ELIMINATION OF BARRIERS TO THE EFFECTIVE ESTABLISHMENT AND ENFORCEMENT OF MEDICAL CHILD SUPPORT.

SEC. 401. ELIMINATION OF BARRIERS TO THE EFFECTIVE ESTABLISHMENT AND ENFORCEMENT OF MEDICAL CHILD SUPPORT. (a) Study on Effectiveness of Enforcement of Medical Support by State Agencies.— (1) Medical child support working group.—Within 60 days after the date of the enactment of this Act, the Secretary of Health and Human Services and the Secretary of Labor shall jointly establish a Medical Child Support Working Group. The purpose of the Working Group shall be to identify the impediments to the effective enforcement of medical support by State agencies administering the programs operated pursuant to part D of title IV of the Social Security Act. (2) Membership.—The Working Group shall consist of not more than 30 members and shall be composed of representatives of— (A) the Department of Labor; (B) the Department of Health and Human Services; (C) State directors of programs under part D of title IV of the Social Security Act; (D) State directors of the Medicaid program under title XIX of the Social Security Act; (E) employers, including owners of small businesses and their trade or industry representatives and certified human resource and payroll professionals; (F) plan administrators and plan sponsors of group health plans (as defined in section 607(1) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1167(1)); (G) children potentially eligible for medical support, such as child advocacy organizations; (H) State medical child support programs; and (I) organizations representing State child support programs. (3) Compensation.—The members shall serve without compensation. (4) Administrative support.—The Department of Health and Human Services and the Department of Labor shall jointly provide appropriate administrative support to the Working Group, including technical assistance. The Working Group may use the services and facilities of either such Department, with or without reimbursement, as jointly determined by such Departments. (5) Report.— (A) Report by working group to the secretaries.—Not later than 18 months after the date of the enactment of this Act, the Working Group shall submit to the Secretary of Labor and the Secretary of Health and Human Services a report containing recommendations for appropriate measures to address the impediments to the effective enforcement of medical support by State agencies administering the programs operated pursuant to part D of title IV of the Social Security Act identified by the Working Group, including— 112 STAT. 660 (i) recommendations based on assessments of the form and content of the National Medical Support Notice, as issued under interim regulations; (ii) appropriate measures that establish the priority of withholding of child support obligations, medical support obligations, arrearages in such obligations, and in the case of a medical support obligation, the employee’s portion of any health care coverage premium, by such State agencies in light of the restrictions on garnishment provided under title III of the Consumer Credit Protection Act (15 U.S.C. 1671-1677); (ii) appropriate procedures for coordinating the provision, enforcement, and transition of health care coverage under the State programs operated pursuant to part D of title IV of the Social Security Act and titles XIX and XXI of such Act; (iv) appropriate measures to improve the availability of alternate types of medical support that are aside from health coverage offered through the noncustodial parent’s health plan and unrelated to the noncustodial parent’s employer, including measures that establish a noncustodial parent’s responsibility to share the cost of premiums, co-payments, deductibles, or payments for services not covered under a child’s existing health coverage; (v) recommendations on whether reasonable cost should remain a consideration under section 452(f) of the Social Security Act; and (vi) appropriate measures for eliminating any other impediments to the effective enforcement of medical support orders that the Working Group deems necessary. (B) Report by secretaries to the congress.—Not later than 2 months after receipt of the report pursuant to subparagraph (A), the Secretaries shall jointly submit a report to each House of the Congress regarding the recommendations contained in the report under subparagraph (A). (6) Termination.—The Working Group shall terminate 30 days after the date of the issuance of its report under paragraph (5). (b) Promulgation of National Medical Support Notice.— (1) In general.—The Secretary of Health and Human Services and the Secretary of Labor shall jointly develop and promulgate by regulation a National Medical Support Notice, to be issued by States as a means of enforcing the health care coverage provisions in a child support order. (2) Requirements.