II

104TH CONGRESS

1ST SESSION S. 798

To amend title XVI of the Social Security Act to improve the provision

of supplemental security income benefits, and for other purposes.

IN THE SENATE OF THE UNITED STATES

MAY 11 (legislative day, MAY 1), 1995

Mr. CONRAD (for himself, Mr. CHAFEE, Mr. JEFFORDS, Mr. BRADLEY, and

Mr. ROCKEFELLER) introduced the following bill; which was read twice

and referred to the Committee on Finance

A BILL

To amend title XVI of the Social Security Act to improve

the provision of supplemental security income benefits,

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 ‘‘Children’s SSI Eligi5 bility Reform Act’’.

6 SEC. 2. PURPOSE.

7 It is the purpose of this Act to ensure that supple8 mental security income benefits—
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1 (1) provide basic necessities to maintain a child

2 with a disability at home or in another appropriate

3 and cost effective setting;

4 (2) cover the additional costs of caring for and

5 raising such a child; and

6 (3) enhance the child’s opportunity to develop

7 into an independent adult.

8 SEC. 3. SUPPLEMENTAL SECURITY INCOME BENEFITS FOR

9 DISABLED CHILDREN.

10 (a) MODIFICATION OF BENEFIT ELIGIBILITY.—

11 (1) IN GENERAL.—Section 1614(a)(3)(A) of the

12 Social Security Act (42 U.S.C. 1382c(a)(3)(A)) is

13 amended—

14 (A) by inserting ‘‘(i)’’ after ‘‘(3)(A)’’;

15 (B) by inserting ‘‘(other than an individual

16 under the age of 18)’’ before ‘‘shall be consid17 ered’’;

18 (C) by striking ‘‘he’’ and inserting ‘‘the in19 dividual’’;

20 (D) by striking ‘‘(or, in the case of an indi21 vidual under the age of 18, if he suffers from

22 any medically determinable physical or mental

23 impairment of comparable severity)’’; and

24 (E) by adding after and below the end the

25 following:
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1 ‘‘(ii)(I) An individual under the age of 18 shall be

2 considered to be disabled for purposes of this title for a

3 month if the individual has any medically determinable

4 physical or mental impairment of comparable severity to

5 an impairment described in clause (i).

6 ‘‘(II) For purposes of subclause (I), an impairment

7 is of comparable severity if such impairment is severe and

8 persistent and substantially limits the individual’s ability

9 to develop or function.

10 (2) EFFECTIVE DATE.—The amendments made

11 by paragraph (1) shall apply to applicants for bene12 fits for months beginning 6 months after the date of

13 the enactment of this Act, without regard to whether

14 regulations have been issued to implement such

15 amendments.

16 (b) ADDITIONAL MODIFICATIONS.—

17 (1) MODIFICATION TO MEDICAL CRITERIA FOR

18 EVALUATION OF MENTAL AND EMOTIONAL DIS19 ORDERS.—The Commissioner of Social Security

20 shall modify paragraph (2) of section 112.02B.2.c.

21 of appendix 1 to subpart P of part 404 of title 20,

22 Code of Federal Regulations, to eliminate references

23 to maladaptive behaviors and to require instead evi24 dence of a persistent pattern of behavior destructive

25 to self or others requiring protective intervention.
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1 (2) MODIFICATIONS TO INDIVIDUALIZED FUNC2 TIONAL ASSESSMENT.—

3 (A) INCREASE IN SEVERITY.—The Com4 missioner of Social Security shall modify the

5 level of severity required to establish com6 parable severity under section 416.924e of title

7 20, Code of Federal Regulations, to either—

8 (i) a marked level of impairment in 2

9 or more domains; or

10 (ii) a marked level of impairment in

11 at least 1 domain and a moderate level of

12 impairment in at least 1 additional do13 main.

14 (B) DOMAINS OF DEVELOPMENT OR FUNC15 TIONING.—The Commissioner of Social Security

16 shall modify the individualized functional as17 sessment for children set forth in section

18 416.924d of title 20, Code of Federal Regula19 tions, to include the following domains of devel20 opment or functioning, to ensure the domains

21 do not overlap from a clinical perspective, and

22 to compare the child’s abilities in each of these

23 domains with those of children of similar age

24 who do not have a disability:
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1 (i) Cognition (the ability to under2 stand and reason and to learn required

3 skills).

