[Federal Register Volume 60, Number 78 (Monday, April 24, 1995)]
[Rules and Regulations]
[Pages 20023-20029]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-9897]



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SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404 and 416

[Regulations Nos. 4 and 16]
RIN 0960-AD63


Testing Modifications to the Disability Determination Procedures

AGENCY: Social Security Administration (SSA).

ACTION: Final rules.

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SUMMARY: We are adding new rules which provide authority to test 
procedures that modify the disability determination process we 
currently follow under titles II and XVI of the Social Security Act 
(the Act). We intend to test up to four model procedures either singly 
or in combination. These tests will provide us with information so we 
can determine the effectiveness of the models in improving the 
disability process. The intended result is to enable us to make 
recommendations for national implementation of improvements identified 
by the tests. These final rules only refer to the changes to the 
disability procedures we may test. Unless specified, all other 
regulations related to the disability determination process remain 
unchanged. Videoconferencing may be used with any of the models.

EFFECTIVE DATE: These rules are effective April 24, 1995.

FOR FURTHER INFORMATION CONTACT: Henry D. Lerner, Legal Assistant, 
Office of Regulations, Social Security Administration, 6401 Security 
Blvd., Baltimore, MD 21235, (410) 965-1762.

SUPPLEMENTARY INFORMATION:

