PSI/NMSN

1. PSI/NMSN History

2. Monday Oct 1, 2007, DCSS began sending PSI cases on all NCPs and children regardless of PeachCare or Medicaid status.

3. The Performance Management Section began an in-depth review of PSI on April 16 and concluded on June 15, 2008.

4. Methodology • The Request for Proposal (RFP) and the PSI contract were reviewed to determine if requirements were being met. • BRT provided a sample of cases for review.

5. Results of the Audit • $TARS was not populated within 24-48 hours after the National Medical Support Notice (NMSN) was sent. • $TARS was not updated with each action taken by PSI. • NMSN sent date was not populated until after PSI received a response from the employer. • The NMSN Response Date field and the NMSN sent date are reversed and incorrect.

6. Cases were referred to PSI for NMSN that should be excluded. • Cases that should have been sent to PSI were not.

7. Representatives of DCSS met with representatives of PSI to discuss the audit. • PSI and DCSS are committed to making needed improvements to the NMSN process.

8. National Medical Support Notice (NMSN) • The National Medical Support Notice (NMSN) is a new, two-part federally-required form. It was designed to provide employers and plan administrators with a standardized set of forms, processes, and timeframes to streamline the work to enroll dependent children in employer-sponsored health care plans. The NMSN meets the requirements for a Qualified Medical Child Support Order (QMCSO) if the child support agency correctly completes it and if coverage for the child(ren) is or will become available. The NMSN is a QMCSO under the Employee Retirement Income Security Act (ERISA) section 609 (a)(5)(s).

9. I’m confused! Who does what?

10. Employer Responsibilities • The NCP employer makes the determination if insurance is available and reasonable. • The language in the PSI NMSN: “If the insurance premium difference between single coverage and adding  the child or children is "equal to" or "less than" 5% of your employee's gross income, the premium is considered reasonable.” • The amount paid for child support and medical support coverage can not exceed 50% of the NCP’s net income. The NMSN's "Limitations on Withholding" section mentions the CCPA guidelines, and there are spaces where the employer is to enter a range between 50-65% of the disposable weekly earnings that should not be exceeded, depending on the NCP's familial status. The FAQ's may need to be revised to state that the total deductions cannot exceed 50-65%, instead of a limiting 50% as currently listed. I referenced CCPA 303 (a)(b) and it stipulates that "In such cases, a garnishment to enforce any order of support shall not exceed 50% of an individual’s disposable earnings if the individual is supporting a spouse or dependent child other than the spouse or child for whose support the order is to be used."

11. Employer Responsibilities Part A -If group health coverage is not available to the employee named herein, or the employee was never or is no longer employed, the employer is still required to complete Part A. • If the response is Part A, the employer must respond within 20 days. The employer must complete Part A and return to PSI. Examples of Part A Responses • Insurance not offered by employer • Employee in class insurance not offered • No longer employed • Not reasonable in cost • Never Employed • Deceased

12. Part B Part B – Medical Support Notice to Plan Administrator applies if the dependent is eligible for coverage. The NMSN is forwarded to the insurance Plan Administrator who has 40 days from the date of the Notice to complete and return to PSI. Examples of Part B Responses • Child Already Enrolled • One Plan Offered, Child Covered • Child Will Be Enrolled In Option Of Participant • Participant Covered, Adding Child • Child Newly Enrolled; Multiple Options Available • Waiting Period • Not QMCSO. (Qualified Medical Child Support Order)

13. PSI Responsibilities • Mail the NMSNs to employers. • Track the NMSN and follow up with employer if no response is received. • Notify DCSS to check with their ADA/SAAG for possible legal action if no response is received from the employer after 75 days. • Insert PSI’s address on the NMSN in lieu of the CP’s address when case is coded Domestic Violence. • Forward insurance cards to CP when employer mails them to PSI. • Provide Customer Service: • Help employers complete the NMSN. • Aide CP with request for insurance cards.

