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Administration for Children and Families US Department of Health and Human Services
The Office of Child Support Enforcement Giving Hope and Support to America's Children
[Code of Federal Regulations]
[Title 45, Volume 2, Parts 200 to 499]
[Revised as of October 1, 1998]
From the U.S. Government Printing Office via GPO Access
[CITE: 45CFR303.31]
[Page 156-157]

TITLE 45--PUBLIC WELFARE AND HUMAN SERVICES

PART 303--STANDARDS FOR PROGRAM OPERATIONS

Sec. 303.31 Securing and enforcing medical support obligations.

     (a) For purposes of this section:

     (1) Health insurance is considered reasonable in cost if it is employment-related or other group health insurance, regardless of service delivery mechanism.

     (2) Health insurance includes fee for service, health maintenance organization, preferred provider organization, and other types of coverage under which medical services could be provided to the dependent child(ren) of an absent parent.

     (b) With respect to cases for which there is an assignment as defined in Sec. 301.1 of this chapter in effect, the IV-D agency shall:

     (1) Unless the custodial parent and child(ren) have satisfactory health insurance other than Medicaid, petition the court or administrative authority to include health insurance that is available to the absent parent at reasonable cost in new or modified court or administrative orders for support.

     (2) Petition the court or administrative authority to include medical support as required under paragraph (b)(1) of this section whether or not--

     (i) Health insurance at reasonable cost is actually available to the absent parent at the time the order is entered; or

     (ii) Modification of current coverage to include the child(ren) in question is immediately possible.

     (3) Establish written criteria to identify cases not included under paragraphs (b)(1) and (b)(2) of this section where there is a high potential for obtaining medical support based on--

     (i) Evidence that health insurance may be available to the absent parent at a reasonable cost, and

     (ii) Facts, as defined by State law, regulation, procedure, or other directive, which are sufficient to warrant modification of the existing support order to include health insurance coverage for a dependent child(ren).

     (4) Petition the court or administrative authority to modify support orders for cases identified in paragraph (b)(3) of this section to include medical support in the form of health insurance coverage.

     (5) Provide the custodial parent with information pertaining to the health insurance policy which has been secured for the dependent child(ren) pursuant to an order obtained under this section.

     (6) Inform the Medicaid agency when a new or modified court or administrative order for child support includes medical support and provide the information referred to in Sec. 303.30(a) of this part to the Medicaid agency when the information is available.

     (7) If health insurance is available to the absent parent at reasonable cost and has not been obtained at the time the order is entered, take steps to enforce the health insurance coverage required by the support order and provide the Medicaid agency with the information referred to in Sec. 303.30(a) of this part.

     (8) Periodically communicate with the Medicaid agency to determine if there have been lapses in health insurance coverage for Medicaid applicants and recipients.

     (9) Request employers and other groups offering health insurance coverage that is being enforced by the IV-D agency to notify the IV-D agency of lapses in coverage.

     (c) The IV-D agency shall inform an individual who is eligible for services under Sec. 302.33 of this chapter that medical support enforcement services are available and shall provide the services specified in paragraph (b) of this section:

     (1) If an individual eligible for services under Sec. 302.33 is a Medicaid recipient; or

     (2) With the consent of the individual who is eligible for services under Sec. 302.33 and is not a Medicaid recipient, except that health insurance information shall not be transmitted to the Medicaid agency.

(Approved by the Office of Management and Budget under control numbers 0960-0420 and 0970-0107)

[50 FR 41895, Oct. 15, 1985, as amended at 51 FR 37732, Oct. 24, 1986; 53 FR 36021, Sept. 16, 1988. Redesignated at 54 FR 32312, Aug. 4, 1989, and amended at 56 FR 8004, Feb. 26, 1991; 61 FR 67241, Dec. 20, 1996]