4 (ii) Communication (the ability to re5 ceive and convey information; the ability to

6 produce speech audibly and intelligibly).

7 (iii) Motor abilities (the ability to

8 move and coordinate the body and extrem9 ities in gross and fine motions).

10 (iv) Ability to care for oneself (the

11 ability to perform normal childhood activi12 ties in the home, school, or community

13 with adult assistance or supervision appro14 priate to one’s age and to control behaviors

15 that could harm oneself or others).

16 (v) Ability to engage in interpersonal

17 relations (the ability to develop and main18 tain positive and productive interpersonal

19 relationships so as to function within the

20 family, peer groups, and community).

21 (vi) Responsiveness to stimuli (the

22 ability of children from birth to the attain23 ment of age 1 to react appropriately to vis24 ual, auditory, or tactile stimulation).
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1 (vii) Ability to concentrate, persist,

2 maintain pace, and have physical stamina

3 to complete essential tasks in the home,

4 school, or community (in children from age

5 3 to the attainment of age 18).

6 (3) EFFECTIVE DATE.—

7 (A) IN GENERAL.—The modifications re8 quired by this subsection shall apply to appli9 cants for benefits for months beginning 6

10 months after the date of the enactment of this

11 Act, without regard to whether regulations have

12 been issued to implement such amendments.

13 (B) CONTINUING REVIEW.—The Commis14 sioner of Social Security shall review and report

15 to the Congress not later than 5 months after

16 the date of the enactment of this Act whether

17 the required modifications described in this sub18 section should be further modified.

19 (c) ADDITIONAL REVIEW AND REVISION OF INDIVID20 UALIZED FUNCTIONAL ASSESSMENT.—

21 (1) IN GENERAL.—The Commissioner of Social

22 Security shall review and revise the individual func23 tional assessment for children set forth in sections

24 416.924d and 416.924e of title 20, Code of Federal
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1 Regulations, to ensure that such assessment is ap2 plied to children who—

3 (A) have multiple impairments, none of

4 which meet or equal the Listings of Impair5 ments set forth in appendix 1 of subpart P of

6 part 404 of such title 20, but which in combina7 tion result in the child being disabled under sec8 tion 1614(a)(3)(A)(ii) of the Social Security

9 Act, as added by subsection (a);

10 (B) are too young, or for other reasons,

11 cannot be fully evaluated;

12 (C) have physical or mental impairments

13 or illnesses which are not explicitly included in

14 such Listings; and

15 (D) have conditions which do not meet or

16 equal the severity of any such Listing, but meet

17 the functional test of severity under such sec18 tion 1614(a)(3)(A)(ii).

19 (2) TESTING.—The Commissioner of Social Se20 curity shall ensure that pursuant to the revised indi21 vidual functional assessment for children under

22 paragraph (1)—

23 (A) valid and reliable tests are used, if

24 available, which provide qualitative and quan25 tifiable measures of childhood functioning, or
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1 (B) criteria of childhood functioning are

2 developed which are equivalent to the findings

3 of a standardized test.

4 (3) APPLICABILITY.—The Commissioner of So5 cial Security shall issue final regulations relating to

6 the individual functional assessment for children

7 under paragraph (1) not later than 6 months after

8 the date of the enactment of this Act and such regu9 lations shall apply to applicants for benefits for

10 months beginning 6 months after such date.

11 (d) APPLICATION TO CURRENT BENEFICIARIES.—

12 Notwithstanding any other provision of law, if the Com13 missioner of Social Security determines that the eligibility

14 an individual who is a recipient of supplemental security

15 income benefits under title XVI of the Social Security Act

16 for the month in which the date of the enactment of this

17 Act occurs is affected by the amendments made by, and

18 provisions of, this section, the Commissioner shall, not

19 later than 1 year after such date, provide for a continuing

20 disability review with respect to such individual in accord21 ance with the provisions of such title.

