42 U.S.C. § 421 — Disability determinations

Page 2061 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 421 elected to serve as a member or the head of the tribal council. (2) The term ‘‘tribal council’’ means the ap- pointed or elected governing body of a feder- ally recognized Indian tribe. (c) Effective date of agreement (1) Any agreement under this section shall be effective with respect to services performed after an effective date specified in such agree- ment, provided that such date may not be ear- lier than the first day of the next calendar month after the month in which the agreement is executed by both parties. (2) At the request of the Indian tribe at the time of the agreement, such agreement may apply with respect to services performed before such effective date for which there were timely paid in good faith (and not subsequently re- funded) to the Secretary of the Treasury amounts equivalent to the sum of the taxes which would have been imposed by sections 3101 and 3111 of the Internal Revenue Code of 1986 had such services constituted employment for pur- poses of chapter 21 of such Code. No agreement under this section may require payment to be made after the effective date specified in such agreement of any taxes with respect to services performed before such effective date. (d) Duration of agreement No agreement under this section may be ter- minated on or after the effective date of the agreement. (Aug. 14, 1935, ch. 531, title II, § 218A, as added Pub. L. 115–243, § 2(a), Sept. 20, 2018, 132 Stat. 2894.) Editorial Notes REFERENCES IN TEXT The Internal Revenue Code of 1986, referred to in sub- sec. (c)(2), is classified generally to Title 26, Internal Revenue Code. Statutory Notes and Related Subsidiaries CONSTRUCTION Nothing in enactment of this section by Pub. L. 115–243 to be construed to affect application of any Fed- eral income tax withholding requirements under Title 26, Internal Revenue Code, see section 2(c) of Pub. L. 115–243, set out as a Construction of 2018 Amendment note under section 3121 of Title 26. § 419. Repealed. Pub. L. 86–778, title I, § 103(j)(1), Sept. 13, 1960, 74 Stat. 937 Section, act Aug. 14, 1935, ch. 531, title II, § 219, as added Aug. 28, 1950, ch. 809, title I, § 107, 64 Stat. 517, prescribed the effective date of this subchapter in Puer- to Rico as January 1 of the first calendar year which begins more than 90 days after the date on which the President received a certification from the Governor of Puerto Rico. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF REPEAL Repeal effective Sept. 13, 1960, see section 103(v)(1), (3) of Pub. L. 86–778, set out as an Effective Date of 1960 Amendment note under section 402 of this title. § 420. Disability provisions inapplicable if benefit rights impaired None of the provisions of this subchapter re- lating to periods of disability shall apply in any case in which their application would result in the denial of monthly benefits or a lump-sum death payment which would otherwise be pay- able under this subchapter; nor shall they apply in the case of any monthly benefit or lump-sum death payment under this subchapter if such benefit or payment would be greater without their application. (Aug. 14, 1935, ch. 531, title II, § 220, as added Sept. 1, 1954, ch. 1206, title I, § 106(g), 68 Stat. 1081.) Editorial Notes PRIOR PROVISIONS A prior section 420, act Aug. 14, 1935, ch. 531, title II, § 220, as added July 18, 1952, ch. 945, § 3(e), 66 Stat. 772, relating to inapplicability of disability provisions if benefits were reduced, ceased to be in effect at the close of June 30, 1953. See Effective and Termination Date of 1952 Amendment note set out under section 413 of this title. § 421. Disability determinations (a) State agencies (1) In the case of any individual, the deter- mination of whether or not he is under a dis- ability (as defined in section 416(i) or 423(d) of this title) and of the day such disability began, and the determination of the day on which such disability ceases, shall be made by a State agen- cy, notwithstanding any other provision of law, in any State that notifies the Commissioner of Social Security in writing that it wishes to make such disability determinations com- mencing with such month as the Commissioner of Social Security and the State agree upon, but only if (A) the Commissioner of Social Security has not found, under subsection (b)(1), that the State agency has substantially failed to make disability determinations in accordance with the applicable provisions of this section or rules issued thereunder, and (B) the State has not no- tified the Commissioner of Social Security, under subsection (b)(2), that it does not wish to make such determinations. If the Commissioner of Social Security once makes the finding de- scribed in clause (A) of the preceding sentence, or the State gives the notice referred to in clause (B) of such sentence, the Commissioner of Social Security may thereafter determine whether (and, if so, beginning with which month and under what conditions) the State may again make disability determinations under this para- graph. (2) The disability determinations described in paragraph (1) made by a State agency shall be made in accordance with the pertinent provi- sions of this subchapter and the standards and criteria contained in regulations or other writ- ten guidelines of the Commissioner of Social Se- curity pertaining to matters such as disability determinations, the class or classes of individ- uals with respect to which a State may make disability determinations (if it does not wish to do so with respect to all individuals in the Page 2062 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 421 State), and the conditions under which it may choose not to make all such determinations. In addition, the Commissioner of Social Security shall promulgate regulations specifying, in such detail as the Commissioner deems appropriate, performance standards and administrative re- quirements and procedures to be followed in per- forming the disability determination function in order to assure effective and uniform adminis- tration of the disability insurance program throughout the United States. The regulations may, for example, specify matters such as— (A) the administrative structure and the re- lationship between various units of the State agency responsible for disability determina- tions, (B) the physical location of and relationship among agency staff units, and other individ- uals or organizations performing tasks for the State agency, and standards for the avail- ability to applicants and beneficiaries of fa- cilities for making disability determinations, (C) State agency performance