5494 Federal Register / Vol. 66, No. 13 / Friday, January 19, 2001 / Proposed Rules

(d), respectively, and a new paragraph

(b) is added to read as follows:

§ 575.307 Reduction or termination of

retention allowance.

* * * * *

(b) An agency must terminate a

retention allowance paid to an

employee (or group of employees) under

§ 575.304(b)(3) (for work on a project

critical to the mission of the agency) not

later than 1 year after the initial

allowance payment. On a case-by-case

basis, the head of an agency may ask

OPM to extend this time limit.

* * * * *

[FR Doc. 01–1486 Filed 1–18–01; 8:45 am]

BILLING CODE 6325–01–P

SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404, 416, and 422

[Regulations Nos. 4 and 16]

RIN 0960–AF44

New Disability Claims Process

AGENCY: Social Security Administration

(SSA).

ACTION: Notice of proposed rulemaking.

SUMMARY: We are proposing to revise

our regulations that pertain to the

processing of initial claims for disability

benefits under title II (Social Security

Disability Insurance) and title XVI

(Supplemental Security Income) of the

Social Security Act (the Act). The

proposed rules would incorporate

modifications to our administrative

review process and disability

determination procedures based on

testing that we are conducting. The

changes, which would apply to initial

applications for disability benefits,

would:

• First, permit disability examiners in

our State agencies the flexibility to

decide whether input from a medical or

psychological consultant is needed to

make a disability determination, so that

our State agencies may use the expertise

of the disability examiners and medical

and psychological consultants more

effectively;

• Second, provide claimants with an

opportunity for an informal disability

conference with the adjudicators of their

claims at the initial level in cases in

which it appears that the evidence does

not support a fully favorable

determination; and

• Third, eliminate the reconsideration

step of the administrative review

process.

We plan to phase in these changes

over a period of 1 year until they apply

in every State.

DATES: To be sure that your comments

are considered, we must receive them

no later than March 20, 2001.

ADDRESSES: Comments should be

submitted to the Commissioner of Social

Security, P.O. Box 17703, Baltimore,

Maryland 21235–7703; sent by telefax to

(410) 966–2830; sent by e-mail to

regulations@ssa.gov; or delivered to the

Office of Process and Innovation

Management, Social Security

Administration, L2109 West Low Rise

Building, 6401 Security Boulevard,

Baltimore, MD 21235–6401, between

8:00 a.m. and 4:30 p.m. on regular

business days. During these same hours,

you may inspect the comments that we

receive by making arrangements with

the contact person shown below.

FOR FURTHER INFORMATION CONTACT:

Georgia E. Myers, Regulations Officer,

Office of Process and Innovation

Management, L2109 West Low Rise

Building, 6401 Security Boulevard,

Baltimore, MD 21235–6401, (410) 965–

3632 or TTY (410) 966–5609, for

information about this notice. For

information on eligibility or claiming

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

www.ssa.gov.

SUPPLEMENTARY INFORMATION:

In Brief, What Are We Proposing To

Do?

We are proposing to change our rules

in three ways:

1. We are proposing to change our

rules for how State agencies make

disability determinations for us. The

change would allow State agency

adjudicators, called ‘‘disability

examiners,’’ to decide whether input

from a medical or psychological

consultant is needed to make a

disability determination. The medical or

psychological consultant would not be

responsible for the determination; i.e.,

would not be an adjudicator of the

claim.

2. We are proposing to add rules

providing that disability examiners will

offer claimants an opportunity for an

informal conference whenever it

appears that the evidence does not

support a fully favorable determination.

3. We are proposing to eliminate the

reconsideration step of our

administrative review process.

On August 30, 1999, we published a

notice in the Federal Register

announcing a ‘‘prototype’’ involving

these three major modifications to our

disability determination process for

initial applications under titles II and

XVI of the Act. (See 64 FR 47218.) In the

notice, we stated that, before proceeding

to national implementation, we

expected that the prototype would

provide a body of information about the

impact of these modifications on agency

operations, notice and other procedures,

and the quality and timeliness of our

determinations and decisions. Although

the prototype is continuing and we

continue to gather information and gain

operational experience, we believe that

we now have sufficient information to

propose changes to our regulations.

Public comments received on these

proposed changes will assist us in finetuning these changes.

Because we now know that

implementation of the process in each

State agency requires support during the

period of transition, we are considering

a plan by which we would implement

the process in groups of State agencies

until all States use the new process. Our

projected completion date will be in

2003. We explain our current plan in

more detail later in this preamble, and

invite public comment.

What Is the Current Process?

Sections 404.1503 and 416.903 of our

regulations provide that State agencies

make disability and blindness

determinations, following rules that we

provide. Sections 404.1615(c) and

416.1015(c) of our regulations provide

with respect to initial disability claims

that, in most cases, these disability

determinations must be made by a State

agency medical or psychological

consultant and a State agency disability

examiner, a lay adjudicator with

expertise in evaluating disability. The

medical or psychological consultant and

the disability examiner work together as

a team and are jointly responsible for

the determination. Under current rules,

a disability examiner alone may make a

determination only in the very unusual

circumstance in which:

• There is no medical evidence to be

evaluated (i.e., no medical evidence

exists or we are unable, despite making

every reasonable effort, to obtain any

medical evidence that may exist); and

• The individual fails or refuses,

without good reason, to attend a

consultative examination.

State agency determinations in initial

claims are generally based on review of

the written information in a claimant’s

case record. Although our procedures

permit disability examiners and medical

and psychological consultants to speak

to claimants to obtain more information,

there are no formal requirements for

such contact. Also, we have no

procedures requiring a State agency

adjudicator to explain and discuss our

disability standards with claimants or to

Federal Register / Vol. 66, No. 13 / Friday, January 19, 2001 / Proposed Rules 5495

explain the determination, apart from

the information that we provide in the

written notice of determination; i.e.,

after we have already made the

determination.

Sections 205(b)(1) and 1631(c)(1)(A)

of the Act provide that an individual

who disagrees with our initial

determination has a right to a hearing.

However, §§ 404.900 and 404.907 (for

title II) and 416.1400 and 416.1407 (for

title XVI) of our regulations have long

provided that, when an individual is

dissatisfied with an initial

determination, he or she may appeal the

determination first to the

‘‘reconsideration’’ level of our

administrative review process. In initial

disability claims, the reconsideration

determination consists of a case review

of evidence from the initial claim as

well as evidence obtained subsequently.

Only after the reconsideration

determination may individuals who are

dissatisfied with their determinations

appeal to a hearing before an

administrative law judge.

What Led Us to These Proposed Rules?

For many years, we have been

exploring methods for improving the

disability determination process to

make it more consistent, accurate,

efficient, and timely. For example, for

several years we have engaged in what

we call ‘‘process unification’’ activities

aimed at improving our ability to

achieve similar results in similar cases

at all stages of the administrative review

process. In 1995, we also published

§ § 404.906 and 416.1406, ‘‘Testing

modifications to the disability

determination procedures,’’ which

permitted us to test a number of

variations to our current processes. We

called the various test processes

‘‘models.’’ (See 60 FR 20023, April 24,

1995.)

Among the models that we included

in § § 404.906 and 416.1406 were

revisions to our current process that

would permit a disability examiner in

the State agency to assume sole

authority for making disability

determinations in certain cases, thereby

giving examiners the flexibility to

decide whether to obtain input from a

medical or psychological consultant

when making the disability

determination. One of the models also

included a ‘‘predecision interview’’

with the claimant to ensure that the case

record was complete and that the

claimant understood our disability

standards. In the preamble to the Notice

of Proposed Rulemaking (NPRM) for

these rules, we indicated that in recent

years we had conducted various studies

on how to improve the disability

determination process, and that we had

a number of goals in proposing the

models. We stated that our goals were:

• To provide assistance to the

disability applicant by making the filing

of a disability claim simpler;

• To promote fairness in each

disability determination by ensuring

that each disability applicant is given an

opportunity to provide all of the

necessary information to complete the

claim and is aware of his or her rights

under the program; and

• To ensure that our determination is

equitable. (See 58 FR 54532, 54533,

October 22, 1993.)

In 1994, we included a number of

similar features in our proposal to

redesign the disability claims process

and the subsequent final redesign plan.

(See 59 FR 18188, April 15, 1994, and

59 FR 47887, September 19, 1994.) Both

the redesign proposal and the final plan

were especially critical of:

• The time it takes for us to

adjudicate some disability claims,

• The number of SSA and State

agency employees who may be involved

in processing a claim initially and

throughout the appeals process,

• The lack of interaction between the

claimant and the decisionmaker, and

• The lack of thorough explanations,

in many cases, of the basis for the

disability determinations.

Therefore, the redesign of the

disability process included the

following goals that are important to

this NPRM:

• To ensure that claims that should

be allowed are allowed at the earliest

point in the process;

• To provide more opportunity for

claimant interaction with the

decisionmaker; and

• To reduce the amount of time

required processing a claim to a final

disability determination or decision.

Over the years since 1994, we have

tested various ideas for addressing these

goals and improving the claims process.

For example, in 1997, we integrated

several of the redesign proposals into

what we called the ‘‘Full Process

Model.’’ We tested this model in eight

States and got especially positive results

from several features of the model:

• We allowed disability examiners

the flexibility to decide whether to

obtain medical or psychological

consultant input in making a disability

determination. (This did not apply to

certain cases, described below, in which

the Act requires a medical or

psychological consultant or other health

care professional to participate in

making the determination.) This process

change revised the role of the medical

and psychological consultants to act as

true consultants in these cases, to be

used as needed.

