PROGRAM OPERATIONS MANUAL SYSTEMPart GN – GeneralChapter 005 – Selection of Representative PayeeSubchapter 04 – Suspensions for Payee Development and Other Payee ActionsTransmittal No. 23, 10/24/2019
This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.
Summary of Changes
GN 00504.260 Representative Payee Requests Waiver of Benefits (Title II)
A.1 - change last sentence of first paragraph
from - The ARC, CPS; for Chicago use ARC, CRSI-SSI, is responsible for making the formal determination.
to - The ARC, CDPS (or CDIPS), is responsible for making the formal determination.
A.2 - change first line
from - The ARC, CPS; for Chicago use ARC, CRSI-SSI will honor a request for waiver if the payee:
to - The ARC, CDPS (or CDIPS)will honor a request for waiver if the payee:
B.5 - change sentence 1 in the NOTE
from - The PC will associate the material with the claims folder and forward to the ARC, CPS; for Chicago use ARC, CRSI-SSI, for a decision.
to - The PC will associate the material with the claims folder and forward to the ARC, CDPS (or CDIPS) for a decision.
A payee's request to waive a beneficiary's right to title II benefits must be submitted in writing. Policy guides shown in GN 02409.001 will also apply when the request is made by a payee. The request is honored if found to be in the beneficiary's best interests. The ARC, CDPS (or CDIPS) is responsible for making the formal determination.
CAUTION: These instructions apply to waiver requests on title II benefits only. Before considering waiver of benefits in initial claims, be sure that the request is received from the proper applicant, and close-out procedures have been properly followed. If there is any question of the advisability of the request, consider appointing another payee for the beneficiary. For information on withdrawal of title II benefits, see GN 00206.005 and GN 00206.010. For information on voluntary termination of title XVI benefits, see SI 02301.230.
The ARC, CDPS (or CDIPS) will honor a request for waiver if the payee:
fully understands the consequences of the request, and
convincingly explains how the request, if approved, will secure some advantage to or further the interests of the beneficiary.
Obtain the following information, as appropriate, for folder documentation:
The name of the requester, his/her relationship to the beneficiary; if he/she has custody of the beneficiary, and/or the amount of money which he/she contributes toward the cost of the beneficiary's care, maintenance, and other day-to-day needs.
Information about the beneficiary's current living situation, what his /her needs are, how needs are being met, if the beneficiary's living arrangements may change in the foreseeable future, and other pertinent information.
The reason for the request; e.g., religious beliefs or an adoptive parent's wish for the child not to know natural parents' identity, etc.
The names, addresses, and relationships of other persons interested in the beneficiary's well-being, including the name of the facility (or person) with custody of the beneficiary.
The name and address of the beneficiary's legal guardian, spouse, and natural or adoptive parent of minor child. Each of these should be considered as potential payees.
A statement to the effect that he/she understands that if the waiver is honored, he/she may request that it be revoked at any time in the future; however, the revocation may have limited retroactivity.
If a withdrawal is approved, a subsequent application is needed and will have limited retroactivity.
Document the file with the date the waiver request is to be effective and secure a signed statement that the payee understands that it will apply to all future benefits due the beneficiary unless it is later revoked. (There are no provisions that authorize a partial waiver of benefit payments with the exception of waiving all of the payment except the SMI premium.)
If the reason for waiving benefits is for financial benefits (e.g., eligibility for Medicaid benefits), verify the expected outcome of waiving the benefits with the appropriate source and document on an RC.
NOTE: Since a waiver of benefits by a payee may be retroactively revoked (unlike one by a capable beneficiary), we must ensure the decision is based on accurate information.
If the requester does not have custody of the beneficiary, contact the beneficiary's custodian and ascertain:
Beneficiary's living situation and needs.
Who is providing funds for care.
Who is demonstrating concern for the beneficiary's well-being.
Degree of concern shown by the person filing the waiver request.
If there is a legal guardian, contact him/her and:
Advise of the waiver request.
Give the legal guardian an opportunity to file to be payee or to protest the waiver.
Request a signed explanation, if the legal guardian does not wish to file.
Summarize on an RC that the legal guardian will not file to be payee, if the legal guardian refuses to furnish a signed statement.
Contact the spouse or natural or adoptive parent of a minor child if he /she contributes to the beneficiary's support or demonstrates strong concern. Inform him/her of the waiver request and give him/her an opportunity to file to be payee or to protest the waiver.
Develop for a qualified payee if the FO investigation shows that the beneficiary's needs are not being adequately provided for and benefits are needed to improve or maintain day-to-day needs. Follow the procedures in GN 00504.100B.1. as part of the development. When appropriate, refer the matter to a public social agency (see GN 00504.300).
Send the waiver request with results of the FO investigation, recommendation, and rationale to the PC.
NOTE: The PC will associate the material with the claims folder and forward to the ARC, CDPS (or CDIPS) for a decision. Document the decision on the Report of Contact Details screen in the eRPS (MS INTRANETERPS 016.002).
Do not suspend unless the requester is the payee, has requested suspension or is refusing to accept future checks and direct payment to beneficiary is prohibited. (Follow guidelines in GN 00504.105.)
NOTE: The PC will ask the FO to develop for a qualified payee if the request is denied and if the FO has not already done so.
Conditions under which benefits may be waived, GN 02409.001 through GN