PL 92-603 Social Security Amendments of 1972 (enacted 10/30/72) |
Title I - Provisions Relating to Old-Age, Survivors, and Disability Insurance
Section 101 provides a special minimum benefit computed by multiplying $8.50 by a worker’s number of years in covered employment in excess of 10 years up to 30 years. A special minimum benefit of $170 a month will be paid for a worker retiring at age 65 (or disabled) who has been employed for 30 years under Social Security coverage. The new minimum benefit is payable to people with 23 or more years of covered employment. Minimum payments to a couple are 1½ times the new minimum benefit amounts. The special minimum benefit will not be increased automatically in the future. Effective 1/73.
Section 102 provides an increase in widow’s and widower’s benefits. A widow (or dependent widower) who first becomes entitled to benefits at age 65 or after will receive either 100% of the deceased’s primary insurance amount or, if the deceased’s benefits began before age 65, an amount equal to the reduced benefit the deceased would have been receiving if the deceased were alive, but not less than 82½% of the deceased’s primary insurance amount. The benefit for a widow (or widower) entitled between 60 and 65 will be reduced to take account of the longer period over which the benefit will be paid. A widow’s or widower’s benefit after reduction for age cannot exceed the amount the deceased spouse would have received, but in no case will a widow or widower who began receiving benefits at or after age 62 get less than 82½% of the deceased spouse’s primary insurance amount. Effective 1/73.
Section 103 provides for an increase in Social Security retirement benefits of one percent for each year after 1970 for which the worker between age 65 and before age 72 did not receive benefits because of earnings from work. No increased benefit would be paid under the provision to the worker’s dependents or survivors. Effective for computations and recomputations after 1972 based on earning after 1970.
Section 104 eliminates the difference in computing benefits for men and women, and making age 62 the computation point for men. Effective 1/73 and will be fully effective in 1/75 by reducing the age for men to 64 in 1973, to 63 in 1974 and to 62 in 1975.
Section 105 provides an automatic adjustment of the earnings test. Provides that the annual exempt amount of earnings that a beneficiary under age 72 may earn in a year and still receive all his or her Social Security benefits for the year are increased from $1,680 to $2,100. This section provides for a $1 reduction in benefits for each $2 of all earnings above $2,100; there is no $1-for-$1 reduction. In the year in which a person attains age 72 earnings in and after the month of age 72 attainment will not be included in determining total earnings for the year. The amount of exempt earnings is to be increased automatically in the future in proportion to the rise in average earnings, whenever Social Security benefits are increased automatically. Effective 1/73.
Section 106 amends Section 203(f)(3) of the Social Security Act by adding except that, in determining an individual’s excess earnings for the taxable year in which he or she attains age 72, there shall be excluded any earnings of such individual for the month in which they attain such age and any subsequent month (with any net earnings or net loss from self-employment in such year being prorated in an equitable manner under regulations). Effective for taxable years ending after 12/72.
Section 107 provides that aged dependent widowers under age 62 can be paid reduced benefits (on the same basis as widows) starting as early as age 60. Effective 1/73.
Section 108 provides that childhood disability benefits will be paid to the disabled son or daughter of an insured retired, deceased, or disabled worker, if the child’s disability began before age 22, rather than before age 18. A person who was entitled to childhood disability benefits will become re-entitled if he or she again becomes disabled within seven years after prior entitlement to such benefits was terminated. Effective 1/73.
Section 109 provides the continuation of child’s benefits for a child who is attending school full time (including a student in a vocational school) when the child reaches age 22 through the end of the semester or quarter in which the child reaches such age if the child has not received, or completed the requirements for, a bachelor’s degree from a college or university. Effective with respect to benefits payable under Title II of the Social Security Act for months after 12/72.
Section 110 provides that a child who is entitled to benefits on the earnings record of more than one worker will be paid benefits based on the earnings record which results in paying the child the highest amount, if the payment would not reduce the benefits of any other individual who is entitled to benefits based on that earnings record. Effective 1/73.
Section 111 states that a child adopted after a retired or disabled worker becomes entitled to benefits will be eligible for child’s benefits based on the worker’s earnings if the child is the natural child or stepchild of the worker or if (1) the adoption was decreed by a court of competent jurisdiction within the U.S., (2) the child lived with the worker in the U.S. for the year before the worker became disabled or entitled to old-age or disability insurance benefits, (3) the child received at least ½ of support from the worker for that year, and (4) the child was under age 18 at the time the child began living with the worker. A child who was born in the 1-year period specified in (2) and (3) is eligible if the child was living with and receiving support from the worker for substantially all of the period after the child was born. Effective 1/68 and after if an application for benefits is filed within six months after the month of enactment; otherwise, effective for the month of enactment.
Section 112 states a child’s benefits will no longer stop when the child is adopted, regardless of who adopts the child. Effective 10/73.
Section 113 provides benefits for a child based on the earnings record of a grandparent. Benefits are extended to the grandchild of a worker or the worker's spouse if (1) the child was living with and receiving at least one half support from the worker for the year immediately before the worker became disabled, or entitled to old-age or disability insurance benefits, or died; (2) the child began living with the worker before age 18; and (3) at the time the worker became disabled, or entitled to old-age or disability benefits, or died, (a) the child’s natural or adopting parents or stepparents were disabled or were not alive, or (b) the child was adopted by the worker’s surviving spouse after the worker’s death and the child’s natural or adopting parent or stepparent was not living in the worker’s household and making regular contributions toward the child’s support at the time the worker died. Effective 1/73.
Section 114 provides that benefits are payable to a divorced wife age 62 or older and a divorced widow age 60 or older if her marriage lasted 20 years before the divorce, and to a surviving divorced mother. Eliminates the support requirement for divorced wives, divorced widows, and surviving divorced mothers. Effective 1/73.
Section 115 states the duration-of-marriage requirement for entitlement to benefits as a worker’s widow, widower, or stepchild - the marriage must have been in existence for not less than nine months immediately prior to the day on which the worker died (except where death was accidental or in the line of duty in the uniformed services) - is waived in cases where the worker and spouse were previously married, divorced, and remarried, if they were married at the time of the worker’s death and if the duration-of-marriage requirement would have been met at the time of the divorce had the worker died then. Effective 1/73.
Section 116 provides that the period throughout which a person must be disabled before becoming eligible for disability benefits is reduced by one month, from six months to five months. Effective 1/73.
Section 117 eliminates the test of recent attachment to covered work for blind people. Provides that a blind person is insured for disability benefits if they are fully insured, that is has as many quarters of coverage as the number of CYs that elapsed after 1950 (or the year they reached 21, if later) and up to the year in which they became disabled. Effective 1/73.
Section 118 states that disability insurance benefits (and dependent’s benefits based on a worker’s entitlement to disability benefits) will be paid to the disabled worker’s survivors if an application for benefits is filed within three months after the worker’s death, or within three months after enactment of this provision. Effective 1/73.
Section 119 states that Social Security disability benefits must be reduced when workmen’s compensation is also payable if the combined payments exceed 80% of the worker’s average current earnings before disablement. Provides an alternative in computing a worker’s average current earnings by basing it on one year of highest earnings in a period consisting of the year of disablement and the five preceding years. Effective 1/73.
Section 120 provides wage credits for members of the uniformed services. Noncontributory wage credits are provided, in addition to contributory credits for basic pay, for military service during the period January 1957 (when military service was first covered under Social Security) through December 1967. The provision would provide Social Security noncontributory wage credit of $300 for each calendar quarter in which the servicemen receives military pay. Effective 1/73.
Section 121 provides an optional method of determining net earnings from nonfarm self-employment. This provision states that nonfarm self-employed persons have the option of reporting as their earnings for Social Security purposes 2/3 of their gross income from nonfarm self-employment, but not more than $1,600 in a year. This optional method of reporting may not be used more than five times by any self-employed person, and it can be used in a taxable year only if the person has actual net earnings from self-employment of $400 or more in at least two out of the three immediately preceding taxable years. The optional method can only be used if actual net earnings from self-employment are less than $1,600 and less than two-thirds of gross income—it may not be used to report and pay Social Security taxes on an amount less than actual net earnings. Effective for the taxable years beginning after 12/31/72.
