A participant in the demonstration project will be suspended if they fail to:

• timely meet the continuing education (CE) requirement; or
• maintain adequate liability insurance; or
• continue to meet all of the prerequisites.

What Happens When A Suspension Occurs?

A participant who is suspended from the demonstration project will not be able to receive direct payment of fees until SSA determines that the unmet requirement that caused the suspension has been satisfied and ends the suspension.

How Will A Participant Be Advised of a Suspension?

A participant will be notified in advance of a proposed suspension based on failure to satisfy the CE requirement and will be given 10 calendar days (protest period) from the date of the proposed suspension notice to protest and show us that the requirement was timely met. See Protest Procedures for more information about the protest process. If no protest is filed, the suspension will be effective the first day of the month following the month in which the protest period ends. If there is a protest and SSA determines that the CE requirement was not timely met, the suspension will be effective the first day of the month following the month in which we notify the participant that the protest has been denied.

A participant who does not maintain the required insurance coverage will be notified that his or her eligibility for direct payment will be suspended unless proof that the required insurance is in force is submitted within 15 calendar days of the date of our notice. We will send an additional notice to advise the individual whether eligibility will be suspended. A suspension for failure to maintain the required insurance coverage takes effect on the first day of the month following the month in which we notify the individual that eligibility will be suspended.

Example 1:

Ms. X became eligible to participate in the demonstration project on July 28, 2005. On July 15, 2006, we send Ms. X a notice of proposed suspension for failure to meet the CE requirement during the 18 month period from January 1, 2005, through June 30, 2006. Ms. X. does not protest and her eligibility to participate in the demonstration project is suspended beginning August 1, 2006.

Example 2:

Assume the same facts as in Example 1 except that Ms. X protests timely and SSA denies the protest on August 11, 2006. On that date, we send a notice informing Ms. X of SSA’s denial of her protest and of the suspension of her eligibility effective September 1, 2006.

Example 3:

Mr. Z became eligible to participate in the demonstration project on July 28, 2005. On September 7, 2005, we notify Mr. Z that SSA has determined that his insurance coverage lapsed on September 5 and that his eligibility for direct payment will be suspended unless proof that the required insurance is in force is submitted within 15 calendar days of the date of our notice. Mr. Z does not timely submit evidence to show that he has the required insurance in force, and on September 25 he is notified that his eligibility is suspended effective October 1, 2005.

The participant’s suspended status will be posted to the SSA’s intranet website used by effectuating components to track the eligibility of non-attorney representatives to receive direct payment of fees on the first day of the suspension. Once a participant is suspended the suspension must last at least one month.

How Does A Suspension End?

A suspension will be terminated after the suspended individual notifies SSA that the unmet prerequisite has again been met and SSA determines that the previously unmet requirement has been satisfied.

A suspension ends effective the first day of the month following the month in which we notify the individual that the previously unmet requirement has been met -- except where the participant satisfies a CE requirement for the prior education period in the first month of the current education period and we notify the participant in that same month that SSA has determined that the requirement has been met. In that circumstance, in order to ensure that the failure to timely satisfy the CE requirement results in an actual suspension, and considering that the suspension could not begin before the first day of the second month of the current period, the suspension ends effective with the first day of the second month following the month in which we notify the individual that the previously unmet requirement has been satisfied (i.e., the first day of the third month of the current period).

Example 3:

Mr. Y becomes eligible to participate in the demonstration project on July 28, 2005. To meet the CE requirement in the initial year after he established eligibility, Mr. Y must have 12 CE hours in the 18-month period beginning January 1, 2005, and continuing through June 30, 2006, including at least one hour on ethics and professional conduct for representatives and at least one hour regarding entitlement to, or eligibility for, benefits under titles II and XVI of the Social Security Act. On July 1, 2006, Mr. Y is sent a notice explaining that a suspension of his eligibility to participate in the demonstration project is proposed beginning August 1, 2006, because he has not taken the required CE hour in ethics and professional conduct. On July 6, Mr. Y protests the suspension explaining that he completed a 3 hour ethics course on July 5. On July 11, a notice is released to Mr. Y denying his protest because he did not meet the CE requirement timely, but accepting the July 5 course as satisfying the CE requirement for the prior period. Because Mr. Y did not timely meet the prior period CE requirement, he will be suspended beginning August 1. Mr. Y’s suspension will continue through August 30, and his eligibility to participate in the project will resume September 1, 2006.

How Will A Participant Know His/Her Suspension Ended?

A participant will be notified in advance of the date a suspension will end. SSA will modify its intranet website to reflect the representative’s renewed eligibility to receive direct payment of fees on the day the suspension is lifted. Favorably decided cases that are effectuated on the day the suspension ends and eligibility resumes will be subject to benefit withholding and direct payment of fees.