—The National Medical Support Notice shall— (A) conform with the requirements which apply to medical child support orders under section 609(a)(3) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1169(a)(3)) in connection with group health plans (subject to section 609(a)(4) of such Act), irrespective of whether the group health plan is covered under section 4 of such Act; 112 STAT. 661 (B) conform with the requirements of part D of title IV of the Social Security Act; and (C) include a separate and easily severable employer withholding notice, informing the employer of— (i) applicable provisions of State law requiring the employer to withhold any employee contributions due under any group health plan in connection with coverage required to be provided under such order; (ii) the duration of the withholding requirement; (iii) the applicability of limitations on any such withholding under title III of the Consumer Credit Protection Act; (iv) the applicability of any prioritization required under State law between amounts to be withheld for purposes of cash support and amounts to be withheld for purposes of medical support, in cases where available funds are insufficient for full withholding for both purposes; and (v) the name and telephone number of the appropriate unit or division to contact at the State agency regarding the National Medical Support Notice. (3) Procedures.—The regulations promulgated pursuant to paragraph (1) shall include appropriate procedures for the transmission of the National Medical Support Notice to employers by State agencies administering the programs operated pursuant to part D of title IV of the Social Security Act. (4) Interim regulations.—Not later than 10 months after the date of the enactment of this Act, the Secretaries shall issue interim regulations providing for the National Medical Support Notice. (5) Final regulations.—Not later than 1 year after the issuance of the interim regulations under paragraph (4), the Secretary of Health and Human Services and the Secretary of Labor shall jointly issue final regulations providing for the National Medical Support Notice. (c) Required Use by States of National Medical Support Notices.— (1) State procedures.—Section 466(a)(19) of the Social Security Act (42 U.S.C. 666(a)(19)) is amended to read as follows: “(19) Health care coverage.—Procedures under which— “(A) effective as provided in section 401(c)(3) of the Child Support Performance and Incentive Act of 1998, all child support orders enforced pursuant to this part which include a provision for the health care coverage of the child are enforced, where appropriate, through the use of the National Medical Support Notice promulgated pursuant to section 401(b) of the Child Support Performance and Incentive Act of 1998 (and referred to in section 609(a)(5)(C) of the Employee Retirement Income Security Act of 1974 in connection with group health plans covered under title I of such Act, in section 401(e)(3)(C) of the Child Support Performance and Incentive Act of 1998 in connection with State or local group health plans, and in section 401(f)(5)(C) of such Act in connection with church group health plans); 112 STAT. 662 “(B) unless alternative coverage is allowed for in any order of the court (or other entity issuing the child support order), in any case in which a noncustodial parent is required under the child support order to provide such health care coverage and the employer of such noncustodial parent is known to the State agency— “(i) the State agency uses the National Medical Support Notice to transfer notice of the provision for the health care coverage of the child to the employer; “(ii) within 20 business days after the date of the National Medical Support Notice, the employer is required to transfer the Notice, excluding the severable employer withholding notice described in section 401(b)(2)(C) of the Child Support Performance and Incentive Act of 1998, to the appropriate plan providing any such health care coverage for which the child is eligible; “(iii) in any case in which the noncustodial parent is a newly hired employee entered in the State Directory of New Hires pursuant to section 453A(e), the State agency provides, where appropriate, the National Medical Support Notice, together with an income withholding notice issued pursuant to section 466(b), within two days after the date of the entry of such employee in such Directory; and “(iv) in any case in which the employment of the noncustodial parent with any employer who has received a National Medical Support Notice is terminated, such employer is required to notify the State agency of such termination; and “(C) any liability of the noncustodial parent to such plan for employee contributions which are required under such plan for enrollment of the child is effectively subject to appropriate enforcement, unless the noncustodial parent contests such enforcement based on a mistake of fact.”. (2) Conforming amendments.—Section 452(f) of such Act (42 U.S.C. 652(f)) is amended in the first sentence— (A) by striking “petition for the inclusion of” and inserting “include”; and (B) by inserting “and enforce medical support” before “whenever”. (3) Effective date.—The amendments made by this subsection shall be effective with respect to periods beginning on or after the later of— (A) October 1, 2001; or (B) the effective date of laws enacted by the legislature of such State implementing such amendments, but in no event later than the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the preceding sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature. (d) National Medical Support Notice Deemed under ERISA a Qualified Medical Child Support Order.—Section 609(a)(5) of the Employee Retirement Income Security Act of 1974 112 STAT. 663(29 U.S.C. 1169(a)(5)) is amended by adding at the end the following: “(C) National medical support notice deemed to be a qualified medical child support order.— “(i) In general.