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S. 3003 (113th): Protecting Social Security Disability Act of 2014

The text of the bill below is as of Dec 11, 2014 (Introduced).


II

113th CONGRESS

2d Session

S. 3003

IN THE SENATE OF THE UNITED STATES

December 11, 2014

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 Step
Work Incentive
Subsidy Rate
0−1
1−0.8
2−0.6
3−0.4
4−0.2
50
60.2
70.35
80.39
90.35
100.3
110.25
120.18
130.125
140.08
150.04
160.01
170.
(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.