H.R. 3236 (96th): Social Security Disability Amendments of 1980

96th Congress, 1979–1980. Text as of Jun 09, 1980 (Passed Congress/Enrolled Bill).

Status & Summary | PDF | Source: GPOStatutes at Large

PUBLIC LAW 96-265—JUNE 9, 1980                                         94 STAT. 441

Public Law 96-265
96th Congress
                                     An Act
                                                                                          June 9, 1980
To amend the Social Security Act to provide better work incentives and improved            [H.R. 3236]
        accountability in the disability programs, and for other purposes.

   Be it enacted by the Senate and House of Representatives of the
                                                                    Social Security
United States of America in Congress assembled. That this Act may beDisability
cited as the Social Security Disability Amendments of 1980". Amendments of
                                                                                        1980.
                              TABLE OF CONTENTS                                         42 u s e 1305
Sec. 1. Short title.                                                                    note.
TITLE I-PROVISIONS RELATING TO DISABILITY BENEFITS UNDER
                      OASDI PROGRAM
Sec. 101. Limitation on total family benefits in disability cases.
Sec. 102. Reduction in dropout years for younger disabled workers.
Sec. 103. Provisions relating to medicare waiting period for recipients of disability
            benefits.
Sec. 104. Continuation of medicare eligibility.
 TITLE II-PROVISIONS RELATING TO DISABILITY BENEFITS UNDER THE
                         SSI PROGRAM
Sec. 201. Benefits for individuals who perform substantial gainful activity despite
            severe medical impairment.
Sec. 202. Earned income in sheltered workshops.
Sec. 203. Termination of attribution of parents' income and resources when child
            attains age 18.
TITLE ra -PROVISIONS AFFECTING DISABILITY RECIPIENTS UNDER OASDI
             AND SSI PROGRAMS; ADMINISTRATIVE PROVISIONS
     301. Continued
          <         payment of benefits to individuals under vocational rehabilita-
            tion plans.
Sec 302. 1Extraordinary work expenses due to severe disability.
        303. ]Reentitlement to disability benefits.
Sec 304. ]Ehsability determinations; Federal review of State agency determinations.
C A T * 305. 1Information to accompany Secretary's decisions.
Sec 306. ]Limitation on prospective effect of application.
        307. ]Limitation on court remands.
Sec 308. Time '     limitations for decisions on benefit clalma
Sec 309. 1Payment for existing medical evidence.
Sec 310. ]Payment of certain travel expenses.
Co/.
        311. ]Periodic review of disability determinations.
Sec. 312. 1Report by Secretary.

     TITLE IV-PROVISIONS RELATING TO AFDC AND CHILD SUPPORT
                           PROGRAMS
Sec. 401. Work requirement under the AFDC prt^ram.
Sec. 402. Use of Internal Revenue Service to collect child support for non-AFDO
            families.
Sec. 403. Safeguards restricting disclosure of certain information under AFDC and
            social service programs.
Sec. 404. Federal matching for child support duties performed by certain court
            personnel.

94 STAT. 442 PUBLIC LAW 96-265—JUNE 9, 1980 Sec. 405. Child support management information sjrstem. Sec. 406. AFDC management information sj^tem. Sec. 407. Child support reporting and matching procedures. Sec. 408. Access to wage information for purpo^s of carrying out State plans for child support. TITLE V-OTHER PROVISIONS RELATING TO THE SOCL\L SECURITY ACT Sec. 501. Relationship between social security and SSI benefits. Sec. 502. Extension of National Commission on Social Security. Sec. 503. Time for making of social security contributions with respect to covered State and local employees. Sec. 504. Eligibility of aliens for SSI benefits. Sec. 505. Authority for demonstration projects. Sec. 506. Additional funds for demonstration project relating to the terminally ill. Sec. 507. Voluntaiy certification of medicare supplemental health insurance policies. TITLE I—PROVISIONS RELATING TO DISABILITY BENEFITS UNDER OASDI PROGRAM LIMITATION ON TOTAL FAMILY BENEFITS IN DISABILITY CASES 42 use 403. SEC. 101. (a) Section 203(a) of the Social Security Act is amended— (1) by striking out "except as provided by paragraph (3)" in paragraph (1) (in the matter preceding subparagraph (A)) and inserting in lieu thereof "except as provided by paragraphs (3) and (6)"; (2) by redesignating paragraphs (6), (7), and (8) as paragraphs (7), (8), and (9), respectively; and (3) by inserting after paragraph (5) the following new paragraph: "(6) Notwithstanding any of the preceding provisions of this subsec- tion other than paragraphs (3XA), (3XC), and (5) (but subject to section 42 use 415. 215(iX2XAXii)), the total monthly benefits to which beneficiaries may 42 use 402,423. be entitled under sections 202 and 223 for any month on the basis of the wajges and self-employment income of an individual entitled to disability insurance benents, whether or not such total benefits are otherwise subject to reduction under this subsection but after any reduction under this subsection which would otherwise be applicable, shall be, reduced or further reduced (before the application of section 42 use 424a. 224) to the smaller of— "(A) 85 percent of such individual's average indexed monthly earnings (or 100 percent of his primary insurance amount, if larger), or "(B) 150 percent of such individual's primary insurance amount.". 42 use 403. (bXl) Section 203(aX2XD) of such Act is amended by striking out "paragraph (7)" and inserting in lieu thereof "paragraph (8)". (2) Section 203(aX8) of such Act, as redesignated by subsection (aX2) of this section, is amended by striking out "paragraph (6)" and inserting in lieu thereof "paragraph (7)". 42 use 415. (3) Section 215(iX2XAXiiXIID of such Act is amended bv striking out "section 203(a) (6) and (7)" and inserting in lieu thereof' Wtion 203(a) (7) and (8)". (4) Section 215(iX2)(D) of such Act is amended by adding at the end thereof the following new sentence: "Notwithstanding the preceding sentence, such revision of maximum family benefits shall be subject to paragraph (6) of section 203(a) (as added Inr section 101(aX3) of the Supra. Social Security Disability Amendments of 1980).".
PUBLIC LAW 96-265—JUNE 9, 1980 94 STAT. 443 (c) The amendments made by this section shall apply only with 42 use 403 note, respect to monthly benefits payable on the basis of the wages and self- employment income of an individual who first becomes eligible for benefits (determined under sections 215(a)(3)(B) and 215(a)(2)(A) of the Social Security Act, as applied for this purpose) after 1978, and who 42 USC 415. first becomes entitled to disability insurance benefits after June 30, 1980. REDUCTION I N N U M B E R OF DROPOUT YEARS FOR YOUNGER DISABLED WORKERS SEC. 102. (a) Section 215(b)(2)(A) of the Social Security Act is 42 use 415. amended to read as follows: "(2)(A) The number of an individual's benefit computation years equals the number of elapsed years reduced— "(i) in the case of an individual who is entitled to old-age insurance benefits (except as provided in the second sentence of this subparagraph), or who has died, by 5 years, and "(ii) in the case of an individual who is entitled to disability insurance benefits, by the number of years equal to one-fifth of such individual's elapsed years (disregarding any resulting frac- tional part of a year), but not by more than 5 years. Clause (ii), once applicable with respect to any individual, shall continue to apply for purposes of determining such individual's primary insurance amount for purposes of any subsequent eligibility for disability or old-age insurance benefits unless prior to the month in which such eligibility begins there occurs a period of at least 12 consecutive months for which he was not entitled to a disability or an old-age insurance benefit. If an individual described in clause (ii) is living with a child (of such individual or his or her spouse) under the age of 3 in any calendar year which is included in such individual's computation base years, but which is not disregarded pursuant to clause (ii) or to subparagraph (B) (in determining such individual's benefit computation years) by reason of the reduction in the number of such individual's elapsed years under clause (ii), the number by which such elapsed years are reduced under this subparagraph pursuant to clause (ii) shall be increased by one (up to a combined total not exceeding 3) for each such calendar year; except that (I) no calendar year shall be disregarded by reason of this sentence (in determining such individual's benefit computation years) unless the individual was living with such child substantially throughout the period in which the child was alive and under the age of 3 in such year and the individual had no earnings as described in section 203(f)(5) in such year, (II) the particular calendar years to be disre- 42 use 403. garded under this sentence (in determining such benefit computation years) shall be those years (not otherwise disregarded under clause (ii)) which, before the application of section 215(f), meet the conditions of subclause (I), and (III) this sentence shall apply only to the extent that its application would not result in a lower primary insurance amount. The number of an individual's benefit computation years as determined under this subparagraph shall in no case be less than 2.". (b) Section 223(a)(2) of such Act is amended by inserting "and 42 use 423. section 215(b)(2)(A)(ii)" after "section 202(q)" in the first sentence. 42 use 415, 402. (c) The amendments made by this section shall apply only with 42 use 415 note. respect to monthly benefits payable on the basis of the wages and self- employment income of an individual who first becomes entitled to disability insurance benefits on or after July 1, 1980; except that the
94 STAT. 444 PUBLIC LAW 96-265—JUNE 9, 1980 Ante, p. 443. third Sentence of section 215(b)(2)(A) of the Social Security Act (as added by such amendments) shall apply only with respect to monthly benefits payable for months beginning on or after July 1, 1981. PROVISIONS RELATING TO MEDICARE WAITING PERIOD FOR RECIPIENTS OF DISABILITY BENEFITS 42 use 426. SEC. 103. (aXlXA) Section 226(bX2) of the Social Security Act is amended by striking out "consecutive" in clauses (A) and (B). (B) Section 226(b) of such Act is further amended by striking out "consecutive" in the matter following paragraph (2). 42 use 1395c. (2) Section 1811 of such Act is amended by striking out 42usei395p. (3) Section'l837(gXl) of such Act is amended by striking out consecutive 45 use 23if. (4) Section *7(dX2Xii) of the Railroad Retirement Act of 1974 is amended by striJking out "consecutive" each place it appears. 42 use 426. (b) Section 226 of the Social Security Act is amended by redesignat- ing subsection (f) as subsection (g), and by inserting after subsection (e) the following new subsection: "(f) For purposes of subsection (b) (and for purposes of section Supra. 1837(gXl) of this Act and section 7(dX2Xii) of the Railroad Retirement Supra. Act of 1974), the 24 months for which an individual has to have been entitled to specified monthly benefits on the basis of disability in order to become entitled to hospital insurance benefits on such basis effective with any particular month (or to be deemed to have enrolled in the supplementary medical insurance program, on the basis of such entitlement, by reason of section 1837(f)), where such individual had been entitled to specified monthly benefits of the same type during a previous period which terminated— "(1) more than 60 months before the month in which his current disability began in any case where such monthl^r benefits were of the type specified in clause (AXi) or (B) of subsection (bX2), or "(2) more than 84 months before the month in which his current disability began in any case where such monthly benefits were of the type specified in clause (AXii) or (AXiii) of such subsection, shall not include any month which occurred during such previous period.". 42 use 426 note. (c) The amendments made by this section shall apply with respect to hospital insurance or supplementary medical insurance benefits for services provided on or after the first day of the sixth month which begins after the date of the enactment of this Act. CONTINUATION OF MEDICARE EUGIBILITY 42 use 426. SEC. 104. (a) Section 226(b) of the Social Security Act is amended— (1) by striking out "ending with the month" in the matter following paragraph (2) and inserting in lieu thereof "ending (subject to the last sentence of this subsection) with the month , and (2) by adding at the end thereof the following new sentence: "For purposes of this subsection, an individual who has had a period of trial work which ended as provided in section 42 use 422. 222(cX4XA), and whose entitlement to benefits or status as a qualified railroad retirement beneficiary as described in para-
PUBLIC LAW 96-265—JUNE 9, 1980 94 STAT. 445 graph (2) has subsequently terminated, shall be deemed to be entitled to such benefits or to occupy such status (notwithstand- ing the termination of such entitlement or status) for the period of consecutive months throughout edl of which the physical or mental impairment, on which such entitlement or status was based, continues, and throughout all of which such individual would have been entitled to monthly insurance benefits under title II or as a qualified railroad retirement beneficiary had such 42 u s e 401. individual been unable to engage in substantial gainful activity, but not in excess of 24 such months.". Ot)) The amendments made by subsection (a) shedl become effective Effective date. on the first day of the sixth month which begins after the date of the 42 u s e 426 note. enactment of this Act, and shcdl apply with respect to any individual whose disability has not been determined to have ceased prior to such first day. TITLE II—PROVISIONS RELATING TO DISABILITY BENEFITS UNDER THE SSI PROGRAM BENEFITS FOR INDIVIDUALS WHO PERFORM SUBSTANTIAL GAINFUL ACTIVITY DESPITE SEVERE MEDICAL IMPAIRMENT SEC. 201. (a) Part A of title XVI of the Social Security Act is amended by adding at the end thereof the following new section: BENEFITS FOR INDIVIDUALS WHO PERFORM SUBSTANTIAL GAINFUL ACTIVITY DESPITE SEVERE MEDICAL IMPAIRMENT "SEC. 1619. (a) Any individual who is an eligible individual (or 42 use I382h. eligible spouse) by reason of being under a disability and was eligible to receive benefits under section 1611(b) or under this section for the 42 use 1382. month preceding the month for which eligibility for benefits under this section is now being determined, and who would otherwise be denied benefits by reason of section 1611(eX4) or ceases to be an eligible individual (or eligible spouse) because his earnings have demonstrated a capacity to engage in substantial gainful activity, shall nevertheless qualify for a monthly benefit equal to an amount determined under section 1611(bXl) (or, in the case of an individusd who has an eligible spouse, under section 1611(bX2)), and for purposes of titles XIX and XX of this Act shall be considered a disabled 42 u s e 1396, individual receiving supplemental security income benefits under 1397. this title, for so long as the Secretary determines that— "(1) such individual continues to have the disabling physical or mental impairment on the basis of which such individual was found to be under a disability, and continues to meet all non- disability-related requirements for eligibility for benefits under this title; and "(2) the income of such individual, other than income excluded pursuant to section 16120t)), is not equal to or in excess of the 42 use I382a. amount which would cause him to be ineligible for pa)rments under section 1611(b) (if he were otherwise eligible for such payments). "(b) For purposes of titles XIX and XX, any individual under age 65 who, for the month preceding the first month in the period to which this subsection applies, received— "(i) a payment of supplemental security income benefits under section 1611(b) on the basis of blindness or disability.
