No. 27434 (Amendment): R527-201. Medical Support Services

DAR File No.: 27434
Filed: 09/16/2004, 11:42
Received by: NL

 

RULE ANALYSIS

Purpose of the rule or reason for the change:

Medical support services are provided to all IV-A and Non-IV-A applicants in accordance with 45 CFR 303.30, 303.31, and 303.32 as stated in Section R527-201-1 of the rule. The Office of Recovery Services/Child Support Services (ORS/CSS) will no longer stop automated insurance enforcement against the non-custodial parent when/if the applicant/custodial parent has insurance.

 

Summary of the rule or change:

This change deletes Section R527-201-4, "Medical Support Services in Non-IV-A Cases" which is no longer needed since ORS/CSS will enforce medical insurance as ordered; and renumbers the remaining sections.

 

State statutory or constitutional authorization for this rule:

Sections 63-46b-1 et seq., 62A-11-326.1, 62A-11-326.2, 62A-11-326.3, and 78-45-7.15; and Subsections 62A-11-406(9) and 35A-7-105(2)

 

Anticipated cost or savings to:

the state budget:

There will be no change in cost or savings as the ORS currently enforces medical insurance for the children.

 

local governments:

None--Administrative rules of ORS do not apply to local governments, therefore there are no costs or savings.

 

other persons:

The cost of the children's portion of the premiums is split 50/50 between the parents. If the unobligated parent has been providing medical insurance and the obligated parent begins providing coverage, both the obligated parent and the unobligated parent may experience a savings if the cost of the obligated parent's insurance is lower. However, the reverse would be true if the cost of the obligated parent's insurance is higher.

 

Compliance costs for affected persons:

The cost of the children's portion of the premiums is split 50/50 between the parents, regardless of which parent obtains coverage, so cost is not the major issue unless there is a large difference in the cost of insurance between the two parents. If the support order requires the Non Custodial Parent (NCP) to carry insurance but the Custodial Parent (CP) has been providing it, the state's federally-required automated system--Office of Recovery Services Information System (ORSIS)--must send the National Medical Support Notice (NMSN) to the NCP's employer. If the parents do not wish this to occur, they can stipulate to a modification of the support order to make the parent who currently carries insurance the obligated parent, or better, to make them both obligated on an "either/or" basis so regardless of which parent obtains insurance in the future the coverage will be consistent with the order.

 

Comments by the department head on the fiscal impact the rule may have on businesses:

The costs associated with implementing the NMSN have already been incurred by employers in this state and nationwide, because existing federally-required automation has already sent notices to employers in most cases. The change in wording will conform the rule to an enhancement in ORSIS that will take effect at the end of September 2004, so in the few remaining cases in which obligated parents have not yet complied with the terms of their support orders, they will be required to do so (unless they wish to stipulate to modify their orders).

 

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Human Services
Recovery Services
515 E 100 S
SALT LAKE CITY UT 84102-4211

 

Direct questions regarding this rule to:

LeAnn Wilber at the above address, by phone at 801-536-8950, by FAX at 801-536-8509, or by Internet E-mail at [e-mail]

 

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

11/15/2004

 

This rule may become effective on:

11/16/2004

 

Authorized by:

Emma Chacon, Director

 

 

RULE TEXT

R527. Human Services, Recovery Services.

R527-201. Medical Support Services.

R527-201-1. Federal Requirements.

The Office of Recovery Services/Child Support Services, (ORS/CSS), adopts the federal regulations as published in 45 CFR 303.30 and 303.31 (2000), and 45 CFR 303.32 which are incorporated by reference in this rule.

 

R527-201-2. Definition.

1. The National Medical Support Notice (NMSN) is the federally approved form that ORS/CSS shall use, when appropriate, to notify an employer to enroll dependent children in an employment-related group health insurance plan in accordance with a child support order.

 

R527-201-3. Limitation of Services.

ORS/CSS shall not:

1. pursue establishment of specific amounts for ongoing medical support,

2. initiate an action to obtain a judgment for uninsured medical expenses, or

3. collect and disburse premium payments to insurance companies.

 

[R527-201-4. Medical Support Services in Non-IV-A Cases.

Medical Support Services shall be provided in conjunction with child support services to applicants who are not receiving Medicaid unless the applicant notifies ORS/CSS that the children are already covered under a health insurance plan and provides ORS/CSS with the insurance information.

 

]R527-201-4[5]. Conditions Under Which Non-IV-A Medicaid Recipients May Decline Support Services.

ORS/CSS shall provide child and spousal support services; however, a Non-IV-A Medicaid recipient may decline child and spousal support services if paternity is not an issue and there is an order for the non-custodial parent to provide medical support.

 

R527-201-5[6]. Securing a Medical Support Provision in the Support Order.

1. Notice to potentially obligated parents: The notice to potentially obligated parents shall include a provision that an administrative or judicial proceeding will occur to determine whether either parent should be ordered to purchase and maintain appropriate medical insurance for the children. This notification shall be provided when either of the following conditions is met:

a. the state initiates an action to establish a final support order or to adjust an existing child support order; or

b. the state joins a divorce or modification action initiated by either the custodial or the non-custodial parent.

2. If a judicial support order does not include a medical support provision, ORS/CSS shall commence judicial action to modify the order to include a medical support provision.

 

R527-201-6[7]. Reasonable Cost of Insurance Premiums.

