Update to Revised Part A National Medical Support Notice and Instructions


Publication Date: December 3, 2019



DATE: December 3, 2019

TO: State IV-D Agencies

SUBJECT:  Update to Revised Part A National Medical Support Notice and Instructions

ATTACHMENT:  National Medical Support Form and Instructions, OMB 0970-0222

The Office of Management and Budget has re-approved the revised National Medical Support Notice (NMSN) Part A with the same expiration date of October 31, 2022. State child support agencies under title IV-D of the Social Security Act must enforce the health care coverage provision in a child support order and use the NMSN to aid enforcement. Tribal IV-D agencies do not have to use these forms. On October 30, 2019, OCSE issued AT-19-05 announcing the changes to the NMSN Part A. However, we have corrected the following paragraph in the form instructions to read:


In any case in which the above employee’s employment terminates, the employer must promptly notify the Issuing Agency listed above of such termination. This requirement may be satisfied by sending to the Issuing Agency a copy of Part A with response 4 checked or any notice the employer is required to provide under the continuation coverage provisions of ERISA or the Health Insurance Portability and Accountability Act.  

As a reminder, the significant changes to Part A include the following:

  1. A checkbox was added to distinguish between the National Medical Support Order/Notice and a Termination Order/Notice.
  2. The Employer Responsibilities section indicates that employers are required to terminate medical insurance when they receive an NMSN with the Termination Order/Notice checkbox checked on page one unless the parent wishes to continue the insurance voluntarily.

The Department of Labor is the agency that will update the NMSN Part B form.  OCSE will publish the revised NMSN Part B on its website once the updated form is available.  Meanwhile, continue using the current NMSN Part B form.

EFFECTIVE DATE:  November 1, 2019.  You can begin using this form immediately, although we understand some states and tribes may need additional time to make programming changes. You must begin generating the revised form by August 31, 2020.


INQUIRIES:  ACF/OCSE Regional Program Managers

Scott M. Lekan
Office of Child Support Enforcement

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