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House Study Bill 629 - IntroducedA Bill ForAn Act 1relating to the provision of medical support in child
2support actions, and including effective date provisions.
3BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. Section 252C.1, subsection 6, Code 2018, is
2amended to read as follows:
36. “Medical support” means either the provision of
4coverage under a health benefit plan, including a group or
5employment-related or an individual health benefit plan, or
6a health benefit plan provided pursuant to chapter 514E, to
7meet the medical needs of a dependent and the cost of any
8premium required by a health benefit plan, or the payment to
9the obligee of a monetary amount in lieu of providing coverage
10under a health benefit plan, either of which is an obligation
11separate from any monetary amount of child support ordered
12to be paid. Medical support which consists of payment of
13a monetary amount in lieu of a health benefit plan is also
14an obligation separate from any monetary amount a parent is
15ordered to pay for uncovered medical expenses pursuant to the
16guidelines established pursuant to section 598.21B medical
17support as defined in section 252E.1.
18 Sec. 2. Section 252E.1, Code 2018, is amended to read as
19follows:
20252E.1 Definitions.
21As used in this chapter, unless the context otherwise
22requires:
231. “Accessible” means any of the following, unless otherwise
24provided in the support order:
25a. The health benefit plan does not have service area
26limitations or provides an option not subject to service area
27limitations.
28b. The health benefit plan has service area limitations and
29the dependent lives within thirty miles or thirty minutes of a
30network primary care provider.
312. “Basic coverage” means health care coverage provided
32under a health benefit plan that at a minimum provides coverage
33for emergency care, inpatient and outpatient hospital care,
34physician services whether provided within or outside a
35hospital setting, and laboratory and x-ray services.
-1- 13. “Cash medical support” means a monetary amount that
2a parent is ordered to pay to the obligee in lieu of that
3parent providing health care coverage, which amount is five
4percent of the gross income of the parent ordered to pay the
5monetary amount or, if the child support guidelines established
6pursuant to section 598.21B specifically provide an alternative
7income-based numeric standard for determining the amount,
8the amount determined by the standard specified by the child
9support guidelines. “Cash medical support” is an obligation
10separate from any monetary amount a parent is ordered to pay
11for uncovered medical expenses pursuant to the guidelines
12established pursuant to section 598.21B.
133. 4. “Child” means a person for whom child or medical
14support may be ordered pursuant to chapter 234, 239B, 252A,
15252C, 252F, 252H, 252K, 598, 600B, or any other chapter of the
16Code or pursuant to a comparable statute of another state or
17foreign country.
184. 5. “Department” means the department of human services,
19which includes but is not limited to the child support recovery
20unit, or any comparable support enforcement agency of another
21state.
225. 6. “Dependent” means a child, or an obligee for whom a
23court may order health care coverage by a health benefit plan
24 pursuant to section 252E.3.
256. 7. “Enroll” means to be eligible for and covered by a
26health benefit plan.
277. 8. “Health benefit plan” means any policy or contract
28of insurance, indemnity, subscription or membership issued by
29an insurer, health service corporation, health maintenance
30organization, or any similar corporation, organization any
31public coverage, or a any self-insured employee benefit plan,
32for the purpose of covering medical expenses. These expenses
33may include but are not limited to hospital, surgical, major
34medical insurance, dental, optical, prescription drugs, office
35visits, or any combination of these or any other comparable
-2-1health care expenses.
29. “Health care coverage” or “coverage” means providing and
3paying for the medical needs of a dependent through a health
4benefit plan.
58. 10. “Insurer” means any entity which provides a health
6benefit plan, but does not include an entity that provides
7public coverage.
89. 11. “Medical support” means either the provision of a
9 health benefit plan, including a group or employment-related
10or an individual health benefit plan, or a health benefit plan
11provided pursuant to chapter 514E, to meet the medical needs
12of a dependent and the cost of any premium required by a health
13benefit plan, care coverage or the payment to the obligee of
14a monetary amount in lieu of a health benefit plan, either
15of which is an obligation separate from any monetary amount
16of child cash medical support ordered to be paid. Medical
17support “Medical support” is not alimony. Medical support which
18consists of payment of a monetary amount in lieu of a health
19benefit plan is also an obligation separate from any monetary
20amount a parent is ordered to pay for uncovered medical
21expenses pursuant to the guidelines established pursuant to
22section 598.21B.
2310. 12. “National medical support notice” means a notice
24as prescribed under 42 U.S.C. §666(a)(19) or a substantially
25similar notice, that is issued and forwarded by the department
26in accordance with section 252E.4 to enforce medical support
27 the health care coverage provisions of a support order. The
28national medical support notice is not applicable to a provider
29of public coverage.
3011. 13. “Obligee” means a parent or another natural person
31legally entitled to receive a support payment on behalf of a
32child.
3312. 14. “Obligor” means a parent or another natural person
34legally responsible for the support of a dependent.
3513. 15. “Order” means a support order entered pursuant to
-3-1chapter 234, 252A, 252C, 252F, 252H, 252K, 598, 600B, or any
2other support chapter, or pursuant to a comparable statute of
3another state or foreign country, or an ex parte order entered
4pursuant to section 252E.4. “Order” also includes a notice of
5such an order issued by the department.
