TN 6 (09-02)
GN 00603.090 Large Amount Due Beneficiary Receiving Direct Payment of Benefits While Residing in a Proprietary Nursing Home
A beneficiary receiving direct payment of benefits who resides in a proprietary (i.e., privately owned) nursing home may not currently be in a position to effectively protect his/her own interests; therefore, caution is necessary before issuing a large accrual of benefits. If it appears that the beneficiary may no longer be capable of managing or directing the management of his or her benefits, or may have difficulty handling this large payment of benefits, develop for beneficiary capability. See GN 00502.020 -- Developing Capability - Adult Beneficiaries.
In any situation where an accumulation of 3 months' benefits or more is payable directly to a beneficiary in a proprietary nursing home, development is required prior to release of the accrual. This is necessary to ensure that facilities available to the beneficiary for cashing his/her check and safeguarding the proceeds are adequate to protect his/her interests.
In a personal interview (face-to-face, if possible), advise the beneficiary of the amount of accrued benefits and ascertain whether he/she prefers to receive the accrual in a lump sum or in installments. Ascertain whether the beneficiary will need help in getting the check cashed. If the beneficiary states that the nursing home will provide any necessary assistance, obtain information from the proprietor of the home about the procedures which will be followed for endorsement by the beneficiary and deposit of the check. If the proceeds of the check are to be kept at the nursing home, ascertain from the proprietor whether arrangements for safekeeping of the money for the beneficiary are adequate and that the beneficiary will have control over the use of the funds.
Except as noted below, make a finding on a SSA-553 (Special Determination) as to whether the amount of accrued benefits may be paid to the beneficiary in a single payment without detriment to his/her interests.
A special determination is not required if the beneficiary has direct deposit. However, development to determine whether installment payments are indicated is still necessary (see GN 00603.085 -- Installment Payments of Accumulated or Conserved Funds - Title II Only). The file should be annotated to show the method of payment.
NOTE: Where the PC has first notice of an accrual, do not delay payment of the current monthly benefit pending development concerning payment of the accrual. The PC will certify payment of current monthly benefits and request the FO to develop and prepare a determination.