COMMENT DUE DATE:
September 27, 2018
DATE:
September 17, 2018
Tammy Hall, Programs Manager 405-522-0022
Dena Thayer, Programs Administrator 405-521-4326
Nancy Kelly, Policy Specialist 405-522-6703
RE:
APA WF 18-14
The proposed policy is Emergency . This proposal is subject to Administrative Procedures Act
It is important that you provide your comments regarding the draft copy of policy by the comment due date.Comments are directed to STO.LegalServices.Policy@okdhs.org.The proposed policy is emergency.
SUBJECT:CHAPTER 25. CHILD SUPPORT SERVICES
Subchapter 5. Operational Policies
Part 20. Medical Support
340:25-5-168 [AMENDED]
(WF 18-14)
SUMMARY:
The proposed amendment to Chapter 25, Subchapter 5, amends the rule to align with Senate Bill 979 (SB 979) from the 2nd Session of the 56th Legislature that amended Section 118F of Title 43 (43 O.S. § 118F) to comply with Section 303.31(b)(2) of Title 45 of the Code of Federal Regulations (45 C.F.R. § 303.31(b)(2)) that mandates Child Support Services (CSS) include government medical assistance, such as SoonerCare (Medicaid), as qualifying health care coverage.
Subchapter 5. Operational Policies
Part 20. Medical Support
Oklahoma Administrative Code (OAC)340:25-5-168 is amended to: (1) modify the definition of health care coverage to include government medical assistance programs or health plans; (2) remove unnecessary language; and (3) change references to health insurance to health care coverage.
LEGAL AUTHORITY:Director of Human Services, 56 O.S. § 162, Section 666 of Title 42 of the United States Code; 45 C.F.R. § 303.31 and 43 O.S. § 118F.
Rule Impact Statement
To:Programs Administrator
Legal Services - Policy
From:Renee Banks, Director
Child Support Services
Date:August 23, 2018
Re:CHAPTER 25. CHILD SUPPORT SERVICES
Subchapter 5. Operational Policies
Part 20. Medical Support
340:25-5-168 [AMENDED]
(WF 18-14)
Contact:Tammy Hall, Programs Manager, 522-0022
A.Brief description of the purpose of the proposed rule.
Purpose.
The proposed amendment to Chapter 25, Subchapter 5, amends the rule to align withSenate Bill 979 (SB 979) from the 2nd Session of the 56th Legislature that amended Section 118F of Title 43 (43 O.S. § 118F) to comply with Section 303.31(b)(2) of Title 45 of the Code of Federal Regulations (45 C.F.R. § 303.31(b)(2)) that mandates Child Support Services (CSS) include government medical assistance, such as SoonerCare (Medicaid), as qualifying health care coverage.
Strategic Plan Impact.
The proposed amendment supports Oklahoma Department of Human Services (DHS) goals of helping Oklahomans lead safer, healthier, more independent and productive lives; by providing customers access to resources to achieve and maintain healthy families, prioritizing CSS staff's ability to provide core services to customers, and clarifying how CSS provides services to customers.
Substantive changes.
Subchapter 5. Operational Policies
Part 20. Medical Support
Oklahoma Administrative Code (OAC)340:25-5-168 is amended to:(1) modify the definition of health care coverage to include government medical assistance programs or health plans; (2) remove unnecessary language; and (3) change references to health insurance to health care coverage.
Reasons.
The proposed amendment brings OAC 340:25-5-168 into compliance with federal and state law. SB 979, approved by the Governor and effective November 1, 2018, changes the definition of health care coverage to include public assistance medical coverage, such as SoonerCare (Medicaid), in the establishment and enforcement of a child support order.
Repercussions.
The proposed amendment aligns OAC 340:25-5-168 with federal and state statutes.Failure to do so could lose or suspend Title IV-D federal funding.
Legal authority.
Director of Human Services, 56 O.S. § 162, Section 666 of Title 42 of the United States Code; 45 C.F.R. § 303.31; and 43 O.S. § 118F.
Emergency rulemaking approval is requested.
B.A description of the classes of persons who most likely will be affected by the proposed rule, including classes that will bear the costs of the proposed rule, and any information on cost impacts received by the Agency from any private or public entities:The classes of persons most likely to be affected by the proposed amendment are children entitled to support, non-custodial parents (NCP) who owe child support, and custodial parents (CP) who are owed child support.The public bears the cost of the proposed amendment through taxes allocated to public assistance programs.
C.A description of the classes of persons who will benefit from the proposed rule:The classes of persons who will benefit are CPs who are owed child support and dependent children.