Employment-related or other group coverage that does not exceed 5% of the obligated parent's monthly gross income is generally considered reasonable in cost. However, an employer may not withhold more than the lesser of the amount allowed under the Consumer Credit Protection Act, the amount allowed by the state of the employee's principal place of employment, or the amount allowed for health insurance premiums by the child support order. If the combined child support and medical support obligations exceed the allowable deduction amount, the employer shall withhold according to the law, if any, of the state of the employee's principal place of employment requiring prioritization between child support and medical support. If the employee's principal place of employment is in Utah, the employer shall deduct current child support before deducting amounts for health insurance coverage. If the amount necessary to cover the health insurance premiums cannot be deducted due to prioritization or limitations on withholding, the employer shall notify ORS/CSS.

 

R527-201-7[8]. Credit for Premium Payments and Effect of Changes to the Premium Amount Subsequent to the Order.

1. If the order or underlying worksheet gives credit of a specific amount for the children's portion of the premium and the amount of the premium decreases, ORS/CSS may reduce the amount of the credit without seeking a modification of the order.

2. If the order or underlying worksheet does not mention a specific credit for insurance premiums, ORS/CSS shall give credit for the child(ren)'s portion of the insurance premium when the obligated parent provides the necessary verification coverage.

3. ORS/CSS shall notify both parents in writing whenever the credit is changed.

 

R527-201-8[9]. Establishing Costs for Pregnancy and Confinement.

1. When establishing a judgment for medical costs for pregnancy and confinement in IV-A and Non-IV-A Medicaid paternity and separation cases, ORS/CSS shall research the exact pregnancy and confinement costs which have accumulated to date.

2. When establishing a judgment for medical costs for pregnancy and confinement in Non-IV-A Non-Medicaid Cases, ORS/CSS shall consult with the mother to determine the amount of the uninsured pregnancy and confinement expenses.

3. When establishing any judgment for medical costs for pregnancy and confinement, one half of the uninsured pregnancy and confinement costs shall be charged to the non-custodial parent.

 

R527-201-9[10]. Enforcement of Obligation to Maintain Medical and Dental Insurance.

1. In Non-IV-A cases and in IV-A Medicaid cases, appropriate steps shall be taken to ensure compliance with orders which require the obligated parent to maintain insurance. Obligated parents shall demonstrate compliance by providing ORS/CSS with policy numbers and the insurance provider name for the dependent children for whom the medical support is ordered.

2. In Non-IV-A cases and in IV-A Medicaid cases, if an obligated parent has been ordered to maintain employer-based medical insurance and insurance is available at a reasonable cost according to R527-201-7 through an employment-related group health plan, ORS/CSS shall use the NMSN to transfer notice of the insurance provision to the obligated parent's employer unless ORS/CSS is notified pursuant to Section 62A-11-326.1 that the children are already enrolled in an insurance plan in accordance with the order.

3. When appropriate, ORS/CSS shall send the NMSN to the obligated parent's employer within two business days after the name of the obligated parent has been entered into the registry of the State Directory of New Hires, matched with ORS/CSS records, and reported to ORS/CSS in accordance with Subsection 35A-7-105(2).

4. The employer shall transfer the NMSN to the appropriate group health plan for which the children are eligible within twenty business days of the date of the NMSN if all of the following criteria are met:

a. the obligated parent is still employed by the employer;

b. the employer maintains or contributes to plans providing dependent or family health coverage;

c. the obligated parent is eligible for the coverage available through the employer; and

d. state or federal withholding limitations, prioritization, or both, do not prevent withholding the amount required to obtain coverage.

5. If more than one coverage option is available under a group insurance plan and the obligated parent is not already enrolled, ORS/CSS in consultation with the custodial parent may select the least expensive option if the option complies with the child support order and benefits the children. The insurer shall enroll the children in the plan's default option or least expensive option in accordance with Subsection 62A-11-326.2(1)(b) unless another option is specified by ORS/CSS.

6. The employer shall determine if the necessary employee contributions for the insurance coverage are available. If the amounts necessary are available, the employer shall begin withholding when appropriate and remit directly to the plan.

7. In accordance with Subsections 62A-11-326.1(2) and (3), the obligated parent may contest withholding insurance premiums based on a mistake of fact. The employer shall continue withholding under the NMSN until notified by ORS/CSS to terminate withholding insurance premiums.

8. If a parent successfully contests the action to enroll the children in a group health plan based on a mistake of fact, ORS/CSS shall notify the employer to discontinue enrollment and withholding insurance premiums for the children.

9. In accordance with Subsection 62A-11-406(9), the employer shall promptly notify ORS/CSS when the obligated parent's employment is terminated.

10. ORS/CSS shall promptly notify the employer when a current order for medical support is no longer in effect for which ORS/CSS is responsible.

 

R527-201-11[10]. Obligated Parent Receiving Medicaid.

1. If an obligated parent is receiving Medicaid or was receiving Medicaid at the time the medical debt was incurred, ORS/CSS shall not enforce payment of the medical debt regardless of medical support provisions in the order.

2. In an unestablished paternity case, if the father's income was taken into consideration when determining the household's eligibility for Medicaid, ORS/CSS shall not enforce payment of medical expenses regardless of the medical support provisions in the order, but shall enforce the health insurance provision.

 

KEY: child support, health insurance, Medicaid

[March 5, 2003]2004

Notice of Continuation January 30, 2002

63-46b-1 et seq.

62A-11-326.1

62A-11-326.2

62A-11-326.3

62A-11-406(9)

78-45-7.15

35A-7-105(2)