94 STAT. 446 PUBLIC LAW 96-265—JUNE 9, 1980 42 use I382e. "([[) ^ supplementary payment under section 1616 of this Act 87 Stat. 155. or under section 212 of Public Law 93-66 on such basis, "(iii) a payment of monthly benefits under subsection (a), or "(iv) a supplementary payment under section 1616(c)(3), shall be considered to be a blind or disabled individual receiving supplemental security income benefits for so long as the Secretary determines under regulations that— "(1) such individual continues to be blind or continues to have the disabling physical or mental impairment on the basis of which he was found to be under a disability and, except for his earnings, continues to meet all non-disability-related require- ments for eligibility for benefits under this title; "(2) the income of such individual would not, except for his earnings, be equal to or in excess of the amount which would cause him to be ineligible for payments under section 1611(b) (if he were otherwise eligible for such payments); "(3) the termination of eligibility for benefits under title XIX or XX would seriously inhibit his ability to continue his employ- ment; and "(4) such individual's earnings are not sufficient to allow him to provide for himself a reasonable equivalent of the benefits under this title and titles XIX and XX which would be available to him in the absence of such earnings.". 42 use I382e. (b)(1) Section 1616(c) of such Act is amended by adding at the end thereof the following new paragraph: "(3) Any State (or political subdivision) making supplementary payments described in subsection (a) shall have the option of making such payments to individuals who receive benefits under this title under the provisions of section 1619, or who would be eligible to receive such benefits but for their income.". 42 use 1382 (2) Section 212(a) of Public Law 93-66 is amended by adding at the "°*^^' end thereof the following new paragraph: "(4) Any State having an agreement with the Secretary under paragraph (1) may, at its option, include individuals receiving bene- Ante, p. 445. fits under section 1619 of the Social Security Act, or who would be eligible to receive such benefits but for their income, under the agreement as though they are aged, blind, or disabled individuals as specified in paragraph (2XA).". (c) Part A of title XVI of the Social Security Act is amended by adding at the end thereof (after the new section added by subsection Ante, p. 445. (a) of this section) the following new section: "MEDICAL AND SOCIAL SERVICES FOR CERTAIN HANDICAPPED PERSONS 42 use 13821. "SEC. 1620. (a) There are authorized to be appropriated such sums as may be necessary to establish and carry out a 3-year Federal-State pilot program to provide medical and social services for certain handicapped individuals in accordance with this section. "(b)(1) The total sum of $18,000,000 shall be allotted to the States for such program by the Secretary, during the period beginning September 1, 1981, and ending September 30, 1984, as follows: "(A) The total sum of $6,000,000 shall be allotted to the States for the fiscal year ending September 30,1982 (which for purposes of this section shall include the month of September 1981). "(B) The total sum of $6,000,000, plus any amount remaining available (after the application of paragraph (4)) from the allot-
PUBLIC LAW 96-265—JUNE 9, 1980 94 STAT. 447 ment made under subparagraph (A), shall be allotted to the States for the fiscal year ending September 30,1983. "(C) The total sum of $6,000,000, plus any amount remaining available (after the application of paragraph (4)) from the allot- ments made under subparagraphs (A) and (B), shall be allotted to the States for the fiscal year ending September 30,1984. "(2) The allotment to each State from the total sum allotted under paragraph (1) for any fiscal year shall bear the same ratio to such total sum as the number of individuals in such State who are over age 17 and under age 65 and are receiving supplemental security income benefits as disabled individuals in such year (as determined by the Secretary on the basis of the most recent data available) bears to the total number of such individuals in all the States. For purposes of the "Supplemental preceding sentence, the term 'supplemental security income benefits' security income benefits." includes payments made pursuant to an agreement under section 1616(a) of this Act or under section 212(b) of Public Law 93-66. 42 u s e 1382e. "(3) At the beginning of each fiscal year in which the pilot program 87 Stat. 155. under this section is in effect, each State that does not intend to use Certification to the allotment to which it is entitled for such year (or any allotment Secretary. which was made to it for a prior fiscal year), or that does not intend to use the full amount of any such allotment, shall certify to the Secretary the amount of such allotment which it does not intend to use, and the State's allotment for the fiscal year (or years) involved shall thereupon be reduced by the amount so certified. "(4) The portion of the total amount available for allotment for any Reallocation. particular fiscal year under paragraph (1) which is not allotted to States for that year by reason of paragraph (3) (plus the amount of any reductions made at the beginning of such year in the allotments of States for prior fiscal years under paragraph (3)) shall be reallo- cated in such manner as the Secretary may determine to be appro- priate to States which need, and will use, additional assistance in providing services to severely handicapped individuals in that partic- ular year under their approved plans. Any amount reallocated to a State under this paragraph for use in a particular fiscal year shall be treated for purposes of this section as increasing such State's allot- ment for that year by an equivalent amount. "(c) In order to participate in the pilot program and be eligible to receive payments for any period under subsection (d), a State (during such period) must have a plan, approved by the Secretary as meeting the requirements of this section, which provides medical and social services for severely handicapped individuals whose earnings are above the level which ordinarily demonstrates an ability to engage in substantial gainful activity and who are not receiving benefits under section 1611 or 1619 or assistance under a State plan approved under 42 u s e 1382. section 1902, and which— Ante, p. 445. "(1) declares the intent of the State to participate in the pilot 42 u s e 1396a. program; "(2) designates an appropriate State agency to administer or supervise the administration of the program in the State; "(3) describes the criteria to be applied by the State in deter- mining the eligibility of any individual for assistance under the plan and in any event requires a determination by the State agency to the effect that (A) such individual's ability to continue his employment would be significantly inhibited without such assistance and (B) such individual's earnings are not sufficient to allow him to provide for himself a reasonable equivalent of the 79-194 O—81—pt. 1 32 : QL3
94 STAT. 448 PUBLIC LAW 96-265—JUNE 9, 1980 cash and other benefits that would be available to him under this 42 u s e 1381, title and titles XIX and XX in the absence of those earnings; 1396, 1397. "(4) describes the process by which the eligibility of individuals for such assistance is to be determined (and such process may not involve the performance of functions by any State agency or entity which is engaged in making determinations of disability for purposes of disability insurance or supplemental security income benefits except when the use of a different agency or entity to perform those functions would not be feasible); "(5) describes the medical and social services to be provided under the plan; "(6) describes the manner in which the medical and social services involved are to be provided and, if they are not to be provided through the State's medical assistance and social serv- ices programs under titles XIX and XX (with the Federal payments being made under subsection (d) of this section rather than under those titles), specifies the particular mechanisms and procedures to be used in providing such services; and "(7) contains such other provisions as the Secretary may find to be necessary or appropriate to meet the requirements of this section or otherwise carry out its purpose. The plan under this section may be developed and submitted as a separate State plan, or may be submitted in the form of an amend- 42 u s e 1397b. ment to the State's plan under section 2003(dXl). "(d)(1) From its allotment under subsection (b) for any fiscal year (and any amounts remaining available from allotments made to it for prior fiscal years), the Secretary shall from time to time pay to each State which has a plan approved under subsection (c) an amount equal to 75 per centum of the total sum expended under such plan (including the cost of administration of such plan) in providing medical and social services to severely handicapped individuals who are eligible for such services under the plan. "(2) The method of computing and making payments under this section shall be as follows: "(A) The Secretary shall, prior to each period for which a payment is to be made to a State, estimate the amount to be paid to the State for such period under the provisions of this section. "(B) From the allotment available therefor, the Secretary shall pay the amount so estimated, reduced or increased, as the case may be, by any sum (not previously adjusted under this subsec- tion) by which he finds that his estimate of the amount to be paid the State for any prior period under this section was greater or less than the amount which should have been paid to the State for such period under this section. Regulations. "(e) Within nine months after the date of the enactment of this section, the Secretary shall prescribe and publish such regulations as may be necessary or appropriate to carry out the pilot program and otherwise implement this section. Reports to "(0 Each State participating in the pilot program under this section Secretary and shall from time to time report to the Secretary on the operation and Congress. results of such program in that State, with particular emphasis upon the work incentive effects of the program. On or before October 1, 1983, the Secretary shall submit to the Congress a report on the program, incorporating the information contained in the State reports along with his findings and recommendations.".
PUBLIC LAW 96-265—JUNE 9, 1980 94 STAT. 449 (d) The amendments made by subsections (a) and (b) shall become Effective date. effective on January 1, 1981, but shall remain in effect only for a 42 u s e 1382h note. period of three years after such effective date. (e) The Secretary shall provide for separate accounts with respect 42 u s e 1382h note. to the benefits payable by reason of the amendments made by subsections (a) and (b) so as to provide for evaluation of the effects of such amendments on the programs established by titles II, XVI, XIX, and XX of the Social Security Act. 42 u s e 401, 1381, 1396, 1397. EARNED INCOME IN SHELTERED WORKSHOPS SEC. 202. (a) Section 1612(a)(1) of the Social Security Act is 42 u s e 1382a. amended— (1) by striking out "and" after the semicolon at the end of subparagraph (A); and (2) by adding after subparagraph (B) the following new subparagraph: **(C) remuneration received for services performed in a sheltered workshop or work activities center; and". (b) The amendments made by subsection (a) shall apply only with 42 u s e 1382a respect to remuneration received in months after September 1980. note. TERMINATION OF ATTRIBUTION OF PARENTS INCOME AND RESOURCES WHEN CHILD ATTAINS AGE 18 S E C 203. (a) Section 1614(f)(2) of the Social Security Act is amended 42 u s e 1382c. by striking out "under age 21" and inserting in lieu thereof "under age 18". (b) The amendment made by subsection (a) shall become effective Effective date. on October 1, 1980; except that the amendment made by such 42 u s e 1382c note. subsection shall not apply, in the case of any child who, in September 1980, was 18 or over and received a supplemental security income benefit for such month, during any period for which such benefit would be greater without the application of such amendment. TITLE III—PROVISIONS AFFECTING DISABILITY RECIPIENTS UNDER OASDI AND SSI PROGRAMS; ADMINISTRATIVE PROVISIONS CONTINUED PAYMENT OF BENEFITS TO INDIVIDUALS UNDER VOCATIONAL REHABIUTATION PLANS SEC. 301. (a)(1) Section 225 of the Social Security Act is amended by 42 use 425. inserting "(a)" after "SEC. 225.", and by adding at the end thereof the following new subsection: "(b) Notwithstanding any other provision of this title, payment to an individual of benefits based on disability (as described in the first sentence of subsection (a)) shall not be terminated or suspended because the physical or mental impairment, on which the individ- ual's entitlement to such benefits is based, has or may have ceased, if— "(1) such individual is participating in an approved vocational rehabilitation program under a State plan approved under title I of the Rehabilitation Act of 1973, and 29 use 720. "(2) the Commissioner of Social Security determines that the completion of such program, or its continuation for a specified period of time, will increase the likelihood that such individual
94 STAT. 450 PUBLIC LAW 96-265—JUNE 9, 1980 may (following his participation in such program) be perma- nently removed from the disability benefit rolls.". (2) Section 225(a) of such Act (as designated under subsection (a) of Ante, p. 449. this section) is amended by striking out "this section" each place it appears and inserting in lieu thereof "this subsection". 42 u s e 1383. (b) Section 1631(a) of such Act is amended by adding at the end thereof the following new paragraph: "(6) Notwithstanding any other provision of this title, pa3mient of the benefit of any individual who is an aged, blind, or disabled individual solely by reason of disability (as determined under section 42 u s e 1382c. 1614(a)(3)) shall not be terminated or suspended because the physical or mental impairment, on which the individual's eligibility for such benefit is based, has or may have ceased, if— "(A) such individual is participating in an approved vocational rehabilitation program under a State plan approved under title I 29 u s e 720. of the Rehabilitation Act of 1973, and "(B) the Commissioner of Social Security determines that the completion of such program, or its continuation for a specified period of time, will increase the likelihood that such individual may (following his participation in such program) be perma- nently removed from the disability benefit rolls.'. Effective date. (c) The amendments made by this section shall become effective on 42 u s e 425 note. the first day of the sixth month which begins after the date of the enactment of this Act, and shall apply with respect to individuals whose disability has not been determined to have ceased prior to such first day. EXTRAORDINARY WORK EXPENSES DUE TO SEVERE DISABILITY 42 use 423. SEC. 302. (a)(1) Section 223(d)(4) of the Social Security Act is amended by inserting after the third sentence the following new sentence: "In determining whether an individual is able to engage in substantial gainful activity by reason of his earnings, where his disability is sufficiently severe to result in a functional limitation requiring assistance in order for him to work, there shall be excluded from such earnings an amount equal to the cost (to such individual) of any attendant care services, medical devices, equipment, prostheses, and similar items and services (not including routine drugs or routine medical services unless such drugs or services are necessary for the control of the disabling condition) which are necessary (as deter- mined by the Secretary in regulations) for that purpose, whether or not such assistance is also needed to enable him to carry out his normal daily functions; except that the amounts to be excluded shall be subject to such reasonable limits as the Secretary may prescribe.". 42 use 1382c. (2) Section 1614(a)(3)(D) of such Act is amended by inserting after Post, p. 453. ^jjg f^j.g^ sentence the following new sentence: "In determining whether an individual is able to engage in substantial gainful activity by reason of his earnings, where his disability is sufficiently severe to result in a functional limitation requiring assistance in order for him to work, there shall be excluded from such earnings an amount equal to the cost (to such individual) of any attendant care services, medical devices, equipment, prostheses, and similar items and services (not including routine drugs or routine medical services unless such drugs or services are necessary for the control of the disabling condition) which are necessary (as determined by the Secretary in regulations) for that purpose, whether or not such assistance is also needed to enable him to carry out his normal daily functions; except that the
PUBLIC LAW 96-265—JUNE 9, 1980 94 STAT. 451 amounts to be excluded shall be subject to such reasonable limits as the Secretary may prescribe.". (b) Section 16120t))(4)(B) of such Act is amended by striking out 42 u s e 1382a. "plus one-half of the remainder thereof, and (ii)" and inserting in lieu thereof the following: "(ii) such additional amounts of earned income of such individual (for purposes of determining the amount of his or her benefits under this title and of determining his or her eligibility for such benefits for consecutive months of eligibility after the initial month of such eligibility), if such individual's disability is sufficiently severe to result in a functional limitation requiring assistance in order for him to work, as may be necessary to pay the costs (to such individual) of attendant care services, medical devices, equipment, prostheses, and similar items and services (not including routine drugs or routine medical services unless such drugs or services are necessary for the control of the disabling condition) which are necessary (as determined by the Secretary in regulations) for that purpose, whether or not such assistance is also needed to enable him to carry out his normal daily functions, except that the amounts to be excluded shall be subject to such reasonable limits as the Secretary may prescribe, (iii) one-half of the amount of earned income not excluded after the application of the preceding provisions of this subparagraph, and (iv)' . (c) The amendments made by this section shall apply with respect 42 u s e 423 note. to expenses incurred on or after the first day of the sixth month which begins after the date of the enactment of this Act. REENTITLEMENT TO DISABIUTY BENEFITS SEC. 303. (a)(1) Section 222(c)(1) of the Social Security Act is 42 u s e 422. amended by striking out "section 223 or 202(d)" and inserting in lieu 42 u s e 423, 402. thereof "section 223,202(d), 202(e), or 202(f)". (2) Section 222(c)(3) of such Act is amended by striking out the period at the end of the first sentence and inserting in lieu thereof ", or, in the case of an individual entitled to widow's or widower's insurance benefits under section 202 (e) or (f) who became entitled to such benefits prior to attaining age 60, with the month in which such individual becomes so entitled.". Ot))(lXA) Section 223(a)(1) of such Act is amended by striking out "or the third month following the month in which his disability ceases." at the end of the first sentence and inserting in lieu thereof "or, subject to subsection (e), the termination month. For purposes of the preceding sentence, the termination month for any individual shall be the third month following the month in which his disability ceases; except that, in the case of an individual who has a period of trial work which ends as determined by application of section 222(cX4XA), the termination month shall be the earlier of (I) the third month following the earliest month after the end of such period of trial work with respect to which such individual is determined to no longer be suffering from a disabling physical or mental impairment, or (II) the third month following the earliest month in which such individual engages or is determined able to engage in substantial gainful activity, but in no event earlier than the first month occurring after the 15 months following such period of trial work in which he engages or is determined able to engage in substantial gainful activity.". (B) Section 202(dXlXG) of such Act is amended— (i) by redesignating clauses (i) and (ii) as clauses (III) and (IV), respectively, and
