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(iv)(I) Except as provided in subclause (VI), not 72 later than 12 months after the birth of an individual, the Commissioner shall review in accordance with paragraph (4) the continuing eligibility for benefits under this title by reason of disability of such individual whose low birth weight is a contributing factor material to the Commissioner's determination that the individual is disabled.

(II) A review under subclause (I) shall be considered a substitute for a review otherwise required under any other provision of the subparagraph during that 12month period.

(III) A representative payee of a recipient whose case is reviewed under this clause shall present, at the time of review, evidence demonstrating that the recipient is, and has been, receiving treatment, to the extent considered medically necessary and available, of the condition which was the basis for providing benefits under this title.

(IV) If the representative payee refuses to comply without good cause with the requirements of subclause (III), the Commissioner of Social Security shall, if the Commissioner determines it is in the best interest of the individual, promptly suspend payment of benefits to the representative payee, and provide for payment of benefits to an alternative representative payee of the individual or, if the interest of the individual under this title would be served thereby, to the individual.

(V) Subclause (III) shall not apply to the representative payee of any individual with respect to whom the Commissioner determines such application would be inappropriate or unnecessary. In making such determination, the Commissioner shall take into consideration the nature of the individual's impairment (or combination of impairments). Section 1631(c) shall not apply to a finding by the Commissioner that the requirements of subclause (III) should not apply to an individual's representative payee. 73

(VI) Subclause (I) shall not apply in the case of an individual described in that subclause who, at the time of the individual's initial disability determination, the Commissioner determines has an impairment that is not expected to improve within 12 months after the birth of that individual, and who the Commissioner schedules for a continuing disability review at a date that is after the individual attains 1 year of age.

74

(I)75 In making any determination under this title with respect to the disability of an individual who has not at

72 P.L. 105-33, §5522(a)(2)(A), struck out "Not" and substituted "Except as provided in subclause (VI), not", effective as if included in the enactment of title II of P.L. 104-193, August 22, 1996.

73 P.L. 104-193, §212(c), added clause (iv), applicable with respect to benefits for months beginning on or after August 22, 1996, without regard to whether regulations have been issued to implement this amendment.

74 P.L. 105-33 §5522(a)(2)(B), added subclause (VI), effective as if included in the enactment of title II of P.L. 104-193, August 22, 1996.

75 P.L. 104-193, §211(a)(3), redesignated the former subparagraph (H) as subparagraph (I).

tained the age of 18 years and to whom section 221(h) does not apply, the Commissioner of Social Security shall make reasonable efforts to ensure that a qualified pediatrician or other individual who specializes in a field of medicine appropriate to the disability of the individual (as determined by the Commissioner of Social Security) evaluates the case of such individual.

(J) 76 Notwithstanding subparagraph (A), an individual shall not be considered to be disabled for purposes of this title if alcoholism or drug addiction would (but for this subparagraph) be a contributing factor material to the Commissioner's determination that the individual is disabled. 77

(4) A recipient of benefits based on disability under this title may be determined not to be entitled to such benefits on the basis of a finding that the physical or mental impairment on the basis of which such benefits are provided has ceased, does not exist, or is not disabling only if such finding is supported by

(A) in the case of an individual who is age 18 or older 78____

(i) 79 substantial evidence which demonstrates that—
(I) 80 there has been any medical improvement
in the individual's impairment or combination of
impairments (other than medical improvement
which is not related to the individual's ability to
work), and

(II) 81 the individual is now able to engage in substantial gainful activity; or

(ii) 82 substantial evidence (except in the case of an individual eligible to receive benefits under section 1619) which

(I) 83 consists of new medical evidence and a new assessment of the individual's residual functional capacity, and demonstrates that

(aa) 84 although the individual has not improved medically, he or she is nonetheless a beneficiary of advances in medical or vocational therapy or technology (related to the individual's ability to work), and

(bb) 85 the individual is now able to engage in substantial gainful activity, or (II) 86 demonstrates that

76 P.L. 104-121, §105(b)(1), added subparagraph (I). For the effective date, see Vol. II, P.L. 104-121, §105(b)(5)(A).

77P.L. 104-193, §211(a)(3), redesignated this subparagraph (I) as subparagraph (J).

