Human Services, Recovery Services

Rule R527-201

Medical Support Services

Notice of Proposed Rule

(Amendment)

DAR File No.: 33627
Filed: 05/10/2010 02:22:07 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

To clarify how the Office of Recovery Services will designate in administrative orders which parent's health, hospital, or dental insurance plan is primary and which parent's health, hospital, or dental insurance plan is secondary in accordance with Sections 30-3-5 and 30-3.5.5. This provision will take effect if, at any time, a dependent child is covered by both parents' health, hospital, or dental insurance plans.

Summary of the rule or change:

This change adds a new section, R527-201-10, Coordination of Health Insurance Benefits, which clarifies that the parent whose birthday occurs first in the calendar year will carry the primary insurance coverage for the child, if at any time a dependent child is covered by both parents' health, hospital, or dental insurance plans. Also, adding the law reference for Sections 30-3-5 and 30-3-5.5 to the Authorizing, and Implemented or Interpreted Law section.

State statutory or constitutional authorization for this rule:

• Section 62A-1-111
• Section 62A-11-326.3
• Subsection 62A-11-103(2)
• Section 63G-4-102 et seq.
• Section 62A-11-326
• Section 62A-11-326.1
• Section 62A-11-326.2
• 45 CFR 303.30
• Subsection 62A-11-406(9)
• Subsection 78B-12-102(6)
• 45 CFR 303.32
• Section 78B-12-212
• Subsection 35A-7-105(2)
• Section 62A-11-107
• 45 CFR 303.31

Anticipated cost or savings to:

the state budget:

There are no anticipated costs or saving to the state because the changes to the rule affect documents that are already being generated for other reasons. The office has been and is still required to provide the same services pursuant to federal regulations and state law.

local governments:

Administrative rules of the Office of Recovery Services/Child Support Services (ORS/CSS) do not apply to local government; therefore, there are no anticipated costs or savings for any local businesses due to this amendment.

small businesses:

There are no anticipated costs or savings to small businesses because the changes to the rule do not affect the ways that employers administer insurance policies. The changes to the rule are consistent with the way insurance companies currently determine the primary insurance carrier when/if both parents provide health, hospital, or dental insurance for the child.

persons other than small businesses, businesses, or local governmental entities:

There are no anticipated costs or savings to other persons because the changes to the rule are consistent with the way insurance companies currently determine the primary insurance carrier when/if both parents provide health, hospital, or dental insurance for the child.

Compliance costs for affected persons:

There are no anticipated costs or savings to affected persons because the changes to the rule do not affect the way that the Office of Recovery Services does business. The changes to the rule only designate which parent's insurance will be designated in administrative orders issued by the Office of Recovery Services as the primary coverage when/if both parents provide heath, hospital, or dental insurance for a minor child. The designation is consistent with the way insurance companies currently determine the primary insurance carrier.

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

There are no anticipated costs or savings to affected persons because the changes to the rule do not affect the way that employers administer insurance policies. The changes to the rule only designate which parent's insurance will be designated in administrative orders issued by the Office of Recovery Services as the primary coverage when/if both parents provide heath, hospital, or dental insurance for a minor child. The designation is consistent with the way insurance companies currently determine the primary insurance carrier.

Lisa-Michelle 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:

• LeAnn Wilber at the above address, by phone at 801-536-8950, by FAX at 801-536-8833, or by Internet E-mail at [email protected]

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:

07/01/2010

This rule may become effective on:

07/08/2010

Authorized by:

Mark Brasher, Director

R527. Human Services, Recovery Services.

R527-201. Medical Support Services.

R527-201-1. Authority and Purpose.

1. The Department of Human Services is authorized to create rules necessary for the provision of social services by Section 62A-1-111 and 62A-11-107.

2. The purpose of this rule is to specify the responsibilities and procedures for the Office of Recovery Services/Child Support Services for providing medical support services.

 

R527-201-2. Federal Requirements.

The Office of Recovery Services/Child Support Services, (ORS/CSS), adopts the federal regulations as published in 45 CFR 303.30, 303.31, and 303.32 (2008)which are incorporated by reference in this rule.

 

R527-201-3. Definitions.

1. Accessibility: Insurance is considered accessible to the child if non-emergency services covered by the health plan are available to the child within 90 minutes or 90 miles of the child's primary residence.

2.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.

3. Cash Medical Support: An obligation to equally share all reasonable and necessary medical and dental expenses of children.

 

R527-201-4. 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.

 

R527-201-5. 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.

 

R527-201-6. 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:

a. order either parent to purchase and maintain appropriate medical insurance for the children, and

b. order both parents to pay cash medical support. 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.

 

R527-201-7. 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.

 

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

1. 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.

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

 

R527-201-9. 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 insurance and insurance is accessible and available at a reasonable cost, 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:

a. notify ORS/CSS within five days after the obligated parent terminates employment;

b. provide the office with the obligated parent's last-known address; and

c. the name and address of any new employer, if known.

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. Coordination of Health Insurance Benefits.

If, at any point in time, a dependent child is covered by the health, hospital, or dental insurance plans of both parents, the health, hospital, or dental insurance plan of the parent whose birthday occurs first in the calendar year, shall be designated as primary coverage for the dependent child. The health, hospital, or dental insurance plan of the other parent shall be designated as secondary coverage for the dependent child.

 

R527-201-11. Obligated Parent Receiving Medicaid.

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

Date of Enactment or Last Substantive Amendment: [November 10, 2009]2010

Notice of Continuation: January 16, 2007

Authorizing, and Implemented or Interpreted Law: 30-3-5; 30-3-5.5; 62A-1-111; 62A-11-103(2); 62A-11-107; 62A-11-326; 62A-11-326.1; 62A-11-326.2; 62A-11-326.3; 62A-11-406(9); 63G-4-102 et seq.; 78B-12-102(6); 78B-12-212; 35A-7-105(2); 45 CFR 303.30; 45 CFR 303.31; 45 CFR 303.32