Library / Laws / 113th / s / S. 3003 / Introduced in Senate
II
113th CONGRESS
2d Session
S. 3003
IN THE SENATE OF THE UNITED STATES
December 11, 2014
Mr. Coburn introduced the following bill; which was read twice and referred to the Committee on Finance
A BILL
To protect the Social Security Disability Insurance program and provide other support for working
disabled Americans, and for other
purposes.
1.
Short title; table of contents
(a)
Short title
This Act may be cited as the
Protecting Social Security Disability Act of 2014.
(b)
Table of contents
The table of contents for this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—Ensuring the long-term solvency of the disability insurance trust fund
Sec. 101. Application of actuarial reduction for disabled beneficiaries who attain early retirement
age.
Sec. 102. Revising disability classifications; requiring periodic continuing disability reviews or
time limiting benefits for certain beneficiaries.
Sec. 103. Adjustment of age criteria for social security disability insurance medical-vocational
guidelines; consideration of work which exists in the national economy.
Sec. 104. Mandatory collection of negotiated civil monetary penalties.
Sec. 105. Required electronic filing of wage withholding returns.
TITLE II—Program integrity: Reforming standards and procedures for disability hearings, medical
evidence, and claimant representatives
Sec. 201. Elimination of reconsideration review level for an initial adverse determination of an
application for disability insurance benefits.
Sec. 202. Deadline for submission of medical evidence; exclusion of certain medical evidence.
Sec. 203. Non-adversarial disability hearing attorneys.
Sec. 204. Procedural rules for hearings.
Sec. 205. Prohibiting attorneys who have relinquished a license to practice in the face of an
ethics investigation from serving as a claimant representative.
Sec. 206. Applying judicial code of conduct to administrative law judges.
Sec. 207. Evaluating medical evidence.
Sec. 208. Reforming fees paid to attorneys and other claimant representatives.
Sec. 209. Strengthening the administrative law judge quality review process.
Sec. 210. Permitting data matching by Inspectors General.
Sec. 211. Accounting for Social Security Program Integrity Spending.
Sec. 212. Use of the National Directory of New Hires.
TITLE III—Providing support for working disabled Americans
Sec. 301. Establishment of Work Incentive Benefit System.
Sec. 302. Early-intervention demonstration project; study on payroll tax reductions.
I
Ensuring the long-term solvency of the disability insurance trust fund
101.
Application of actuarial reduction for disabled beneficiaries who attain early retirement age
(a)
In
general
Section 202(k)(4) of
the Social Security Act (42 U.S.C. 402(k)(4)) is amended to read as
follows:
(4) With the exception of individuals
who are classified by the Commissioner of Social Security as medical improvement not expected, any individual who, under this section and section 223, is
entitled for any month to both an old-age insurance benefit and a
disability
insurance benefit under this title shall only be entitled to the
old-age
insurance benefit for such month, as reduced for such month
pursuant to
subsection
(q)(1).
.
(b)
Conforming
amendments
(1)
Period of
disability
Clause (i) of section 216(i)(2)(D) of the Social
Security Act (42 U.S.C. 416(i)(2)(D)) is amended by striking retirement
age (as defined in subsection (l)) and inserting early
retirement age (as defined in subsection (l)(2)), or for individuals
classified
by the Commissioner of Social Security as medical improvement not expected, retirement age (as defined in subsection
(l)(1)).
(2)
Disability
insurance benefit payments
Section 223(a)(1) of the Social
Security (42 U.S.C. 423(a)(1)) is amended, in the flush matter at the end,
by
striking retirement age (as defined in section 216(l)) and
inserting early retirement age (as defined in section 216(l)(2)), or for
individuals classified by the Commissioner of Social Security as medical improvement not
expected, retirement age (as defined in section
216(l)(1)).
(c)
Effective
date
The amendments made by this section shall take effect on
January 1, 2020, and shall apply to
any individual (with the exception of individuals classified by the
Commissioner of Social Security as medical improvement not
expected) who attains early retirement age (as defined in section
216(l)(2) of the Social Security Act) on or after such date.
102.
Revising disability classifications; requiring periodic continuing disability reviews or time
limiting benefits for certain beneficiaries
(a)
In general
(1)
Disability classifications
Not later than 1 year after the date of the enactment of this Act, the Commissioner of Social
Security shall establish a
system for classifying any individual who is determined to be entitled to
disability insurance benefits under title II of the Social Security Act or
to monthly benefits under section 202 of such Act by reason of being under
a disability in the following manner:
(A) An individual shall be classified as medical improvement expected if the impairment or combination of impairments causing the individual to be disabled is expected
to medically improve to the point where the individual will no longer be
disabled in 1 to 2 years.
(B) An individual shall be classified as medical improvement likely if the impairment or combination of impairments causing the individual to be disabled is expected
to medically improve to the point where the individual will no longer be
disabled in 3 to 5 years.
(C) An individual shall be classified as medical improvement possible if the impairment or combination of impairments causing the individual to be disabled is not
expected to medically improve to the point where the individual will no
longer be disabled in 5 years, but future improvement is possible.
(D) An individual shall be classified as medical improvement not expected if the individual has an impairment or combination of impairments that is chronic or progressive
with permanent, irreversible structural or functional loss, and for which
there is no known effective therapy, treatment, or surgical intervention
that could result in medical improvement to the point where the individual
is no longer disabled.
(2)
Consideration of age
In classifying an individual under paragraph (1), the Commissioner of Social Security shall not
classify an individual as medical improvement not expected solely by reason of such individual's age where a lesser classification is appropriate.