78 P.L. 104-293, §211(c)(4), added this new subparagraph (A), applicable with respect to benefits for months beginning on or after August 22, 1996, without regard to whether regulations have been issued to implement this amendment.

79 P.L. 104-293, §211(c)(3), redesignated the former subparagraph (A) as clause (i).

80 P.L. 104-293, §211(c)(2), redesignated the former clause (i) as subclause (I).

81 P.L. 104-293, §211(c)(2), redesignated the former clause (ii) as subclause (II).
82 P.L. 104-293, §211(c)(3), redesignated the former subparagraph (B) as clause (ii).
83 P.L. 104-293, §211(c)(2), redesignated the former clause (i) as subclause (I).
84 P.L. 104-293, §211(c)(1), redesignated the former subclause (I) as item (aa).
85 P.L. 104-293, §211(c)(1), redesignated the former subclause (II) as item (bb).
86 P.L. 104-293, §211(c)(2), redesignated the former clause (ii) as subclause (II).

(aa) 87 although the individual has not improved medically, he or she has undergone vocational therapy (related to the individual's ability to work), and

(bb) 88 the individual is now able to engage in substantial gainful activity; or

(iii) 89 substantial evidence which demonstrates that, as determined on the basis of new or improved diagnostic techniques or evaluations, the individual's impairment or combination of impairments is not as disabling as it was considered to be at the time of the most recent prior decision that he or she was under a disability or continued to be under a disability, and that therefore the individual is able to engage in substantial gainful activity; or

(B) In the case of an individual who is under the age of 18

(i) substantial evidence which demonstrates that there has been medical improvement in the individual's impairment or combination of impairments, and that such impairment or combination of impairments no longer results in marked and severe functional limitations; or

(ii) substantial evidence which demonstrates that, as determined on the basis of new or improved diagnostic techniques or evaluations, the individual's impairment or combination of impairments, is not as disabling as it was considered to be at the time of the most recent prior decision that the individual was under a disability or continued to be under a disability, and such impairment or combination of impairments does not result in marked and severe functional limitations; or 90 (C) in the case of any individual, 92 substantial evidence (which may be evidence on the record at the time any prior determination of the entitlement to benefits based on disability was made, or newly obtained evidence which relates to that determination) which demonstrates that a prior determination was in error.

Nothing in this paragraph shall be construed to require a determination that an individual receiving benefits based on disability under this title is entitled to such benefits if the prior determination was fraudulently obtained or if the individual is engaged in substantial gainful activity, cannot be located, or fails, without good cause, to cooperate in a review of his or her entitlement or to follow prescribed treatment which would be expected (i) 93 to restore his or her ability to engage in substantial gainful activity, or (ii) in the case of an individual under

87 P.L. 104-293, §211(c)(1), redesignated the former subclause (I) as item (aa).

88 P.L. 104-293, §211(c)(1), redesignated the former subclause (II) as item (bb).

89 P.L. 104-293, §211(c)(3), redesignated the former subparagraph (C) as clause (iii).

90 P.L. 104-293, §211(c)(5), added this new subparagraph (B), applicable with respect to benefits for months beginning on or after August 22, 1996, without regard to whether regulations have been issued to implement this amendment.

91 P.L. 104-293, $211(c)(6), redesignated subparagraph (D) as subparagraph (C).

92 P.L. 104-293, $211(c)(6), inserted "in the case of any individual,", applicable with respect to benefits for months beginning on or after August 22, 1996, without regard to whether regulations have been issued to implement this amendment.

93 P.L. 104-293, §211(c)(7)A), inserted “(i)”.

the age of 18, to eliminate or improve the individal's impairment or combination of impairments so that it no longer results in marked and severe functional limitations 94. Any determination under this paragraph shall be made on the basis of all the evidence available in the individual's case file, including new evidence concerning the individual's prior or current condition which is presented by the individual or secured by the Commissioner of Social Security. Any determination made under this paragraph shall be made on the basis of the weight of the evidence and on a neutral basis with regard to the individual's condition, without any initial inference as to the presence or absence of disability being drawn from the fact that the individual has previously been determined to be disabled.

