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6432 Federal Register / Vol. 62, No. 28 / Tuesday, February 11, 1997 / Rules and Regulationsyour functioning and that wasprescribed by a treating source, asdefined in § 416.902. If you do not havea treating source, we will decidewhether there is treatment that ismedically necessary that could havebeen prescribed by a treating source.The treatment may include (but is notlimited to)—(i) Medical management;(ii) Psychiatric, psychological, orpsychosocial counseling;(iii) Physical therapy; and(iv) Home therapy, such asadministering oxygen or givinginjections.(2) How we will consider whethermedically necessary treatment isavailable. When we decide whethermedically necessary treatment isavailable, we will consider such thingsas (but not limited)—(i) The location of an institution orfacility or place where treatment,services, or resources could be providedto you in relationship to where youreside;(ii) The availability and cost oftransportation for you and your payee tothe place of treatment;(iii) Your general health, includingyour ability to travel for the treatment;(iv) The capacity of an institution orfacility to accept you for appropriatetreatment;(v) The cost of any necessarymedications or treatments that are notpaid for by Medicaid or another insureror source; and(vi) The availability of localcommunity resources (e.g., clinics,charitable organizations, publicassistance agencies) that would providefree treatment or funds to covertreatment.(3) When we will not require evidenceof treatment that is medically necessaryand available. We will not require yourrepresentative payee to present evidencethat you are and have been receivingtreatment if we find that thecondition(s) that was the basis forproviding you benefits is not amenableto treatment.(4) Removal of a payee who does notprovide evidence that a child is and hasbeen receiving treatment that ismedically necessary and available. Ifyour representative payee refuseswithout good cause to provide evidencethat you are and have been receivingtreatment that is medically necessaryand available, we may, if it is in yourbest interests, suspend payment ofbenefits to the representative payee, andpay benefits to another payee or to you.When we decide whether yourrepresentative payee had good cause, wewill consider factors such as theacceptable reasons for failure to followprescribed treatment in § 416.930(c) andother factors similar to those describinggood cause for missing deadlines in§ 416.1411.(5) If you do not have a representativepayee. If you do not have arepresentative payee and we make yourpayments directly to you, the provisionsof this paragraph do not apply to you.However, we may still decide that youare failing to follow prescribedtreatment under the provisions of§ 416.930, if the requirements of thatsection are met.29. Section 416.998 is revised to readas follows:§ 416.998 If you become disabled byanother impairment(s).If a new severe impairment(s) beginsin or before the month in which yourlast impairment(s) ends, we will findthat your disability is continuing. Thenew impairment(s) need not beexpected to last 12 months or to resultin death, but it must be severe enoughto keep you from doing substantialgainful activity, or severe enough so thatyou are still disabled under § 416.994,or, if you are a child, to result in markedand severe functional limitations.[FR Doc. 97–3317 Filed 2–10–97; 8:45 am]BILLING CODE 4190–29–M
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