Background

    We published a notice of proposed rulemaking (NPRM) in the Federal 
Register on October 22, 1993, (58 FR 54532) proposing to establish the 
authority to test model projects designed to improve the disability 
determination process. The initial public comment period was 30 days. A 
30-day extension of the public comment period was published in the 
Federal Register on December 6, 1993, (58 FR 64207) and the comment 
period ended on January 5, 1994. The comments we received on the NPRM 
and the changes we have made in the final rules are discussed below.
    On April 15, 1994, the Social Security Administration (SSA) 
published a notice in the Federal Register (59 FR 18188) setting out a 
proposal to redesign the initial and administrative appeals system for 
determining an individual's entitlement to Social Security and 
Supplementary Security Income (SSI) disability payments. Comments on 
this comprehensive and far reaching proposal developed by SSA's 
Disability Process Reengineering Team (the Team) were requested, and 
during the comment period that began on April 1, 1994, and ended on 
June 14, 1994, SSA received over 6,000 written responses. They came 
from a broad spectrum of respondents including: Professional 
associations, claimant representatives, claimant advocacy groups, 
Federal and State agencies, State governments, employee unions, Federal 
and State employees, and other members of the public. Comments also 
were received by members of the Team who conducted briefings and spoke 
with more than 3,000 individuals about their reaction to the proposal. 
The commenters expressed their belief that improvements were needed to 
provide better service and to manage the claims process more 
effectively. While some concerns were expressed, the commenters praised 
SSA and the Team for taking on the task of redesigning the disability 
claim process.
    The Team made revisions to the redesign proposal and submitted them 
to the Commissioner of Social Security on June 30, 1994. The 
Commissioner accepted the recommendations of the Team on September 7, 
1994, with the full understanding that certain aspects of the redesign 
proposal recommended by the Team would require extensive research and 
testing to determine whether they can be implemented. The plan approved 
by the Commissioner was published in the Federal Register on September 
19, 1994 (59 FR 47887). The proposed changes to the disability 
determination process contained in the plan approved by the 
Commissioner that are the same as or similar to changes we proposed to 
test in the NPRM include:
    <bullet> Making the process more personalized by assigning a 
disability claim manager who is knowledgeable about the case to be the 
claimant's principal contact with SSA;
    <bullet> Providing the claimant with an opportunity for a 
predecision interview with the decisionmaker(s) when the decisionmaker 
finds that the evidence in the claim file is insufficient to make a 
fully favorable determination or requires an initial determination 
denying the claim;
    <bullet> Eliminating the reconsideration step of the administrative 
review process and providing a claimant who is dissatisfied with his or 
her initial determination with the opportunity to request a hearing 
before an administrative law judge (ALJ).
    These final rules were developed based on the NPRM, the comments we 
received on it which are discussed below, and the Commissioner's 
acceptance on September 7, 1994, of the Team's recommendations to 
redesign the disability process. Under the final rules we plan to test 
one or more modifications to the current disability determination 
process to determine whether the modifications should become permanent. 
The modifications we plan to test pursuant to these final rules that 
were not contained in the NPRM, are based on, and are an outgrowth of, 
the NPRM.
    Some modifications of procedures that were in the NPRM, such as 
having a single decisionmaker in the proposed claims intake and 
determination model, the face-to-face predenial interview model and the 
face-to-face Federal reconsideration models, are now found in these 
final rules in the single decisionmaker model. Also, a modification 
similar to, though less formal than, the predenial interview concept 
that was part of the face-to-face predenial interview model is now 
found in the predecision interview model.
    Other modifications contained within the models described in the 
NPRM and the redesign proposal are now combined in models in these 
final rules. For example, the NPRM described a disability specialist as 
a claims representative who would be given special disability program 
training similar to the training that State agency disability examiners 
receive. The disability specialist would be able to review the claim 
before forwarding it to the State agency, request and evaluate existing 
medical evidence and, if appropriate, arrange for a consultative 
examination. With respect to applications for SSI payments based on 
disability, the disability specialist would, where appropriate, make 
presumptive disability findings. The second model in the NPRM, the 
claims intake and determination model, described a process whereby the 
applicant would be interviewed by a decisionmaker when a claim for 
disability benefits or SSI payments based on disability was filed. 
[[Page 20024]] 
    Whereas the NPRM described a disability specialist and a 
decisionmaker at claims intake who could perform these functions, the 
final rules now have a disability claim manager model and a single 
decisionmaker model. The disability claim manager will assume primary 
responsibility for the processing of any initial disability claim, and 
he or she will act as the focal point for the claimant's contacts with 
us throughout the claims intake process and until an initial 
determination is issued. The disability claim manager will perform many 