22 SEC. 4. BETTER TARGETING AND USE OF BENEFITS.

23 (a) PROHIBITION ON COACHING OF CHILDREN TO

24 OBTAIN BENEFITS.—
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1 (1) IN GENERAL.—Section 1632 of the Social

2 Security Act (42 U.S.C. 1383a) is amended by add3 ing at the end the following new subsection:

4 ‘‘(c) In any case in which the court determines that

5 a violation described in paragraph (1), (2), or (3) of sub6 section (a) includes—

7 ‘‘(1) any knowing and willful coaching of a

8 child by a parent or guardian to feign an impair9 ment for the purposes of gaining eligibility under

10 this title, the court, in addition to any penalty im11 posed under subsection (a), may require full restitu12 tion of the benefit such child has received under this

13 title, plus up to $100 for each month the child re14 ceived such benefit; and

15 ‘‘(2) any attorney or legal representative, inter16 preter, or social service worker knowingly and will17 fully causing a parent or guardian to so coach a

18 child, subsection (a) shall be applied by substituting

19 ‘$5000, plus $500 for each child involved’ for

20 ‘$1,000’.’’.

21 (2) EFFECTIVE DATE.—The amendment made

22 by paragraph (1) shall apply to actions occurring

23 after the date of the enactment of this Act.

24 (b) TIGHTENING OF REPRESENTATIVE PAYEE RE25 QUIREMENTS.—
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1 (1) CLARIFICATION OF ROLE.—Section

2 1631(a)(2)(B)(ii) of the Social Security Act (42

3 U.S.C. 1383(a)(2)(B)(ii)) is amended by striking

4 ‘‘and’’ at the end of subclause (II), by striking the

5 period at the end of subclause (IV) and inserting ‘‘;

6 and’’, and by adding after subclause (IV) the follow7 ing new subclause:

8 ‘‘(V) advise such person through the notice of

9 award of benefits, and at such other times as the

10 Commissioner of Social Security deems appropriate,

11 of specific examples of appropriate expenditures of

12 benefits under this title and the proper role of a rep13 resentative payee.’’.

14 (2) DOCUMENTATION OF EXPENDITURES RE15 QUIRED.—

16 (A) IN GENERAL.—Subparagraph (C)(i) of

17 section 1631(a)(2) of such Act (42 U.S.C.

18 1383(a)(2)) is amended to read as follows:

19 ‘‘(C)(i) In any case where payment is made to a rep20 resentative payee of an individual or spouse, the Commis21 sioner of Social Security shall—

22 ‘‘(I) require such representative payee to docu23 ment expenditures and keep contemporaneous

24 records of transactions made using such payment;
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1 ‘‘(II) establish a system of accountability mon2 itoring under which such representative payee shall

3 report at least annually with respect to the use of

4 such payment; and

5 ‘‘(III) implement statistically valid procedures

6 for reviewing each such report in order to identify

7 instances in which such representative payee is not

8 properly using such payment.’’.

9 (B) CONFORMING AMENDMENT WITH RE10 SPECT TO PARENT PAYEES.—Clause (ii) of sec11 tion 1631(a)(2)(C) of such Act (42 U.S.C.

12 1383(a)(2)(C)) is amended by striking ‘‘Clause

13 (i)’’ and inserting ‘‘Subclauses (II) and (III) of

14 clause (i)’’.

15 (3) EFFECTIVE DATE.—The amendments made

16 by this subsection shall apply to benefits paid after

17 the date of the enactment of this Act.

18 (c) GRADUATED BENEFITS FOR ADDITIONAL CHIL19 DREN.—

20 (1) IN GENERAL.—Section 1611(b) of the So21 cial Security Act (42 U.S.C. 1382(b)) is amended by

22 adding at the end the following new paragraph:

23 ‘‘(3) In the case of a family (other than a foster or

24 group home) with more than 1 child eligible for a benefit

25 under this title, the benefit under this title for each addi-
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1 tional child (other than an adopted child with special

2 needs (within the meaning of paragraphs (1) and (2) of

3 section 473(c)) shall be determined under the following

4 table:

‘‘If the child is the: The benefit is:

2nd child ........................................ 85 percent of the otherwise determined benefit

3rd child ........................................ 65 percent of such benefit

4th child ........................................ 45 percent of such benefit

5th child ........................................ 35 percent of such benefit

6th child ........................................ 25 percent of such benefit

7th child or more ........................... $50 for each child.’’.