(b)
Continuing disability reviews
(1)
In general
Section 221(i) of the Social Security Act (42 U.S.C. 421(i)) is amended—
(A) by amending paragraph (1) to read as follows:
(1)
(A) In the case of any individual who is determined to be under a disability and is classified as medical improvement likely or medical improvement possible, the applicable State agency or the Commissioner of Social Security (as may be appropriate) shall,
for purposes of continuing eligibility—
(i) if the individual is classified as medical improvement likely, conduct a review to determine whether the individual remains under a disability during the 5th year following the first month after the individual's waiting period (as defined in section
223(c)(2)); and
(ii) if the individual is classified as medical improvement possible, conduct a review to determine whether the individual remains under a disability during the 7th year following the first month after the individual's waiting period (as so defined).
(B) In addition to the continuing eligibility reviews required under subparagraph (A) and
notwithstanding how an individual is classified under the system
established by the Commissioner of Social Security under section 102(a) of
the Protecting Social Security Disability Act of 2014, if the
Commissioner has reason to believe that an individual
that has been determined to be under a disability is not under a
disability, the Commissioner may review such individual's case at such
time
and in such manner as the Commissioner
determines appropriate except that the Commissioner shall not initiate a
review on the basis of income earned by an individual who is a participant
in the Work
Incentive Benefit System established under section 223(l).
(C) Reviews of cases which are required or permitted under this paragraph shall
be in addition to, and shall not be considered as a substitute for,
any other reviews which are required or provided for
under or in the administration of this title.
;
(B) by striking paragraphs (2) and (5);
(C) by redesignating paragraphs (3) through (4) as paragraphs (2) through (3), respectively; and
(D) in paragraph (2), as so redesignated—
(i) by striking Committee on Finance and inserting Committees on Finance and Homeland Security and Government Affairs;
(ii) by striking Committee on Ways and Means and inserting Committees on Ways and Means and Oversight and Government Reform;
(iii) by striking for reconsideration of such initial termination or;
(iv) by striking or both,; and
(v) by striking reconsideration or.
(2)
Standard of review for continuing disability reviews
(A)
In general
Section 223(f) of the Social Security Act (42 U.S.C. 423(f)) is amended—
(i) in paragraph (4), by striking the period at the end and inserting ; or;
(ii) by inserting after paragraph (4) the following new paragraph:
(5) in the case of a continuing disability review under section 221(i), evidence that would
be sufficient to support a finding in an initial determination that the
individual is not under a disability and is able to engage in substantial
gainful activity.
; and
(iii) by inserting , except that, in the case of a continuing disability review under section 221(i), the Commissioner
shall not consider the fact that an individual is engaged in substantial
gainful work as part of the Work Incentive Benefit System established
under subsection (l) as evidence that the individual is able to engage in
substantial gainful activity after secured by the Commissioner of Social Security.
(B)
Conforming amendment to definition of disability
Section 223(d)(2) of the Social Security Act (42 U.S.C. 423(d)(2) is amended—
(i) in subparagraph (A), by striking An individual and inserting Subject to subparagraph (D), an individual
(ii) by adding at the end the following new subparagraph:
(D) In the case of a continuing disability review under section 221(i), an individual may be found to
be under a disability even though the individual is engaged in substantial
gainful work as part of the Work Incentive Benefit System established
under subsection (l).
.
(c)
Time-Limiting disability benefits for MIE individuals
Section 223 of the Social Security Act (42 U.S.C. 423) is amended—
(1) in subsection
(a)(1), as amended by section 101(b)(2), in the flush language after and
below subparagraph (E), by
striking
subsection (e) and inserting subsections (e) and
(k); and
(2) by adding at the
end the following:
(k)
Time-limited disability benefits
(1) In the case of an
individual who files an application for disability
insurance
benefits under
this section or for monthly benefits under section 202 by reason of
being under
a disability for any month that begins on or after the date that is
1 year after the date of the
enactment of the Protecting Social Security Disability Act of 2014, is determined
to be under a disability, and is classified by the Commissioner of
Social Security as medical improvement expected, the termination month applicable to the individual shall be the 35th
month
following the first month after the individual's waiting period (as
defined in
subsection (c)(2)).
(2)
(A)
(i) For purposes of this paragraph, the term timely reapplication means an application for disability
insurance
benefits under this section or for monthly benefits under section
202 by reason
of being under a disability that is submitted—
(I) by an individual who is a recipient of such benefits; and
(II) during the period that is 14 months before the end
of the
termination month applicable (or most recently applicable) to the
individual under paragraph (1) as
of the date of such application and ending with the date that is
12 months before the end of such termination month.
(ii) Notwithstanding clause (i), the Commissioner of Social Security may deem an application for
disability
insurance
benefits under this section or for monthly benefits under section
202 by reason
of being under a disability submitted by an individual who is a
recipient of such benefits that is submitted after the period described in
clause (i)(II) to be a timely reapplication if—
(I) the individual can show good cause for why the application was not submitted during such period;
and
(II) the application is submitted not later than 6 months before the end of the termination month
applicable (or most recently applicable) to the individual under paragraph
(1) as of the date
of such application.
(B)
(i) An individual who submits a timely reapplication and who is determined to be
under a disability shall be deemed to have satisfied the waiting period
applicable under subsection (c)(2).
(ii)
(I) If the Commissioner of Social Security fails to make an initial determination with respect to the
timely reapplication
of an individual who is a recipient of disability insurance benefits under
this section or monthly benefits under section 202 by reason of being
under a disability before the end of the
termination month applicable to the individual as of the date of such
reapplication, such individual shall continue to be entitled to such
benefits until an initial determination with respect to such timely
reapplication is made.