of the functions associated with a disability specialist, but will also 
perform other functions. A disability claim manager will provide the 
claimant with an explanation of the disability programs, including the 
definition of disability and how we determine whether or not the 
claimant meets the other requirements for entitlement to disability 
benefits. The disability claim manager will also explain what the 
claimant will be asked to do throughout the initial claims process and 
provide information that will assist the claimant in pursuing his or 
her claim. When tested in combination with the single decisionmaker 
model, the disability claim manager will also be the decisionmaker, 
similar to the decisionmaker in the claims intake and determination 
model described in the NPRM.
    The disability claim manager may work in a team environment with 
medical consultants who provide assistance for case adjudication, as 
well as with technical and other clerical personnel who may handle 
other aspects of case development and payment effectuation. Each team 
member will have a familiarity with all the steps in the process and an 
understanding of how he or she assists another's efforts. Team members 
will be able to draw upon each other's expertise on complex issues. We 
expect that this team environment, combined with the proper training, 
program tools and technological support, will eventually enable one 
individual to handle the responsibilities of the disability claim 
manager. This individual may be either a Federal employee or a State 
agency employee. An individual employee serving as the disability claim 
manager is basic to our objective of providing a single point of 
contact for the claimant during the initial disability process.
    In the near term, it may be necessary to have the duties of a 
disability claim manager carried out by more than one individual and, 
therefore, to expand the ``disability team'' described above to include 
additional employees. The final rules will allow us to test the 
disability claim manager function performed by one individual or a team 
of individuals. If the disability claim manager model is being tested 
in combination with the single decisionmaker model (i.e., the 
disability claim manager would be the single decisionmaker for both the 
medical and nonmedical aspects of the claim), and a State agency 
employee is performing the duties of the disability claim manager, the 
ultimate determination of whether or not the claimant is entitled to 
benefits will be made by a team that includes a Federal employee. This 
procedure is in accordance with current provisions of the Act which 
authorize State agency employees only to make determinations of 
disability and not determinations of entitlement to benefits based on 
disability.
    The disability models proposed in the NPRM were designed only to 
modify those aspects of the disability determination process based upon 
the medical factors of entitlement. That is why, for example, the face-
to-face predenial interview model proposed in the NPRM only provided 
for direct appeal of disability issues to the ALJ. Since then, we have 
decided to test ways to improve both the disability and nondisability 
aspects of the disability determination process. The face-to-face 
predenial interview model with limited direct appeal rights to the ALJ 
has been changed in the final rules to a less formal predecision 
interview model. As some commenters suggested, the predecision 
interview model does not place conditions on a claimant's appeal 
rights. It still provides, however, the claimant with the opportunity 
for an interview with the decisionmaker(s) before an initial 
determination denying the claim is made or when the evidence is 
insufficient to make a fully favorable determination. The 
decisionmaker(s) who will conduct the interview has the discretion to 
determine which method of interview (face-to-face, videoconferencing, 
or telephone) is most appropriate for each claimant's special needs. 
The reconsideration elimination model has also been modified to allow 
appeal to an administrative law judge if the claimant is dissatisfied 
with the initial determination made in his or her claim, based upon 
either disability or nondisability factors.
    Finally, we decided not to test the face-to-face Federal 
reconsideration model described in the NPRM because its primary 
benefit, namely, an earlier opportunity to appear before a Federal 
decisionmaker is now contained within the single decisionmaker model.
    These regulations provide the authority to test major elements of 
our Disability Redesign Plan. However, there are elements of the 
Redesign not referenced in these final regulations. There are two 
principal reasons why elements are omitted. First, we do not need 
regulatory authority to test or implement many aspects of the Redesign 
(e.g., improved public information materials or more efficient ways of 
working with applicants to obtain medical evidence). Second, some 
elements of the Redesign were not referenced in the NPRM, since the 
Redesign was developed subsequent to issuance of the NPRM. Therefore, 
separate regulations will be needed for those elements which are beyond 
the scope of the original rulemaking.
    For example, separate regulations are required to establish the 
position of an adjudication officer who is authorized to issue some 
disability decisions. Current implementation planning for the 
Disability Redesign includes the development of regulations to test the 
adjudication officer element in the Redesign. We plan to test the 
adjudication officer in combination with one or more of the models 
included in these regulations as well as other aspects of the Redesign 
in some test sites. This will provide us with a body of information 
about each individual part of the Redesign as well as the combined 
effect on individuals and on program expenditures of the overall 
Redesign.