Section 122 provides that payments will not be counted for Social Security benefit or tax purposes, if made by an employer to a survivor or estate of a deceased former employee after the CY in which the employee died or to a disabled former employee after the CY in which the employee became entitled to Social Security disability insurance benefits provided the disabled employee does not perform any services for that employer in the period for which the payment is made. Effective for payments made after 12/72.
Section 123 states Social Security coverage is made available to members of religious orders who have taken a vow of poverty, if the order makes an irrevocable election to cover all of its members and lay employees.
Section 124 provides that U.S. citizens who are self-employed outside the U.S. and who retain their residence in the U.S. (for 510 days, approximately 17 months, out of 18 consecutive months may not exclude the first $20,000 of earned income for Social Security purposes. Instead, they must compute their earnings for self-employment for Social Security purposes in the same way as those who are self-employed in the U.S. Effective for taxable years beginning after 12/31/72.
Section 125 states that the provisions of Section 210 (a)(6)(B)(ii) of the Social Security Act and Section 3121(b)(6)(B)(ii) of the IRC of 1954 shall be effective with respect to all service performed in the employ of a Federal home loan bank on and after the first day of the first calendar quarter which begins on or after the date of enactment of this Act.
Section 126 amends Section 218(p)(1) of the Social Security Act to extend Social Security coverage to policemen and firemen in Idaho.
Section 127 extends Social Security coverage to certain hospital employees in New Mexico, but only if such hospital has prior to 1966 withdrawn from a retirement system which had been applicable to the employees of such hospital.
Section 128 amends Section 210(a)(7) of the Social Security Act and Section 3121(b)(7) of the IRC of 1954 to extend Social Security coverage to certain employees of the government of Guam. Effective with respect to service performed on or after the first day of the first calendar quarter which begins on or after the date of enactment.
Section 129 states that services of a student performed in the employ of an auxiliary non-profit organization which is organized and operated exclusively for the benefit of, and supervised or controlled by, the school, college, or university at which the student is enrolled and regularly attends classes is excluded from Social Security coverage. This exclusion does not apply to the services of a student for an organization connected with a public school, college, or university whose student employees are covered under Social Security pursuant to a State coverage agreement. Effective for services performed after 12/72.
Section 130 amends Section 208 of the Social Security Act by providing criminal penalties for (1) willfully, knowingly, and with the intent to deceive the Secretary of HEW his or her true identity (or the true identity of any other person), furnishes false information required by the Secretary for purposes of establishing and maintenance of SSN records; (2) for the purpose of increasing a payment under Social Security or any other federally funded program, or for the purpose of obtaining such payment or benefit that the person is not entitled, willfully, knowingly and with the intent to deceive uses a SSN that was obtained with false information furnished to the Secretary by any individual, or with the intent to deceive, falsely represents a number to be a SSN assigned by the Secretary. Establishes a penalty of up to a $1,000 fine, imprisonment up to one year, or both.
Section 131 provides an increase in the amount of Social Security Trust Fund moneys that may be used to pay for the costs of rehabilitating Social Security disability beneficiaries. The amount is increased from 1% of the previous year’s disability benefits to 1¼% for FY 1973 and to 1½% for FY 1974 and subsequent years. Effective upon enactment for expenditures after 6/30/72.
Section 132 states that money gifts made unconditionally to the Social Security program shall be deposited in the specific Trust Fund designated by the donor or if the donor has not so designated, the Federal OASDI Trust Fund. Effective for gifts and bequests received after the date of enactment.
Section 133 provides that if an individual would, upon the timely filing of an application for a disability determination under Section 216(i) of the Social Security Act and of an application for disability insurance benefits under Section 223, have been entitled to benefits under Section 223 for a period which began after 1959 and ended prior to 1964, such individual shall, upon filing application for disability insurance benefits with respect to such period not later than six months after the date of enactment, be entitled to receive in a lump sum an amount equal to the total amounts of benefits which would have been payable for such period, but only if such period was determined to be a period of disability. Effective with respect to information furnished to the Sec. of HEW after the date of enactment.
Section 134 states that upon the death after 1967 of an individual entitled to benefits under Section 202(a) or Section 223 of the Social Security Act, if any person is entitled to monthly benefits or a lump-sum death payment, on the wages and self-employment income of such individual, the Sec. of HEW shall recompute the decedent’s primary insurance amount, but only if the decedent during his or her lifetime was paid compensation which was treated under Section 205(o) as remuneration for employment.
Section 135 amends Section 3101 (a) of the IRC of 1954 by making changes to the tax schedule relating to the rate of tax on self-employment income for purposes of OASDI and hospital insurance, the rate of tax on employees for purposes of OASDI and hospital insurance, and the rate of tax on employers for purposes of OASDI and hospital insurance.
Section 136 makes allocation changes to the DI Trust Fund.
Section 137 amends Section 205(c)(2) of the Social Security Act to require the Sec. of HEW to assign SSNs (to the maximum extent practicable) to 1) aliens at the time of their lawful admission to the U.S. for permanent residence or under authority which permits them to work, and to other aliens at such time as their status changes to permit them to work; 2) to individuals who are applicants for or recipients of benefits that are funded in part or in whole by Federal funds; and, 3) to any individual that could have been but was not assigned an SSN as noted above but only after an investigation to establish certain requirements. The Sec. of HEW is authorized to assign SSNs to children below school age at the request of a parent or guardian or when they enter the school system. The Sec. of HEW must require evidence of age, citizenship, or alien status, and identity for applicants for an SSN. In carrying out these requirements, the Sec. of HEW may enter into agreements with the Attorney General, and with State and local welfare agencies and school officials as necessary.
[NOTE: This is the first explicit statutory authority to issue SSNs. SSNs were previously issued pursuant to administrative procedures that the Agency had established.]
Section 138 amends Section 209 of the Social Security Act by adding subsection (o), which states that the definition of “wages” excludes any payment made by an employer to an employee, if at the time such payment is made such employee is entitled to disability insurance benefits under Section 223(a) and such entitlement commenced prior to the CY in which such payment is made, and if such employee did not perform any services for such employer during the period for which such payment is made. Amends Section 3121(a) of the IRC of 1954 by adding paragraph (15), which provides that the definition of “wages” excludes any payment made by an employer to an employee, if at the time such payment is made such employee is entitled to disability insurance benefits under Section 223(a) of the Social Security Act and such entitlement commenced prior to the CY in which such payment is made, and if such employee did not perform any services for such employer during the period for which such payment is made. Effective for any payment made after 12/72.
Section 139(a) states that the Sec. of HEW may, under such conditions as he or she deems appropriate, permit the State of Louisiana to modify its agreement entered into under Section 218 of the Social Security Act so as to terminate the coverage of all employees who are in positions under the Registrars of Voters Employee’s Retirement System, but only if such State files with the Sec. of HEW notice of termination on or before 12/31/73. Effective after 12/75.
Section 139(b) states if the coverage of such employees in positions under such retirement system is terminated pursuant to subsection (a), coverage cannot later be extended to employees in positions under such retirement system.
Section 140 provides that the self-employment earnings of any American clergyman serving outside the U.S. is computed the same as clergymen in the U.S. by eliminating from the application the $20,000 exclusion provision for clergymen and members of religious orders who do not maintain a residence in the U.S. Effective for taxable years beginning after 12/31/72.
Section 141 permits States to modify their Social Security coverage agreements for State and local employees prior to 1/1/74, so as to remove the coverage services of students employed by the public school or college they are attending, and the services of other part-time employees.