614. 16. “Plan administrator” means the employer or sponsor
7that offers the health benefit plan or the person to whom the
8duty of plan administrator is delegated by the employer or
9sponsor offering the health benefit plan, by written agreement
10of the parties. “Plan administrator” does not include a
11provider of public coverage.
1215. 17. “Primary care provider” means a physician who
13provides primary care who is a family or general practitioner,
14a pediatrician, an internist, an obstetrician, or a
15gynecologist.
1618. “Public coverage” means health care benefits provided by
17any form of federal or state medical assistance, including but
18not limited to benefits provided under chapter 249A or 514I,
19or under comparable laws of another state, foreign country, or
20Indian nation or tribe.
2119. “Unit” or “child support recovery unit” means unit as
22defined in section 252B.1.
23 Sec. 3. Section 252E.1A, Code 2018, is amended to read as
24follows:
25252E.1A Establishing and modifying orders for medical
26support.
271. This section shall apply to all initial or modified
28orders for support entered under chapter 234, 252A, 252C, 252F,
29252H, 598, 600B, or any other applicable chapter. If an action
30to establish or modify an order for support is initiated by the
31child support recovery unit, section 252E.1B shall also apply.
321. 2. An order or judgment that provides for temporary or
33permanent support for a child shall include a provision for
34medical support for the child as provided in this section.
352. 3. The court shall order as medical support for the
-4-1child health care coverage if a health benefit plan if other
2than public coverage is available to either parent at the time
3the order is entered or modified. A health benefit plan is
4available if the plan is accessible and the cost of the plan is
5reasonable.
6a. The cost of a health benefit plan is considered
7reasonable, and such amount shall be stated in the order, if
8one of the following applies:
9(1) The premium cost for a child to the parent ordered
10to provide the plan coverage does not exceed five percent of
11that parent’s gross income or the child support guidelines
12established pursuant to section 598.21B specifically provide an
13alternative income-based numeric standard for determining the
14reasonable cost of the premium, in which case the reasonable
15cost of the premium as determined by the standard specified by
16the child support guidelines shall apply.
17(2) The premium cost for a child exceeds the amount
18specified in subparagraph (1) and that parent consents or does
19not object to entry of that order.
20b. For purposes of this section, “gross income” has the same
21meaning as gross income for calculation of support under the
22guidelines established under section 598.21B.
23c. For purposes of this section, “the premium cost for
24a child to the parent” ordered to provide the plan coverage
25 means the amount of the premium cost for family coverage to
26the parent which is in excess of the premium cost for single
27coverage, regardless of the number of individuals covered under
28the plan. However, this paragraph shall not be interpreted to
29reduce the amount of the health insurance premium deduction
30a parent may be entitled to when calculating the amount of a
31child support obligation under Iowa court rule 9.5 of the child
32support guidelines.
33d. For purposes of this section, “family coverage” means
34coverage that covers multiple individuals and covers or could
35cover the child or children subject to the child support order.
-5- 13. 4. If a health benefit plan other than public coverage
2 is not available to either parent at the time of the entry
3of the order, and the custodial parent does not have public
4coverage for the child, the court shall order a reasonable
5monetary cash medical support in an amount in lieu of a health
6benefit plan, which amount shall be stated in the order. For
7purposes of this subsection, a reasonable amount means five
8percent of the gross income of the parent ordered to provide
9the monetary amount for medical support or, if the child
10support guidelines established pursuant to section 598.21B
11 specifically provide an alternative income-based numeric
12standard for determining the reasonable amount, a reasonable
13amount means the amount as determined by the standard specified
14by the child support guidelines. This subsection shall not
15apply in any of the following circumstances:
16a. If the parent’s monthly support obligation established
17pursuant to the child support guidelines prescribed by the
18supreme court pursuant to section 598.21B is the minimum
19obligation amount. If this paragraph applies, the court shall
20order the parent to provide a health benefit plan care coverage
21 when a plan becomes available for which there is no premium
22cost for a child to the parent.
23b. If subsection 7, paragraph “d”, “e”, or “f” applies the
24noncustodial parent does not have income which may be subject
25to income withholding for collection of cash medical support at
26the time of the entry of the order. If this paragraph applies,
27the court shall order the noncustodial parent to provide health
28care coverage when a health benefit plan becomes available at
29a reasonable cost, and the order shall specify the amount of
30the reasonable cost as specified in subsection 3, paragraph “a”,
31subparagraph (1).
32c. If the noncustodial parent is receiving assistance or
33is residing with any child receiving assistance as provided
34in section 252E.2A, subsection 1, paragraph “c”, subparagraph
35(3) or (4). If this paragraph applies, the court shall order
-6-1the noncustodial parent to provide health care coverage when
2a health benefit plan becomes available for which there is no
3premium cost for a child to the parent.
44. 5. If a health benefit plan other than public coverage
5is not available to either parent at the time of the entry of
6the order, and the custodial parent has public coverage for the
7child, the court orders shall order the custodial parent to
8provide a health benefit plan under subsection 2 care coverage,
9and the court may also shall order the noncustodial parent to
10provide a reasonable monetary pay cash medical support, which
11 amount in lieu of a health benefit plan shall be stated in the
12order, unless an exception under subsection 4 applies. For
13purposes of this subsection, a reasonable monetary amount means
14an amount not to exceed the lesser of a reasonable amount as
15described in subsection 3, or the premium cost of coverage for
16the child to the custodial parent as described in subsection
172, paragraph “c”.
