GN 00506.400 Change in Status of an Authorized Organization
Authorized organizations are instructed to notify SSA of any change, which may affect the qualifying factors. (For example, loss of bonding, license revoked, less than five beneficiaries being served, etc.)
SSA will reexamine an organization's status if information is received which indicates that their qualifications may have changed.
We must assume, absent evidence to the contrary, that an authorized organization's qualified status is continuing between annual licensing recertifications unless information is received indicating an organization may no longer meet all the qualification factors.
If, upon reexamination, it is determined that an organization no longer meets all the qualifying factors in GN 00506.100, revoke its authorization beginning with the first day of the month after the month in which the decision is made. The revocation decision is not an initial determination, which has appeal rights. However, the organization is offered the opportunity to request an informal review of the decision.
EXCEPTION: A previously authorized organization temporarily serving less than five beneficiaries, may continue to collect a fee with the approval of the FO (See GN 00506.400B.5.)
A payee may request in writing that it no longer wants to be a FFS organization for whatever reason.
1. Re-examining Qualification Requirements
When information is received indicating an organization may no longer meet all qualification factors:
2. Organization Remains Qualified
Document the eRPS Fee For Service screens (MS INTRANTERPS 014.008 and 015.004) with the information obtained. No further action is necessary.
3. Organization No Longer Qualified
If an organization is no longer qualified:
Send a copy of the eRPS Fee For Service screen, the revocation notices, and any related information to the address listed in GN00506.170 and to the Programs Section of your RO, and keep copies in the paper precedent file in the FO.
4. Revocation Decision
a. Notice to Organization
Use the notice in NL 00703.949 to inform the organization of the revocation decision.
Release the notice to the organization immediately after preparation. Express mail the notice if prepared in the last 10 days of the month.
NOTE: A revocation may seriously affect the financial status of an organization. Although financial status is not considered in our determination, it is an issue that may prompt the organization to involve third parties (media, congressional staff, etc.). Be alert to this possibility. If needed, contact the Regional Public Affairs Office for guidance.
Revocation notices offer an organization the opportunity to request a review of the decision. Process review requests following guidelines in GN 00506.150.
b. Notices to Beneficiaries
Send a notice to all individuals listed on the eRPS currently receiving benefits through the organization. Inform them that the agency can no longer collect fees for services. Use the language in NL 00703.771 for this purpose.
If possible, time the release of the beneficiary notices to coincide with the date the notice is released to the organization.
5. No Longer Payee for Five Beneficiaries
If the organization is no longer payee for five beneficiaries, you must decide whether this situation is temporary or whether the organization's authorization should be revoked.
a. Six months or more, serving less that five beneficiaries
Revoke the authorization immediately if six or more months have elapsed since the organization dropped below the “five or more beneficiaries” limit.
b. Less than six months have elapsed
If less than six months have elapsed, the SSA reviewing official will use the following information to evaluate the organization's commitment to serve as payee for at least five beneficiaries. Consider the following:
The willingness of the organization to serve five or more beneficiaries.
Determine if the organization is willing to continue to be payee for at least five beneficiaries. Consider the organization for referral as payee for additional beneficiaries as needed.
The length of time the organization has served less than five individuals. Determine the last month in which the organization was payee for five beneficiaries.
It is the FO’s option to contact past or present beneficiaries and obtain their feedback as to the performance of the payee. One of the reasons that the payee is serving a lesser number of beneficiaries may be poor payee performance, and a rapid decrease in the number of beneficiaries served can also be viewed as a “triggering a review” event.
6. Authorization Determination
When the reviewing official is reasonably certain that the organization will resume serving as payee for at least five beneficiaries, authorization may temporarily continue up to six months from the last month it was payee for 5+ beneficiaries.
Control the case to re-contact the organization six months from the last month it was payee for five beneficiaries. If it has not acquired the additional beneficiaries needed, revoke its authorization, as above. If the organization alleges serving at least five beneficiaries, query the eRPS and MBR /SSR, as necessary, to verify its allegation and update the FO precedent file accordingly.
7. Request for Cancellation of Authority
Before processing an organization's request for cancellation, ensure that the organization understands that the FFS authorization does not compel them to collect a fee; it gives them the option to collect a fee.
a. FO Receives Notice
Review the request and the date the organization stopped, or will stop, collecting fees. Contact the person who signed the request to determine the effective date if it is unclear from the notice.
Enter the stop date to the eRPS Fee For Service screen and select the reason for cancellation. Remember that the RFEE is a restricted screen and only management personnel (OS, MSS or above) have access to it. Document the Fee for Servie screen (MS INTRANTERPS 015.004) as well.
Send revocation notices to the affected beneficiaries.
Send a copy of the cancellation notice, and any related information, to the Programs Section of your RO. Keep copies in the paper precedent file.
b. FO Receives Inquiry
Inform the organization that a written cancellation request to the servicing FO is needed. Explain that the FO will issue notices to the affected beneficiaries after it receives the cancellation request.
NL 00703.948B. Review Decision Notice to Organization
NL 00703.949B. Revocation Notice to Organization