• We provided claimants with an

opportunity for a conference with the

disability examiners who were deciding

their claims when it appeared that the

evidence was not sufficient to support a

fully favorable determination. This gave

claimants an opportunity to provide

additional explanations and evidence,

or sources of evidence. The disability

examiners also explained the Social

Security definition of disability and

why it appeared that the claimants did

not meet that definition or why it did

not appear that the evidence supported

a fully favorable determination.

• Finally, we eliminated the

reconsideration step of the

administrative review process.

Claimants who were dissatisfied with

their initial determinations appealed

directly to the administrative law judge

hearing level.

We found that these actions resulted

in better determinations at the initial

level, with more allowances of claims

that should have been allowed. We

believe that many claims that would

have been allowed only after appeal

under the old process were allowed at

the initial step under the new process.

These claimants were able to receive

benefits months sooner than they

otherwise would have, an important

protection for individuals who are

unable to work. By eliminating the

reconsideration step, claimants who

appealed reached the hearing level an

average of 2 months sooner than

claimants who went through the

reconsideration step and therefore had

an opportunity to receive their hearing

decisions sooner. Also, the quality of

our determinations improved. Reviews

of disability determinations from the

FPM by SSA’s Office of Quality

Assessment indicated that the new

process improved the accuracy of initial

decisions to deny claims from 92.6

percent to 94.8 percent. If implemented

nationally, this would translate to

approximately 34,000 fewer disabled

claimants being erroneously denied

benefits and facing the prospect of a

lengthy appeal.

We believe that these positive results

were due to a number of factors. For

example, we know that removing the

reconsideration step permitted the State

agencies to redirect their resources so

that the individuals who formerly

worked on reconsideration claims could

work on initial claims. This permitted

increased contact with the claimants

and improved documentation of the

disability determinations.

The success of the Full Process Model

provided the impetus for our current

5496 Federal Register / Vol. 66, No. 13 / Friday, January 19, 2001 / Proposed Rules

prototype, which includes the three

most successful elements of the Full

Process Model, the elements we are

proposing in this Notice of Proposed

Rulemaking (NPRM). We have been

operating the prototype in 10 States

since October 1999. The States are:

Alabama, Alaska, California, Colorado,

Louisiana, Michigan, Missouri, New

Hampshire, New York, and

Pennsylvania. In New York at this time,

the prototype applies only to residents

in areas served by the Albany and

Brooklyn branches of the State agency.

In California, it applies only to residents

in areas served by the Los Angeles

North and Los Angeles West branches of

the State agency.

This notice pertains to features that

have been used in these Prototype

States. We continue testing other

features that were part of the 1995

proposal separately from the prototype

process, but this notice does not pertain

to those features.

What Are the Key Features of the

Proposed Rules?

The process we are proposing in this

NPRM is similar to the prototype

process with some modifications based

on our experience with the Full Process

Model and in the prototype States. The

following are the key features and our

reasons for proposing them. We explain

the specific changes in the proposed

rules in detail later in this preamble.

1. Enhanced Roles of State Agency

Disability Examiners and Medical and

Psychological Consultants

By ‘‘enhanced roles’’ of these

individuals, we mean that disability

examiners would be responsible for

making the disability determination in

many claims, and may decide whether

medical consultant or psychological

consultant input is needed. We also

mean that medical or psychological

consultants will serve as true

consultants in these claims by providing

review and advice in cases with difficult

or complex medical issues. Medical and

psychological consultants would be

expected to participate in training and

mentoring the disability examiners. This

change would let us better use the

expertise of our adjudicators and

medical resources, minimize file

handoffs and allow State agencies to

make disability determinations in a

more timely and cost-effective manner.

However, the proposed rules provide

two situations in which a medical or

psychological consultant must be

involved in assessing disability because

of requirements in the Act:

• Sections 221(h) and 1614(a)(3)(H) of

the Act, and §§ 404.1503(e),

404.1615(d), 416.903(e), and 416.1015(e)

of our regulations require that, before

we may find an individual ‘‘not

disabled’’ in any case in which there is

evidence of a mental impairment, we

will make every reasonable effort to

ensure that a qualified psychiatrist or

psychologist has completed the medical

portion of the case review and any

applicable residual functional capacity

assessment. Therefore, the proposed

rules provide that a disability examiner

alone may make a fully favorable

determination, but that any

determination that is less than fully

favorable must be made by a team that

includes a medical or psychological

consultant, as under current procedures.

However, in these cases, the disability

examiner will still offer a claimant

conference, and the first stage of appeal

will be to the administrative law judge

hearing level.

• Section 1614(a)(3)(I) of the Act and

§§ 416.903(f) and 416.1015(e) of our

regulations require that, for all claims

for childhood disability benefits under

title XVI, we will make reasonable

efforts to ensure that a qualified

pediatrician or other individual who

specializes in a field of medicine

appropriate to the child’s impairment(s)

evaluates the case of the child.

Therefore, the proposed rules provide

that we must use disability examiners

and medical or psychological

consultants as a team in all

determinations of childhood disability

under title XVI, including fully

favorable determinations. However, the

disability examiner will still offer a

claimant conference, and appeal will be

to the administrative law judge hearing

level.

We also provide that, in addition to

these two mandatory situations in

which a determination is made by a

disability examiner and medical or

psychological consultant team, State

agencies may require medical or

psychological consultant involvement

in other cases. For example, we would

expect a State agency to require its

trainees and other less experienced

disability examiners to work in teams

with medical and psychological

consultants until they have become

sufficiently expert to determine cases

alone.

• We are proposing this change

because our experience in the prototype

States continues to affirm the successes

we had in the Full Process Model. We

believe that enhancing the roles of

disability examiners and medical and

psychological consultants will

maximize the effectiveness of

adjudicative resources, focusing State

agency medical and psychological

consultants on duties and

responsibilities commensurate with

their training and experience.

Furthermore, evidence from the Full

Process Model as well as the prototype

States shows that the accuracy of initial

determinations improves, reducing the

likelihood that a disabled claimant will

have to go through the appeals process

in order to receive benefits for which he

or she is eligible.

2. Increased Contact Between Claimants

and Adjudicators

The proposed rules would require

disability examiners to provide

claimants with an opportunity for an

‘‘informal disability conference’’ in any

claim in which the evidence does not

appear to support a fully favorable

determination. By ‘‘fully favorable’’ we

mean a determination that the claimant

is (1) disabled and (2) that the

determination matches the claimant’s

allegations about onset of disability and

(3) that the claimant is still disabled at

the time of the determination.

The purpose of the conference would

be to:

• Explain our disability requirements

to the claimant;

• Explain why the facts currently in

the case record indicate that the

determination should be less than fully

favorable; and

• Ensure that we have identified and

made every reasonable effort to obtain

relevant evidence from all appropriate

sources.

The proposed rules do not prohibit a

disability examiner from contacting a

claimant at other times. For example, a

disability examiner may contact a

claimant before he or she requests any

evidence to ensure that the information

in the case file about the claimant’s

medical sources is complete. However,

under the proposed rules, the disability

examiner must still make contact with

the claimant at or near the end of the

process, when the disability examiner

believes that he or she has obtained

sufficient evidence on which to base a

determination and it appears that the

determination will be less than fully

favorable.

Our experience in the Full Process

Model and the prototype States has

shown that increased interaction

between claimants and disability

examiners makes the process more

personal, and it changes the

determinations in some claims because

of new information provided by

claimants during their conferences.

Federal Register / Vol. 66, No. 13 / Friday, January 19, 2001 / Proposed Rules 5497

3. Eliminate the Reconsideration Step of

the Administrative Review Process for

Initial Disability Claims

We are proposing to remove the

reconsideration step of our

administrative review process in all

determinations on initial disability

applications except appeals of

determinations based on a finding that

the claimant is engaging in, or has

engaged in, substantial gainful activity.

Findings about substantial gainful

activity are made in our field offices, not

in the State agencies, and the

appropriate appeal will continue to be

to the reconsideration level.

We are proposing this change

primarily because evidence indicates

that the reconsideration step adds little

value to the disability determination

process, at a great cost of staffing

resources and processing time.

Eliminating the reconsideration step

permits State agencies to use their

resources to make better determinations

at the initial level, thereby increasing

the accuracy of initial determinations. It

will also provide an opportunity for

denied claimants to request a hearing

sooner than under the current process

and, therefore, result in earlier

administrative law judge decisions in

many claims.

How Do We Plan To Implement the

New Disability Claims Process?

We have determined that it is not

feasible to change over to the new

process in all of our State agencies all

at once. As we have already noted, it is

clear from both the Full Process Model

and the Prototype that each State will

need substantial lead time for training

and preparation, and we must retain our

capacity to process new claims as timely

as possible during implementation.

We believe that our only option for

accomplishing this goal is to implement

the redesigned process in smaller

groups of States in several stages over

approximately a 1-year period beginning

with the publication of the final rules

that result from this NPRM. This will

permit us to plan and conduct critical

activities in each group of States, such

as training, systems enhancement,

staffing, and workload management.

Most importantly, a staged

implementation will also allow us to

minimize delays in processing claims.

Our goal is to ensure to the extent

possible that, while we implement the

new process, we continue to make all of

our disability determinations timely.

Therefore, the proposed rules explain

that only individuals whose cases are

adjudicated by State agencies that have

implemented the new process will be

subject to the new rules. In the proposed

revisions, we have described which

cases are subject to the new rules and

which will continue to be adjudicated

under the current rules.

To make clear which cases will be

handled using the new rules, we are

proposing to include a new temporary

appendix 1 to subpart J of part 404 that

lists participating State agencies and the

criteria for identifying which cases will

be handled under the proposed rules.