94 STAT. 452 PUBLIC LAW 96-265—JUNE 9, 1980 (ii) by striking out "the third month following the month in which he ceases to be under such disability" and inserting in lieu 42 use 423. thereof ", or, subject to section 223(e), the termination month (and for purposes of this subparagraph, the termination month for any individual shall be the third month following the month in which his disability ceases; except that, in the case of an individual who has a period of trial work which ends as deter- 42 use 422. mined by application of section 222(c)(4)(A), the termination month shall be the earlier of (I) the third month following the earliest month after the end of such period of trial work with respect to which such individual is determined to no longer be suffering from a disabling physical or mental impairment, or (II) the third month following the earliest month in which such individual engages or is determined able to engage in substantial gainful activity, but in no event earlier than the first month occurring after the 15 months following such period of trial work in which he engages or is determined able to engage in substan- tial gainful activity,". 42 use 402. (C) Section 202(eXl) of such Act is amended by striking out "the third month following the month in which her disability ceases (unless she attains age 65 on or before the last day of such third month)." at the end thereof and inserting in lieu thereof ", subject to section 223(e), the termination month (unless she attains age 65 on or before the last day of such termination month). For purposes of the preceding sentence, the termination month for any individual shall be the third month following the month in which her disability ceases; except that, in the case of an individual who has a period of trial work which ends as determined by application of section 222(c)(4)(A), the termination month shall be the earlier of (I) the third month following the earliest month after the end of such period of trial work with respect to which such individual is determined to no longer be suffering from a disabling physical or mental impairment, or (II) the third month following the earliest month in which such individual engages or is determined able to engage in substantial gainful activity, but in no event earlier than the first month occur- ring after the 15 months following such period of trial work in which he engages or is determined able to engage in substantial gainful activity.". (D) Section 202(fKl) of such Act is amended by striking out "the third month following the month in which his disability ceases (unless he attains age 65 on or before the last day of such third month)." at the end thereof and inserting in lieu thereof ", subject to section 223(e), the termination month (unless he attains age 65 on or before the last day of such termination month). For purposes of the preceding sentence, the termination month for any individual shall be the third month following the month in which his disability ceases; except that, in the case of an individual who has a period of trial work which ends as determined by application of section 222(cX4XA), the termination month shall be the earlier of (I) the third month following the earliest month after the end of such period of trial work with respect to which such individual is determined to no longer be suffering from a disabling physical or mental impairment, or (II) the third month following the earliest month in which such individual engages or is determined able to engage in substantial gainful activity, but in no event earlier than the first month occurring after the 15 months following such period of trial work in which he engages or is determined able to engage in substantial gainful activity.".
PUBLIC LAW 96-265—JUNE 9, 1980 94 STAT. 453 (2XA) Section 223 of such Act is amended by adding at the end 42 u s e 423. thereof the following new subsection: "(e) No benefit shall be payable under subsection (dXl)(B)(ii), (eXlXBXii), or (fXlXBXii) of section 202 or under subsection (aXD of 42 u s e 402. this section to an individual for any month, after the third month, in which he engages in substantial gainful activity during the 15-month period following the end of his trial work period determined by application of section 222(cX4XA).". 42 u s e 422. (B) Section 216(iX2XD) of such Act is amended by striking out "(ii)" 42 u s e 416. and all that follows and inserting in lieu thereof "(ii) the month preceding (I) the termination month (as defined in section 223(aXl)), or, if earlier (II) the first month for which no benefit is payable by reason of section 223(e), where no benefit is payable for any of the succeeding months during the 15-month period referred to in such section." (cXlXA) Section 1614(aX3) of such Act is amended by adding at the 42 u s e 1382c. end thereof the following new subparagraph: "(F) For purposes of this title, an individual whose trial work period has ended by application of paragraph (4XDXi) shall, subject to section 1611(eX4), nonetheless be considered (except for purposes of section 42 u s e 1382. 1631(aX5)) to be disabled through the end of the month preceding the 42 u s e 1383. termination month. For purposes of the preceding sentence, the termination month for any individual shall be the earlier of (i) the earliest month after the end of such period of trial work with respect to which such individual is determined to no longer be suffering from a disabling physical or mental impairment, or (ii) the first month, after the period of 15 consecutive months following the end of such period of trial work, in which such individual engages in or is determined to be able to engage in substantial gainful activity.". (B) Section 1614(aX3XD) of such Act is amended by striking out Ante, p. 450. "paragraph (4)" and inserting in lieu thereof "subparagraph (F) or paragraph (4)". (2) Section 1611(e) of such Act is amended by adding at the end thereof the following new paragraph: "(4) No benefit shall be payable under this title, except as provided in section 1619 (or section 1616(cX3)), with respect to an eligible Ante, pp. 445, individual or his eligible spouse who is an aged, blind, or disabled 446. individual solely by application of section 1614(aX3XF) for any month, Supra. after the third month, in which he engages in substantial gainful activity during the fifteen-month period following the end of his trial work period determined by application of section 1614(aX4XDXi).". (d) The amendments made by this section shall become effective on Effective date. the first day of the sixth month which begins after the date of the 42 u s e 402 note. enactment of this Act, and shall apply with respect to any individual whose disability has not been determined to have ceased prior to such first day. DISABIUTY D E T E R M I N A T I O N S ; FEDERAL REVIEW OF STATE AGENCY DETERMINATIONS SEC. 304. (a) Section 221(a) of the Social Security Act is amended to 42 use 421. read as follows: "(aXD In the case of any individual, the determination of whether or not he is under a disability (as defined in section 216(i) or 223(d)) 42 use 416, 423. and of the day such disability began, and the determination of the day on which such disability ceases, shall be made by a State agency, notwithstanding any other provision of law, in any State that notifies
94 STAT. 454 PUBLIC LAW 96-265—JUNE 9, 1980 the Secretary in writing that it wishes to make such disability determinations commencing with such month as the Secretary and the State agree upon, but only if (A) the Secretary has not found, under subsection (b)(1), that the State agency has substantially failed to make disability determinations in accordance with the applicable provisions of this section or rules issued thereunder, and (B) the State has not notified the Secretary, under subsection (bX2), that it does not wish to make such determinations. If the Secretary once makes the finding described in clause (A) of the preceding sentence, or the State gives the notice referred to in clause (B) of such sentence, the Secretary may thereafter determine whether (and, if so, beginning with which month and under what conditions) the State may again make disability determinations under this paragraph. "(2) The disability determinations described in paragraph (1) made by a State agency shall be made in accordance with the pertinent provisions of this title and the standards and criteria contained in regulations or other written guidelines of the Secretary pertaining to matters such as disability determinations, the class or classes of individuals with respect to which a State may make disability determinations (if it does not wish to do so with respect to all individuals in the State), and the conditions under which it may Regulations. choose not to make all such determinations. In addition, the Secre- tary shall promulgate regulations specifying, in such detail as he deems appropriate, performance standards and administrative requirements and procedures to be followed in performing the dis- ability determination function in order to assure effective and uni- form administration of the disability insurance program throughout the United States. The regulations may, for example, specify matters such as— "(A) the administrative structure and the relationship between various units of the State agency responsible for disability determinations, "(B) the physical location of and relationship among agency staff units, and other individuals or organizations performing tasks for the State agency, and standards for the availability to applicants and beneficiaries of facilities for making disability determinations, "(C) State agency performance criteria, including the rate of accuracy of decisions, the time periods within which determina- tions must be made, the procedures for and the scope of review by the Secretary, and, as he finds appropriate, by the State, of its performance in individual cases and in classes of cases, and rules governing access of appropriate Federal officials to State offices and to State records relating to its administration of the disabil- ity determination function, "(D) fiscal control procedures that the State agency may be required to adopt, and "(E) the submission of reports and other data, in such form and at such time as the Secretary may require, concerning the State agency's activities relating to the disability determination. Nothing in this section shall be construed to authorize the Secretary to take any action except pursuant to law or to regulations promul- gated pursuant to law.", 42 u s e 421. (b) Section 221(b) of such Act is amended to read as follows: Disability "(b)(1) If the Secretary finds, after notice and opportunity for a determinations. hearing, that a State agency is substantially failing to make disability determinations in a manner consistent with his regulations and other
PUBLIC LAW 96-265—JUNE 9, 1980 94 STAT. 455 written guidelines, the Secretary shall, not earlier than 180 days following his finding, and after he has complied with the require- ments of paragraph (3), make the disability determinations referred to in subsection (a)(1). "(2) If a State, having notified the Secretary of its intent to make Notification to disability determinations under subsection (a)(1), no longer wishes to Secretary. make such determinations, it shall notify the Secretary in writing of that fact, and, if an agency of the State is making disability determi- nations at the time such notice is given, it shall continue to do so for not less than 180 days, or (if later) until the Secretary has complied with the requirements of paragraph (3). Thereafter, the Secretary shall make the disability determinations referred to in subsection (a)(1). "(3)(A) The Secretary shall develop and initiate all appropriate Assumption of procedures to implement a plan with respect to any partial or State agency function. complete assumption by the Secretary of the disability determination function from a State agency, as provided in this section, under which employees of the affected State agency who are capable of performing duties in the disability determination process for the Secretary shall, notwithstanding any other provision of law, have a preference over any other individual in filling an appropriate employment position with the Secretary (subject to any system established by the Secre- tary for determining hiring priority among such employees of the State agency) unless any such employee is the administrator, the deputy administrator, or assistant administrator (or his equivalent) of the State agency, in which case the Secretary may accord such priority to such employee. "(B) The Secretary shall not make such assumption of the disability State agency determination function until such time as the Secretary of Labor employees, determination determines that, with respect to employees of such State agency who by Secretary of will be displaced from their emplo3mient on account of such assump- Labor. tion by the Secretary and who will not be hired by the Secretary to perform duties in the disability determination process, the State has made fair and equitable arrangements to protect the interests of employees so displaced. Such protective arrangements shall include only those provisions which are provided under all applicable Fed- eral, State and local statutes including, but not limited to, (i) the preservation of rights, privileges, and benefits (including continu- ation of pension rights and benefits) under existing collective- bargaining agreements; (ii) the continuation of collective-bargaining rights; (iii) the assignment of affected employees to other jobs or to retraining programs; (iv) the protection of individual employees against a worsening of their positions with respect to their employ- ment; (v) the protection of health benefits and other fringe benefits; and (vi) the provision of severance pay, as may be necessary.". (c) Section 221(c) of such Act is amended to read as follows: 42 u s e 421. "(c)(1) The Secretary may on his own motion or as required under Review. paragraphs (2) and (3) review a determination, made by a State agency under this section, that an individual is or is not under a disability (as defined in section 216(i) or 223(d)) and, as a result of such 42 u s e 416, 423. review, may modify such agency's determination and determine that such individual either is or is not under a disability (as so defined) or that such individual's disability began on a day earlier or later than that determined by such agency, or that such disability ceased on a day earlier or later than that determined by such agency. A review by the Secretary on his own motion of a State agency determination
94 STAT. 456 PUBLIC LAW 96-265—JUNE 9, 1980 under this paragraph may be made before or after any action is taken to implement such determination. "(2) The Secretary (in accordance with paragraph (3)) shall review determinations, made by State agencies pursuant to this section, that 42 u s e 416, 423. individuals are under disabilities (as defined in section 216(i) or 223(d)). Any review by the Secretary of a State agency determination under this paragraph shall be made before any action is taken to implement such determination. "(3) In carrying out the provisions of paragraph (2) with respect to the review of determinations, made by State agencies pursuant to this section, that individuals are under disabilities (as defined in section 216(i) or 223(d)), the Secretary shall review— "(A) at least 15 percent of ^1 such determinations made by State agencies in thefiscalyear 1981, "(B) at least 35 percent of all such determinations made by State agencies in the fiscal year 1982, and "(C) at least 65 percent of all such determinations made by State agencies in any fiscal year after the fiscal year 1982. . 42 u s e 421. (d) Section 221(d) of such Act is amended by striking out "(a)" and inserting in lieu thereof "(a), (b)". (e) The first sentence of section 221(e) of such Act is amended— (1) by striking out "which has an agreement with the Secre- tary" and inserting in lieu thereof "which is making disability determinations under subsection (aXl)'\ (2) by striking out "as may be mutually agreed upon" and inserting in lieu thereof "as aetermined by the Secretary", and (3) by striking out "carrying out the agreement under this section" and inserting in lieu thereof "making disability determinations under subsection (aXl)". (f) Section 221(g) of such Act is amended— (1) by striking out "has no agreement under subsection (b)" and inserting in lieu thereof "does not undertake to perform disabil- ity determinations under subsection (aXD* or which has been found by the Secretaiy to have substantially failed to make disability determinations in a manner consistent with his regula- tions and guidelines", and (2) by striking out "not included in an agreement under subsection (b)" and inserting in lieu thereof "for whom no State undertakes to make disability determinations". Report to (g) The Secretary of Health and Himian Services shall implement a Congress. program of reviewing, on his own motion, decisions rendered by 42 u s e 421 note. administrative law judges as a result of hearings under section 221(a) of the Social Security Act, and shall report to the Congress by January 1,1982, on his progress. Effective date. (h) The amendments made by subsections (a), (b), (d), (e), and (f) 42 u s e 421 note. shall be effective beginning with the twelfth month following the State month in which this Act is enacted. Any State that, on the effective agreements with date of the amendments made by this section, has in effect an Secretary of Health and agreement with the Secreta^ of Health and Human Services under Human Services, section 221(a) of the Social Security Act (as in effect prior to such notification. amendments) will be deemed to have given to the Secretary the notice specified in section 221(aXl) of such Act as amended by this section, in lieu of continuing such agreement in effect after the effective date of such amendments. Thereafter, a State may notify the Secretary in writing that it no longer wishes to make disability determinations, effective not less than 180 days after the notification is given.