(II) If the Commissioner of Social Security makes an initial adverse determination with respect to the
timely reapplication of an individual who is a recipient of disability
insurance benefits under this section or monthly benefits under section
202 by reason of being under a disability and such individual files a
timely request for a hearing under section 221(d), such individual may
elect to have the payment of such benefits (as well as any other benefits
payable under this title or title XVIII on the basis of such individual's
entitlement to such benefits) continue in the same manner and subject to
the same conditions as an election made under subsection (g).
(C) For purposes of reviewing a timely reapplication submitted by an individual who is a recipient of
disability insurance benefits under this section or monthly benefits under
section 202 by reason of being under a disability—
(i) the fact that the individual was previously found to be under a disability shall have no
evidentiary weight; and
(ii) subsection (f) shall not apply.
.
(d)
Regulations
The Commissioner of Social Security shall promulgate or revise, as appropriate, regulations
relating to the determination, classification, and review of the
disability status of individuals
who apply for or receive disability insurance benefits under title II of
the Social Security Act and related provisions of the Social Security
Administration Programs Operations Manual (POMS) to carry out subsection
(a) and the amendments made by subsection (b).
103.
Adjustment of
age criteria for social security disability insurance medical-vocational
guidelines; consideration of work which exists in the national economy
(a)
In general
(1)
Age criteria
Notwithstanding Appendix 2 to Subpart P of Part 404 of
title 20, Code of Federal Regulations, with respect to disability
determinations or reviews made on or
after the date that is 1 year after the date of the enactment of this Act,
age shall not be considered
as a vocational factor for any
individual who has not attained the age that is 12 years less than the
retirement age for such individual (as defined in section 216(l)(1) of the
Social Security Act (42 U.S.C. 416(l)).
(2)
Work which exists in the national economy
With respect to disability determinations or reviews made on or after the date of the
enactment of this Act, in determining whether an individual is able to
engage in any work which exists in the national economy (as defined in
section 223(d)(2)(A) of the Social Security Act (42 U.S.C. 423(d)(2)(A)),
the Commissioner of Social Security shall consider the share and ages of
individuals currently participating in the labor force and the number and
types of jobs available in the current economy.
(b)
Updating data on work which exists in national economy
Not later than 2 years after the date of the enactment of this Act, and every year thereafter, the
Commissioner of Social Security shall update the data used by the
Commissioner to determine the jobs which
exist in the national economy to ensure that such data reflects the full
range of work which exists in the national economy,
including newly-created jobs in emerging industries.
104.
Mandatory
collection of negotiated civil monetary penalties
Section 1129(i)(2) of the Social Security Act (42
U.S.C. 1320a–8(i)(2)) is amended by inserting and shall delegate
authority for collecting civil money penalties and assessments negotiated
under
this section to the Inspector General before the period.
105.
Required
electronic filing of wage withholding returns
(a)
In
general
Paragraph (2) of section 6011(e) of the Internal Revenue
Code of 1986 is amended—
(1) by redesignating
subparagraphs (A) and (B) as subparagraphs (B) and (C), respectively,
(2) by inserting
before subparagraph (B), as so redesignated, the following new
subparagraph:
(A) shall—
(i) require any
person that is required to file a return containing information
described in
section 6051(a) to file such return on magnetic media, and
(ii) provide for
waiver of the requirements of clause (i) in the case of
demonstrated hardship
for—
(I) for any period before January 1, 2020, a person having 25 or fewer
employees, and
(II) for any period after December 31, 2019, a person having 5 or fewer employees,
,
and
(3) by inserting
except as provided in subparagraph (A), before shall not
require in subparagraph (B), as so redesignated.
(b)
Conforming
amendment
Paragraph (4) of section 6011(e) of the Internal
Revenue Code of 1986 is amended by striking paragraph (2)(A) and
inserting paragraph (2)(B).
(c)
Effective
date
The amendments made by this section shall apply to returns
filed after December 31, 2016.
II
Program integrity: Reforming standards and procedures for disability hearings, medical evidence,
and claimant
representatives
201.
Elimination of
reconsideration review level for an initial adverse determination of an
application for disability insurance benefits
(a)
In
general
Section 205(b) of the Social Security
Act (42 U.S.C. 405(b)) is amended—
(1) in paragraph (2), by striking In any and inserting Subject to paragraph (4), in any; and
(2) by adding at the end the following:
(4) Any review of an initial adverse
determination with respect to an application for disability
insurance benefits
under section 223 or for monthly benefits under section 202 by
reason of being
under a disability shall only be made before an administrative law
judge in a hearing under paragraph (1).
.
(b)
Effective
date
The amendment made by subsection (a) shall apply to initial
adverse determinations on applications for disability insurance benefits
under
title II of the Social Security Act made after the date of the enactment
of
this
Act.
202.
Deadline for submission of medical evidence; exclusion of certain medical evidence
(a)
Closing of record for submission of medical evidence
Section 205(b)(1) of the Social Security Act (42
U.S.C. 405(b)(1)) is amended—
(1) by striking The Commissioner of Social Security is directed and inserting—
(A) The Commissioner of Social Security is directed
; and
(2) by adding at the end the following new subparagraph:
(B)
(i) Notwithstanding the last sentence of subparagraph (A), in the case of a hearing before an
administrative law judge to determine if an individual is under
a disability (as defined in section 223(d)) or a review of such a
determination before the Appeals Council of the Office of Appellate
Operations of the Social Security Administration, medical evidence (other
than the evidence already in the record) shall not be
received if the evidence is submitted less than 5 days prior to the date
on which the hearing is held
unless the individual can show that the evidence is material and there is
good cause for the failure to submit it before the deadline, but in no
case shall medical evidence be received if it is—
(I) based on information obtained during the period that begins after a
determination is
made by an administrative law judge; or
(II) submitted more than 1
year after a determination is made by an administrative law judge.