Section 142 provides non-contributory Social Security credits for U.S. citizens of Japanese ancestry for the periods they were interned by the U.S. Government during World War II and were age 18 or older. The credits will be determined on the basis of the then prevailing minimum wage or the individual’s prior earnings, whichever is larger. Effective 1/73.
Section 143 modifies the agreement with West Virginia, under Section 218 of the Social Security Act, to provide coverage for certain policemen and firemen.
Section 144 perfects the amendments relating to the 20% increase provision enacted in PL 92-336.
Section 145 amends Section 216(k) of the Social Security Act by reducing from nine months to three months the duration-of-relationship requirement when death is accidental or in line of duty in the Armed Forces so that there would be no duration-of-relationship requirement in such cases if at the time of the marriage it is reasonable to expect that the deceased would have lived for at least nine months. Effective 1/73.
Title II - Provision Relating to Medicare, Medicaid, and Maternal and Child Health
Section 201 states that Social Security disability beneficiaries will be covered under Medicare after entitlement to disability benefits for not less than 24 consecutive months. Those covered include disabled workers at any age; disabled widows and disabled dependent widowers between the ages of 50 and 65; beneficiaries age 18 or older who receive benefits because of disability prior to reaching age 22; and disabled qualified railroad retirement annuitants. Effective 7/73.
Section 202 states that people age 65 or over who are ineligible for Part A of Medicare can voluntarily enroll for hospital insurance coverage by applying the full cost of coverage (initially $33 monthly to be recalculated annually). Where the Sec. of HEW finds it administratively feasible, those States and other public employee groups which have voluntarily elected not to participate in the Social Security program, could opt for and pay the Part A premium costs for retired or active employees age 65 or over. Enrollment in Part B of Medicare is required as a condition of buying into the Part A program. Effective 7/73.
Section 203 provides that Part B premium increases for FY 1974 and thereafter will be limited to not more than the percentage by which Social Security cash benefits had been generally increased since the last Part B premium adjustment. Costs above those met by such premium payments will be paid out of general revenues in addition to the regular general revenue matching. Effective 7/73.
Section 204 states the annual Part B deductible is increased from $50 to $60. Effective 1/73.
Section 206 provides for automatic enrollment under Part B for the elderly and the disabled as they become eligible for Part A hospital insurance coverage (except for residents of Puerto Rico and foreign countries). Those eligible for automatic enrollment must be fully informed as to the procedure and given an opportunity to decline the coverage. Effective 7/73.
Section 210 states that Medicare will not pay a beneficiary who is also a Federal retiree or employee for services covered under their Federal employee’s health insurance policy which are also covered under Medicare unless they have had an option of selecting a policy supplementing Medicare benefits. If a supplemental policy is not made available, the Federal employee plan pays first on any items of care which were covered under both the Federal employee’s program and Medicare. Effective 1/75.
Section 211 provides that payment under Medicare for care in a foreign hospital of a U.S. resident is authorized where such hospital is closer to his or her residence or more accessible than the nearest suitable U.S. hospital. Such hospitals must be approved under an appropriate hospital approval program. Part B payments for necessary physicians’ services furnished in conjunction with such hospitalization are authorized. Medicare payments for emergency hospital and physician services needed by beneficiaries in transit between Alaska and the other continental States is also covered. Effective 1/73.
Section 213 relieves beneficiaries from liability in certain situations where Medicare claims are disallowed and the beneficiary is without fault. Effective for claims for items and services furnished after 10/30/72.
Section 221 states that Medicare and Medicaid payments will not be made with respect to certain disapproved capital expenditures (except for construction toward which preliminary expenditures of $100,000 or more had been made in the three year period ending 12/17/70) which are specifically determined to be inconsistent with State or local health facility plans. Effective 1/73, or earlier if requested by a State.
Section 222 states that the Sec. of HEW is authorized to undertake studies, experiments or demonstration projects with respect to: various forms of prospective reimbursement of facilities; ambulatory surgical centers; intermediate care and homemaker services (with respect to the extended care benefit under Medicare); elimination or reduction of the three-day prior hospitalization requirement for admission to a skilled nursing facility; determination of the most appropriate methods of reimbursing the services of physicians’ assistants and nurse practitioners; provision of day care services to older persons eligible under Medicare and Medicaid; and possible means of making the services of clinical psychologists more generally available under Medicare and Medicaid.
Section 223 provides that the Sec. of HEW is authorized to establish limits on overall direct or indirect costs which will be recognized as reasonable for comparable services in comparable facilities in an area. The Sec. of HEW may also establish maximum acceptable costs in such facilities with respect to items or groups of services (for example, food costs, or standby costs). The beneficiary will be liable (except in the case of emergency care) for any amounts determined as excessive (except that they may not be charged for excessive amounts in a facility in which their admitting physician has a direct or indirect ownership interest in the facility). Effective for accounting periods beginning after 12/72.
Section 224 provides that reasonable charges for medical services, supplies, and equipment may not exceed the lowest charge levels at which such services, supplies, and equipment are widely and consistently available in a locality except to the extent and under the circumstances specified by the Sec. of HEW. Effective 7/73 for physicians’ services, and 1/73 for other items and services.
Section 225 states that Federal financial participation in reimbursement for skilled nursing facility care and intermediate care per diem costs are not available to the extent such costs exceed 105% of prior year levels of payment (except for those costs attributable to any additional required services). Also excepted are increased payments resulting from increases in the Federal minimum wage or other new Federal laws. Effective 1/73.
Section 226 states that Medicare is authorized to make a single combined Part A and B payment, on a capitation basis, to a HMO, which would agree to provide care to a group not more than one-half of whom are Medicare beneficiaries who freely choose this arrangement. Such payments may not exceed 100% of present Part A and B per capita costs for a comparable group of non-HMO beneficiaries in a given geographic area, and the exact amount of the incentive payment would be dependent upon the relative efficiency of the HMO. Effective 7/73.
Section 227 provides that services of teaching physicians will be reimbursed under Medicare on a costs basis unless: (A) the patient is a bona fide private patient; or (B) the hospital has charged all patients and collected from a majority on a fee-for-service basis. For donated services of teaching physicians, a salary cost will be imputed equal to the prorated usual costs of full-time salaried physicians. Any such payment would be made to a special fund designated by the medical staff to be used for charitable or educational purposes. Effective 7/73.
Section 228 states that the Sec. of HEW is authorized to establish, by diagnosis, minimum periods during which the post-hospital patient would be presumed to be eligible for skilled nursing facility and home health benefits. Effective 1/73.
Section 229 provides that the Sec. of HEW is authorized to suspend or terminate Medicare payments to a provider found to have abused the program. Further, there will be no Federal participation in Medicaid payments which might be made subsequently to such a provider. Effective for Medicare 1/73; for Medicaid 10/30/72.
Section 234 states all providers of services, as a condition of Medicare participation, are required to have a written overall plan and budget reflecting an operating budget and a capital expenditures plan which would be updated at least annually. The required annual operating budget does not have to be a detailed item budget. Effective for FYs of providers beginning after 3/73.
Section 236 provides that payment under Medicare and Medicaid cannot be made to anyone other than the physician or other person who provided the service, unless such person is required as a condition of employment to turn fees over to his or her employer. Effective 10/30/72 for Medicare and 1/73 for Medicaid.
Section 238 states that notification to patient and physician, and a payment cut-off after three days, is required under Medicare in those cases where unnecessary utilization is discovered during a sample review of admissions to hospitals or skilled nursing facilities. Effective 1/73.
Section 241 provides for proficiency testing of paramedical personnel under Medicare and Medicaid until 12/31/77.
Section 242 provides penalties for soliciting, offering or accepting bribes or kickbacks, or for concealing events affecting a person’s rights to benefits with intent to defraud, and for converting benefit payments to improper use, of up to one year’s imprisonment and a $10,000 fine or both may be imposed. Additionally, false reporting of a material fact as to conditions or operations of a health care facility is a misdemeanor and is subject to up to six months’ imprisonment, a fine of $2,000, or both. Effective for acts occurring on or after 10/30/72.
