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House File 2414 - 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, or 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, including a health
6service corporation, health maintenance organization, or any
7similar corporation or organization, or an employer offering
8self-insurance, that provides a health benefit plan, but does
9not include an entity that provides public coverage.
109. 11. “Medical support” means either the provision of a
11 health benefit plan, including a group or employment-related
12or an individual health benefit plan, or a health benefit plan
13provided pursuant to chapter 514E, to meet the medical needs
14of a dependent and the cost of any premium required by a health
15benefit plan, care coverage or the payment to the obligee of
16a monetary amount in lieu of a health benefit plan, either
17of which is an obligation separate from any monetary amount
18of child cash medical support ordered to be paid. Medical
19support “Medical support” is not alimony. Medical support which
20consists of payment of a monetary amount in lieu of a health
21benefit plan is also an obligation separate from any monetary
22amount a parent is ordered to pay for uncovered medical
23expenses pursuant to the guidelines established pursuant to
24section 598.21B.
2510. 12. “National medical support notice” means a notice
26as prescribed under 42 U.S.C. §666(a)(19) or a substantially
27similar notice, that is issued and forwarded by the department
28in accordance with section 252E.4 to enforce medical support
29 the health care coverage provisions of a support order. The
30national medical support notice is not applicable to a provider
31of public coverage.
3211. 13. “Obligee” means a parent or another natural person
33legally entitled to receive a support payment on behalf of a
34child.
3512. 14. “Obligor” means a parent or another natural person
-3-1legally responsible for the support of a dependent.
213. 15. “Order” means a support order entered pursuant to
3chapter 234, 252A, 252C, 252F, 252H, 252K, 598, 600B, or any
4other support chapter, or pursuant to a comparable statute of
5another state or foreign country, or an ex parte order entered
6pursuant to section 252E.4. “Order” also includes a notice of
7such an order issued by the department.
814. 16. “Plan administrator” means the employer or sponsor
9that offers the health benefit plan or the person to whom the
10duty of plan administrator is delegated by the employer or
11sponsor offering the health benefit plan, by written agreement
12of the parties. “Plan administrator” does not include a
13provider of public coverage.
1415. 17. “Primary care provider” means a physician who
15provides primary care who is a family or general practitioner,
16a pediatrician, an internist, an obstetrician, or a
17gynecologist; an advanced registered nurse practitioner; or a
18physician assistant.
1918. “Public coverage” means health care benefits provided by
20any form of federal or state medical assistance, including but
21not limited to benefits provided under chapter 249A or 514I,
22or under comparable laws of another state, foreign country, or
23Indian nation or tribe.
2419. “Unit” or “child support recovery unit” means unit as
25defined in section 252B.1.
26 Sec. 3. Section 252E.1A, Code 2018, is amended to read as
27follows:
28252E.1A Establishing and modifying orders for medical
29support.
301. This section shall apply to all initial or modified
31orders for support entered under chapter 234, 252A, 252C, 252F,
32252H, 598, 600B, or any other applicable chapter. If an action
33to establish or modify an order for support is initiated by the
34child support recovery unit, section 252E.1B shall also apply.
351. 2. An order or judgment that provides for temporary or
-4-1permanent support for a child shall include a provision for
2medical support for the child as provided in this section.
32. 3. The court shall order as medical support for the
4child health care coverage if a health benefit plan if other
5than public coverage is available to either parent at the time
6the order is entered or modified. A health benefit plan is
7available if the plan is accessible and the cost of the plan is
8reasonable.
9a. The cost of a health benefit plan is considered
10reasonable, and such amount shall be stated in the order, if
11one of the following applies:
12(1) The premium cost for a child to the parent ordered
13to provide the plan coverage does not exceed five percent of
14that parent’s gross income or the child support guidelines
15established pursuant to section 598.21B specifically provide an
16alternative income-based numeric standard for determining the
17reasonable cost of the premium, in which case the reasonable
18cost of the premium as determined by the standard specified by
19the child support guidelines shall apply.
20(2) The premium cost for a child exceeds the amount
21specified in subparagraph (1) and that parent consents or does
22not object to entry of that order.
23b. For purposes of this section, “gross income” has the same
24meaning as gross income for calculation of support under the
25guidelines established under section 598.21B.
