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6410 Federal Register / Vol. 62, No. 28 / Tuesday, February 11, 1997 / Rules and Regulationsto these redeterminations (Section211(d) (2)).• The medical improvement reviewstandard for determining continuingeligibility for children was revised toconform to the new definition ofdisability for children (Section 211(c)).• Not less frequently than once every3 years, we must conduct a CDR for anychildhood disability recipient eligibleby reason of an impairment(s) which islikely to improve. At the option of theCommissioner, we may also perform aCDR with respect to those individualsunder age 18 whose impairments areunlikely to improve (Section 212(a)).• We must redetermine the eligibilityof individuals who were eligible for SSIbased on disability in the month beforethe month in which they attained age 18using the rules for determining initialeligibility for adults. We will do theredetermination during the 1-yearperiod beginning on the individual’s18th birthday. The medicalimprovement review standard used inCDRs does not apply to theseredeterminations (Section 212(b)).• We must conduct a CDR not laterthan 12 months after the birth of thechild for any child whose low birthweight is a contributing factor materialto our determination that the child wasdisabled (Section 212(c)).• At the time of a CDR, a child’srepresentative payee shall presentevidence that the child is and has beenreceiving treatment to the extentconsidered medically necessary andavailable for the disabling impairment.If a payee refuses without good cause toprovide such evidence, we may selectanother representative payee, or paybenefits directly to the child, if wedetermine that it is appropriate and inthe best interests of the child (Section212(a)).These rules implement all of theprovisions of sections 211 and 212 ofPublic Law 104–193, with the exceptionof section 211(d)(2). Because Public Law104–193 repealed the ‘‘comparableseverity’’ disability standard forchildren, and eliminated use of the IFA,step 4 of our prior sequential evaluationprocess (the comparable severity step)has been removed. To be found disabledunder these rules, an individual underage 18 must have ‘‘marked and severefunctional limitations,’’ which meansthat his or her impairment orcombination of impairments must meet,or medically equal or functionallyequal, the severity of a listedimpairment.Summary of Specific RevisionsThese interim final rules revise ourprior rules for deciding initial eligibilityand continuing eligibility for childrenclaiming SSI benefits based ondisability. They also provide rules forredetermining the eligibility ofindividuals who attain age 18 and whowere eligible for SSI based on disabilityin the month before the month in whichthey attained age 18.The major changes to the rules areexplained below. In addition, we haveadded, removed, and revised languagethroughout subpart I of 20 CFR part 416to remove references to the ‘‘comparableseverity’’ standard and our priorregulatory definition of disabilityinterpreting that standard. Since theseare only conforming changes to complywith the new law, we have notsummarized each of them in thissummary.These rules do not address everyaspect of the evaluation of disability ofchildren and of individuals who haveattained age 18. They implementprimarily those changes required byPublic Law 104–193. Therefore, theymust be read in the context of all ourother relevant rules for determiningdisability.Appendix 1 to Subpart P of Part 404—Listings 112.00C and 112.02B2Public Law 104–193 mandatesremoval of references to ‘‘maladaptivebehaviors’’ in listings 112.00C2 and112.02B2c(2) in the childhood mentaldisorders section of the Listing ofImpairments. Listing 112.00C explainsthe severity criteria we use to evaluatea mental impairment in most of ourchildhood mental disorder listings.These severity criteria are often referredto as the ‘‘paragraph B’’ criteria becausethey are found in paragraph B of mostof the listings to which they apply.Listing 112.02B2c(2) was a particularparagraph B criterion for persistent,serious maladaptive behaviors inchildren aged 3 to 18. Pursuant toPublic Law 104–193, we have removedall references to ‘‘maladaptivebehaviors’’ in listing 112.00C anddeleted all of prior listing 112.02B2c(2);we have also redesignated the‘‘personal/behavioral’’ area as the areaof ‘‘personal function.’’ For this reason,we also removed the reference to‘‘activities of daily living’’ from formerlisting 112.02B2c(1), which we nowdesignate as listing 112.02B2c because itis the only paragraph remaining.The area of personal function nowpertains only to self-care; that is, theability to help oneself and to cooperatewith others in taking care of personalneeds, health, and safety (e.g., feeding,dressing, toileting, bathing, followingmedication regimes, and followingsafety precautions). Further, we haveclarified the description of the socialarea of functioning to make it clearerthat many impairment-relatedbehavioral problems (including thosepreviously considered in the priorpersonal/behavioral area) are likely tohave their most significant effects on achild’s social functioning.In addition, we revised the fourth areaof function from ‘‘concentration,persistence, and pace’’ to‘‘concentration, persistence, or pace.’’This is a technical correction to conformthe language of this section to the rulesin listings 112.00C3 and 112.02B2d,which have always read ‘‘deficiencies ofconcentration, persistence, or pace.’’ Wemade a corresponding change in listing112.00C4, which also used the word‘‘and.’’ We also made severalclarifications in listing 112.00C2b. Thechanges are not substantive and are onlyintended to parallel the adult mentallisting 12.00C2 with appropriatelanguage for children.Section 416.635 Responsibilities of aRepresentative Payee.We revised this section to providethat, in cases in which the beneficiaryis an individual under age 18 (includingcases in which the beneficiary is anindividual whose low birth weight is acontributing factor material to ourdetermination that the individual isdisabled), the representative payee isresponsible for ensuring that thebeneficiary is and has been receivingtreatment to the extent consideredmedically necessary and available forthe condition that was the basis forproviding benefits.Section 416.902 General Definitionsand Terms for This SubpartWe have added four new definitions.First, we explain that a disabilityredetermination (see § 416.987) is aredetermination of eligibility based ondisability using the rules for newapplicants appropriate to theindividual’s age, except the rulespertaining to performance of substantialgainful activity. Second, we explain thatthe term impairment(s) means ‘‘amedically determinable physical ormental impairment or a combination ofmedically determinable physical ormental impairments.’’Third, we explain that the termmarked and severe functionallimitations, when used as a phrase,means the standard of disability in theAct for children claiming SSI benefits,and is a level of severity that meets ormedically or functionally equals therequirements of a listing. We explainthat the separate words Marked andsevere are also terms used throughout