5 (2) EFFECTIVE DATE.—The amendment made

6 by paragraph (1) shall apply to determinations made

7 after the date of the enactment of this Act.

8 (d) CONTINUING DISABILITY REVIEWS.—

9 (1) CONTINUING DISABILITY REVIEWS FOR

10 CERTAIN CHILDREN.—Section 1614(a)(3)(G) of the

11 Social Security Act (42 U.S.C. 1382c(a)(3)(G)) is

12 amended—

13 (A) by inserting ‘‘(i)’’ after ‘‘(G)’’; and

14 (B) by adding at the end the following:

15 ‘‘(ii)(I) Not less frequently than once every 7 years,

16 the Commissioner of Social Security shall redetermine in

17 accordance with paragraph (4) the eligibility for benefits

18 under this title of each child who is eligible for benefits

19 by reason of disability with respect to which medical im20 provement is not expected.
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1 ‘‘(II) If a child has a disability with respect to which

2 medical improvement is possible, subclause (I) shall be ap3 plied by substituting ‘3 years’ for ‘7 years’.

4 ‘‘(III) If a child has a disability with respect to which

5 medical improvement is expected subclause (I) shall be ap6 plied by substituting ‘year’ for ‘7 years’.

7 ‘‘(IV) A parent or guardian of a recipient whose case

8 is reviewed under this clause shall present, at the time

9 of review, evidence demonstrating that the recipient is,

10 and has been, receiving treatment, to the extent consid11 ered medically necessary and available, of the condition

12 which was the basis for providing benefits under this

13 title.’’.

14 (2) DISABILITY REVIEW REQUIRED FOR LOW

15 BIRTH WEIGHT BABIES WHO HAVE RECEIVED SSI

16 BENEFITS FOR 12 MONTHS.—Section 1614(a)(3)(G)

17 of such Act (42 U.S.C. 1382c(a)(3)(G)), as amended

18 by paragraph (1) of this subsection, is amended by

19 adding at the end the following:

20 ‘‘(iii)(I) The Commissioner of Social Security shall

21 redetermine the eligibility for benefits under this title by

22 reason of disability of a child whose low birth weight is

23 a contributing factor material to the Commissioner’s de24 termination that the child is disabled.
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1 ‘‘(II) The redetermination required by subclause (I)

2 shall be conducted once the child has received such bene3 fits for 12 months.

4 ‘‘(III) A redetermination under subclause (I) shall be

5 considered a substitute for a review required under any

6 other provision of this subparagraph.

7 ‘‘(IV) A parent or guardian of a recipient whose case

8 is reviewed under this clause shall present, at the time

9 of review, evidence demonstrating that the recipient is,

10 and has been, receiving treatment, to the extent consid11 ered medically necessary and available, of the condition

12 which was the basis for providing benefits under this

13 title.’’.

14 (3) DISABILITY REVIEW REQUIRED FOR SSI RE15 CIPIENTS WHO ARE 18 YEARS OF AGE.—

16 (A) IN GENERAL.—Section 1614(a)(3)(G)

17 of such Act (42 U.S.C. 1382c(a)(3)(G)), as

18 amended by paragraphs (1) and (2) of this sub19 section, is amended by adding at the end the

20 following:

21 ‘‘(iv)(I) The Commissioner of Social Security shall re22 determine the eligibility of a qualified individual for sup23 plemental security income benefits under this title by rea24 son of disability, by applying the criteria used in determin-
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1 ing eligibility for such benefits of applicants who have at2 tained 18 years of age.

3 ‘‘(II) The redetermination required by subclause (I)

4 with respect to a qualified individual shall be conducted

5 during the 1-year period that begins on the date the quali6 fied individual attains 18 years of age.

