[Federal Register: May 9, 2003 (Volume 68, Number 90)]
[Proposed Rules]
[Page 24896-24898]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr09my03-30]
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SOCIAL SECURITY ADMINISTRATION
20 CFR Parts 404 and 416
[Regulations Nos. 4 and 16]
RIN 0960-AF33
Revised Medical Criteria for Evaluating Immune System Disorders
AGENCY: Social Security Administration.
ACTION: Advance notice of proposed rulemaking.
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SUMMARY: We are planning to update and revise the rules that we use to
evaluate immune system disorders of adults and children who apply for,
or receive, disability benefits under title II and Supplemental
Security Income (SSI) payments based on disability under title XVI of
the Social Security Act (the Act). The rules we plan on revising are
sections 14.00 and 114.00 in the Listing of Impairments in appendix 1
to subpart P of part 404 of our regulations (the listings). We invite
you to send us comments and suggestions for updating and revising these
rules.
After we have considered your comments and suggestions, as well as
information about advances in medical knowledge, treatment, and methods
of evaluating immune system disorders, and our program experience, we
intend to publish for public comment a Notice of Proposed Rulemaking
(NPRM) that will propose specific revisions to the rules.
As part of our long-term planning for the disability programs, we
are also interested in your ideas for how we may be able to improve our
programs for people who have immune system disorders, especially those
who would like to work.
[[Page 24897]]
DATES: To be sure your comments are considered, we must receive them by
July 8, 2003.
ADDRESSES: You may give us your comments using: our Internet site
facility (i.e., Social Security Online) at: http://policy.ssa.gov/
pnpublic.nsf/LawsRegs; e-mail to http://policy.ssa.gov/966-2830
; or, by letter to the Commissioner of Social Security, P.O.
Box 17703, Baltimore, Maryland 21235-7703. You may also deliver them to
the Office of Regulations, Social Security Administration, 100 Altmeyer
Building, 6401 Security Boulevard, Baltimore, Maryland 21235-6401,
between 8 a.m. and 4:30 p.m. on regular business days. Comments are
posted in our Internet site at http://policy.ssa.gov/pnpublic.nsf/LawsRegs
, or you may inspect them on regular business days by making
arrangements with the contact person shown in this preamble.
Electronic Version: The electronic file of this document is
available on the date of publication in the Federal Register at http://www.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/regulations/
.
FOR FURTHER INFORMATION CONTACT: Suzanne DiMarino, 100 Altmeyer
Building, 6401 Security Boulevard, Baltimore, Maryland 21235-6401,
(410) 965-1769 or TTY (410) 966-5609. For information on eligibility or
filing for benefits, call our national toll-free number 1-800-772-1213
or TTY 1-800-325-0778, or visit our Internet Web site, Social Security
Online, at www.ssa.gov.
SUPPLEMENTARY INFORMATION:
What Is the Purpose of This Notice?
We are planning to update and revise the rules that we use to
evaluate immune system disorders of adults and children who apply for,
or receive, disability benefits under title II and Supplemental
Security Income (SSI) payments based on disability under title XVI of
the Act. The purpose of this notice is to give you an opportunity to
send us comments and suggestions for updating and revising those rules
as we begin the rulemaking process. We are also asking for your
comments and ideas about how we can improve our disability programs in
the future for people with immune system disorders.
Who Should Send Us Comments and Suggestions?
We invite comments and suggestions from anyone who has an interest
in the rules we use to evaluate claims for benefits filed by people who
have immune system disorders. We are interested in getting comments and
suggestions from people who apply for or receive benefits from us,
members of the general public, advocates and organizations who advocate
for people who have immune system disorders, experts in the evaluation
of immune system disorders, researchers, people who make disability
determinations for us, and any other people who may have ideas for us
to consider.
Will We Respond to Your Comments from This Notice?
