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The Wagner Law Group

The Wagner Law Group, A Professional Corporation, is a nationally recognized ERISA & employee benefits, estate planning, employment, labor & human resources practice. 

 

Established in 1996, The Wagner Law Group has 22 attorneys engaged exclusively in employee benefits, estate planning and employment law. Six of our attorneys are AV rated by Martindale-Hubbell as having very high to preeminent legal abilities and ethical standards. The firm is among the largest ERISA boutiques in the country. Our practice is national in scope, with clients in more than 40 states and several foreign countries.

  

 

 

 

Contact Info

The Wagner Law Group

 

  Integrity | Excellence

  

Boston 

Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110


Palm Beach Gardens 

Tel: (561) 293-3590
Fax: (561) 293-3591
7108 Fairway Drive
Suite 125
Palm Beach Gardens, FL 33418

   

Tampa

Tel: (813) 603-2959

Fax: (813) 603-2961

101 East Kennedy Boulevard

Suite 2140
Tampa, FL  33602 

 

San Francisco

Tel: (415) 625-0002

Fax: (415) 358-8300

315 Montgomery Street

Suite 904

San Francisco, CA 94104

 

St. Louis

Tel: (314) 236-0065

Fax: (314) 236-5743
100 South 4th Street, Suite 550
St. Louis, MO  63102 

 

www.wagnerlawgroup.com

 

 

 

 

July 16, 2015

 

 Health and Welfare Law Alert

 

 

 

Agencies Issue Final Regulations on ACA's Preventive Services Mandate 

 

 

 

The DOL, HHS and IRS have published final regulations addressing the preventive services mandate requirement in the Affordable Care Act ("ACA"). Most notably, the final regulations, which are effective for plan years beginning on or after September 14, 2015, formalize a proposed rule that accommodated the objections of religious organizations to covering contraceptive services, which are considered preventive services under the ACA. The final regulations also make other minor changes to other aspects of the preventive services mandate as provided in the interim final regulations issued in 2010.

 

Background. The ACA requires all non-grandfathered health plans to cover certain preventive services without cost sharing.  These services include preventive care and screenings for women as listed in guidelines promulgated by the Health Resources and Services Administration ("HRSA"). HRSA's guidelines require coverage of contraceptive services.

 

DOL, HHS and IRS, which are responsible for implementing the ACA's preventive services mandate, have previously issued guidance attempting to accommodate the objections of religious organizations to covering contraceptive services. The accommodation was originally intended only for nonprofit organizations. However, in the wake of the Supreme Court's decision in Burwell v. Hobby Lobby Stores, Inc., which held that closely-held, for-profit organizations are also entitled to an accommodation of their religious beliefs, the agencies published a proposed rule to accommodate the beliefs of closely held for-profit organizations as well. (See the Alert of 7/10/14.)

 

Final Regulations. The following are some of the highlights from the final regulations:

 

Contraceptive coverage accommodation for religious employers. The final regulations formalize the proposed rule that accommodated the objections of closely-held, for-profit organizations to the ACA's contraceptive mandate. The final regulations explain that status as a closely-held, for-profit organization is generally determined by using the same general approach as under the Internal Revenue Code (i.e., at least 50% of the organization must be directly or indirectly owned by five or fewer individuals). However, the final regulations provide more flexibility than the proposed rule in that a company with a "substantially similar" ownership structure may now also qualify for the accommodation. The final regulations also provide attribution rules and prohibit qualifying organizations from having any publicly-traded ownership interests.

 

The eligible entity's governing body must adopt resolutions or take other similar formal action to establish its objection to providing contraceptive services on account of its owners' religious views. In addition, eligible entities must affirmatively indicate their objection to providing contraceptive coverage by either filing EBSA Form 700 (with the DOL) or notifying the DOL or HHS directly.

 

Out-of-network providers. The final regulations provide that a plan will be required to cover out-of-network preventive services without cost sharing if the plan does not have an in-network provider who can provide the required preventive services.

 

Mid-year plan changes. The final regulations provide that, as a general rule, a service that qualifies as a recommended preventive service on the first day of the plan year must continue to be provided throughout the plan year even if the recommendation changes. An exception to this general rule is that a plan may drop coverage mid-year for any service that is either downgraded to a "D" rating (by the applicable governing body), is subject to a safety recall, or is otherwise deemed by a federal agency to pose a significant safety concern. In addition, other requirements may apply in connection with ceasing to provide coverage for a preventive service mid-year, such as notifying participants in advance of the change.

 

Action Steps for Employers. Employers that meet the requirements for eliminating coverage for a specific preventive service must be sure to address any administrative issues (e.g., providing participants with advance notice of the change) before eliminating any such coverage.

 

The final regulations are available at: http://webapps.dol.gov/FederalRegister/PdfDisplay.aspx?DocId=28364

 

  

 

 

 

 

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This Newsletter is provided for information purposes by The Wagner Law Group to clients and others who may be interested in the subject matter, and may not be relied upon as specific legal advice.  This material is not to be construed as legal advice or legal opinions on specific facts. Under the Rules of the Supreme Judicial Court of Massachusetts, this material may be considered advertising.