In the case of any individual, the determination of whether or not he is under a disability (as defined in section 416(i) or 423(d) of this title) and of the day such disability began, and the determination of the day on which such disability ceases, shall be made by a State agency, notwithstanding any other provision of law, in any State that notifies the Commissioner of Social Security in writing that it wishes to make such disability determinations commencing with such month as the Commissioner of Social Security and the State agree upon, but only if (A) the Commissioner of Social Security has not found, under subsection (b)(1), that the State agency has substantially failed to make disability determinations in accordance with the applicable provisions of this section or rules issued thereunder, and (B) the State has not notified the Commissioner of Social Security, under subsection (b)(2), that it does not wish to make such determinations. If the Commissioner of Social Security once makes the finding described in clause (A) of the preceding sentence, or the State gives the notice referred to in clause (B) of such sentence, the Commissioner of Social Security may thereafter determine whether (and, if so, beginning with which month and under what conditions) the State may again make disability determinations under this paragraph.
The disability determinations described in paragraph (1) made by a State agency shall be made in accordance with the pertinent provisions of this subchapter and the standards and criteria contained in regulations or other written guidelines of the Commissioner of Social Security pertaining to matters such as disability determinations, the class or classes of individuals with respect to which a State may make disability determinations (if it does not wish to do so with respect to all individuals in the State), and the conditions under which it may choose not to make all such determinations. In addition, the Commissioner of Social Security shall promulgate regulations specifying, in such detail as the Commissioner deems appropriate, performance standards and administrative requirements and procedures to be followed in performing the disability determination function in order to assure effective and uniform administration of the disability insurance program throughout the United States. The regulations may, for example, specify matters such as—
the administrative structure and the relationship between various units of the State agency responsible for disability determinations,
the physical location of and relationship among agency staff units, and other individuals or organizations performing tasks for the State agency, and standards for the availability to applicants and beneficiaries of facilities for making disability determinations,
State agency performance criteria, including the rate of accuracy of decisions, the time periods within which determinations must be made, the procedures for and the scope of review by the Commissioner of Social Security, and, as the Commissioner finds appropriate, by the State, of its performance in individual cases and in classes of cases, and rules governing access of appropriate Federal officials to State offices and to State records relating to its administration of the disability determination function,
fiscal control procedures that the State agency may be required to adopt, and
the submission of reports and other data, in such form and at such time as the Commissioner of Social Security may require, concerning the State agency’s activities relating to the disability determination.
Nothing in this section shall be construed to authorize the Commissioner of Social Security to take any action except pursuant to law or to regulations promulgated pursuant to law.
Review of disability cases to determine continuing eligibility; permanent disability cases; appropriate number of cases reviewed; reporting requirements
In any case where an individual is or has been determined to be under a disability, the case shall be reviewed by the applicable State agency or the Commissioner of Social Security (as may be appropriate), for purposes of continuing eligibility, at least once every 3 years, subject to paragraph (2); except that where a finding has been made that such disability is permanent, such reviews shall be made at such times as the Commissioner of Social Security determines to be appropriate. Reviews of cases under the preceding sentence shall be in addition to, and shall not be considered as a substitute for, any other reviews which are required or provided for under or in the administration of this subchapter.
The requirement of paragraph (1) that cases be reviewed at least every 3 years shall not apply to the extent that the Commissioner of Social Security determines, on a State-by-State basis, that such requirement should be waived to insure that only the appropriate number of such cases are reviewed. The Commissioner of Social Security shall determine the appropriate number of cases to be reviewed in each State after consultation with the State agency performing such reviews, based upon the backlog of pending reviews, the projected number of new applications for disability insurance benefits, and the current and projected staffing levels of the State agency, but the Commissioner of Social Security shall provide for a waiver of such requirement only in the case of a State which makes a good faith effort to meet proper staffing requirements for the State agency and to process case reviews in a timely fashion. The Commissioner of Social Security shall report annually to the Committee on Finance of the Senate and the Committee on Ways and Means of the House of Representatives with respect to the determinations made by the Commissioner of Social Security under the preceding sentence.
The Commissioner of Social Security shall report annually to the Committee on Finance of the Senate and the Committee on Ways and Means of the House of Representatives with respect to the number of reviews of continuing disability carried out under paragraph (1), the number of such reviews which result in an initial termination of benefits, the number of requests for reconsideration of such initial termination or for a hearing with respect to such termination under subsection (d), or both, and the number of such initial terminations which are overturned as the result of a reconsideration or hearing.
In any case in which the Commissioner of Social Security initiates a review under this subsection of the case of an individual who has been determined to be under a disability, the Commissioner of Social Security shall notify such individual of the nature of the review to be carried out, the possibility that such review could result in the termination of benefits, and the right of the individual to provide medical evidence with respect to such review.
[Aug. 14, 1935, ch. 531], title II, § 221, as added [Sept. 1, 1954, ch. 1206], title I, § 106(g), [68 Stat. 1081]; amended [Aug. 1, 1956, ch. 836], title I, § 103(c)(7), (8), (h), [70 Stat. 818], 823; [Pub. L. 90–248, title I, § 158(c)(3)], (4), Jan. 2, 1968, [81 Stat. 869]; [Pub. L. 96–265, title III], §§ 304(a)–(f), 311(a), June 9, 1980, [94 Stat. 453–456], 460; [Pub. L. 97–455], §§ 3(a), 6, Jan. 12, 1983, [96 Stat. 2499], 2500; [Pub. L. 98–369, div. B, title VI, § 2663(a)(14)], July 18, 1984, [98 Stat. 1164]; [Pub. L. 98–460], §§ 6(a), 8(a), 9(a)(1), 10(a), 17(a), Oct. 9, 1984, [98 Stat. 1802], 1804, 1805, 1811; [Pub. L. 99–514, title XVIII, § 1883(a)(9)], Oct. 22, 1986, [100 Stat. 2916]; [Pub. L. 100–647, title VIII, § 8012(a)], Nov. 10, 1988, [102 Stat. 3789]; [Pub. L. 101–239, title X, § 10306(a)(1)], Dec. 19, 1989, [103 Stat. 2484]; [Pub. L. 101–508, title V, § 5128(a)], Nov. 5, 1990, [104 Stat. 1388–286]; [Pub. L. 103–296, title I, § 107(a)(4)], Aug. 15, 1994, [108 Stat. 1478]; [Pub. L. 106–170, title I], §§ 101(b)(1)(A), 111(a), Dec. 17, 1999, [113 Stat. 1873], 1881; [Pub. L. 108–271, § 8(b)], July 7, 2004, [118 Stat. 814]; [Pub. L. 114–74, title VIII, § 832(a)], Nov. 2, 2015, [129 Stat. 613].)