Public Comments

    We received comments on the NPRM from twenty-one commenters. The 
commenters included attorneys, medical professionals, advocates, State 
agency employees and Federal employees, and representatives of numerous 
organizations that represent the disabled. We received no comments from 
persons receiving benefits based on disability. Many commenters 
supported and applauded us for undertaking tests of models that modify 
the disability determination process. These commenters included the ARC 
(formerly known as the Association for Retarded Citizens of the United 
States); the American Academy of Pediatrics; the American Foundation 
for the Blind; the United Cerebral Palsy Associations; the 
Administrative Conference of the United States; the Council for 
Exceptional Children; and the National Council on Disability. Some of 
the comments we received were outside the scope of the proposed rules, 
and therefore, have not been addressed. The substantive comments made 
by the [[Page 20025]] commenters and our responses are summarized 
below.
    Comment: Many commenters raised concerns regarding the adequacy of 
the training that would be provided to interviewers and decisionmakers 
(particularly single decisionmakers).
    Response: We will ensure that the interviewers and decisionmakers 
who participate in our tests will be highly trained individuals who are 
well versed in both the disability and nondisability aspects of the 
disability programs and are individuals who have the necessary 
knowledge, skills, and abilities to conduct personal interviews, 
develop evidentiary records, and fully adjudicate disability claims, as 
appropriate. These individuals will also be able to call on other SSA 
resources, including medical and technical support personnel, to 
provide advice and assistance in the claims process.
    Comment: Several commenters raised concerns regarding the apparent 
lack of involvement of the medical consultant in making disability 
determinations because the medical consultant would not be required to 
sign the disability determination forms used to certify the 
determination of disability to us.
    Response: The fact that we intend to test a model or combinations 
of models where the determination of disability is made by a single 
decisionmaker does not mean that the medical consultant is being 
removed from the decisionmaking process. The decisionmaker will consult 
with the medical consultant whenever appropriate. This means that the 
decisionmaker will make reasonable efforts to ensure that a qualified 
pediatrician or other appropriate specialist evaluates the claim 
whenever a determination of disability is required in claims filed on 
behalf of children under age 18 claiming SSI payments based on 
disability. Similarly, before making a determination that an individual 
is not under a disability in any case which indicates the existence of 
a mental impairment, the decisionmaker will make every reasonable 
effort to ensure that a qualified psychiatrist or psychologist 
completes the medical portion of the case review and any applicable 
residual functional assessment. In addition, the decisionmaker will 
consult with the medical consultant in all other situations where the 
decisionmaker finds that a consultation is appropriate. However, the 
single decisionmaker concept is based on the premise that the 
decisionmaker is fully competent to make an initial determination when 
an individual files an application for benefits based on disability. It 
also gives the decisionmaker flexibility to make such determinations 
without having to wait for the medical consultant to take part formally 
in the determination.
    Comment: Several commenters wanted us to include quality 
assessments of accuracy in our evaluation of all possible approaches to 
improved disability determinations. The commenters' concerns stem 
partially from the use of a single decisionmaker in some of the 
proposed models and from the fact that medical consultants will not be 
required to sign the disability determination forms used to certify the 
determination of disability to us.
    Response: Our evaluation of the models we test will include quality 
assurance procedures to ensure a thorough assessment of the accuracy of 
the disability determinations made under the test procedures. As 
previously noted, decisionmakers will comply with the statutory 
requirements regarding the use of medical consultants in SSI childhood 
disability claims, and in all denials of claims based upon mental 
impairments. In addition, such consultation will take place with 
respect to any other claim in which the decisionmaker finds it is 
appropriate to consult with the medical consultant.
    Comment: One commenter was concerned with how we would evaluate the 
success and impact of the model procedures.
    Response: We will have a study design and evaluation plan in place 
to assure a valid and accurate assessment of the degree to which the 
modifications to the disability determination process we test attain 
the goals we wish to achieve before any national implementation of the 
modifications begins.
    Comment: Several commenters expressed concerns that the proposed 
models did not appear to make any provisions for applicants requiring 
special assistance--e.g., individuals with mental impairments, older 
persons, the homeless, etc.
    Response: The modifications to the disability determination process 
we test will not compromise any provisions that we currently have to 
provide accommodations for those individuals who require special 
assistance. As we stated in the summary sections of the NPRM and final 
rules, all other regulations related to the disability determination 
procedures remain unchanged unless specified. This would include 
provisions for claimants who may require special assistance. In fact, 
the disability claim manager model we now intend to test provides even 
more flexibility and opportunity to assist claimants who may require 
special assistance. The disability claim manager, acting as the focal 
point for the claimant's contacts with us throughout the initial 
disability process, will explain the disability programs to the 
claimant, including the definition of disability and how SSA determines 
if a claimant meets the disability requirements of the Act. The 
disability claim manager will also tell the claimant what he or she 
will be asked to do throughout the process, what the claimant may 