We are printing the appendix only in

part 404 to save space; the proposed

rules in part 416 cross-refer to the

appendix in part 404. As we add more

State agencies, we will publish an

appropriate notice in the Federal

Register changing the appendix to

include them.

When all State agencies are using the

new rules, we will publish rules

removing the appendix and all language

in the proposed rules that indicates that

there are two processes.

What Are the Specific Provisions of the

Proposed Rules?

The following are the major revisions

of the proposed rules:

Proposed §§ 404.904 and 416.1404

Informal Disability Conference

We are proposing to redesignate

current §§ 404.904 and 416.1404,

‘‘Notice of the initial determination,’’ as

§§ 404.904a and 416.1404a so that we

can insert these new provisions.

Proposed §§ 404.904 and 416.1404

would provide our rules explaining:

• Who will be offered an informal

disability conference;

• What a disability conference is; and

• The procedures associated with the

informal disability conference.

Paragraph (a), ‘‘What is an informal

disability conference?’’ explains that we

will offer a claimant an informal

disability conference in a case of an

initial application for benefits if the

individual meets all of the following

factors:

1. Based on the evidence in the

individual’s case record, it appears that

we will not be able to make a ‘‘fully

favorable’’ determination, except if the

determination will be based on a finding

that the individual is, or was, engaging

in substantial gainful activity. We

provide an explanation of what we

mean by a ‘‘fully favorable’’

determination and to specify what is

‘‘not fully favorable’’ for purposes of

this section. We adopted the language

for the definition of a ‘‘fully favorable’’

determination from §§ 404.948(a) and

416.1448(a).

2. The individual’s case is being

determined according to the identifying

criteria listed in proposed appendix 1 to

subpart J of part 404. These criteria

involve people who have filed

applications for benefits based on

disability and whose claims are handled

by one of the State agencies that is using

the new rules. As already noted, we

intend this proposed provision to be

temporary. When all State agencies are

participating in the new process, we

will delete appendix 1 to subpart J.

Other paragraphs in these proposed

sections provide more information

about the procedures we would require

in connection with the informal

disability conference.

• In paragraph (b)—‘‘How will I be

contacted?’’—we explain how we will

notify the individual of the date, time,

and place or method (e.g., telephone) of

the informal disability conference. We

also explain that we will notify the

claimant’s representative when he or

she is represented.

In paragraph (c)—‘‘Where will my

informal disability conference be

held?—we explain that we may hold the

conference by telephone, in person, or

using videoconferencing technology but

that in most cases we will hold the

conference by telephone. We also

explain that we will decide the method

we will use for the conference.

• In paragraph (d)—‘‘Can an attorney

or other representative participate in the

informal disability conference?’’—we

indicate that the individual has the right

to have an attorney or other

representative present at the informal

disability conference.

Sections 404.908 and 416.1408 Parties

to a Reconsideration

We propose to revise the first

sentence of paragraph (a), ‘‘Who may

request a reconsideration,’’ to add an

exception to the statement that the first

level of appeal from an initial

determination is a reconsideration. The

proposed language includes crossreferences to the new appendix and to

§ 404.930.

Sections 404.930 and 416.1430

Availability of a Hearing Before an

Administrative Law Judge

We propose to add a new

subparagraph (a)(2) to explain that

individuals who meet the criteria in the

new appendix appeal their initial

determinations to the administrative

law judge hearing level. Because of this,

we would redesignate the numbers of

the other subparagraphs within these

paragraphs.

5498 Federal Register / Vol. 66, No. 13 / Friday, January 19, 2001 / Proposed Rules

Sections 404.948 and 416.1448

Deciding a Case Without an Oral

Hearing Before an Administrative Law

Judge

We propose to revise the heading of

paragraph (a) from ‘‘Decision wholly

favorable’’ to ‘‘Decision fully favorable.’’

This will make the heading consistent

with the text of current §§ 404.948(c)

and 404.1448(c) and these proposed

rules. The change is only editorial.

Proposed Appendix 1 to Subpart J of

Part 404

As we explained earlier in this

preamble, we are proposing to add this

new appendix to list the types of claims

that will be handled under the new

disability claims process and the State

agencies that will be using the new

process. The proposed appendix

includes three paragraphs. In paragraph

(a)—‘‘What is this appendix for?’’—we

briefly note the three major differences

between the new process and the

current process.

In paragraph (b)—‘‘Why aren’t all

State agencies using the new disability

claims process?’’—we explain briefly

how we are implementing the rules

gradually in the States. We also explain

that the appendix is temporary and that

we will remove it when all State

agencies are using the new process.

Paragraph (c)—‘‘Which claims will be

handled under the new disability claims

process?’’—explains that applications

for benefits based on disability

processed in certain state agencies come

under the new rules. It is central to all

of the other rules in this NPRM because

we refer back to it to provide the basic

criteria for all three of the major features

of these proposed rules: The informal

disability conference, no

reconsideration appeal step, and

permitting disability examiners the

flexibility to decide whether to obtain

medical or psychological consultant

input when making the disability

determination except in cases in which

the Act requires that a medical or

psychological consultant participate in

making the determination. For example,

in proposed §§ 404.930(a)(2) and

416.1430(a)(2), we explain that the first

level of appeal for a person who meets

the criteria in the proposed appendix is

the administrative law judge hearing.

(We also include this provision in

proposed §§ 404.904(g) and

416.1404(g).) Likewise, we explain in

proposed §§ 404.1615(c)(1) and

416.1015(c)(1) that a disability examiner

may make the determination in the case

of an individual who meets the criteria

in the proposed appendix, except in

cases requiring by statute participation

by a medical or psychological

consultant.

Paragraph (d)—‘‘Which State agencies

are using the new disability claims

process?’’—lists the participating State

agencies. The State agencies listed in

this NPRM are the same State agencies

and branches of State agencies that have

been participating in the Prototype test.

When we decide which State agencies

will be in the next group to begin using

the new process, we will publish an

appropriate notice in the Federal

Register revising the list.

Sections 404.1512 and 416.912

Evidence of Your Impairment

We propose to revise paragraph (b)(6)

of these sections for consistency with

the changes we are proposing in

§§ 404.1615 and 416.1015. In current

§§ 404.1527(f) and 416.927(f), we

recognize that State agency medical and

psychological consultants are members

of the teams that make determinations

of disability under the current process.

Therefore, we do not consider their

administrative findings of fact (e.g.,

about residual functional capacity) at

the initial level to be medical opinions

that must be weighed together with the

evidence in the case record. However,

our regulations have long provided that

at the administrative law judge hearing

and Appeals Council levels of

administrative review, administrative

law judges and administrative appeal

judges must consider these findings as

opinions of nonexamining sources. For

this reason, current §§ 404.1512(b)(6)

and 416.912(b)(6) provide that our term

‘‘evidence’’ includes opinions from

State agency medical and psychological

consultants when a case is at the

administrative law judge hearing or

Appeals Council level.

Under the proposed rules, there will

now be cases in which disability

examiners will make initial

determinations when there are opinions

from state agency medical or

psychological consultants in the claims

file. In these cases, we will expect

disability examiners to consider these

opinions as evidence from

nonexamining sources in the same way

as administrative law judges and

administrative appeals judges.

Therefore, we propose to revise

§§ 404.1512(b)(6) and 416.912(b)(6) to

include disability examiners who make

decisions alone.

Sections 404.1526 and 416.926

Medical Equivalence

We propose to revise paragraph (b),

‘‘Medical equivalence must be based on

medical findings,’’ to be consistent with

the changes in these proposed rules that

provide an enhanced role for disability

examiners in making disability

determinations. The current provision

requires that in every case we must

consider the medical opinion given by

one or more medical or psychological

consultants designated by the

Commissioner in deciding medical

equivalence. Under the current process,

this requirement is always satisfied at

the initial level of administrative review

because medical and psychological

consultants are always members of

teams that make the initial

determination and are responsible for

this finding.

In view of the changes we are

proposing to our process, we now

propose to remove this requirement for

cases that are adjudicated under the

new process. Proposed paragraph (b)

would provide that we ‘‘may’’ consider

the opinion of a medical or

psychological consultant designated by

the Commissioner, i.e., when a medical

consultant provides an opinion on

equivalency we will consider it. Under

the Full Process Model and the

Prototype, we found no evidence that

omitting a medical or psychological

consultant’s opinion from the

determination whether an

impairment(s) medically equaled a

listing lowered the quality of the

determinations.

The proposed change would also

affect adjudication at the administrative

law judge hearing and Appeals Council

levels of administrative review (when

the Appeals Council makes a decision).

Under §§ 404.1526(b) and 416.926(b),

and Social Security Ruling (SSR) 96–6p,

we require that administrative law

judges and administrative appeals

judges (when the Appeals Council

makes a decision) must also consider

the opinion of a medical or

psychological consultant designated by

the Commissioner when they consider

whether an individual’s impairment or

combination of impairments medically

equals a listing. See SSR 96–6p, ‘‘Titles

II and XVI: Consideration of

Administrative Findings of Fact by State

Agency Medical and Psychological

Consultants and Other Program

Physicians and Psychologists at the

Administrative Law Judge and Appeals

Council Levels of Administrative

Review; Medical Equivalence,’’ (61 FR

34466, July 2, 1996). In many cases, this

requirement is satisfied because State

agency medical and psychological

consultants have already considered the

issue and provided this opinion in

connection with the initial and

reconsideration determinations. SSR

96–6p provides that their signatures on

the determinations satisfy the

Federal Register / Vol. 66, No. 13 / Friday, January 19, 2001 / Proposed Rules 5499

requirement to obtain an opinion from

a medical or psychological consultant

designated by the Commissioner at the

administrative law judge hearing and

Appeals Council levels of

administrative review when an

administrative law judge or the Appeals

Council finds that an individual’s

impairment(s) does not medically equal

a listing. However, SSR 96–6p requires that,

when an administrative law judge or

administrative appeals judge determines

that he or she may make a finding that

an individual’s impairment(s) medically

equals a listing, he or she must obtain

an updated medical opinion from a

medical expert. If the proposed revision

in §§ 404.1526(b) and 416.926(b)

becomes final, we will remove this

requirement for administrative law

judges and the Appeals Council, in

order to be consistent with the changes

for disability examiners. In current § 416.926, we include a

paragraph (d), ‘‘Responsibility for

determining medical equivalence,’’

which we do not now include in

§ 404.1526. We propose to add a new

paragraph (d) in § 404.1526 that is

identical to the paragraph in § 416.926,

and to revise the paragraph to

incorporate reference to disability

examiners who make determinations.

