TN 46 (01-17)

GN 00502.055 Reevaluating a Beneficiary's Ability to Manage Benefits

A. Policy for reevaluating a beneficiary’s ability to manage benefits

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.

You must consider reviewing a beneficiary’s capability whenever there is an allegation or indication that a beneficiary’s capability has changed or when you receive a valid request for a new determination indicating that the prior capability determination may no longer apply. Consider whether such a reevaluation is necessary anytime you contact a beneficiary who has a payee. For example, an incapable beneficiary who requests direct payment may now be capable, or a capable beneficiary admitted to a mental hospital may now be incapable.

NOTE: “Consider reviewing” does not necessarily mean conducting a full capability development. It means examining the indicators in a case and deciding whether you need full development.

B. Situations in which you must consider reviewing capability

These situations include the following:

  • Continuing disability reviews (CDRs);

  • SSI redeterminations (including age 18 disability redeterminations);

  • Discovery that a beneficiary manages any other benefit(s) he or she may be receiving;

  • A beneficiary appeal to the appointment of a payee;

  • Creditable referrals or reports from third-party sources regarding beneficiary’s need for assistance in managing his or her benefits; and

  • Any other contact with the beneficiary or payee that raises a question about the beneficiary's capability.

C. Identifying beneficiaries in need of a payee

Field Offices (FOs) should establish and maintain relationships with community social service organizations to help identify beneficiaries who may need assistance in managing benefits. The Social Security Administration (SSA) does not have routine touch points (e.g. Continuing Disability Reviews) 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.

D. Procedure for direct payment to a beneficiary who has been in representative payment

Before making direct payment to a beneficiary who has been in representative payment, you must obtain evidence to make and document a new capability determination.

REMEMBER: If you decide that a previously incapable beneficiary is now capable, you may need a CDR or SSI redetermination. (If a beneficiary is using a ticket under the Ticket to Work program, do not initiate a medical CDR. See DI 55000.000)

1. Incapability

If the beneficiary has a payee because of a previous SSA determination of incapability, obtain new evidence and determine if the beneficiary is now capable before initiating direct payment (see GN 00502.020 through GN 00502.075).

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:

  • 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):

  • On the Beneficiary Details page, using the Add Report of Contact link complete the RPOC. In the “Report” section write “CAPA-CRRT PAYEE CONTACT” before adding your details (see MS INTRANETERPS 016.002).

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

    • Title 2 or Concurrent—Complete the Report of Contact (RPOC). In the “Report” section, write “CAPA-CRRT PAYEE CONTACT” before adding your details (see MS MCS 008.007).

    • Title 16—Complete the Report of Contact (DROC). In the “Report Text” section write “CAPA-CRRT PAYEE CONTACT” before adding your details (see MS MSSICS 022.010).

      NOTE: If you are unable to establish a RPOC in MCS and MSSICS, use the paper Form SSA-5002 (Report of Contact) for your documentation and scan into NDRED or eView.

      EXCEPTION: If you need to make direct payment to an incapable beneficiary 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 (see 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 his or her payee.

IMPORTANT: When you consider a reevaluation of capability and decide you do not need capability development, you must document a detailed explanation, including the date and reason of why you are not performing a capability reevaluation. For instructions on documenting your explanation follow the guidelines in GN 00502.065B for documenting a capability determination, but write “EXPLANATION-NO CAPA-REEVALUATION” before adding your details.

E. References

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GN 00502.055 - Reevaluating a Beneficiary's Ability to Manage Benefits - 01/21/2005
Batch run: 01/26/2017