—If the plan administrator of a group health plan which is maintained by the employer of a noncustodial parent of a child or to which such an employer contributes receives an appropriately completed National Medical Support Notice promulgated pursuant to section 401(b) of the Child Support Performance and Incentive Act of 1998 in the case of such child, and the Notice meets the requirements of paragraphs (3) and (4), the Notice shall be deemed to be a qualified medical child support order in the case of such child. “(ii) Enrollment of child in plan.—In any case in which an appropriately completed National Medical Support Notice is issued in the case of a child of a participant under a group health plan who is a noncustodial parent of the child, and the Notice is deemed under clause (i) to be a qualified medical child support order, the plan administrator, within 40 business days after the date of the Notice, shall— “(I) notify the State agency issuing the Notice with respect to such child whether coverage of the child is available under the terms of the plan and, if so, whether such child is covered under the plan and either the effective date of the coverage or, if necessary, any steps to be taken by the custodial parent (or by the official of a State or political subdivision thereof substituted for the name of such child pursuant to paragraph (3)(A)) to effectuate the coverage; and “(II) provide to the custodial parent (or such substituted official) a description of the coverage available and any forms or documents necessary to effectuate such coverage. “(iii) Rule of construction.—Nothing in this subparagraph shall be construed as requiring a group health plan, upon receipt of a National Medical Support Notice, to provide benefits under the plan (or eligibility for such benefits) in addition to benefits (or eligibility for benefits) provided under the terms of the plan as of immediately before receipt of such Notice.”. (e) National Medical Support Notices for State or Local Governmental Group Health Plans.— (1) In general.—Each State or local governmental group health plan shall provide benefits in accordance with the applicable requirements of any National Medical Support Notice. (2) Enrollment of child in plan.—In any case in which an appropriately completed National Medical Support Notice is issued in the case of a child of a participant under a State or local governmental group health plan who is a noncustodial parent of the child, the plan administrator, within 40 business days after the date of the Notice, shall—112 STAT. 664 (A) notify the State agency issuing the Notice with respect to such child whether coverage of the child is available under the terms of the plan and, if so, whether such child is covered under the plan and either the effective date of the coverage or any steps necessary to be taken by the custodial parent (or by any official of a State or political subdivision thereof substituted in the Notice for the name of such child in accordance with procedures appliable under subsection (b)(2) of this section) to effectuate the coverage; and (B) provide to the custodial parent (or such substituted official) a description of the coverage available and any forms or documents necessary to effectuate such coverage. (3) Rule of construction.—Nothing in this subsection shall be construed as requiring a State or local governmental group health plan, upon receipt of a National Medical Support Notice, to provide benefits under the plan (or eligibility for such benefits) in addition to benefits (or eligibility for benefits) provided under the terms of the plan as of immediately before receipt of such Notice. (4) Definitions.—For purposes of this subsection— (A) State or local governmental group health plan.—The term “State or local governmental group health plan” means a group health plan which is established or maintained for its employees by the government of any State, any political subdivision of a State, or any agency or instrumentality of either of the foregoing. (B) Alternate recipient.—The term “alternate recipient” means any child of a participant who is recognized under a National Medical Support Notice as having a right to enrollment under a State or local governmental group health plan with respect to such participant. (C) Group health plan.—The term “group health plan” has the meaning provided in section 607(1) of the Employee Retirement Income Security Act of 1974. (D) State.—The term “State” includes the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, and American Samoa. (E) Other terms.—The terms “participant” and “administrator” shall have the meanings provided such terms, respectively, by paragraphs (7) and (16) of section 3 of the Employee Retirement Income Security Act of 1974. (5) Effective date.—The provisions of this subsection shall take effect on the date of the issuance of interim regulations pursuant to subsection (b)(4) of this section. (f) Qualified Medical Child Support Orders and National Medical Support Notices for Church Plans.— (1) In general.—Each church group health plan shall provide benefits in accordance with the applicable requirements of any qualified medical child support order. A qualified medical child support order with respect to any participant or beneficiary shall be deemed to apply to each such group health plan which has received such order, from which the participant or beneficiary is eligible to receive benefits, and with respect to which the requirements of paragraph (4) are met. (2) Definitions.—For purposes of this subsection— 112 STAT. 665 (A) Church group health plan.