BASIC (03-05)

A. Background

The servicing field office authorizes qualified organizations to collect a fee from a beneficiary's monthly payments. Community-based, nonprofit organizations must meet specific requirements in order to be authorized to collect a fee, and must continue to satisfy these requirements to remain eligible to collect a fee. SSA will verify that these organizational payees continue to meet the requirements, as part of its expanded monitoring program.

B. Policy

The servicing field offices are responsible for re-certifying continuing eligibility of each Fee for Service payee every year. Generally, the RO's will create a list of organizations to be re-certified and forward the same to the ADO's and/or the servicing FO's.

FO's should follow their regional protocol for selecting payees for increased monitoring.

C. Procedure

1. What needs to be verified?

The following items will need to be verified at the time of the re-certification:

• That the organizational payee continues to provide payee services to 5 or more people, and

• It continues to be bonded and licensed (provided that licensing is available in the State), and

• Any independent audit performed since the previous certification.

  NOTE: For state or local government agencies, you only need to query the eRPS and certify that the payee continues to serve 5 or more beneficiaries.

2. When to verify continued eligibility

Eligibility verification can be done in two ways:

a. Triennial Review

Conduct site reviews to a selected number (approximately one third) of Fee for Service payees each year. This selection should be extracted from eRPS. During the site review, the field office should collect necessary information to verify whether the organization remains eligible to collect a fee.

NOTE: The selection for those FFS payees subject to a triennial site visit is determined at the RO level.

b. Annual Re-certification

For the payees not selected during the current site review year, (remaining two thirds) the FO will query the eRPS to verify that they actively serve as payee for at least five people. Then contact the payee by mail or telephone requesting copies of the current bonding, licensing agreement and audit forms. If the contact is done by phone, document the file using a SSA-5002 RC or the Fee For Service (MS INTRANTERPS 015.004) screen in eRPS.

File a copy in the paper precedent file.

NOTE: Request a copy of the entire bond/insurance contract, if not already in precedent file. If contract is already in precedent file, a declaration page is sufficient. Be certain to verify that coverage includes that of officers/owners and employees. Contact the licensing board or bonding agent if necessary to resolve discrepancies or concerns.

3. Documenting the eRPS

In the Fee For Service screen, enter any updated information, the date of last certification, and the diary date for next certification.

4. Examples

a. Example 1

A site review was conducted on 03/15/02. The payee serves 124 beneficiaries and is bonded for $250,000 through 01/15/03 with Aetna Insurance. Enter 03/02 as date of last site visit and date of last certification. Enter 01/03 as date for the next certification and 03/05 as the diary date for next site visit. Complete all other applicable items in the Fee For Service screen in accordance with MSOM Section 242-G.

b. Example 2

A payee had continued certification verified on 02/12/02. The payee serves 16 beneficiaries, and the FO received a copy of the operating license from the State of Hawaii, which expires on 06/01/05. Enter 02/02 as date of last certification and 02/03 as date of next certification.

5. Notice requesting documentation

Use the notice provided in NL 00703.946.

The notice can be reproduced locally or incorporate it into the DPS.

When the yearly certification is completed, please submit a copy of the:

• site review forms (if triennial review completed this year),

• bond and/or license, and

• Fee For Service screens

to their regional rep payee coordinator and also keep copies in their paper precedent file.

D. References

GN 00506.001C. Fee for Services-Qualification Requirements

GN 00506.110B.5. Reviewing Evidence in a Fee for Services Request

GN 00506.170B. Establishing Information on Fees for Service Organizations and the Beneficiaries They Serve