Section 243 establishes under Medicare a Provider Reimbursement Review Board to hear cases involving an issue of $10,000 or more. Groups of providers can appeal where the amounts at issue on a common matter aggregate $50,000 or more. Any provider which believes that its fiscal intermediary has failed to make a timely cost determination on its annual cost report or timely determination on a supplemental filing can appeal to the Board where the amount involved is $10,000 or more. Effective for accounting periods ending on or after 6/30/73.
Section 244 states that State health certification agencies, as directed by the Sec. of HEW, will survey on a selective sample basis (or where substantial allegations of noncompliance have been made) hospitals accredited by the Joint Commission on Accreditation of Hospitals. The Sec. of HEW is also authorized to promulgate health and safety standards without being restricted to Joint Commission on Accreditation of Hospital standards.
Section 245 states that the Sec. of HEW is authorized to experiment with reimbursement approaches which are intended to eliminate unreasonable expenses resulting from prolonged rentals of durable medical equipment and then to implement the approaches found effective.
Section 246 provides a single definition and set of standards for extended care facilities under Medicare and skilled nursing homes under Medicaid are established. This provision creates a single category of “skilled nursing facilities” which will be eligible to participate in both health care programs. A “skilled nursing facility” is defined as an institution meeting the prior definition of an extended care facility and which also satisfies certain other Medicaid requirements. Effective 7/73.
Section 247 states the definition of care requirements with respect to entitlement for extended care benefits under Medicare and with respect to skilled nursing care under Medicaid is made the same. Amends the prior law to authorize skilled care benefits for individuals in need of skilled nursing care and/or skilled rehabilitation services on a daily basis in a skilled nursing facility which it is practical to provide only on an inpatient basis. Coverage will also be continued during short term periods (e.g., a day or two) when no skilled services are actually provided but when discharge from a skilled facility for such brief period is neither desirable nor practical. Effective 1/73.
Section 248 authorizes an interval of more than 14 days for patients whose conditions do not permit immediate provision of skilled services within the 14-day limitation. An extension not to exceed two weeks beyond the 14 days is also authorized in those instances where an admission to a skilled nursing facility is prevented because of the non-availability of appropriate bed space in facilities ordinarily utilized by patients in a geographic area.
Section 249 provides that States will be required to reimburse skilled nursing and intermediate care facilities on a reasonable cost-related basis under Medicaid, using acceptable cost-finding techniques and methods approved and validated by the Sec. of HEW cost reimbursement methods which the Sec. of HEW finds to be acceptable for a State’s Medicaid program could be adapted, with appropriate adjustments, for purposes of Medicare skilled nursing facility reimbursements in that State. Effective 7/76.
Section 249C states that HEW must regularly make public the following types of evaluations and reports with respect to the Medicare and Medicaid programs: (1) individual contractor performance reviews and other formal evaluations of the performance of carriers, intermediaries, and State agencies including the reports of follow-up reviews; (2) comparative evaluations of the performance of contractors - including comparisons of either overall performance or of any particular contractor operation; (3) program validation survey reports - with the names of individuals deleted. Effective for reports completed after 1/73.
Section 249D provides that Federal matching for that portion of any money payment to a cash public assistance recipient which is related to institutional medical or remedial care will not be made.
Section 249F provides for the establishment of Professional Standards Review Organizations (PSRO’s) consisting of substantial numbers of practicing physicians (usually 300 or more) in local areas to assume responsibility for comprehensive and on-going review of services covered under the Medicare and Medicaid programs. Until 1/1/76 only such qualified physician-sponsored organizations may be designated as PSRO’s. Subsequent to that date priority will be given to such organizations but where they do not choose to or do not qualify to assume such responsibilities in an area, the Sec. of HEW may designate another organization having professional medical competence as the PSRO for the area. The PSRO will be responsible for assuring that institutional services were (1) medically necessary and (2) provided in accordance with professional standards. A PSRO, at its option, and with the approval of the Sec. of HEW, may also assume responsibility for the review of non-institutional care and services provided under Medicare and Medicaid. PSRO’s would not be involved with reasonable charge determinations. Safeguards included are designed to protect the public interest, including appeals procedures, and to prevent pro forma assumption in carrying out review responsibilities. The provision requires recognition of and use by the PSRO of utilization review committees in hospitals and medical organizations to the extent they are determined to be effective.
Section 251 provides (1) physical therapy provided in the therapist’s office pursuant to a physician’s written plan of treatment is covered under Part B of Medicare. Benefit payments in one year for services by an independent practitioner in his or her office or the patient’s home cannot be based on more than $100 of incurred expenses. Effective 7/73; (2) a hospital or skilled nursing facility could provide covered outpatient physical therapy services to its inpatients, so that an inpatient could conveniently receive Part B benefits after inpatient benefits have expired. Effective 10/30/72; and (3) reimbursement for services provided by physical and other therapists in health institutions will generally be limited to a reasonable salary-related basis rather than a fee-for-service basis. Effective 1/73.
Section 252 provides Medicare coverage of the costs of supplies directly related to the care of a colostomy.
Section 256 states that the dentist who is caring for a Medicare patient is authorized to make the certification of the necessity for inpatient hospital admission for noncovered dental services without requiring a corroborating certification by a physician. Effective 1/73.
Section 257 states that the 90-day grace period can be extended for an additional 90 days where the Sec. of HEW finds that there was good cause for failure to pay the Part B premium before the expiration of the initial 90-day grace period. Effective 10/30/72 and with premiums due 90 days before 10/30/72.
Section 258 provides that where a claim under supplementary medical insurance is not filed timely due to error of the Government or one of its agents, the claim may nevertheless be honored if filed as soon as possible after the facts in the case have been established. Effective 3/68.
Section 259 states the Sec. of HEW is authorized to provide such equitable relief as may be necessary to correct or eliminate the effects of situations where an individual’s rights were prejudiced by administrative error or inaction, including (but not limited to) the establishment of a special initial or subsequent enrollment period, with a coverage period determined on the basis thereof and with appropriate adjustments of premiums. Effective 10/30/72, for all cases arising since the beginning of Medicare.
Section 260 provides that the prior three-year limit with respect to both initial enrollment and reenrollment after an initial termination is removed. Effective 10/30/72, for all those who could not enroll.
Section 261 states any individual who is liable for repayment of a Medicare overpayment can qualify for waiver of recovery of the overpaid amount if they are without fault and if such recovery would defeat the purpose of Title II or would be against equity and good conscience.
Section 262 states that a minimum amount of $100 must be at issue before an enrollee in the supplementary medical insurance program can be granted a fair hearing by the carrier.
Section 263 provides that the Railroad Retirement Board shall be responsible for collection of supplementary medical insurance premiums for all enrollees who are entitled under that program.
Section 264 provides an optometrist can attest to a beneficiary’s need for prosthetic lenses under Medicare.
Section 265 states that the provision of medical social services will no longer be required as a condition of participation for a skilled nursing facility under Medicare.
Section 266 provides that the Sec. of HEW is authorized to dispose of excess supplementary medical insurance premiums and excess hospital insurance premiums in the same manner as unpaid medical insurance benefits are treated.
Section 267 states that a special waiver of the R.N. nursing requirement for skilled nursing facilities in rural areas can be granted provided that a registered nurse is absent from the facility for not more than two day-shifts (if the facility employs one full-time registered nurse and the facility is making good-faith efforts to obtain another on a part-time basis). This special waiver may be granted only if (1) the facility is caring only for patients whose physicians have indicated (in written form on order sheet and admission note) that they could go without a registered nurse’s services for a 48-hour period or (2) if the facility has any patients for whom physicians have indicated a need for a registered nurse or a physician to spend such time as is necessary at the facility to provide the skilled nursing services required by patients on the uncovered day.