expect from SSA during the process, and how the claimant can interact 
with the disability claim manager to obtain more information or 
assistance. The disability claim manager will also advise the claimant 
regarding the right to representation and provide the appropriate 
referral sources for representation.
    Comment: Several commenters were concerned regarding the use of 
videoconferencing as a substitute for personal face-to-face interviews, 
because videoconferencing may not carry the same weight as a face-to-
face interview and the lack of personal contact could make the 
applicant feel depersonalized. In addition, some commenters expressed 
concerns that videoconferencing may not be an option for those 
claimants with special needs such as those with visual or hearing-
related disabilities, or for those individuals who could not provide 
their own videoconferencing equipment.
    Response: The testing of videoconferencing as an alternative to a 
personal face-to-face interview was proposed and is included in these 
final rules because it has the potential of becoming a viable and more 
convenient alternative for many claimants who would find it a hardship 
or impossibility to travel for an interview, but who still wanted to 
take advantage of the opportunity of an interview with the 
decisionmaker prior to the determination of disability. An interview 
conducted via video or via the telephone will carry the same weight as 
an interview conducted face-to-face. In these final rules the 
decisionmaker(s) who will conduct the interview has the discretion to 
determine which method of interview (face-to-face, videoconferencing, 
or telephone) is most appropriate for each claimant's special needs. If 
we decide to conduct a claimant's interview via videoconferencing, we 
will provide the necessary videoconferencing services for the claimant. 
We are exploring and testing the option of videoconferencing at all 
levels of the claims process, both within and outside the projects to 
be done under these regulations. [[Page 20026]] Regulatory authority to 
offer it as a service option is not needed.
    Comment: We received several comments regarding claimant due 
process rights and the possibility that they could be compromised by 
some of the models.
    Response: None of the models we intend to test will compromise or 
diminish the claimant's due process rights. In fact, the disability 
claim manager model we now intend to test provides a process that is 
committed to keeping the claimant more informed regarding his or her 
rights and allows the claimant to obtain information and assistance 
more easily. Also, in the context of ensuring a fair and correct 
initial determination of disability, the predecision interview model 
provides the claimant an opportunity to have an interview with the 
decisionmaker(s) and to submit additional evidence before an initial 
determination denying the claim is made or when the evidence in file is 
insufficient to make a fully favorable determination.
    Comment: Several commenters were interested in having us test the 
models that involved face-to-face contact with the decisionmaker(s) 
prior to the initial disability determination in combination with the 
reconsideration elimination model.
    Response: These final rules provide us with the flexibility to test 
models individually or in combination with other models. Therefore, we 
may test model(s) involving the opportunity for face-to-face contact 
between the claimant and the decisionmaker(s) with the reconsideration 
elimination model.
    Comment: Several commenters were concerned with the fact that the 
face-to-face predenial interview model only provided direct appeal of 
disability issues involved in the initial determination to the ALJ.
    Response: These final rules have been revised to allow appeal of 
both disability and nondisability factors to the ALJ whenever any of 
the first three models are tested in combination with the 
reconsideration elimination model. As stated earlier, the face-to-face 
predenial interview model with limited direct appeal rights to the 
administrative law judge has been changed in the final rule to a less 
formal predecision interview model. The predecision interview model 
does not place conditions on a claimant's appeal rights, but still 
provides the claimant with the opportunity for a face-to-face interview 
with the decisionmaker(s) when the decisionmaker finds that the 
evidence in the file is insufficient to make a fully favorable 
determination or requires an initial determination denying the claim. 
The reconsideration elimination model has also been modified to allow 
appeal to the ALJ if the claimant is dissatisfied with the initial 
determination made on his or her claim, based upon either medical or 
nonmedical factors.
    Comment: Several commenters were concerned that there was no 
specific indication as to whether children's claims would be included 
in the tests.
    Response: As stated previously, the summary section of the NPRM and 
these final rules state that all other regulations related to the 
disability determination procedures remain unchanged unless specified. 
That includes the rules for determinations of disability in children. 
We have no plans to exclude claims filed by or behalf of children from 
the tests. As stated previously, the decisionmaker will make reasonable 
efforts to ensure that a qualified pediatrician or other appropriate 
specialist evaluates the claim whenever a determination of disability 
is required in claims filed by or on behalf of children under age 18 
claiming SSI benefits based on disability. We have no intention of 
compromising any of the safeguards currently in place to protect the 
rights of children in the disability determination process.
    Comment: Several commenters were concerned that the models would 
generate increased workload demands (particularly the elimination of 
the reconsideration model and its predicted effect of increasing ALJ 
workloads) and some felt that some of the models would be too costly.
    Response: These types of concerns are one of the reasons why we 
proposed testing, rather than implementing changes to our current 
rules. If the model process or combination of processes we test proves 
to be prohibitively costly or to create unmanageable workloads or both, 
we will either drop the model from consideration or revise the model 
process to address the problem.