185. 6. Notwithstanding the requirements of this section, the
19court may order provisions in the alternative to those provided
20in this section to address the health care needs of the child
21if the court determines that extreme circumstances so require
22and documents the court’s written findings in the order.
236. 7. An order, decree, or judgment entered before July 1,
242009 October 1, 2018, that provides for the support of a child
25may be modified in accordance with this section.
267. If the child support recovery unit is providing services
27under chapter 252B and initiating an action to establish or
28modify support, all of the following shall also apply:
29a. If a health benefit plan is available as described in
30subsection 2 to the noncustodial parent, the unit shall seek an
31order for the noncustodial parent to provide the plan.
32b. If a health benefit plan is available as described
33in subsection 2 to the custodial parent and not to the
34noncustodial parent, the unit shall seek an order for the
35custodial parent to provide the plan.
-7- 1c. If a health benefit plan is available as described in
2subsection 2 to each parent, and if there is an order for joint
3physical care, the unit shall seek an order for the parent
4currently ordered to provide a health benefit plan to provide
5the plan. If there is no current order for a health benefit
6plan for the child, the unit shall seek an order for the parent
7who is currently providing a health benefit plan to provide the
8plan.
9d. If a health benefit plan is not available, and the
10noncustodial parent does not have income which may be subject
11to income withholding for collection of a reasonable monetary
12amount in lieu of a health benefit plan at the time of the
13entry of the order, the unit shall seek an order that the
14noncustodial parent provide a health benefit plan when a plan
15becomes available at reasonable cost, and the order shall
16specify the amount of reasonable cost as defined in subsection
172.
18e. If a health benefit plan is not available, and the
19noncustodial parent is receiving assistance or is residing with
20any child receiving assistance as provided in section 252E.2A,
21subsection 1, paragraph “c”, subparagraph (3) or (4), the unit
22shall seek an order that the noncustodial parent shall provide
23a health benefit plan when a plan becomes available for which
24there is no premium cost for a child to the parent.
25f. This section shall not apply to chapter 252H, subchapter
26IV.
27 Sec. 4. NEW SECTION. 252E.1B Establishing and modifying
28orders for medical support — actions initiated by child support
29recovery unit.
301. If the child support recovery unit is initiating an
31action to establish or modify support, this section shall apply
32in addition to the provisions of section 252E.1A.
332. The unit shall apply the following order of priority when
34the unit enters or seeks an order for medical support:
35a. If the custodial parent is currently providing coverage
-8-1for the child under a health benefit plan other than public
2coverage, and the plan is available as described in section
3252E.1A, subsection 3, the unit shall enter or seek an order
4for the custodial parent to provide coverage.
5b. If the noncustodial parent is currently providing
6coverage for the child under a health benefit plan other than
7public coverage, and the plan is available as described in
8section 252E.1A, subsection 3, the unit shall enter or seek an
9order for the noncustodial parent to provide coverage.
10c. If a health benefit plan other than public coverage is
11available as described in section 252E.1A, subsection 3, to the
12custodial parent, the unit shall enter or seek an order for the
13custodial parent to provide coverage.
14d. If a health benefit plan other than public coverage is
15available as described in section 252E.1A, subsection 3, to the
16noncustodial parent, the unit shall enter or seek an order for
17the noncustodial parent to provide coverage.
18e. If a health benefit plan other than public coverage is
19not available to either parent, and the custodial parent has
20public coverage for the child, the unit shall enter or seek an
21order for the custodial parent to provide health care coverage
22and shall enter or seek an order for the noncustodial parent to
23pay cash medical support. However, if any of the circumstances
24described in section 252E.1A, subsection 4, paragraph “a”,
25“b”, or “c” is met, the unit shall enter or seek an order as
26specified by the applicable paragraph.
273. Notwithstanding subsection 2, if there is an order for
28joint physical care for the child and the parties subject to
29the support order, the unit shall apply the following order of
30priority when the unit enters or seeks an order for medical
31support:
32a. If only one parent is currently providing coverage
33for the child under a health benefit plan other than public
34coverage, and the plan is available as described in section
35252E.1A, subsection 3, the unit shall enter or seek an order
-9-1for that parent to provide coverage.
2b. If both parents are currently providing coverage for the
3child under a health benefit plan other than public coverage,
4and both plans are available as described in section 252E.1A,
5subsection 3, the unit shall enter or seek an order for both
6parents to provide coverage.
7c. If neither parent is currently providing coverage
8for the child under a health benefit plan other than public
9coverage, and a health benefit plan other than public coverage
10is available as described in section 252E.1A, subsection 3,
11to one parent, the unit shall enter or seek an order for that
12parent to provide coverage.
13d. If neither parent is currently providing coverage
14for the child under a health benefit plan other than public
15coverage, and a health benefit plan other than public coverage
16is available as described in section 252E.1A, subsection 3, to
17both parents, the unit shall enter or seek an order for both
18parents to provide coverage.