(ii) At the request of an individual applying for benefits under this title, such individual's
representative, or a disability
hearing attorney (as defined in section 203(a) of the Protecting Social Security Disability Act of 2014), and for the purpose of completing the record, an administrative law judge may postpone a hearing
to determine if the individual is under a
disability (as so defined) to a date that is no more than 30 days after
the date for which the hearing was originally scheduled if—
(I) the request is made no less than 7 days prior to the date for which the hearing was originally
scheduled; and
(II) the party making the request shows good cause for why the hearing should be postponed.
.
(b)
Exclusion of medical evidence that is not submitted in its entirety or furnished by a licensed
practitioner
Section 223(d)(5) of the Social Security Act (42 U.S.C. 423(d)(5)) is amended—
(1) in subparagraph (B), by striking In and inserting Subject to subparagraphs (C) and (D), in; and
(2) by adding at the end the following new subparagraphs:
(C)
(i) An individual
and, if applicable, such individual's representative shall submit, in its
entirety and without redaction, all
relevant medical evidence known to the individual or the representative to
the Commissioner of Social Security.
(ii) In the case of a hearing before an administrative law judge to determine if an individual is under
a disability (as defined in paragraph (1)), the Commissioner of Social
Security shall not consider any piece of medical evidence furnished by an
individual or such individual's representative unless such individual and,
if
applicable, such individual's representative, certifies at the hearing
that all relevant medical evidence has been submitted in its entirety and
without redaction.
(iii) For purposes of
this subparagraph, the term relevant medical evidence means any medical evidence relating to the individual's claimed physical or mental impairments
that the Commissioner of Social Security should consider to determine
whether the individual is under a disability, regardless of whether such
evidence is favorable or unfavorable to the individual's case, but shall
not include any oral or written communication or other document exchanged
between the individual and such individual's attorney representative that
are subject to attorney-client privilege or work product doctrine, unless
the individual voluntarily discloses such communication to the
Commissioner. Neither the attorney-client privilege nor the work product
doctrine shall prevent from disclosure medical evidence, medical source
opinions, or any other factual matter that the Commissioner may consider
in determining whether or not the individual is entitled to benefits.
(iv) Any individual or representative who knowingly violates this subparagraph
shall be guilty of making
a false statement or representation of material fact, shall be subject to
civil and criminal penalties under sections 208 and 1129, and, in the case
of a representative, shall be suspended or disqualified from appearing
before the Social Security Administration.
(D) The Commissioner of Social Security shall not consider any evidence furnished by a physician or
health care practitioner who is not licensed, has been sanctioned, or is
under investigation for ethical misconduct.
.
(c)
Effective date
The amendments made by this section shall take effect on the date of the enactment of this Act, and
shall apply to applications for disability insurance benefits filed on or
after that date.
203.
Non-adversarial disability hearing attorneys
(a)
In general
(1)
Establishment
The Commissioner of Social Security shall establish disability hearing attorney positions within
the Office of
Appellate Operations of the Social Security Administration for the purpose
of improving the quality, timeliness, and consistency of disability
determinations by administrative
law judges as described in this section. The Commissioner shall hire and
employ such attorneys and other personnel as are necessary to carry out
the responsibilities of disability hearing attorneys, as described in
subsection (b).
(2)
Definition
For purposes of this section, the term disability hearing attorney means an attorney employed under this section.
(b)
Assignment of cases; responsibilities of disability hearing attorneys
(1)
Assignment of cases
Each case that is scheduled for a hearing to determine if an individual is under a disability (as
defined in section 223(d) of the Social Security Act (42 U.S.C. 423(d))
shall be assigned to a disability hearing attorney as soon as practicable.
(2)
Responsibilities of disability hearing attorneys
The disability hearing attorney assigned to a case under paragraph (1) shall—
(A) develop the evidentiary record, and, if necessary, work with the officials that made the initial
determination that the individual was not under a disability to understand
why such determination was made;
(B) in cases where the individual has representation, work with the representative to ensure that the
record is complete prior to the hearing, and examine witnesses and present
evidence to the
administrative law judge during the hearing;
(C) prior to the hearing, if the attorney finds that the evidence clearly establishes that the
individual is under a disability, recommend that the administrative law
judge make a determination that the individual is under a disability
without requiring a hearing; and
(D) after the hearing, if the attorney finds that the evidence clearly does not support the
determination of the administrative law judge that the individual is
disabled, recommend to the Appeals
Council of the Office of Appellate Operations of the Social Security
Administration that the Appeals Council review the determination on its
own motion.
(c)
Qualifications and training
The Commissioner of Social Security shall ensure that disability hearing attorneys employed under
this section are
appropriately qualified and trained to understand relevant medical,
vocational, and legal issues.
204.
Procedural rules for hearings
(a)
In general
Not later than 1 year after the date of the enactment of this Act, the Commissioner of Social
Security
shall establish and make available to the public procedural rules for
hearings to determine whether or not an individual is entitled to
disability insurance benefits under title II of the Social Security Act
(42 U.S.C. 401 et seq.). These rules shall include those established in
this Act as well as—
(1) rules and procedures for motions and requests;
(2) rules related to the representation of individuals in such a hearing, such as the qualifications
and standards of conduct required of representatives;
(3) rules and procedures for the submission of evidence;
(4) rules related to the closure of the record; and
(5) rules and procedures for imposing sanctions on parties for failing to comply with hearing rules.