PUBLIC LAW 96-265—JUNE 9, 1980 94 STAT. 457 (i) The Secretary of Health and Human Services shall submit to the p^n, submittal Congress by July 1,1980, a detailed plan on how he expects to assume J" us(?42?note the functions and operations of a State disability determination unit when this becomes necessary under the amendments made by this section, and how he intends to meet the requirements of section 221(bX3) of the Social Security Act. Such plan should assume the 42 use 42i. uninterrupted operation of the disability determination function and the utilization of the best qualified personnel to carry out such function. If any amendment of Federal law or regulation is required to carry out such plan, recommendations for such amendment should be included in the report. INFORMATION TO ACCOMPANY SECRETARY S DECISIONS SEC. 305. (a) Section 205(b) of the Social Security Act is amended by 42 u s e 405. inserting after the first sentence the following new sentence: "Any such decision by the Secretary which involves a determination of disability and which is in whole or in part unfavorable to such individual shall contain a statement of the case, in understandable language, setting forth a discussion of the evidence, and stating the Secretary's determination and the reason or reasons upon which it is based.". (b) Section 1631(cXl) of such Act is amended by inserting after the 42 use 1383. first sentence thereof the following new sentence: "Any such decision by the Secretary which involves a determination of disability and which is in whole or in part unfavorable to such individuad shall contain a statement of the case, in understandable language, setting forth a discussion of the evidence, and stating the Secretary's deter- mination and the reason or reasons upon which it is based.". (c) The amendments made by this section shall apply with respect 42 use 405 note. to decisions made on or after the first day of the 13th month following the month in which this Act is enacted. UMITATION ON PROSPECTIVE EFFECT OF APPLICATION SEC. 306. (a) Section 202(jX2) of the Social Security Act is amended 42 use 402. to read as follows: "(2) An application for any monthly benefits under this section filed before the first month in which the applicant satisfies the requirements for such benefits shall be deemed a valid application (and shall be deemed to have been filed in such first month) only if the applicant satisfies the requirements for such benefits before the Secretary makes a final decision on the application and no request under section 205(b) for notice and opportunity for a hearing thereon 42 use 405. is made or, if such a request is made, before a decision based upon the evidence adduced at the hearing is made (regardless of whether such decision becomes the final decision of the Secretary).". (b) Section 216(iX2XG) of such Act is amended— 42 use 416. (1) by inserting "(and shall be deemed to have been filed on such first day)" immediately after "shall be deemed a valid application" in the first sentence, (2) by striking out the period at the end of the first sentence and inserting in lieu thereof "and no request under section 205(b) for notice and opportunity for a hearing thereon is made or, if such a request is made, before a decision based upon the evidence adduced at the hearing is made (regardless of whether such decision becomes the final decision of the Secretary).", and
94 STAT. 458 PUBLIC LAW 96-265—JUNE 9, 1980 (3) by striking out the second sentence. 42 use 423. (c) Sectlon 223(b) of such Act is amended— (1) by inserting "(and shall be deemed to have been filed in such first month)" immediately after "shall be deemed a valid application" in the first sentence, (2) by striking out the period at the end of the first sentence and inserting in lieu thereof "and no request under section 205(b) for notice and opportunity for a hearing thereon is made, or if such a request is made, before a decision based upon the evidence adduced at the hearing is made (regardless of whether such decision becomes the final decision of the Secretary).", and (3) by striking out the second sentence. 42 use 402 note. (d) The amendments made by this section shall apply to applica- tions filed after the month in which this Act is enacted. UMITATION ON COURT REMANDS SEC. 307. The sixth sentence of section 205(g) of the Social Security 42 use 405. Act is amended by striking out all that precedes "and the Secretary shall" and inserting in lieu thereof the following: "The court may, on motion of the Secretary made for good cause shown before he files his answer, remand the case to the Secretary for further action by the Secretary, gmd it may at any time order additional evidence to be taken before the Secretary, but only upon a showing that there is new evidence which is material and that there is good cause for the failure to incorporate such evidence into the record in a prior proceeding;". TIME UMITATIONS FOR DECISIONS ON BENEFIT CLAIMS Report to SEC. 308. The Secretary of Health and Human Services shall Congress. submit to the Congress, no later than July 1, 1980, a report recom- 42 use 401 note, mending the establishment of appropriate time limitations governing 42 use 401. decisions on claims for benefits under title II of the Social Security Act. Such report shall specifically recommend— (1) the maximum period of time (after application for a pay- ment under such title is filed) within which the initial decision of the Secretary as to the rights of the applicant should be made; (2) the maximum period of time (after application for reconsid- eration of any decision described in paragraph (1) is filed) within which a decision of the Secretary on such reconsideration should be made; (3) the maximum period of time (after a request for a hearing with respect to any decision described in paragraph (1) is filed) within which a decision of the Secretary upon such hearing (whether affirming, modifying, or reversing such decision) should be made; and (4) the maximum period of time (after a request for review by the Appeals Council with respect to any decision described in paragraph (1) is made) within which the decision of the Secretary upon such review (whether affirming, modifying, or reversing such decision) should be made. In determining the time limitations to be recommended, the Secre- tary shall take into account both the need for expeditious processing of claims for benefits and the need to assure that all such claims will be thoroughly considered and accurately determined.
PUBLIC LAW 96-265—JUNE 9, 1980 94 STAT. 459 PAYMENT FOR EXISTING MEDICAL EVIDENCE SEC. 309. (a) Section 223(d)(5) of the Social Security Act is amended 42 use 423. by adding at the end thereof the following new sentence: "Any non- Federal hospital, clinic, laboratory, or other provider of medical services, or physician not in the employ of the Federal Government, which supplies medical evidence required and requested by the Secretary under this paragraph shall be entitled to payment from the Secretary for the reasonable cost of providing such evidence.". (b) The amendment made by subsection (a) shall apply with respect 42 use 423 note. to evidence requested on or after the first day of the sixth month which begins after the date of the enactment of this Act. P A Y M E N T OF CERTAIN TRAVEL EXPENSES SEC. 310. (a) Section 201 of the Social Security Act is amended by 42 use 401. adding at the end thereof the following new subsection: "(j) There are authorized to be made available for expenditure, out of the Federal Old-Age and Survivors Insurance Trust Fund, or the Federal Disability Insurance Trust Fund (as determined appropriate by the Secretary), such amounts as are required to pay travel expenses, either on an actual cost or commuted basis, to individuals for travel incident to medical examinations requested by the Secre- tary in connection with disability determinations under this title, and to parties, their representatives, and all reasonably necessary wit- nesses for travel within the United States (as defined in section 210(i)) 42 use 410. to attend reconsideration interviews and proceedings before adminis- trative law judges with respect to any determination under this title. The amount available under the preceding sentence for pa3rment for air travel by any person shall not exceed the coach fare for air travel between the points involved unless the use of first-class accommoda- tions is required (as determined under regulations of the Secretary) because of such person's health condition or the unavailability of alternative accommodations; and the amount available for payment for other travel by any person shall not exceed the cost of travel (between the points involved) by the most economical and expeditious means of transportation appropriate to such person's health condi- tion, as specified in such regulations.". (b) Section 1631 of such Act is amended by adding at the end thereof 42 use 1383. the following new subsection: "Pa)nment of Certain Travel Expenses "(h) The Secretary shall pay travel expenses, either on an actual cost or commuted basis, to individuals for travel incident to medical examinations requested by the Secretary in connection with disabil- ity determinations under this title, and to parties, their representa- tives, and all reasonably necessary witnesses for travel within the United States (as defined in section 1614(e)) to attend reconsideration 42 use I382c. interviews and proceedings before administrative law judges with respect to any determination under this title. The amount available under the preceding sentence for payment for air travel by any person shall not exceed the coach fare for air travel between the points involved unless the use of first-class accommodations is required (as determined under regulations of the Secretary) because of such person's health condition or the unavailability of ^ternative accommodations; and the amount available for pajnnent for other travel by any person shall not exceed the cost of travel (between the
94 STAT. 460 PUBLIC LAW 96-265—JUNE 9, 1980 points involved) by the most economical and expeditious means of transportation appropriate to such person's health condition, as specified in such regulations.". 42 u s e 13951. (c) Section 1817 of such Act is amended by adding at the end thereof the following new subsection: Travel expenses, "(i) There are authorized to be made available for expenditure out authorized trust of the Trust Fund such amounts as are required to pay travel fund payments. expenses, either on an actual cost or commuted basis, to parties, their representatives, and all reasonably necessary witnesses for travel 42 u s e 410. within the United States (as defined in section 210(i)) to attend reconsideration interviews and proceedings before administrative law judges with respect to any determination under this title. The amount available under the preceding sentence for payment for air travel by any person shall not exceed the coach fare for air travel between the points involved unless the use of first-class accommoda- tions is required (as determined under regulations of the Secretary) because of such person's health condition or the unavailability of alternative accommodations; and the amount available for payment for other travel by any person shall not exceed the cost of travel (between the points involved) by the most economical and expeditious means of transportation appropriate to such person's health condi- tion, as specified in such regulations.". PERIODIC REVIEW OF DISABIUTY DETERMINATIONS 42 u s e 421. SEC. 311. (a) Section 221 of the Social Security Act is amended by adding at the end thereof the following new subsection: "(i) In any case where an individual is or has been determined to be under a disability, the case shall be reviewed by the applicable State agency or the Secretary (as may be appropriate), for purposes of continuing eligibility, at least once every 3 years; except that where a finding has been made that such disability is permanent, such reviews shall be made at such times as the Secretary determines to be appropriate. Reviews of cases under the preceding sentence 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.". Effective date. (b) The amendment made by subsection (a) shall become effective 42 u s e 421 note. on January 1,1982. REPORT BY SECRETARY Submittal to SEC. 312. The Secretary of Health and Human Services shall Congress. submit to the Congress not later than January 1, 1985, a full and 42 u s e 401 note. complete report as to the effects produced by reason of the preceding provisions of this Act and the amendments made thereby. TITLE IV—PROVISIONS RELATING TO AFDC AND CHILD SUPPORT PROGRAMS WORK REQUIREMENT UNDER THE AFDC PROGRAM 42 use 602. SEC. 401. (a) Section 402(aX19XA) of the Social Security Act is amended— (1) by striking out all that follows "(A)" and precedes clause (i), and inserting in lieu thereof the following: "that every indi- vidual, as a condition of eligibility for aid under this part, shall
PUBLIC LAW 96-265—JUNE 9, 1980 94 STAT. 461 register for manpower services, training, employment, and other employment-related activities (including employment search, not to exceed eight weeks in total in each year) with the Secretary of Labor as provided by regulations issued by him, unless such individual is—"; (2) by striking out "or" at the end of clause (v); (3) by striking out "under section 433(g)" in clause (vi); 42 u s e 633. (4) by adding "or" after the semicolon at the end of clause (vi); and (5) by inserting after clause (vi) the following new clause: "(vii) a person who is working not less than 30 hours per week;'. (b) Section 402(a)(19XB) of such Act is amended by inserting "to 42 USC 602. families with dependent children" immediately after "that aid". (c) Section 402(aX19)(D) of such Act is amended by striking out ", and income derived from a special work project under the program established by section 432(bX3)". 42 use 632. (d) Section 402(aX19XF) of such Act is amended— (1) by striking out, "and for so long as any child, relative, or individual (certified to the Secretary of Labor pursuant to sub- paragraph (G))" in the matter preceding clause (i), and inserting in lieu thereof "(and for such period as is prescribed under joint regulations of the Secretary and the Secretary of Labor) any child, relative or individual"; and (2) by inserting "and" after the semicolon at the end of clause (iv), and striking out all that follows. (e) Section 402(aX19XG) of such Act is amended— (1) by inserting "(which will, to the maximum extent feasible, be located in the same facility as that utilized for the administra- tion of programs established pursuant to section 4320t>) (1), (2), or (3))" immediately after "administrative unit" in clause (i); (2) by striking out "subparagraph (A)," in clause (ii), and inserting in lieu thereof "subparagraph (A) of this paragraph (I)"; (3) by striking out "part C" where it first appears in clause (ii) and inserting in lieu thereof "section 43203) (1), (2), or (3)"; and (4) by striking out "employment or training under part C," in clause (ii) and inserting in lieu thereof "emplo)mient or training under section 43203) (1), (2), or (3), (II) such social and supportive services as are necessary to enable such individuals as deter- mined appropriate by the Secretary of Labor actively to engage in other emplo5TTient-related (including but not limited to employment search) activities, as well as timely pajmient for necessary employment search expenses, and (III) for a period deemed appropriate by the Secretary of Labor after such an individual accepts employment, such social and supportive serv- ices as are reasonable and necessary to enable him to retain such emplojonent,". (f) Section 402(aX19) of such Act is further amended— (1) by striking out "and" at the end of subparagraph (F); (2) by adding "and" after the semicolon at the end of subpara- graph (G); and (3) by adding after subparagraph (G) the following new subparagraph: "(H) that an individual participating in emplojmient search activities shall not be referred to emplojrment oppor- tunities which do not meet the criteria for appropriate work