D.A description of the probable economic impact of the proposed rule upon the affected classes of persons or political subdivisions, including a listing of all fee changes and, whenever possible, a separate justification for each fee change:The proposed amendment does not have a negative economic impact on CPs or NCPs.There is no effect on political subdivisions.There are no fees associated with the proposed amendments.
E.The probable costs and benefits to the Agency and to any other agency of the implementation and enforcement of the proposed rule, the source of revenue to be used for implementation and enforcement of the proposed rule and any anticipated effect on state revenues, including a projected net loss or gain in such revenues if it can be projected by the Agency:The probable cost to DHS includes the cost of printing and distributing the rules and training materials is estimated to be under $100, is within current budget, and requires no additional funding.
F.A determination whether implementation of the proposed rule will have an impact on any political subdivisions or require their cooperation in implementing or enforcing the rule:The proposed amendment does not have an economic impact on any political subdivision, nor will the cooperation of any political subdivisions be required in implementation or enforcement of the rules.
G.A determination whether implementation of the proposed rule will have an adverse economic effect on small business as provided by the Oklahoma Small Business Regulatory Flexibility Act:There are no anticipated adverse effects on small business as provided by the Oklahoma Small Business Regulatory Flexibility Act.
H.An explanation of the measures the Agency has taken to minimize compliance costs and a determination whether there are less costly or nonregulatory methods or less intrusive methods for achieving the purpose of the proposed rule:The proposed amendment is intended to minimize compliance costs and intrusive regulations while fully complying with federal and state mandates.There are no less costly or intrusive methods to achieve full compliance.
I.A determination of the effect of the proposed rule on the public health, safety, and environment and, if the proposed rule is designed to reduce significant risks to the public health, safety, and environment, an explanation of the nature of the risk and to what extent the proposed rule will reduce the risk:The proposed amendment is intended to comply with federal and state child support mandates, increase program effectiveness, protect CSS staff's ability to deliver services, and improve services delivered to families, thereby contributing to the health, safety, and wellbeing of children entitled to support.
J.A determination of any detrimental effect on the public health, safety, and environment if the proposed rule is not implemented:Failure to adopt this amendment could cause hardships on families by limiting the ability of qualifying persons to select SoonerCare (Medicaid) as sufficient to meet the requirements of providing medical support for dependent child(ren).
K.The date the rule impact statement was prepared and, if modified, the date modified:Prepared: August 23, 2018.
SUBCHAPTER 5. OPERATIONAL POLICIES
PART 20. MEDICAL SUPPORT
340:25-5-168. Establishment of medical support
Revised 9-15-1611-1-18
(a) Scope and applicability.Oklahoma Department of Human Services (DHS) Child Support Services (CSS) refers to federal and state law for establishment of a medical support order, per:
(1) Section 666 of Title 42 of the United States Code;
(2) Sections 302.33, 302.56, 303.7, 303.30, and 303.31 of Title 45 of the Code of Federal Regulations; and
(3) Section 6058A of Title 36 of the Oklahoma Statutes (36 O.S. § 6058A),; 43 O.S. §§ 112, 118-118I, 118.2, and 119,; and 56 O.S. § 237.¢ 1
(b) Medical support provision of child support order.A child support order established by CSS must contain a medical support provision.¢ 2
(c) Calculating the cost of medical support.To calculate the actual premium cost of health insurance, CSS:
(1) deducts from the total insurance premium, the cost of coverage for the parent;
(2) deducts from the total insurance premium, the cost of coverage for any other adults in the household, when that cost information is available;
(3) divides the remainder by the number of dependent children covered; and
(4) multiplies the amount per child by the number of children in the child support case under consideration.¢ 3 & 4
(d) Standards for medical support provision.When choosing a medical support provision, CSS requests the court to apply the standards in paragraphs (1) through (3) of this subsection.
(1) Health insurance must be reasonable in cost, meaning that the pro rata share of the actual out-of-pocket premium cost paid for the child(ren) by the insured does not exceed five percent of the gross income of the parent ordered to provide health insurance.¢ 3, 5, & 6
(2) Health insurance must be accessible, meaning the health care providers must be available to meet the child(ren)'s individual health care needs, and must be located no more than 60 miles one-way from the primary residence of the child(ren).¢ 5
(3) Health insurance must provide coverage for both routine and major medical expenses including, but not limited to:preventive care, office visits, hospitalization, and medication coverage in compliance with the Oklahoma Insurance Department per Oklahoma Administrative Code (OAC) 365:10-5-3(14) and OAC 365:10-5-5(f).Limited Insurance Coverage, per OAC 365:10-5-5(k) does not satisfy this requirement.Annual deductibles must be reasonable and relate to the medical circumstances of the child(ren).¢ 5
(e) Exceptions to standards for medical support provision.When the parents agree or it is otherwise appropriate, CSS requests the court make an exception to the standards for health coverage when the:
(1) reasonable cost of health insurance exceeds five percent of the gross income of the parent ordered to provide health insurance; or
(2) closest insurance provider exceeds 60 miles one-way from the primary residence of the child(ren).
