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DAR File No. 32492

This filing was published in the 05/01/2009, issue, Vol. 2009, No. 9, of the Utah State Bulletin.

Human Services, Recovery Services


Medical Support Services


DAR File No.: 32492
Filed: 04/02/2009, 09:01
Received by: NL


Purpose of the rule or reason for the change:

The purpose of this amendment is to add the authority and purpose, a couple of new definitions, and delete the references to the Office of Recovery Services/Child Support Services (ORS/CSS) not enforcing an obligated parent to pay a medical debt or expenses, even if there is a medical support provision in the order, if the obligated parent is or has been on Medicaid. This change will allow ORS to collect court-ordered cash medical support.

Summary of the rule or change:

This amendment adds the purpose and authority sections and renumbers subsequent sections, adds definitions to Section R527-203-3, adds supporting language to Sections R527-201-6 and R527-201-9 to support cash medical support, and deletes the current Subsection R527-201-9(1).

State statutory or constitutional authorization for this rule:

Sections 63G-4-102 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 may be a small savings to the state budget when/if the office collects court-ordered cash medical support from an obligated parent and those funds can be used to avoid state Medicaid expenses for the obligated parent's child. There will also be costs associated with enforcing these debts via the generation and mailing of the Notice to Withhold Income to the obligated parent's employer, as well as the state employee's time to monitor these debts.

local governments:

Administrative rules of the 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 and persons other than businesses:

There are not anticipated costs for small business because the changes affect the internal procedures of the ORS/CSS and provide clarification to the child support staff. There will now be costs to the obligated parent who receives Medicaid if that parent has a court-ordered cash medical support obligation. The costs will vary depending on the medical support amount identified in the court order.

Compliance costs for affected persons:

There will now be costs associated with the obligated parent who receives Medicaid and has a court-ordered cash medical support obligation. The costs will vary depending on the medical support amount identified in the court order.

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

The impact to businesses as a result of these changes to this rule should be minimal, because many of the obligated parents meeting this criteria work for employers that have procedures in place to accommodate a Notice to Withhold Income for Child Support received from the office. Some of the cases meeting the criteria will already have a Notice to Withhold Income for Child Support currently in place with the employer. Because the employer has already implemented withholding procedures for the obligated parent, there should be minimal cost associated with an updated Notice to Withhold Income for Child Support to include an amount for the medical support debt. Most of the other cases will have a Notice to Withhold Income for Child Support sent to the employer anyway, once a child support obligation has been established. The office only needs to include an additional amount for the medical support debt in that withholding order. If the case is a Medicaid-only case, the office currently sends the National Medical Support Notice to employers to enroll the obligated parent's child(ren) in health insurance. If the obligated parent has a monthly medical support debt, the office will send a Notice to Withhold Income for Child Support to include collection of the monthly medical support debt. The cost to the employer should still be minimal, because the employer already processes the National Medical Support Notice to enroll the obligated parent's child(ren) in health insurance. In addition to enrolling the child(ren) in health insurance, the employer will now need to include a deduction for the monthly medical support debt. 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

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:


This rule may become effective on:


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, [and ]303.31, and 303.32 ([2000]2008)[, and 45 CFR 303.32 ]which are incorporated by reference in this rule.


R527-201-[2]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.

[1]2. [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.

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


R527-201-[3]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-[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]

a. order either parent [should be ordered ]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-[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. 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 accessible and 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-[9]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

Date of Enactment or Last Substantive Amendment: [November 17, 2005]2009

Notice of Continuation: January 16, 2007

Authorizing, and Implemented or Interpreted Law: 62A-1-111; 62A-11-103(2); 62A-11-107; 62A-11-326;[63G-4-102 et seq.; ]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




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For questions regarding the content or application of this rule, please contact LeAnn Wilber at the above address, by phone at 801-536-8950, by FAX at 801-536-8833, or by Internet E-mail at

For questions about the rulemaking process, please contact the Division of Administrative Rules (801-538-3764). Please Note: The Division of Administrative Rules is NOT able to answer questions about the content or application of these administrative rules.

Last modified:  04/29/2009 12:08 PM