criteria, in- cluding the rate of accuracy of decisions, the time periods within which determinations must be made, the procedures for and the scope of review by the Commissioner of Social Security, and, as the Commissioner finds ap- propriate, by the State, of its performance in individual cases and in classes of cases, and rules governing access of appropriate Federal officials to State offices and to State records relating to its administration of the disability determination function, (D) fiscal control procedures that the State agency may be required to adopt, and (E) the submission of reports and other data, in such form and at such time as the Commis- sioner of Social Security may require, con- cerning the State agency’s activities relating to the disability determination. Nothing in this section shall be construed to au- thorize the Commissioner of Social Security to take any action except pursuant to law or to regulations promulgated pursuant to law. (b) Determinations by Commissioner (1) If the Commissioner of Social Security finds, after notice and opportunity for a hearing, that a State agency is substantially failing to make disability determinations in a manner consistent with the Commissioner’s regulations and other written guidelines, the Commissioner of Social Security shall, not earlier than 180 days following the Commissioner’s finding, and after the Commissioner has complied with the requirements of paragraph (3), make the dis- ability determinations referred to in subsection (a)(1). (2) If a State, having notified the Commis- sioner of Social Security of its intent to make disability determinations under subsection (a)(1), no longer wishes to make such determina- tions, it shall notify the Commissioner of Social Security in writing of that fact, and, if an agen- cy of the State is making disability determina- tions at the time such notice is given, it shall continue to do so for not less than 180 days, or (if later) until the Commissioner of Social Secu- rity has complied with the requirements of para- graph (3). Thereafter, the Commissioner of So- cial Security shall make the disability deter- minations referred to in subsection (a)(1). (3)(A) The Commissioner of Social Security shall develop and initiate all appropriate proce- dures to implement a plan with respect to any partial or complete assumption by the Commis- sioner of Social Security of the disability deter- mination function from a State agency, as pro- vided in this section, under which employees of the affected State agency who are capable of performing duties in the disability determina- tion process for the Commissioner of Social Se- curity shall, notwithstanding any other provi- sion of law, have a preference over any other in- dividual in filling an appropriate employment position with the Commissioner of Social Secu- rity (subject to any system established by the Commissioner of Social Security for deter- mining hiring priority among such employees of the State agency) unless any such employee is the administrator, the deputy administrator, or assistant administrator (or his equivalent) of the State agency, in which case the Commis- sioner of Social Security may accord such pri- ority to such employee. (B) The Commissioner of Social Security shall not make such assumption of the disability de- termination function until such time as the Sec- retary of Labor determines that, with respect to employees of such State agency who will be dis- placed from their employment on account of such assumption by the Commissioner of Social Security and who will not be hired by the Com- missioner of Social Security to perform duties in the disability determination process, the State has made fair and equitable arrangements to protect the interests of employees so dis- placed. Such protective arrangements shall in- clude only those provisions which are provided under all applicable Federal, State and local statutes including, but not limited to, (i) the preservation of rights, privileges, and benefits (including continuation of pension rights and benefits) under existing collective-bargaining agreements; (ii) the continuation of collective- bargaining rights; (iii) the assignment of af- fected employees to other jobs or to retraining programs; (iv) the protection of individual em- ployees against a worsening of their positions with respect to their employment; (v) the pro- tection of health benefits and other fringe bene- fits; and (vi) the provision of severance pay, as may be necessary. (c) Review of determination by Commissioner (1) The Commissioner of Social Security may on the Commissioner’s own motion or as re- quired under paragraphs (2) and (3) review a de- termination, made by a State agency under this section, that an individual is or is not under a disability (as defined in section 416(i) or 423(d) of this title) and, as a result of such review, may modify such agency’s determination and deter- mine that such individual either is or is not under a disability (as so defined) or that such in- dividual’s disability began on a day earlier or later than that determined by such agency, or that such disability ceased on a day earlier or later than that determined by such agency. A review by the Commissioner of Social Security on the Commissioner’s own motion of a State Page 2063 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 421 agency determination under this paragraph may be made before or after any action is taken to implement such determination. (2) The Commissioner of Social Security (in accordance with paragraph (3)) shall review de- terminations, made by State agencies pursuant to this section, that individuals are under dis- abilities (as defined in section 416(i) or 423(d) of this title). Any review by the Commissioner of Social Security of a State agency determination under this paragraph shall be made before any action is taken to implement such determina- tion. (3)(A) In carrying out the provisions of para- graph (2) with respect to the review of deter- minations made by State agencies pursuant to this section that individuals are under disabil- ities (as defined in section 416(i) or 423(d) of this title), the Commissioner of Social Security shall review— (i) at least 50 percent of all such determina- tions made by State agencies on applications for benefits under this subchapter, and (ii) other determinations made by State agencies pursuant to this section to the extent necessary to assure a high level of accuracy in such other determinations. (B) In conducting reviews pursuant to subpara- graph (A), the Commissioner of Social Security shall, to the extent feasible, select for review those determinations which the Commissioner