TN 5 (03-03)

GN 00506.150 Requests for Review of Fee for Service Decisions

A. Policy

1. Beneficiary Requests Review

The decision by the organization to collect a fee from the beneficiary is not an SSA initial determination that carries formal appeal rights. If a beneficiary requests a review of this decision, the request must be submitted in writing. A form SSA-795 (Statement of Claimant or Other Person) can be used for this purpose.

2. Organization Requests Review

The decisions contained in the authorization and denial notices (the approval, the date an organization can begin to collect fees or the disapproval) are not initial determinations, which carry formal appeal rights. However, the organization has an opportunity to request a one-time review of the decisions involved. The review has to be requested in writing on the payee’s letterhead and signed and dated by the designated official of the organization. A form SSA-795 can also be used for this purpose. No further reviews are granted. A member of management (other than the person who made the original decision) should make the review determination.

B. Procedure

1. Beneficiary Requests Review

There will be instances where a beneficiary, or interested third party, objects to paying fees to the representative payee. Be sensitive to the fact that the beneficiary will have less available income when fees are collected. Explain the Fee for Service policy (GN 00506.150A) to the beneficiary. (This explanation can be given by mail, by phone, or face-to-face). Inform the individual that as long as the authorized organization follows legal and SSA guidelines, the organization alone determines from which beneficiaries to collect a fee, when, and the amount (su to permitted limits). Also inform the individual of the possibility of locating a new payee or requesting a new capability determination to see if direct payment can be instituted. Explore these possibilities with the individual and take appropriate action.

NOTE: If the reason the beneficiary objects to the fees is that his/her SSA payment is low, you may want to suggest that the beneficiary get in touch with the payee; the payee may be willing to partially or totally waive the fee on any given month, when funds are low or exhausted.

Many payees are sensitive to their clients’ financial situation and needs and oftentimes will not charge a fee if it significantly reduces the amount available for current needs.

2. Organization Requests Review

Review the determination in the FFS paper precedent file and in eRPS. Consult with the individual who made the original determination or the regional office for guidance if necessary. Consider any additional information presented.

3. Decisions – Notices

Document your decision on the eRPS Fee For Service screen.

  • If the organization is approved to collect a fee, follow the procedures in GN 00506.130 and GN 00506.140 for preparation and release of the notices to the organization and to the beneficiary.

  • If the organization’s request to collect a fee is disapproved, use the language in NL 00703.948 for notification. Address the notice to the person who requested a review of the original decision. Include the title of the individual and the name of the organization in the address block.

  • Document your decision on the eRPS Make Note Screen.

C. References

NL 00703.948 Review Decision Notice to Organization

GN 00506.140A Fee for Service Notification - Beneficiaries

GN 00506.300B.1 Processing Payee Applications from Organizations Approved To Collect A Fee for Payee Services

GN 00506.400B.2 Change in Status of an Authorized Organization


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0200506150