Suspending Title XVI payments retroactively requires us to reopen and revise a prior determination or decision, which we may do only under the rules of administrative finality. Under those rules, you may reopen and revise Title XVI determinations and decisions:

• •

  up to 1 year from the date of the notice of the initial determination or decision for any reason;

• •

  within 2 years of the date of the notice of the initial determination or decision upon a finding of “good cause.” (For more information on finding good cause, see SI 04070.010 and SI 04070.015); or

• •

  beyond the 2-year period if we find that a recipient obtained a favorable determination or decision by committing fraud or similar fault. (For more information on establishing fraud or similar fault, see SI 04070.020.)

For more information on administrative finality, see SI 04070.001.

A PUPS record may support a finding of good cause if the inmate data contained in the PUPS record constitutes new and material evidence (e.g., we did not have evidence that the recipient was an inmate when we made the prior determination or decision). The date of the PUPS alert shown in the “Date Generated” field on the Title XVI Prisoner Status Query Screen (P6QY) is the date of affirmative action in writing. For more information on the P6QY, see MSOM PRISON 003.009.

Since we provide written notification to recipients advising them of their responsibility to notify us of any changes that would affect eligibility or payment amount, failure to report entry into a correctional or mental health facility may constitute a knowing concealment of material information and may be grounds for finding similar fault. For the definition of similar fault, see GN 04105.005B, and for more information on similar fault, see SI 04070.020B.

If the inmate’s SSR is non-MSSICS and none of the processing situations listed in GN 02607.705D in this section exist, suspend payments as follows:

1. a. 

   Update the following PU16 fields on the PUPS record warranting a suspension action:

   • •

     SELECT TYPE OF ACTION--Enter “1” (SUSPEND BENEFITS);

   • •

     ACTION EFFECTIVE DATE--Enter the suspension effective date;

   • •

     CONFINEMENT DATE--Enter the confinement date;

   • •

     FACILITY ID – Update if not already present;

   • •

     REMARKS--Explain the suspension action. You can also record case-related information about an individual on the PRMK screen and in the Remarks Data (RMKS) field of the SSR. (For information on the RMKS field, see SM 01601.910); and

   • •

     IF LOCALLY PREPARED NOTICE ISSUED, NOTICE DATE--If appropriate, suppress the systems generated notice and send a manual notice. If needed, change the recipient’s mailing and residence addresses on the PU16 screen, as explained in MSOM PRISON 003.008.

2. b. 

   Clear all other PUPS pending records by selecting TYPE OF ACTION = 2 (CLEAR CONTROL - NO SUSPENSION NECESSARY) on the PU16 screen. To issue a correct incentive payment, there must be only one PUPS record pending when you input the suspension.

When you update the PU16 fields:

1. a. 

   PUPS builds an SSA-1719B suspension transaction and places an asterisk “*” immediately before the "PENDING" in the status field on the Prisoner Summary (PUST) screen. A "*PENDING" in the status field means that PUPS transmitted the suspension input but has not received feedback yet from the SSR that the N22 suspension has occurred. If the PUPS status remains “PENDING” after updating the PU16 fields, contact your RPC;

2. b. 

   upon receipt of the N22 feedback, PUPS changes status from “*PENDING” to “SUSPENSION,” which clears the PUPS record; and

3. c. 

   the N22 feedback also triggers PUPS to determine whether an incentive payment IP is due a facility, compute the IP amount, and post the IP amount and the date paid to the P6QY screen. While PUPS issues automated IPs in most cases, some situations require a manual incentive payment. (For information on situations requiring a manual incentive payment, see GN 02607.820.)

The SSR will remain in current pay if updates to the PU16 screen result in a PE edit. Process the N22 suspension as follows:

1. a. 

   input the suspension on an SSA-1719B; and

2. b. 

   enter the same first month of payment status N22 on the SSA-1719B input that you used in the ACTION EFFECTIVE DATE field on the edited PU16 update.

After an N22 payment status posts to the SSR, the PUPS record status should change to “SUSPENSION.” If, after the SSA-1719B input, the SSR reflects the proper period of N22 but the PUPS status remains “*PENDING,” contact your RPC for instructions.

PUPS cannot automatically generate a suspension transaction if the SSR contains:

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  representative payee data;

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  temporary institutionalization data;

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  Goldberg-Kelly data;

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  suspense or non-pay status other than payment status N01, E01, or E02; or

• •

  Federal living arrangement B for the month prior to the suspension month.

If one of these exclusions exists, process the prisoner suspension for non-MSSICS records as follows:

1. a. 

   Update the following PU16 fields on the PUPS record warranting a suspension action:

   • •

     TYPE OF ACTION CODE--Enter “6” (CHANGE INFORMATION ONLY) - the status of the PUPS record will remain PENDING;

   • •

     ACTION EFFECTIVE DATE--Enter the suspension effective date;

   • •

     FACILITY ID – Update if not already present;

2. b. 

   Enter "PUPS Exclusion Case - 1719B needed” and any other remarks that help explain your reason for suspending benefits on the PRMK screen;

3. c. 

   Clear all other PUPS pending records by selecting TYPE OF ACTION = 2 (CLEAR CONTROL - NO SUSPENSION NECESSARY) on the PU16 screen; and

4. d. 

   Input the suspension on an SSA-1719B. If you attempt to suspend benefits through PUPS, the following message will appear after page 2 of the PU16 screen: “Suspension not sent to SSR, use MSSICS or SSI data inputs.”