of Social Security identifies as being the most likely to be incorrect. (C) Not later than April 1, 1992, and annually thereafter, the Commissioner of Social Security shall submit to the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate a written report setting forth the number of reviews con- ducted under subparagraph (A)(ii) during the preceding fiscal year and the findings of the Commissioner of Social Security based on such reviews of the accuracy of the determinations made by State agencies pursuant to this section. (d) Hearings and judicial review Any individual dissatisfied with any deter- mination under subsection (a), (b), (c), or (g) shall be entitled to a hearing thereon by the Commissioner of Social Security to the same ex- tent as is provided in section 405(b) of this title with respect to decisions of the Commissioner of Social Security, and to judicial review of the Commissioner’s final decision after such hearing as is provided in section 405(g) of this title. (e) State’s right to cost from Trust Funds Each State which is making disability deter- minations under subsection (a)(1) shall be enti- tled to receive from the Trust Funds, in advance or by way of reimbursement, as determined by the Commissioner of Social Security, the cost to the State of making disability determinations under subsection (a)(1). The Commissioner of So- cial Security shall from time to time certify such amount as is necessary for this purpose to the Managing Trustee, reduced or increased, as the case may be, by any sum (for which adjust- ment hereunder has not previously been made) by which the amount certified for any prior pe- riod was greater or less than the amount which should have been paid to the State under this subsection for such period; and the Managing Trustee, prior to audit or settlement by the Government Accountability Office, shall make payment from the Trust Funds at the time or times fixed by the Commissioner of Social Secu- rity, in accordance with such certification. Ap- propriate adjustments between the Federal Old- Age and Survivors Insurance Trust Fund and the Federal Disability Insurance Trust Fund with respect to the payments made under this sub- section shall be made in accordance with para- graph (1) of subsection (g) of section 401 of this title (but taking into account any refunds under subsection (f) of this section) to insure that the Federal Disability Insurance Trust Fund is charged with all expenses incurred which are at- tributable to the administration of section 423 of this title and the Federal Old-Age and Survivors Insurance Trust Fund is charged with all other expenses. (f) Use of funds All money paid to a State under this section shall be used solely for the purposes for which it is paid; and any money so paid which is not used for such purposes shall be returned to the Treas- ury of the United States for deposit in the Trust Funds. (g) Regulations governing determinations in cer- tain cases In the case of individuals in a State which does not undertake to perform disability deter- minations under subsection (a)(1), or which has been found by the Commissioner of Social Secu- rity to have substantially failed to make dis- ability determinations in a manner consistent with the Commissioner’s regulations and guide- lines, in the case of individuals outside the United States, and in the case of any class or classes of individuals for whom no State under- takes to make disability determinations, the de- terminations referred to in subsection (a) shall be made by the Commissioner of Social Security in accordance with regulations prescribed by the Commissioner. (h) Evaluation of impairments by qualified med- ical professionals An initial determination under subsection (a), (c), (g), or (i) shall not be made until the Com- missioner of Social Security has made every reasonable effort to ensure— (1) in any case where there is evidence which indicates the existence of a mental impair- ment, that a qualified psychiatrist or psychol- ogist has completed the medical portion of the case review and any applicable residual func- tional capacity assessment; and (2) in any case where there is evidence which indicates the existence of a physical impair- ment, that a qualified physician has com- pleted the medical portion of the case review and any applicable residual functional capac- ity assessment. (i) Review of disability cases to determine con- tinuing eligibility; permanent disability cases; appropriate number of cases reviewed; reporting requirements (1) In any case where an individual is or has been determined to be under a disability, the Page 2064 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 421 case shall be reviewed by the applicable State agency or the Commissioner of Social Security (as may be appropriate), for purposes of con- tinuing eligibility, at least once every 3 years, subject to paragraph (2); except that where a finding has been made that such disability is permanent, such reviews shall be made at such times as the Commissioner of Social Security determines to be appropriate. Reviews of cases under the preceding sentence shall be in addi- tion to, and shall not be considered as a sub- stitute for, any other reviews which are required or provided for under or in the administration of this subchapter. (2) The requirement of paragraph (1) that cases be reviewed at least every 3 years shall not apply to the extent that the Commissioner of Social Security determines, on a State-by-State basis, that such requirement should be waived to insure that only the appropriate number of such cases are reviewed. The Commissioner of Social Security shall determine the appropriate num- ber of cases to be reviewed in each State after consultation with the State agency performing such reviews, based upon the backlog of pending reviews, the projected number of new applica- tions for disability insurance benefits, and the current and projected staffing levels of the State agency, but the Commissioner of Social Secu- rity shall provide for a waiver of such require- ment only in the case of a State which makes a good faith effort to meet proper staffing require- ments for the State agency and to process case reviews in a timely fashion. The Commissioner of Social Security shall report annually to the Committee on Finance of the Senate and the Committee on Ways and Means of the House of Representatives with respect to the determina- tions made by the Commissioner of Social Secu- rity under the preceding sentence. (3) The Commissioner of Social Security shall report annually to the Committee on Finance of the Senate and the Committee on Ways and Means of the House of Representatives with re- spect