(b)
Authority of administrative law judges To sanction claimant representatives
Section 206(a)(1) of the Social Security Act (42 U.S.C. 406(a)(1)) is amended by inserting after
the fifth sentence the following: The Commissioner of Social Security shall establish rules under which an administrative law judge
may impose fines and other sanctions the Commissioner determines to be
appropriate on a representative for failure to follow the Commissioner's
rules and regulations.
(c)
Effective
date
Any rules adopted pursuant to this section or the amendment made thereby shall take effect on the
date that is 6 months after the
date of their publication and shall apply to hearings held on or after
that date.
205.
Prohibiting attorneys who have relinquished a license to practice in the face of an ethics
investigation from serving as a claimant representative
Section 206(a)(1) of the Social Security Act (42 U.S.C. 406(a)(1)), as amended by section 204(b),
is further amended—
(1) in the first sentence, by inserting , and, in cases where compensation is sought for services as a representative, shall before prescribe;
(2) in the second sentence, by striking Federal courts, and inserting Federal courts and certifies to the Commissioner that such
attorney has never (A) been disbarred or suspended from any court or bar
to which such attorney was previously admitted to practice or disqualified
from participating in or appearing before any Federal program or agency,
or (B) relinquished a license to practice in, participate in, or appear
before any court, bar, or Federal program or agency in connection with a
settlement of an
investigation into ethical misconduct,; and
(3) in the third sentence—
(A) by striking may each place it appears and inserting shall;
(B) by striking or who has been disqualified from participating in or appearing before any Federal program or
agency and inserting , who has been disqualified from participating in or appearing before any Federal program or
agency, or who has voluntarily relinquished a license to practice in,
participate in, or appear before any court, bar, or Federal program or
agency in settlement of an investigation into ethical misconduct; and
(C) by inserting or who has voluntarily relinquished a license to practice in any court or bar in settlement of an
investigation into ethical misconduct before the period.
206.
Applying judicial code of conduct to administrative law judges
(a)
In general
Section 3105 of title 5, United States Code, is amended—
(1) by striking Each agency and inserting
(a) Each agency
; and
(2) by adding at the end the following:
(b) The Code of Conduct for United States Judges adopted by the Judicial Conference of the United
States shall apply to administrative law judges appointed under this
section.
(c) If, in applying a standard of conduct to an administrative law judge appointed under this section,
there is a conflict between the Code of Conduct for United States Judges
and any other law or regulation, the stricter standard of conduct shall
apply.
(d) Pursuant to section 7301, the President may issue such regulations as may be necessary to carry out
subsections (b) and (c).
.
(b)
Limitation on regulatory authority
Section 1305 of title 5, United States Code, is amended by striking 3105 and inserting 3105(a).
207.
Evaluating medical evidence
(a)
In general
Not later than 1 year after the date of the enactment of this Act, the Commissioner of Social
Security shall ensure that all
administrative law judges within the Office of Disability Adjudication and
Review of the Social Security Administration receive training on how to
appropriately evaluate and weigh medical evidence provided by medical
professionals.
(b)
Opinion evidence
Section 223(d)(5)(B) of the Social Security Act (42 U.S.C. 423(d)(5)(B)), as amended by section
202(b), is further amended by adding at the end the following new
sentences: In weighing medical evidence, the Commissioner of Social Security may assign greater weight
to certain opinion evidence supplied by an individual's treating physician
(or
other treating health care provider) than to opinion evidence obtained
from another source, but in no circumstance shall opinion evidence from
any source be given controlling weight.
(c)
Health care providers supplying consultative exams
(1)
In general
Beginning 1 year after the date of enactment of this Act, in determining whether an individual
applying for
disability insurance benefits under title II of the Social Security Act is
disabled, the Commissioner of Social Security shall not consider medical
evidence resulting from a consultative exam with a health care provider
conducted for the purpose of
supporting the individual's application unless the evidence is accompanied
by a Medical Consultant Acknowledgment Form signed by the health care
provider who conducted the exam.
(2)
Medical Consultant Acknowledgment Form
(A)
Definition
As used in this subsection, the term Medical Consultant Acknowledgment Form means a form published by the Commissioner of Social Security that meets the requirements of
subparagraph (B).
(B)
Requirements
The Commissioner of Social Security shall develop the Medical Consultant Acknowledgment Form and
make it available to the public not later than 6 months after the date of
enactment of this Act. The contents of the Medical Consultant
Acknowledgment Form shall include—
(i) information on how medical evidence is used in disability determinations;
(ii) instructions on completing a residual functional capacity form;
(iii) information on the legal and ethical obligations of a health care provider who supplies medical
evidence for use in a disability determination, including any civil or
criminal penalties that may be imposed on a health care provider who
supplies medical evidence for use in a disability determination; and
(iv) a statement that the signatory has read and understands the contents of the form.
(3)
Penalties for fraud
In addition to any other penalties that may be prescribed by law, any individual who forges a
signature on a Medical Consultant Acknowledgment Form submitted to the
Commissioner of Social Security shall be guilty of making a false
statement or representation of material fact, and upon conviction shall be
subject to civil and criminal penalties under sections 208 and 1129 of the
Social Security Act and, in the case of a representative, shall be
suspended or disqualified from appearing before the Social Security
Administration.
(d)
Symptom validity tests
(1)
In general
For purposes of evaluating the credibility of an individual's medical evidence, an administrative
law judge responsible for conducting a hearing to determine whether an
individual applying for disability insurance benefits under title II of
the Social Security Act or for monthly benefits under section 202 of such
Act by reason of a disability may require the individual to undergo a
symptom validity test either prior to or after the hearing.