(f) Hierarchy of medical support provisionsSelection of health care coverage.The provision for medical support must be consistent with one of the priorities listed in (1) through (4) of this subsection.¢ 2
(1) Health insurance is provided through a parent's employer or other available group health insurance plan.
(2) No coverage is available under (1) of this subsection, and a private insurance policy or group health insurance is available to the child(ren) through another source, such as a third party custodian or spouse of a parent, CSS seeks an order for the:
(A) parent to provide health insurance when insurance is provided through the spouse of a parent; or
(B) third party custodian to provide health insurance when insurance is provided through a third party custodian and the third party custodian requested an order to provide the coverage.
(3) No health coverage is available under (1) or (2) of this subsection, and alternative health coverage including, but not limited to, Indian Health Services (IHS) and Defense Eligibility Enrollment Reporting System (DEERS) is available to the child(ren).CSS requests the court consider the cost, quality, and accessibility of health care coverage available to the parties when entering a medical support order.
(4) When none of the provisions in (1) through (3) of this subsection are available at reasonable cost or are not accessible, the custodial person (CP) is required to make application for the child(ren) for health coverage through a government medical assistance program, such as SoonerCare (Medicaid).
(g) Health coverage preference.When health coverage meeting standards in (d) of this Section is available to both parents, CSS requests the court give priority to the preference of the custodial person (CP).
(h) Exceptions to hierarchyApplicability of cash medical support.CSS requests a cash medical order instead of an order for health coverage by the noncustodial parent (NCP)per (f)(1) or (2) of this Sectionobligor, when the:
(1) the court determines an order for health insurance is inappropriate due to family violence concerns; or
(2) obligor is an applicant for a governmental medical assistance program, such as Insure Oklahoma, State Children's Health Insurance Program (S-CHIP), orthe only health care plan available for the child is a governmental medical assistance program or health plan, such as SoonerCare (Medicaid).; or
(3) there is no health care plan available for the child(ren).
(i) Cash medical support.
(1) When (f)(4) of this Section is chosen as the provision forcash medical support is applicable, CSS requests the court order cash medical support to be paid by the NCPsobligor until insurance is provided per (f)(1) through (3) of this Sectionthe obligor enrolls the child(ren) in accessible insurance coverage and provides proof of enrollment to CSS and the CP.
(2) CSS refers to the Cash Medical Income Guidelines Table as found in the child support computation form prescribed by CSS and published by the Administrative Office of the Courts on the Oklahoma State Courts Network site, per 43 O.S. § 120 to determine the cash medical support amount.
(3) CSS computes a cash medical order by applying the Cash Medical Income Guidelines Table, using the gross income for the noncustodial person (NCP) of the child in the case under consideration and the number of children in the instant case.
(A) When the NCP's gross income is at or below the income amount for the number of children in the case, CSS requests the court order a cash medical order at $0 per month.
(B) When the NCP's gross income exceeds the income amount for the number of children in the case, CSS computes the requested cash medical order by:
(i) multiplying the amount of $115, representing the average monthly cost of health care for an uninsured child(ren), by the number of children in the case not covered by insurance; and
(ii) prorating the result by the percentage of income for each parent.
(C) The NCP's share of the cash medical amount is added to the child support obligation.
(D) CSS does not request the court set cash medical support against a parent who has equally shared physical custody with at least 182 overnights.
(4) Unless the parties agree or the court orders a greater amount, the prorated cash medical support amount must not exceed five percent of the gross income of the parent who is ordered to pay cash medical support.
(5) CSS seeks cash medical support only as part of a prospective order for child support.CSS does not include a cash medical support amount in a judgment for support for a prior period per OAC 340:25-5-179.1.
(6) In a child support modification action, CSS requests a cash medical support order be effective the first day of the month following the date the modification order is entered.
(j) Medical support for DHS adopted children.CSS does not request health insurance or cash medical support for children who are adopted through DHS Adoption Services.CSS requests a medical support order reflecting that the child(ren) receive SoonerCare through the adoption plan.The parties may agree to cover the child(ren) on health insurance.
(k) Termination of cash medical support.