26c. For purposes of this section, “the premium cost for
27a child to the parent” ordered to provide the plan coverage
28 means the amount of the premium cost for family coverage to
29the parent which is in excess of the premium cost for single
30coverage, regardless of the number of individuals covered under
31the plan. However, this paragraph shall not be interpreted to
32reduce the amount of the health insurance premium deduction
33a parent may be entitled to when calculating the amount of a
34child support obligation under Iowa court rule 9.5 of the child
35support guidelines.
-5- 1d. For purposes of this section, “family coverage” means
2coverage that covers multiple individuals and covers or could
3cover the child or children subject to the child support order.
43. 4. If a health benefit plan other than public coverage
5 is not available to either parent at the time of the entry
6of the order, and the custodial parent does not have public
7coverage for the child, the court shall order a reasonable
8monetary cash medical support in an amount in lieu of a health
9benefit plan, which amount shall be stated in the order. For
10purposes of this subsection, a reasonable amount means five
11percent of the gross income of the parent ordered to provide
12the monetary amount for medical support or, if the child
13support guidelines established pursuant to section 598.21B
14 specifically provide an alternative income-based numeric
15standard for determining the reasonable amount, a reasonable
16amount means the amount as determined by the standard specified
17by the child support guidelines. This subsection shall not
18apply in any of the following circumstances:
19a. If the parent’s monthly support obligation established
20pursuant to the child support guidelines prescribed by the
21supreme court pursuant to section 598.21B is the minimum
22obligation amount. If this paragraph applies, the court shall
23order the parent to provide a health benefit plan care coverage
24 when a plan becomes available for which there is no premium
25cost for a child to the parent.
26b. If subsection 7, paragraph “d”, “e”, or “f” applies the
27noncustodial parent does not have income which may be subject
28to income withholding for collection of cash medical support at
29the time of the entry of the order. If this paragraph applies,
30the court shall order the noncustodial parent to provide health
31care coverage when a health benefit plan becomes available at
32a reasonable cost, and the order shall specify the amount of
33the reasonable cost as specified in subsection 3, paragraph “a”,
34subparagraph (1).
35c. If the noncustodial parent is receiving assistance or
-6-1is residing with any child receiving assistance as provided
2in section 252E.2A, subsection 1, paragraph “c”, subparagraph
3(3) or (4). If this paragraph applies, the court shall order
4the noncustodial parent to provide health care coverage when
5a health benefit plan becomes available for which there is no
6premium cost for a child to the parent.
74. 5. If a health benefit plan other than public coverage
8is not available to either parent at the time of the entry of
9the order, and the custodial parent has public coverage for the
10child, the court orders shall order the custodial parent to
11provide a health benefit plan under subsection 2 care coverage,
12and the court may also shall order the noncustodial parent to
13provide a reasonable monetary pay cash medical support, which
14 amount in lieu of a health benefit plan shall be stated in the
15order, unless an exception under subsection 4 applies. For
16purposes of this subsection, a reasonable monetary amount means
17an amount not to exceed the lesser of a reasonable amount as
18described in subsection 3, or the premium cost of coverage for
19the child to the custodial parent as described in subsection
202, paragraph “c”.
215. 6. Notwithstanding the requirements of this section, the
22court may order provisions in the alternative to those provided
23in this section to address the health care needs of the child
24if the court determines that extreme circumstances so require
25and documents the court’s written findings in the order.
266. 7. An order, decree, or judgment entered before July 1,
272009 October 1, 2018, that provides for the support of a child
28may be modified in accordance with this section.
297. If the child support recovery unit is providing services
30under chapter 252B and initiating an action to establish or
31modify support, all of the following shall also apply:
32a. If a health benefit plan is available as described in
33subsection 2 to the noncustodial parent, the unit shall seek an
34order for the noncustodial parent to provide the plan.
35b. If a health benefit plan is available as described
-7-1in subsection 2 to the custodial parent and not to the
2noncustodial parent, the unit shall seek an order for the
3custodial parent to provide the plan.
4c. If a health benefit plan is available as described in
5subsection 2 to each parent, and if there is an order for joint
6physical care, the unit shall seek an order for the parent
7currently ordered to provide a health benefit plan to provide
8the plan. If there is no current order for a health benefit
9plan for the child, the unit shall seek an order for the parent
10who is currently providing a health benefit plan to provide the
11plan.