Section 273 states the definition of the term “physician” in title XVIII includes a licensed chiropractor who also meets uniform minimum standards promulgated by the Sec. of HEW. The services furnished by chiropractors are covered under the program as “physician services,” but only with respect to treatment of the spine by means of manual manipulation which the chiropractor is legally authorized to perform. Claims for such treatment must be verifiable with a satisfactory X-ray indicating the existence of a subluxation of the spine. Effective 7/73.
Section 276 states services furnished by an intern or resident-in-training in the field of podiatry under a teaching program approved by the Counsel on Podiatry Education of the American Podiatry Association are included within the definition of approved hospital teaching programs. Effective 1/73.
Section 277 provides that those State agencies, which are capable of and willing to, may provide specialized consultative services for Medicare patients in a skilled nursing facility, subject to approval of the State’s arrangements by the Sec. of HEW.
Section 278(a) makes a minor technical amendment to Section 1814(a)(2)(C); Section 1814(a)(6); Section 1814(a)(7); Section 1861(a)(2); Section 1861(h); Section 1861(i); Section 1861(j); Section 1861(k); 1861(l); Section 1861(m)(7); Section 1861(n); Section 1861(u); Section 1861(v)(3); Section 1861(w); Section 1861(y); Section 1864(a); Section 1866; Section 1902(a)(13); Section 1902(a)(26); Section 1902(a)(28); Section 1905(a)(4); Section 1905(a)(5); Section 1905(a)(14); and Section 1121.
Section 278(b) makes minor technical amendments to Sections 1903(g), (h); Section 402(a)(1)(E) of the Social Security Amendments of 1967; Section 1876; Section 1814(h); Section 1903(h); Section 1861(z); Section 1903(i)(4); Section 1877(c); Section 1909(c); Section 1861(i); Section 1861(v)(1)(E); Section 1910; Section 1861(j); Section 1902(a); Section 1864(a); Section 1903(j); Section 1814(h); and Section 1866(a)(1). Effective 1/73.
Section 279 states with respect to diagnostic laboratory tests for which payment is to be made to a laboratory, the Sec. of HEW is authorized to negotiate a payment rate with a laboratory which would be considered the full charge for such tests, and for which reimbursement would be made at 100% of such negotiated rate. Such negotiated rate must be limited to an amount not to exceed the total payment that would have been made in the absence of such rate.
Section 281 limits Medicare’s right of recovery of overpayments to a three-year period (or as short as one year if the Sec. of HEW so decides) from the date of payment where the beneficiary acted in good faith. Permits the Sec. of HEW to set a time between one and three years within which claims for underpayments have to be made.
Section 283 provides that the costs of speech pathology services, where such services are provided in clinics participating in the program as providers of covered physical therapy services, are covered under Medicare. Effective 1/73.
Section 288 provides for modification of the role of the health insurance benefits advisory council so that its role would be that of offering suggestions for the consideration of the Sec. of HEW on matters of general policy in the Medicare and Medicaid programs.
Section 289 states that the Sec. of HEW, in carrying out his or her responsibility for administration of the Medicare program, is authorized to administer oaths and affirmations in the course of any hearing, investigation, or proceeding.
Section 293 deletes the prior requirement that railroad include the amount of hospital insurance tax withheld on W-2 forms. Employees will be notified, however, that those with dual employment may be entitled to a refund of excess hospital insurance tax paid. Effective for remuneration paid after 1971.
Section 294 provides that appointments to the office of the Administrator of the Social and Rehabilitation Service will be made by the President, by and with the advice and consent of the Senate.
Section 299D states that the Sec. of HEW is required to make reports of an institution’s significant deficiencies or the absence thereof (such as in the areas of staffing, fire safety, and sanitation) a matter of public record readily and generally available. Such information must be available for inspection within 90 days of completion of the survey. Effective 5/1/73.
Section 299I provides that fully or currently insured workers under Social Security and their dependents with chronic renal disease would be deemed disabled for purposes of coverage under Parts A and B of Medicare. Coverage would begin three months after a course of renal dialysis is begun. Institutional care will be covered only in institutions which meet a minimum utilization rate requirement and which provide for a medical review board to screen the appropriateness of patients for proposed treatment procedures. Effective with respect to services provided on and after 7/1/73.
Section 299K eliminates the coinsurance payment under Part B of Medicare for home health services. Effective 1/73.
Section 299L provides that the Sec. of HEW, rather than the States only, may certify institutions on Indian reservations as intermediate care facilities or skilled nursing facilities.
Section 299O makes clear that there is no authorization for an appeal to the Sec. of HEW or for judicial review on matters solely involving amounts of benefits under Part B, and that insofar as Part A amounts are concerned, appeal is authorized only if the amount in controversy is $100 or more and judicial review only if the amount in controversy is $1,000 or more.
Title III - Supplemental Security Income for the Aged, Blind, and Disabled
Section 301 establishes the Supplemental Security Income (SSI) program for the Aged, Blind, and Disabled. Amends Title XVI of the Social Security Act by adding the following:
“Title XVI - Supplemental Security Income for the Aged, Blind, and Disabled”
Section 1601 states that for the purpose of establishing a national program to provide supplemental security income to individuals who have attained age 65 or are blind or disabled, there are authorized to be appropriated sums sufficient to carry out this Title.
Section 1602 states that every aged, blind, or disabled individual who is determined to be eligible on the basis of income and resources shall be paid benefits by the Sec. of HEW.
Section 1611(a)(1) states that each aged, blind, or disabled individual who does not have an eligible spouse and (A) whose income, other than income excluded pursuant to Section 1612(b), is at a rate of not more than $1,560 for the CY 1974 or any CY thereafter, and (B) whose resources, other than resources excluded pursuant to Section 1613(a), are not more than (i) in cases where such individual has a spouse with whom the individual is living with, $2,250, or (ii) in cases where such individual has no spouse with whom that individual is living with, $1,500, shall be an eligible individual for purposes of this Title.
Section 1611(a)(2) states each aged, blind, or disabled individual who has an eligible spouse and (A) whose income (together with the income of such spouse), other than income excluded pursuant to Section 1612(b), is at a rate of not more than $2,340 for the CY 1974, or any CY thereafter, and (B) whose resources (together with the resources of such spouse), other than resources excluded pursuant to Section 1613(a), are not more than $2,250, shall be an eligible individual for purposes of this Title.
Section 1611(b)(1) states that the benefits under this Title for an individual who does not have an eligible spouse shall be payable at the rate of $1,560 for the CY 1974 and any CY thereafter, reduced by the amount of income, not excluded pursuant to Section 1612(b), of such individual.
Section 1611(b)(2) states that the benefits under this Title for an individual who has an eligible spouse shall be payable at the rate of $2,340 for the CY 1974 and any CY thereafter, reduced by the amount of income, not excluded pursuant to Section 1612(b), of such individual.
Section 1611(c)(1) provides that an individual’s eligibility for benefits under this Title and the amount of such benefits shall be determined for each quarter of a CY except that, if the initial application for benefits is filed in the second or third month of a calendar quarter, such determinations shall be made for each month in such quarter. Eligibility for and the amount of such benefits for any quarter shall be redetermined at such time or times as may be provided by the Sec. of HEW.
Section 1611(c)(2) states that for purposes of this subsection an application shall be considered to be effective as of the first day of the month in which it was actually filed.
Section 1611(d) provides that the Sec. of HEW may prescribe the circumstances under which, the gross income from a trade or business (including farming) will be considered sufficiently large to make an individual ineligible for benefits under this Title.
Section 1611(e)(1)(A) states that except as provided in subparagraph (B), no person shall be an eligible individual or eligible spouse for purposes of this Title with respect to any month if throughout such month the individual is an inmate of a public institution.