(2)
Weight given to SVTs
An administrative law judge may only consider the results of a symptom validity test as a part of
an individual's entire medical history and shall not give controlling
weight to such results.
(e)
Evidence obtained from publicly available social media
For purposes of evaluating the credibility of an individual's medical evidence, an administrative
law judge responsible for conducting a hearing to determine whether an
individual applying for disability insurance benefits under title II of
the Social Security Act is disabled shall be permitted to consider
information about the individual obtained from publicly available social
media.
(f)
Regulations related to evaluating medical evidence
Not later than 1 year after the date of enactment of this Act, the Commissioner of Social Security
shall promulgate
rules and regulations to carry out the purposes of this section, including
regulations
relating to when it is appropriate for an administrative law judge to
order a symptom validity test or to consider evidence obtained from
publicly available social media.
208.
Reforming fees paid to attorneys and other claimant representatives
(a)
In general
Not later than 1 year after the date of enactment of this Act, the Commissioner of Social Security
shall establish rules
and regulations relating to the fees payable to representatives of
individuals claiming entitlement to disability insurance benefits under
title II of the Social Security Act (42 U.S.C. 401 et seq.). Such rules
and regulations
shall—
(1) require representatives to account for the work performed with respect to a case, whether or not
there is a valid fee agreement between the representative
and the individual; and
(2) prohibit a representative from being reimbursed by the Social Security Administration for travel
expenses related
to a case.
(b)
Review of highest-Earning claimant representatives
(1)
Review
Not later than 1 year after the date of enactment of this Act and annually thereafter, the
Inspector General of the Social Security Administration shall conduct a
review of the practices of a sample of the highest-earning claimant
representatives to ensure compliance with the policies of the Social
Security Administration. In reviewing representative practices, the
Inspector General shall look for suspicious practices, including—
(A) repetitive language in residual functional capacity forms;
(B) irregularities in the licensing history of medical professionals providing medical opinions in
support of a claimant's application; and
(C) a disproportionately high number of appearances by a representative before the same administrative
law judge.
(2)
Report
Not later than December 1 of each year in which a review described in paragraph (1) is conducted,
the Inspector General of
the Social Security Administration shall submit a report containing the
results of such review, together with any recommendations for
administrative action or proposed legislation that the Inspector General
determines appropriate, to the Committees on Finance and Homeland Security
and Government Affairs of the Senate and the
Committees on Ways and Means and Oversight and Government Reform of the
House of Representatives.
(c)
Applicability of the Equal Access to Justice Act
Section 205 of the Social Security Act (42 U.S.C. 405) is amended by adding at the end the
following new subsection:
(v) Sections 504 of title 5 and 2412 of title 28, United States Code (commonly known as the Equal Access to Justice Act), shall not apply to—
(1) any review under this title of a determination of disability made by the Commissioner of Social
Security; or
(2) if new evidence is submitted by an individual after a hearing to determine whether or not the
individual is under a disability, judicial review of a final determination
of disability under subsection (g) of this section.
.
209.
Strengthening the administrative law judge quality review process
(a)
In general
(1)
Review
Not later than 1 year after the date of enactment of this Act and annually thereafter, the Division
of Quality of the Office of Appellate Operations of the Social Security
Administration shall conduct a review of a sample of determinations that
individuals are entitled to disability insurance benefits by outlier
administrative law judges and identify any determinations that are not
supported by the evidence.
(2)
Report
Not later than December 1 of each year in which a review described in paragraph (1) is conducted,
the Division of Quality
Review of the Office of Appellate Operations of the Social Security
Administration shall submit a report containing the results of such
review, including all determinations that were found to be unsupported by
the evidence, together with any recommendations for administrative action
or proposed legislation that the Division determines appropriate, to—
(A) the Inspector General of the Social Security Administration;
(B) the Commissioner of the Social Security Administration;
(C) the Committees on Ways and Means and Oversight and Government Reform of the House of the
Representatives; and
(D) the Committees on Finance and Homeland Security and Government Affairs of the Senate.
(3)
Definition of outlier administrative law judge
For purposes of this subsection, the term outlier administrative law judge means an administrative law judge within the Office of Disability Adjudication and Review of the
Social
Security Administration who, in a given year—
(A) issues more than 700 decisions; and
(B) determines that the applicant is entitled to disability insurance benefits in not less than 85
percent of cases.
(b)
Mandatory continuing disability review
(1)
In general
The Commissioner of Social Security shall ensure that, not less than 6 months after receiving a
report described in subsection (a)(2), every determination of entitlement
found to be unsupported by the evidence is in the process of being
reviewed under section 221(i)(1)(B) of the Social Security Act (as
amended by section 102(b)(1)).
(2)
Conforming amendment
Section 221(i)(1) of the Social Security Act (42 U.S.C. 421(i)(1)), as amended by section
102(b)(1), is further amended in subparagraph (C) by inserting or under section 209(b) of the Protecting Social Security Disability Act of 2014 before the period.
210.
Permitting
data matching by Inspectors General
Clause (ix) of
section 552a(a)(8)(B) of title 5, United States Code, is amended by
striking
the Secretary of Health and Human Services or the Inspector General of the Department of Health and
Human
Services and inserting the Inspector General of an agency, or an agency in coordination with an Inspector
General.
211.
Accounting for
Social Security Program Integrity Spending
Amounts made available for Social Security
program integrity spending by the Social Security Administration for a
fiscal
year shall be—
(1) included in a
separate account within the Federal budget; and
(2) funded in a
separate account in the appropriate annual appropriations bill.
212.
