Professional Service Agreement

Week In review

July 20, 2015

Final regulations issued on ACA contraceptive coverage
Under the ACA, all non-grandfathered insured and self-insured health plans must cover contraceptive services. The final rules maintain the existing contraceptive services accommodation for eligible religious nonprofit organizations, but also finalize an alternative pathway for those organizations to provide notice of their objection to covering contraceptive services. In addition, the final regulations provide certain “closely held” for-profit entities the same accommodations.

Religious Objection Accommodations. An organization may notify the federal government of their religious objection to providing contraceptive coverage by completing EBSA Form 700 or providing HHS with written notice including: the name of the eligible organization and the basis on which it qualified for an accommodation; its objection is based on sincerely held religious beliefs to covering some or all contraceptive services; the plan name and type; and the name and contact information for any of the plan’s third party administrators and health insurance issuers. HHS and DOL will then notify insurers and third party administrators of the organization’s objection so that enrollees in plans of such organizations can receive separate payments for contraceptive services, with no additional cost to the enrollee or organization, and no involvement by the organization.

Closely Held For-profit Entities. The final regulations extend the contraceptive coverage accommodation to closely held for-profit entities. A “closely held for-profit entity” is an entity that is not publicly traded and that has an ownership structure under which more than 50 percent of the organization’s ownership interest is owned by five or fewer individuals, or an entity with a substantially similar ownership structure. For purposes of this definition, all of the ownership interests held by members of a family are treated as being owned by a single individual. This definition includes all of the for-profit companies that have challenged the contraceptive coverage requirement on religious grounds. The organization’s highest governing body must adopt a resolution establishing that the organization objects to covering some or all of the contraceptive services on account of its owners’ sincerely held religious beliefs.

National Safety Council calls for workplace policies around opioid painkiller use
The National Safety Council is calling on employers to develop workplace policies around the use of opioid prescription painkillers after reviewing research and court cases showing the negative impacts of these medicines on employee safety and worker's compensation costs. The Council says workers who use opioid painkillers for more than a week to treat on-the-job injuries have double the risk of being disabled one year later. Worker's compensation claims also skyrocket, they say, and the average lost time worker's compensation claim for workers using opioid painkillers can total as much as
$117,000 – 900% higher than the cost for workers who do not take opioid painkillers.
To help protect injured workers and mitigate liability, the Council recommends employers:
• Educate workers about the risks of opioid painkillers;
• Work with insurance carriers to identify inappropriate opioid painkiller prescribing and adopt
Procedures to manage worker's opioid use;
• Ensure medical providers follow prescribing guidelines and use state Prescription Drug Monitoring Programs, which track prescribing history;
• Provide supervisor education focused on identifying impaired employees;
• Expand drug testing programs that include testing for all common opioids; and
• Evaluate employee assistance programs and make sure they include access to treatment.

New EEOC suit levels charges of pregnancy and disability discrimination
The EEOC has filed a lawsuit asserting that a South Carolina licensed nursing center violated Title VII and the ADA when it failed to accommodate a pregnant employee and then fired her because of her pregnancy and her disability. In February 2002, employer hired employee as a full-time licensed practical nurse. The employee suffers from paroxysmal supraventricular tachycardia (PSVT), which, without medication, can cause rapid heart rate, numbness in the extremities, tunnel vision, and occasional blackouts. The employee’s PSVT is controlled by medication, and employer was aware of employee’s medical condition. In mid-December 2012, the employee learned she was pregnant and stopped taking her PSVT medicine due to possible side effects to her unborn child. As a result, her PSVT symptoms became uncontrolled. Additionally, the employee’s normal pregnancy symptoms, such as fatigue and nausea, were exacerbated by her PSVT. Due to her medical condition and pregnancy, the employee was placed on bed rest and excused for three days' work in early January 2013. That same month, the employee was fired because of absences related to her pregnancy and PSVT. The
EEOC contends that NHC Healthcare refused to accommodate the employee by allowing her medical leave, and subsequently fired her because of her disability and pregnancy.

SESCO recommends that clients review all applicable policy and practices to ensure compliance. For assistance, contact us at 423-764-4127 or by email at