No, we will not respond directly to comments you send us because of
this notice. However, after we consider your comments in response to
this notice, along with other information such as medical research and
our program experience, we will decide how to revise the rules we use
to evaluate immune system disorders. When we propose specific revisions
to the rules, we will publish an NPRM in the Federal Register. In
accordance with the usual rulemaking procedures we follow, you will
have a chance to comment on the revisions we propose when we publish
the NPRM, and we will summarize and respond to the significant comments
on the NPRM in the preamble to any final rules.
Which Rules Are We Considering for Updating and Revising?
We are considering two sections of our listings for revision,
sections 14.00 and 114.00. These are the listings for immune disorders
for adults (Part A, 14.00) and children (Part B, 114.00). It includes
such disorders as HIV infection, other Immunoglobulin deficiency
syndromes or deficiencies of cell-mediated immunity, Systemic Lupus
Erythematosus, Scleroderma, Polymyositis, Inflammatory Arthritis, and
other connective tissue disorders.
Where Can You Find These Rules on the Internet?
You can find these rules on our Internet site at these locations:
[sbull] Sections 14.00 and 114.00 are in the Listing of Impairments
in appendix 1 to subpart P of part 404 of our regulations at: http://www.ssa.gov/OP_Home/cfr20/404/404-ap09.htm
.
[sbull] You can also look up sections 14.00 and 114.00 at: http://www.ssa.gov/disability/professionals/bluebook/
.
[sbull] If you do not have Internet access, you can find the Code
of Federal Regulations in some public libraries, Federal depository
libraries, and public law libraries.
Why Are We Updating and Revising Our Rules for Evaluating Immune System
Disorders?
[sbull] The current listings for immune system disorders for adults
(14.00) and children (114.00) will no longer be in effect on July 2,
2003, unless we extend them or revise and promulgate them again, so we
must consider now whether to update and revise them.
We published final rules on July 2, 1993, which established body
system listings in part A and part B of the listings for immune system
disorders (58 FR 36008). We made those rules effective for five years
from the date of publication, unless we extended them, or revised and
issued them again (58 FR 36051). Since that time, we have extended the
expiration date of the immune body system listings. Most recently, on
June 28, 2001, we published rules that extended the effective date of
the current immune system listings until July 2, 2003 (66 FR 34361).
Although we published final rules in the Federal Register revising some
of the immune system listings on November 19, 2001 (66 FR 58009), we
have not comprehensively revised them since 1993.
We will be considering information from many sources, including the
following recent documents, for relevance to our policy for evaluating
immune system diseases.
[sbull] Kippel, J., Weyand, C., & Wortmann, R. (Eds.). (1997).
Primer on the Rheumatic Diseases, (11th ed.). Atlanta: Arthritis
Foundation.
[sbull] Davidson, A. & Diamond, B. (2001). Autoimmune Diseases. The
New England Journal of Medicine, 345(5), 1-21.
[sbull] Marmont, A. (2000). New Horizons in the Treatment of
Autoimmune Diseases: Immunoablation and Stem Cell Transplantation.
Annual Reviews, 51, 115-134.
[sbull] Nash, R.A. (2000). Prospects of Stem Cell Transplantation
in Autoimmune Diseases. Journal of Clinical Immunology, 20(1), 38-45.
[sbull] Sicherer, S.H. (et al.). (1998). Primary Immunodeficiency
Diseases in Adults. Journal of American Medical Association, 279:58.
What Should You Comment About?
We are interested in any comments and suggestions you have for
revising sections 14.00 and 114.00 of our listings. For example, with
regard to our listings, we are interested in knowing if:
[sbull] You have concerns about any of the current listings
provisions for adults or children; such as whether you think we should
change any of our criteria or
[[Page 24898]]
whether you think a listing is difficult to use or understand.
[sbull] You would like to see our listings include something that
they do not include now.
You can also make any other comments or suggestions to help us
improve our rules for evaluating claims for benefits filed by adults
and children who have immune system disorders.
