1 ion, regardless of the legal compeey or incompetency of the beneficiary itled thereto, either for direct payit to such beneficiary, or for his use 1 benefit to a relative or some other son as the "representative payee" of beneficiary. When it appears that an ividual who is receiving benefit payats may be incapable of managing h payments in his own interest, the ninistration shall, if such individual ge 18 or over and has not been adged legally incompetent, continue ments to such individual pending a ermination as to his capacity to man-benefit payments and the selection a representative payee. F.R. 14698, Sept. 22, 1970] 04.1602 Submission of evidence by representative payee. Before any amount shall be certified payment to any relative or other rson as representative payee for and behalf of a beneficiary, such relative other person shall submit to the Adnistration such evidence as it may uire of his relationship to, or his reonsibility for the care of, the beneary on whose behalf payment is to made, or of his authority to receive ch payment. The Administration ay, at any time thereafter, require idence of the continued existence of ch relationship, responsibility or auority. If any such relative or other rson fails to submit the required evince within a reasonable period of time ter it is requested, no further payents shall be certified to him on bealf of the beneficiary unless for good use shown, the default of such relative · other person is excused by the Adinistration, and the required evidence thereafter submitted. 404.1603 Responsibility of representative payee. A relative or other person to whom ertification of payment is made on bealf of a beneficiary as representative ayee shall, subject to review by the dministration and to such requireents as it may from time to time rescribe, apply the payments certified O him on behalf of a beneficiary only or the use and benefit of such beneciary in the manner and for the puroses determined by him to be in the eneficiary's best interest. § 404.1604 Use of benefits for current maintenance. Payments certified to a relative or other person on behalf of a beneficiary shall be considered as having been applied for the use and benefit of the beneficiary when they are used for the beneficiary's current maintenance-i.e., to replace current income lost because of the disability, retirement, or death of the insured individual. Where a beneficiary is receiving care in an institution (see § 404.1606), current maintenance shall include the customary charges made by the institution to individuals it provides with care and services like those it provides the beneficiary and charges made for current and foreseeable needs of the beneficiary which are not met by the institution. § 404.1605 Conservation and investment of payments. Payments certified to a relative or other person on behalf of a beneficiary which are not needed for the current maintenance of the beneficiary except as they may be used pursuant to § 404.1607, shall be conserved or invested on the beneficiary's behalf. Preferred investments are U.S. Savings Bonds, but such funds may also be invested in accordance with the rules applicable to investment of trust estates by trustees. For example, surplus funds may be deposited in an interest or dividend bearing account in a bank or trust company or in a savings and loan association if the account is either federally insured or is otherwise insured in accordance with State law requirements. Surplus funds deposited in an interest or dividend bearing account in a bank or trust company or in a savings and loan association must be in a form of account which clearly shows that the representative payee has only a fiduclary, and not a personal, interest in the funds. The preferred forms of such accounts are as follows: by (Name of beneficiary) (Name of representative payee) representative payee; or (Name of beneficiary) (Name of payee) resentative payee for social security benefits. A representative payee who is the legally appointed guardian or fiduciary of the beneficiary may also register U.S. Savings Bonds purchased with funds from title II payments in accordance with applicable regulations of the U.S. Treasury Department (31 CFR 315.5 through 315.8). Any other approved investment of the beneficiary's funds made by the representative payee must clearly show that the payee holds the property in trust for the beneficiary. [37 F.R. 7881, Apr. 21, 1972] § 404.1606 Use of benefits for bene. ficiary in institution. Where a beneficiary is confined in a Federal, State or private institution because of mental or physical incapacity, the relative or other person to whom payments are certified on behalf of the beneficiary shall give highest priority to expenditure of the payments for the current maintenance needs of the beneficiary, including the customary charges made by the institution (see § 404.1604) in providing care and maintenance. It is considered in the best interests of the beneficiary for the relative or other person to