7 ‘‘(III) As used in this clause, the term ‘qualified indi8 vidual’ means an individual who attains 18 years of age

9 and for whom, for the month preceding the month in

10 which the individual attained such age, a determination

11 was in effect that the individual is eligible for benefits

12 under this title by reason of disability.

13 ‘‘(IV) A redetermination under subclause (I) of this

14 clause shall be considered a substitute for a review re15 quired under any other provision of this subparagraph.’’.

16 (B) REPORT TO THE CONGRESS.—Not

17 later than October 1, 1998, the Commissioner

18 of Social Security shall submit to the Commit19 tee on Ways and Means of the House of Rep20 resentatives and the Committee on Finance of

21 the Senate a report on the activities conducted

22 under section 1614(a)(3)(G)(iv) of the Social

23 Security Act.

24 (C) CONFORMING REPEAL.—Section 207

25 of the Social Security Independence and Pro-
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1 gram Improvements Act of 1994 (42 U.S.C.

2 1382 note; 108 Stat. 1516) is hereby repealed.

3 (4) REVOLVING FUND.—The Secretary of the

4 Treasury shall pay into a revolving fund for each fis5 cal year an amount equal to 50 percent of the sav6 ings resulting from the amendments made by sub7 section (c) with respect to such fiscal year. Such

8 fund shall be available to the Commissioner of Social

9 Security, without regard to appropriation Acts and

10 without fiscal year limitation, to supplement funds

11 otherwise made available for disability reviews re12 quired by the amendments made by this subsection.

13 (5) EFFECTIVE DATE.—The amendments made

14 by this subsection shall apply to benefits for months

15 beginning after the date of the enactment of this

16 Act.

17 SEC. 5. ENCOURAGING MOVEMENT TOWARD INDEPEND18 ENCE.

19 (a) DEDICATED SAVINGS ACCOUNTS.—

20 (1) IN GENERAL.—Section 1631(a)(2)(B) of the

21 Social Security Act (42 U.S.C. 1383(a)(2)(B)) is

22 amended by adding at the end the following new

23 clause:

24 ‘‘(xiv) Notwithstanding clause (x), the Commissioner

25 of Social Security may, at the request of the representative
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1 payee, pay any lump sum payment for the benefit of a

2 child into a dedicated savings account that could only be

3 used to purchase for such child—

4 ‘‘(I) education and job skills training;

5 ‘‘(II) special equipment or housing modifica6 tions or both specifically related to, and required by

7 the nature of, the child’s disability; and

8 ‘‘(III) appropriate therapy and rehabilitation.’’.

9 (2) DISREGARD OF TRUST FUNDS.—Section

10 1613(a) of such Act (42 U.S.C. 1382b) is amend11 ed—

12 (A) by striking ‘‘and’’ at the end of para13 graph (9),

14 (B) by striking the period at the end of

15 paragraph (10) the first place it appears and

16 inserting a semicolon,

17 (C) by redesignating paragraph (10) the

18 second place it appears as paragraph (11) and

19 striking the period at the end of such para20 graph and inserting ‘‘; and’’, and

21 (D) by inserting after paragraph (11), as

22 so redesignated, the following new paragraph:

23 ‘‘(12) all amounts deposited in, or interest cred24 ited to, a dedicated savings account described in sec25 tion 1631(a)(2)(B)(xiv).’’.
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1 (3) EFFECTIVE DATE.—The amendments made

2 by this subsection shall apply to payments made

3 after the date of the enactment of this Act.

4 (b) INFORMATION AND REFERRAL SYSTEM.—Section

5 1631 of the Social Security Act (42 U.S.C. 1383) is

6 amended by redesignating subsection (n) (relating to no7 tice requirements) as subsection (o) and by adding at the

8 end the following new subsection:

9 ‘‘INFORMATION AND REFERRAL SYSTEM FOR CHILDREN

10 ‘‘(p) The Commissioner of Social Security shall estab11 lish or identify a system of information and referral for

12 treatment and services available to children receiving ben13 efits under this title under State and Federal programs.’’.

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