19e. If a health benefit plan other than public coverage
20is not available to either parent and one parent has public
21coverage for the child, the unit shall enter or seek an order
22for that parent to provide health care coverage.
234. The child support recovery unit or the court shall not
24order any modification to an existing medical support order
25in a proceeding conducted solely pursuant to chapter 252H,
26subchapter IV.
27 Sec. 5. Section 252E.2, subsection 1, Code 2018, is amended
28to read as follows:
291. An order requiring the provision of coverage under a
30health benefit plan other than public coverage is authorization
31for enrollment of the dependent if the dependent is otherwise
32eligible to be enrolled. The dependent’s eligibility and
33enrollment for coverage under such a plan shall be governed by
34all applicable terms and conditions, including, but not limited
35to, eligibility and insurability standards. The dependent, if
-10-1eligible, shall be provided the same coverage as the obligor.
2 Sec. 6. Section 252E.3, Code 2018, is amended to read as
3follows:
4252E.3 Health benefit care coverage of obligee.
5For cases for which services are being provided pursuant
6to chapter 252B, the order may require an obligor providing a
7 health benefit plan care coverage for a child to also provide a
8 health benefit plan care coverage for the benefit of an obligee
9if the obligee is eligible for enrollment under the plan in
10which the child or the obligor is enrolled, and if the plan
11 coverage for the obligee is available at no additional cost.
12 Sec. 7. Section 252E.4, subsection 1, Code 2018, is amended
13to read as follows:
141. When a support order requires an obligor to provide
15coverage under a health benefit plan other than public
16coverage, the district court or the department may enter an
17ex parte order directing an employer to take all actions
18necessary to enroll an obligor’s dependent for coverage under
19a health benefit plan or may include the provisions in an ex
20parte income withholding order or notice of income withholding
21pursuant to chapter 252D. The child support recovery unit,
22where appropriate, shall issue a national medical support
23notice to an employer within two business days after the
24date information regarding a newly hired employee is entered
25into the centralized employee registry and matched with a
26noncustodial parent in the case being enforced by the unit, or
27upon receipt of other employment information for such parent.
28The department may amend the information in the ex parte order
29or may amend or terminate the national medical support notice
30regarding health insurance provisions if necessary to comply
31with health insurance requirements including but not limited to
32the provisions of section 252E.2, subsection 2, or to correct
33a mistake of fact.
34 Sec. 8. Section 252E.16, subsection 1, Code 2018, is amended
35to read as follows:
-11- 11. The Unless otherwise specified, the provisions of this
2chapter take effect July 1, 1990, for all support orders
3entered pursuant to chapter 234, 252A, 252C, 598, or 600B.
4 Sec. 9. ADMINISTRATIVE RULES — TRANSITION. Until such
5time as the department of human services adopts rules pursuant
6to chapter 17A necessary to administer this Act, all of the
7following shall apply:
81. The child support recovery unit may initiate proceedings
9to establish and modify support orders in accordance with
10chapter 252E, as amended in this Act.
112. The child support recovery unit may, to the extent
12appropriate, apply and utilize procedures, rules, and forms
13substantially similar to those applicable and utilized pursuant
14to section 252E.1B, as enacted in this Act, for proceedings
15initiated in accordance with section 252E.1A.
16 Sec. 10. EFFECTIVE DATE. This Act takes effect October 1,
172018.
18EXPLANATION
19The inclusion of this explanation does not constitute agreement with
20the explanation’s substance by the members of the general assembly.
21This bill amends provisions relating to medical support
22for a child, based on the final rule adopted by the centers
23for Medicare and Medicaid services and the administration
24for children and families of the United States department of
25health and human services on December 20, 2016, pursuant to
26Executive Order 13563 of January 18, 2011. Under 45 C.F.R.
27subtitle B, chapter III, section 303.31, specifically, states
28are provided with flexibility to permit parents to meet their
29medical support obligations by providing health care coverage
30or payment for medical expenses that are reasonable in cost and
31best meet the health care needs of the child, and clarifies
32that health care coverage includes public and private coverage.
33The bill provides definitions including “cash medical
34support”, “health care coverage”, and “public coverage”, and
35includes public coverage in the definition of a “health benefit
-12-1plan”.
2The bill provides for the provision of medical support
3either by providing and paying for the medical needs of a
4dependent through a health benefit plan, including public
5coverage, or the payment of cash medical support. The bill
6provides the conditions for determining whether medical support
7is to be provided through a health benefit plan other than
8public coverage or through public coverage and whether the
9custodial or noncustodial parent is required to provide health
10care coverage.
11The bill also provides the process and order of priority to
12be followed when the child support recovery unit (CSRU) enters
13or seeks an order for medical support.
14The bill directs the department of human services to adopt
15rules pursuant to Code chapter 17A as necessary to administer
16the bill, but provides that until such time as rules are
17adopted the CSRU may initiate proceedings to establish and
18modify support orders in accordance with Code chapter 252E,
19as amended in the bill, and may, to the extent appropriate,
20apply and utilize procedures, rules, and forms substantially
21similar to those applicable and utilized pursuant to Code
22section 252E.1B for proceedings initiated in accordance with
23Code section 252E.1A, as enacted in the bill.