whom payments are certified on the beneficiary's behalf to allocate expenditure of the payments so certified in a manner which will facilitate the beneficiary's earliest possible rehabilitation or release from the institution or which otherwise will help him live as normal a life as practicable in the institutional environment. § 404.1607 Support of legally depend. ent spouse, child, or parent. If current maintenance needs of a beneficiary are being reasonably met, a relative or other person to whom payments are certified as representative payee on behalf of the beneficiary may use part of the payments so certified for the support of the legally dependent spouse, a legally dependent child, or a legally dependent parent of the beneficiary. [31 F.R. 3394, Mar. 4, 1966] § 404.1608 Claims of creditors. A relative or other person to whom payments under Title II of the Act are certified as representative payee on behalf of a beneficiary may not be required to use such payments to discharge an indebtedness of the beneficiary which was incurred before the first month for which payments are certified to a relative or other person on the beneficiary's behalf. In no case, however, may such payee use such payments to discharge such indebtedness of the beneficiary unless the current and reasonably foreseeable future needs of the beneficiary are otherwise provided for. [28 F.R. 7182, July 12, 1963] § 404.1609 Accountability. A relative or other person to whom payments are certified as representative payee on behalf of a beneficiary shall submit a written report in such form and at such times as the Administration may require, accounting for the payments certified to him on behalf of the beneficiary unless such payee is a courtappointed fiduciary and, as such, is required to make an annual accounting to the court, in which case a true copy of each such account filled with the court may be submitted in lieu of the accounting form prescribed by the Administration. If any such relative or other person fails to submit the required accounting within a reasonable period of time after it is requested, no further payments shall be certified to him on behalf of the beneficiary unless for good cause shown, the default of such relative or other person is excused by the Administration, and the required accounting is thereafter submitted. Payment for services; hospital outside the United States. 405.154 Payment for services furnished; Federal providers. 405.155 Payment for services furnished; providers obligated to furnish services at public expense. 405.156 Payment to entitled individual for services furnished by a nonparticipating hospital; inpatient admission before January 1, 1968. 405.157 Payment to entitled individual for emergency services furnished after 1967. 405.158 Payment to entitled individual; determination of amount payable for services furnished by a nonparticipating hospital. 405.160 Payment to participating hospital for inpatient hospital services; conditions for payment. Payment for inpatient hospital services; furnished after 90- or 150-day limit or after 190-day limit. 405.161 405.162 5.120 Posthospital extended care services; 5.122 Posthospital extended care services; services considered for purposes of limitation on days of coverage. 5.123 Posthospital extended care services; whole blood cost deductible. 138 FR 13637, May 24, 1973. Prohibition against payment for Inpatient hospital services furnished after utilization review finding that further services are not medically necessary. 405.163 Prohibition against payment for inpatient hospital services furnished after 20th consecutive day by a hospital which has failed to make timely utilization review. Sec. 405.226 Equitable relief for individual whose enrollment rights have been prejudiced by government misrepresentation, inaction о error. 405.230 Supplementary medical insurance benefits. 405.232 405.231 Medical and other health services included items and services Medical and other health services conditions, limitations, and ex clusions. 405.232a Physician defined. 405.232b Chiropractors. 405.232c Optometrists. 405.233 Home health services; general. 405.234 Home health services; conditions. 405.235 Home health services; place where items and services must b furnished. 405.236 Home health services; items and services included. 405.237 Home health services; items and services not included. 405.238 Home health services; "visits" defined. 405.239 Option available to patients unde a home health plan who requir physical therapy or speech therapy services. 405.240 Payment of supplementary medica insurance benefits; amount payable. 405.241 Payment of supplementary medical insurance benefits; election by group-practice prepayment plar as to method of determining amount of payment. 405.243 Psychiatric services limitation; ex penses incurred for physicia services. 405.244 Incurred expenses; expenses ex cluded from total expenses o not considered for purposes o the deductibles. Conditions prohibiting payment o benefits. |