TN 13 (03-19)

GN 00506.420 Fee-for-Service Certification Process

A. Background on Fee-for-Service Payees

The servicing field office (FO) authorizes qualified representative payee organizations to collect a fee from a beneficiary's monthly payments. Community-based, nonprofit payee organizations must meet specific requirements in order to be authorized to collect a fee, and must continue to satisfy those requirements to remain eligible to collect a fee. SSA will verify that organizational payees continue to meet the requirements as part of our monitoring program.

B. Policy for certifying Fee-for-Service Payees

The servicing FO is responsible for annually certifying the continuing eligibility of each Fee-for-Service (FFS) payee. Generally, the Regional Offices (RO) will create a list of organizations to be certified and forward that list to the Area Director Offices (ADO) and/or the servicing field offices.

C. Procedure for certifying Fee-for-Service Payees

1. What to verify?

To certify a FFS payee, technicians must verify the FFS payee organization:

  • Continues to provide payee services to 5 or more people (see GN 00506.100B.3.a);

  • Business office has not closed or relocated (see GN 00506.100B.2.a);

  • Continues to meet all the FFS community-based criteria (see GN 00506.100B.2.a);

  • Continues to be bonded and licensed (provided that licensing is available in the State) (see GN 00506.100B.2.c); and

  • Provides any independent audit that has been performed since the previous certification.

2. How to verify continued eligibility

The FO verifies continued eligibility to collect a fee for payee services in two ways:

a. Triennial Review

Protection and Advocacy agencies (P&A) conduct all representative payee reviews on behalf of SSA, per GN 00605.635B. The Representative Payee Monitoring Tool (RPMT) automatically lists when a FFS payee is due for its 3-year review.

The P&A gathers information from FFS payees regarding certification, per the operational P&A business process document (BPD). The P&A BPD is located in RPMT for reference. Based on the information provided to SSA by the P&A’s, the FO must determine whether the organization can continue to collect a fee, per GN 00605.677B.8.

b. Annual Certification

For the remaining payees not selected for a review during the current year, the FO will query eRPS to verify that they actively serve as payee for at least five beneficiaries, and then contact the payee by mail or telephone requesting copies of the current bonding, licensing agreement and audit forms. If the contact is by phone, document the file using the Fee-for-Service Information screen in eRPS (see MS 07414.008).

If you learn during the annual certification that the payee’s physical business office has relocated or closed, verify whether the payee still meets the community-based requirement (see GN 00506.100B.2.a).

File a copy of all of the certification documentation in the paper FO precedent file.

NOTE: Request a copy of the entire bond/insurance contract, if it is not already in the precedent file. If a copy of the contract is already in the precedent file, a declaration page is sufficient. Be certain to verify that bond/insurance coverage includes all of the officers and/or owners and employees. Contact the licensing board or bonding agent if necessary to resolve discrepancies or concerns.

3. Documenting the FFS certification in eRPS

On the FFS screen in eRPS, enter any updated information, the date of last certification, and the diary date for next certification.

4. Examples of documenting the FFS certification in eRPS

a. Example 1

A site review was conducted on 03/15/18. The payee serves 124 beneficiaries and is bonded for $250,000 through 01/15/19 with Aetna Insurance. Enter 03/18 as date of last site visit and date of last certification. Enter 01/19 as date for the next certification and 03/21 as the diary date for next site visit. Complete all other applicable items on the Fee-for-Service Information screen in eRPS (see MS 07414.008).

b. Example 2

A payee had continued certification verified on 02/12/18. The payee serves 16 beneficiaries, and the FO received a copy of the operating license from the State of Hawaii, which expires on 06/01/21. Enter 02/18 as date of last certification and 02/19 as date of next certification.

5. Notice requesting information for the annual certification

Use the notice provided in NL 00703.946.

The notice can be reproduced locally or incorporate it into the Document Processing System (DPS).

When the annual certification is complete, submit copies of the below documents to the regional representative payee coordinator and make sure that copies are in the FO precedent file:

  • site review forms (if a triennial review was completed this year),

  • bond/insurance contract,

  • license, provided that licensing is available in the state, and

  • eRPS Fee-for-Service Information screens

D. References

  • GN 00506.001C. Fee for Services-Qualification Requirements

  • GN 00506.110B.5. Reviewing Evidence in a Fee for Services Request

  • GN 00506.170B. Establishing Information on Fees for Service Organizations and the Beneficiaries They Serve

To Link to this section - Use this URL:
GN 00506.420 - Fee-for-Service Certification Process - 04/15/2016
Batch run: 03/22/2019