Section 1611(e)(1)(B) states that in any case where an eligible individual or their eligible spouse is, throughout any month, in a hospital, extended care facility, nursing home, or intermediate care facility receiving payments (with respect to such individual or spouse) under a State plan approved under Title XIX, the benefit under this Title for such individual for such month shall be payable (i) at a rate not in excess of $300 per year (reduced by the amount of any income not excluded pursuant to Section 1612(b)) in the case of an individual who does not have an eligible spouse; (ii) at a rate not in excess of the sum of the applicable rate specified in subsection (b)(1) and the rate of $300 per year (reduced by the amount of any income not excluded pursuant to Section 1612(b)) in the case of an individual who has an eligible spouse, if only one of them is in such a hospital, home, or facility throughout such month; and (iii) at a rate not in excess of $600 per year (reduced by the amount of any income not excluded pursuant to Section 1612(b)) in the case of an individual who has an eligible spouse, if both of them are in such a hospital, home, or facility throughout such month.
Section 1611(e)(2) provides that no person shall be an eligible individual or eligible spouse for purposes of this Title if, after notice to such person is eligible for any payments of the type enumerated in Section 1612(a)(2)(B), such person fails within 30 days to take all appropriate steps to apply for and (if eligible) obtain any such payments.
Section 1611(e)(3)(A) states no person who is an aged, blind, or disabled individual solely by reason of disability (as determined under Section 1614(a)(3)) shall be an eligible individual or eligible spouse for purposes of this Title with respect to any month if such individual is medically determined to be a drug addict or an alcoholic unless such individual is undergoing any treatment that may be appropriate for their condition as a drug addict or alcoholic at an institution or facility approved for purposes of this paragraph by the Sec. of HEW (so long as such treatment is available) and demonstrates that they are complying with the terms, conditions, and requirements of such treatment and with requirements imposed by the Sec. of HEW under subparagraph (B).
Section 1611(e)(3)(B) states the Sec. of HEW shall provide for the monitoring and testing of all individuals who are receiving benefits under this Title and who as a condition of such benefits are required to be undergoing treatment and complying with the terms, conditions, and requirements thereof as described in subparagraph (A), in order to assure such compliance and to determine the extent to which the imposition of such requirement is contributing to the achievement of the purposes of this Title. The Sec. of HEW shall annually submit to the Congress a full and complete report on their activities under this paragraph.
Section 1611(f) provides that notwithstanding any other provision of this Title, no individual shall be considered an eligible individual for purposes of this Title for any month during all of which such individual is outside the U.S. (and no person shall be considered the eligible spouse of an individual for purposes of this title with respect to any month during all of which such person is outside the U.S.). For purposes of the preceding sentence, after an individual has been outside the U.S. for any period of 30 consecutive days, they shall be treated as remaining outside the U.S. until they have been in the U.S. for a period of 30 consecutive days.
Section 1611(g) states in the case of any individual or any individual and their spouse who for the month of 12/73 was a recipient of aid or assistance under a State plan approved under Title I, X, XIV, or XVI, the resources of such individual or such individual and their spouse shall be deemed not to exceed the amount specified in Sections 1611(a)(1)(B) and 1611(a)(2)(B) during any period that the resources of such individual or individual and their spouse does not exceed the maximum amount of resources, as specified in the State plan (as in effect in 10/72) under which he/she or they are entitled to aid or assistance for the month of 12/72.
Section 1611(h) provides that in determining eligibility for, and the amount of, benefits payable under this Section in the case of any individual or any individual and their spouse who is blind and who for the month of 12/73 was a recipient of aid or assistance under a State plan approved under Title X or XVI, there shall be disregarded an amount equal to the greater of the amounts determined as follows (1) the maximum amount of any earned or unearned income which could have been disregarded under the State plan (as in effect in 10/72), or (2) the amount which would be required to be disregarded under Section 1612 without application of this subsection.
Section 1612(a)(1) states earned income means only (A) wages as determined under Section 203(f)(5)(C); and (B) net earnings from self-employment, as defined in Section 211 including earnings for services described in paragraphs (4), (5), and (6) of subsection (c).
Section 1612(a)(2) states unearned income means all other income, including (A) support and maintenance furnished in cash or kind; except that in the case of any individual (and eligible spouse, if any) living in another person’s household and receiving support and maintenance in kind from such person, the dollar amounts otherwise applicable to such individual (and spouse) as specified in subsections (a) and (b) of Section 1611 shall be reduced by 33⅓% in lieu of including such support and maintenance in the unearned income of such individual (and spouse) as otherwise required by this subparagraph; (B) any payments received as an annuity, pension, retirement, or disability benefit, including veterans’ compensation and pensions, workmen’s compensation payments, old-age, survivors, and disability insurance benefits, railroad retirement annuities and pensions, and unemployment insurance benefits; (C) prizes and awards; (D) the proceeds of any life insurance policy to the extent that they exceed the amount expended by the beneficiary for purposes of the insured individual’s last illness and burial or $1,500, whichever is less; (E) gifts (cash or otherwise), support and alimony payments, and inheritances; and (F) rents, dividends, interest, and royalties.
Section 1612(b)(1) states that in determining the income of an individual (and eligible spouse) there shall be excluded subject to limitations (as to amount or otherwise) prescribed by the Sec. of HEW, if such individual is a child who is, as determined by the Sec. of HEW, a student regularly attending a school, college, or university, or a course of vocational or technical training designed to prepare them for gainful employment, the earned income of such individual.
Section 1612(b)(2) states that in determining the income of an individual (and their eligible spouse) there shall be excluded the first $240 per year (or proportionately smaller amounts for shorter periods) of income (whether earned or unearned) other than income which is paid on the basis of the need of the eligible individual.
Section 1612(b)(3) states that in determining the income of an individual (and eligible spouse) there shall be excluded (A) the total unearned income of such individual (and such spouse, if any) in a calendar quarter which, as determined in accordance with criteria prescribed by the Sec. of HEW, is received too infrequently or irregularly to be included, if such income so received does not exceed $60 in such quarter, and (B) the total earned income of such individual (and such spouse, if any) in a calendar quarter which, as determined in accordance with such criteria, is received too infrequently and irregularly to be included, if such income so received does not exceed $30 in such quarter.
Section 1612(b)(4)(A) states that in determining the income of an individual (and eligible spouse) there shall be excluded if such individual (or such spouse) is blind (and has not attained age 65, or received benefits under this Title (or aid under a State plan approved under Section 1002 or 1602) for the month before the month in which they attained age 65), (i) the first $780 per year (or proportionately smaller amounts for shorter periods) of earned income not excluded by the preceding paragraphs of this subsection, plus ½ of the remainder thereof, (ii) an amount equal to any expenses reasonably attributable to the earning of any income, and (iii) such additional amounts of other income, where such individual has a plan for achieving self-support approved by the Sec. of HEW, as may be necessary for the fulfillment of such plan.
Section 1612(b)(4)(B) states that in determining the income of an individual (and their eligible spouse) there shall be excluded if such individual (or such spouse) is disabled but not blind (and has not attained age 65, or received benefits under this Title (or aid under a State plan approved under Section 1402 or 1602) for the month before the month in which they attained age 65), (i) the first $780 per year (or proportionately smaller amounts for shorter periods) of earned income not excluded by the preceding paragraphs of this subsection, plus ½ of the remainder thereof, (ii) such additional amounts of other income, where such individual has a plan for achieving self-support approved by the Sec. of HEW, as may be necessary for the fulfillment of such plan.
Section 1612(b)(4)(C) state if such individual (or such spouse) has attained age 65 and is not included under subparagraphs (A) or (B), the first $780 per year ( or proportionately smaller amounts for shorter periods) of earned income not excluded by the preceding paragraphs of this subsection, plus ½ of the remainder thereof.
Section 1612(b)(5) states that in determining the income of an individual (and eligible spouse) there shall be excluded any amount received from any public agency as a return or refund of taxes paid on real property or on food purchased by such individual (or such spouse).