The new language would explain that in

such cases, the disability examiner is

responsible for determining medical

equivalence.

Sections 404.1527 and 416.927

Evaluating Opinion Evidence

We propose to revise paragraph (f),

‘‘Opinions of nonexamining sources,’’ to

include disability examiners when they

make disability determinations. As we

have already explained under the

explanation of the proposed revisions to

§§ 404.1512(b)(6) and 416.912(b)(6),

these individuals must consider

opinions from medical and

psychological consultants to be opinion

evidence from nonexamining sources in

the same way that administrative law

judges and the administrative appeals

judges do (when the Appeals Council

makes a decision).

To reflect this change, we propose to

add a new paragraph (f)(2) for disability

examiners who make disability

determinations. The language in the

proposed provision is similar to the

provisions for administrative law judges

in current paragraph (f)(2). Because we

would add a new paragraph (f)(2), we

would redesignate current paragraphs

(f)(2) and (f)(3) as paragraphs (f)(3) and

(f)(4).

We propose minor revisions in

paragraph (f)(1) to make clear that the

current rules would continue to apply to

cases that are adjudicated in State

agencies that are not using the new

process.

Sections 404.1546 and 416.946

Responsibility for Assessing and

Determining Residual Functional

Capacity

We propose to revise this section to

clarify the responsibility for making

assessments of a claimant’s residual

functional capacity. The existing, unnumbered paragraph

will be replaced by numbered

paragraphs that will clarify the

responsibility for making assessments of

residual functional capacity in various

types of claims. We will add a

paragraph that will state that a State

agency disability examiner may make

assessments of residual functional

capacity.

Sections 404.1615 and 416.1015

Making Disability Determinations

In paragraph (c) of these sections, we

propose to add the rules that will permit

disability examiners to make disability

determinations in certain cases.

In proposed paragraph (c)(1)(i), we

explain that a State agency disability

examiner may make the disability

determination in cases of individuals

who meet the criteria in the appendix

and that are not excluded in proposed

paragraph (c)(2). We explain that this is

not an absolute rule, because each State

agency will have the option to decide

whether to permit a disability examiner

to make these determinations. Our

intent is to provide each State agency

with the authority to determine whether

a given disability examiner is

sufficiently skilled to make disability

determinations without working in a

team with a medical or psychological

consultant.

We also provide in the third sentence

of the proposed paragraph a reminder

that a disability examiner may still

request assistance from a medical or

psychological consultant. In the

prototype States, there have been many

cases in which disability examiners

sought opinions from medical and

psychological consultants on various

aspects of claims. Proposed paragraph (c)(1)(ii) is the

same as current paragraph (c)(2). In the proposed rule, we would

redesignate current paragraph (c)(1) as

paragraph (c)(2). The current paragraph

provides the requirement that a

disability examiner and a medical or

psychological consultant must make the

determination in almost all cases. In the

proposed paragraph, we would retain

this provision for States that are not yet

using the new process in proposed

§§ 404.1615(c)(2)(iii) and

416.1015(c)(2)(iv). The reason the part

404 and part 416 sections have different

numbers is that there is an additional

section (proposed paragraph (c)(2)(iii))

containing the requirement of title XVI

of the Act that in any case of a child

claiming SSI disability benefits, we

must make reasonable efforts to ensure

that a qualified pediatrician or other

individual who specializes in a field of

medicine appropriate to a child’s

impairment(s) evaluates the case of the

child. We decided to make the

paragraphs providing the current rule

for using teams last so that when we

need to revise the rules again after all

State agencies are using the new

process, we can delete them without

having to renumber the paragraphs.

In proposed paragraph (c)(2)(i), we

would provide, as required by the Act,

that a team must make the

determination in any case in which the

State agency determines that the

individual is not disabled and there is

evidence that indicates the existence of

a mental impairment. In proposed

paragraph (c)(2)(ii) we provide that a

State agency may at its option require

any disability examiner to work in a

team with a medical or psychological

consultant.

We are also proposing two changes to

current paragraph (c) that are not related

to the Prototype. At the end of

§ 404.1615(c), are two undesignated

paragraphs. There is one undesignated

paragraph at the end of § 416.1015(c)

that contains the same text as the two

undesignated paragraphs at the end of

§ 404.1615(c). The first sentence of both

versions provides cross-references to the

rules defining ‘‘medical or

psychological consultant’’ and

‘‘disability hearing officer.’’ In the

proposed rules, we have moved those

cross-references to the appropriate

sections of paragraph (c) that address

these individuals.

The second sentence explains that

State agency disability examiners and

disability hearing officers must be

qualified to interpret and evaluate

medical reports and other evidence as

necessary to determine the capacities of

the claimant to perform substantial

gainful activity. We propose to

designate this sentence as paragraph (d)

so that it can be cited, and to

redesignate all the subsequent

paragraphs in the sections. We are not

proposing any changes to this sentence.

The second undesignated paragraph

at the end of current § 404.1615(c),

which is the third sentence in the single

undesignated paragraph in current

§ 416.1015(c), provides a cross-reference

to § 404.1572 (in § 404.1615(c)) and to

5500 Federal Register / Vol. 66, No. 13 / Friday, January 19, 2001 / Proposed Rules

§ 416.972 (in § 416.1015(c)) ‘‘for what

we mean by substantial gainful

activity.’’ Although these rules do in

fact define the term ‘‘substantial gainful

activity’’ for purposes of evaluating a

person’s earnings and work activity, the

cross-references are misleading in the

context of the preceding text. Disability

examiners and disability hearing

officers do not determine whether

claimants who are working are engaging

in ‘‘substantial gainful activity’’ and do

not use the rules in §§ 404.1572 and

416.972. This determination is made in

our field offices. Disability examiners

and disability hearing officers make

determinations about whether an

individual is able to work using other

rules regarding medical and vocational

factors. Therefore, we propose to delete

these sentences since they could be

confusing.

Other Changes

We are proposing changes to other

rules in subparts J, P, and Q of part 404,

subparts I, J, and N of part 416, and

subparts B and C of part 422. These

changes are intended to make these

other rules consistent with the proposed

changes we have explained above.

Clarity of This Regulation

Executive Order (E.O.) 12866 and the

President’s memorandum of June 1,

1998, require 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 unclear?

• 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?

Electronic Version

The electronic file of this document is

available on the date of publication in

the Federal Register on the Internet site

for the Government Printing Office:

http://www.access.gpo.gov/su_docs/

aces/aces140.html. It is also available

on the Internet site for SSA (i.e., Social

Security Online): http://www.ssa.gov/.

Regulatory Procedures

Executive Order 12866 and the

Congressional Review Act 

We have consulted with the Office of

Management and Budget (OMB) and

determined that these proposed

regulations meet the criteria of an

economically significant regulatory

action under E.O. 12866 because the

impact in any single year exceeds $100

million. Thus, they were subject to OMB

review. We have provided below an

assessment of the costs and benefits of

these proposed rules. It should also be

noted that this proposed rule is a major

rule under the criteria of the

Congressional Review Act (Chapter 8 of

5 U.S.C.).

Program Savings

We do not expect any program

savings to result from these regulations.

Program Costs

1. Title II

We estimate that these rules will

result in increased program outlays

resulting in the following costs (in

millions of dollars) to the title II

program:

[Million of dollars]

FY2001 FY2002 FY2003 FY2004 FY2005 FY2001–

2005

FY2001–

2010

70 155 360 751 1,247 2,583 17,105

Related Medicare Costs

[Millions of dollars]

FY2001 FY2002 FY2003 FY2004 FY2005 FY2001–

2005

FY2001–

2010

3 26 75 174 277 4,420

2. Title XVI

We estimate that these rules will result in increased program outlays resulting in the following costs (in millions

of dollars) to the title XVI program:

[Millions of dollars]

FY2001 FY2002 FY2003 FY2004 FY2005 FY2001–

2005

FY2001–

2010

Federal ........................................................................................... 4 30 81 188 335 638 3,922

State ............................................................................................... .............. 3 8 19 34 64 392

Federal Register / Vol. 66, No. 13 / Friday, January 19, 2001 / Proposed Rules 5501

[Millions of dollars]

FY2001 FY2002 FY2003 FY2004 FY2005 FY2001–

2005

FY2001–

2010

Federal ........................................................................................... 3 40 120 310 576 1,049 8,940

State ............................................................................................... 2 30 91 234 435 791 6,743

Administrative Savings

We do not expect any administrative

savings to result from these regulations.

Administrative Costs

We expect there will be some

administrative costs associated with the

transition to these rules.

