No. 28244 (Amendment): R527-201. Medical Support Services

DAR File No.: 28244
Filed: 09/19/2005, 09:37
Received by: NL

 

RULE ANALYSIS

Purpose of the rule or reason for the change:

The reason for the change is to delete reference to a procedure which the child support program has not used since January 2001 due to national and state policy considerations. These considerations include the following: first, pregnancy and confinement costs are viewed under state law as attributable to the care of the mother rather than as child support. The federal/state child support program is authorized to establish orders only for child support obligations, but not for spousal support obligations. The program is authorized to collect a spousal support obligation, but only if it has been established previously along with a child support obligation in a court order that was obtained privately by the parents; second, federal and state policy considerations place priority on encouraging Medicaid-eligible pregnant mothers to obtain needed pre-natal care and pregnancy and confinement assistance for the health and welfare of both the mother and unborn child, and the prospect of creating a large debt for the fathers of such children immediately after birth tends to discourage mothers from obtaining the needed assistance; and third, federal and state policy considerations place a priority on encouraging both parents to voluntarily cooperate in establishing paternity and a prospective support order as early as possible after the birth of the child, and charging a large retroactive debt immediately after the birth tends to discourage such voluntary cooperation.

 

Summary of the rule or change:

The change to this rule deletes the establishment of pregnancy and confinement costs procedure which the Office of Recovery Services (ORS) has not used since January 2001.

 

State statutory or constitutional authorization for this rule:

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

 

Anticipated cost or savings to:

the state budget:

There will be no change to state budgets because the procedure has not been in use since January 2001, after discussions with decision-makers in the Department of Human Services and the Department of Health. Currently, when paternity is established, ORS establishes a prospective support order which includes both a financial support award and a provision requiring the parents to maintain health insurance coverage; however, a retroactive judgment for the cost of pregnancy and confinement is not established.

 

local governments:

None--Administrative rules of ORS do not apply to local government.

 

other persons:

Under state law Mothers who have not received Medicaid may still pursue judgments for pregnancy and confinement costs through private legal counsel and the courts if they wish, but this service is not offered through the federal/state-funded child support program.

 

Compliance costs for affected persons:

There may be a cost to mothers that want to establish a judgment on their own for pregnancy and confinement costs.

 

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

There will be no fiscal impact on businesses because this change has been in practice since January 2001. Lisa-Michele Church, Executive Director

 

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:

Kristen Lowe at the above address, by phone at 801-536-0347, by FAX at 801-536-8833, 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:

11/14/2005

 

This rule may become effective on:

11/15/2005

 

Authorized by:

Mark Brasher, Acting Director

 

 

RULE TEXT

R527. Human Services, Recovery Services.

R527-201. Medical Support Services.

[R527-201-8. 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]8. 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-[10]9. 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

[November 30, 2004]2005

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)