12d. If a health benefit plan is not available, and the
13noncustodial parent does not have income which may be subject
14to income withholding for collection of a reasonable monetary
15amount in lieu of a health benefit plan at the time of the
16entry of the order, the unit shall seek an order that the
17noncustodial parent provide a health benefit plan when a plan
18becomes available at reasonable cost, and the order shall
19specify the amount of reasonable cost as defined in subsection
202.
21e. If a health benefit plan is not available, and the
22noncustodial parent is receiving assistance or is residing with
23any child receiving assistance as provided in section 252E.2A,
24subsection 1, paragraph “c”, subparagraph (3) or (4), the unit
25shall seek an order that the noncustodial parent shall provide
26a health benefit plan when a plan becomes available for which
27there is no premium cost for a child to the parent.
28f. This section shall not apply to chapter 252H, subchapter
29IV.
30 Sec. 4. NEW SECTION. 252E.1B Establishing and modifying
31orders for medical support — actions initiated by child support
32recovery unit.
331. If the child support recovery unit is initiating an
34action to establish or modify support, this section shall apply
35in addition to the provisions of section 252E.1A.
-8- 12. The unit shall apply the following order of priority when
2the unit enters or seeks an order for medical support:
3a. If the custodial parent is currently providing coverage
4for the child under a health benefit plan other than public
5coverage, and the plan is available as described in section
6252E.1A, subsection 3, the unit shall enter or seek an order
7for the custodial parent to provide coverage.
8b. If the noncustodial parent is currently providing
9coverage for the child under a health benefit plan other than
10public coverage, and the plan is available as described in
11section 252E.1A, subsection 3, the unit shall enter or seek an
12order for the noncustodial parent to provide coverage.
13c. If a health benefit plan other than public coverage is
14available as described in section 252E.1A, subsection 3, to the
15custodial parent, the unit shall enter or seek an order for the
16custodial parent to provide coverage.
17d. If a health benefit plan other than public coverage is
18available as described in section 252E.1A, subsection 3, to the
19noncustodial parent, the unit shall enter or seek an order for
20the noncustodial parent to provide coverage.
21e. If a health benefit plan other than public coverage is
22not available to either parent, and the custodial parent has
23public coverage for the child, the unit shall enter or seek an
24order for the custodial parent to provide health care coverage
25and shall enter or seek an order for the noncustodial parent to
26pay cash medical support. However, if any of the circumstances
27described in section 252E.1A, subsection 4, paragraph “a”,
28“b”, or “c” is met, the unit shall enter or seek an order as
29specified by the applicable paragraph.
303. Notwithstanding subsection 2, if there is an order for
31joint physical care for the child and the parties subject to
32the support order, the unit shall apply the following order of
33priority when the unit enters or seeks an order for medical
34support:
35a. If only one parent is currently providing coverage
-9-1for 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 that parent to provide coverage.
5b. If both parents are currently providing coverage for the
6child under a health benefit plan other than public coverage,
7and both plans are available as described in section 252E.1A,
8subsection 3, the unit shall enter or seek an order for both
9parents to provide coverage.
10c. If neither parent is currently providing coverage
11for the child under a health benefit plan other than public
12coverage, and a health benefit plan other than public coverage
13is available as described in section 252E.1A, subsection 3,
14to one parent, the unit shall enter or seek an order for that
15parent to provide coverage.
16d. If neither parent is currently providing coverage
17for the child under a health benefit plan other than public
18coverage, and a health benefit plan other than public coverage
19is available as described in section 252E.1A, subsection 3, to
20both parents, the unit shall enter or seek an order for both
21parents to provide coverage.
22e. If a health benefit plan other than public coverage
23is not available to either parent and one parent has public
24coverage for the child, the unit shall enter or seek an order
25for that parent to provide health care coverage.
264. The child support recovery unit or the court shall not
27order any modification to an existing medical support order
28in a proceeding conducted solely pursuant to chapter 252H,
29subchapter IV.
30 Sec. 5. Section 252E.2, subsection 1, Code 2018, is amended
31to read as follows:
321. An order requiring the provision of coverage under a
33health benefit plan other than public coverage is authorization
34for enrollment of the dependent if the dependent is otherwise
35eligible to be enrolled. The dependent’s eligibility and
-10-1enrollment for coverage under such a plan shall be governed by
2all applicable terms and conditions, including, but not limited
3to, eligibility and insurability standards. The dependent, if
4eligible, shall be provided the same coverage as the obligor.
