REVIEW AND ADJUSTMENT OF A SUPPORT ORDER

CS 451P Review and Adjustment (Modification) of a Support Order to Include MEDICAL Support Only

01/92 Revised 04/03/18 Training Completed 04/17/18 

45 CFR 303.31; UCA 62A-11-326, 78B-12-111, 78B-12-212

 

 

Statutory Authority

 

Federal regulations found at 45 CFR 303.31 states:

“(b) The State IV–D agency must:

(1) Petition the court or administrative authority to -

(i) Include health care coverage that is accessible to the child(ren), as defined by the State, and is available to the parent responsible for providing medical support and can be obtained for the child at reasonable cost, as defined under paragraph (a)(3) of this section, in new or modified court or administrative orders for support; and

(ii) Allocate the cost of coverage between the parents.

(2) If health care coverage described in paragraph (b)(1) of this section is not available at the time the order is entered or modified, petition to include cash medical support in new or modified orders until such time as health care coverage, that is accessible and reasonable in cost as defined under paragraph (a)(3) of this section, becomes available. In appropriate cases, as defined by the State, cash medical support may be sought in addition to health care coverage.

 

This requirement applies to IV-A cases, Medicaid only cases, and Non-IV-A cases where the applicant is not a Medicaid recipient. 

 

Federal regulations also require states to develop criteria to identify child support cases with existing orders which do not include medical insurance coverage for the dependent children but have a high potential for obtaining medical support, and to pursue modification of support orders in these cases to include a medical insurance provision.  The case criteria developed by the Office of Recovery Services/Child Support Services (ORS/CSS) are listed below.

 

U.C.A. 62A-11-326.  Medical and dental expenses of dependent children, states:

 “In any action under this part, the office and the department in their orders shall:

(1) include a provision assigning responsibility for cash medical support;

(2) include a provision requiring the purchase and maintenance of appropriate medical, hospital, and dental care insurance for those children, if:

(a) insurance coverage is or becomes available at a reasonable cost; and

(b) the insurance coverage is accessible to the children; and

(3) include a designation of which health, dental or hospital insurance plan, is primary and which is secondary in accordance with the provisions of Section 30-3-5.4 which will take effect if at any time the dependent children are covered by both parents' health, hospital, or dental insurance plans.”

 

NOTE:  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.  If this primary/secondary designation is specifically contested during an administrative establishment process, refer the case for judicial establishment.

 

If both parents were born in the same month, then the parent, whose birthday occurs first in the month, is designated as the primary coverage for the dependent child.  If both parents were born on the same day, then the parent whose birth year is first is designated as primary coverage for the child.  If both parents were born in the same year, then the parent whose insurance plan was in effect first is designated as primary coverage for the child.

 

U.C.A. 78B-12-111.  Court order – Medical expenses of dependent children – Assigning responsibility for payment – Insurance coverage – Income withholding:

“The court shall include the following in its order:

(1) a provision assigning responsibility for the payment of reasonable and necessary medical expenses for the dependent children;

(2) a provision requiring the purchase and maintenance of appropriate insurance for the medical expenses of dependent children, if coverage is or becomes available at a reasonable cost; . . .”

 

U.C.A. 78B-12-212.  Medical expenses:

 “(2) (a) The court shall order that a parent provide insurance for the medical expenses of a minor child if insurance is available to that parent at a reasonable cost.”

 

 

Criteria

 
Federal regulations found at 45 CFR 303.31(b)(3) requires states to:

(3) Establish criteria, which are reflected in a record, to identify orders that do not address the health care needs of children based on -

(i) Evidence that health care coverage may be available to either parent at reasonable cost, as defined under paragraph (a)(3) of this section; and

(ii) Facts, as defined by State law, regulation, procedure, or other directive, and review and adjustment requirements under § 303.8(d) of this part, which are sufficient to warrant modification of the existing support order to address the health care needs of children in accordance with paragraph (b)(1) of this section.

 

If the case was opened prior to September 1, 1999, and the applicant originally declined medical support services, the case will fall into one of the categories listed below.

 

NOTE:  Work all cases in category one before moving on to cases in the other categories.

 

1.                   No medical provision in the judicial support order, but either the non-custodial parent (NCP) or the custodial parent (CP) currently has insurance coverage on the children. You must proceed to obtain an insurance order.

 

The insurance must be accessible to the child(ren) pursuant to R527-201-3(1), which states, “. . . 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.                   No medical support provision in the support order, the children are currently NOT covered by insurance, and insurance MAY be available to the NCP.  Proceed as follows:

a.                   Contact the NCP or his/her employer by phone or letter to determine if insurance is available to the NCP through his/her employer.

b.                  If insurance is unavailable to the NCP, but s/he informs you that insurance is available to the CP, contact the CP or his/her employer to determine if insurance is available.