(1) When CSS receives notice the parent ordered to pay cash medical support enrolled the child(ren) in health insurance, CSS sends a Notice of Proposed Termination of Cash Medical Support to all parties in the case by regular mail.When a party believes the child(ren) is not covered by accessible health insurance, a party may request a review of the termination of cash medical support within 10-calendar days from the date of mailing of the notice.¢ 7
(2) When a party requests a review to contest the Notice of Proposed Termination of Cash Medical Support, CSS reviews the case within 10-calendar days of receipt of the request and determines if termination of cash medical support is proper based on information provided by the contesting party.CSS notifies the parties of the review decision.¢ 7
(3) When the parties disagree with the review decision, the parties have 15-calendar days from the date of mailing the review decision to request a hearing on the termination of cash medical support.
(4) CSS files a Notice of Termination of Cash Medical Support with the proper court when no party requests a:
(A) review within the 10-day time period; or
(B) hearing after CSS notifies them of the review decision.
(5) CSS does not proceed with a separate termination of cash medical support when the child support and medical support order is modified within 30-calendar days of notification that the child(ren) is enrolled in health insurance.
(6) When a cash medical support order is terminated within a modification action, CSS requests the termination become effective the date of filing of the Motion to Modify or the date, if later when the child was actually enrolled in the insurance.
(l) Reinstatement of cash medical support.
(1) CSS seeks reinstatement of the cash medical order when:
(A) a child support court order previously ordered the NCP to pay cash medical support until insurance was available;
(B) insurance became available;
(C) the cash medical support was terminated; and
(D) the insurance subsequently lapsed.¢ 8
(2) CSS uses one of the following processes to seek reinstatement of the cash medical order:
(A) Modification.CSS seeks modification of the child support order and reinstatement of cash medical support, per OAC 340:25-5-198.1 and OAC 340:25-5-198.2, when:
(i) the child support order that provided for cash medical support was modified to include credit for insurance premium costs; or
(ii) there is another material change of circumstance in addition to the lapse of health coverage.
(B) Expedited Process.When (A) of this paragraph does not apply, CSS uses an expedited process to reinstate the cash medical support.CSS uses the expedited process when there is an address of record for the obligor.
(3) CSS initiates a reinstatement of cash medical support when it receives notice the parent whose cash medical support was terminated due to the enrollment of the child(ren) in health insurance has allowed the coverage to lapse.CSS sends a Notice of Proposed Reinstatement of Cash Medical Support to all parties in the case by regular mail.When a party believes the child(ren) is covered by health insurance, a party may request a review of the reinstatement within 10-calendar days of the date the notice was mailed.
(4) A party may file a written objection to the reinstatement of cash medical support and submit it to CSS with supporting health care coverage documentation.CSS reviews the case within 10-calendar days of receipt of the objection and determines if reinstatement of cash medical support is proper based on the information provided by the contesting party.CSS provides the CP and the NCP with written notice of the review decision.
(5) When the parties disagree with the review decision, they have 15-calendar days from the date of the review decision to request a hearing.
(6) CSS files a Notice of Reinstatement of Cash Medical Support with the proper court when no party requests a:
(A) review within the 10-calendar day time period; or
(B) hearing after CSS notifies them of the review decision.
(m) Fixed medical costs.When the parties agree or the court orders, CSS includes the total monthly fixed medical costs in the child support guidelines computation.When the obligor's share of fixed medical costs exceeds five percent of the obligor's gross income and the parties do not agree to exceed the five percent standard, CSS requests the court determine the monthly amount of fixed medical costs included in the current child support order.¢ 9
(n) Indian Health Services (IHS).
(1) A child support order that provides for the enrollment of a child(ren) in IHS may comply with the standards in (d) of this Section.CSS seeks an order for either or both parents to secure health insurance for the minor child(ren), when:
(A) IHS does not meet the standards in (d) of this Section; or
(B) health insurance is available through an employer or other group plan and the CP requests it.
(2) CSS does not request cash medical support when IHS is the chosen provider.
(o) Notification requirements.The NCP and the CP must notify CSS in writing within 30-calendar days after:
(1) health insurance becomes available;
(2) the cost of existing health insurance changes; or
(3) other provisions of existing health insurance change.
(p) Modification request.When a child support order exists, CSS considers a request to establish a medical support order as a request for modification of the order per 43 O.S. § 118.1.CSS seeks a medical support order in a tribunal that has jurisdiction to modify the child support order.
INSTRUCTIONS TO STAFF 340:25-5-168
Revised 9-15-1611-1-18
1.In cases referred to Child Support Services (CSS) by an Adult and Family Services (AFS) worker, CSS provides all appropriate Title IV-D services, unless the person requests medical enforcement only.CSS opens a full-service case when the AFS worker enters Y in the D8 block on the ED screen on the PS2 automated system.