Policy Alternatives

We considered, but did not select, the

following policy alternative:

Keep the Current Disability Claim

Process

As noted above, the initiative to

redesign the disability claim process

was critical of several aspects of the

current process, including: the time it

takes for a final agency decision; the

lack of interaction between the claimant

and the decisionmaker; and the lack of

thorough explanations, in many cases,

of the basis for the disability

determination. Based on the Full

Process Model test and our experience

with the prototype so far, we found that

the proposed new process results in

better determinations at the initial level,

with more allowances of claims that

should be allowed. Many claims that

would have been allowed only after

appeal under the old process, were

allowed at the initial step of the new

process. Eliminating the reconsideration

step enables claimants who appeal to

reach the hearing level sooner than

under the old process, and the resources

previously used at the reconsideration

step can be used to ensure a more

complete determination process at the

initial level. These positive results

support implementation of the

redesigned claim process.

Unfunded Mandates Reform Act

Title II of the Unfunded Mandates

Reform Act of 1995 (2 U.S.C. 1531–

1538) establishes requirements for

Federal agencies to assess the effects of

their regulatory actions on State, local,

and tribal governments, and on the

private sector. This final rule would not

impose any Federal mandates on any

State, local, or tribal governments, or on

the private sector, within the meaning of

the Unfunded Mandates Reform Act of

1995.

Regulatory Flexibility Act

We certify that these proposed rules

will 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 would

impose no new reporting or

recordkeeping requirements requiring

OMB clearance.

(Catalog of Federal Domestic Assistance

Programs No. 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).

20 CFR Part 422

Administrative practice and

procedure, Freedom of information,

Organization and functions

(Government agencies), Social Security.

Dated: January 11, 2001.

Kenneth S. Apfel,

Commissioner of Social Security.

For the reasons set out in the

preamble, we propose to amend

subparts J, P, and Q of part 404, subparts

I, J, and N of part 416, and subparts B

and C of part 422 of 20 CFR, chapter III

as set forth below:

PART 404—FEDERAL OLD-AGE,

SURVIVORS AND DISABILITY

INSURANCE (1950–)

1. The authority citation for subpart J

of part 404 continues to read as follows:

Authority: Secs. 201(j), 204(f), 205(a), (b),

(d)–(h), and (j), 221, 225, and 702(a)(5) of the

Social Security Act (42 U.S.C. 401(j), 404(f),

405(a), (b), (d)–(h), and (j), 421, 425, and

902(a)(5)); 31 U.S.C. 3720A; sec. 5, Pub. L.

97–455, 96 Stat. 2500 (42 U.S.C. 405 note);

secs. 5, 6(c)–(e), and 15, Pub. L. 98–460, 98

Stat. 1802 (42 U.S.C. 421 note).

2. Section 404.900 is amended by

revising paragraphs (a)(2) and (a)(3) to

read as follows:

§ 404.900 Introduction.

(a) * * *

(2) Reconsideration. If you are

dissatisfied with an initial

determination, except for certain

determinations about whether you are

disabled (see paragraph (a)(3)(ii) of this

section), you may ask us to reconsider

it.

(3) Hearing before an administrative

law judge. You may request a hearing

before an administrative law judge if

you are dissatisfied with:

(i) A reconsideration determination;

or

(ii) Certain initial determinations on

your application for benefits based on

disability, if you are a person entitled to

an informal disability conference, as

explained in § 404.904 and appendix 1

to this subpart.

* * * * *

3. Section 404.901 is amended by

adding the following definition to the

alphabetical list of definitions:

§ 404.901 Definitions

* * * * *

‘‘Fully favorable,’’ with respect to a

disability determination, means that we

determine that: the claimant is disabled;

the beginning date of disability is no

later than the date alleged by the

claimant; and either disability has not

ended or, if the claimant alleges that

disability has ended, it ended no earlier

than the date alleged by the claimant.

* * * * *

4. Section 404.904 is redesignated as

Section 404.904a and revised to read as

follows:

§ 404.904a Notice of the initial

determination.

We will mail a written notice of the

initial determination to you at your last

known address. The notice will state the

reasons for the initial determination and

the effect of the initial determination.

5502 Federal Register / Vol. 66, No. 13 / Friday, January 19, 2001 / Proposed Rules

The notice also will explain your right

to appeal the determination and

whether the appeal should be for a

reconsideration or a hearing before an

administrative law judge. (See

§§ 404.900(a), 404.904(g), 404.907, and

404.930, and appendix 1 to this

subpart.) We will not mail a notice if the

beneficiary’s entitlement to benefits has

ended because of his or her death.

5. A new section 404.904 is added to

read as follows:

§ 404.904 Informal disability conference.

(a) What is an informal disability

conference? When you file an

application for disability benefits, the

disability examiner may offer you an

opportunity to have an informal

disability conference. If your claim is

decided by a component of our office

other than a State agency, the disability

examiner in that component may offer

you an opportunity to have an informal

disability conference. The purpose of

the informal disability conference is to

explain how your medical condition

relates to our disability requirements,

and to make sure that we have all of the

information we need to make a

determination about whether you are

disabled. We will offer you an informal

disability conference if all of the

following apply in your case:

(1) Based on the evidence in your case

record, it appears that we will not be

able to make a fully favorable disability

determination. However, we will not

offer you an informal disability

conference if the determination is less

than fully favorable because:

(i) You are, or were, engaging in

substantial gainful activity; or

(ii) You fail to cooperate in the

processing of your claim; or

(iii) You fail to meet one or more

eligibility requirement that is not related

to your medical condition (e.g., insured

status).

(2) Your claim meets the requirements

in paragraphs (c) and (d) of Appendix 1

of this subpart (claims for disability

being determined by certain State

agencies).

(b) Notification. We will notify you in

writing to offer you the conference. You

may choose to have a conference or not

have a conference. If you have an

attorney or other representative, we will

also notify that person about the

conference. The attorney or

representative may participate in the

conference.

(c) How will my informal disability

conference be held? In most cases, we

will hold your informal disability

conference by telephone. In some cases,

we may ask you to come to the State

agency for a conference in person. We

may also ask you to go to a location near

you for a videoconference. We will

decide how your conference will be

held.

(d) What happens during the informal

disability conference? The disability

examiner will have an informal

conversation with you. If he or she has

not already done so in earlier

conversations, the disability examiner

will explain our disability standard. He

or she also will tell you why the

evidence in your case does not appear

to support a fully favorable

determination. You will have a chance

to give us any information that we may

not have. If you want to give us

information that we need to make a

determination, we will give you a

chance to get the information or we will

try to get it for you, following our rules

in § 404.1512.

(e) What happens if I decide not to

have an informal disability conference?

If you decide not to have a conference,

we will make an initial determination

based on the information that we have.

6. Section 404.905 is revised to read

as follows:

§ 404.905 Effect of an initial determination.

Our initial determination is final

unless you request appeal (see

§ 404.907) within the stated time period,

or we revise the determination.

7. Section 404.907 is revised to read

as follows:

§ 404.907 Reconsideration—general.

(a) If you are dissatisfied with the

initial determination, reconsideration is

the first step in the administrative

review process that we provide, except

for the following determinations. In

these cases, the next step in the

administrative review process is to the

administrative law judge hearing level.

(1) Determinations described in

§ § 404.930(a)(6) and (a)(7), where you

appeal an initial determination denying

your request for waiver or adjustment or

recovery of an overpayment (see

§ 404.506).

(2) If you meet the requirements in

paragraphs (c) and (d) of Appendix 1 of

this subpart, an initial determination

about whether you are disabled that is

not fully favorable to you, except for a

determination based on a finding that

you are, or were, engaging in substantial

gainful activity. (See appendix 1 to this

subpart.)

(b) If you are dissatisfied with our

reconsidered determination, you may

request a hearing before an

administrative law judge.

8. Section 404.908 is amended by

revising paragraph (a) to read as follows:

§ 404.908 Parties to a reconsideration.

(a) Who may request a

reconsideration. If you are dissatisfied

with our initial determination, you may

request that we reconsider it, unless you

are entitled to request a hearing before

an administrative law judge, as we

explain in § 404.930 and Appendix 1 of

this subpart. In addition, a person who

shows in writing that his or her rights

may be adversely affected by the initial

determination may request a

reconsideration.

* * * * *

9. Section 404.930 is amended by

redesignating existing paragraphs (a)(2)

through (a)(7) as paragraphs (a)(3)

through (a)(8), and adding a new

paragraph (a)(2) to read as follows:

§ 404.930 Availability of a hearing before

an administrative law judge.

(a) * * *

(2) an initial determination about

whether you are disabled that is not

fully favorable to you, unless that

determination was about whether you

are engaging or were engaging in

substantial gainful activity, if your claim

meets the requirements in paragraphs

(c) and (d) of Appendix 1 of this

subpart;

* * * * *

10. Section 404.948 is amended by

revising the heading of paragraph (a) to

read as follows:

§ 404.948 Deciding a case without an oral

hearing before an administrative law judge.

(a) Decision fully favorable. ***

* * * * *

11. A new appendix 1 to subpart J is

added to read as follows:

Appendix 1—Claims That Will Be

Handled Under the New Disability

Claims Process

(a) What is this appendix for? This

appendix lists the types of claims that will

be handled under the new disability claims

process, and which State agencies will

participate in the process. Individuals who

meet the criteria in paragraphs (c) and (d) of

this appendix, except for individuals whose

determinations of disability are based on a

finding that they are, or were, engaging in

substantial gainful activity, may appeal to an

administrative law judge hearing if they are

dissatisfied with their initial determinations.

In the States listed in paragraph (d), a

disability examiner is responsible for making

the disability determination in certain cases.