to the number of reviews of continuing disability carried out under paragraph (1), the number of such reviews which result in an ini- tial termination of benefits, the number of re- quests for reconsideration of such initial termi- nation or for a hearing with respect to such ter- mination under subsection (d), or both, and the number of such initial terminations which are overturned as the result of a reconsideration or hearing. (4) In any case in which the Commissioner of Social Security initiates a review under this subsection of the case of an individual who has been determined to be under a disability, the Commissioner of Social Security shall notify such individual of the nature of the review to be carried out, the possibility that such review could result in the termination of benefits, and the right of the individual to provide medical evidence with respect to such review. (5) For suspension of reviews under this sub- section in the case of an individual using a tick- et to work and self-sufficiency, see section 1320b–19(i) of this title. (j) Rules and regulations; consultative examina- tions The Commissioner of Social Security shall prescribe regulations which set forth, in detail— (1) the standards to be utilized by State dis- ability determination services and Federal personnel in determining when a consultative examination should be obtained in connection with disability determinations; (2) standards for the type of referral to be made; and (3) procedures by which the Commissioner of Social Security will monitor both the referral processes used and the product of professionals to whom cases are referred. Nothing in this subsection shall be construed to preclude the issuance, in accordance with sec- tion 553(b)(A) of title 5, of interpretive rules, general statements of policy, and rules of agen- cy organization relating to consultative exami- nations if such rules and statements are con- sistent with such regulations. (k) Establishment of uniform standards for de- termination of disability (1) The Commissioner of Social Security shall establish by regulation uniform standards which shall be applied at all levels of determination, review, and adjudication in determining whether individuals are under disabilities as defined in section 416(i) or 423(d) of this title. (2) Regulations promulgated under paragraph (1) shall be subject to the rulemaking procedures established under section 553 of title 5. (l) Special notice to blind individuals with re- spect to hearings and other official actions (1) In any case where an individual who is ap- plying for or receiving benefits under this sub- chapter on the basis of disability by reason of blindness is entitled to receive notice from the Commissioner of Social Security of any decision or determination made or other action taken or proposed to be taken with respect to his or her rights under this subchapter, such individual shall at his or her election be entitled either (A) to receive a supplementary notice of such deci- sion, determination, or action, by telephone, within 5 working days after the initial notice is mailed, (B) to receive the initial notice in the form of a certified letter, or (C) to receive notifi- cation by some alternative procedure estab- lished by the Commissioner of Social Security and agreed to by the individual. (2) The election under paragraph (1) may be made at any time, but an opportunity to make such an election shall in any event be given, to every individual who is an applicant for benefits under this subchapter on the basis of disability by reason of blindness, at the time of his or her application. Such an election, once made by an individual, shall apply with respect to all no- tices of decisions, determinations, and actions which such individual may thereafter be enti- tled to receive under this subchapter until such time as it is revoked or changed. (m) Work activity as basis for review (1) In any case where an individual entitled to disability insurance benefits under section 423 of this title or to monthly insurance benefits under Page 2065 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 421 section 402 of this title based on such individ- ual’s disability (as defined in section 423(d) of this title) has received such benefits for at least 24 months— (A) no continuing disability review con- ducted by the Commissioner may be scheduled for the individual solely as a result of the indi- vidual’s work activity; (B) no work activity engaged in by the indi- vidual may be used as evidence that the indi- vidual is no longer disabled; and (C) no cessation of work activity by the indi- vidual may give rise to a presumption that the individual is unable to engage in work. (2) An individual to which paragraph (1) ap- plies shall continue to be subject to— (A) continuing disability reviews on a regu- larly scheduled basis that is not triggered by work; and (B) termination of benefits under this sub- chapter in the event that the individual has earnings that exceed the level of earnings es- tablished by the Commissioner to represent substantial gainful activity. (Aug. 14, 1935, ch. 531, title II, § 221, as added Sept. 1, 1954, ch. 1206, title I, § 106(g), 68 Stat. 1081; amended Aug. 1, 1956, ch. 836, title I, § 103(c)(7), (8), (h), 70 Stat. 818, 823; Pub. L. 90–248, title I, § 158(c)(3), (4), Jan. 2, 1968, 81 Stat. 869; Pub. L. 96–265, title III, §§ 304(a)–(f), 311(a), June 9, 1980, 94 Stat. 453–456, 460; Pub. L. 97–455, §§ 3(a), 6, Jan. 12, 1983, 96 Stat. 2499, 2500; Pub. L. 98–369, div. B, title VI, § 2663(a)(14), July 18, 1984, 98 Stat. 1164; Pub. L. 98–460, §§ 6(a), 8(a), 9(a)(1), 10(a), 17(a), Oct. 9, 1984, 98 Stat. 1802, 1804, 1805, 1811; Pub. L. 99–514, title XVIII, § 1883(a)(9), Oct. 22, 1986, 100 Stat. 2916; Pub. L. 100–647, title VIII, § 8012(a), Nov. 10, 1988, 102 Stat. 3789; Pub. L. 101–239, title X, § 10306(a)(1), Dec. 19, 1989, 103 Stat. 2484; Pub. L. 101–508, title V, § 5128(a), Nov. 5, 1990, 104 Stat. 1388–286; Pub. L. 103–296, title I, § 107(a)(4), Aug. 15, 1994, 108 Stat. 1478; Pub. L. 106–170, title I, §§ 101(b)(1)(A), 111(a), Dec. 17, 1999, 113 Stat. 1873, 1881; Pub. L. 108–271, § 8(b), July 7, 2004, 118 Stat. 814; Pub. L. 114–74, title VIII, § 832(a), Nov. 2, 2015, 129 Stat. 613.) Editorial Notes PRIOR PROVISIONS A prior section 421, act Aug. 14, 1935, ch. 531, title II, § 221, as added July 18, 1952, ch. 945, § 3(e), 66 Stat. 772; amended by 1953 Reorg. Plan No. 1, § 5, eff. Apr. 11, 1953, 18 F.R. 2053, 67 Stat. 631, relating to disability deter- minations, ceased to be in effect at the close of June 30, 1953. See section 3(g) of act July 18, 1952, set out as an Effective and Termination Date of 1952 Amendment note under section 413 of this title. AMENDMENTS 2015—Subsec. (h). Pub. L. 114–74 amended subsec. (h) generally. Prior to amendment, text read as follows: ‘‘An initial determination under subsection (a), (c), (g), or (i) that an individual is not under a disability, in any case where there is evidence which indicates the existence of a mental impairment, shall be made only if the Commissioner of Social Security has made 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.’’ 