Effective Dates: 05/10/2023 - Present Previous | Next

TN 82 (05-23)

GN 00502.055 Reevaluating a Beneficiary's Capability

A. When you can reevaluate a beneficiary’s capability

It is important to remember that you can reevaluate capability regardless of past determinations. Therefore, you must always be alert to changes in circumstances that might indicate the need for a new capability determination. If you become aware of indicators or evidence that there is a change in a beneficiary's capability or when you receive a request for a new determination indicating that the prior capability determination may no longer apply, you must develop capability and make a capability determination. For information on developing capability, see GN 00502.001 through GN 00502.075.

If you become aware of potential changes in capability during contact with the beneficiary, representative payee (payee), or third party or during your normal course of business, see GN 00502.055B. When a subsequent payee application is filed and you become aware that a prior capability determination was inadequately developed or documented, conduct a new capability determination.

B. Situations where you may become aware of indicators or evidence that there is a change in a beneficiary's capability

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    Continuing disability reviews (CDRs), see DI 28001.015.

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    Supplemental Security Income (SSI) redeterminations (including age 18 disability redeterminations), see SI 02305.123.

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    A beneficiary’s receipt of a new benefit type, such as student benefit.

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    An applicant completes a payee application for a beneficiary who does not have a payee.

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    Discovery that a beneficiary manages any other benefit(s) or income they may be receiving.

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    A beneficiary appeal to the appointment of a payee.

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    Credible referrals or reports from third-party sources regarding beneficiary’s need for assistance in managing their benefits.

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    An incapable beneficiary who requests direct payment may now be capable.

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    A capable beneficiary admitted to a mental hospital may now be incapable.

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    Notification that a new court order is in effect noting, e.g., the beneficiary is legally incompetent, a legal guardian appointment occurred, or the inability of the beneficiary to manage their financial affairs, see GN 00502.023.

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    Notification that a prior court order that noted the beneficiary was legally incompetent is no longer in effect, for example, a legally beneficiary requests direct payment as described in GN 00502.023C.

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    Any other information you become aware of that raises a question about the beneficiary's capability.

If you become aware of indicators or evidence that the beneficiary’s capability has changed, you must develop capability and make a new capability determination (see GN 00502.001 through GN 00502.075), and document your determination per GN 00502.065.

C. Direct payment to a beneficiary who currently has a payee

Before making direct payment to a beneficiary who currently has a payee, you must obtain evidence to develop for, determine, and document a new capability determination indicating the beneficiary is now capable.

1. Incapability

If the beneficiary has a payee because of a previous Social Security Administration (SSA) determination of incapability, obtain new evidence and determine if the beneficiary is now capable before initiating direct payment, see GN 00502.000.

Contact the current payee, per GN 00504.100B.1. You must document your discussion with the current payee on the proposed change of payee as follows:

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    Cases established in the electronic Representative Payee System (eRPS) (a payee application is taken or will be taken, whether the application is denied or approved):

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    On the Beneficiary Details page, using the Add Report of Contact link complete the RPOC. In the “Report” section write “CAPA-CURRENT PAYEE CONTACT” before adding your details (see MS 07416.002).

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    Cases not established in eRPS (e.g., the payee does not have an SSN):

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      Title II or Concurrent—Complete the Report of Contact (RPOC). In the “Report” section, write “CAPA-CURRENT PAYEE CONTACT” before adding your details (see MS 03508.007).

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      Title XVI—Complete the Report of Contact page in the Consolidated Claims Experience (CCE). In the “Report ” section, write “CAPA-CURRENT PAYEE CONTACT” before adding your details (see MS 07416.002).

      NOTE: If you are unable to establish a Report of Contact in the system, use the paper SSA-5002 Report of Contact for your documentation and scan into NDRed using the Evidence Portal or scan into eView.

    IMPORTANT: If you determine that a previously incapable beneficiary is now capable, you may need a CDR or SSI redetermination (see DI 13001.005 and SI 02305.022). If a beneficiary is using a ticket under the Ticket to Work program, do not initiate a medical CDR (see DI 55000.000).

    EXCEPTION: If you need to make direct payment to an incapable beneficiary (i.e. who currently has a payee) because payee development is pending (see GN 00504.105), you do not need to make a new capability determination unless you believe the beneficiary is now capable. In this instance, have the beneficiary complete an SSA-11.

2. Voluntary conservator

If a voluntary conservator was appointed payee, a capability determination may not have been made before appointing the conservator as payee, per GN 00502.139B.4. Develop capability fully before deciding if direct payment is appropriate, unless the beneficiary insists on having the voluntary conservator appointed as their payee.

D. Identifying beneficiaries in need of a payee

Field Offices should establish and maintain relationships with community social service organizations to help identify beneficiaries who may need assistance in managing benefits. SSA does not have routine touch points (e.g., CDRs) with beneficiaries who receive retirement and survivors benefits. Therefore, we may not receive information through our normal business processes about beneficiaries in this population who undergo changes in their ability to manage benefits over time. FO technicians should be vigilant and proactively address capability issues in all of our beneficiary programs; this helps prevent instances of misuse and fraud. For information on SSA’s referrals to other agencies, see Types of Referral Services SSA Provides in GN 00903.100. Referrals specific to the elderly population may include Area Agencies on Aging or Long Term Care Ombudsmen.

 

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0200502055
GN 00502.055 - Reevaluating a Beneficiary's Capability - 05/10/2023
Batch run: 05/10/2023
Rev:05/10/2023