The disability examiner will have the

flexibility to decide whether input from a

medical or psychological consultant is

needed in making the disability

determination. See §§ 404.1615 and

416.1015. Individuals who also meet the

criteria in § 404.904(a) of this section or

§ 416.1404 of part 416 and whose State

agencies are using the new claims process

Federal Register / Vol. 66, No. 13 / Friday, January 19, 2001 / Proposed Rules 5503

will be offered an informal disability

conference.

(b) Why aren’t all State agencies using the

new disability claims process? We are

phasing in the new process gradually,

because each State will need substantial lead

time for training and preparation, and we

must retain our capacity to process new

claims as timely as possible during

implementation. This means that we will add

more State agencies to this list from time-totime until all State agencies are using the

new process. When all State agencies are

using the new process, we will delete this

appendix and the new process will apply to

everyone.

(c) Which claims will be handled under the

new disability claims process? Your claim

will be handled under the new process if you

filed an application for benefits (disability

insurance benefits or Supplemental Security

Income) based on disability or blindness and

if your case is processed in one of the State

agencies listed in paragraph (d) of this

appendix.

(d) Which State agencies are using the new

disability claims process? The following State

agencies are using the new process:

Alabama; Alaska; California (North Los

Angeles and West Los Angeles branches);

Colorado; Louisiana; Michigan; Missouri;

New Hampshire; New York (Brooklyn and

Albany branches); Pennsylvania.

12. The authority citation for subpart

P of part 404 continues to read as

follows:

Authority: Secs. 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)); sec. 211(b), 104–193, 110 Stat.

2105, 2189.

13. Section 404.1512 is amended by

revising paragraph (b)(6) to read as

follows:

§ 404.1512 Evidence of your impairment.

* * * * *

(b) * * *

(6) Findings, other than the ultimate

determination about whether you are

disabled, made by State agency medical

or psychological consultants and other

program physicians or psychologists,

and opinions expressed by medical

experts we consult based on their

review of the evidence in your case

record. See § § 404.1527(f)(2) and (f)(3).

* * * * *

14. Section 404.1526 is amended by

revising the last sentence of paragraph

(b) and by adding a new paragraph (d)

to read as follows:

§ 404.1526 Medical equivalence.

* * * * *

(b) * * * We may request, and will

consider if requested, any medical

opinion from one or more medical or

psychological consultants designated by

the Commissioner when we decide

medical equivalence. (See § 404.1616.)

* * * * *

(d) Responsibility for determining

medical equivalence. In cases where the

State agency or other designee of the

Commissioner makes the initial

disability determination, a disability

examiner is responsible for determining

medical equivalence in cases in which

a medical or psychological consultant

does not make the determination

together with the disability examiner

(see § 404.1615 and Appendix 1 of

subpart J). In cases in which a medical

or psychological consultant makes the

determination together with the

disability examiner, the medical or

psychological consultant is responsible

for assessing medical severity, and the

disability examiner and medical or

psychological consultant are jointly

responsible for determining medical

equivalence. For cases in the disability

hearing process or otherwise decided by

a disability hearing officer, the

responsibility for determining medical

equivalence rests with either the

disability hearing officer or, if the

disability hearing officer’s

reconsideration determination is

changed under § 404.918, with the

Associate Commissioner for Disability

or his or her delegate. For cases at the

Administrative Law Judge or Appeals

Council level, the responsibility for

deciding medical equivalence rests with

the administrative law judge or Appeals

Council.

15. Section 404.1527 is amended by

revising paragraph (f)(1), by

redesignating existing paragraphs (f)(2)

and (f)(3) as paragraphs (f)(3) and (f)(4)

and by adding a new paragraph (f)(2) to

read as follows:

§ 404.1527 Evaluating opinion evidence.

* * * * *

(f) * * *

(1) In some cases, State agency

medical and psychological consultants

are members of teams that make initial

determinations of disability (see

§ 404.1615(c)(2)). In these cases, a State

agency medical or psychological

consultant will consider the evidence in

your case record and make findings of

fact about the medical issues, including,

but not limited to, the existence and

severity of your impairment(s), the

existence and severity of your

symptoms, whether your impairment(s)

meets or equals the requirements for any

impairment listed in appendix 1 to this

subpart, and your residual functional

capacity. These administrative findings

of fact are based on the evidence in your

case record but they are not themselves

evidence at this step.

(2) In other cases, a State agency

disability examiner is responsible for

making the initial determination (see

§ 404.1615(c)(1)). In these cases, the

disability examiner may obtain the

opinion of a State agency medical or

psychological consultant with respect to

issues, including, but not limited to, the

existence and severity of your

impairment(s), the existence and

severity of your symptoms, whether

your impairment(s) meets or equals the

requirements for any impairment listed

in appendix 1 to this subpart, and your

residual functional capacity. In these

cases, State agency disability examiners

weigh any opinions provided by State

agency medical or psychological

consultants in accordance with these

rules. State agency medical and

psychological consultants are highly

qualified and are also experts in Social

Security disability evaluation. See

§ 404.1512(b)(6). When a State agency

disability examiner considers findings

of a State agency medical or

psychological consultant, the State

agency disability examiner will evaluate

the findings using relevant factors in

paragraphs (a) through (e) of this

section, such as the medical or

psychological consultant’s medical

specialty and expertise in our rules, the

supporting explanations provided by

the medical or psychological consultant,

and any other factors relevant to the

weighing of the opinions.

* * * * *

16. Section 404.1529 is amended by

revising the third sentence of paragraph

(b) and by adding a new fourth sentence

to paragraph (b) to read as follows:

§ 404.1529 How we evaluate symptoms,

including pain.

* * * * *

(b) Need for medically determinable

impairment that could reasonably be

expected to produce your symptoms,

such as pain. * * * In some cases at the

initial step in the administrative review

process, and all cases at the

reconsideration step, a State agency

medical or psychological consultant (or

other medical or psychological

consultant designated by the

Commissioner) directly participates in

determining whether your medically

determinable impairment(s) could

reasonably be expected to produce your

alleged symptoms (see § 404.1615(c)(2)).

In other cases at the initial step of the

administrative review process, a State

agency disability examiner may ask for

and consider the opinion of a State

agency medical or psychological

consultant in determining whether your

medically determinable impairment(s)

could reasonably be expected to

5504 Federal Register / Vol. 66, No. 13 / Friday, January 19, 2001 / Proposed Rules

produce your alleged symptoms (see

§ 404.1615). * * *

* * * * *

17. Section 404.1546 is revised to read

as follows:

§ 404.1546 Responsibility for assessing

and determining residual functional

capacity.

(a) Initial determinations. (1) In cases

in which a State agency disability

determination is made by a team

consisting of a State agency disability

examiner and a medical or

psychological consultant, the medical or

psychological consultant is responsible

for assessing your residual functional

capacity (see § 404.1615(c)(2)).

(2) In cases in which a State agency

disability examiner makes the disability

determination, the State agency

disability examiner is responsible for

assessing your residual functional

capacity (see § 404.1615(c)(1)).

(b) Disability hearing cases. For cases

in the disability hearing process, the

responsibility for deciding your residual

functional capacity rests with either the

disability hearing officer or, if the

disability hearing officer’s reconsidered

determination is changed under

§ 404.918, with the Associate

Commissioner for Disability or his or

her delegate.

(c) Administrative law judge or

Appeals Council cases. For cases at the

Administrative Law Judge or Appeals

Council level, the administrative law

judge or Appeals Council is responsible

for assessing your residual functional

capacity.

18. The authority citation for subpart

Q of part 404 continues to read as

follows:

Authority: Secs. 205(a), 221, and 702(a)(5)

of the Social Security Act (42 U.S.C. 405(a),

421, and 902(a)(5)).

19. Section 404.1615 is amended by

revising paragraph (c), by redesignating

the first undesignated paragraph

following paragraph (c)(3) as paragraph

(d), by removing the second

undesignated paragraph following

paragraph (c)(3), by revising new

paragraph (d), and by redesignating

existing paragraphs (d), (e), (f), and (g),

as paragraphs (e), (f), (g), and (h), to read

as follows:

§ 404.1615 Making disability

determinations.

* * * * *

(c) The following individuals in the

State agency will make disability

determinations:

(1)(i) If your claim meets the

requirements in paragraphs (c) and (d)

of Appendix 1 of subpart J, a State

agency disability examiner is

responsible for making the disability

determination in your claim, unless it is

a claim described in (c)(2) of this

section. The State agency disability

examiner may request advice from a

State agency medical or psychological

consultant on the medical aspects of

your impairment.

(ii) In any State agency, a State agency

disability examiner may make the

disability determination when there is

no medical evidence to be evaluated

(i.e., no medical evidence exists or we

are unable, despite making every

reasonable effort, to obtain any medical

evidence that may exist) and the

individual fails or refuses, without a

good reason, to attend a consultative

examination (see § 404.1518).

(2) A State agency medical or

psychological consultant (see

§ 404.1616) and a State agency disability

examiner together will make the

disability determination in the

following situations:

(i) Any case in which the State agency

determines that you are not disabled

and there is evidence that indicates the

existence of a mental impairment, as

described in paragraph (e) of this

section;

(ii) Any case in which the State

agency decides to require a State agency

medical or psychological consultant and

a State agency disability examiner to

make the disability determination

together; and

(iii) Any case, if your claim does not

meet the requirements in paragraphs (c)

and (d) of Appendix 1 of subpart J.

(3) A State agency disability hearing

officer (see § 404.915).

(d) The State agency disability

examiner and disability hearing officer

must be qualified to interpret and

evaluate medical reports and other

evidence relating to the claimant’s

physical or mental impairments and as

necessary to determine the capacities of

the claimant to perform substantial

gainful activity.

