TN 23 (01-17)

GN 02604.440 Suspense Actions for Administrative Sanctions Cases

A. Suspending benefits in administrative sanction cases

The sanction period must be the same for both Title II and Title XVI. When a sanction applies for a particular month, the affected payment is the one payable for that month. For example, a sanction for March would stop the Title II March benefit that is payable in April, while the sanction would stop the Title XVI March benefit that is payable in March.

For more information on administrative sanction periods when a person does not request reconsideration, see GN 02604.435A.

All other normal entitlement rules continue to apply. If another event occurs that requires termination or suspension, take the appropriate action for that event. Once the sanction period begins, it must run continuously for the prescribed period (i.e., 6, 12, or 24 months), regardless of whether the the person is entitled, or eligible, for all months of the sanction period.

Enter a remark in the Shared Process Menu, the Master Beneficiary Record (MBR) or Supplemental Security Income Record (SSR) to identify the reason for the sanction and the sanction period. This remark must remain on the MBR and SSR indefinitely to identify the sanction period for future inquirers. The sanction period will appear in the Administrative Sanctions Tool.

When the Regional Sanction Coordinator concurs with the sanctions determination and notice(s), FO technicians should impose the administrative sanction and release the notice(s) within 14 days. Untimely processing of an administrative sanction will create an overpayment on the record.

1. Suspending Title II benefits

To suspend Title II benefits:

  • After the field office (FO) sends the initial notice that includes information about appeal rights, and person does not file an appeal or the appeal affirms the decision, no future due process notice is necessary. Under the Title II Redesign process, Post-entitlement Online System (POS) suspensions generate subsequent due process notices automatically; however, in administrative sanction cases, the Administrative Sanctions Suspension (ADMSANCT) data line on the MBR suppresses the second notice.

  • Use POS following instructions in MS T2PE 003.013 and the instructions on administrative sanctions in MS COMMON 005.005. Only use POS to suspend benefits for the current and later months. Use the Manual Adjustment Credit and Data Entry (MACADE) system to suspend for other months and suspense reasons having a higher priority per GN 02602.025.

NOTE: Medicare coverage will continue for beneficiaries while we impose administrative sanctions. The beneficiary is responsible for paying the Part B premiums during the sanction period.

2. Suspending Title XVI benefits

To suspend Title XVI benefits:

  • The FO suspends benefits after the recipient has received due process as provided in the initial administrative sanctions notice.

  • The FO enters N24, the administrative sanctions non-pay suspense code for providing false or misleading statements affecting benefit eligibility or amount.

  • The FO suppresses the notice that the N24 payment status (PSY) would otherwise generate.

  • If another event occurs that requires termination or suspension, take the appropriate action for that event. Change the N24 PSY to the appropriate PSY (e.g. N01 for non-pay for excess income, N04 for non-pay for excess resources, etc.). Changing the PSY code will notify Medicaid of the recipient's ineligibility.

NOTE: Medicaid coverage will continue for recipients in PSY N24.

3. Suspending concurrent benefits

Suspend both Title II and Title XVI benefits for a concurrent beneficiary for the same months benefits are due. False statements or omissions under one program affect the payment of benefits under both programs. The sanction period must be the same for both programs. If a sanction applies for a particular month, the affected payment is the one payable for that month.

For EXAMPLE, in a concurrent case, a sanction for March means we stop the Title II payment for March (payable in April) and the Title XVI payment for March (payable in March.) To suspend benefits under both titles, take the actions indicated in GN 02604.440A.1 and GN 02604.440A.2 (in this section).

B. Accessing the client database

Access the clie