If the SSR payment status changes to N22, feedback from the SSR changes the PUPS status from “PENDING” to “SUSPENSION.” PUPS determines whether an IP is due the reporting facility, computes the IP amount, and posts the IP amount and the date paid to the P6QY screen.

If you must establish a new SSR to post the N22 suspension, PUPS will not recognize a change in payment status and the PUPS record will remain “PENDING.” Clear the alert by selecting TYPE OF ACTION = 2 (CLEAR CONTROL - NO SUSPENSION NECESSARY) on the PU16 screen. Determine if a manual incentive payment is due.

The method for processing a closed period of N22 suspension depends on whether the recipient is currently eligible, in non-payment status, terminated, or in force due payment status. In each of these situations, first clear the appropriate PUPS records. For additional information on processing closed periods of suspension, see MSOM PRISON 003.001.

In concurrent cases, both Title II and Title XVI have their own pending PUPS record. Complete all development and update each record separately. For instructions on suspending Title II benefits using PUPS, see GN 02607.700.

If an institution releases an inmate after a confinement of less than a calendar month, clear the PUPS record by updating the following PU16 fields:

1. a. 

   SELECT TYPE OF ACTION--Enter “2” (Clear Control—No Suspension Necessary);

2. b. 

   RELEASED DATE--Enter the date the inmate was no longer in the custody of the correctional or mental health institution; and

3. c. 

   REMARKS--Explain why you are not suspending benefits to avoid possible duplicate development.

Address any possible retroactive periods of suspension, if applicable.

If the recipient identified on the PUPS alert is not the inmate:

1. a. 

   SELECT TYPE OF ACTION = 3 (CLEAR CONTROL – ERRONEOUS PERSON) on the PU16 field; and

2. b. 

   Document how you determined that this is an erroneous person case on the PRMK screen to avoid future duplicate development.

Occasionally, an institution will confine a recipient who was a fugitive felon. If you receive both a PUPS alert and a fugitive felon alert for the same person, process the alerts as follows:

1. a. 

   post the N22 suspension beginning the first full calendar month of confinement; and

2. b. 

   after the inmate is in payment status N22, post the N25 fugitive felon suspension on an SSA-1719B. (For instructions on processing fugitive felon warrant information, see SI 00530.000.)

Processing the N22 prisoner suspension before the N25 suspension triggers the incentive payment to the reporting institution. The N25 payment status input suspends the recipient effective with the correct initial suspension month based on the fugitive felon report.

Process the PUPS alert as follows:

1. a. 

   While awaiting a decision on a claim or appeal:

   • •

     clear the PUPS PENDING record by selecting TYPE OF ACTION = 2 (CLEAR CONTROL - NO SUSPENSION NECESSARY) on the PU16 screen;

   • •

     enter “Decision pending - alert to be developed if decision favorable” on the PRMK screen;

   • •

     enter an issue of “Prison” on the Development Worksheet page in CCE; and

   • •

     enter “Prisoner alert to be developed if decision favorable" in the SSR Remarks.

2. b. 

   If there is a favorable decision:

   • •

     fully develop the PUPS alert per GN 02607.600; and

   • •

     process the claim or appeal to completion, including posting the proper period of payment status N22.

An SSR may have a blank payment status code upon completion of the non-medical development if:

• •

  a medical decision is pending;

• •

  an edit condition exists; or

• •

  verification is pending.

To prevent these records from going automatically into pay if there is a favorable medical decision or upon resolving all edit and verification issues, leave the PUPS record in “PENDING” status and develop the alert. After completing the alert development, process as follows:

1. a. 

   If prisoner suspension does not apply, clear the alert using the PU16 screen:

   • •

     select TYPE OF ACTION = 2 (CLEAR CONTROL - NO SUSPENSION NECESSARY); and

   • •

     update the RELEASED DATE field, if appropriate.

2. b. 

   If prisoner suspension applies:

   • •

     clear the alert on the PU16 screen by selecting TYPE OF ACTION = 2 (CLEAR CONTROL - NO SUSPENSION NECESSARY) and updating the RELEASED DATE field, if appropriate;

   • •

     add a remark “Prison suspension applies. MSSICS screens updated and Title XVI claim taken out of adjudicative mode" to the PRMK screen; and

   • •

     update MSSICS screens with the living arrangement information and put the Title XVI claim into H80 payment status. (For additional information on updating living arrangement information, see MSOM INTRANETSSI 010.009.

If, subsequently, there is a favorable medical decision or all edit and verification issues are resolved, process the award to completion, including posting the proper period of payment status N22.

If an inmate is a member of a couple’s record, complete the following steps:

1. a. 

   clear the PUPS record by selecting TYPE OF ACTION = 2 (CLEAR CONTROL - NO SUSPENSION NECESSARY) on the PU16 screen;

2. b. 

   post the N22 suspension on the couple’s record using either MSSICS or an SSA-1719B, as needed;

3. c. 

   terminate the couple's record;

4. d. 

   build new individual records for each member of the couple;

5. e. 

   post a payment status of N22 on the inmate’s new record;

6. f. 

   carry the N22 overpayment forward to the inmate’s new record;

7. g. 

   suppress all automated notices on the terminated and new records. Send a manual notice to each recipient; and

8. h. 

   request a manual incentive payment, if appropriate. (For information on how to request a manual incentive payment, see GN 02607.820.)

The SSR will share suspension information on the new record with PUPS. However, the payment status N22 effective date on the new record will not agree with the PUPS ACTION EFFECTIVE DATE.