TN 11 (02-16)

A. Policy for organizations to collect fees

Organizations can collect the lesser of 10% of the combined Title II and Title XVI monthly payment, or the amounts listed in the chart. The field office (FO) provides the Fee-for-Service (FFS) organizational payee with a list of beneficiaries who meet the Drug Alcohol Addiction (DAA) condition for a higher fee.

NOTE: DAA condition means the beneficiary or recipient is entitled to disability benefits and has a medically determinable substance abuse disorder listed as a secondary diagnosis. DAA cannot be material to the disability determination.

B. Procedure for DAA condition

To determine if a beneficiary meets the DAA condition, query the Master Beneficiary Record (MBR) and Supplemental Security Income Record (SSR) and look for the identifying DAA coding shown in SM 01601.790C.19. (for Title XVI) and SM 00510.200 (for Title II).

C. Procedure for determining the amounts

Under P.L. 103-296 (SSIPIA '94), the limit on the fee a qualified organization can collect may be increased by the same percentage as the cost-of- living adjustment (COLA). The increased fee should be adjusted against the January check.

1. Determining the fee

The FO must determine fees based on the net amount of the beneficiary's total monthly payments including past-due benefits, installment payments, and restitution payments. Do not include the amount of Medicare premiums or other deductions (including overpayment recoveries) when determining the fee amount.

2. Fee amounts

If a fee increase is applicable, the representative payee may collect the fee increase amount from the check payable for January.

The fee should be the lesser of 10% percent of the monthly benefit amount (MBA), or as follows:

NOTE: There was no increase in fees in 2010, 2011, 2016, and 2017.

We notify organizations and the beneficiaries they serve of the fee changes in late November of the previous year. Some payees and beneficiaries may not receive a notice. If the payee requests a copy of the notice, provide a manual notice to the payee and/or beneficiary by preparing a notice using the instructions in NL 00703.774.

NOTE: The organization can collect less than the permitted fee amounts or choose not to collect a fee at all. (See GN 00506.200D.3. in this section.)

The payee’s voluntary decision to not collect a fee does not affect their organization’s FFS status.

3. Payee charges a fee in excess of the statutory amounts

Regardless of the length of time or amount of the erroneous fees charged, the payee must refund the excess amounts to the beneficiary immediately upon discovery.

The payee must furnish proof to the FO that the payee refunded the amount in question to the beneficiary(ies). The beneficiary can, in the form of a canceled check or a receipt, sign proof that the payee returned the excess fees.

FO’s should monitor these payees closely. Documentation of the erroneous charges and refund action must be kept in the paper precedent file and recorded in the eRPS. If unable to resolve the excess fees, the FO should initiate development for a new payee and investigate and develop for possible misuse of benefits.

EXCEPTION: A FFS organization may collect a fee of more than the prescribed monthly amount when a retroactive payment is made for a prior period of nonpayment or incorrect payment and the organization:

• is a FFS payee approved to collect a fee for the months for which payment is made,

• provided payee services in the months for which payment is made as defined in GN 00502.113A, and

• is payee of record when the retroactive payment is received.

NOTE: Use scheduled yearly rates when determining retroactive fees unless the 10 percent provision applies.

D. Examples of fee amounts

1. Customary Fee

In November 2014, a disabled individual who meets the DDA condition receives both Social Security and SSI each month. The combined checks total $460. The maximum fee a FFS payee authorized to collect in this case could charge is $46 (10 percent) per month since the beneficiary meets the DAA condition. If the same beneficiary did not meet the DAA condition, the maximum fee the FFS payee could charge would be $40 each month.

2. Fees collected from retroactive payments

A county mental health association was a FFS payee for a beneficiary who has a DAA condition; the disability benefits were terminated effective January 2014. Staff members of the association assisted the beneficiary in processing an appeal on the termination. They also visited him at least monthly to ensure that his county assistance payments were used for his basic needs. In March 2014, the beneficiary’s benefits were reinstated and he received retroactive payments for January 2014 through March 2014. We issued the benefits to the county mental health association, which continued to perform as a FFS payee. The association is permitted to charge the beneficiary up to 10% of the monthly benefits, up to a maximum fee amount of $77 for each month covered in the retroactive payments.

3. Change in benefit amount and underpayment due

An organization is payee for an SSI beneficiary. SSA authorized the organization to collect a fee beginning 07/01/02. The beneficiary is paid $100 each month for 07/14 through 10/14. The organization can collect up to $10 (10%) from the payment for each month. However, it declined to collect the fee to allow the beneficiary to meet his immediate living expenses. In 11/14, the FO determined the monthly rate beginning 07/14 should have been $130 and the beneficiary receives a check for $120 representing back payments owed him. Since the organization, based on the new payment amount, is authorized to collect up to $13 (10% of $130) for each month from 07/14 through 10/14, it may withhold up to $52 ($13 for each of the months from 07/14 to 10/14) from the retroactive check and $13 from the current check received in 11/14.

E. References

• GN 00502.113 Interviewing the Payee Applicant

• SM 01601.790 Computation History - CMPH

• SM 00510.200 Disability Insurance Benefit (DIB) Data Line