5 Sec. 6. Section 252E.3, Code 2018, is amended to read as
6follows:
7252E.3 Health benefit care coverage of obligee.
8For cases for which services are being provided pursuant
9to chapter 252B, the order may require an obligor providing a
10 health benefit plan care coverage for a child to also provide a
11 health benefit plan care coverage for the benefit of an obligee
12if the obligee is eligible for enrollment under the plan in
13which the child or the obligor is enrolled, and if the plan
14 coverage for the obligee is available at no additional cost.
15 Sec. 7. Section 252E.4, subsection 1, Code 2018, is amended
16to read as follows:
171. When a support order requires an obligor to provide
18coverage under a health benefit plan other than public
19coverage, the district court or the department may enter an
20ex parte order directing an employer to take all actions
21necessary to enroll an obligor’s dependent for coverage under
22a health benefit plan or may include the provisions in an ex
23parte income withholding order or notice of income withholding
24pursuant to chapter 252D. The child support recovery unit,
25where appropriate, shall issue a national medical support
26notice to an employer within two business days after the
27date information regarding a newly hired employee is entered
28into the centralized employee registry and matched with a
29noncustodial parent in the case being enforced by the unit, or
30upon receipt of other employment information for such parent.
31The department may amend the information in the ex parte order
32or may amend or terminate the national medical support notice
33regarding health insurance provisions if necessary to comply
34with health insurance requirements including but not limited to
35the provisions of section 252E.2, subsection 2, or to correct
-11-1a mistake of fact.
2 Sec. 8. Section 252E.16, subsection 1, Code 2018, is amended
3to read as follows:
41. The Unless otherwise specified, the provisions of this
5chapter take effect July 1, 1990, for all support orders
6entered pursuant to chapter 234, 252A, 252C, 598, or 600B.
7 Sec. 9. ADMINISTRATIVE RULES — TRANSITION. Until such
8time as the department of human services adopts rules pursuant
9to chapter 17A necessary to administer this Act, all of the
10following shall apply:
111. The child support recovery unit may initiate proceedings
12to establish and modify support orders in accordance with
13chapter 252E, as amended in this Act.
142. The child support recovery unit may, to the extent
15appropriate, apply and utilize procedures, rules, and forms
16substantially similar to those applicable and utilized pursuant
17to section 252E.1B, as enacted in this Act, for proceedings
18initiated in accordance with section 252E.1A.
19 Sec. 10. EFFECTIVE DATE. This Act takes effect October 1,
202018.
21EXPLANATION
22The inclusion of this explanation does not constitute agreement with
23the explanation’s substance by the members of the general assembly.
24This bill amends provisions relating to medical support
25for a child, based on the final rule adopted by the centers
26for Medicare and Medicaid services and the administration
27for children and families of the United States department of
28health and human services on December 20, 2016, pursuant to
29Executive Order 13563 of January 18, 2011. Under 45 C.F.R.
30subtitle B, chapter III, section 303.31, specifically, states
31are provided with flexibility to permit parents to meet their
32medical support obligations by providing health care coverage
33or payment for medical expenses that are reasonable in cost and
34best meet the health care needs of the child, and clarifies
35that health care coverage includes public and private coverage.
-12- 1The bill provides definitions including “cash medical
2support”, “health care coverage”, and “public coverage”, and
3includes public coverage in the definition of a “health benefit
4plan”.
5The bill provides for the provision of medical support
6either by providing and paying for the medical needs of a
7dependent through a health benefit plan, including public
8coverage, or the payment of cash medical support. The bill
9provides the conditions for determining whether medical support
10is to be provided through a health benefit plan other than
11public coverage or through public coverage and whether the
12custodial or noncustodial parent is required to provide health
13care coverage.
14The bill also provides the process and order of priority to
15be followed when the child support recovery unit (CSRU) enters
16or seeks an order for medical support.
17The bill directs the department of human services to adopt
18rules pursuant to Code chapter 17A as necessary to administer
19the bill, but provides that until such time as rules are
20adopted the CSRU may initiate proceedings to establish and
21modify support orders in accordance with Code chapter 252E,
22as amended in the bill, and may, to the extent appropriate,
23apply and utilize procedures, rules, and forms substantially
24similar to those applicable and utilized pursuant to Code
25section 252E.1B for proceedings initiated in accordance with
26Code section 252E.1A, as enacted in the bill.