94 STAT. 462 PUBLIC LAW 96-265—JUNE 9, 1980 and training to which an individual may otherwise be 42 u s e 632. assigned under section 432(b) (1), (2), or (3);". 42 u s e 603. (g) Section 403(c) of such Act is amended by striking out "part C" and inserting m lieu thereof ''section 432(b) (1), (2), or (3)". (h) Section 403(dXl) of such Act is amended by adding at the end thereof the following new sentence: "In determining the amount of the expenditures made under a State i>lan for any quarter with respect to social and supportive services pursuant to section Ante, p. 461. 402(aX19XG), there shall be mcluded the fair and reasonable v^ue of goods and services furnished in kind from the State or any political subdivision thereof". 42 use 602 note. (i) The amendments made by this section (other than those made by subsections (c) and (d)) shall take effect on September 30,1980, and Ante, p. 461. the joint r^ulations referred to in section 402(aX19)(F) of the SocisQ Security Act (as amended by this section) shall be promulgated on or before such date, and take effect on such date. USE OF INTERNAL REVENUE SERVICE TO COLLECT CHILD SUPPORT FOR NON-AFDC FAMILIES SEC. 402. (a) The first sentence of section 452(b) of the Social 42 u s e 652. Security Act is amended by inserting "(or undertaken to be collected 42 u s e 654. by such State pursuant to section 454(6))" immediately after "assigned to such State". Effective date. (b) The amendment made by subsection (a) shall take effect July 1, 42 u s e 652 note. 1980. SAFEGUARDS RESTRICTING DISCLOSURE OF CERTAIN INFORlifATION UNDER AFDC AND SOCIAL SERVICE PROGRAMS 42 use 602. SEC. 403. (a) Section 402(aX9) of the Social Security Act is amended— (1) by striking out "and" at the end of clause (B); and (2) by striking out "; and the safeguards" and all that follows and inserting in lieu thereof the following:", and (D) any audit or similar activity conducted in connection with the administration of any such plan or program by any governmental entity which is authorized by law to conduct such audit or activity; and the safeguards so provided shall prohibit disclosure, to any commit- tee or legislative body (other than an entity referred to in clause (D) with respect to an activity referred to m such clause), of any information which identifies by name or address any such applicant or recipient;". 42 use 1397b. (b) Section 2003(dXlXB) of such Act is amended— (1) by striking out "provides that" and inserting in lieu thereof "provides saf^uards which restrict"; (2) by striking out "will be restricted"; (3) by inserting "(A)" after "connected with"; and (4) by inserting before the semicolon at the end thereof the foUowinjg: ", and (B) any audit or similar activity conducted in connection with the administration of any such ^lan or program by any governmental entity which is authorized by law to conduct such audit or activity; and the safeguards so provided shall prohibit disclosure, to any committee or legislative body (other than an entity referred to in clause (B) with respect to an activity referred to in such clause), of any information which identifies by name or address any such applicant or recipient;".
PUBLIC LAW 96-265—JUNE 9, 1980 94 STAT. 463 (c) The amendments made by this section shall take effect on ^fff^jy^^f*^- September 1,1980. 42 use 602 note. FEDERAL MATCHING FOR CHILD SUPPORT DUTIES PERFORMED BY CERTAIN COURT PERSONNEL SEC. 404. (a) Section 455 of the Social Security Act is amended by 42 u s e 655. adding at the end thereof the following new subsection: "(c)(1) Subject to paragraph (2), there shall be included, in deter- mining amounts expended by a State during any quarter for the operation of the plan approved under section 454, so much of the 42 u s e 654. expenditures of courts of such State and its political subdivisions (excluding expenditures for or in connection with judges and other individuals making judicial determinations, but not excluding expenditures for or in connection with their administrative and support personnel) as are attributable to the performance of services which are directly related to, and clearly identifiable with, the operation of such plan. "(2) The aggregate amount of the expenditures which are included pursuant to paragraph (1) for the quarters in any calendar year shall be reduced (but not below zero) by the total amount of expenditures described in paragraph (1) which were made by the State for the 12- month period beginning January 1,1978. "(3) The State agency may, if the law (or procedures established thereunder) of the State so provides, pay so much of the amount it receives under subsection (a) for any quarter as is payable by reason of the provisions of this subsection directly to the courts of the State (or political subdiAdsions thereof) furnishing the services on account of which the payment is payable.", (b) The amendment made by subsection (a) shall apply with respect Effective date. to expenditures made by States on or after July 1,1980. 42 u s e 655 note. CHILD SUPPORT MANAGEMENT INFORMATION SYSTEM SEC 405. (a) Section 455(a) of the Social Security Act is amended^ 42 u s e 655. (1) by striking out "and" at the end of paragraph (1); (2) by striking out the period at the end of paragraph (2) and inserting in lieu thereof", and "; and (3) by adding after and below paragraph (2) the following new paragraph; "(3) equal to 90 percent (rather than the percent specified in Automatic data clause (1) or (2)) of so much of the sums expended during such processing and quarter as are attributable to the planning, design, development, information retrieval system. installation or enhancement of an automatic data processing and information retrieval system which the Secretary finds meets the requirements specified in section 454(16);". Infra. Ot>) Section 454 of such Act is amended— 42 u s e 654. (1) by striking out "and" at the end of paragraph (14), (2) by striking out the period at the end of paragraph (15) and inserting in lieu thereof ; and", and (3) by adding after paragraph (15) the following new paragraph: "(16) provide, at the option of the State, for the establishment, in accordance with an (initial and annually updated) advance automatic data processing planning document approved under section 452(d), of an automatic data processing and information Post, p. 464 retrieval system designed effectively and efficiently to assist 79-194 O—81—pt. 1 33 : QL3
94 STAT. 464 PUBLIC LAW 96-265—JUNE 9, 1980 management in the administration of the State plan, in the State and localities thereof, so as (A) to control, account for, and monitor (i) all the factors in the child support enforcement collection and paternity determination process under such plan (including, but not limited to, (I) identifiable correlation factors (such as social security numbers, names, dates of birth, home addresses and mailing addresses (including postal ZIP codes) of any individual with respect to whom child support obligations are sought to be established or enforced and with respect to any person to whom such support obligations are owing) to assure sufficient compatibility among the systems of different jurisdic- tions to permit periodic screening to determine whether such individual is paying or is obligated to pay child support in more than one jurisdiction, (II) checking of records of such individuals on a periodic basis with Federal, intra- and inter-State, and local agencies, (III) maintaining the data necessary to meet the Fed- eral reporting requirements on a timely basis, and (IV) delin- quency and enforcement activities), (ii) the collection and distribution of support pa)mients (both intra- and inter-State), the determination, collection and distribution, of incentive payments both inter- and intra-State, and the maintenance of accounts receivable on all amounts owed, collected and distributed, and (iii) the costs of all services rendered, either directly or by interfacing with State financial management and expenditure information, (B) to provide interface with records of the State's aid to families with dependent children program in order to determine if a collection of a support payment causes a change affecting eligibility for or the amount of aid under such program, (C) to provide for security against unauthorized access to, or use of, the data in such system, and (D) to provide management information on all cases under the State plan from initial referral or application through collection and enforcement.". 42 use 652. (c) Section 452 of such Act is amended by adding at the end thereof the following new subsection: "(dXD The Secretary shall not approve the initial and annually updated advance automatic data processing planning document. Ante, p. 463. referred to in section 454(16), unless he finds that such document, when implemented, will generally carry out the objectives of the management system referred to in such subsection, and such document— "(A) provides for the conduct of, aild reflects the results of, requirements analysis studies, which include consideration of the program mission, functions, organization, services, con- straints, and current support, of, in, or relating to, such system, "(B) contains a description of the proposed management Ante, p. 463. system referred to in section 455(aX3), including a description of information flows, input data, and output reports and uses, "(C) sets forth the security and interface requirements to be employed in such management system, "(D) describes the projected resource requirements for staff and other needs, and the resources available or expected to be available to meet such requirements, "(E) contains an implementation plan and backup procedures to handle possible failures, "(F) contains a summary of proposed improvement of such management system in terms of qualitative and quantitative benefits, and
PUBLIC LAW 96-265—JUNE 9, 1980 94 STAT. 465 "(G) provides such other information as the Secretary deter- mines under regulation is necessary. "(2XA) The Secretary shall through the separate organizational unit established pursuant to subsection (a), on a continuing basis, review, Eissess, and inspect the planning, design, and operation of, management information systems referred to in section 455(aX3), ^^te, p. 463 with a view to determining whether, and to what extent, such systems meet and continue to meet requirements imposed under paragraph (1) and the conditions specified under section 454(16). Ante, p. 463. "(B) If the Secretary finds with respect to any statewide manage- ment information system referred to in section 455(aX3) that there is a failure substantially to comply with criteria, requirements, and other undertakings, prescribed by the advance automatic data proc- essing planning document theretofore approved by the Secretary with respect to such system, then the Secretary shall suspend his approval of such document until there is no longer any such failure of such system to comply with such criteria, requirements, and other undertakings so prescribed.". (d) Section 452 of the Social Security Act is further amended by adding after subsection (d) (as added by subsection (c) of this section) Ante, p. 464. the following new subsection: "(e) The Secretary shall provide such technical assistance to States Technical as he determines necessary to assist States to plan, design, develop, or assistance States. to install and provide for the security of, the management information systems referred to in section 455(aX3).". (e) The amendments made by this section shall take effect on July Effective date. 1, 1981, and shall be effective only with respect to expenditures, 42 u s e 652 note. referred to in section 455(aX3) of the Social Security Act (as amended by this Act), made on or after such date. AFDC MANAGEMENT INFORMATION SYSTEM SEC. 406. (a) Section 403(aX3) of the Social Security Act is 42 use 603. amended— (1) by striking out "and" at the end of subparagraph (A); (2) by redesignating subparagraph (B) as subparagraph (C); and (3) by inserting after subparagraph (A) the following new subparagraph: "(B) 90 per centum of so much of the sums expended during such quarter as are attributable to the planning, design, development, or installation of such statewide mechanized claims processing and information retrieval systems as (i) meet the conditions of section 402(aX30), and Wra- (ii) the Secretary determines are likely to provide more efficient, economical, and effective administration of the plan and to be compatible with the claims processing and information retrieval systems utilized in the administration of State plans approved under title XIX, and State programs 42 use 1396. with respect to which there is Federal financial participation under title XX, and". 42 use 1397. (bXD Section 402(a) of such Act is amended— 42 use 602. (A) by striking out "and" at the end of paragraph (28); (B) by striking out the period at the end of paragraph (29) and inserting in lieu thereof "; and"; and (C) by adding after paragraph (29) the following new paragraph:
94 STAT. 466 PUBLIC LAW 96-265—JUNE 9, 1980 "(30) at the option of the State, provide for the establishment and operation, in accordance with an (initial and annually updated) advance automatic data processing planning document approved under subsection (d), of an automated statewide man- agement information system designed effectively and efficiently, to assist management in the administration of the State plan for aid to families with dependent children approved under this part, so as (A) to control and account for (i) all the factors in the total eligibility determination process under such plan for aid (includ- ing but not limited to (1) identifiable correlation factors (such as social security numbers, names, dates of birth, home addresses, and mailing addresses (including postal ZIP codes), of all appli- cants and recipients of such aid and the relative with whom any child who is such an applicant or recipient is living) to assure sufficient compatibility among the systems of different jurisdic- tions to permit periodic screening to determine whether an individual is or has been receiving benefits from more than one jurisdiction, (II) checking records of applicants and recipients of such aid on a periodic basis with other agencies, both intra- and inter-State, for determination and verification of eligibility and payment pursuant to requirements imposed by other provisions of this Act), (ii) the costs, quality, and delivery of funds and services furnished to applicants for and recipients of such aid, (B) to notify the appropriate officials of child support, food stamp, social service, and medical assistance programs approved under 42 use 1396. title XIX whenever the case becomes ineligible or the amount of aid or services is changed, and (C) to provide for security against unauthorized access to, or use of, the data in such system.". 42 use 602. (2) Section 402 of such Act is further amended by adding at the end thereof the following new subsection: "(dXD The Secretary shall not approve the initial and annually updated advance automatic data processing planning document, Ante, p. 465. referred to in subsection (aX30), unless he finds that such document, when implemented, will generally carry out the objectives of the statewide management system referred to in such subsection, and such document— "(A) provides for the conduct of, and reflects the results of, requirements analysis studies, which include consideration of the program mission, functions, organization, services, con- straints, and current support, of, in, or relating to, such system, "(B) contains a description of the proposed statewide manage- ment system, including a description of information flows, input data, and output reports and uses, "(C) sets forth the security and interface requirements to be employed in such statewide management system, "(D) describes the projected resource requirements for staff and other needs, and the resources available or expected to be available to meet such requirements, "(E) includes cost-benefit analyses of each alternative manage- ment system, data processing services and equipment, and a cost allocation plan containing the basis for rates, both direct and indirect, to be in effect under such statewide management system, "(F) contains an implementation plan with charts of develop- ment events, testing descriptions, proposed acceptance criteria, and backup and fallback procedures to handle possible failure of contingencies, and