24The bill takes effect October 1, 2018.
-13-pf/rh
2support actions, and including effective date provisions.
3BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. Section 252C.1, subsection 6, Code 2018, is
2amended to read as follows:
36. “Medical support” means either the provision of
4coverage under a health benefit plan, including a group or
5employment-related or an individual health benefit plan, or
6a health benefit plan provided pursuant to chapter 514E, to
7meet the medical needs of a dependent and the cost of any
8premium required by a health benefit plan, or the payment to
9the obligee of a monetary amount in lieu of providing coverage
10under a health benefit plan, either of which is an obligation
11separate from any monetary amount of child support ordered
12to be paid. Medical support which consists of payment of
13a monetary amount in lieu of a health benefit plan is also
14an obligation separate from any monetary amount a parent is
15ordered to pay for uncovered medical expenses pursuant to the
16guidelines established pursuant to section 598.21B medical
17support as defined in section 252E.1.
18 Sec. 2. Section 252E.1, Code 2018, is amended to read as
19follows:
20252E.1 Definitions.
21As used in this chapter, unless the context otherwise
22requires:
231. “Accessible” means any of the following, unless otherwise
24provided in the support order:
25a. The health benefit plan does not have service area
26limitations or provides an option not subject to service area
27limitations.
28b. The health benefit plan has service area limitations and
29the dependent lives within thirty miles or thirty minutes of a
30network primary care provider.
312. “Basic coverage” means health care coverage provided
32under a health benefit plan that at a minimum provides coverage
33for emergency care, inpatient and outpatient hospital care,
34physician services whether provided within or outside a
35hospital setting, and laboratory and x-ray services.
-1- 13. “Cash medical support” means a monetary amount that
2a parent is ordered to pay to the obligee in lieu of that
3parent providing health care coverage, which amount is five
4percent of the gross income of the parent ordered to pay the
5monetary amount or, if the child support guidelines established
6pursuant to section 598.21B specifically provide an alternative
7income-based numeric standard for determining the amount,
8the amount determined by the standard specified by the child
9support guidelines. “Cash medical support” is an obligation
10separate from any monetary amount a parent is ordered to pay
11for uncovered medical expenses pursuant to the guidelines
12established pursuant to section 598.21B.
133. 4. “Child” means a person for whom child or medical
14support may be ordered pursuant to chapter 234, 239B, 252A,
15252C, 252F, 252H, 252K, 598, 600B, or any other chapter of the
16Code or pursuant to a comparable statute of another state or
17foreign country.
184. 5. “Department” means the department of human services,
19which includes but is not limited to the child support recovery
20unit, or any comparable support enforcement agency of another
21state.
225. 6. “Dependent” means a child, or an obligee for whom a
23court may order health care coverage by a health benefit plan
24 pursuant to section 252E.3.
256. 7. “Enroll” means to be eligible for and covered by a
26health benefit plan.
277. 8. “Health benefit plan” means any policy or contract
28of insurance, indemnity, subscription or membership issued by
29an insurer, health service corporation, health maintenance
30organization, or any similar corporation, organization any
31public coverage, or a any self-insured employee benefit plan,
32for the purpose of covering medical expenses. These expenses
33may include but are not limited to hospital, surgical, major
34medical insurance, dental, optical, prescription drugs, office
35visits, or any combination of these or any other comparable
-2-1health care expenses.
29. “Health care coverage” or “coverage” means providing and
3paying for the medical needs of a dependent through a health
4benefit plan.
58. 10. “Insurer” means any entity which provides a health
6benefit plan, but does not include an entity that provides
7public coverage.
89. 11. “Medical support” means either the provision of a
9 health benefit plan, including a group or employment-related
10or an individual health benefit plan, or a health benefit plan
11provided pursuant to chapter 514E, to meet the medical needs
12of a dependent and the cost of any premium required by a health
13benefit plan, care coverage or the payment to the obligee of
14a monetary amount in lieu of a health benefit plan, either
15of which is an obligation separate from any monetary amount
16of child cash medical support ordered to be paid. Medical
17support “Medical support” is not alimony. Medical support which
18consists of payment of a monetary amount in lieu of a health
19benefit plan is also an obligation separate from any monetary
20amount a parent is ordered to pay for uncovered medical
21expenses pursuant to the guidelines established pursuant to
22section 598.21B.
2310. 12. “National medical support notice” means a notice
24as prescribed under 42 U.S.C. §666(a)(19) or a substantially
25similar notice, that is issued and forwarded by the department
26in accordance with section 252E.4 to enforce medical support
27 the health care coverage provisions of a support order. The
28national medical support notice is not applicable to a provider
29of public coverage.
3011. 13. “Obligee” means a parent or another natural person
31legally entitled to receive a support payment on behalf of a
32child.
3312. 14. “Obligor” means a parent or another natural person
34legally responsible for the support of a dependent.
3513. 15. “Order” means a support order entered pursuant to
-3-1chapter 234, 252A, 252C, 252F, 252H, 252K, 598, 600B, or any
2other support chapter, or pursuant to a comparable statute of
3another state or foreign country, or an ex parte order entered
4pursuant to section 252E.4. “Order” also includes a notice of
5such an order issued by the department.