27The 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, or 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, including a health
6service corporation, health maintenance organization, or any
7similar corporation or organization, or an employer offering
8self-insurance, that provides a health benefit plan, but does
9not include an entity that provides public coverage.
109. 11. “Medical support” means either the provision of a
11 health benefit plan, including a group or employment-related
12or an individual health benefit plan, or a health benefit plan
13provided pursuant to chapter 514E, to meet the medical needs
14of a dependent and the cost of any premium required by a health
15benefit plan, care coverage or the payment to the obligee of
16a monetary amount in lieu of a health benefit plan, either
17of which is an obligation separate from any monetary amount
18of child cash medical support ordered to be paid. Medical
19support “Medical support” is not alimony. Medical support which
20consists of payment of a monetary amount in lieu of a health
21benefit plan is also an obligation separate from any monetary
22amount a parent is ordered to pay for uncovered medical
23expenses pursuant to the guidelines established pursuant to
24section 598.21B.
2510. 12. “National medical support notice” means a notice
26as prescribed under 42 U.S.C. §666(a)(19) or a substantially
27similar notice, that is issued and forwarded by the department
28in accordance with section 252E.4 to enforce medical support
29 the health care coverage provisions of a support order. The
30national medical support notice is not applicable to a provider
31of public coverage.
3211. 13. “Obligee” means a parent or another natural person
33legally entitled to receive a support payment on behalf of a
34child.
3512. 14. “Obligor” means a parent or another natural person
-3-1legally responsible for the support of a dependent.
213. 15. “Order” means a support order entered pursuant to
3chapter 234, 252A, 252C, 252F, 252H, 252K, 598, 600B, or any
4other support chapter, or pursuant to a comparable statute of
5another state or foreign country, or an ex parte order entered
6pursuant to section 252E.4. “Order” also includes a notice of
7such an order issued by the department.
814. 16. “Plan administrator” means the employer or sponsor
9that offers the health benefit plan or the person to whom the
10duty of plan administrator is delegated by the employer or
11sponsor offering the health benefit plan, by written agreement
12of the parties. “Plan administrator” does not include a
13provider of public coverage.
1415. 17. “Primary care provider” means a physician who
15provides primary care who is a family or general practitioner,
16a pediatrician, an internist, an obstetrician, or a
17gynecologist; an advanced registered nurse practitioner; or a
18physician assistant.
1918. “Public coverage” means health care benefits provided by
20any form of federal or state medical assistance, including but
21not limited to benefits provided under chapter 249A or 514I,
22or under comparable laws of another state, foreign country, or
23Indian nation or tribe.
2419. “Unit” or “child support recovery unit” means unit as
25defined in section 252B.1.
26 Sec. 3. Section 252E.1A, Code 2018, is amended to read as
27follows:
28252E.1A Establishing and modifying orders for medical
29support.
301. This section shall apply to all initial or modified
31orders for support entered under chapter 234, 252A, 252C, 252F,
32252H, 598, 600B, or any other applicable chapter. If an action
33to establish or modify an order for support is initiated by the
34child support recovery unit, section 252E.1B shall also apply.
351. 2. An order or judgment that provides for temporary or
-4-1permanent support for a child shall include a provision for
2medical support for the child as provided in this section.
32. 3. The court shall order as medical support for the
4child health care coverage if a health benefit plan if other
5than public coverage is available to either parent at the time
6the order is entered or modified. A health benefit plan is
7available if the plan is accessible and the cost of the plan is
8reasonable.
9a. The cost of a health benefit plan is considered
10reasonable, and such amount shall be stated in the order, if
11one of the following applies:
12(1) The premium cost for a child to the parent ordered
13to provide the plan coverage does not exceed five percent of
14that parent’s gross income or the child support guidelines
15established pursuant to section 598.21B specifically provide an
16alternative income-based numeric standard for determining the
17reasonable cost of the premium, in which case the reasonable
18cost of the premium as determined by the standard specified by
19the child support guidelines shall apply.
20(2) The premium cost for a child exceeds the amount
21specified in subparagraph (1) and that parent consents or does
22not object to entry of that order.
23b. For purposes of this section, “gross income” has the same
24meaning as gross income for calculation of support under the
25guidelines established under section 598.21B.
