TN 60 (01-00)

A. Background

On August 22, 1996, the President signed P.L. 104-193, (the Personal Responsibility and Work Opportunity Reconciliation Act of 1996), which includes significant changes affecting the title XVI childhood disability evaluation and determination process. The new law requires more serious limitations for a finding of disability than was required under the old law.

Subsequently, on August 5, 1997, P.L. 105-33 was passed. This legislation modified the earlier legislation by extending the time frames for conducting certain disability redeterminations required under the earlier law. The legislation affects:

• All child disability applicants who file applications on or after August 22, 1996;

• Most childhood applicants whose claims for benefits are finally adjudicated on or after August 22, 1996; and

• Many current beneficiaries.

This subchapter explains the provisions of the law and provides field office (FO) instructions for processing childhood and age 18 disability redetermination cases.

B. Policy - Provisions of the Law

1. Definition of Disability for Children

Section 211(a) of P.L. 104-193 amended section 1614(a)(3) of the Act to provide a definition of disability for children separate from that for adults. The "comparable severity" criterion in the Act was repealed and replaced with the following definition:

“(C)(i) An individual under the age of 18 shall be considered disabled for the purposes of this title if that individual has a medically determinable physical or mental impairment, which results in marked and severe functional limitations, and which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

(ii) Notwithstanding clause (i), no individual under the age of 18 who engages in substantial gainful activity (determined in accordance with regulations prescribed pursuant to subparagraph (E)) may be considered to be disabled.”

Further provisions concerning childhood disability adjudication are summarized below with references to the relevant sections of P.L. 104-193.

2. Changes to Evaluation Criteria

• The Commissioner was directed to remove references to maladaptive behavior in the personal/behavioral domain from listings 112.00C.2 and 112.02B.2.c(2) of the childhood mental disorders listings (section 211(b)(1)).

• The Commissioner was directed to discontinue the Individualized Functional Assessment (IFA) for children in 20 CFR 416.924d and 416.924e (section 211(b)(2)).

3. Childhood Disability Redeterminations

P.L. 104-193, as modified by P.L. 105-33, requires that within 18 months after the date of enactment; i.e., by February 22, 1998, or as soon as practicable thereafter, SSA must redetermine the eligibility of individuals under the age of 18 who were eligible for Supplemental Security Income (SSI) based on disability as of August 22, 1996, and whose eligibility may terminate by reason of the new law. The cases are to be redetermined using the eligibility criteria for new applicants. The medical improvement review standard (MIRS) in section 1614(a)(4) of the Act and 20 CFR 416.994a, used in continuing disability reviews (CDRs), shall not apply to these disability redeterminations (section 211(d)(2)).

4. Age 18 Disability Redeterminations

According to P.L. 104-193, SSA must redetermine the eligibility of individuals who were eligible for SSI based on disability in the month before the month in which they attained age 18 using the rules for determining initial eligibility for adults. The MIRS used in CDRs does not apply to these redeterminations (section 212(b)).

P.L. 105-33 changed the time limit from “the 1-year period beginning on the individual's 18 birthday” as required by P.L. 104-193 to “either during the 1-year period beginning on the individual's 18th birthday or, in lieu of a continuing disability review, whenever the Commissioner determines that the individual's case is subject to a redetermination under this clause.” The effect of the change is to eliminate the time limits on SSA to initiate an age 18 disability redetermination only during the one year period following the individual's 18th birthday. This means that not only will disability redeterminations be appropriate as the individual attains age 18, but may be appropriate for individuals who attained age 18 on or after August 22, 1996, if the individual was not subject to a disability redetermination after attaining age 18. Age 18 disability redeterminations are an ongoing workload. The changes in the law mean that cases can be identified for redetermination not only as age 18 is attained but also by the DDS during a later CDR if, for some reason, they were not previously selected for a disability redetermination or it's equivalent (See DI 23570.010B.1.b.)

5. Effective Dates

The definition of disability for children applies to any individual under age 18 who files for, or whose claim is finally adjudicated, with respect to benefits under title XVI of the Social Security Act, on or after August 22, 1996.

With respect to individuals finally adjudicated prior to August 22, 1996, the definition will apply the earlier of the first unadjudicated month occurring after August 22, 1996 (closed period cases) or the date of the disability redetermination.

With respect to unadjudicated months, if an individual was first found disabled prior to enactment, the individual was subsequently ceased as in a closed period case, and the individual appealed, the old standard would apply up to enactment and the new standard would apply beginning with enactment.