614. 16. “Plan administrator” means the employer or sponsor
7that offers the health benefit plan or the person to whom the
8duty of plan administrator is delegated by the employer or
9sponsor offering the health benefit plan, by written agreement
10of the parties. “Plan administrator” does not include a
11provider of public coverage.
1215. 17. “Primary care provider” means a physician who
13provides primary care who is a family or general practitioner,
14a pediatrician, an internist, an obstetrician, or a
15gynecologist.
1618. “Public coverage” means health care benefits provided by
17any form of federal or state medical assistance, including but
18not limited to benefits provided under chapter 249A or 514I,
19or under comparable laws of another state, foreign country, or
20Indian nation or tribe.
2119. “Unit” or “child support recovery unit” means unit as
22defined in section 252B.1.
23 Sec. 3. Section 252E.1A, Code 2018, is amended to read as
24follows:
25252E.1A Establishing and modifying orders for medical
26support.
271. This section shall apply to all initial or modified
28orders for support entered under chapter 234, 252A, 252C, 252F,
29252H, 598, 600B, or any other applicable chapter. If an action
30to establish or modify an order for support is initiated by the
31child support recovery unit, section 252E.1B shall also apply.
321. 2. An order or judgment that provides for temporary or
33permanent support for a child shall include a provision for
34medical support for the child as provided in this section.
352. 3. The court shall order as medical support for the
-4-1child health care coverage if a health benefit plan if other
2than public coverage is available to either parent at the time
3the order is entered or modified. A health benefit plan is
4available if the plan is accessible and the cost of the plan is
5reasonable.
6a. The cost of a health benefit plan is considered
7reasonable, and such amount shall be stated in the order, if
8one of the following applies:
9(1) The premium cost for a child to the parent ordered
10to provide the plan coverage does not exceed five percent of
11that parent’s gross income or the child support guidelines
12established pursuant to section 598.21B specifically provide an
13alternative income-based numeric standard for determining the
14reasonable cost of the premium, in which case the reasonable
15cost of the premium as determined by the standard specified by
16the child support guidelines shall apply.
17(2) The premium cost for a child exceeds the amount
18specified in subparagraph (1) and that parent consents or does
19not object to entry of that order.
20b. For purposes of this section, “gross income” has the same
21meaning as gross income for calculation of support under the
22guidelines established under section 598.21B.
23c. For purposes of this section, “the premium cost for
24a child to the parent” ordered to provide the plan coverage
25 means the amount of the premium cost for family coverage to
26the parent which is in excess of the premium cost for single
27coverage, regardless of the number of individuals covered under
28the plan. However, this paragraph shall not be interpreted to
29reduce the amount of the health insurance premium deduction
30a parent may be entitled to when calculating the amount of a
31child support obligation under Iowa court rule 9.5 of the child
32support guidelines.
33d. For purposes of this section, “family coverage” means
34coverage that covers multiple individuals and covers or could
35cover the child or children subject to the child support order.
-5- 13. 4. If a health benefit plan other than public coverage
2 is not available to either parent at the time of the entry
3of the order, and the custodial parent does not have public
4coverage for the child, the court shall order a reasonable
5monetary cash medical support in an amount in lieu of a health
6benefit plan, which amount shall be stated in the order. For
7purposes of this subsection, a reasonable amount means five
8percent of the gross income of the parent ordered to provide
9the monetary amount for medical support or, if the child
10support guidelines established pursuant to section 598.21B
11 specifically provide an alternative income-based numeric
12standard for determining the reasonable amount, a reasonable
13amount means the amount as determined by the standard specified
14by the child support guidelines. This subsection shall not
15apply in any of the following circumstances:
16a. If the parent’s monthly support obligation established
17pursuant to the child support guidelines prescribed by the
18supreme court pursuant to section 598.21B is the minimum
19obligation amount. If this paragraph applies, the court shall
20order the parent to provide a health benefit plan care coverage
21 when a plan becomes available for which there is no premium
22cost for a child to the parent.
23b. If subsection 7, paragraph “d”, “e”, or “f” applies the
24noncustodial parent does not have income which may be subject
25to income withholding for collection of cash medical support at
26the time of the entry of the order. If this paragraph applies,
27the court shall order the noncustodial parent to provide health
28care coverage when a health benefit plan becomes available at
29a reasonable cost, and the order shall specify the amount of
30the reasonable cost as specified in subsection 3, paragraph “a”,
31subparagraph (1).
32c. If the noncustodial parent is receiving assistance or
33is residing with any child receiving assistance as provided
34in section 252E.2A, subsection 1, paragraph “c”, subparagraph
35(3) or (4). If this paragraph applies, the court shall order
-6-1the noncustodial parent to provide health care coverage when
2a health benefit plan becomes available for which there is no
3premium cost for a child to the parent.
44. 5. If a health benefit plan other than public coverage
5is not available to either parent at the time of the entry of
6the order, and the custodial parent has public coverage for the
7child, the court orders shall order the custodial parent to
8provide a health benefit plan under subsection 2 care coverage,
9and the court may also shall order the noncustodial parent to
10provide a reasonable monetary pay cash medical support, which
11 amount in lieu of a health benefit plan shall be stated in the
12order, unless an exception under subsection 4 applies. For
13purposes of this subsection, a reasonable monetary amount means
14an amount not to exceed the lesser of a reasonable amount as
15described in subsection 3, or the premium cost of coverage for
16the child to the custodial parent as described in subsection
172, paragraph “c”.