* * * * *

20. Section 404.1616 is amended by

revising paragraph (a) to read as follows:

§ 404.1616 Medical or psychological

consultants.

(a) What is a medical consultant? A

medical consultant is a person who is a

member of a team that makes disability

determinations in a State agency, as

explained in § 404.1615(c)(2), or who

provides advice to a State agency

disability examiner, as explained in

§ 404.1615(c)(1). A medical consultant

may also be a person who serves the

same functions for us when a federal

component makes the disability

determination.

* * * * *

PART 416—SUPPLEMENTAL

SECURITY INCOME FOR THE AGED,

BLIND, AND DISABLED

21. The authority citation for subpart

I of part 416 continues to read as

follows:

Authority: Secs. 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 1383b); 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, 423 note,

1382h note).

22. Section 416.912 is amended by

revising paragraph (b)(6) to read as

follows:

§ 416.912 Evidence of your impairment.

* * * * *

(b) * * *

(6) Findings, other than the ultimate

determination about whether you are

disabled, made by State agency medical

or psychological consultants and other

program physicians or psychologists,

and opinions expressed by medical

experts we consult based on their

review of the evidence in your case

record. See §§ 416.1527(f)(2) and (f)(3).

* * * * *

23. Section 416.926 is amended by

revising the last sentence of paragraph

(b) and by adding a new paragraph (d)

to read as follows:

§ 416.926 Medical equivalence for adults

and children.

* * * * *

(b) * * * We may request, and will

consider if requested, any medical

opinion from one or more medical or

psychological consultants designated by

the Commissioner when we decide

medical equivalence. (See § 416.1016.)

* * * * *

(d) Responsibility for determining

medical equivalence. In cases where the

State agency or other designee of the

Commissioner makes the initial

disability determination, a disability

examiner is responsible for determining

medical equivalence in cases in which

a medical or psychological consultant

does not make the determination

together with the disability examiner

(see § 416.1015 and Appendix 1 of

subpart J). In cases in which a medical

or psychological consultant makes the

determination together with the

disability examiner, the medical or

psychological consultant is responsible

for assessing medical severity, and the

disability examiner and medical or

Federal Register / Vol. 66, No. 13 / Friday, January 19, 2001 / Proposed Rules 5505

psychological consultant are jointly

responsible for determining medical

equivalence. For cases in the disability

hearing process or otherwise decided by

a disability hearing officer, the

responsibility for determining medical

equivalence rests with either the

disability hearing officer or, if the

disability hearing officer’s

reconsideration determination is

changed under § 416.1418, with the

Associate Commissioner for Disability

or his or her delegate. For cases at the

Administrative Law Judge or Appeals

Council level, the responsibility for

deciding medical equivalence rests with

the administrative law judge or Appeals

Council.

24. Section 416.927 is amended by

revising paragraph (f)(1), by

redesignating existing paragraphs (f)(2)

and (f)(3) as paragraphs (f)(3) and (f)(4)

and by adding a new paragraph (f)(2) to

read as follows:

§ 416.927 Evaluating opinion evidence.

* * * * *

(f) * * *

(1) In some cases, State agency

medical and psychological consultants

are members of teams that make initial

determinations of disability (see

§ 416.1015(c)(2)). In these cases, a State

agency medical or psychological

consultant will consider the evidence in

your case record and make findings of

fact about the medical issues, including,

but not limited to, the existence and

severity of your impairment(s), the

existence and severity of your

symptoms, whether your impairment(s)

meets or equals the requirements for any

impairment listed in appendix 1 to

subpart P of part 404 of this chapter,

and your residual functional capacity.

These administrative findings of fact are

based on the evidence in your case

record but they are not themselves

evidence at this step.

(2) In other cases, a State agency

disability examiner is responsible for

making the initial determination (see

§ 416.1015(c)(1)). In these cases, the

disability examiner may obtain the

opinion of a State agency medical or

psychological consultant with respect to

issues, including, but not limited to, the

existence and severity of your

impairment(s), the existence and

severity of your symptoms, whether

your impairment(s) meets or equals the

requirements for any impairment listed

in appendix 1 to subpart P of part 404

of this chapter, and your residual

functional capacity. In these cases, State

agency disability examiners weigh any

opinions provided by State agency

medical or psychological consultants in

accordance with these rules. State

agency medical and psychological

consultants are trained and are also

experts in Social Security disability

evaluation. See § 416.912(b)(6). When a

State agency disability examiner

considers findings of a State agency

medical or psychological consultant, the

State agency disability examiner will

evaluate the findings using relevant

factors in paragraphs (a) through (e) of

this section, such as the medical or

psychological consultant’s medical

specialty and expertise in our rules, the

supporting explanations provided by

the medical or psychological consultant,

and any other factors relevant to the

weighing of the opinions.

* * * * *

25. Section 416.929 is amended by

revising the third sentence of paragraph

(b) and by adding a new fourth sentence

to paragraph (b) to read as follows:

§ 416.929 How we evaluate symptoms,

including pain.

* * * * *

(b) Need for medically determinable

impairment that could reasonably be

expected to produce your symptoms,

such as pain. * * * In some cases at the

initial step in the administrative review

process, and all cases at the

reconsideration step, a State agency

medical or psychological consultant (or

other medical or psychological

consultant designated by the

Commissioner) directly participates in

determining whether your medically

determinable impairment(s) could

reasonably be expected to produce your

alleged symptoms (see § 416.1015(c)(2)).

In other cases at the initial step of the

administrative review process, a State

agency disability examiner may ask for

and consider the opinion of a State

agency medical or psychological

consultant in determining whether your

medically determinable impairment(s)

could reasonably be expected to

produce your alleged symptoms (see

§ 416.1015). * * *

* * * * *

26. Section 416.946 is revised to read

as follows:

§ 416.946 Responsibility for assessing and

determining residual functional capacity.

(a) Initial determinations. (1) In cases

in which a State agency disability

determination is made by a team

consisting of a State agency disability

examiner and a medical or

psychological consultant, the medical or

psychological consultant is responsible

for assessing your residual functional

capacity (see § 416.1015(c)(2)).

(2) In cases in which a State agency

disability examiner makes the disability

determination, the State agency

disability examiner is responsible for

assessing your residual functional

capacity (see § 416.1015(c)(1)).

(b) Disability hearing cases. For cases

in the disability hearing process, the

responsibility for deciding your residual

functional capacity rests with either the

disability hearing officer or, if the

disability hearing officer’s reconsidered

determination is changed under

§ 416.1418, with the Associate

Commissioner for Disability or his or

her delegate.

(c) Administrative law judge or

Appeals Council cases. For cases at the

Administrative Law Judge or Appeals

Council level, the administrative law

judge or Appeals Council is responsible

for assessing your residual functional

capacity.

27. The authority citation for subpart

J of part 416 continues to read as

follows:

Authority: Secs. 702(a)(5), 1614, 1631, and

1633 of the Social Security Act (42 U.S.C.

902(a)(5), 1382c, 1383, and 1383b).

28. Section 416.1015 is amended by

redesignating paragraphs (d) through (h)

as paragraphs (e) through (i), by

redesignating the undesignated

paragraph following paragraph (c)(3) as

paragraph (d) and revising it, and by

revising paragraph (c) to read as follows:

§ 416.1015 Making disability

determinations.

* * * * *

(c) The following individuals in the

State agency will make disability

determinations:

(1) (i) If your claim meets the

requirements of paragraphs (c) and (d)

of Appendix 1 of subpart J, part 404 of

this chapter, a State agency disability

examiner is responsible for making the

disability determination in your claim,

unless it is a claim described in (c)(2) of

this section. The State agency disability

examiner may request advice from a

State agency medical or psychological

consultant on the medical aspects for

your impairment.

(ii) In any State agency, a State agency

disability examiner may make the

disability determination when there is

no medical evidence to be evaluated

(i.e., no medical evidence exists or we

are unable, despite making every

reasonable effort, to obtain any medical

evidence that may exist) and the

individual fails or refuses, without a

good reason, to attend a consultative

examination (see § 416.918).

(2) A State agency medical or

psychological consultant (see

§ 416.1016) and a State agency disability

examiner together will make the

disability determination in the

following situations:

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(i) Any case in which the State agency

determines that you are not disabled

and there is evidence that indicates the

existence of a mental impairment, as

described in paragraph (e) of this

section;

(ii) Any case in which the State

agency decides to require a State agency

medical or psychological consultant and

a State agency disability examiner to

make the disability determination

together; and

(iii) Any case of a child claiming

disability benefits, as described in

paragraph (f) of this section;

(iv) Any case, if your claim does not

meet the requirements in paragraphs (c)

and (d) of Appendix 1 of subpart J, part

404 of this chapter.

(3) A State agency disability hearing

officer (see § 416.1015).

(d) The State agency disability

examiner and disability hearing officer

must be qualified to interpret and

evaluate medical reports and other

evidence relating to the claimant’s

physical or mental impairments and as

necessary to determine the capacities of

the claimant to perform substantial

gainful activity.

* * * * *

29. Section 416.1016 is amended by

revising paragraph (a) to read as follows:

§ 416.1016 Medical or psychological

consultants.

(a) What is a medical consultant? A

medical consultant is a person who is a

member of a team that makes disability

determinations in a State agency, as

explained in § 416.1015(c)(2), or who

provides advice to a State agency

disability examiner, as explained in

§ 416.1015(c)(1). A medical consultant

may also be a person who serves the

same functions for us when a federal

component makes the disability

determination.

* * * * *

30. The authority citation for subpart

N of part 416 continues to read as

follows:

Authority: Secs. 702(a)(5), 1631, and 1633

of the Social Security Act (42 U.S.C.

