

12 title, in the case of a person who fails to continue treat13 ment as required by paragraph (2), no benefit based on

14 disability shall be paid under this title for any month end15 ing after such failure and before the person has completed

16 2 weeks of such treatment.

17 ‘‘(B) In the case of a person to whom a benefit based

18 on disability under this title becomes payable for any

19 month after a month for which such benefit was not pay20 able under subparagraph (A), and who thereafter fails to

21 continue treatment as required by paragraph (2), no bene22 fit based on disability shall be paid under this title for

23 any month ending after such failure and before the person

24 has completed 2 months of such treatment.
5

•HR 3814 IH

1 ‘‘(C) In the case of a person to whom a benefit based

2 on disability under this title becomes payable for any

3 month after a month for which such benefit was not pay4 able under subparagraph (B), and who thereafter fails to

5 continue treatment as required by paragraph (2), no bene6 fit based on disability shall be paid under this title for

7 any month ending after such failure.

8 ‘‘(4) For purposes of this subsection, the term ‘bene9 fit based on disability’ of an individual means a disability

10 insurance benefit of such individual under section 223 or

11 a child’s, widow’s, or widower’s insurance benefit of such

12 individual under section 202 based on the disability of

13 such individual.

14 ‘‘(5) Monthly insurance benefits under this title

15 which would be payable to any individual (other than the

16 disabled individual to whom benefits are not payable by

17 reason of this subsection) on the basis of the wages and

18 self-employment income of such a disabled individual but

19 for the provisions of paragraph (1), shall be payable as

20 though such disabled individual were receiving such bene21 fits which are not payable under this subsection.

22 ‘‘(6) The Secretary shall provide for the monitoring

23 and testing of all individuals who are receiving benefits

24 under this title and who as a condition of such benefits

25 are required to be undergoing treatment and complying
6

•HR 3814 IH

1 with the terms, conditions, and requirements thereof as

2 described in the preceding provisions of this subsection,

3 in order to assure such compliance and to determine the

4 extent to which the imposition of such requirements is con5 tributing to the achievement of the purposes of this title.

6 The Secretary may retain jurisdiction in the case of a

7 hearing before the Secretary under this title to the extent

8 the Secretary determines necessary to carry out the pre9 ceding sentence. The Secretary shall annually submit to

10 the Congress a full and complete report on the Secretary’s

11 activities under this paragraph.

12 ‘‘(7) The Secretary, in consultation with drug and al13 cohol treatment professionals, shall develop standards for

14 drug and alcohol treatment programs, and in consultation

15 with States, shall develop guidelines to be used to review

16 and evaluate the progress of participants in such pro17 grams.’’.

18 (b) PRESERVATION OF MEDICARE BENEFITS.—Sec19 tion 226 of such title (42 U.S.C. 426) is amended by add20 ing at the end the following:

21 ‘‘(i) For purposes of this section, each person to

22 whom a benefit for any month is not payable by reason

23 of section 225(c) shall be treated as entitled to such bene24 fit for such month if such person would be entitled to such

25 benefit for such month in the absence of such section.’’.
7

•HR 3814 IH

1 (c) EFFECTIVE DATE.—The amendments made by

2 this section shall apply to benefits payable for months be3 ginning 90 or more days after the date of the enactment

4 of this Act.

5 SEC. 3. RESTRICTION OF FUTURE REPRESENTATIVE PAY6 EES TO GOVERNMENT AGENCIES, STATE7 LICENCED OR CERTIFIED FACILITIES, OR

8 STATE-BONDED OR LICENSED COMMUNITY9 BASED NONPROFIT SOCIAL SERVICE AGEN10 CIES.

11 (a) RESTRICTION TO QUALIFIED ORGANIZATIONS.—

12 Section 205(j) of the Social Security Act (42 U.S.C.

13 405(j)) is amended—

14 (1) in paragraph (1), by striking ‘‘another indi15 vidual, or an organization,’’ and inserting ‘‘a quali16 fied organization’’;

17 (2) in paragraph (2)(A)(i), by striking ‘‘the per18 son’’ and inserting ‘‘the qualified organization’’, and

19 by striking ‘‘such person’’ and inserting ‘‘representa20 tives of such qualified organization’’;

21 (3) in paragraph (2)(B)(i), by striking ‘‘person’’

