Citations:

Sections 205(j)(4) and 1631(a)(2)(D) of the Social Security Act;

20 CFR 404.2040a; 20 CFR 416.640a

BASIC (03-05)

GN 00506.001 Fee for Service - Overview

Citations:

Sections 205(j)(4) and 1631(a)(2)(D) of the Social Security Act;

20 CFR 404.2040a; 20 CFR 416.640a

A. Introduction

Section 5105 of the Omnibus Budget Reconciliation Act of 1990 (OBRA), Pub. L. No. 101-508, included a provision permitting qualified organizations to collect a fee. This fee is deducted from the beneficiary's payment and is used for expenses (including overhead) incurred by the organization in providing services performed as the beneficiary's representative payee. This provision was effective from July 1, 1991 until July 1, 1994.

Section 201 of the Social Security Independence and Program Improvements Act of 1994 (SSIPIA), Pub. L. No. 103-296, extended the authority for qualified organizations to collect fees for representative payee services beyond July 1, 1994. It also changed the definition of “qualified organization” and increased the allowable fee amount in certain circumstances, effective December 1, 1994.

Effective September 1, 2004, section 104 of the Social Security Protection Act of 2004 (SSPA), Pub. L. No. 108-203, requires fee for service representative payees to forfeit its fees for any month during which they are found to have misused all or part of a beneficiary's benefits. In addition, effective April 1, 2005, section 102 of the SSPA requires non-governmental fee for service representative payees to be bonded and to be licensed in each state in which they serve as representative payees, provided that licensing is available in the state.

B. Policy - General

Before an organization begins collecting a fee from a beneficiary's monthly payment, SSA must authorize it.

The payee may choose to collect a lesser fee or none at all, or waive the fee for months in which the beneficiary does not have enough funds to cover living expenses. In any case, the organization will not lose its Fee for Service (FFS) status, as long as it continues to meet all the requirements listed in GN 00506.001C.

C. Policy - Qualification Requirements

To qualify as a FFS organization, the payee must be either:

  • a state or local government agency, OR

  • a community based, non-profit social service agency, that is bonded and licensed by each state in which it serves as a representative payee (if licensing is available).

Additionally the organization must also:

  • regularly provide representative payee services to at least five beneficiaries, AND

  • Demonstrate that it is not a creditor of the beneficiary.

D. Procedure

1. Role of the Servicing Field Office

The FO serving the organization's address is responsible for:

  • furnishing info to interested organizations on how to apply to collect fees for payee services;

  • assisting the organization with all steps of the FFS application process, explaining what documents are required, and explaining the FFS responsibilities and compliance procedures;

  • approving or denying requests to collect fees;

  • issuing decision notices to applicant organizations;

  • entering the Fee for Service data in the Fee For Service screen on eRPS, in accordance with MS INTRANETERPS 014.008.

  • notifying affected beneficiaries that fees may be collected and the amounts of the fees;

  • notifying organizations about which beneficiaries can be charged the DAA higher fee based on their secondary diagnosis;

  • monitoring the payee's performance and ensuring continued eligibility to collect fees (for example, 6-month site visit, annual certification, triennial site review and random reviews).

    NOTE: Your regional office may re-direct some of these work assignments to cadre teams.

2. Role of Non-Servicing Field Office, PSC, or TSC

Components not serving the organization's address are responsible for:

  • referring inquiries from interested organizations to the reviewing official in the servicing FO using current routing procedures; and

  • notifying the organi