185. 6. Notwithstanding the requirements of this section, the
19court may order provisions in the alternative to those provided
20in this section to address the health care needs of the child
21if the court determines that extreme circumstances so require
22and documents the court’s written findings in the order.
236. 7. An order, decree, or judgment entered before July 1,
242009 October 1, 2018, that provides for the support of a child
25may be modified in accordance with this section.
267. If the child support recovery unit is providing services
27under chapter 252B and initiating an action to establish or
28modify support, all of the following shall also apply:
29a. If a health benefit plan is available as described in
30subsection 2 to the noncustodial parent, the unit shall seek an
31order for the noncustodial parent to provide the plan.
32b. If a health benefit plan is available as described
33in subsection 2 to the custodial parent and not to the
34noncustodial parent, the unit shall seek an order for the
35custodial parent to provide the plan.
-7- 1c. If a health benefit plan is available as described in
2subsection 2 to each parent, and if there is an order for joint
3physical care, the unit shall seek an order for the parent
4currently ordered to provide a health benefit plan to provide
5the plan. If there is no current order for a health benefit
6plan for the child, the unit shall seek an order for the parent
7who is currently providing a health benefit plan to provide the
8plan.
9d. If a health benefit plan is not available, and the
10noncustodial parent does not have income which may be subject
11to income withholding for collection of a reasonable monetary
12amount in lieu of a health benefit plan at the time of the
13entry of the order, the unit shall seek an order that the
14noncustodial parent provide a health benefit plan when a plan
15becomes available at reasonable cost, and the order shall
16specify the amount of reasonable cost as defined in subsection
172.
18e. If a health benefit plan is not available, and the
19noncustodial parent is receiving assistance or is residing with
20any child receiving assistance as provided in section 252E.2A,
21subsection 1, paragraph “c”, subparagraph (3) or (4), the unit
22shall seek an order that the noncustodial parent shall provide
23a health benefit plan when a plan becomes available for which
24there is no premium cost for a child to the parent.
25f. This section shall not apply to chapter 252H, subchapter
26IV.
27 Sec. 4. NEW SECTION. 252E.1B Establishing and modifying
28orders for medical support — actions initiated by child support
29recovery unit.
301. If the child support recovery unit is initiating an
31action to establish or modify support, this section shall apply
32in addition to the provisions of section 252E.1A.
332. The unit shall apply the following order of priority when
34the unit enters or seeks an order for medical support:
35a. If the custodial parent is currently providing coverage
-8-1for the child under a health benefit plan other than public
2coverage, and the plan is available as described in section
3252E.1A, subsection 3, the unit shall enter or seek an order
4for the custodial parent to provide coverage.
5b. If the noncustodial parent is currently providing
6coverage for the child under a health benefit plan other than
7public coverage, and the plan is available as described in
8section 252E.1A, subsection 3, the unit shall enter or seek an
9order for the noncustodial parent to provide coverage.
10c. If a health benefit plan other than public coverage is
11available as described in section 252E.1A, subsection 3, to the
12custodial parent, the unit shall enter or seek an order for the
13custodial parent to provide coverage.
14d. If a health benefit plan other than public coverage is
15available as described in section 252E.1A, subsection 3, to the
16noncustodial parent, the unit shall enter or seek an order for
17the noncustodial parent to provide coverage.
18e. If a health benefit plan other than public coverage is
19not available to either parent, and the custodial parent has
20public coverage for the child, the unit shall enter or seek an
21order for the custodial parent to provide health care coverage
22and shall enter or seek an order for the noncustodial parent to
23pay cash medical support. However, if any of the circumstances
24described in section 252E.1A, subsection 4, paragraph “a”,
25“b”, or “c” is met, the unit shall enter or seek an order as
26specified by the applicable paragraph.
273. Notwithstanding subsection 2, if there is an order for
28joint physical care for the child and the parties subject to
29the support order, the unit shall apply the following order of
30priority when the unit enters or seeks an order for medical
31support:
32a. If only one parent is currently providing coverage
33for the child under a health benefit plan other than public
34coverage, and the plan is available as described in section
35252E.1A, subsection 3, the unit shall enter or seek an order
-9-1for that parent to provide coverage.
2b. If both parents are currently providing coverage for the
3child under a health benefit plan other than public coverage,
4and both plans are available as described in section 252E.1A,
5subsection 3, the unit shall enter or seek an order for both
6parents to provide coverage.
7c. If neither parent is currently providing coverage
8for the child under a health benefit plan other than public
9coverage, and a health benefit plan other than public coverage
10is available as described in section 252E.1A, subsection 3,
11to one parent, the unit shall enter or seek an order for that
12parent to provide coverage.
13d. If neither parent is currently providing coverage
14for the child under a health benefit plan other than public
15coverage, and a health benefit plan other than public coverage
16is available as described in section 252E.1A, subsection 3, to
17both parents, the unit shall enter or seek an order for both
18parents to provide coverage.