PUBLIC LAW 96-265-JUNE 9, 1980 94 STAT. 467 "(G) contains a summary of proposed improvement of such statewide management system in terms of qualitative and quan- titative benefits. "(2XA) The Secretary shall, on a continuing basis, review, assess, and inspect the planning, design, and operation of, statewide manage- ment information systems referred to in section 403(aX3XB), with a Ante, p. 465. view to determining whether, and to what extent, such systems meet and continue to meet requirements impcKsed under such section and the conditions specified under subsection (aX30) of this section. Ante, p. 465. "(B) If the Secretary finds with respect to any statewide manage- ment information system referred to in section 403(aX3)(B) that there is a failure substantially to comply with criteria, requirements, and other undertakings, prescribed by the advance automatic data proc- essing planning document theretofore approved by the Secretary with respect to such system, then the Secretary shall suspend his approval of such document until there is no longer any such failure of such system to comply with such criteria, requirements, and other undertakings so prescribed.". (c) Part A of title IV of such Act is amended by adding at the end thereof the following new section: "TECHNICAL ASSISTANCE FOR DEVELOPING MANAGEMENT INFORMATION SYSTEMS "SEC. 413. The Secretary shall provide such technical assistance to 42 use 613. States as he determines necessary to assist States to plan, design, develop, or install and provide for the security of, the management information systems referred to in section 403(aX3)(B) of this Act.". Ante, p. 465. (d) The amendments made by this section shall be effective with Effective date. respect to expenditures made during calendar quarters beginning on 42 use 6i3 note. or after July 1,1981. CHILD SUPPORT REPORTING AND MATCHING PROCEDURES SEC. 407. (a) Section 455(bX2) of the Social Security Act is amended 42 use 655. by striking out "The Secretary" and inserting in lieu thereof "Subject to subsection (d), the Secretaiy". (b) Section 455 of such Act is further amended by adding after subsection (c) (as added by section 404 of this Act) the following new Ante, p. 463. subsection: "(d) Notwithstanding any other provision of law, no amount shall be paid to any State under this section for any quarter, prior to the close of such quarter, unless for the period consisting of all prior quarters for which pavment is authorized to be made to such State under subsection (a), there shall have been submitted by the State to the Secretary, with respect to each quarter in such period (other than the last two quarters in such period), a full and complete report (in such form and manner and containing such information as the Secretary shall prescribe or require) as to the amount of child support collected and disbursed and all expenditures with respect to which payment is authorized under subsection (a).". (c) Section 403(bX2) of such Act is amended— 42 use 603. (1) by striking out "and" at the end of clause (A); and (2) by adding immediately before the semicolon at the end of clause (B) the following: ", and (C) reduced by such amount as is necessary to provide the 'appropriate reimbursement of the Federal Government' that the State is required to make under
94 STAT. 468 PUBLIC LAW 96-265—JUNE 9, 1980 42 u s e 657. section 457 out of that portion of child support collections retained by it pursuant to such section", Effective date. (d) The amendments made by this section shall be effective in the 42 u s e 603 note. case of calendar quarters commencing on or after January 1, 1981. ACCESS TO WAGE INFORMATION FOR PURPOSES OP CARRYING OUT STATE PLANS FOR CHILD SUPPORT SEC. 408. (aXD Subsection (1) of section 6103 of the Internal Revenue 26 u s e 6103. C!ode of 1954 (relating to disclosure of returns and return information for purposes other than tax administration) is amended by adding at the end thereof the following new paragraph: "(7) DISCLOSURE OF CERTAIN RETURN INFORMATION BY SOCIAL SECURITY ADMINISTRATION TO STATE AND LOCAL CHILD SUPPORT ENFORCEMENT AGENCIES.— "(A) IN GENERAL.—Upon written request, the Commis- sioner of Social Security shall disclose directly to officers and employees of a State or local child support enforcement agency return information from returns with respect to net 26 u s e 1402. earnings from self-employment (as defined in section 1402), 26 u s e 3121, wages (as defined in section 3121(a) or 3401(a)), and payments 3401. of retirement income which have been disclosed to the Social Security Administration as provided by paragraph (1) or (5) of this subsection. "(B) RESTRICTION ON DISCLOSURE.—The Commissioner of Social Security shall disclose return information under sub- paragraph (A) only for purposes of, and to the extent neces- sary in, establishing and collecting child support obligations "ehild support from, and locating, individuals owing such obligations. For obligations." purposes of the preceding sentence, the term 'child support obligations' only includes obligations which are being enforced pursuant to a plan described in section 454 of the 42 u s e 654. Social Security Act which has been approved by the Secre- taiy of Health and Human Services under part D of title IV 42 u s e 651. of such Act. "(C) STATE OR LOCAL CHILD SUPPORT ENFORCEMENT AGENCY.—For purposes of this paragraph, the term 'State or local child support enforcement agency' means any agency of a State or political subdivision thereof operating pursuant to a plan described in subparagraph (B)." 26 u s e 6103. (2XA) Subparagraph (A) of section 6103(pX3) of such Code (relating to records of inspection and disclosure) is amended by striking out "aXD or (4XB) or (5)" and inserting in lieu thereof "aXD, (4XB), (5), or (7)". (B) Paragraph (4) of section 6103(p) of such Code (relating to safi^uards) is amended by striking out "(1X3) or (6)" in so much of such paragraph as precedes subparagraph (A) thereof and inserting in Ueu thereof "aX3), (6), or (7)". (C) Qause (i) of section 6103(pX4XF) of such Code is amended by striking out "0X6)" and inserting in lieu thereof "aX6) or (7) . (D) The first sentence of paragraph (2) of section 7213(a) of such Code is amended by striking out "subsection (d), (1X6), or (mX4)(B)" and inserting in lieu thereof "subsection (d), (1X6) or (7), or (m)(4)(B)". Effective date. (3) The amendments made by this subsection shall take effect on 26 u s e 6103 the date of the enactment of this Act. note. 0>X1) Section 303 of the Social Security Act is amended by adding at 42 u s e 503. the end thereof the following new subsection:
PUBLIC LAW 96-265—JUNE 9, 1980 94 STAT. 469 "(dXD The State agency charged with the administration of the State law— "(A) shall disclose, upon request and on a reimbursable basis, Wage directly to oflEicers or employees of any State or local child information. support enforcement agency any wage information contained in the records of such State agency, and "(B) shall establish such safeguards as are necessary (as Safeguards, determined by the Secretary of Labor in regulations) to insure establishment. that information disclosed under subparagrai>h (A) is used only for purposes of establishing and collecting child support obliga- tions from, and locating, individuals owing such obligations. For purposes of the preceding sentence, the term 'child support "Child support obligations' only includes obligations which are being enforced pursu- obligations." ant to a plan described in section 454 of this Act which has been 42 u s e 654. approved by the Secretary of Health and Human Services under part D of title IV of this Act. 42 u s e 651. "(2) Whenever the Secretary of Labor, after reasonable notice and Noncompliance opportunity for hearing to the State agency charged with the admin- of State agency. istration of the State law, finds that there is a failure to comply substantially with the requirements of paragraph (1), the Secretary of Labor shall notify such State agen(^ thatrartherpayments will not be made to the State until he is satisfied that there is no longer any such failure. Until the Secretary of Labor is so satisfied, he shall make no further certification to the Secretary of the Treasury with respect to such State. "(3) For purposes of this subsection, the term 'State or local child Definition. support enforcement agency* means any agency of a State or political subdivision thereof operating pursuant to a plan described in the last sentence of paragraph (1)." (2) Paragraph (2) of section 304(a) of the Social Security Act is 42 u s e 504. amended by striUng out "subsection Qy) or (c)" and inserting in lieu thereof "subsection (b), (c), or (d)". (3) The amendments made by this subsection shall take efiTect on Effective date. July 1,1980. 42 u s e 503 note. TITLE V-OTHER PROVISIONS RELATING TO THE SOCIAL SECURITY ACT RELATIONSHIP BETWEEN SOCIAL SECURITY AND SSI BENEFITS SEC. 501. (a) Part A of title XI of the Social Security Act is amended by inserting immediately after section 1126 the following new section: ADJUSTMENT OF RETROACTIVE BENEFITS UNDER TITLE H ON ACCOUNT OF SUPPLEMENTAL SECURITY INCOME BENEFITS "SEC. 1127. Notwithstanding any other provision of this Act, in any 42 use i320a-6. case where an individual— "(1) makes application for benefits under title 11 and is subse- 42 use 40i. quently determined to be entitled to those benefits, and "(2) was an individual with respect to whom supplemental security income benefits were paid under title XVI (inclucUng 42 use i38i. State supplementary payments which were made under an agreement pursuant to section 1616(a) or an administration 42usei382e. agreement under section 212 of Public Law 93-66) for one or 87 stat. 155. more months during the period beginning with the first month
94 STAT. 470 PUBLIC LAW 96-265—JUNE 9, 1980 for which a benefit described in paragraph (1) is payable and ending with the month before the first month in which such benefit is paid pursuant to the application referred to in para- graph (1), the benefits (described in paragraph (1)) which are otherwise retroac- tively payable to such individual for months in the period described in paragraph (2) shall be reduced by an amount equal to so much of such supplemental security income benefits (including State supple- mentary payments) described in paragraph (2) for such month or months as would not have been paid with respect to such individual or his eligible spouse if the individual had received the benefits under 42 use 401. title II at the times they were regularly due during such period rather than retroactively; and from the amount of such reduction the Secretary shall reimburse the State on behalf of which such supple- mentary payments were made for the amount (if any) by which such State's expenditures on account of such supplementary payments for the period involved exceeded the expenditures which the State would have made (for such period) if the individual had received the benefits under title II at the times they were regularly due during such period rather than retroactively. An amount equal to the portion of such reduction remaining after reimbursement of the State under the preceding sentence shall be covered into the general fund of the Treasury.". 42 use 404. (b) Section 204 of such Act is amended by adding at the end thereof the following new subsection: "(e) For payments which are adjusted by reason of payment of benefits under the supplemental security income program estab- 42 use 1381. lished by title XVI, see section 1127.". Ante, p. 469. (^.) Section 1631(b) of such Act is amended— 42 use 1383. (1) t,y inserting "(1)" immediately after "(b)", and (2) by adding at the end thereof the following new paragraph: "(2) For pa3Tnents for which adjustments are made by reason of a 42 use 401. retroactive payment of benefits under title II, see section 1127.". Ante, p. 469. (j) rpj^g amendments made by this section shall be applicable in the 42 use i320a-6 ^.^gg Qf pa3mients of monthly insurance benefits under title II of the "° ^ Social Security Act entitlement for which is determined on or after the first day of the thirteenth month which begins after the date of the enactment of this Act. EXTENSION OF NATIONAL COMMISSION ON SOCIAL SECURITY SEC. 502. (a) Section 361(aX2)(F) of the Social Security Amendments 42 use 907a. of 1977 is amended by striking out "a term of two years" and inserting in lieu thereof "a term which shall end on April 1, 1981". Ot)) Section 361(c)(2) of the Social Security Amendments of 1977 is amended by striking out all that follows the semicolon and inserting in lieu thereof "and the Commission shall cease to exist on April 1, 1981.". TIME FOR MAKING OF SOCIAL SECURITY CONTRIBUTIONS WITH RESPECT TO COVERED STATE AND LOCAL EMPLOYEES S E C 503. (a) Subparagraph (A) of section 218(e)(1) of the Social 42 use 418. Security Act is amended to read as follows: "(A) that the State will pay to the Secretary of the Treasury, within the thirty-day period immediately following the last day of each calendar month, amounts equivalent to the sum of the