—The term “church group health plan” means a group health plan which is a church plan. (B) Qualified medical child support order.—The term “qualified medical child support order” means a medical child support order— (i) which creates or recognizes the existence of an alternate recipient’s right to, or assigns to an alternate recipient the right to, receive benefits for which a participant or beneficiary is eligible under a church group health plan; and (ii) with respect to which the requirements of paragraphs (3) and (4) are met. (C) Medical child support order.—The term “medical child support order” means any judgment, decree, or order (including approval of a settlement agreement) which— (i) provides for child support with respect to a child of a participant under a church group health plan or provides for health benefit coverage to such a child, is made pursuant to a State domestic relations law (including a community property law), and relates to benefits under such plan; or (ii) is made pursuant to a law relating to medical child support described in section 1908 of the Social Security Act (as added by section 13822 of the Omnibus Budget Reconciliation Act of 1993) with respect to a church group health plan, if such judgment, decree, or order: (I) is issued by a court of competent jurisdiction; or (II) is issued through an administrative process established under State law and has the force and effect of law under applicable State law. For purposes of this paragraph, an administrative notice which is issued pursuant to an administrative process referred to in subclause (II) of the preceding sentence and which has the effect of an order described in clause (i) or (ii) of the preceding sentence shall be treated as such an order. (D) Alternate recipient.—The term “alternate recipient” means any child of a participant who is recognized under a medical child support order as having a right to enrollment under a church group health plan with respect to such participant. (E) Group health plan.—The term “group health plan” has the meaning provided in section 607(1) of the Employee Retirement Income Security Act of 1974. (F) State.—The term “State” includes the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, and American Samoa. (G) Other terms.—The terms “; participant”, “beneficiary”, “administrator”, and “church plan” shall have the meanings provided such terms, respectively, by paragraphs (7), (8), (16), and (33) of section 3 of the Employee Retirement Income Security Act of 1974. (3) Information to be included in qualified order.—A medical child support order meets the requirements of this paragraph only if such order clearly specifies— 112 STAT. 666 (A) the name and the last known mailing address (if any) of the participant and the name and mailing address of each alternate recipient covered by the order, except that, to the extent provided in the order, the name and mailing address of an official of a State or a political subdivision thereof may be substituted for the mailing address of any such alternate recipient; (B) a reasonable description of the type of coverage to be provided to each such alternate recipient, or the manner in which such type of coverage is to be determined; and (C) the period to which such order applies. (4) Restriction on new types or forms of benefits.—A medical child support order meets the requirements of this paragraph only if such order does not require a church group health plan to provide any type or form of benefit, or any option, not otherwise provided under the plan, except to the extent necessary to meet the requirements of a law relating to medical child support described in section 1908 of the Social Security Act (as added by section 13822 of the Omnibus Budget Reconciliation Act of 1993). (5) Procedural requirements.— (A) Timely notifications and determinations.—In the case of any medical child support order received by a church group health plan— (i) the plan administrator shall promptly notify the participant and each alternate recipient of the receipt of such order and the plan’s procedures for determining whether medical child support orders are qualified medical child support orders; and (ii) within a reasonable period after receipt of such order, the plan administrator shall determine whether such order is a qualified medical child support order and notify the participant and each alternate recipient of such determination. (B) Establishment of procedures for determining qualified status of orders.—Each church group health plan shall establish reasonable procedures to determine whether medical child support orders are qualified medical child support orders and to administer the provision of benefits under such qualified orders. Such procedures— (i) shall be in writing; (ii) shall provide for the notification of each person specified in a medical child support order as eligible to receive benefits under the plan (at the address included in the medical child support order) of such procedures promptly upon receipt by the plan of the medical child support order; and (iii) shall permit an alternate recipient to designate a representative for receipt of copies of notices that are sent to the alternate recipient with respect to a medical child support order. (C) National medical support notice deemed to be a qualified medical child support order.— (i) In general.