22 each place it appears in subclause (I) and inserting

23 ‘‘qualified organization’’, by striking ‘‘person’s social

24 security account number (or employer identification

25 number)’’ in subclause (II) and inserting ‘‘qualified
8

•HR 3814 IH

1 organization’s employer identification number’’, by

2 striking ‘‘such person’’ in subclause (III) and insert3 ing ‘‘such qualified organization’’, and by striking

4 ‘‘such person’’ each place it appears in subclause

5 (IV) and inserting ‘‘such qualified organization’’;

6 and

7 (4) by striking paragraph (2)(B)(ii), by redesig8 nating paragraph (2)(B)(i) (as amended by para9 graph (3)) as paragraph (2)(B), and by redesignat10 ing subclauses (I), (II), (III), and (IV) of paragraph

11 (2)(B) (as redesignated) as clauses (i), (ii), (iii), and

12 (iv), respectively.

13 (b) QUALIFIED ORGANIZATION DEFINED.—

14 (1) IN GENERAL.—Section 205(j)(2)(C)(i) of

15 such Act (42 U.S.C. 405(j)(2)(C)(i)) is amended by

16 striking ‘‘Benefits of an individual may not be cer17 tified for payment to any other person pursuant to

18 this subsection if—’’ and inserting ‘‘For purposes of

19 this subsection, the term ‘qualified organization’

20 means an agency or instrumentality of a State or a

21 political subdivision of a State, a nonprofit facility

22 that is licensed or certified as a care facility under

23 the law of a State or a political subdivision of a

24 State, and, in connection with services provided as

25 a representative payee under this subsection in any
9

•HR 3814 IH

1 State, a community-based nonprofit social service

2 agency which is bonded or licensed in such State.

3 Except as otherwise provided in this subsection, such

4 term does not include any person if—’’.

5 (2) CONFORMING AMENDMENTS.—Section

6 205(j)(2)(C) of such Act is further amended—

7 (A) by striking ‘‘subparagraph (B)(i)(III)’’

8 in clause (i)(I) and inserting ‘‘subparagraph

9 (B)(iii)’’, and by striking ‘‘subparagraph

10 (B)(i)(IV)’’ in clause (i)(II) and inserting ‘‘sub11 paragraph (B)(iv)’’;

12 (B) in clause (iii), by striking subclauses

13 (I) and (IV), by redesignating subclauses (II),

14 (III), and (V) as subclauses (I), (II), and (III),

15 respectively, and by striking ‘‘an individual’’ in

16 subclause (III) (as redesignated) and inserting

17 ‘‘a person’’; and

18 (C) in clause (iv), by striking ‘‘individual’’

19 each place it appears and inserting ‘‘person’’.

20 (c) AUTHORIZATION FOR FEES.—Section 205(j)(4)

21 of such Act (42 U.S.C. 405(j)(4)) is amended—

22 (1) by striking subparagraph (A) and inserting

23 the following:

24 ‘‘(4)(A) A qualified organization may collect from an

25 individual a monthly fee for expenses (including overhead)
10

•HR 3814 IH

1 incurred by such organization in providing services per2 formed as such individual’s representative payee pursuant

3 to this subsection if such fee does not exceed 10 percent

4 of the monthly benefit involved. Any agreement providing

5 for a fee in excess of the amount permitted under this

6 subparagraph shall be void and shall be treated as misuse

7 by such organization of such individual’s benefits.’’;

8 (2) by striking subparagraph (B);

9 (3) by redesignating subparagraph (C) as sub10 paragraph (B) and, in subparagraph (B) (as so re11 designated), by striking ‘‘qualified organization’’ and

12 inserting ‘‘person’’; and

13 (4) by striking subparagraph (D).

14 (d) EFFECTIVE DATE.—The amendments made by

15 this section shall apply with respect to certifications of

16 payments to representative payees made on or after the

17 date of the enactment of this Act. Section 205(j) of the

18 Social Security Act (42 U.S.C. 405(j)) as in effect imme19 diately before the date of the enactment of this Act shall

20 continue to apply, in the case of any person who is then

21 a representative payee under such section with respect to

22 benefits for which certification of payment to such person

23 under such section is then in effect, until such certification

24 ceases to be effective under such section as then in effect.

Æ