14. Forward to the CP the insurance information when it is received from employer requesting that they, the CP, make a selection and then contact PSI’s office. PSI then forwards that information back to employer. • Mail CP notice if insurance is not available. • Call CP if insurance is available. • Notify DCSS if NMSN is returned for bad address. • Notify DCSS if no Social Security Number is provided for NCP/CP. • Notify DCSS if NMSN is returned “undeliverable as addressed.” • Export data back to DCSS that updates the NCP Employer screen when Part A or Part B is returned. • Update the insurance policy information on the Insurance screen if the child is enrolled. • Coordinate resolution with the local office if the NCP contacts PSI to dispute the court order (i.e. medical was not ordered) or has issues related to case management.

15. Two check boxes were added to allow staff to: • Generate FIW locally • Send NMSN to vendor • If a change is made on the employer screen, and the FIW and NMSN are not checked, the user will be asked: Do you wish to continue without generating a FIW or NMSN? Y/N.

16. DCSS Responsibilities • If new employment information is reported, user must add information to NCP Employer screen and select “Generate a NMSN to Vendor.” • When contacted by either the CP or NCP about enforcing the medical support order and NCP is employed: • Review the NCP Employer screen or CAL to determine if the NMSN has been sent by PSI and if a response was recorded. • If the NMSN portion of the NCP employer screen is not populated: • Verify that the Medical Code on the support order screen is correct. • Contact PSI to see if a referral was received. • If a referral was received, obtain the status and report back to CP/NCP. • If a referral was not received, generate NMSN to the employer and set prompt to ensure that a response is received. • If PSI did not receive the referral and the case was coded correctly, submit a request to the $TARS Help Desk.

17. If insurance cards are mailed to the local office, forward them to the CP and document the CAL. • If at any time agent is notified the insurance has expired, enter the expiration date on the Case Management/Case Summary/Insurance Screen. • Work System Generated CALs relating to medical • CHK CASE CRTORD REQ • CHK CHLD STAT/CHILD CRTORD REQ • CHK CHLD MLTRY INS/CP ADDR REQ • CORRECT CP ADDR & REFER NMSN **

18. Work PSI escalations • NMSN RETURNED, MARKED AS UNDELIVERABLE ADDRESS AND CLOSED. • EMPLOYER FOUND NEW/COMPLETE CP ADDRESS. GENERATED FAMILY CARE LETTER TO BE SENT TO CP.   • Report any problems to $TARS Help Desk

19. How to Read NMSN Screen

20. PSI Escalations

21. $TARS PSI Case Action Logs These cases do not pass the filtering criteria • CHK CASE CRTORD REQ - is generated when the case(s) of the NCP does not have a valid court order on the VCOURT_Order table. Required action: Check the court order screen. Is “Who is ordered to Provide Health Insurance” checked? If not, review the court order and determine who is court ordered to provide health insurance. Update the screen.

22. 2.CHK CHLD STAT/CHILD CRTORD REQ – when no children on the case have a child court order on the VCHILD_Court_Order table, or All children on the case are emancipated All children on the case are deceased All children on the case are non participating All children on the case are not associated with the case Required action: Review the child detail screen; participation status.

23. 3. CHK CHLD MLTRY INS/CP ADDR REQ is generated when the NCP of the child has military insurance or the custodial parent has an invalid address. A referral is not generated when the CP has an invalid address. • A prompt is generated to agent CORRECT CP ADDR & REFER NMSN • Required Action: • Correct CP address and refer NMSN from the NCP Employer screen. • Military: If agent has not received a prompt from DCMCrefer the CP to the nearest base

24. Referring Customer’s to PSI • PSI phone #: 866-304-8199 • Customer Service Representatives are available 8:00 AM to 6:00 PM Eastern Time, Monday through Friday. • http://www.ga-nmsn.com/

25. Coding on the Support Order Screen • The coding for health and medical insurance must always follow the language of the court order. Do not to change from “Yes” to “No” if the child emancipates or the case closes.