Regulatory Procedures

Executive Order 12866

    The Office of Management and Budget (OMB) has reviewed these final 
rules and determined they do not meet the criteria for a significant 
regulatory action under E.O. 12866.

Paperwork Reduction Act

    Data collection involved in the evaluation of any of the models may 
necessitate new reporting or recordkeeping requirements which may need 
clearance by OMB. These requirements are still being developed. When 
specifics have been determined, any necessary request for clearance 
will be forwarded to OMB as required by the Paperwork Reduction Act.

Regulatory Flexibility Act

    We certify that these regulations will not have a significant 
economic impact on a substantial number of small entities because they 
affect individuals. Therefore, a regulatory flexibility analysis as 
provided in Pub. L. 96-354, the Regulatory Flexibility Act, is not 
required.

(Catalog of Federal Domestic Assistance Program Nos. 93.802, Social 
Security-Disability Insurance; 93.807, Supplemental Security Income)

List of Subjects

20 CFR Part 404

    Administrative practice and procedure, Death benefits, Disability 
benefits, Old-Age, Reporting and recordkeeping requirements, Survivors 
and Disability insurance.

20 CFR Part 416

    Administrative practice and procedure, Aged, Blind, Disability 
benefits, Public assistance programs, Reporting and recordkeeping 
requirements, Supplemental Security Income.

    Dated: February 15, 1995.
Shirley Chater,
Commissioner of Social Security.
    Approved: March 30, 1995.
Donna E. Shalala,
Secretary of Health and Human Services.