19e. If a health benefit plan other than public coverage
20is not available to either parent and one parent has public
21coverage for the child, the unit shall enter or seek an order
22for that parent to provide health care coverage.
234. The child support recovery unit or the court shall not
24order any modification to an existing medical support order
25in a proceeding conducted solely pursuant to chapter 252H,
26subchapter IV.
27 Sec. 5. Section 252E.2, subsection 1, Code 2018, is amended
28to read as follows:
291. An order requiring the provision of coverage under a
30health benefit plan other than public coverage is authorization
31for enrollment of the dependent if the dependent is otherwise
32eligible to be enrolled. The dependent’s eligibility and
33enrollment for coverage under such a plan shall be governed by
34all applicable terms and conditions, including, but not limited
35to, eligibility and insurability standards. The dependent, if
-10-1eligible, shall be provided the same coverage as the obligor.
2 Sec. 6. Section 252E.3, Code 2018, is amended to read as
3follows:
4252E.3 Health benefit care coverage of obligee.
5For cases for which services are being provided pursuant
6to chapter 252B, the order may require an obligor providing a
7 health benefit plan care coverage for a child to also provide a
8 health benefit plan care coverage for the benefit of an obligee
9if the obligee is eligible for enrollment under the plan in
10which the child or the obligor is enrolled, and if the plan
11 coverage for the obligee is available at no additional cost.
12 Sec. 7. Section 252E.4, subsection 1, Code 2018, is amended
13to read as follows:
141. When a support order requires an obligor to provide
15coverage under a health benefit plan other than public
16coverage, the district court or the department may enter an
17ex parte order directing an employer to take all actions
18necessary to enroll an obligor’s dependent for coverage under
19a health benefit plan or may include the provisions in an ex
20parte income withholding order or notice of income withholding
21pursuant to chapter 252D. The child support recovery unit,
22where appropriate, shall issue a national medical support
23notice to an employer within two business days after the
24date information regarding a newly hired employee is entered
25into the centralized employee registry and matched with a
26noncustodial parent in the case being enforced by the unit, or
27upon receipt of other employment information for such parent.
28The department may amend the information in the ex parte order
29or may amend or terminate the national medical support notice
30regarding health insurance provisions if necessary to comply
31with health insurance requirements including but not limited to
32the provisions of section 252E.2, subsection 2, or to correct
33a mistake of fact.
34 Sec. 8. Section 252E.16, subsection 1, Code 2018, is amended
35to read as follows:
-11- 11. The Unless otherwise specified, the provisions of this
2chapter take effect July 1, 1990, for all support orders
3entered pursuant to chapter 234, 252A, 252C, 598, or 600B.
4 Sec. 9. ADMINISTRATIVE RULES — TRANSITION. Until such
5time as the department of human services adopts rules pursuant
6to chapter 17A necessary to administer this Act, all of the
7following shall apply:
81. The child support recovery unit may initiate proceedings
9to establish and modify support orders in accordance with
10chapter 252E, as amended in this Act.
112. The child support recovery unit may, to the extent
12appropriate, apply and utilize procedures, rules, and forms
13substantially similar to those applicable and utilized pursuant
14to section 252E.1B, as enacted in this Act, for proceedings
15initiated in accordance with section 252E.1A.
16 Sec. 10. EFFECTIVE DATE. This Act takes effect October 1,
172018.
18EXPLANATION
19The inclusion of this explanation does not constitute agreement with
20the explanation’s substance by the members of the general assembly.
21This bill amends provisions relating to medical support
22for a child, based on the final rule adopted by the centers
23for Medicare and Medicaid services and the administration
24for children and families of the United States department of
25health and human services on December 20, 2016, pursuant to
26Executive Order 13563 of January 18, 2011. Under 45 C.F.R.
27subtitle B, chapter III, section 303.31, specifically, states
28are provided with flexibility to permit parents to meet their
29medical support obligations by providing health care coverage
30or payment for medical expenses that are reasonable in cost and
31best meet the health care needs of the child, and clarifies
32that health care coverage includes public and private coverage.
33The bill provides definitions including “cash medical
34support”, “health care coverage”, and “public coverage”, and
35includes public coverage in the definition of a “health benefit
-12-1plan”.
2The bill provides for the provision of medical support
3either by providing and paying for the medical needs of a
4dependent through a health benefit plan, including public
5coverage, or the payment of cash medical support. The bill
6provides the conditions for determining whether medical support
7is to be provided through a health benefit plan other than
8public coverage or through public coverage and whether the
9custodial or noncustodial parent is required to provide health
10care coverage.
11The bill also provides the process and order of priority to
12be followed when the child support recovery unit (CSRU) enters
13or seeks an order for medical support.
14The bill directs the department of human services to adopt
15rules pursuant to Code chapter 17A as necessary to administer
16the bill, but provides that until such time as rules are
17adopted the CSRU may initiate proceedings to establish and
18modify support orders in accordance with Code chapter 252E,
19as amended in the bill, and may, to the extent appropriate,
20apply and utilize procedures, rules, and forms substantially
21similar to those applicable and utilized pursuant to Code
22section 252E.1B for proceedings initiated in accordance with
23Code section 252E.1A, as enacted in the bill.
24The bill takes effect October 1, 2018.
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