2.When the parties state health coverage is available, but there is no proof that it is in effect at the time the order is entered, CSS seeks a temporary medical support order until proof of coverage is received.A final order may then be obtained.
3.CSS staff determines the out-of-pocket cost for health insurance by subtracting any amount paid by the employer through a benefit allowance from the premium amount paid by the insured.
4.(a) When the cost of the insurance premium for other adults in the household is included with the cost for the child(ren) and information is not available to determine a separate amount for the other adults, CSS staff uses this premium cost to determine the amount per child.
(b) For example, the total health insurance premium is $275.The portion of the premium for the parent carrying the insurance is $75.The portion of the premium for the other adults in the home is unknown and cannot be determined.The number of children covered is four.The number of children in the child support case is three.The cost of the insurance premium for each child in the child support case is $50 ($275 - $75 = $200 ¸ 4 = $50 x 3 = $150).
5.Child support CSS staff follows the Child Support Manual, Medical Support chapter for information on deductible and co-payment amounts.Child support CSS staff accesses the Child Support Manual on the CSS InfoNet.Examples of when health insurance does not meet the standards for health coverage include when the noncustodial parent has:
(1) gross income of $1,733 a month and has an employer-sponsored plan that would cost the parent $225 a month in out-of-pocket premium costs for three children in the case under consideration.CSS does not consider the contribution to the premium that might be made by another person or other entity.Since $225 is more than 10 percent of the $1,733, the cost of the insurance is not considered reasonable;
(2) available health coverage, but the nearest network provider is 60 miles one-way from the primary residence of the child(ren); and
(3) available health coverage that only meets the definition of a:
(A) Limited Benefit Health Insurance Coverage; or
(B) policy with an excessive deductible and co-payment amount.
6.When applying the reasonable cost standard, CSS staff uses the gross income of the parent at the time the order is established to determine whether the actual premium cost of available coverage for the child(ren)'s portion only exceeds five percent of the parent's gross income.
7.(a) CSS staff terminates cash medical support:
(1) when a request for review is received.CSS staff uses the first day of the second month following the date of the Notice of Proposed Termination of Cash Medical Support as the termination date for the cash medical support.Example:When a Notice of Proposed Termination is issued on September 14, the termination date for the cash medical support is November 1; or
(2) at an earlier date when the parties agree health care coverage is in place and agree to an earlier date.
(b) When CSS staff denies a request for review of termination of cash medical support and no party requests an administrative review within 15-calendar days CSS staff:
(1) updates the child support case information on the Oklahoma Support Information System (OSIS) to remove the cash medical support amount in the current monthly child support obligation; and
(2) generates an amended Notice of Income Assignment to the employer that does not include the cash medical support amount.
(c) Examples of cases when termination of cash medical support is appropriate include when CSS staff receives notice that:
(1) a parent's employer has enrolled the child in health insurance;
(2) the child is enrolled in health insurance through a private insurance policy or group health insurance through another source, such as a third party custodian or spouse of a parent; or
(3) the child is enrolled inalternative coverage such as Indian Health Services (IHS) or Defense Eligibility Enrollment Reporting System (DEERS).
(d) Examples of cases in which termination of cash medical support is not appropriate include, when CSS staff has information that:
(1) a parent's employer has health insurance available, but staff has not received notice that the employer enrolled the child in health insurance; or
(2) the child may be eligible for IHS services or DEERS, but has not received notice that the child is enrolled in this alternative coverage.
8.(a) CSS staff uses the first day of the second month following the date of the Notice of Proposed Reinstatement of Cash Medical Support as the reinstatement date for the cash medical support.Example:The Notice of Proposed Reinstatement is printed on September 14.The reinstatement date for the cash medical support is November 1.
(b) When CSS staff denies a request for review of reinstatement of cash medical support and no party requests an administrative hearing within 15-calendar days:
(1) CSS staff updates the child support case information on OSIS to add the cash medical support amount to the current monthly child support obligation; and
(2) generates an amended Income Withholding Order to the employer, including the cash medical support amount.
9.When there are multiple custodial persons (CP) and it is not clear which CP is incurring a fixed medical expense, CSS staff inquires of all CPs.After obtaining the information, CSS staff creates or updates the obligation(s) to ensure the fixed medical support portion of the current monthly support obligation is distributed to the CP incurring the fixed medical expense.When staff is unable to ascertain the correct CP, the fixed medical support follows the child per Oklahoma Administrative Code 340:25-5-133, until otherwise ordered by the court.When CPs disagree as to whom the fixed medical support is owed, CSS staff requests a court determination.
