Expedited Reinstatement of Entitlement to Disability Benefits (EXR): Notice of Proposed Rulemaking Reinstatement of Entitlement to Disability Benefits

December, 2003

Paul J. Seifert, Director of Government Affairs, Int'l. Assoc. of Psychosocial Rehab. Services (IAPSRS) and the disability community have developed comments on the draft regulations. Some of those comments are listed below. To view the proposed rules for Expedited Reinstatement of Entitlement to Disability Benefits (EXR) in its entirety, go to: http://policy.ssa.gov/erm/rules.nsf/0/f3737bf370ab27c785256dce00753455/$FILE/rin0960_af21p.htm

Expedited reinstatement to disability benefits (EXR) was envisioned as one of several "safety net" elements within TTWWIIA to afford Social Security disability beneficiaries the assurance of a smooth transition back to the benefit rolls in the event that a work attempt above substantial gainful activity (SGA) did not succeed. EXR is a distinct and separate part of P. L. 106-170, independent of other elements of the law such as Ticket to Work.  However, use of EXR by a beneficiary using a Ticket could have an adverse impact on that beneficiary's ability to return to the workforce under the Ticket to Work program. The following are some of the categories described in the comments:

Special Circumstances -- Section 404.1592e and 416.999c - These provisions set out the criteria which the Social Security Administration (SSA) will use to evaluate whether someone seeking EXR is unable to reach SGA because of his or her medical condition. If the individual’s work is done under special conditions, we may find that it does not show that the individual has the ability to do substantial gainful activity. Examples of the special conditions that may relate to an impairment include, but are not limited to, situations in which-
(1) You required and received special assistance from other employees in performing your work, and
(2) You were allowed to work irregular hours or take frequent rest periods.

Reinstatement Denial - Section 404.1592c outlines the criteria for individuals entitled to expedited reinstatement. The implication here is that individuals can use EXR only once during any period of eligibility and therefore fails to take into account the cyclical or recurrent nature of many disabilities.

Provisional benefits and overpayments - Sections 404.1592f and 416.999d clearly follow the statute in stipulating that provisional payments will not be considered overpayments unless the beneficiary knew or should have known he or she did not meet the requirements for reinstatement. There are some concerns about SSA’s timeliness in making reinstatement determinations within the six month time frame. If a local disability determination service (DDS) is unable to make an EXR determination within six months, either that decision should be made by the federal DDS or SSA should ask Congress to change the law to permit provisional payments until a determination is made.

SSA should provide some means for a beneficiary using EXR to obtain a new Ticket or, at a minimum, ensure that the consequences of using EXR on future use of the Ticket program are fully explained to beneficiaries when they first seek reentry to the rolls.