Use of the National Directory of New Hires
Beginning with the date that is 1 year after the date of the enactment of this Act, the
Commissioner of Social Security shall consult the National Directory of
New Hires established under section 453(i) of the Social Security Act (42
U.S.C. 653(i)) in determining whether any individual who submits an
application or reapplication for disability insurance benefits under title
II of the Social Security Act or for monthly benefits under section 202 of
such Act by reason of a disability is able to engage in substantial
gainful activity.
III
Providing support for working disabled Americans
301.
Establishment of Work Incentive Benefit System
(a)
Elimination of the Ticket to Work and Self-Sufficiency Program
(1)
In general
Part A of title XI of the Social Security Act (42 U.S.C. 1301 et seq.) is amended by striking
section 1148.
(2)
Conforming amendments
(A) Section 225(b)(1) of such Act is amended by striking consisting of the Ticket to Work and Self-Sufficiency Program under section 1148 or another program.
(B) Section 1631(a)(6)(A) of such Act is amended by striking consisting of the Ticket to Work and Self-Sufficiency Program under section 1148 or another program.
(C) Section 1633(c) of such Act is amended by striking paragraph (2).
(b)
Establishment of the Work Incentive Benefit System
(1)
In general
Section 223 of the Social Security Act (42 U.S.C. 423), as amended by section 102(c), is further
amended—
(A) in subsection (a)(2), by striking section 202(q) and section 215(b)(2)(A)(ii) and inserting subsection (l) and sections 202(q) and 215(b)(2)(A)(ii); and
(B) by adding at the end the following new subsection:
(l)
Work Incentive Benefit System
(1) The Commissioner shall establish a Work Incentive Benefit System in accordance with the provisions
of this subsection, pursuant to which an eligible individual entitled to a
disability insurance benefit under this section may elect to return to
employment and receive an adjusted disability insurance benefit amount
(as determined pursuant to paragraph (3)).
(2)
(A) For purposes of this subsection, the term eligible individual means an individual who has been entitled to a disability insurance benefit for period of not less
than 9 months preceding
participation in the Work Incentive Benefit
System.
(B) Participation by an eligible individual in the Work Incentive Benefit System shall be suspended if
such individual has no reported wages or self-employment income for the 4
preceding
calendar quarters (as defined in section 213(a)(1)).
(3)
(A) For purposes of subsection (a)(2), the amount of the disability insurance benefit provided to an
eligible individual who is participating in the Work Incentive Benefit
System for any month shall be equal to—
(i) in the case of an individual who has average monthly earnings (as determined under subparagraph
(B)) equal to or less than $50, the amount
otherwise applicable under subsection (a)(2), or
(ii) in the case of an individual who has average monthly earnings greater than $50, an amount equal to
the sum of—
(I) an amount (not less than zero) equal to—
(aa) the enhanced benefit amount (as determined under subparagraph (C)) for such individual, minus
(bb) the quotient obtained by dividing the average monthly earnings for such individual by 3, and
(II) the work incentive adjustment amount (as determined under subparagraph (D)) for such individual.
(B)
(i) The average monthly earnings for an eligible individual shall be equal to the quotient of—
(I) the total amount of wages and self-employment income for such individual
in any eligible months during the 2 calendar quarters (as defined in
section 213(a)(1)) that
precede the most recently completed calendar quarter, divided by
(II) the total number of eligible months during such 2 calendar quarter period.
(ii) For purposes of clause (i), the term eligible month means any month subsequent to the month in which an eligible individual became entitled to a
disability insurance benefit.
(C) The enhanced benefit amount for an eligible individual shall be equal to 106.7 percent of the
primary
insurance amount for such month for such individual.
(D)
(i) The work incentive adjustment amount for an eligible individual shall be equal to the product of
the average
monthly earnings for such individual multiplied by the applicable work
incentive subsidy rate (as determined in accordance with the table under
clause (iii), based on the applicable work incentive step for such
individual).
(ii) For purposes of the table under clause (iii), the work incentive step for an eligible individual
shall be
equal to the quotient obtained by dividing—
(I) the average monthly earnings for such individual, by
(II) an amount equal to the quotient obtained by dividing the primary insurance amount for such month
for such individual by 5.
(iii) The work incentive subsidy rate shall be determined by linear interpolation between the amounts
established under the following table: Work Incentive StepWork Incentive Subsidy Rate0−11−0.82−0.63−0.44−0.25060.270.3580.3990.35100.3110.25120.18130.125140.08150.04160.01170.
(4) For purposes of paragraph (3)(B), wages and self-employment income of an individual shall be
determined based on relevant information for such individual as provided
by the State agency responsible for the administration of State
unemployment compensation law.
(5) For purposes of an eligible individual who is participating in the Work Incentive Benefit System
under this subsection, any services performed or earnings derived from
services during the period of such participation shall not be considered
for purposes of demonstrating an individual's ability to engage in
substantial gainful activity under subsection (d)(4) and shall not be
considered substantial gainful activity for purposes of subsection (e).
(6) For purposes of this title, the disability insurance benefit received by an
eligible individual under this subsection shall not be applied for
purposes of determining
any monthly benefits payable to any other individuals entitled to benefits
for any month based on the wages and self-employment income of such
individual.
.
(c)
Program savings
(1)
In general
For each calendar year after 2015, the Commissioner of Social Security shall determine if, as a
result of the repeal of the Ticket to Work and Self-Sufficiency Program
under section 1148 of the Social Security Act and the establishment the
Work Incentive Benefit System under section 223(l) of such Act, the total
amount of expenditures from the Trust Funds (as defined under section
201(c) of such Act) for payment of disability insurance benefits pursuant
to section 223 of such Act has been reduced.