In addition to your comments about our regulations, we are also
interested in any ideas you have about how the disability requirements
of the Act and our regulations affect people who have immune system
disorders, especially those who would like to work, full-time or part-
time with supports. Your ideas can address our existing rules and
regulations or suggest changes to the law. For example, we know that
many people who have immune system disorders might not need benefits
from us if they could get treatment before their disorders make them
unable to work. Others may be unable to work but may not need to stay
out of work indefinitely if they could get treatment or other
interventions. Many people with permanent disorders can work if they
have a supporting safety net (including title II disability benefits
and SSI payments). Work can also be therapeutic for some people.
Although the Act and our regulations include some access to health care
through Medicare and Medicaid, some provision for vocational
rehabilitation, and a number of work incentives, these provisions are
generally for people who already qualify for benefits under our
disability programs.
We are interested in your ideas for how we may be able to improve
our programs for people who have immune system disorders, especially
those who would like to work full-time or part-time with supports. Your
ideas can address our existing rules and regulations or suggest changes
to the law. We will consider your ideas as we develop the NPRM we
intend to publish for public comment, and, where applicable, as part of
our long-term planning for the disability program.
Other Information
Who Can Get Disability Benefits?
Under title II of the Act, we provide for the payment of disability
benefits if you are disabled and belong to one of the following three
groups:
[sbull] Workers insured under the Act,
[sbull] Children of insured workers, and
[sbull] Widows, widowers, and surviving divorced spouses (see 20
CFR 404.336) of insured workers.
Under title XVI of the Act, we provide for Supplemental Security
Income (SSI) payments on the basis of disability if you are disabled
and have limited income and resources.
How Do We Define Disability?
Under both the title II and title XVI programs, disability must be
the result of any medically determinable physical or mental impairment
or combination of impairments that is expected to result in death or
which has lasted or is expected to last for a continuous period of at
least 12 months. Our definitions of disability are shown in the
following table:
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Disability means you
have a medically
If you file a claim under * * And you are * * * determinable
* impairment(s) as
described above and
that results in * * *
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title II...................... an adult or a the inability to do
child. any substantial
gainful activity
(SGA).
title XVI..................... a person age 18 the inability to do
or older. any SGA.
title XVI..................... a person under marked and severe
age 18. functional
limitations.
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What Are the Listings?
The listings are examples of impairments that we consider severe
enough to prevent a person from doing any gainful activity, or that
result in ``marked and severe functional limitations'' in children
seeking SSI payments under title XVI of the Act. Although we publish
the listings only in appendix 1 to subpart P of part 404 of our rules,
we incorporate them by reference in the SSI program in Sec. 416.925 of
our regulations, and apply them to claims under both title II and title
XVI of the Act.
How Do We Use the Listings?
The listings are in two parts. There are listings for adults (part
A) and for children (part B). If you are a person age 18 or over, we
apply the listings in part A when we assess your claim, and we never
use the listings in part B.
If you are a person under age 18, we first use the criteria in part
B of the listings. If the listings in part B do not apply, and the
specific disease process(es) has a similar effect on adults and
children, we then use the criteria in part A. (See Sec. Sec. 404.1525
and 416.925.)
If your impairment(s) does not meet any listing, we will also
consider whether it medically equals any listing; that is, whether it
is as medically severe. (See Sec. Sec. 404.1526 and 416.926.)
We use the listings only to decide that people are disabled or that
they are still disabled. We will never deny your claim or decide that
you no longer qualify for benefits simply because your impairment(s)
does not meet or medically equal a listing. If you have a severe
impairment(s) that does not meet or medically equal any listing, we may
still find you disabled based on other rules in the ``sequential
evaluation process'' that we use to evaluate all disability claims.
(See Sec. Sec. 404.1520, 416.920, and 416.924.) If you have a severe
impairment(s) that does not meet or medically equal any listing, we may
still find you disabled based on other rules in the ``sequential
evaluation process'' that we use to evaluate all disability claims.
(See Sec. Sec. 404.1520, 416.920, and 416.924.)
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, Supplemental Security Income
(SSI), Reporting and recordkeeping requirements.
Dated: April 16, 2003.
Jo Anne B. Barnhart,
Commissioner of Social Security.
[FR Doc. 03-11491 Filed 5-8-03; 8:45 am]
BILLING CODE 4191-02-U