2004—Subsec. (e). Pub. L. 108–271 substituted ‘‘Govern- ment Accountability Office’’ for ‘‘General Accounting Office’’. 1999—Subsec. (i)(5). Pub. L. 106–170, § 101(b)(1)(A), added par. (5). Subsec. (m). Pub. L. 106–170, § 111(a), added subsec. (m). 1994—Pub. L. 103–296 substituted ‘‘Commissioner of Social Security’’ for ‘‘Secretary’’ wherever appearing except where appearing before ‘‘of Labor’’ in subsec. (b)(3)(B) and substituted ‘‘the Commissioner deems’’ for ‘‘he deems’’ and ‘‘the Commissioner finds’’ for ‘‘he finds’’ in subsec. (a)(2), ‘‘the Commissioner’s’’ for ‘‘his’’ wherever appearing in subsecs. (b)(1), (c)(1), and (g), ‘‘the Commissioner has complied’’ for ‘‘he has com- plied’’ in subsec. (b)(1), ‘‘Commissioner’s’’ for ‘‘Sec- retary’s’’ in subsec. (d), and ‘‘prescribed by the Com- missioner’’ for ‘‘prescribed by him’’ in subsec. (g). 1990—Subsec. (c)(3). Pub. L. 101–508 amended par. (3) generally. Prior to amendment, par. (3) read as follows: ‘‘In carrying out the provisions of paragraph (2) with respect to the review of determinations, made by State agencies pursuant to this section, that individuals are under disabilities (as defined in section 416(i) or 423(d) of this title), the Secretary shall review— ‘‘(A) at least 15 percent of all such determinations made by State agencies in the fiscal year 1981, ‘‘(B) at least 35 percent of all such determinations made by State agencies in the fiscal year 1982, and ‘‘(C) at least 65 percent of all such determinations made by State agencies in any fiscal year after the fiscal year 1982.’’ 1989—Subsec. (l). Pub. L. 101–239 added subsec. (l). 1988—Subsec. (i)(3). Pub. L. 100–647 substituted ‘‘semi- annually’’ for ‘‘annually’’. 1986—Subsec. (e). Pub. L. 99–514 struck out ‘‘under this section’’ before ‘‘shall be entitled’’. 1984—Subsec. (a)(1)(A). Pub. L. 98–460, § 17(a)(2), (b), temporarily substituted ‘‘subsection (b)(1)(C)’’ for ‘‘sub- section (b)(1)’’. See Effective and Termination Dates of 1984 Amendments note below. Subsec. (b)(1). Pub. L. 98–460, § 17(a)(1), (b), tempo- rarily amended par. (1) generally. Prior to amendment, par. (1) read as follows: ‘‘If the Secretary finds, after notice and opportunity for a hearing, that a State agency is substantially failing to make disability de- terminations in a manner consistent with his regula- tions and other written guidelines, the Secretary shall, not earlier than 180 days following his finding, and after he has complied with the requirements of para- graph (3), make the disability determinations referred to in subsection (a)(1).’’ See Effective and Termination Dates of 1984 Amendments note below. Subsec. (b)(3). Pub. L. 98–460, § 17(a)(3), (b), tempo- rarily substituted ‘‘Except as provided in subparagraph (D)(i) of paragraph (1), the Secretary’’ for ‘‘The Sec- retary’’ in subpars. (A) and (B). See Effective and Ter- mination Dates of 1984 Amendments note below. Subsec. (d). Pub. L. 98–460, § 17(a)(4), (b), temporarily substituted ‘‘Except as provided in subsection (b)(1)(D), any individual’’ for ‘‘Any individual’’. See Effective and Termination Dates of 1984 Amendments note below. Subsec. (e). Pub. L. 98–369 substituted ‘‘Federal Dis- ability Insurance Trust Fund is charged’’ for ‘‘Federal Disability Trust Fund is charged’’. Subsec. (h). Pub. L. 98–460, § 8(a), added subsec. (h). Subsec. (i)(4). Pub. L. 98–460, § 6(a), added par. (4). Subsec. (j). Pub. L. 98–460, § 9(a)(1), added subsec. (j). Subsec. (k). Pub. L. 98–460, § 10(a), added subsec. (k). 1983—Subsec. (i). Pub. L. 97–455 designated existing provisions as par. (1), inserted ‘‘, subject to paragraph (2)’’ after ‘‘at least once every 3 years’’, and added pars. (2) and (3). 1980—Subsec. (a). Pub. L. 96–265, § 304(a), completely revised provisions under which determinations are to be made by State agencies. Subsec. (b). Pub. L. 96–265, § 304(b), substituted provi- sions covering the making of disability determinations by the Secretary rather than by the State for provi- sions relating to agreements between the Secretary and the State under which the State would make disability determinations. Subsec. (c). Pub. L. 96–265, § 304(c), designated existing provisions as par. (1), inserted provision that a review Page 2066 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 421 by the Secretary on his own motion of a State agency determination may be made before or after any action is taken to implement that determination, and added pars. (2) and (3). Subsec. (d). Pub. L. 96–265, § 304(d), substituted ‘‘sub- section (a), (b), (c), or (g)’’ for ‘‘subsection (a), (c), or (g)’’. Subsec. (e). Pub. L. 96–265, § 304(e), substituted ‘‘which is making disability determinations under subsection (a)(1)’’ for ‘‘which has an agreement with the Sec- retary’’, substituted ‘‘as determined by the Secretary’’ for ‘‘as may be mutually agreed upon’’, and substituted ‘‘making disability determinations under subsection (a)(1)’’ for ‘‘carrying out the agreement under this sec- tion’’. Subsec. (g). Pub. L. 96–265, § 304(f), substituted ‘‘does not undertake to perform disability determinations under subsection (a)(1), or which has been found by the Secretary to have substantially failed to make dis- ability determinations in a manner consistent with his regulations and guidelines’’ for ‘‘has no agreement under subsection (b)’’ and ‘‘for whom no State under- takes to make disability determinations’’ for ‘‘not in- cluded in an agreement under subsection (b)’’. Subsec. (i). Pub. L. 96–265, § 311(a), added subsec. (i). 1968—Subsec. (a). Pub. L. 90–248, § 158(c)(3), sub- stituted in first sentence reference to ‘‘423(d)’’ for ‘‘423(c)’’. Subsec. (c). Pub. L. 90–248, § 158(c)(4), substituted ref- erence to ‘‘423(d)’’ for ‘‘423(c)’’. 1956—Subsec. (a). Act Aug. 1, 1956, § 103(c)(7), inserted reference to section 423(c) of this title. Subsec. (c). Act Aug. 1, 1956, § 103(c)(8), restricted dis- ability to definition of such term contained in section 416(i) or 423(c) of this title. Subsec. (e). Act Aug. 1, 1956, § 103(h), substituted ‘‘Trust Funds’’ for ‘‘Trust Fund’’, and provided for ad- justments between the Federal Old-Age and Survivors Insurance Trust Fund and the Federal Disability Insur- ance Trust Fund with respect to payments made under this subsection. Subsec. (f). Act Aug. 1, 1956, § 103(h), substituted ‘‘Trust Funds’’ for ‘‘Trust Fund’’. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2015 AMENDMENT Pub. L. 114–74, title VIII, § 832(b), Nov. 2, 2015, 129 Stat. 613, provided that: ‘‘The amendment made by sub- section (a) [amending this section] shall apply with re- spect to determinations of disability made on or after the date that is 1 year after the date of the enactment of this Act [Nov. 2, 2015].’’ EFFECTIVE DATE OF 1999 AMENDMENT Amendment by section 101(b)(1)(A) of Pub. L. 106–170 effective with the first month following one year after Dec. 17, 1999, subject to section 101(d) of Pub. L. 106–170, see section 101(c) of Pub. L. 106–170, set out as an Effec- tive Date note under section 1320b–19 of this title. Pub. L. 106–170, title I, § 111(b), Dec. 17, 1999, 113 Stat. 1881, provided that: ‘‘The amendment made by sub- section (a) [amending this section] shall take effect on January 1, 2002.’’ EFFECTIVE DATE OF 1994 AMENDMENT Amendment by Pub. L. 103–296 effective Mar. 31, 1995, see section 110(a) of Pub. L. 103–296, set out as a note under section 401 of this title. EFFECTIVE DATE OF 1990 AMENDMENT Pub. L. 101–508, title V, § 5128(b), Nov. 5, 1990, 104 Stat. 1388–287, provided that: ‘‘The amendment made by sub- section (a) [amending this section] shall apply with re- spect to determinations made by State agencies in fis- cal years after fiscal year 1990.’’ EFFECTIVE DATE OF 1989 AMENDMENT Pub. L. 101–239, title X, § 10306(a)(3), Dec. 19, 1989, 103 Stat. 2484, provided that: ‘‘The amendment made by this section [amending this section] shall apply with respect to notices issued on or after July 1, 1990.’’ EFFECTIVE DATE OF 1988 AMENDMENT Pub. L. 100–647, title VIII, § 8012(b), Nov. 10, 1988, 102 Stat. 3789, provided that: ‘‘The amendment made by this section [amending this section] shall apply to re- ports required to be submitted after the date of the en- actment of this Act [Nov. 10, 1988].’’ EFFECTIVE AND TERMINATION DATES OF 1984 AMENDMENT Pub. L. 98–460, § 8(c), Oct. 9, 1984, 98 Stat. 1804, pro- vided that: ‘‘The amendments made by this section [amending this section and section 1382c of this title] shall apply to determinations made after 60 days after the date of the enactment of this Act [Oct. 9, 1984].’’ Pub. L. 98–460, § 17(b), Oct. 9, 1984, 98 Stat. 1812, pro- vided that: ‘‘The amendments made by subsection (a) of this section [amending this section] shall become effec- tive on the date of the enactment of this Act [Oct. 9, 1984] and shall expire on December 31, 1987. The provi- sions of the Social Security Act amended by subsection (a) of this section (as such provisions were in effect im- mediately before the date of the enactment of this Act) shall be effective after December 31, 1987.’’ Amendment by Pub. L. 98–369 effective July 18, 1984, but not to be construed as changing or affecting any right, liability, status, or interpretation which existed (under the provisions of law involved) before that date, see section 2664(b) of Pub. L. 98–369, set out as a note under section 401 of this title. EFFECTIVE DATE OF 1983 AMENDMENT Pub. L. 97–455, § 3(b), Jan. 12, 1983, 96 Stat. 2499, pro- vided that: ‘‘The amendments made by subsection (a) [amending this section] shall become effective on the date of the enactment of this Act [Jan. 12, 1983].’’ EFFECTIVE DATE OF 1980 AMENDMENT Pub. L. 96–265, title III, § 304(h), June 9, 1980, 94 Stat. 456, provided that: ‘‘The amendments made by sub- sections (a), (b), (d), (e), and (f) [amending this section] shall be effective beginning with the twelfth month fol- lowing the month in which this Act is enacted [June 1980]. Any State that, on the effective date of the amendments made by this section, has in effect an agreement with the Secretary of Health and Human Services under section 221(a) of the Social Security Act [42 U.S.C. 421(a)] (as in effect prior to such amend- ments) will be deemed to have given to the Secretary the notice specified in section 221(a)(1) of such Act as amended by this section, in lieu of continuing such agreement in effect after the effective date of such amendments. Thereafter, a State may notify the Sec- retary in writing that it no longer wishes to make dis- ability determinations, effective not less than 180 days after the notification is given.’’ Pub. L. 96–265, title III, § 311(b), June 9, 1980, 94 Stat. 460, provided that: ‘‘The amendment made by sub- section (a) [amending this section] shall become effec- tive on January 1, 1982.’’ EFFECTIVE DATE OF 1968 AMENDMENT Amendment by Pub. L. 90–248 applicable with respect to application for disability insurance benefits under section 423 of this title and to disability determinations under section 416(i) of this title, see section 158(e) of Pub. L. 90–248, set out as a note under section 423 of this title. EXPANSION OF COOPERATIVE DISABILITY INVESTIGATIONS UNITS Pub. L. 114–74, title VIII, § 811, Nov. 2, 2015, 129 Stat. 601, provided that: ‘‘(a) IN GENERAL.—Not later than October 1, 2022, the Commissioner of Social Security shall take any nec- essary actions, subject to the availability of appropria- Page 2067 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 421 tions, to ensure that cooperative disability investiga- tions units have been established, in areas where there is cooperation with local law enforcement agencies, that would cover each of the 50 States, the District of Columbia, Puerto Rico, Guam, the Northern Mariana Islands, the Virgin Islands, and American Samoa. ‘‘(b) REPORT.—Not later than 90 days after the date of the enactment of this Act [Nov. 2, 2015] and annually thereafter until the earlier of 2022 or the date on which nationwide coverage is achieved, the Commissioner of Social Security shall submit to the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate a report de- scribing a plan to implement the nationwide coverage described in subsection (a) and outlining areas where the Social Security Administration did not receive the cooperation of local law enforcement agencies.’’ REPORT ON WORK-RELATED CONTINUING DISABILITY REVIEWS Pub. L. 114–74, title VIII, § 845(b), Nov. 2, 2015, 129 Stat. 618, provided that: ‘‘The Commissioner of Social Security shall annually submit to the Committee on Ways and Means of the House of Representatives and the Committee on Fi- nance of the Senate a report on the number of work-re- lated continuing disability reviews conducted each year to determine whether earnings derived from serv- ices demonstrate an individual’s ability to engage in substantial gainful activity. Such report shall in- clude— ‘‘(1) the number of individuals receiving benefits based on disability under title II of such Act [prob- ably means title II of act Aug. 14, 1935, ch. 531, which is classified to 42 U.S.C. 401 et seq.] for whom reports of earnings were received from any source by the Commissioner in the previous calendar year, reported as a total number and separately by the source of the report; ‘‘(2) the number of individuals for whom such re- ports resulted in a determination to conduct a work- related continuing disability review, and the basis on which such determinations were made; ‘‘(3) in the case of a beneficiary selected for a work- related continuing disability review on the basis of a report of earnings from any source— ‘‘(A) the average number of days— ‘‘(i) between the receipt of the report and the initiation of the review; ‘‘(ii) between the initiation and the completion of the review; and ‘‘(iii) the average amount of overpayment, if any; ‘‘(B) the number of such reviews completed during such calendar year, and the number of such reviews that resulted in a suspension or termination of ben- efits; ‘‘(C) the number of such reviews initiated in the current year that had not been completed as of the end of such calendar year; ‘‘(D) the number of such reviews initiated in a prior year that had not been completed as of the end of such calendar year; ‘‘(4) the total savings to the Trust Funds and the Treasury generated from benefits suspended or termi- nated as a result of such reviews; and ‘‘(5) with respect to individuals for whom a work-re- lated continuing disability review was completed dur- ing such calendar year— ‘‘(A) the number who participated in the Ticket to Work program under section 1148 [probably means section 1148 of act Aug. 14, 1935, ch. 531, which is classified to 42 U.S.C. 1319b–19] during such calendar year; ‘‘(B) the number who used any program work in- centives during such calendar year; and ‘‘(C) the number who received vocational rehabili- tation services during such calendar year with re- spect to which the Commissioner of Social Security reimbursed a State agency under section 222(d) [probably means section 222(d) of act Aug. 14, 1935, ch. 531, which is classified to 42 U.S.C. 422(d)].’’ ELECTION UNDER SUBSECTION (l)(1) BY CURRENT RECIPIENTS Pub. L. 101–239, title X, § 10306(a)(2), Dec. 19, 1989, 103 Stat. 2484, provided that: ‘‘Not later than July 1, 1990, the Secretary of Health and Human Services shall pro- vide every individual receiving benefits under title II of the Social Security Act [42 U.S.C. 401 et seq.] on the basis of disability by reason of blindness an oppor- tunity to make an election under section 221(l)(1) of such Act [42 U.S.C. 421(l)(1)] (as added by paragraph (1)).’’ MORATORIUM ON MENTAL IMPAIRMENT REVIEWS Pub. L. 98–460, § 5, Oct. 9, 1984, 98 Stat. 1801, provided that: ‘‘(a) The Secretary of Health and Human Services (hereafter in this section referred to as the ‘Secretary’) shall revise the criteria embodied under the category ‘Mental Disorders’ in the ‘Listing of Impairments’ in effect on the date of the enactment of this Act [Oct. 9, 1984] under appendix 1 to subpart P of part 404 of title 20 of the Code of Federal Regulations. The revised cri- teria and listings, alone and in combination with as- sessments of the residual functional capacity of the in- dividuals involved, shall be designed to realistically evaluate the ability of a mentally impaired individual to engage in substantial gainful activity in a competi- tive workplace environment. Regulations establishing such revised criteria and listings shall be published no later than 120 days after the date of the enactment of this Act. ‘‘(b)(1) Until such time as revised criteria have been established by regulation in accordance with sub- section (a), no continuing eligibility review shall be carried out under section 221(i) of the Social Security Act [42 U.S.C. 421(i)], or under the corresponding re- quirements established for disability determinations and reviews under title XVI of such Act [42 U.S.C. 1381 et seq.], with respect to any individual previously de- termined to be under a disability by reason of a mental impairment, if— ‘‘(A) no initial decision on such review has been rendered with respect to such individual prior to the date of the enactment of this Act, or ‘‘(B) an initial decision on such review was rendered with respect to such individual prior to the date of the enactment of this Act but a timely appeal from such decision was filed or was pending on or after June 7, 1983. For purposes of this paragraph and subsection (c)(1) the term ‘continuing eligibility review’, when used to refer to a review of a previous determination of disability, includes any reconsideration of or hearing on the ini- tial decision rendered in such review as well as such initial decision itself, and any review by the Appeals Council of the hearing decision. ‘‘(2) Paragraph (1) shall not apply in any case where the Secretary determines that fraud was involved in the prior determination, or where an individual (other than an individual eligible to receive benefits under section 1619 of the Social Security Act [42 U.S.C. 1382h]) is determined by the Secretary to be engaged in sub- stantial gainful activity (or gainful activity, in the case of a widow, surviving divorced wife, widower, or surviving divorced husband for purposes of section 202(e) and (f) of such Act [42 U.S.C. 402(e), (f)]). ‘‘(c)(1) Any initial determination that an individual is not under a disability by reason of a mental impair- ment and any determination that an individual is not under a disability by reason of a mental impairment in a reconsideration of or hearing on an initial disability determination, made or held under title II or XVI of the Social Security Act [42 U.S.C. 401 et seq., 1381 et seq.] after the date of the enactment of this Act [Oct. 9, 1984] and prior to the date on which revised criteria are established by regulation in accordance with sub- Page 2068 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 422 section (a), and any determination that an individual is not under a disability by reason of a mental impair- ment made under or in accordance with title II or XVI of such Act in a reconsideration of, hearing on, review by the Appeals Council of, or judicial review of a deci- sion rendered in any continuing eligibility review to which subsection (b)(1) applies, shall be redetermined by the Secretary as soon as feasible after the date on which such criteria are so established, applying such revised criteria. ‘‘(2) In the case of a redetermination under paragraph (1) of a prior action which found that an individual was not under a disability, if such individual is found on re- determination to be under a disability, such redeter- mination shall be applied as though it had been made at the time of such prior action. ‘‘(3) Any individual with a mental impairment who was found to be not disabled pursuant to an initial dis- ability determination or a continuing eligibility review between March 1, 1981, and the date of the enactment of this Act [Oct. 9, 1984], and who reapplies for benefits under title II or XVI of the Social Security Act, may be determined to be under a disability during the pe- riod considered in the most recent prior determination. Any reapplication under this paragraph must be filed within one year after the date of the enactment of this Act, and benefits payable as a result of the preceding sentence shall be paid only on the basis of the re- application.’’ INSTITUTION OF NOTIFICATION SYSTEM Pub. L. 98–460, § 6(c), Oct. 9, 1984, 98 Stat. 1802, pro- vided that: ‘‘The Secretary shall institute a system of notification required by the amendments made by sub- sections (a) and (b) [amending this section and section 1383b of this title] as soon as is practicable after the date of the enactment of this Act [Oct. 9, 1984].’’ DEMONSTRATION PROJECTS; OPPORTUNITY FOR PER- SONAL APPEARANCE PRIOR TO DISABILITY DETERMINA- TIONS; REPORT TO CONGRESSIONAL COMMITTEES Pub. L. 98–460, § 6(d), (e), Oct. 9, 1984, 98 Stat. 1802, 1803, required the Secretary of Health and Human Serv- ices, as soon as practicable after Oct. 9, 1984, to imple- ment demonstration projects in at least five States in which the opportunity for a personal appearance prior to a determination of ineligibility for disability bene- fits under 42 U.S.C. 421(i) or prior to initial disability determinations under 42 U.S.C. 421(a), (c), (g) and title XVI of the Social Security Act (42 U.S.C. 1381 et seq.) was substituted for the face to face evidentiary hearing required by 42 U.S.C. 405(b)(2), and to report to the ap- propriate committees of Congress by Dec. 31, 1986. PROMULGATION OF REGULATIONS Pub. L. 98–460, § 9(a)(2), Oct. 9, 1984, 98 Stat. 1805, pro- vided that: ‘‘The Secretary of Health and Human Serv- ices shall prescribe regulations required under section 221(j) of the Social Security Act [42 U.S.C. 421(j)] not later than 180 days after the date of the enactment of this Act [Oct. 9, 1984].’’ FREQUENCY OF CONTINUING ELIGIBILITY REVIEWS Pub. L. 98–460, § 15, Oct. 9, 1984, 98 Stat. 1808, provided that: ‘‘The Secretary of Health and Human Services shall promulgate final regulations, within 180 days after the date of the enactment of this Act [Oct. 9, 1984], which establish the standards to be used by the Secretary in determining the frequency of reviews under section 221(i) of the Social Security Act [42 U.S.C. 421(j)]. Until such regulations have been issued as final regulations, no individual may be reviewed more than once under section 221(i) of the Social Secu- rity Act.’’ TRAVEL EXPENSES FOR MEDICAL EXAMINATIONS, RE- CONSIDERATION INTERVIEWS, AND PROCEEDINGS BE- FORE ADMINISTRATIVE LAW JUDGES Provisions authorizing payment of travel expenses ei- ther on an actual cost or commuted basis, to an indi- vidual for travel incident to medical examinations, and to parties, their representatives and all reasonably nec- essary witnesses for travel within the United States, Puerto Rico, and the Virgin Islands, to reconsider interviews and to proceedings before administrative law judges under subchapters II, XVI, and XVIII of this chapter were contained in the following appropriation acts: Oct. 18, 1978, Pub. L. 95–480, title II, 92 Stat. 1582. Sept. 30, 1976, Pub. L. 94–439, title II, 90 Stat. 1432. Jan. 28, 1976, Pub. L. 94–206, title II, 90 Stat. 17. Dec. 7, 1974, Pub. L. 93–517, title II, 88 Stat. 1645. Dec. 18, 1973, Pub. L. 93–192, title II, 87 Stat. 759. Aug. 10, 1971, Pub. L. 92–80, title II, 85 Stat. 296. Jan. 11, 1971, Pub. L. 91–667, title II, 84 Stat. 2013. Mar. 5, 1970, Pub. L. 91–204, title II, 84 Stat. 41. Oct. 11, 1968, Pub. L. 90–557, title II, 82 Stat. 988. Nov. 8, 1967, Pub. L. 90–132, title II, 81 Stat. 402. Nov. 7, 1966, Pub. L. 89–787, title II, 80 Stat. 1395. Aug. 31, 1965, Pub. L. 89–156, title II, 79 Stat. 604. Sept. 19, 1964, Pub. L. 88–605, title II, 78 Stat. 974. Oct. 11, 1963, Pub. L. 88–136, title II, 77 Stat. 239. Aug. 14, 1962, Pub. L. 87–582, title II, 76 Stat. 375. Sept. 22, 1961, Pub. L. 87–290, title II, 75 Stat. 604. Sept. 2, 1960, Pub. L. 86–703, title II, 74 Stat. 769. Aug. 14, 1959, Pub. L. 86–158, title II, 73 Stat. 352. Aug. 1, 1958, Pub. L. 85–580, title II, 72 Stat. 471. June 29, 1957, Pub. L. 85–67, title II, 71 Stat. 221. June 29, 1956, ch. 477, title II, 70 Stat. 434. Aug. 1, 1955, ch. 437, title II, 69 Stat. 408. REVIEW OF DECISIONS RENDERED BY ADMINISTRATIVE LAW JUDGES AS RESULT OF DISABILITY HEARINGS; REPORT TO CONGRESS Pub. L. 96–265, title III, § 304(g), June 9, 1980, 94 Stat. 456, required the Secretary of Health and Human Serv- ices to implement a program of reviewing decisions rendered by administrative law judges based on hear- ings under subsec. (d) of this section and to report to Congress by Jan. 1, 1982, on its progress. ASSUMPTION BY SECRETARY OF FUNCTIONS AND OPER- ATIONS OF STATE DISABILITY DETERMINATION UNITS Pub. L. 96–265, title III, § 304(i), June 9, 1980, 94 Stat. 457, directed Secretary of Health and Human Services to submit to Congress by July 1, 1980, a detailed plan on how he intended to assume functions and operations of a State disability determination unit when this became necessary under amendments made by this section [amending this section], and how he intended to meet requirements of section 221(b)(3) of Social Security Act [42 U.S.C. 421(b)(3)]. Such plan was to assume the unin- terrupted operation of disability determination func- tion and utilization of best qualified personnel to carry out such function, and was to include recommendations for any amendment of Federal law or regulation re- quired to carry out such plan. § 422. Rehabilitation services (a), (b) Repealed. Pub. L. 106–170, title I, § 101(b)(1)(B), (C), Dec. 17, 1999, 113 Stat. 1873 (c) ‘‘Period of trial work’’ defined (1) The term ‘‘period of trial work’’, with re- spect to an individual entitled to benefits under section 423, 402(d), 402(e), or 402(f) of this title, means a period of months beginning and ending as provided in paragraphs (3) and (4). (2) For purposes of sections 416(i) and 423 of this title, any services rendered by an individual during a period of trial work shall be deemed not to have been rendered by such individual in determining whether his disability has ceased in a month during such period. For purposes of this subsection the term ‘‘services’’ means activity (whether legal or illegal) which is performed for