26c. For purposes of this section, “the premium cost for
27a child to the parent” ordered to provide the plan coverage
28 means the amount of the premium cost for family coverage to
29the parent which is in excess of the premium cost for single
30coverage, regardless of the number of individuals covered under
31the plan. However, this paragraph shall not be interpreted to
32reduce the amount of the health insurance premium deduction
33a parent may be entitled to when calculating the amount of a
34child support obligation under Iowa court rule 9.5 of the child
35support guidelines.
-5- 1d. For purposes of this section, “family coverage” means
2coverage that covers multiple individuals and covers or could
3cover the child or children subject to the child support order.
43. 4. If a health benefit plan other than public coverage
5 is not available to either parent at the time of the entry
6of the order, and the custodial parent does not have public
7coverage for the child, the court shall order a reasonable
8monetary cash medical support in an amount in lieu of a health
9benefit plan, which amount shall be stated in the order. For
10purposes of this subsection, a reasonable amount means five
11percent of the gross income of the parent ordered to provide
12the monetary amount for medical support or, if the child
13support guidelines established pursuant to section 598.21B
14 specifically provide an alternative income-based numeric
15standard for determining the reasonable amount, a reasonable
16amount means the amount as determined by the standard specified
17by the child support guidelines. This subsection shall not
18apply in any of the following circumstances:
19a. If the parent’s monthly support obligation established
20pursuant to the child support guidelines prescribed by the
21supreme court pursuant to section 598.21B is the minimum
22obligation amount. If this paragraph applies, the court shall
23order the parent to provide a health benefit plan care coverage
24 when a plan becomes available for which there is no premium
25cost for a child to the parent.
26b. If subsection 7, paragraph “d”, “e”, or “f” applies the
27noncustodial parent does not have income which may be subject
28to income withholding for collection of cash medical support at
29the time of the entry of the order. If this paragraph applies,
30the court shall order the noncustodial parent to provide health
31care coverage when a health benefit plan becomes available at
32a reasonable cost, and the order shall specify the amount of
33the reasonable cost as specified in subsection 3, paragraph “a”,
34subparagraph (1).
35c. If the noncustodial parent is receiving assistance or
-6-1is residing with any child receiving assistance as provided
2in section 252E.2A, subsection 1, paragraph “c”, subparagraph
3(3) or (4). If this paragraph applies, the court shall order
4the noncustodial parent to provide health care coverage when
5a health benefit plan becomes available for which there is no
6premium cost for a child to the parent.
74. 5. If a health benefit plan other than public coverage
8is not available to either parent at the time of the entry of
9the order, and the custodial parent has public coverage for the
10child, the court orders shall order the custodial parent to
11provide a health benefit plan under subsection 2 care coverage,
12and the court may also shall order the noncustodial parent to
13provide a reasonable monetary pay cash medical support, which
14 amount in lieu of a health benefit plan shall be stated in the
15order, unless an exception under subsection 4 applies. For
16purposes of this subsection, a reasonable monetary amount means
17an amount not to exceed the lesser of a reasonable amount as
18described in subsection 3, or the premium cost of coverage for
19the child to the custodial parent as described in subsection
202, paragraph “c”.
215. 6. Notwithstanding the requirements of this section, the
22court may order provisions in the alternative to those provided
23in this section to address the health care needs of the child
24if the court determines that extreme circumstances so require
25and documents the court’s written findings in the order.
266. 7. An order, decree, or judgment entered before July 1,
272009 October 1, 2018, that provides for the support of a child
28may be modified in accordance with this section.
297. If the child support recovery unit is providing services
30under chapter 252B and initiating an action to establish or
31modify support, all of the following shall also apply:
32a. If a health benefit plan is available as described in
33subsection 2 to the noncustodial parent, the unit shall seek an
34order for the noncustodial parent to provide the plan.
35b. If a health benefit plan is available as described
-7-1in subsection 2 to the custodial parent and not to the
2noncustodial parent, the unit shall seek an order for the
3custodial parent to provide the plan.
4c. If a health benefit plan is available as described in
5subsection 2 to each parent, and if there is an order for joint
6physical care, the unit shall seek an order for the parent
7currently ordered to provide a health benefit plan to provide
8the plan. If there is no current order for a health benefit
9plan for the child, the unit shall seek an order for the parent
10who is currently providing a health benefit plan to provide the
11plan.
