[Federal Register Volume 78, Number 147 (Wednesday, July 31, 2013)]
[Proposed Rules]
[Pages 46309-46310]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-18360]
=======================================================================
-----------------------------------------------------------------------
SOCIAL SECURITY ADMINISTRATION
20 CFR Parts 404 and 416
[Docket No. SSA 2013-0011]
Rules of Administrative Finality
AGENCY: Social Security Administration (SSA)
ACTION: Notice and request for comments.
-----------------------------------------------------------------------
SUMMARY: We are requesting information from the public regarding
whether and how we should change our rules of administrative finality.
These rules govern when we can reopen and revise a determination or
decision that has become final and is no longer subject to
administrative or judicial review. We are requesting information about
several possible ways to change various aspects of our administrative
finality rules. We are interested in obtaining information about issues
such as whether and how we should revise the rules that govern the
timeframes in which we can reopen a determination or decision, and
whether and how we should revise the rules that govern the diligent
pursuit of an investigation. We are also interested in obtaining
information about whether we should adopt rules that would address our
ability to make prospective changes to the amount of an individual's
benefits without making changes for months in which the individual has
already received payment. We are requesting your comments on several
questions that we address below.
DATES: To ensure that your comments are considered, we must receive
them no later than September 30, 2013.
ADDRESSES: You may submit written comments by any one of three
methods--Internet, fax or mail. Do not submit the same comments
multiple times, or by more than one method. Regardless of which method
you choose, please state that your comments refer to Docket No. SSA-
2013-0011, so that we may associate your comments with the correct
activity.
Caution: You should be careful to include in your comments only
information that you wish to make publicly available. We strongly urge
you not to include in your comments any personal information, such as
Social Security numbers or medical information.
Internet: We strongly recommend this method for submitting
your comments. Visit the Federal eRulemaking portal at http://www.regulations.gov. Use the Search function of the Web page to find
docket number SSA-2013-0011, and then submit your comment. Once you
submit your comment, the system will issue you a tracking number to
confirm your submission. You will not be able to view your comment
immediately as we must manually post each comment. It may take up to a
week for your comment to be viewable.
Fax: Fax comments to (410) 966-2830.
Mail: Mail your comments to the Office of Regulations and
Reports Clearance, Social Security Administration, 107 Altmeyer
Building, 6401 Security Boulevard, Baltimore, Maryland 21235-6401.
Comments are available for public viewing on the Federal
eRulemaking portal at http://www.regulations.gov, or in person, during
regular business hours, by arranging with the contact person identified
below.
FOR FURTHER INFORMATION CONTACT: Zeenat Kolia, Office of Income
Security Programs, Social Security Administration, 6401 Security
Boulevard, Baltimore, Maryland 21235-6401, 410-965-8629. For
information on eligibility or filing for benefits, call our national
toll-free number, 1-800-772-1213 or TTY 1-800-325-0778, or visit our
Internet site, Social Security Online, at http://www.socialsecurity.gov.
SUPPLEMENTARY INFORMATION:
Background
An initial determination is a determination we make that is subject
to administrative and judicial review. Generally, an initial
determination resolves the legal or factual issues affecting your
entitlement or eligibility as provided by the Social Security Act
(Act). Some examples of initial determinations are determinations about
your entitlement to benefits, the benefit amount you receive, the
termination of your benefits, and any overpayments or underpayments
that may occur. Initial determinations are final and binding unless you
request an appeal within the appropriate timeframe or we reopen and
revise the initial determination under our rules of administrative
finality.
The rules of administrative finality govern whether we may reopen
and revise determinations or decisions that are no longer subject to
administrative and judicial review. The administrative finality rules
that allow us to reopen and revise determinations or decisions only in
specific situations and within specific timeframes were first put in
place to help ensure that individuals could rely on the determinations
and decisions we made in their claims.
Current Rules for Reopening
Our rules of administrative finality are located at 20 CFR 404.987-
404.996 for title II claims and at 20 CFR 416.1487-416.1494 for title
XVI claims.
Some of the timeframes for reopening are different for title II and
title XVI. Currently, for title II claims, we may reopen a
determination or decision:
Within 12 months of the date of the notice of the initial
determination for any reason;
Within 4 years of the date of the notice of the initial
determination if we find good cause to reopen the determination or
decision; or
At any time in certain situations, such as when fraud or
similar fault is involved.
