Effective Dates: 10/04/2022 - Present Previous | Next

TN 20 (10-22)

GN 00506.001 Fee-for-Service - Overview

CITATIONS:

Sections 205(j)(4) and 1631(a)(2)(D) of the Social Security Act;
20 CFR 404.2040a; 20 CFR 416.640a

A. Introduction

Section 5105 of the Omnibus Budget Reconciliation Act of 1990 (OBRA), Pub. L. No. 101-508, included a provision permitting qualified organizations to collect a fee. This fee is collected from the beneficiary and is used for expenses (including overhead) incurred by the organization in providing services performed as the beneficiary's representative payee. This provision was effective from July 1, 1991 until July 1, 1994.

Section 201 of the Social Security Independence and Program Improvements Act of 1994 (SSIPIA), Pub. L. No. 103-296, extended the authority for qualified organizations to collect fees for representative payee services beyond July 1, 1994. It also changed the definition of “qualified organization” and increased the allowable fee amount in certain circumstances, effective December 1, 1994.

Effective September 1, 2004, section 104 of the Social Security Protection Act of 2004 (SSPA), Pub. L. No. 108-203, requires fee-for-service (FFS) representative payees to forfeit its fees for any month during which they are found to have misused all or part of a beneficiary's benefits. In addition, effective April 1, 2005, section 102 of the SSPA requires non-governmental fee for service representative payees to be bonded and to be licensed in each state in which they serve as representative payees, provided that licensing is available in the state.

B. Policy - General

Before an organization begins collecting a fee from a beneficiary, SSA must authorize it in writing. We must authorize any fee collected from the beneficiary, including fees taken from the beneficiary’s Social Security benefit as well as fees taken from some other source of funds belonging to the beneficiary.

Note: 

Some payees receive payment for payee services from sources other than the beneficiary, such as from a third-party payer (e.g. a state program). Payees do not need to obtain approval from SSA to receive fees from a third party for services provided to a beneficiary because these funds do not belong to the beneficiary (see GN 00506.220A).

The payee may choose to collect a lesser fee or none at all. The payee must ensure that the beneficiary's needs are met before it collects a fee from the beneficiary. In months where the beneficiary does not have enough funds to cover living expenses, the payee cannot collect a fee. The organization will not lose FFS status, as long as it continues to meet all the requirements listed in GN 00506.001C.

C. Policy - Qualification Requirements

To qualify as a FFS organization, the payee must be either:

  • •

    a state or local government agency, OR

  • •

    a community based, non-profit social service agency, that is bonded and licensed by each state in which it serves as a representative payee (if licensing is available).

Additionally, the organization must:

  • •

    regularly provide representative payee services to at least five beneficiaries, AND

  • •

    demonstrate that it is not a creditor of the beneficiary. Refer to GN 00502.135 when the representative payee is a creditor.

D. Procedure

1. Role of the Servicing Field Office

The FO serving the organization's address is responsible for:

  • •

    furnishing information to interested organizations on how to apply to collect fees for payee services;

  • •

    assisting the organization with all steps of the FFS application process, explaining what documents are required, and explaining the FFS responsibilities and compliance procedures;

  • •

    approving or denying applications to collect fees;

  • •

    issuing decision notices to applicant organizations;

  • •

    entering the Fee for Service data in the Fee for Service screen on eRPS, in accordance with MS 07414.008;

  • •

    notifying affected beneficiaries that fees may be collected and the amounts of the fees;

  • •

    notifying organizations about which beneficiaries can be charged the DAA higher fee based on their secondary diagnosis;

  • •

    ensuring continued suitability and continued eligibility to collect fees (for example, annual certification and quick response checks).

    NOTE: Your regional office may re-direct some of these work assignments to cadre teams.

2. Role of Non-Servicing Field Office, PSC, or TSC

Components not serving the organization's address are responsible for:

  • •

    referring inquiries from interested organizations to the servicing FO using current routing procedures; and

  • •

    notifying the organization that the request was transferred to the servicing field office of jurisdiction.

3. Role of the Organization

The organization is responsible for:

  • •

    furnishing SSA with all evidence needed in a timely manner so that a determination can be made as to whether the organization is qualified to collect a fee;

  • •

    adhering to SSA guidelines when collecting fees; and

  • •

    producing documentation of the fees collected upon request from SSA.

E. References

GN 00506.100, Criteria for Receiving Fees for Services

GN 00506.220, When Fees for Service Cannot Be Collected

GN 00602.110, Reimbursements for Payee Services

GN 00502.020A.4., DAA Condition

http://www.socialsecurity.gov/payee/fee_fact_sheet.htm, Fee for Service Fact Sheet

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0200506001
GN 00506.001 - Fee-for-Service - Overview - 10/04/2022
Batch run: 10/04/2022
Rev:10/04/2022