 

3.                   No medical support provision in the support order, the children are currently NOT covered by insurance and insurance is not available to the children.  For cases to fall into this category you must have verified, at a minimum, that insurance is unavailable to both the NCP and the CP by contacting his/her employer.  You do not need to pursue the medical insurance provision until such time coverage becomes available to the children. 

 

4.                   There is a medical support provision in an administrative order but it does not specifically include dental coverage, and the NCP’s and/or CP’s employer is challenging a “National Medical Support Notice" on the grounds that the order does not specify that dental coverage should be provided.  Only enforce the medical provision and amend the order to include the current medical provision that orders medical and dental coverage.   The modification for dental coverage will be prospective only.  Any claims for dental expenses prior to the effective date of the amended order must be addressed judicially by the participants through private counsel.  A new “National Medical Support Notice” may be sent to the employer after the order has been amended.  Judicial orders issued by CSS are not affected.

 

5.                   There is a medical support provision in the order, but the parent ordered to provide medical insurance is currently on Medicaid with the child(ren).  This criteria is in accordance with Federal regulations found at 45 CFR 303.31(b)(1), which states:

(1) Petition the court or administrative authority to -

(i) Include health care coverage that is accessible to the child(ren), as defined by the State, and is available to the parent responsible for providing medical support and can be obtained for the child at reasonable cost, as defined under paragraph (a)(3) of this section, in new or modified court or administrative orders for support; . . . 

 

Write a case narrative every time you evaluate a case for possible adjustment to include a medical support provision and record the results of the evaluation in the case narrative.

 

 

Criteria Exceptions

 

Do NOT proceed to establish a medical support order if the case meets the criteria listed below.

 

1.                   The last child on the case will emancipate within 12 months of the date the case would be referred to the AG to pursue judicial action.  (If the parties are willing to stipulate to the standard language, refer the case to the AG.)

 

2.                   It is not in the best interests of the child. Generally, the best interest of the child is limited to the determination of good cause, or a protective order or non-disclosure order has been issued.

 

3.                   You have verified that insurance (employment related) is unavailable  to either party.  However, if the parties are willing to stipulate to the standard language, refer the case to the AGO.


NOTE:  In this situation, you may still want to pursue a medical support modification; employment related insurance may become available to one of the parties in the future.

 

4.                   A tribal support order does not mention medical support and either the CP or the NCP reside on the reservation.

 

5.                   If the NCP has entered a court ordered in-patient licensed mental health or substance abuse treatment program, do not attempt to review or adjust the support order to include medical support.  If the NCP is in an out-patient treatment program, or once s/he is released as an in-patient, you may proceed to review an order to include medical.

 

 

Pre-request Procedures

 

When you receive a written request for a medical only review or when the criteria listed above for a medical only review are met, follow the review and adjustment procedures in CS 450P-1 Initiating a Review and Pre-request Procedures.

 

 

Review Procedures

 

You have 180 days to complete a review and adjustment, if necessary.  Follow the steps below to complete the review.

 

1.                   If the non-requesting parent has failed to return the required documents, attempt to obtain the best available information regarding the non-requesting parent’s insurance. 

 

2.                   Update ORSIS with the results of the review.

 

For judicial orders, follow the steps below to refer the case to the AGO.

 

3.                   Send the case to the AGO. 


NOTE:  If either parent contacts you and asks, “Do I need to respond to the Summons if I agree with the pleadings?”, inform the parent that each party must answer the Summons in writing because we do not represent either party in the action.  In particular, if the parent who requested the modification fails to answer the Summons, the AGO may file a motion to dismiss.  Refer the parent to the AGO to find out exactly how to respond.

 

4.                   When the AGO is done with the modification, they will document the results and return the case to you.

 

5.                   If the AGO:

a.                   Declines to proceed with the modification - verify that Volume 2 was followed: 

i.                     Were followed – proceed to step #7.

ii.       Were not followed – consult with your management chain for further discussion.  The case may need to be addressed in the monthly meetings held with the AGO.

b.                  Completed the modification – the medical support order must also contain a cash medical support provision pursuant to 78B-12-212(6), which states, “The order shall include a case medical support provision that requires each parent to equally share all reasonable and necessary uninsured and unreimbursed medical and dental expenses incurred for the dependent children, including but not limited to deductibles and copayments.”

 

The insurance must be accessible to the child(ren) pursuant to R527-201-3(1), which states, “. . . 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.”

 

6.                   Update the ORSIS with the new order information.

 

7.                   Write a case narrative any time you take an action during the review process.

 

 

Cooperation

 

If the CP in a IV-A case refuses to stipulate to a medical support order, refer the case to the AGO to initiate legal action.  If the applicant in a Non-IV-A case refuses to cooperate, follow closure procedures.  

 

If the NCP refuses to cooperate in obtaining a medical support order, refer the case to the AGO.

 

 

Intergovernmental Cases, Other State Orders

 

On incoming interstate cases, if insurance is available you must proceed to establish a medical support provision if one does not exist. Federal Regulations requires us to provide the same services to interstate and intrastate cases when establishing and/or enforcing a medical support provision.