Section 1612(b)(6) states that in determining the income of an individual (and eligible spouse) there shall be excluded assistance described in Section 1616(a) which is based on need and furnished by any State or political subdivision of a State.
Section 1612(b)(7) states that in determining the income of an individual (and eligible spouse) there shall be excluded any portion of any grant, scholarship, or fellowship received for use in paying the cost of tuition and fees at any educational (including technical or vocational education) institution.
Section 1612(b)(8) states that in determining the income of an individual (and eligible spouse) there shall be excluded home produce of such individual (or spouse) utilized by the household for its own consumption.
Section 1612(b)(9) states that in determining the income of an individual (and eligible spouse) there shall be excluded if such individual is a child ⅓ of any payment for their support received from an absent parent.
Section 1612(b)(10) states that in determining the income of an individual (and eligible spouse) there shall be excluded any amounts received for the foster care of a child who is not an eligible individual but who is living in the same home as such individual and was placed in such home by a public or nonprofit private child-placement or child-care agency.
Section 1613(a)(1) states in determining the resources of an individual (and eligible spouse, if any) there shall be excluded the home (including the land that appertains thereto), to the extent that its value does not exceed such amount as the Sec. of HEW determines to be reasonable.
Section 1613(a)(2) states in determining the resources of an individual (and eligible spouse, if any) there shall be excluded household goods, personal effects, and an automobile, to the extent that their total value does not exceed such amount as the Sec. of HEW determines to be reasonable.
Section 1613(a)(3) states in determining the resources of an individual (and eligible spouse, if any) there shall be excluded other property which, as determined in accordance with and subject to limitations prescribed by the Sec. of HEW, is so essential to the means of self-support of such individual (and such spouse) as to warrant its exclusion.
Section 1613(a)(4) states in determining the resources of an individual (and eligible spouse, if any) there shall be excluded such resources of an individual who is blind or disabled and who has a plan for achieving self-support approved by the Sec. of HEW, as may be necessary for the fulfillment of such plan.
Section 1613(a)(5) states in determining the resources of an individual (and eligible spouse, if any) there shall be excluded in the case of Natives of Alaska, shares of stock held in a Regional or a Village Corporation, during the period of twenty years in which such stock is inalienable, as provided in Section 7(h) and Section 8(c) of the Alaska Native Claims Settlement Act.
Section 1613(b) states that the Sec. of HEW shall prescribe the period or periods of time within which, and the manner in which, various kinds of property must be disposed of in order not to be included in determining an individual’s eligibility for benefits. Any portion of the individual’s benefits paid for any such period shall be conditioned upon such disposal; and any benefits sopaid shall (at the time of the disposal) be considered overpayments to the extent they would not have been paid had the disposal occurred at the beginning of the period for which such benefits were paid.
Section 1614(a)(1) states that for purposes of this Title, the term aged, blind, or disabled individual means an individual who (A) is 65 years of age or older, is blind (as determined under paragraph (2), or is disabled (as determined under paragraph (3),and (B) is a resident of the United States, and is either (i) a citizen or (ii) an alien lawfully admitted for permanent residence or otherwise permanently residing in the U.S. under color of law.
Section 1614(a)(2) provides that an individual shall be considered to be blind for purposes of this Title if such individual has central visual acuity of 20/200 or less in the better eye with the use of a correcting lens. An eye which is accompanied by a limitation in the fields of vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be considered for purposes of the first sentence of this subsection as having a central visual acuity of 20/200 or less. An individual shall also be considered to be blind for purposes of this title if such individual is blind as defined under a State plan approved under Title X or XVI as in effect for 10/72 and received aid under such plan (on the basis of blindness) for 12/73, so long as such individual is continuously blind as so defined.
Section 1614(a)(3)(A) states that an individual shall be considered to be disabled for purposes of this Title if such individual is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months (or, in the case of a child under the age of 18, if such child suffers from any medically determinable physical or mental impairment of comparable severity). An individual shall also be considered to be disabled for purposes of this Title if he or she is permanently and totally disabled as defined under a State plan approved under Title XIV or XVI as in effect for 10/72 and received aid under such plan (on the basis of disability) for 12/73, so long as he or she is continuously disabled as so defined.
Section 1614(a)(3)(B) provides that for purposes of subparagraph (A), an individual shall be determined to be under a disability only if physical or mental impairment or impairments are of such severity that he or she is not only unable to do previous work but cannot, considering age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy, regardless of whether such work exists in the immediate area in which the person lives, or whether a specific job vacancy exists, or whether the individual would be hired if he or she applied for work. For purposes of the preceding sentence (with respect to any individual), ‘work which exists in the national economy’ means work which exists in significant numbers either in the region where such individual lives or in several regions of the country.
Section 1614(a)(3)(C) states that for purposes of this paragraph, a physical or mental impairment is an impairment that results from anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques .
Section 1614(a)(3)(D) provides that the Sec. of HEW shall by regulations prescribe the criteria for determining when services performed or earnings derived from services demonstrate an individual’s ability to engage in SGA. Notwithstanding the provisions of subparagraph (B), an individual whose services or earnings meet such criteria, except for purposes of paragraph (4), shall be found not to be disabled.
Section 1614(a)(4)(A) states that for purposes of this Title, any services rendered during a period of trial work (as defined in subparagraph (B)) by an individual who is an aged, blind, or disabled individual solely by reason of disability shall be deemed not to have been rendered by such individual in determining whether disability has ceased in a month during such period. As used in this paragraph, the term ‘services’ means activity which is performed for remuneration or gain or is determined by the Sec. of HEW to be of a type normally performed for remuneration or gain.
Section 1614(a)(4)(B) states that the term ‘period of trial work’, with respect to an individual who is an aged, blind, or disabled individual solely by reason of disability means a period of months beginning and ending as provided in subparagraphs (C) and D) .
Section 1614(a)(4)(C) provides that a period of trial work for any individual shall begin with the month in which the individual became eligible for benefits under this Title on the basis of disability; but no such period may begin for an individual who is eligible for benefits under this Title on the basis of a disability if the individual had a previous period of trial work while eligible for benefits on the basis of the same disability.
Section 1614(a)(4)(D) states that a period of trial work for any individual shall end with the close of whichever of the following months is the earlier: (i) the ninth month, beginning on or after the first day of such period, in which the individual renders services (whether or not such nine months are consecutive); or (ii) the month in which disability ceases (as determined after the application of subparagraph (A)of this paragraph).
Section 1614(b) states that for purposes of this Title, the term ‘eligible spouse’ means an aged, blind, or disabled individual who is the husband or wife of another aged, blind, or disabled individual and who has not been living apart from such other aged, blind, or disabled individual for more than six months. If two aged, blind, or disabled individuals are husband and wife as described in the preceding sentence, only one of them may be an ‘eligible individual’ within the meaning of Section 1611(a).
Section 1614(c) states that for purposes of this Title, the term ‘child’ means an individual who is neither married nor (as determined by the Sec. of HEW) the head of a household, and who is (1) under the age of 18, or (2) under the age of 22 and (as determined by the Sec. of HEW) a student regularly attending a school, college, or university, or a course of vocational or technical training designed to prepare such individual for gainful employment.
Section 1614(d) provides that in determining whether two individuals are husband and wife for purposes of this Title, appropriate State law shall be applied; except that (1) if a man and women have been determined to be husband and wife under Section 216(h)(1) for purposes of Title II they shall be considered (from and after the date of such determination or the date of their application for benefits under this Title, whichever is later) to be husband and wife for purposes of this Title, or (2) if a man and woman are found to be holding themselves out to the community in which they reside as husband and wife, they shall be so considered for purposes of this Title notwithstanding any other provision of this Section.
Section 1614(e) states that for purposes of this Title, the term ‘ U.S.’, when used in a geographical sense, means the 50 States and the District of Columbia.