—If the plan administrator of any church group health plan which is maintained by the employer of a noncustodial parent of a child or to112 STAT. 667 which such an employer contributes receives an appropriately completed National Medical Support Notice promulgated pursuant to subsection (b) of this section in the case of such child, and the Notice meets the requirements of paragraphs (3) and (4) of this subsection, the Notice shall be deemed to be a qualified medical child support order in the case of such child. (ii) Enrollment of child in plan.—In any case in which an appropriately completed National Medical Support Notice is issued in the case of a child of a participant under a church group health plan who is a noncustodial parent of the child, and the Notice is deemed under clause (i) to be a qualified medical child support order, the plan administrator, within 40 business days after the date of the Notice, shall— (I) notify the State agency issuing the Notice with respect to such child whether coverage of the child is available under the terms of the plan and, if so, whether such child is covered under the plan and either the effective date of the coverage or any steps necessary to be taken by the custodial parent (or by the official of a State or political subdivision thereof substituted for the name of such child pursuant to paragraph (3)(A)) to effectuate the coverage; and (II) provide to the custodial parent (or such substituted official) a description of the coverage available and any forms or documents necessary to effectuate such coverage. (iii) Rule of construction.—Nothing in this subparagraph shall be construed as requiring a church group health plan, upon receipt of a National Medical Support Notice, to provide benefits under the plan (or eligibility for such benefits) in addition to benefits (or eligibility for benefits) provided under the terms of the plan as of immediately before receipt of such Notice. (6) Direct provision of benefits provided to alternate recipients.—Any payment for benefits made by a church group health plan pursuant to a medical child support order in reimbursement for expenses paid by an alternate recipient or an alternate recipient’s custodial parent or legal guardian shall be made to the alternate recipient or the alternate recipient’s custodial parent or legal guardian. (7) Payment to state official treated as satisfaction of plan’s obligation to make payment to alternate recipient.—Payment of benefits by a church group health plan to an official of a State or a political subdivision thereof whose name and address have been substituted for the address of an alternate recipient in a medical child support order, pursuant to paragraph (3)(A), shall be treated, for purposes of this subsection and part D of title IV of the Social Security Act, as payment of benefits to the alternate recipient. (8) Effective date.—The provisions of this subsection shall take effect on the date of the issuance of interim regulations pursuant to subsection (b)(4) of this section. 112 STAT. 668 (g) Report and Recommendations Regarding the Enforcement of Qualified Medical Child Support Orders.—Not later than 8 months after the issuance of the report to the Congress pursuant to subsection (a)(5), the Secretary of Health and Human Services and the Secretary of Labor shall jointly submit to each House of the Congress a report containing recommendations for appropriate legislation to improve the effectiveness of, and enforcement of, qualified medical child support orders under the provisions of subsection (f) of this section and section 609(a) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1169(a)). (h) Technical Corrections.— (1) Amendment relating to public law 104–266.— (A) In general.—Subsection (f) of section 101 of the Employee Retirement Income Security Act of 1974 (29U.S.C. 1021(f)) is repealed. (B) Effective date.—The amendment made by subparagraph (A) shall take effect as if included in the enactment of the Act entitled “An Act to repeal the Medicare and Medicaid Coverage Data Bank”, approved October 2, 1996 (Public Law 104–226; 110 Stat. 3033). (2) Amendments relating to public law 103–66.— (A) In general.— (i) Section 4301(c)(4)(A) of the Omnibus Budget Reconciliation Act of 1993 (Public Law 103–66; 107 Stat. 377) is amended by striking “subsection(b)(7)(D)” and inserting “subsection (b)(7)”. (ii) Section 514(b)(7) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1144(b)(7)) is amended by striking “enforced by” and inserting “they apply to”. (iii) Section 609(a)(2)(B)(ii) of such Act (29 U.S.C.1169(a)(2)(B)(ii)) is amended by striking “enforces” and inserting “is made pursuant to”. (B) Child defined.—Section 609(a)(2) of the Employee Retirement Income Security Act of 1974 (29 U.S.C.1169(a)(2)) is amended by adding at the end the following: “(D) Child.—The term ‘child’ includes any child adopted by, or placed for adoption with, a participant of a group health plan.”. (C) Effective date.—The amendments made by subparagraph (A) shall be effective as if included in the enactment of section 4301(c)(4)(A) of the Omnibus Budget Reconciliation Act of 1993. (3) Amendment related to public law 105–33.— (A) In general.—Section 609(a)(9) of the Employee Retirement Income Security Act of 1974 (29 U.S.C.1169(a)(9)) is amended by striking “the name and address” and inserting “the address”. (B) Effective date.—The amendment made by subparagraph (A) shall be effective as if included in the enactment of section 5611(b) of the Balanced Budget Act of 1997.