902(a)(5), 1383, and 1383b); 31 U.S.C. 3720A.

31. Section 416.1400 is amended by

revising paragraphs (a)(2) and (a)(3) to

read as follows:

§ 416.1400 Introduction.

(a) * * *

(2) Reconsideration. If you are

dissatisfied with an initial

determination, except for certain

determinations about whether you are

disabled (see (a)(3)(ii) of this section),

you may ask us to reconsider it.

(3) Hearing before an administrative

law judge. You may request a hearing

before an administrative law judge if

you are dissatisfied with:

(i) A reconsideration determination;

or

(ii) Certain initial determinations on

your application for benefits based on

disability, if you are a person entitled to

an informal disability conference, as

explained in § 416.1404 and appendix 1

to subpart J of part 404 of this chapter.

* * * * *

32. Section 416.1401 is amended by

adding the following definition to the

alphabetical listing of definitions in this

section, to read as follows:

§ 416.1401 Definitions.

* * * * *

‘‘Fully favorable’’ with respect to a

disability determination, means that we

determine that: the claimant is disabled;

the beginning date of disability is no

later than the date alleged by the

claimant; and either disability has not

ended or, if the claimant alleges that

disability has ended, it ended no earlier

than the date alleged by the claimant.

* * * * *

33. Section 416.1404 is redesignated

as Section 416.1404a and revised to read

as follows:

§ 416.1404a Notice of the initial

determination.

(a) We will mail a written notice of

the initial determination to you at your

last known address. Generally, we will

not send a notice if your benefits are

stopped because of your death, or if the

initial determination is a

redetermination that your eligibility for

benefits and the amount of your benefits

have not changed.

(b) The written notice that we send

will tell you:

(1) What our initial determination is;

(2) The reasons for our determination;

and

(3) What rights you have to a

reconsideration of the determination or

a hearing before an administrative law

judge. (See § § 416.1400(a), 416.1404(g),

416.1407, and 416.1430, and appendix 1

to subpart J of part 404 of this chapter.)

(c) If our initial determination is that

we must suspend, reduce or terminate

your benefits, the notice will also tell

you that you have a right to a

reconsideration before the

determination takes effect (see

§ 416.1336).

34. A new section 416.1404 is added

to read as follows:

§ 416.1404 Informal disability conference.

(a) What is an informal disability

conference? When you file an

application for disability benefits, the

disability examiner may offer you an

opportunity to have an informal

disability conference. If your claim is

decided by a component of our office

other than a State agency, the disability

examiner in that component may offer

you an opportunity to have an informal

disability conference. The purpose of

the informal disability conference is to

explain how your medical condition

relates to our disability requirements,

and to make sure that we have all of the

information we need to make a

determination about whether you are

disabled. We will offer you an informal

disability conference if all of the

following apply in your case:

(1) Based on the evidence in your case

record, it appears that we will not be

able to make a fully favorable disability

determination. However, we will not

offer you an informal disability

conference if the determination is less

than fully favorable because:

(i) You are, or were, engaging in

substantial gainful activity; or

(ii) You fail to cooperate in the

processing of your claim; or

(iii) You fail to meet one or more

eligibility requirement that is not related

to your medical condition (e.g.,

limitations on income and resources).

(2) Your claim meets the requirements

of paragraphs (c) and (d) of appendix 1,

subpart J of part 404.

(b) Notification We will notify you in

writing to offer you the conference. You

may choose to have a conference or not

have a conference. If you have an

attorney or other representative, we will

also notify that person. The attorney or

representative may participate in the

conference.

(c) How will my informal disability

conference be held? In most cases, we

will hold your informal disability

conference by telephone. In some cases,

we may ask you to come to the State

agency for a conference in person. We

may also ask you to go to a location near

you for a videoconference. We will

decide how your conference will be

held.

(d) What happens during the informal

disability conference? The disability

examiner will have an informal

conversation with you. If he or she has

not already done so in earlier

conversations, he or she will explain

our disability standard. He or she also

will tell you why the evidence in your

case does not appear to support a fully

favorable determination. You will have

a chance to provide information that we

may not have. If you want to give us

information that we need to make a

determination, we will give you a

chance to get the information or we will

try to get it for you, following our rules

in § 416.912.

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(e) What happens if I decide not to

have an informal disability conference?

If you decide not to have a conference,

we will make an initial determination

based on the information that we have.

35. Section 416.1405 is revised to read

as follows:

§ 416.1405 Effect of an initial

determination.

Our initial determination is final

unless you request a reconsideration or

an administrative law judge hearing

within the stated time period, or we

revise the determination.

36. Section 416.1407 is revised to read

as follows:

§ 416.1407 Reconsideration—general.

If you are dissatisfied with the initial

determination, reconsideration is the

first step in the administrative review

process that we provide, with one

exception. If your claim meets the

requirements of paragraphs (c) and (d)

of Appendix 1, subpart J, part 404 of

this chapter, and we make an initial

determination about whether you are

disabled that is not fully favorable to

you, except for a determination based

on a finding that you are, or were,

engaging in substantial gainful activity,

the next step in the administrative

review process is to the administrative

law judge hearing level. If you are

dissatisfied with our reconsidered

determination, you may request a

hearing before an administrative law

judge.

37. Section 416.1408 is amended by

revising paragraph (a) to read as follows:

§ 416.1408 Parties to a reconsideration.

(a) Who may request a

reconsideration. If you are dissatisfied

with our initial determination, you may

request that we reconsider it, unless you

are entitled to request a hearing before

an administrative law judge, as we

explain in § 416.1430 and appendix 1 of

subpart J, part 404 of this chapter. In

addition, a person who shows in writing

that his or her rights may be adversely

affected by the initial determination

may request a reconsideration.

* * * * *

38. Section 416.1430 is amended by

redesignating existing paragraphs (a)(2),

(a)(3), and (a)(4) as paragraphs (a)(3),

(a)(4), and (a)(5), and by adding a new

paragraph (a)(2) to read as follows:

§ 416.1430 Availability of a hearing before

an administrative law judge.

(a) * * *

(2) An initial determination about

whether you are disabled that is not

fully favorable to you, unless that

determination was about whether you

are engaging or were engaging in

substantial gainful activity, if your claim

meets the requirements of paragraphs (c)

and (d) of appendix 1 of subpart J, part

404 of this chapter;

* * * * *

39. Section 416.1448 is amended by

revising the heading of paragraph (a) to

read as follows:

§ 416.1448 Deciding a case without an oral

hearing before an administrative law judge.

(a) Decision fully favorable. ***

* * * * *

PART 422—ORGANIZATION AND

PROCEDURES

40. The authority citation for subpart

B of part 422 continues to read as

follows:

Authority: Secs. 205, 232, and 702(a)(5),

1131, and 1143 of the Social Security Act (42

U.S.C. 405, 432, 902(a)(5), 1320b–l, and

1320b–13).

41. Section 422.140 is amended by

revising the first sentence to read as

follows:

§ 422.140 Reconsideration of initial

determination.

Except in the case of certain

determinations regarding disability (see

§ 404.930 and appendix 1 of subpart J,

part 404 of this chapter), any party who

is dissatisfied with an initial

determination with respect to

entitlement to monthly benefits, a lumpsum death payment, a period of

disability, a revision of an earnings

record, with respect to any other right

under title II of the Social Security Act,

or with respect to entitlement to

hospital insurance benefits or

supplementary medical insurance

benefits, or the amount of hospital

insurance benefits, may request that the

Social Security Administration

reconsider such determination. * * *

42. The authority citation for subpart

C of part 422 continues to read as

follows:

Authority: Secs. 205, 221, and 702(a)(5) of

the Social Security Act (42 U.S.C. 405, 421,

and 902(a)(5)); 30 U.S.C. 923(b).

43. Section 422.203 is amended by

revising the first sentence of paragraph

(a)(1), by redesignating paragraph (c) as

paragraph (c)(1), and by adding

paragraph (c)(2) to read as follows:

§ 422.203 Hearings.

(a) * * * (1) After certain

determinations regarding disability (see

§ 404.930 and appendix 1 of subpart J,

part 404 of this chapter), and after a

reconsidered or a revised determination

(i) of a claim for benefits or any other

right under title II of the Social Security

Act; or (ii) of eligibility or amount of

benefits or any other matter under title

XVI of the Act, except where an initial

or reconsidered determination involving

an adverse action is revised, after such

revised determination has been

reconsidered; or (iii) as to entitlement

under part A or part B of title XVIII of

the Act, or as to the amount of benefits

under part A of such title XVIII (where

the amount in controversy is $100 or

more); or of health services to be

provided by a health maintenance

organization without additional costs

(where the amount in controversy is

$100 or more); or as to the amount of

benefits under part B of title XVIII

(where the amount in controversy is

$500 or more); or as to a determination

by a peer review organization (PRO)

under title XI (where the amount in

controversy is $200 or more); or as to

certain determinations made under

section 1154, 1842(1), 1866(f)(2), or

1879 of the Act; any party to such a

determination may, pursuant to the

applicable section of the Act, file a

written request for a hearing on the

determination. * * *

* * * * *

(c) * * *

(2) Unless for good cause shown on

extension of time has been granted, a

request for hearing must be filed within

60 days after the receipt of the notice of

the reconsidered or revised

determination, or after an initial

determination described in

§ 404.900(a)(3)(ii), 42 CFR 498.3(b) and

(c) (see §§ 404.933, 410.631, and

416.1433 of this chapter and 42 CFR

405,722, 498.40, and 417.260.)

* * * * *

[FR Doc. 01–1442 Filed 1–18–01; 8:45 am]

BILLING CODE 4191–02–P