Section 1614(f)(1) provides that for purposes of determining eligibility for and the amount of benefits for any individual who is married and whose spouse is living in the same household but is not an eligible spouse, such individual’s income and resources shall be deemed to include any income and resources of such spouse, whether or not available to such individual, except to the extent determined by the Sec. of HEW to be inequitable under the circumstances.
Section 1614(f)(2) further provides that for purposes of determining eligibility for and the amount of benefits for any individual who is a child under age 21, such individual’s income and resources shall be deemed to include any income and resources of a parent of such individual (or the spouse of such a parent) who is living in the same household as such individual, whether or not available to such individual, except to the extent determined by the Sec. of HEW to be inequitable under the circumstances.
Section 1615(a) states that in the case of any blind or disabled individual who (1) has not attained age 65, and ( 2) is receiving benefits (or with respect to whom benefits are paid) under this Title, the Sec. of HEW shall make provision for referral of such individual to the appropriate State agency administering the State plan for vocational rehabilitation services approved under the Vocational Rehabilitation Act, and (except in such cases as the Secretary may determine) for a review not less often than quarterly of such individual’s blindness or disability and his or her need for and utilization of the rehabilitation services made available under such plan.
Section 1615(b) provides that every individual with respect to whom the Sec. of HEW is required to make provision for referral under subsection (a) shall accept such rehabilitation services as are made available under the State plan for vocational rehabilitation services approved under the Vocational Rehabilitation Act; and the Sec. of HEW is authorized to pay to the State agency administering or supervising the administration of such State plan the costs incurred in the provision of such services to individuals so referred.
Section 1615(c) states that no individual shall be an eligible individual or eligible spouse for purposes of this Title if he or she refuses without good cause to accept vocational rehabilitation services for which referred under subsection (a).
Section 1616(a) states that any cash payments which are made by a State (or political subdivision thereof) on a regular basis to individuals who are receiving benefits under this title or who would but for income be eligible to receive benefits under this Title, as assistance based on need in supplementation of such benefits (as determined by the Sec. of HEW), shall be excluded under Section 1612(b)(6) in determining the income of such individuals for purposes of this Title and the Sec. of HEW and such State may enter into an agreement which satisfies subsection (b) under which the Sec. of HEW will, on behalf of such State (or subdivision) make such supplementary payments to all such individuals.
Section 1616(b) provides that any agreement between the Sec. of HEW and a State entered into under subsection (a) shall provide (1) that such payments will be made to all individuals residing in such State (or subdivision) who are receiving benefits under this Title, and (2) such other rules with respect to eligibility for or amount of the supplementary payments, and such procedural or other general administrative provisions, as the Sec. of HEW finds necessary to achieve efficient and effective administration of both the program which he or she conducts under this Title and the optional State supplementation.
Section 1616(c)(1) states any State (or political subdivision) making supplementary payments described in subsection (a) may at its option impose as a condition of eligibility for such payments, and include in the State’s agreement with the Sec. of HEW under such subsection, a residence requirement which excludes individuals who have resided in the State (or political subdivision) for less than a minimum period prior to application for such payments.
Section 1616(c)(2) further states that any State (or political subdivision), in determining the eligibility of any individual for supplementary payments described in subsection (a), may disregard amounts of earned and unearned income in addition to other amounts which it is required or permitted to disregard under this Section in determining such eligibility, and shall include a provision specifying the amount of any such income that will be disregarded, if any.
Section 1616(d) provides that any State which has entered into an agreement with the Sec. of HEW under this Section which provides that the Sec. of HEW will, on behalf of the State (or political subdivision) make the supplementary payments to individuals who are receiving benefits under this Title (or who would but for their income be eligible to receive such benefits), shall, at such times and in such installments as may be agreed upon between the Sec. of HEW and such State, pay to the Sec. of HEW an amount equal to the expenditures made by the Sec. of HEW as such supplementary payments.
Section 1631(a)(1) states that benefits under this Title shall be paid at such time or times and in such installments as will best effectuate the purposes of this Title, as determined under regulations (and may in any case be paid less frequently than monthly where the amount of the monthly benefit would not exceed $10).
Section 1631(a)(2) provides that payments of the benefit of any individual may be made to any such individual or to the eligible spouse (if any) or partly to each, or, if the Sec. of HEW deems it appropriate to any other person (including an appropriate public or private agency) who is interested in or concerned with the welfare of such individual (or spouse). Notwithstanding the provisions of the preceding sentence, in the case of any individual or eligible spouse referred to in Section 1611(e)(3)(A), the Sec. of HEW shall provide for making payments of the benefit to any other person (including an appropriate public or private agency) who is interested in or concerned with the welfare of such individual (or spouse).
Section 1631(a)(3) states that the Sec. of HEW may by regulation establish ranges of incomes within which a single amount of benefits under this Title shall apply.
Section 1631(a)(4)(A) provides that the Sec. of HEW may make to any individual initially applying for benefits under this Title who is presumptively eligible for such benefits and who is faced with financial emergency a cash advance against such benefits in an amount not exceeding $100.
Section 1631(a)(4)(B) provides that the Sec. of HEW may pay benefits under this Title to an individual applying for such benefits on the basis of disability for a period not exceeding three months prior to the determination of such individual’s disability, if such individual is presumptively disabled and is determined to be otherwise eligible for such benefits, and any benefits so paid prior to such determination shall in no event be considered overpayments for purposes of subsection (b).
Section 1631(a)(5) states payment of the benefit of any individual who is an aged, blind, or disabled individual solely by reason of blindness or disability, and who ceases to be blind or to be under such disability, shall continue (so long as such individual is otherwise eligible) through the second month following the month in which such blindness or disability ceases.
Section 1631(b) provides whenever the Sec. of HEW finds that more or less than the correct amount of benefits has been paid with respect to any individual, proper adjustment or recovery shall, subject to the succeeding provisions of this subsection, be made by appropriate adjustments in future payments to such individual or by recovery from or payment to such individual or eligible spouse (or by recovery from the estate of either). The Sec. of HEW shall make such provision as he or she finds appropriate in the case of payment of more than the correct amount of benefits with respect to an individual with a view to avoiding penalizing such individual or eligible spouse who was without fault in connection with the overpayment, if adjustment or recovery on account of such overpayment in such case would defeat the purposes of this Title, or be against equity or good conscience, or because of the small amount involved) impede efficient or effective administration of this Title.
Section 1631(c)(1) states that the Sec. of HEW shall provide reasonable notice and opportunity for a hearing to any individual who is or claims to be an eligible individual or eligible spouse and is in disagreement with any determination under this Title with respect to eligibility of such individual for benefits, or the amount of such individual’s benefits, if such individual requests a hearing on the matter in disagreement within 30 days after notice of such determination is received.
Section 1631(c)(2) provides determination on the basis of such hearing, except to the extent that the matter in disagreement involves the existence of a disability, shall be made within 90 days after the individual requests the hearing as provided in paragraph (1).
Section 1631(c)(3) states the final determination of the Sec. of HEW after a hearing under paragraph (1) shall be subject to judicial review as provided in Section 205(g) to the same extent as the Sec. of HEW’s final determinations under Section 205; except that the determination of the Sec. of HEW after such hearing as to any fact shall be final and conclusive and not subject to review by any court.
Section 1631(d)(1) states the provisions of Section 207 and subsections (a), (d), (e), and (f) of Section 205 shall apply with respect to this part to the same extent as they apply in the case of Title II.
Section 1631(d)(2) provides that to the extent the Sec. of HEW finds it will promote the achievement of the objectives of this Title, qualified persons may be appointed to serve as hearing examiners in hearings under subsection (c) without meeting the specific standards prescribed for hearing examiners by or under subchapter II of Chapter 5 of Title 5 U.S. Code.
Section 1631(d)(3) states the Sec. of HEW may prescribe rules and regulations governing the recognition of agents or other persons, other than attorneys, as hereinafter provided, representing claimants before the Sec. of HEW under this Title, and may require o |
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