12d. If a health benefit plan is not available, and the
13noncustodial parent does not have income which may be subject
14to income withholding for collection of a reasonable monetary
15amount in lieu of a health benefit plan at the time of the
16entry of the order, the unit shall seek an order that the
17noncustodial parent provide a health benefit plan when a plan
18becomes available at reasonable cost, and the order shall
19specify the amount of reasonable cost as defined in subsection
202.
21e. If a health benefit plan is not available, and the
22noncustodial parent is receiving assistance or is residing with
23any child receiving assistance as provided in section 252E.2A,
24subsection 1, paragraph “c”, subparagraph (3) or (4), the unit
25shall seek an order that the noncustodial parent shall provide
26a health benefit plan when a plan becomes available for which
27there is no premium cost for a child to the parent.
28f. This section shall not apply to chapter 252H, subchapter
29IV.
30 Sec. 4. NEW SECTION. 252E.1B Establishing and modifying
31orders for medical support — actions initiated by child support
32recovery unit.
331. If the child support recovery unit is initiating an
34action to establish or modify support, this section shall apply
35in addition to the provisions of section 252E.1A.
-8- 12. The unit shall apply the following order of priority when
2the unit enters or seeks an order for medical support:
3a. If the custodial parent is currently providing coverage
4for the child under a health benefit plan other than public
5coverage, and the plan is available as described in section
6252E.1A, subsection 3, the unit shall enter or seek an order
7for the custodial parent to provide coverage.
8b. If the noncustodial parent is currently providing
9coverage for the child under a health benefit plan other than
10public coverage, and the plan is available as described in
11section 252E.1A, subsection 3, the unit shall enter or seek an
12order for the noncustodial parent to provide coverage.
13c. If a health benefit plan other than public coverage is
14available as described in section 252E.1A, subsection 3, to the
15custodial parent, the unit shall enter or seek an order for the
16custodial parent to provide coverage.
17d. If a health benefit plan other than public coverage is
18available as described in section 252E.1A, subsection 3, to the
19noncustodial parent, the unit shall enter or seek an order for
20the noncustodial parent to provide coverage.
21e. If a health benefit plan other than public coverage is
22not available to either parent, and the custodial parent has
23public coverage for the child, the unit shall enter or seek an
24order for the custodial parent to provide health care coverage
25and shall enter or seek an order for the noncustodial parent to
26pay cash medical support. However, if any of the circumstances
27described in section 252E.1A, subsection 4, paragraph “a”,
28“b”, or “c” is met, the unit shall enter or seek an order as
29specified by the applicable paragraph.
303. Notwithstanding subsection 2, if there is an order for
31joint physical care for the child and the parties subject to
32the support order, the unit shall apply the following order of
33priority when the unit enters or seeks an order for medical
34support:
35a. If only one parent is currently providing coverage
-9-1for 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 that parent to provide coverage.
5b. If both parents are currently providing coverage for the
6child under a health benefit plan other than public coverage,
7and both plans are available as described in section 252E.1A,
8subsection 3, the unit shall enter or seek an order for both
9parents to provide coverage.
10c. If neither parent is currently providing coverage
11for the child under a health benefit plan other than public
12coverage, and a health benefit plan other than public coverage
13is available as described in section 252E.1A, subsection 3,
14to one parent, the unit shall enter or seek an order for that
15parent to provide coverage.
16d. If neither parent is currently providing coverage
17for the child under a health benefit plan other than public
18coverage, and a health benefit plan other than public coverage
19is available as described in section 252E.1A, subsection 3, to
20both parents, the unit shall enter or seek an order for both
21parents to provide coverage.
22e. If a health benefit plan other than public coverage
23is not available to either parent and one parent has public
24coverage for the child, the unit shall enter or seek an order
25for that parent to provide health care coverage.
264. The child support recovery unit or the court shall not
27order any modification to an existing medical support order
28in a proceeding conducted solely pursuant to chapter 252H,
29subchapter IV.
30 Sec. 5. Section 252E.2, subsection 1, Code 2018, is amended
31to read as follows:
321. An order requiring the provision of coverage under a
33health benefit plan other than public coverage is authorization
34for enrollment of the dependent if the dependent is otherwise
35eligible to be enrolled. The dependent’s eligibility and
-10-1enrollment for coverage under such a plan shall be governed by
2all applicable terms and conditions, including, but not limited
3to, eligibility and insurability standards. The dependent, if
4eligible, shall be provided the same coverage as the obligor.