PUBLIC LAW 96-265—JUNE 9, 1980 94 STAT. 471 taxes which would be imposed by sections 3101 and 3111 of the Internal Revenue Code of 1954 if the services for which wages 26 u s e 3101, 3111. were paid in such month to employees covered by the agreement constituted emplo3nnent as defined in section 3121 of such Code; 26 u s e 3121. and". (b) The amendment made by subsection (a) shall be effective with Effective date. respect to the pa5nnent of taxes (referred to in section 218(eXlXA) of 42 u s e 418 note. the Social Security Act, as amended by subsection (a)) on account of Ante, p. 470. wages paid on or after July 1,1980. (c) The provisions of section 7 of Public Law 94-202 shall not be 42 u s e 405a. applicable to any regulation which becomes effective on or after July 42 u s e 405a note. 1,1980, and which is designed to carry out the purposes of subsection (a) of this section. ELIGIBILITY OF ALIENS FOR SSI BENEFITS SEC. 504. (a) Section 1614(f) of the Social Security Act is amended by 42 use I382c. adding at the end thereof the following new paragraph: "(3) For purposes of determining eligibility for and the amount of benefits for any individual who is an £dien, such individual's income and resources shall be deemed to include the income and resources of his sponsor and such sponsor's spouse (if such alien has a sponsor) as provided in section 1621. Any such income deemed to be income of Wra. such individual shall be treated as unearned income of such individual.". (b) Part A of title XVI of such Act is amended by adding at the end thereof (after the new section added by section 201(c) of this Act) the Ante, p. 445. following new section: 'ATTRIBUTION O F S P O N S O R ' S INCOME AND RESOURCES TO ALIENS "SEC. 1621. (a) For purposes of determining eligibility for and the Eligibility amount of benefits under this title for an individual who is an alien, determination the income and resources of any person who (as a sponsor of such for benefits. 42 u s e 1382J. individual's entry into the United States) executed an affidavit of support or similar agreement with respect to such individual, and the income and resources of the sponsor's spouse, shall be deemed to be the income and resources of such individual (in accordance with subsections (b) and (c)) for a period of three years after the individ- ual's entry into the United States. Any such income deemed to be income of such individual shall be treated as unearned income of such individual. "(bXD The amount of income of a sponsor (and his spouse) which shall be deemed to be the unearned income of an alien for any year shall be determined as follows: "(A) The total yearly rate of earned and unearned income (as determined under section 1612(a)) of such sponsor and such Ante, p. 449. sponsor's spouse (if such spouse is living with the sponsor) shall be determined for such year. "(B) The amount determined under subparagraph (A) shall be reduced by an amount equal to (i) the maximum amount of the Federal benefit under tms title for such year which woidd be payable to an eligible individual who has no other income and who does not have an eligible spouse (as determined under section 1611(bXl)), plus (ii) one-half of the amount determined 42 use 1382 under clause (i) multiplied by the number of individuate who are dependents of such sponsor (or such sponsor's spouse if such
94 STAT. 472 PUBLIC LAW 96-265—JUNE 9, 1980 spouse is living with the sponsor), other than such alien and such alien's spouse. "(C) The amount of income which shall be deemed to be unearned income of such alien shall be at a yearly rate equal to the amount determined under subparagraph (B). The period for determination of such amount shall be the same as the period for 42 u s e 1382. determination of benefits under section 1611(c). "(2) The amount of resources of a sponsor (and his spouse) which shall be deemed to be the resources of an alien for any year shall be determined as follows: "(A) The total amount of the resources (as determined under 42 u s e 1382b. section 1613) of such sponsor and such sponsor's spouse (if such spouse is living with the sponsor) shall be determined, "(B) The amount determined under subparagraph (A) shall be reduced by an amount equal to (i) $1,500 in the case of a sponsor who has no spouse with whom he is living, or (ii) $2,250 in the case of a sponsor who has a spouse with whom he is living. "(C) The resources of such sponsor (and spouse) as determined under subparagraphs (A) and (B) shall be deemed to be resources of such alien in addition to any resources of such alien. "(c) In determining the amount of income of an alien during the period of three years after such alien's entry into the United States, the reduction in dollar amounts otherwise required under section 42 u s e 1382a. 1612(a)(2)(A)(i) shall not be applicable if such alien is living in the household of a person who is a sponsor (or such sponsor's spouse) of such alien, and is receiving support and maintenance in kind from such sponsor (or spouse), nor shall support or maintenance furnished in cash or kind to an alien by such alien's sponsor (to the extent that it reflects income or resources which were taken into account in determining the amount of income and resources to be deemed to the alien under subsection (a) or (b)) be considered to be income of such alien under section 1612(aX2XA). Information and "(d)(1) Any individual who is an alien shall, during the period of documentation three years after entry into the United States, in order to be an respecting sponsor. eligible individual or eligible spouse for purposes of this title, be required to provide to the Secretary such information and documen- tation with respect to his sponsor as may be necessary in order for the Secretary to make any determination required under this section, and to obtain any cooperation from such sponsor necessary for any such determination. Such alien shall also be required to provide to the Secretary such information and documentation as the Secretary may request and which such alien or his sponsor provided in support of such alien's immigration application. "(2) The Secretary shall enter into agreements with the Secretary of State and the Attorney General whereby any information avail- able to such persons and required in order to make any determination under this section will be provided by such persons to the Secretary, and whereby such persons shall inform any sponsor of an alien, at the time such sponsor executes an affidavit of support or similar agree- ment, of the requirements imposed by this section. Sponsor and "(e) Any sponsor of an alien, and such alien, shall be jointly and alien, liability for overpayment. severably liable for an amount equal to any overpajnnent made to such alien during the period of three years after such alien's entry into the United States, on account of such sponsor's failure to provide correct information under the provisions of this section, except where such sponsor was without fault, or where good cause for such failure existed. Any such overpayment which is not repaid to the Secretary
PUBLIC LAW 96-265—JUNE 9, 1980 94 STAT. 473 or recovered in accordance with section 16310)) shall be withheld ^^te, p. 470. from any subsequent payment to which such alien or such sponsor is entitled under any provision of this Act. "(fXD The provisions of this section shall not apply with respect to Aged, blind, or any individual who is an 'aged, blind, or disabled individual' for disabled individual, purposes of this title by reason of blindness (as determined under nonapplicability. section 1614(aX2)) or disability (as determined under section 42 u s e 1382c. 1614(aX3)), from and after the onset of the impairment, if such blindness or disabihty commenced after the date of such individual's admission into the United States for permanent residence. "(2) Tlie provisions of this section shall not apply with respect to any alien who is— "(A) admitted to the United States as a result of the applica- tion, prior to April 1,1980, of the provisions of section 203(aX7) of the Immigration and Nationality Act; 8 u s e 1153. "(B) admitted to the United States as a result of the applica- tion, after March 31,1980, of the provisions of section 207(cXl) of such Act; Ante, p. 103. "(C) paroled into the United States as a refugee under section 212(dX5) of such Act; or Ante, p. 107. "(D) granted political asylum by the Attorney General.". (c) The amendments made by this section shall be effective with Effective date. respect to individuals applying for supplemental security income 42 u s e 1382J benefits under title XVI of the Social Security Act for the first time note. after September 30,1980. 42 u s e 1381. AUTHORITY FOR DEMONSTRATION PROJECTS SEC. 505. (aXD The Secretary of Health and Human Services shall 42 u s e 1310 develop and carry out experiments and demonstration projects note. designed to determine the relative advantages and disadvantages of (A) various alternative methods of treating the work activity of disabled beneficiaries under the old-age, survivors, and disability insurance program, including such methods as a reduction in benefits based on earnings, designed to encourage the return to work of disabled beneficiaries and (B) altering other limitations and condi- tions applicable to such disabled beneficiaries (including, but not limited to, lengthening the trial work period, altering the 24-month waiting period for medicare benefits, ^tering the manner in which such program is administered, earlier referral of beneficiaries for rehabilitation, and greater use of employers and others to develop, perform, and otherwise stimulate new forms of rehabilitation), to the end that savings will accrue to the Trust FHmds, or to otherwise promote the objectives or facilitate the administration of title n of the Social Security Act. 42 u s e 401. (2) The experiments and demonstration projects developed under paragraph (1) shall be of sufficient scope and sliall be carried out on a wide enough scale to permit a thorough evaluation of the alternative methods under consideration while giving assurance that the results derived from the experiments and projects mil obtain generally in the operation of the disability insurance program without commit* ting such program to the adoption of any particular system either locally or nationally. (3) In the case of any experiment or demonstration project under para^aph (1), the Secreta^ m^j^raive compliance with the benefit requirements of titles n and XVm of the Social Security Act insofar 42 u s e 401, as is necessary for a thorough evaluation of the alternative methods 1395.
94 STAT. 474 PUBLIC LAW 96-265—JUNE 9, 1980 under consideration. No such experiment or project shall be actually placed in operation unless at least ninety days prior thereto a written report, prepared for purposes of notification and information only and containing a full and complete description thereof, has been transmitted by the Secretary to the Committee on Ways and Means of the House of Representatives and to the Committee on Finance of the Senate. Periodic reports on the progress of such experiments and demonstration projects shall be submitted by the Secretary to such committees. When appropriate, such reports shall include detailed recommendations for changes in administration or law, or both, tc carry out the objectives stated in paragraph (1). Report to (4) The Secretary shall submit to the Congress no later than Congress. January 1, 1983, a report on the experiments and demonstration projects with respect to work incentives carried out under this subsection together with any related data and materials which he may consider appropriate. 42 u s e 401. (5) Section 201 of the Social Security Act is amended by adding at the end thereof (after the new subsection added by section 310(a) of Ante, p. 459. this Act) the following new subsection: "(k) Expenditures made for experiments and demonstration proj- ects under section 505(a) of the Social Security Disability Amend- Ante, p. 473. ments of 1980 shall be made from the Federal Disability Insurance Trust Fund and the Federal Old-Age and Survivors Insurance Trust Fund, as determined appropriate by the Secretary.". 42 u s e 1310. (b) Section 1110 of the Social Security Act is amended— (1) by inserting "(1)" after "SEC. 1110. (a)"; (2) by striking out "for (1)" and "(2)" and inserting in lieu thereof "for (A)" and "(B)", respectively; (3) by redesignating subsections (b) and (c) as paragraphs (2) and (3), respectively; (4) by striking out "under subsection (a)" each place it appears and inserting in lieu thereof "under paragraph (1)"; (5) by striking out "purposes of this section" and inserting in lieu thereof "purposes of this subsection"; and (6) by adding at the end thereof the following new subsection: Waiver. "(b)(1) The Secretary is authorized to waive any of the require- 42 u s e 1381. ments, conditions, or limitations of title XVI (or to waive them only for specified purposes, or to impose additional requirements, condi- tions, or limitations) to such extent and for such period as he finds necessary to carry out one or more experimental, pilot, or demonstra- tion projects which, in his judgment, are likely to assist in promoting the objectives or facilitate the administration of such title. Any costs for benefits under or administration of any such project (including planning for the project and the review and evaluation of the project and its results), in excess of those that would have been incurred without regard to the project, shall be met by the Secretary from amounts available to him for this purpose from appropriations made to carry out such title. The costs of any such project which is carried out in coordination with one or more related projects under other titles of this Act shall be allocated among the appropriations avail- able for such projects and any Trust Funds involved, in a manner determined by the Secretary, taking into consideration the programs (or types of benefit) to which the project (or part of a project) is most closely related or which the project (or part of a project) is intended to benefit. If, in order to carry out a project under this subsection, the Secretary requests a State to make supplementary payments (or 42 u s e 1382e. makes them himself pursuant to an agreement under section 1616),
PUBLIC LAW 96-265—JUNE 9, 1980 94 STAT. 475 or to provide medical assistance under its plan approved under title XIX, to individuals who are not eligible therefor, or in amounts or 42 use 1396. under circumstances in which the State does not make such pay- ments or provide such medical assistance, the Secretary shall reim- burse such State for the non-Federal share of such payments or assistance from amounts appropriated to carry out title XVI. 42 u s e 1381. "(2) With respect to the participation of recipients of supplemental security income benefits in experimental, pilot, or demonstration projects under this subsection— "(A) the Secretary is not authorized to cany out any project that would result in a substantial reduction in any individual's total income and resources as a result of his or her participation in the project; "(B) the Secretary may not require any individual to partici- pate in a project; and he shall assure (i) that the voluntary participation of individuals in any project is obtained through informed written consent which satisfies the requirements for informed consent established by the Secretary for use in any experimental, pilot, or demonstration project in which human subjects are at risk, and (ii) that any individual's voluntary agreement to participate in any project may be revoked by such individual at any time; "(C) the Secretary shall, to the extent feasible and appropriate, include recipients who are under age 18 as well as adult recipi- ents; and "(D) the Secretary shall include in the projects carried out under this section such experimental, pilot, or demonstration projects as may be necessary to ascertain the feasibility of treating alcoholics and drug addicts to prevent the onset of irreversible medical conditions which may result in permanent disability, including programs in residential care treatment centers.". (c) The Secretary shall submit to the Congress a final report with Report to respect to all experiments and demonstration projects carried out eongress. 42 u s e 1310 under this section no later than five years after the date of the note. enactment of this Act. ADDITIONAL FUNDS FOR DEMONSTRATION PROJECT RELATING TO THE TERMINALLY ILL SEC. 506. (a) The Secretary of Health and Human Services is 42 u s e 1395ZZ note. authorized to provide for the participation, by the Social Security Administration, in a demonstration project relating to the terminally ill which is currently being conducted within the Department of Health and Human Services. The purpose of such participation shall be to study the impact on the terminally ill of provisions of the disability programs administered by the Social Security Administra- tion and to determine how best to provide services needed by persons who are terminally ill through programs over which the Social Security Administration has administrative responsibility. (b) For the purpose of carrying out this section there are authorized Appropriation to be appropriated such sums (not in excess of $2,000,000 for any fiscal authorization. year) as may be necessary.