(2)
Sharing of savings
The Commissioner of Social Security shall, by regulations, establish a program to provide payments
to organizations providing vocational rehabilitation services to eligible
individuals (as defined under section 223(l)(2) of the Social Security
Act) from any amounts
determined to be saved under the Work Incentive Benefit System, as
determined pursuant to paragraph (1). The amount of any payments made to
an organization providing vocational rehabilitation services to an
eligible individual shall be adjusted based on the disability
classification of such individual, with increased amounts to be provided
for eligible individuals with a lower expectation of medical improvement.
(d)
Effective date
The amendments made by this section shall apply to benefits payable for months beginning after June
30, 2016.
302.
Early-Intervention demonstration project; study on payroll tax reductions
(a)
Targeted early-Intervention demonstration project
(1)
In general
(A)
Establishment
The Commissioner shall conduct a demonstration project designed to examine the effectiveness of
providing targeted early-intervention support to
eligible individuals.
(B)
Vocational rehabilitation services
The Commissioner shall coordinate with State vocational rehabilitation agencies to provide eligible
individuals who elect to participate in the demonstration project with
vocational rehabilitation services.
(C)
Other benefits
In addition to the vocational rehabilitation services described in subparagraph (B), the
Commissioner shall provide eligible individuals who elect to participate
in the demonstration project with a package of benefits that may include—
(i) health care subsidies;
(ii) wage subsidies; and
(iii) cash stipends.
(D)
Suspension of eligibility for disability assistance
An eligible individual who elects to participate in the demonstration project shall not be eligible
for disability assistance for as long as the individual receives
assistance through the demonstration project, and in no case shall an
eligible individual who elects to participate in the demonstration project
be eligible for disability assistance during the 1 year period that begins
on the date that the individual first receives assistance through the
demonstration project.
(E)
Participation voluntary
The option to participate in the demonstration project conducted under this subsection shall be
voluntary, and the designation of an applicant for disability assistance
as an eligible individual shall not preclude such applicant from electing
to receive disability insurance rather than participate in the
demonstration project.
(2)
Identifying eligible individuals
(A)
In general
The Commissioner shall identify eligible individuals from among applicants for disability
assistance whose applications have not been processed yet.
(B)
Eligibility standards
The Commissioner shall only identify an applicant for disability assistance as an eligible
individual if the Commissioner finds that—
(i) it is highly probable that the applicant will be determined to be eligible disability assistance;
and
(ii) the applicant could, with the help of assistance provided under the demonstration project, engage
in substantial gainful activity.
(3)
Scope
(A)
In general
The demonstration project shall be of sufficient scope and shall be carried out on a wide enough
scale to permit a thorough evaluation of the provision of targeted
early-intervention support under consideration while giving assurance that
the results derived from the demonstration project will obtain generally
in the operation of the disability insurance program under title II of the
Social Security Act (42 U.S.C. 401 et seq.) without committing such
program to the adoption of any particular system either locally or
nationally.
(B)
Authority to expand scope
The Commissioner may expand the scope of the demonstration project to include
any group of applicants for disability assistance with impairments that
reasonably may be presumed to be
disabling for purposes of the demonstration project, and may limit any
such demonstration project to any such group of applicants, subject to the
terms of such demonstration project which shall define the extent of any
such presumption.
(C)
Duration
The demonstration project shall be implemented not later than January 1, 2016, and shall be
conducted for a period of 5 years.
(4)
Reports
(A)
Interim reports
On or before June 1 of each year that begins after 2016, the Commissioner shall submit to the
Committee on Ways and Means
of the House of Representatives and to the Committee on Finance of the
Senate an annual interim report on the progress of the demonstration
project together with any
related data and materials that the Commissioner may consider appropriate.
(B)
Final report
Not later than 90 days after the termination of the demonstration project, the Commissioner shall
submit to the Committee on Ways and Means of the House of Representatives
and to the Committee on Finance of the Senate a final report with respect
to the demonstration project.
(C)
GAO evaluation and report
The Comptroller General of the United States shall—
(i) perform an evaluation of the implementation of and results achieved by the demonstration project;
and
(ii) not later than January 1, 2020, submit to Congress a report on the evaluation described in clause
(i), including a recommendation as to whether the Commissioner's authority
to conduct the demonstration project should be made permanent.
(5)
Definitions
In this subsection:
(A)
Commissioner
The term Commissioner means the Commissioner of Social Security.
(B)
Demonstration project
The term demonstration project means the demonstration project conducted under this subsection.
(C)
Disability assistance
The term disability assistance means disability insurance benefits or monthly benefits under section 202 of the Social Security
Act for which eligibility is based on a disability.
(D)
Eligible individual
The term eligible individual means an applicant for disability assistance who has been identified by the Commissioner under
paragraph (2).
(b)
Study on payroll tax reductions for businesses that provide disability support
(1)
In general
Not later than 2 years after the date of the enactment of this Act, the Commissioner of Social
Security shall complete a study to determine whether reducing the rate at
which an employer is taxed under subsection (a) of section 3111 of the
Internal Revenue Code of 1986 in exchange for such employer offering its
employees private disability insurance and other disability supports would
be an effective means of reducing the rate at which such employees enter
the disability insurance program established under title II of the Social
Security Act.
(2)
Report
Not later than 90 days after the completion of the study described in paragraph (1), the
Commissioner of Social security shall submit to the Committee on Ways and
Means of the House of Representatives
and to the Committee on Finance of the Senate a report on the study that
includes detailed analysis of the Commissioner's findings and
recommendations for further legislative or administrative action.