TN 25 (07-06)

GN 00605.541 Collecting Data for Onsite Review

A. Policy

A random sample of patients is selected from the beneficiary listings for review (see GN 00605.521—Beneficiary Listing—Sample Selection). The financial records should cover the 12-month period just prior to the review. The account review provides information on the effectiveness of the accounting system, the amount of funds available for personal needs, the level and documentation of personal needs spending (see GN 00602.010—Current Maintenance Needs for Institutionalized Beneficiaries), and the accumulation of conserved funds. It may be helpful to make notes of spending patterns, significant personal expenditures, large purchases, etc., for use when visiting the beneficiary's living quarters. The reviewers should request supporting documentation (receipts, bills, cancelled checks) for any large purchases that are noted in reviewing the accounting records.

B. Procedure

Sufficient information should be gathered to evaluate the institution's performance as representative payee. In order to obtain enough data to support the findings and recommendations SSA will present to the State in the onsite report, the reviewers should use the following list of questions to assist in gathering information during the review:

  1. Were the sample beneficiaries in the payee's (institution’s) custody at the time of the review?

  2. Were the beneficiaries who were not in the institution's custody away for over 12 months? Is a change of payee appropriate?

  3. Is the institution applying its stated policies with respect to allocating a monthly amount for personal needs? Are additional funds provided if more are needed?

  4. Were there any beneficiaries in the sample who did not receive personal needs funds during the entire review period? Were these cases brought to the facility’s attention?

  5. Were large purchases ($100 or more) documented with receipts?

  6. Were any unusual or improper expenditures noted? If so, were these brought to the attention of the RO?

  7. Were accounting records maintained properly?

  8. Were significant events which could affect entitlement or representative payment reported timely?

  9. What happens to remaining conserved funds when a beneficiary dies?

C. Exhibits

The review team may find it helpful to complete the following worksheets when reviewing each beneficiary’s financial records.

1. Exhibit A - Representative Payee Onsite Review—Worksheet

G-GN_00605.541C-1

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2. Exhibit B – Representative Payee Onsite Review, Client Account Reconciliation

G-GN_00605.541C-2

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