TN 25 (08-14)

GN 02607.705 Suspending Title XVI Payments

Inmate data obtained through the inmate matching operation provide us with information that could affect a recipient’s Title XVI eligibility. A report that a recipient is an inmate of a correctional or mental health facility may be cause for suspending the recipient’s Title XVI payments. A recipient who is an inmate of a public institution throughout a full calendar month is not eligible for Title XVI payments.

How we suspend a recipient’s payments will depend on whether the Supplemental Security Record (SSR) is an active Modernized SSI Claims System (MSSICS) record or, if not, whether we can use the Prisoner Update Processing System (PUPS) to suspend payments. Instructions for suspending payments using MSSICS, PUPS, and non-PUPS processing follow in this section.

A. Administrative finality considerations

1. Administrative finality rules

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.

2. PUPS supports good cause

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.

3. PUPS supports similar fault

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.

B. Suspending Title XVI payments using MSSICS

If an inmate has an active MSSICS record, suspending through PUPS will lock the MSSICS record. For active MSSICS records, suspend payments as follows:

  1. Access the PUPS Title XVI Prisoner Update (PU16) screen following instructions in MSOM PRISON 003.008.

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

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

    • ACTION EFFECTIVE DATE--enter the suspension effective date; and

    • FACILITY ID – update if not already present.

  3. Enter "MSSICS CASE" on the PUPS Prisoner Remarks (PRMK) screen. (For information on the PRMK screen, see MSOM PRISON 003.010.)

  4. 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.

  5. Update the MSSICS screens to record and post the proper period of payment status N22 (inmate of a penal institution) by selecting “Prisoner” from the dropdown list for “Confinement Reason” on the Institution Residence screen. For more information on the LINS screen, see MSOM INTRANETSSI 010.009.

  6. The PENDING FILE BEGIN DATE, if present, on the SSI Claims Application (ACLM) screen must be at least 1 month before the N22 payment status date is effective. For more information on the ACLM screen, see MSOM MSSICS 008.003.

The SSR sends feedback to PUPS once it posts the N22 payment status. This feedback changes the PUPS status from “PENDING” to “SUSPENSION.” PUPS determines whether an incentive payment (IP) is due the reporting facility, computes the IP amount, and posts the IP amount and the date paid to the T16 Prisoner Status Query (P6QY) screen.

NOTE: If the PUPS record still shows “PENDING” after the MSSICS action posts the N22 payment status to the SSR, report the problem to your regional prisoner coordinator (RPC). For a list of RPCs, see GN 02607.990.

C. Suspending Title XVI payments using PUPS

1. PUPS suspension procedure

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. 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. 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.

2. How PUPS processes suspension actions

When you update the PU16 fields:

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

  3. 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.)

D. Suspending non-MSSICS records using non-PUPS procedures

If an inmate’s SSR is non-MSSICS, the following situations require non-PUPS suspension processing:

  • PUPS status is “*PENDING” and the SSR remains in current pay;

  • A PUPS exclusion exists; or

  • There is a closed period of N22 suspension.

1. PUPS is *PENDING and the SSR remains in current pay

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. input the suspension on an SSA-1719B; and

  2. 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.

2. PUPS exclusion cases

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

  • representative payee data;

  • temporary institutionalization data;

  • Goldberg-Kelly data;

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

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

  4. 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.

3. Closed period of N22 suspension

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.

a. Clearing PUPS records

Clear the PUPS record warranting a suspension action by entering the following information on the PU16 screen:

  • TYPE OF ACTION--Enter “6” (CHANGE INFORMATION ONLY) or, if the inmate is in force due or termination payment status, enter “2” (CLEAR CONTROL - NO SUSPENSION NECESSARY);

  • ACTION EFFECTIVE DATE--Enter the suspension effective date; and

  • RELEASED DATE--Post the released date if not already present.

Clear all other PUPS pending records by entering “2” (CLEAR CONTROL - NO SUSPENSION NECESSARY) in the TYPE OF ACTION field on the PU16 screen.

b. Recipient currently eligible

Process the N22 suspension and subsequent reinstatement as follows:

  • input the closed-period suspension on an SSA-1719B. Feedback from the SSR changes the PUPS status from PENDING to SUSPENSION and pays the incentive payment to the reporting facility, if one is due;

  • suppress the automated suspension notice;

  • after the SSR posts the N22 payment status, input the reinstatement on an SSA-1719B;

  • suppress the automated reinstatement notice; and

  • prepare one manual notice covering both the suspension and reinstatement actions.

c. Recipient in a non-payment status

If, during the closed suspension period, a recipient was in a non-payment status (other than terminated or force due) that the N22 payment status can overlay, input the closed-period suspension using an SSA-1719B. The N22 payment status begin date must match the ACTION EFFECTIVE DATE used to clear the PUPS record. Feedback from the SSR changes the PUPS status from PENDING to SUSPENSION, pays the incentive payment, if one is due, and issues a notice.

If, during the closed suspension period, a recipient was in a non-payment status that the N22 payment status cannot overlay, record the N22 suspension period in the SSR Remarks field. For information on which non-payment status codes that the N22 payment status can and cannot overlay, see SM 01305.001H.

d. Recipient terminated or in force due payment status

For an inmate in force due or terminated payment status, input the closed period of suspension on the SSR as follows:

  • use the force due process to transmit a zero due amount for each month of suspension. (For more information on the force due process, see MSOM BUSSR 002.006);

  • record the N22 suspension period in the SSR Remarks field;

  • explain why you manually cleared the case on the PRMK screen; and

  • notify your RPC if a manual incentive payment is due. (For information on requesting a manual incentive payment, see GN 02607.820.)

The updated SSR will show payment status M02 (force due) with an overpayment for each month of suspension, if appropriate. If later SSRs exist, the system will transfer any overpayment to the latest record.

E. Special PUPS alert processing

1. Concurrent (Title II and Title XVI) PUPS pending records

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.

2. PUPS status is pending and inmate confined for less than a calendar month

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

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

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

Address any possible retroactive periods of suspension, if applicable.

3. Recipient is not the inmate (erroneous person)

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

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

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

4. Fugitive felon suspension before prisoner suspension

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

  2. 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.

5. Pending initial claims and appeals

Process the PUPS alert as follows:

  1. 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 DW01; and

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

  2. 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.

6. Blank payment status

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. 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. 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.

7. Inmate is a member of a couple's record

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

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

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

  3. terminate the couple's record;

  4. build new individual records for each member of the couple;

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

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

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

  8. 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.