Notice of Changes to the OCSE-157 Form regarding Medical Support

ACTION TRANSMITTAL

AT-11-10

DATE: October 17, 2011

ATTACHMENTS: Instructions for Completing the Child Support Enforcement Annual Data Report Form OCSE-157 (Expired 09/2014)

TO: ALL STATE AND TRIBAL IV-D DIRECTORS

SUBJECT: Notice of changes to the OCSE-157 Form regarding Medical Support

BACKGROUND: State agencies administering child support enforcement programs under Title IV-D of the Social Security Act are required to submit the OCSE-157 data collection form. The data collected on this form are compiled and presented in the Child Support Enforcement’s preliminary reports and Annual Report to the Congress. These data are also used to compute individual state incentive, penalty, and program performance measures. The form was last reviewed and published in 2008 with an expiration date of September 30, 2011.

The need to renew clearance of the OCSE-157 form through the Office of Management and Budget (OMB) provided the opportunity to consider revisions to the definition of medical support in the instructions. These changes are needed in order to be consistent with the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) (P.L. 111-3), the Affordable Care Act (P.L. 111-148 and P.L. 111-152), and Secretary Sebelius’ goal of enrolling all eligible uninsured children in Medicaid and the Children’s Health Insurance Program (CHIP) by 2014. Also, OCSE plans to issue a Notice of Proposed Rulemaking in the next year to allow states to use the flexibility provided by sections 452(f) and 466(a)(19) of the Social Security Act to improve interoperability with Medicaid and CHIP.

The primary change to the definition of medical support is that publicly funded programs will now be included in the definition of medical support regardless of whether there is an order for a cash contribution. Thus, the changes to the OCSE-157 medical support instructions will provide states with the option to define medical support to include private health insurance as well as other publicly funded health care coverage such as Medicaid, CHIP, other state coverage plans, and cash medical support.

Comments were solicited for revisions to the OCSE-157 form via the Federal Register on May 18, 2011 and further revisions were made based on these comments. Listed below are the revisions that were made to the form instructions regarding medical support. These changes are optional for states. In implementing any of these options, state IV-D agencies must continue to provide medical child support enforcement services in compliance with all statutory requirements, including Sections 452(f) and 466(a)(19) of the Act.

Changes to OCSE-157 Form Instructions:

Service Definitions

• Medical Support—The definition of medical support has been revised to provide states with the option to include publicly funded health care coverage such as Medicaid, CHIP, and other state coverage plans.

Section E: Medical Support

• Line 21—Cases Open at the End of the Fiscal Year in Which Medical Support is Ordered—The instructions for this line have been revised to provide states with the option to include cases with publicly funded health care coverage such as Medicaid, CHIP, and other state coverage plans.

  Line 21a—Cases Open at the End of the Fiscal Year in Which Medical Support is Ordered and Provided—The instructions for this line have been revised to provide states with the option to include cases with publicly funded health care coverage such as Medicaid, CHIP, and other state coverage plans. The following text will be deleted from the instructions for this line to reduce the burden of states having to verify and document those cases where health insurance is not available at a reasonable cost: “If private health insurance is ordered, states cannot include cash medical support payments, unless it is documented that private health insurance is not available to the non-custodial parent at a reasonable cost. Publicly-funded health insurance is included only if there is documentation that private health insurance coverage is unavailable at a reasonable cost and a parent is ordered by a court or administrative process to provide a cash medical support payment to help pay the cost of Medicaid or State Child Health Insurance Program (SCHIP).”

• Line 22—Cases Open at the End of the Fiscal Year Where Health Insurance is Ordered—The following sentence has been deleted from the instructions for this line: &ldqup;States may exclude cases where the unavailability of health insurance at a reasonable cost is confirmed.”
• Line 23—Cases Open at the End of the Fiscal Year Where Health Insurance is Provided and Ordered—The wording in this line name, “Provided as Ordered,” has been changed to “Provided and Ordered.” This change will give states the option to include cases where health insurance (including publicly funded health insurance) is provided.
• Other medical support lines including lines 33, 34, and 35 will remain unchanged (except that Line 33 will no longer be optional according to phase-in requirements).

As previously communicated in OCSE-AT-10-02, state IV-D agencies will not be penalized if OCSE is unable to certify that the state IV-D agency is in compliance with federal medical support regulations that were amended by a Final Rule published in the Federal Register on July 21, 2008 (73 FR 42416) and disseminated with OCSE-AT-08-08. This suspension provides relief to states by permitting them to avoid making new investments in medical support enforcement to comply with regulatory requirements that may soon become obsolete as OCSE develops further guidance.

All medical support line items on the OCSE-157 will continue to be reported for compliance and statistical purposes. However, audits have been temporarily suspended as previously communicated in OCSE-AT-10-10. This data is also not currently used to compute incentive payments or penalties and there are no immediate plans to do so. In addition, a medical support incentive measure has been put on hold until OCSE provides further guidance.

RELATED REFERENCES: DCL-11-10, AT-10-10, AT-10-02

EFFECTIVE DATE: States are to begin using this Form to report Title IV-D Program status and accomplishments for Federal Fiscal Year 2011. The first report is due by October 30, 2011. The new OMB expiration date is September 30, 2014.

SUPERSEDED MATERIAL: AT-08-10

INQUIRIES TO: OCSE Division of Planning, Research, and Evaluation

Vicki Turetsky
Commissioner
Office of Child Support Enforcement