94 STAT. 476 PUBLIC LAW 96-265—JUNE 9, 1980 VOLUNTARY CERTIFICATION OF MEDICARE SUPPLEMENTAL HEALTH INSURANCE POLICIES SEC. 507. (a) Title XVIII of the Social Security Act is amended by adding at the end thereof the following new section: VOLUNTARY CERTIFICATION OF MEDICARE SUPPLEMENTAL HEALTH INSURANCE POLICIES 42 u s e 1395SS. "SEC. 1882, (a) The Secretary shall establish a procedure whereby medicare supplemental policies (as defined in subsection (g)(1)) may be certified by the Secretary as meeting minimum standards and requirements set forth in subsection (c). Such procedure shall provide an opportunity for any insurer to submit any such policy, and such additional data as the Secretary finds necessary, to the Secretary for his examination and for his certification thereof as meeting the standards and requirements set forth in subsection (c). Such certifica- tion shall remain in effect if the insurer files a notarized statement with the Secretary no later than June 30 of each year stating that the policy continues to meet such standards and requirements and if the insurer submits such additional data as the Secretary finds necessary to independently verify the accuracy of such notarized statement. Emblem. Where the Secretary determines such a policy meets (or continues to meet) such standards and requirements, he shall authorize the insurer to have printed on such policy (but only in accordance with such requirements and conditions as the Secretary may prescribe) an emblem which the Secretary shall cause to be designed for use as an List of certified indication that a policy has received the Secretary's certification. The policies. Secretary shall provide each State commissioner or superintendent of insurance with a list of all the policies which have received his certification. State regulatory "(bXl) Any medicare supplemental policy issued in any State which program, the Supplemental Health Insurance Panel (established under para- standards and requirements. graph (2)) determines has established under State law a regulatory program that— "(A) provides for the application of standards with respect to such policies equal to or more stringent than the NAIC Model Standards (as defined in subsection (gX2XA)); "(B) includes a requirement equal to or more stringent than the requirement described in subsection (cX2); and "(C) provides for application of the standards and require- ments described in subparagraphs (A) and (B) to all medicare supplemental policies (as defined in subsection (gXD) issued in such State, shall be deemed (for so long as the Panel finds that such State regulatory program continues to meet the standards and require- ments of this paragraph) to meet the standards and requirements set forth in subsection (c). Supplemental "(2XA) There is hereby established a panel (hereinafter in this Health section referred to as the 'Panel') to be known as the Supplemental Insurance Panel, establishment. Health Insurance Panel. The Panel shall consist of the Secretary, who shall serve as the Chairman, and four State commissioners or superintendents of insurance, who shall be appointed by the Presi- dent and serve at his pleasure. Such members shall first be appointed not later than December 31,1980. Quorum. "(B) A majority of the members of the Panel shall constitute a quorum, but a lesser number may conduct hearings.
PUBLIC LAW 96-265—JUNE 9, 1980 94 STAT. 477 "(C) The Secretary shall provide such technical, secretarial, cleri- cal, and other assistance as the Panel may require. "(D) There are authorized to be appropriated such sums as may be Appropriation authorization. necessary to carry out this paragraph. "(E) Members of the Panel shall be allowed, while away from their Travel expenses. homes or regular places of business in the performance of services for the Panel, travel expenses (including per diem in lieu of subsistence) in the same manner as persons employed intermittently in the Government service are allowed expenses under section 5703 of title 5, United States Code. "(c) The Secretary shall certify under this section any medicare Medicare supplemental supplemental policy, or continue certification of such a policy, only if policy, he finds that such policy— certification "(1) meets or exceeds (either in a single policy or, in the case of criteria. nonprofit hospital and medical service associations, in one or more policies issued in conjunction with one another) the NAIC Model Standards; and "(2) can be expected (as estimated for the entire period for which rates are computed to provide coverage, on the basis of incurred claims experience and earned premiums for such period and in accordance with accepted actuarial principles and prac- tices) to return to policyholders in the form of aggregate benefits provided under the policy, at least 75 percent of the aggregate amount of premiums collected in the case of group policies and at least 60 percent of the aggregate amount of premiums collected in the case of individual policies. For purposes of paragraph (2), policies issued as a result of solicita- Individual tions of individuals through the mails or by mass media advertising policies. (including both print and broadcast advertising) shall be deemed to be individual policies. "(d)(1) Whoever knowingly or willfully makes or causes to be made False statement or representa- or induces or seeks to induce the making of any false statement or tion, penalties representation of a material fact with respect to the compliance of and fines. any policy with the standards and requirements set forth in subsec- tion (c) or in regulations promulgated pursuant to such subsection, or with respect to the use of the emblem designed by the Secretary under subsection (a), shall be guilty of a felony and upon conviction thereof shall be fined not more than $25,000 or imprisoned for not more than 5 years, or both. "(2) Whoever falsely assumes or pretends to be acting, or misrepre- sents in any way that he is acting, under the authority of or in association with, the program of health insurance established by this title, or any Federal agency, for the purpose of selling or attempting to sell insurance, or in such pretended character demands, or obtains money, paper, documents, or anything of value, shall be guilty of a felony and upon conviction thereof shall be fined not more than $25,000 or imprisoned for not more than 5 years, or both. "(3)(A) Whoever knowingly sells a health insurance policy to an individual entitled to benefits under part A or enrolled under part B of this title, with knowledge that such policy substantially duplicates 42 u s e 1395c, health benefits to which such individual is otherwise entitled, other 1395J. than benefits to which he is entitled under a requirement of State or Federal law (other than this title), shall be guilty of a felony and upon conviction thereof shall be fined not more than $25,000 or imprisoned for not more than 5 years, or both.
94 STAT. 478 PUBLIC LAW 96-265—JUNE 9, 1980 "(B) For purposes of this paragraph, benefits which are payable to or on behalf of an individual without regard to other health benefit coverage of such individual, shall not be considered as duplicative. "(C) Subparagraph (A) shall not apply with respect to the selling of a group policy or plan of one or more employers or labor organiza- tions, or of the trustees of a fund established by one or more employers or labor organizations (or combination thereof), for em- ployees or former employees (or combination thereof) or for members or former members (or combination thereof) of the labor organizations. Policies mailed "(4)(A) Whoever knowingly, directly or through his agent, mails or for prohibited causes to be mailed any matter for a prohibited purpose (as deter- purpose. mined under subparagraph (B)) shall be guilty of a felony and upon conviction thereof shall be fined not more than $25,000 or imprisoned for not more than 5 years, or both. Definition. "(B) For purposes of subparagraph (A), a prohibited purpose means the advertising, solicitation, or offer for sale of a medicare supple- mental policy, or the delivery of such a policy, in or into any State in which such policy has not been approved by the State commissioner or superintendent of insurance. For purposes of this paragraph, a medicare supplemental policy shall be deemed to be approved by the commissioner or superintendent of insurance of a State if— "(i) the policy has been certified by the Secretary pursuant to subsection (c) or was issued in a State with an approved regula- tory program (as defined in subsection (gX2XB)); "(ii) the policy has been approved by the commissioners or superintendents of insurance in States in which more than 30 percent of such policies are sold; or "(iii) the State has in effect a law which the commissioner or superintendent of insurance of the State has determined gives him the authority to review, and to approve, or effectively bar from sale in the State, such policy; except that such a policy shall not be deemed to be approved by a State commissioner or superintendent of insurance if the State notifies the Secretary that such policy has been submitted for approval to the State and has been specifically disapproved by such State after providing appropriate notice and opportunity for hearing pursuant to the procedures (if any) of the State. Exceptions. "(C) Subparagraph (A) shall not apply in the case of a person who mails or causes to be mailed a medicare supplemental policy into a State if such person has ascertained that the party insured under such policy to whom (or on whose behalf) such policy is mailed is located in such State on a temporary basis. "(D) Subparagraph (A) shall not apply in the case of a person who mails or causes to be mailed a duplicate copy of a medicare supple- mental policy previously issued to the party to whom (or on whose behalf) such duplicate copy is mailed, if such policy expires not more than 12 months after the date on which the duplicate copy is mailed. Benefit "(e) The Secretary shall provide to all individuals entitled to information. benefits under this title (and, to the extent feasible, to individuals about to become so entitled) such information as will permit such individuals to evaluate the value of medicare supplemental policies to them and the relationship of any such policies to benefits provided under this title. State regulatory "(f)(1)(A) The Secretary shall, in consultation with Federal and programs, study State regulatory agencies, the National Association of Insurance and evaluation. Commissioners, private insurers, and organizations representing
PUBLIC LAW 96-265—JUNE 9, 1980 94 STAT. 479 consumers and the aged, conduct a comprehensive study and evalua- tion of the comparative effectiveness of various State approaches to the regulation of medicare supplemental policies in (i) limiting marketing and agent abuse, (ii) assuring the dissemination of such information to individuals entitled to benefits under this title (and to other consumers) as is necessary to permit informed choice, (iii) promoting policies which provide reasonable economic benefits for such individuals, (iv) reducing the purchase of unnecessary duplica- tive coverage, (v) improving price competition, and (vi) establishing effective approved State regulatory programs described in subsection (b). "(B) Such study shall also address the need for standards or certification of health insurance policies, other than medicare supple- mental policies, sold to individuals eligible for benefits under this title. "(C) The Secretary shall, no later than January 1, 1982, submit a Report to report to the Congress on the results of such study and evaluation, Congress. accompanied by such recommendations as the Secretary finds war- ranted by such results with respect to the need for legislative or administrative changes to accomplish the objectives set forth in subparagraphs (A) and (B), including the need for a mandatory Federal regulatory program to assure the marketing of appropriate types of medicare supplemental policies, and such other means as he finds may be appropriate to enhance effective State regulation of such policies. "(2) The Secretary shall submit to the Congress no later than July Report to 1, 1982, and periodically as may be appropriate thereafter (but not Congress. less often than once every 2 years), a report evaluating the effective- ness of the certification procedure and the criminal penalties estab- lished under this section, and shall include in such reports an analysis of— "(A) the impact of such procedure and penalties on the types, market share, value, and cost to individuals entitled to benefits under this title of medicare supplemental policies which have been certified by the Secretary; "(B) the need for any change in the certification procedure to improve its administration or effectiveness; and "(C) whether the certification program and criminal penalties should be continued. "(g)(1) For purposes of this section, a medicare supplemental policy Medicare is a health insurance policy or other health benefit plan offered by a supplemental policy, private entity to individuals who are entitled to have payment made definition. under this title, which provides reimbursement for expenses incurred for services and items for which payment may be made under this title but which are not reimbursable by reason of the applicability of deductibles, coinsurance amounts, or other limitations imposed pur- suant to this title; but does not include any such policy or plan of one or more employers or labor organizations, or of the trustees of a fund established by one or more employers or labor organizations (or combination thereof), for employees or former employees (or combi- nation thereof) or for members or former members (or combination thereof) of the labor organizations. For purposes of this section, the term 'policy' includes a certificate issued under such policy. "Policy." "(2) For purposes of this section: "(A) The term 'NAIC Model Standards' means the 'NAIC "NAIC Model Model Regulation to Implement the Individual Accident and Standards." Sickness Insurance Minimum Standards Act', adopted by the 79-194 O—81—pt. 1 34 : QU
94 STAT. 480 PUBLIC LAW 96-265—JUNE 9, 1980 National Association of Insurance Commissioners on June 6, 1979, as it applies to medicare supplement policies, Definition. "(B) The term 'State with an approved regulatory program' means a State for which the Panel has made a determination under subsection (b)(1). "(C) The State in which a policy is issued means— "(i) in the case of an individual policy, the State in which the policyholder resides; and "(ii) in the case of a group policy, the State in which the holder of the master policy resides. Regulations. "(h) The Secretary shall prescribe such regulations as may be necessary for the effective, efficient, and equitable administration of the certification procedure established under this section. The Secre- tary shall first issue final regulations to implement the certification procedure established under subsection (a) not later than March 1, 1981. Emblem usage, "(i)(l) No medicare supplemental policy shall be certified and no effective date. such policy may be issued bearing the emblem authorized by the Secretary under subsection (a) until July 1, 1982. On and after such date policies certified by the Secretary may bear such emblem, including policies which were issued prior to such date and were subsequently certified, and insurers may notify holders of such certified policies issued prior to such date using such emblem in the notification. "(2)(A) The Secretary shall not implement the certification pro- gram established under subsection (a) with respect to policies issued in a State unless the Panel makes a finding that such State cannot be expected to have established, by July 1, 1982, an approved State regulatory program meeting the standards and requirements of subsection (bXD. If the Panel makes such a finding, the Secretary shall implement such program under subsection (a) with respect to medicare supplemental policies issued in such State, until such time as the Panel determines that such State has a program that meets the standards and requirements of subsection (b)(1). Panel findings, "(B) Any finding by the Panel under subparagraph (A) shall be transmittal to transmitted in writing, not later than January 1, 1982, to the congressional committees; Committee on Finance of the Senate and to the Committee on effective date. Interstate and Foreign Commerce and the Committee on Ways and Means of the House of Representatives and shall not become effective until 60 days after the date of its transmittal to the Committees of the Congress under this subparagraph. In counting such days, days on which either House is not in session because of an adjournment sine die or an adjournment of more than three days to a day certain are excluded in the computation.
PUBLIC LAW 96-265—JUNE 9, 1980 94 STAT. 481 "(j) Nothing in this section shall be construed so as to afTect the right of any State to regulate medicare supplemental policies which, under the provisions of this section, are considered to be issued in another State.". (b) The amendment made by this section shall become effective on Effective date. the date of the enactment of this Act, except that the provisions of 42 use i395ss paragraph (4) of section 1882(d) of the Social Security Act (as added by "° ^ this section) shall become effective on July 1,1982. ^"^« p 476. Approved June 9, 1980. LEGISLATIVE HISTORY: HOUSE REPORTS: No. 96-100 (Comm. on Ways and Means) and No. 96-944 (Comm. of Conference). SENATE REPORT No. 96-408 (Comm. on Finance). CONGRESSIONAL RECORD: Vol. 125 (1979): Sept. 6, considered and passed House. Dec. 5, considered in Senate. Vol. 126 (1980): Jan. 30, 31, considered and passed Senate, amended. May 22, House agreed to conference report. May 29, Senate agreed to conference report. WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS: Vol. 16, No. 24 (1980): June 9, Presidential statement.