    For the reasons set out in the preamble, parts 404 and 416 of 
chapter III of title 20 of the Code of Federal Regulations are amended 
as set forth below.

PART 404--FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE 
(1950-  )

    Subpart J is amended as follows:
    1. The authority citation for subpart J of part 404 continues to 
read as follows:

    Authority: Secs. 201(j), 205 (a), (b), (d)-(h), and (j), 221(d), 
and 1102 of the Social Security Act; 31 U.S.C. 3720A; 42 U.S.C. 
401(j), 405(a), (b), (d)-(h), and (j), 421(d), and 1302, sec. 5 of 
Pub. L. 97-455, 96 Stat. 2500; sec. 6 of Pub. L. 98-460, 98 Stat. 
1802.

    2. Section 404.906 is revised to read as follows:


Sec. 404.906  Testing modifications to the disability determination 
procedures.

    (a) Applicability and scope. Notwithstanding any other provision in 
this part or part 422 of this chapter, we are establishing the 
procedures set out [[Page 20027]] in this section to test modifications 
to our disability determination process. These modifications will 
enable us to test, either individually or in one or more combinations, 
the effect of: having disability claim managers assume primary 
responsibility for processing an application for disability benefits; 
providing persons who have applied for benefits based on disability 
with the opportunity for an interview with a decisionmaker when the 
decisionmaker finds that the evidence in the file is insufficient to 
make a fully favorable determination or requires an initial 
determination denying the claim; having a single decisionmaker make the 
initial determination with assistance from medical consultants, where 
appropriate; and eliminating the reconsideration step in the 
administrative review process and having a claimant who is dissatisfied 
with the initial determination request a hearing before an 
administrative law judge. The model procedures we test will be designed 
to provide us with information regarding the effect of these procedural 
modifications and enable us to decide whether and to what degree the 
disability determination process would be improved if they were 
implemented on a national level.
    (b) Procedures for cases included in the tests. Prior to commencing 
each test or group of tests in selected site(s), we will publish a 
notice in the Federal Register. The notice will describe which model or 
combinations of models we intend to test, where the specific test 
site(s) will be, and the duration of the test(s). The individuals who 
participate in the test(s) will be randomly assigned to a test group in 
each site where the tests are conducted. Paragraphs (b) (1) through (4) 
of this section lists descriptions of each model.
    (1) In the disability claim manager model, when you file an 
application for benefits based on disability, a disability claim 
manager will assume primary responsibility for the processing of your 
claim. The disability claim manager will be the focal point for your 
contacts with us during the claims intake process and until an initial 
determination on your claim is made. The disability claim manager will 
explain the disability programs to you, including the definition of 
disability and how we determine whether you meet all the requirements 
for benefits based on disability. The disability claim manager will 
explain what you will be asked to do throughout the claims process and 
how you can obtain information or assistance through him or her. The 
disability claim manager will also provide you with information 
regarding your right to representation, and he or she will provide you 
with appropriate referral sources for representation. The disability 
claim manager may be either a State agency employee or a Federal 
employee. In some instances, the disability claim manager may be 
assisted by other individuals.
    (2) In the single decisionmaker model, the decisionmaker will make 
the disability determination and may also determine whether the other 
conditions for entitlement to benefits based on disability are met. The 
decisionmaker will make the disability determination after any 
appropriate consultation with a medical or psychological consultant. 
The medical or psychological consultant will not be required to sign 
the disability determination forms we use to have the State agency 
certify the determination of disability to us (see Sec. 404.1615). 
However, before an initial determination is made that a claimant is not 
disabled in any case where there is evidence which indicates the 
existence of a mental impairment, the decisionmaker 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 pursuant to our 
existing procedures (see Sec. 404.1617). In some instances the 
decisionmaker may be the disability claim manager described in 
paragraph (b)(1) of this section. When the decisionmaker is a State 
agency employee, a team of individuals that includes a Federal employee 
will determine whether the other conditions for entitlement to benefits 
are met.
    (3) In the predecision interview model, if the decisionmaker(s) 
finds that the evidence in your file is insufficient to make a fully 
favorable determination or requires an initial determination denying 
your claim, a predecision notice will be mailed to you. The notice will 
tell you that, before the decisionmaker(s) makes an initial 
determination about whether you are disabled, you may request a 
predecision interview with the decisionmaker(s). The notice will also 
tell you that you may submit additional evidence. You must request a 
predecision interview within 10 days after the date you receive the 
predecision notice. You must also submit any additional evidence within 
10 days after you receive the predecision notice. If you request a 
predecision interview, the decisionmaker(s) will conduct the 
predecision interview in person, by videoconference, or by telephone as 
the decisionmaker(s) determines is appropriate under the circumstances. 
If you make a late request for a predecision interview, or submit 
additional evidence late, but show in writing that you had good cause 
under the standards in Sec. 404.911 for missing the deadline, the 
decisionmaker(s) will extend the deadline. If you do not request the 
predecision interview, or if you do not appear for a scheduled 
predecision interview and do not submit additional evidence, or if you 
do not respond to our attempts to communicate with you, the 
decisionmaker(s) will make an initial determination based upon the 
evidence in your file. If you identify additional evidence during the 
predecision interview, which was previously not available, the 
decisionmaker(s) will advise you to submit the evidence. If you are 
unable to do so, the decisionmaker(s) may assist you in obtaining it. 
The decisionmaker(s) also will advise you of the specific timeframes 
you have for submitting any additional evidence identified during the 
predecision interview. If you have no treating source(s) (see 
Sec. 404.1502), or your treating source(s) is unable or unwilling to 
provide the necessary evidence, or there is a conflict in the evidence 
that cannot be resolved through evidence from your treating source(s), 
the decisionmaker(s) may arrange a consultative examination or resolve 
conflicts according to existing procedures (see Sec. 404.1519a). If you 
attend the predecision interview, or do not attend the predecision 
interview but you submit additional evidence, the decisionmaker(s) will 
make an initial determination based on the evidence in your file, 
including the additional evidence you submit or the evidence obtained 
as a result of the predecision notice or interview, or both.
    (4) In the reconsideration elimination model, we will modify the 
disability determination process by eliminating the reconsideration 
step of the administrative review process. If you receive an initial 
determination on your claim for benefits based on disability, and you 
are dissatisfied with the determination, we will notify you that you 
may request a hearing before an administrative law judge. If you 
request a hearing before an administrative law judge, we will apply our 
usual procedures contained in subpart J of this part.