Eligible Spouse

(b) For purposes of this title, the term "eligible spouse" means an aged, blind, or disabled individual who is the husband or wife of another aged, blind, or disabled individual, and who, in a month, is living with such aged, blind, or disabled individual on the first day of the month or, in any case in which either spouse files an application for benefits, on the first day of the month following the date the application is filed, or, in any case in which either spouse requests 95 restoration of eligibility under this title during the month, at the time the 96 request is filed. If two aged, blind, or disabled individuals are husband and wife as described in the preceding sentence, only one of them may be an "eligible individual" within the meaning of section 1611(a).

Definition of Child

(c) For purposes of this title, the term "child" means an individual who is neither married nor (as determined by the Commissioner of Social Security) the head of a household, and who is (1) under the age of eighteen, or (2) under the age of twenty-two and (as determined by the Commissioner of Social Security) a student regularly attending a school, college, or university, or a course of vocational or technical training designed to prepare him for gainful employment.

Determination of Marital Relationships

(d) In determining whether two individuals are husband and wife for purposes of this title, appropriate State law shall be applied; except that

(1) if a man and woman have been determined to be husband and wife under section 216(h)(1) for purposes of title II they shall be considered (from and after the date of such determina

P.L. 104-293, §211(c)(7)(B), inserted ", or" and added clause (ii), applicable with respect to benefits for months beginning on or after August 22, 1996, without regard to whether regulations have been issued to implement this amendment.

95 P.L. 104-193, §204(c)(1)(A), struck out "or requests" and substituted “, on the first day of the month following the date the application is filed, or, in any case in which either spouse request", applicable with respect to applications for benefits under title XVI filed on or after August 22, 1996, without regard to whether regulations have been issued to implement this amendment.

P.L. 104-193, §204(c)(1)(B), struck out "application or", applicable with respect to applications for benefits under title XVI filed on or after August 22, 1996, without regard to whether regulations have been issued to implement this amendment.

tion or the date of their application for benefits under this title, whichever is later) to be husband and wife for purposes of this title, or

(2) if a man and woman are found to be holding themselves out to the community in which they reside as husband and wife, they shall be so considered for purposes of this title notwithstanding any other provision of this section.

United States

(e) For purposes of this title, the term "United States", when used in a geographical sense, means the 50 States and the District of Columbia.

Income and Resources of Individuals Other Than Eligible
Individuals and Eligible Spouses

(f)(1) For purposes of determining eligibility for and the amount of benefits for any individual who is married and whose spouse is living with him in the same household but is not an eligible spouse, such individual's income and resources shall be deemed to include any income and resources of such spouse, whether or not available to such individual, except to the extent determined by the Commissioner of Social Security to be inequitable under the circumstances.

(2)(A) For purposes of determining eligibility for and the amount of benefits for any individual who is a child under age 18, such individual's income and resources shall be deemed to include any income and resources of a parent of such individual (or the spouse of such a parent) who is living in the same household as such individual, whether or not available to such individual, except to the extent determined by the Commissioner of Social Security to be inequitable under the circumstances.

(B) Subparagraph (A) shall not apply in the case of any child who has not attained the age of 18 years who

(i) is disabled;

(ii) received benefits under this title, pursuant to section 1611(e)(1)(B), while in an institution described in section 1611(e)(1)(B);

(iii) is eligible for medical assistance under a State home care plan approved by the Secretary under the provisions of section 1915(c) relating to waivers, or authorized under section 1902(e)(3); and

(iv) but for this subparagraph, would not be eligible for benefits under this title.

(3) For purposes of determining eligibility for and the amount of benefits for any individual who is an alien, such individual's income and resources shall be deemed to include the income and resources of his sponsor and such sponsor's spouse (if such alien has a sponsor) as provided in section 1621. Any such income deemed to be income of such individual shall be treated as unearned income of such individual.

(4) For purposes of paragraphs (1) and (2), a spouse or parent (or spouse of such a parent) who is absent from the household in which the individual lives due solely to a duty assignment as a member of the Armed Forces on active duty shall, in the absence of evidence to the contrary, be deemed to be living in the same household as the individual.

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