For title XVI claims, we may reopen a determination or decision:
Within 12 months of the date of the notice of the initial
determination for any reason;
Within 2 years of the date of the notice of the initial
determination if we find good cause to reopen the determination or
decision; or
At any time only if fraud or similar fault is involved.
[[Page 46310]]
For both title II and title XVI, after we have reopened a
determination or decision, we apply the concept of diligent pursuit on
cases where the applicable reopening period ends but we have not
completed our investigation. We will presume diligent pursuit to have
been met if we conclude the investigation and if needed, revise the
determination or decision within 6 months from the date we began the
investigation. If we have not diligently pursued the investigation to
its conclusion, we will revise the determination or decision only if it
will be favorable to you.
In addition, under our current rules of administrative finality, if
we cannot reopen the case, we also will not make any prospective
changes to the amount of an individual's benefits. For example, if we
erroneously entitled you to a larger payment amount than was due, we
will continue to pay you the larger benefit amount even though we know
it is wrong.
Why are we considering changing our rules of administrative
finality?
We are considering changing our rules of administrative finality
for a variety of reasons:
1. We take our responsibility as effective stewards of the trust
funds very seriously. Modifying our rules would enable us to take
corrective action on more cases, and could decrease the amount of
improper payments that we make.
2. Our current rules are complex to administer. The fact that our
rules under title II and title XVI contain different timeframes for
reopening for good cause can result in confusion for our adjudicators
and the public, particularly in situations where an individual is
concurrently receiving benefits under title II and title XVI of the
Act.
3. The current rules may prevent us from making changes regardless
of the possible outcome for the individual. For example, if an
individual presents or we discover new and material evidence after the
time period that would allow us to reopen, we cannot take corrective
action and revise the determination or decision. Modifying our rules to
change certain timeframes for reopening may enable us to take
corrective actions on more cases.
4. The Office of the Inspector General has recommended that we
review our rules on administrative finality to find ways that will
allow us to correct more erroneous payments.
5. Some of our administrative finality rules have not been revised
in sixty years. Over the years, there has been an increase in our
workloads and the complexity of our programs. Updating the rules would
allow us to reflect these changes.
6. Finally, modifying our current rules would enable us to
streamline and simplify our rules on administrative finality. We
believe this would allow us to operate more efficiently in a
challenging, limited-resource environment.
Request for Comments
We are requesting comments concerning whether and how we should
change our rules of administrative finality. We ask that, in preparing
comments, you address questions such as:
1. Should the timeframe for reopening for good cause be consistent
for both title II and title XVI? If so, what should that timeframe be?
2. Should we extend the timeframe for reopening for any reason
under both title II and title XVI? If so, what would a reasonable
timeframe be? If not, how would you address concerns that the current
12-month timeframe does not give us adequate time to correct errors in
determinations or decisions without applying complex good cause rules?
3. Should we revise our rules to provide that we can change an
individual's current and future payments, even if we cannot reopen a
determination or decision to correct previously issued payments? If
not, what actions would you take to address the Office of the Inspector
General's September 2007 report \1\ that reviewed our title II
administrative finality rules and estimated that we would pay
approximately an additional $50 million in incorrect payments in the
future because we did not correct ongoing benefits?
---------------------------------------------------------------------------
\1\ Social Security Administration, Office of the Inspector
General, Administrative Finality in the Old-Age, Survivors and
Disability Insurance Program (Audit No. A-01-07-27029) (September
2007), at page 3 (available at: http://oig.ssa.gov/sites/default/files/audit/full/pdf/A-01-07-27029.pdf).
---------------------------------------------------------------------------
4. Should we revise our rules on diligent pursuit? If so, what
would be a reasonable timeframe? Or should we eliminate diligent
pursuit and instead require that we both reopen and complete any
revisions during the applicable reopening timeframe?
5. Are there any other aspects of our administrative finality rules
that we should consider revising?
Please see the information under ADDRESSES earlier in this document
for methods to give us your comments. We will not respond to your
comments, but we will consider them as we review our policies and
instructions to determine if we should revise or update them.
Dated: July 24, 2013.
Carolyn W. Colvin,
Acting Commissioner of Social Security.
[FR Doc. 2013-18360 Filed 7-30-13; 8:45 am]
BILLING CODE 4191-02-P