PART 416--SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND 
DISABLED

    Subpart N is amended as follows:
    1. The authority citation for subpart N of part 416 continues to 
read as follows:

    [[Page 20028]] Authority: Secs. 1102, 1631, and 1633 of the 
Social Security Act; 42 U.S.C. 1302, 1383, and 1383b.

    2. Section 416.1406 is revised to read as follows:


Sec. 416.1406  Testing modifications to the disability determination 
procedures.

    (a) Applicability and scope. Notwithstanding any other provision in 
this part or part 422 of this chapter, we are establishing the 
procedures set out in this section to test modifications to our 
disability determination process. These modifications will enable us to 
test, either individually or in one or more combinations, the effect 
of: having disability claim managers assume primary responsibility for 
processing an application for SSI payments based on disability; 
providing persons who have applied for benefits based on disability 
with the opportunity for an interview with a decisionmaker when the 
decisionmaker finds that the evidence in the file is insufficient to 
make a fully favorable determination or requires an initial 
determination denying the claim; having a single decisionmaker make the 
initial determination with assistance from medical consultants, where 
appropriate; and eliminating the reconsideration step in the 
administrative review process and having a claimant who is dissatisfied 
with the initial determination request a hearing before an 
administrative law judge. The model procedures we test will be designed 
to provide us with information regarding the effect of these procedural 
modifications and enable us to decide whether and to what degree the 
disability determination process would be improved if they were 
implemented on a national level.
    (b) Procedures for cases included in the tests. Prior to commencing 
each test or group of tests in selected site(s), we will publish a 
notice in the Federal Register. The notice will describe which model or 
combinations of models we intend to test, where the specific test 
site(s) will be, and the duration of the test(s). The individuals who 
participate in the test(s) will be randomly assigned to a test group in 
each site where the tests are conducted. Paragraph (b) (1) through (4) 
of this section lists descriptions of each model.
    (1) In the disability claim manager model, when you file an 
application for SSI payments based on disability, a disability claim 
manager will assume primary responsibility for the processing of your 
claim. The disability claim manager will be the focal point for your 
contacts with us during the claims intake process and until an initial 
determination on your claim is made. The disability claim manager will 
explain the SSI disability program to you, including the definition of 
disability and how we determine whether you meet all the requirements 
for SSI payments based on disability. The disability claim manager will 
explain what you will be asked to do throughout the claims process and 
how you can obtain information or assistance through him or her. The 
disability claim manager will also provide you with information 
regarding your right to representation, and he or she will provide you 
with appropriate referral sources for representation. The disability 
claim manager may be either a State agency employee or a Federal 
employee. In some instances, the disability claim manager may be 
assisted by other individuals.
    (2) In the single decisionmaker model, the decisionmaker will make 
the disability determination and may also determine whether the other 
conditions of eligibility for SSI payments based on disability are met. 
The decisionmaker will make the disability determination after any 
appropriate consultation with a medical or psychological consultant. 
The medical or psychological consultant will not be required to sign 
the disability determination forms we use to have the State agency 
certify the determination of disability to us (see Sec. 416.1015). 
However, before an initial determination is made that a claimant is not 
disabled in any case where there is evidence which indicates the 
existence of a mental impairment, the decisionmaker 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 pursuant to our 
existing procedures (see Sec. 416.1017). Similarly, in making an 
initial determination with respect to the disability of a child under 
age 18 claiming SSI payments based on disability, the decisionmaker 
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 claim of such child (see 
Sec. 416.903(f)). In some instances the decisionmaker may be the 
disability claim manager described in paragraph (b)(1) of this section. 
When the decisionmaker is a State agency employee, a team of 
individuals that includes a Federal employee will determine whether the 
other conditions of eligibility for SSI payments are met.
    (3) In the predecision interview model, if the decisionmaker(s) 
finds that the evidence in your file is insufficient to make a fully 
favorable determination or requires an initial determination denying 
your claim, a predecision notice will be mailed to you. The notice will 
tell you that, before the decisionmaker(s) makes an initial 
determination about whether you are disabled, you may request a 
predecision interview with the decisionmaker(s). The notice will also 
tell you that you may also submit additional evidence. You must request 
a predecision interview within 10 days after the date you receive the 
predecision notice. You must also submit any additional evidence within 
10 days after the date you receive the predecision notice. If you 
request a predecision interview, the decisionmaker(s) will conduct the 
predecision interview in person, by videoconference, or by telephone as 
the decisionmaker(s) determines is appropriate under the circumstances. 
If you make a late request for a predecision interview, or submit 
additional evidence late, but show in writing that you had good cause 
under the standards in Sec. 416.1411 for missing the deadline, the 
decisionmaker(s) will extend the deadline. If you do not request the 
predecision interview or if you do not appear for a scheduled 
predecision interview and do not submit additional evidence, or if you 
do not respond to our attempts to communicate with you, the 
decisionmaker(s) will make an initial determination based upon the 
evidence in your file. If you identify additional evidence during the 
predecision interview, which was previously not available, the 
decisionmaker(s) will advise you to submit the evidence. If you are 
unable to do so, the decisionmaker(s) may assist you in obtaining it. 
The decisionmaker(s) also will advise you of the specific timeframes 
you have for submitting any additional evidence identified during the 
predecision interview. If you have no treating source(s) (see 
Sec. 416.902), or your treating source(s) is unable or unwilling to 
provide the necessary evidence, or there is a conflict in the evidence 
that cannot be resolved through evidence from your treating source(s), 
the decisionmaker(s) may arrange a consultative examination or resolve 
conflicts according to existing procedures (see Sec. 416.919a). If you 
attend the predecision interview, or do not attend the predecision 
interview but you submit additional evidence, the decisionmaker(s) will 
make an initial determination based on the evidence in your file, 
including the additional evidence you submit or the evidence 
[[Page 20029]] obtained as a result of the predecision notice or 
interview, or both.
    (4) In the reconsideration elimination model, we will modify the 
disability determination process by eliminating the reconsideration 
step of the administrative review process. If you receive an initial 
determination on your claim for SSI payments based on disability, and 
you are dissatisfied with the determination, we will notify you that 
you may request a hearing before an administrative law judge. If you 
request a hearing before an administrative law judge, we will apply our 
usual procedures contained in subpart N of this part.

[FR Doc. 95-9897 Filed 4-21-95; 8:45 am]
BILLING CODE 4190-29-P