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Federal Register / Vol. 62, No. 28 / Tuesday, February 11, 1997 / Rules and Regulations6415mandated by section 212(b) of PublicLaw 104–193.In paragraphs (a)(1) and (a)(2), weexplain that Public Law 104–193requires these redeterminations andthat, when we do these disabilityredeterminations, we generally will usethe rules for adults filing new claims,not the rules we use for CDRs.In paragraph (a)(3) we explain that wewill notify individuals before we begina disability redetermination. Inparagraph (a)(4) we explain that we willnotify the individual in writing of theresults of the redetermination andexplain the individual’s rights inconnection with our notice of disabilityredetermination.Paragraph (b) concerns a group ofrecipients who are subject to disabilityredeterminations under section 212(b)of the new law: individuals who becameeligible by reason of disability prior toattaining age 18, and who were eligiblefor SSI benefits based on disability forthe month before the month in whichthey attained age 18. Paragraphs (b)(1)through (b)(7) of this section providethat, during the 1-year period beginningon the individual’s eighteenth birthday,we will redetermine the eligibility ofthese individuals using the rules in§§ 416.920 (c) through (f), and not therules in § 416.920(b) or § 416.994; i.e.,we will decide whether an individual isdisabled using the rules for adults filingnew claims, except the rule that says anindividual engaging in substantialgainful activity will be found notdisabled. If an individual age 18 or olderhas a ‘‘disabling impairment’’ as definedin § 416.911 and is working, we willapply the rules for special SSI eligibilityin §§ 416.920ff. We also provide thateligibility will end if we find that theindividual is not disabled and describethe month in which we may find anindividual not disabled. Finally, weexplain that, if we find an individual isnot disabled, the last month for whichbenefits can be paid is the secondmonth after the month in which theindividual was determined not to bedisabled.Section 416.990 When and How OftenWe Will Conduct a Continuing DisabilityReviewIn paragraph (b), ‘‘When we willconduct a continuing disability review,’’we have added a new paragraph (b)(11),mandated by Public Law 104–193. Thenew paragraph provides that we will doa CDR by a child’s first birthday if thechild’s low birth weight is acontributing factor material to thedetermination that the child is disabled;i.e., whether we would have found thechild disabled if we had not consideredthe child’s low birth weight.In paragraph (c), ‘‘Definitions,’’ wehave revised the definition of apermanent impairment, medicalimprovement not expected, to explainthat for a child, such an impairment isone that is unlikely to improve to thepoint that the child’s functionallimitations will no longer be markedand severe.Section 416.994a How We WillDetermine Whether Your DisabilityContinues or Ends, and Whether YouAre and Have Been Receiving TreatmentThat Is Medically Necessary andAvailable, Disabled ChildrenWe revised this section extensively tocomport with provisions in Public Law104–193 in two ways:• To revise the medical improvementreview standard (MIRS) used inconducting a CDR, and• To add rules that, at the time of aCDR, a child’s representative payeemust show evidence that the child isand has been receiving treatment that ismedically necessary and available forthe condition that was the basis forproviding SSI benefits.The new evaluation sequence forapplying the medical improvementreview standard in a CDR is:1. Has there been medicalimprovement in the impairment(s) onwhich eligibility was based? If there hasbeen no medical improvement, we willfind that the child is still disabled,unless certain exceptions apply.2. If there has been medicalimprovement, does the impairment(s)the child had at the time of our mostrecent favorable medical determinationor decision still meet, medically equal,or functionally equal the severity of thelisting that it met or equalled at the timeof the prior determination or decision?If that impairment(s) still meets orequals the severity of that listedimpairment as it was written at thattime, we will find the child stilldisabled, unless certain exceptionsapply.3. If that impairment(s) does not stillmeet or equal the severity of that listedimpairment as it was written at thattime, is the child now disabled, takinginto consideration all currentimpairments.Because the childhood disabilitystandard is no longer linked to the adultstandard of inability to work, there is nolonger a step to assess whether anymedical improvement is ‘‘related to theability to work.’’In paragraph (a)(1), we changed theoutline of the sequential evaluationprocess for CDRs in childhood disabilitycases to reflect the new sequence ofevaluation. The sequence outlined inparagraph (a)(1) and discussed in moredetail in paragraphs (b)(1) through (b)(3)differs significantly from the sequenceunder our prior rules. In our prior rules,the first step of the CDR evaluationprocess for children requiredconsideration of whether the child’simpairment(s) met, or was equivalent inseverity to, a listing. However, the newstatutory definition of disability forchildren—‘‘marked and severefunctional limitations’’—means a levelof severity that meets or is medically orfunctionally equivalent in severity tothe severity of a listing. Thus, if we werefirst to consider whether the child’simpairment(s) is of listing-level severity,we would also be deciding whether thatimpairment(s) is disabling. In thoseinstances in which the impairment(s) isfound neither to meet nor to beequivalent in severity to any listing, webelieve it would be difficult for anadjudicator to then fairly consider theissue of medical improvement, becausethe adjudicator would already haveconcluded that the child is not disabled.Section 1614(a)(4)(B) of the Act statesthat, with some exceptions, disabilitycan be found to have ceased only ifthere is ‘‘substantial evidence whichdemonstrates that there has beenmedical improvement * * * and that[the] impairment or combination ofimpairments no longer results inmarked and severe functionallimitations.’’Thus, to ensure proper considerationof the issue of medical improvement, wehave placed that issue first in thesequence. If there has been no medicalimprovement, we will generally findthat the child is still disabled. There areexceptions to this rule, set forth in finalparagraphs (e) and (f) of this section anddiscussed below.Under our prior rules, pursuant to theMIRS provisions in the Act at that time,if there had been medical improvement,we considered whether theimprovement was related to the abilityto work (which we defined forchildhood cases as meaning the medicalimprovement resulted in an increase inability to function independently,appropriately, and effectively in an ageappropriatemanner.) However, theMIRS as revised by Public Law 104–193contains no provision for a ‘‘related tothe ability to work’’ step for childrenand, thus, limits the application of thisprovision to individuals age 18 or over.Accordingly, we have deleted that stepfrom our rules (paragraph (d) of ourprior rules).If there has been medicalimprovement, the next step under these