5 Sec. 6. Section 252E.3, Code 2018, is amended to read as
6follows:
7252E.3 Health benefit care coverage of obligee.
8For cases for which services are being provided pursuant
9to chapter 252B, the order may require an obligor providing a
10 health benefit plan care coverage for a child to also provide a
11 health benefit plan care coverage for the benefit of an obligee
12if the obligee is eligible for enrollment under the plan in
13which the child or the obligor is enrolled, and if the plan
14 coverage for the obligee is available at no additional cost.
15 Sec. 7. Section 252E.4, subsection 1, Code 2018, is amended
16to read as follows:
171. When a support order requires an obligor to provide
18coverage under a health benefit plan other than public
19coverage, the district court or the department may enter an
20ex parte order directing an employer to take all actions
21necessary to enroll an obligor’s dependent for coverage under
22a health benefit plan or may include the provisions in an ex
23parte income withholding order or notice of income withholding
24pursuant to chapter 252D. The child support recovery unit,
25where appropriate, shall issue a national medical support
26notice to an employer within two business days after the
27date information regarding a newly hired employee is entered
28into the centralized employee registry and matched with a
29noncustodial parent in the case being enforced by the unit, or
30upon receipt of other employment information for such parent.
31The department may amend the information in the ex parte order
32or may amend or terminate the national medical support notice
33regarding health insurance provisions if necessary to comply
34with health insurance requirements including but not limited to
35the provisions of section 252E.2, subsection 2, or to correct
-11-1a mistake of fact.
2 Sec. 8. Section 252E.16, subsection 1, Code 2018, is amended
3to read as follows:
41. The Unless otherwise specified, the provisions of this
5chapter take effect July 1, 1990, for all support orders
6entered pursuant to chapter 234, 252A, 252C, 598, or 600B.
7 Sec. 9. ADMINISTRATIVE RULES — TRANSITION. Until such
8time as the department of human services adopts rules pursuant
9to chapter 17A necessary to administer this Act, all of the
10following shall apply:
111. The child support recovery unit may initiate proceedings
12to establish and modify support orders in accordance with
13chapter 252E, as amended in this Act.
142. The child support recovery unit may, to the extent
15appropriate, apply and utilize procedures, rules, and forms
16substantially similar to those applicable and utilized pursuant
17to section 252E.1B, as enacted in this Act, for proceedings
18initiated in accordance with section 252E.1A.
19 Sec. 10. EFFECTIVE DATE. This Act takes effect October 1,
202018.
21EXPLANATION
22The inclusion of this explanation does not constitute agreement with
23the explanation’s substance by the members of the general assembly.
24This bill amends provisions relating to medical support
25for a child, based on the final rule adopted by the centers
26for Medicare and Medicaid services and the administration
27for children and families of the United States department of
28health and human services on December 20, 2016, pursuant to
29Executive Order 13563 of January 18, 2011. Under 45 C.F.R.
30subtitle B, chapter III, section 303.31, specifically, states
31are provided with flexibility to permit parents to meet their
32medical support obligations by providing health care coverage
33or payment for medical expenses that are reasonable in cost and
34best meet the health care needs of the child, and clarifies
35that health care coverage includes public and private coverage.
-12- 1The bill provides definitions including “cash medical
2support”, “health care coverage”, and “public coverage”, and
3includes public coverage in the definition of a “health benefit
4plan”.
5The bill provides for the provision of medical support
6either by providing and paying for the medical needs of a
7dependent through a health benefit plan, including public
8coverage, or the payment of cash medical support. The bill
9provides the conditions for determining whether medical support
10is to be provided through a health benefit plan other than
11public coverage or through public coverage and whether the
12custodial or noncustodial parent is required to provide health
13care coverage.
14The bill also provides the process and order of priority to
15be followed when the child support recovery unit (CSRU) enters
16or seeks an order for medical support.
17The bill directs the department of human services to adopt
18rules pursuant to Code chapter 17A as necessary to administer
19the bill, but provides that until such time as rules are
20adopted the CSRU may initiate proceedings to establish and
21modify support orders in accordance with Code chapter 252E,
22as amended in the bill, and may, to the extent appropriate,
23apply and utilize procedures, rules, and forms substantially
24similar to those applicable and utilized pursuant to Code
25section 252E.1B for proceedings initiated in accordance with
26Code section 252E.1A, as enacted in the bill.
27The bill takes effect October 1, 2018.
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