Particularly under those circumstances, the Departments believe that agencies charged with administering a statute that imposes a substantial burden on the exercise of religion under RFRA have discretion in determining whether the appropriate response is to provide an exemption from the burdensome requirement or instead to attempt to create an accommodation that would mitigate the burden. of the site will not work as intended if you do so. Found inside Page 162027521 [ 18NOJ Immigration and Nationality Act : increase the period of authorized stay under the Guam visa Waiver program GROVER , HENRY C. Remarks in House ( 180C ) Workforce Investment Act : prohibit faith - based organi- Tribute The Departments now reaffirm the conclusion set forth in the Religious IFC, that requiring certain religiously objecting entities or individuals to choose between the Mandate, the accommodation, or incurring penalties for noncompliance imposes a substantial burden on religious exercise under RFRA. 32. [65] (5) An eligible organization may revoke its use of the accommodation process, and its issuer or third party administrator must provide participants and beneficiaries written notice of such revocation, as specified herein. PDF Department of The Air Force Headquarters 10th Air Base Assuming that those 9 entities will have a similar number of covered persons per entity as the 100 entities encompassing 2,180,000 Start Printed Page 57584persons, the Departments estimate that all 109 accommodated entities will encompass approximately 2,376,000 covered persons. . Presents the full text of the Book of Mormon with stylistic revisions, bibliographic references, maps, charts, illustrations, images, testimonials, quotations and commentaries. (82 FR at 47806). Later, on September 09, 2021, President Biden announced Executive Orders 14042 and 14043, which promoted his authority to mandate vaccines for federal employees and federal contractors under 5 U.S . Below, based on limited data, but on years of receiving public comments and defending litigation brought by organizations challenging the Mandate on the basis of their religious objections, our best estimate of the anticipated effects of these rules is that no publicly traded employers will invoke the religious exemption. At a minimum, students who attend private colleges and universities have the ability to ask those institutions in advance what religious tenets they follow, including whether the institutions will provide contraceptives in insurance plans they arrange. What's behind religious exemptions to the Covid-19 vaccine v. Grumet, 512 U.S. 687, 705 (1994). Instead, such a serious imposition on religious liberty should be created, if at all, by Congress, in response to citizens exercising their rights of political participation. Calling that result a governmental burden rests on an incorrect presumption: that the government has an obligation to force private parties to benefit those third parties and that the third parties have a right to those benefits. Another study, which proposed an economic model for the decision to engage in sexual activity, stated that `[p]rograms that increase access to contraception are found to decrease teen pregnancies in the short run but increase teen pregnancies in the long run.' 34. In addition, cost is not the only barrier to accessing a full range of method options, and [t]he fact that income is not associated with use of most other methods [besides male sterilization and withdrawal] obtained through health care settings may reflect broader access to affordable and/or free contraception made possible through programs such as Title X.. Some commenters said that if contraceptives are not removed from the Guidelines entirely, some entities or individuals with religious objections might not qualify for the exemptions or accommodation. They objected to the accommodation process because it was another method to require compliance with the Mandate. The Departments received comments in support of, and in opposition to, this expansion. Federal Register issue. To satisfy the notice requirement, issuers and third party administrators may, but are not required to, use the model language previously provided by HHS or substantially similar language. 19 vaccination consistent with guidance from the CDC, American College of Obstetricians and. Data from the Department of Education shows that in 2014, there were 20,207,000 students enrolled in degree-granting postsecondary institutions. browsers and GEMG properties, your selection will take effect only on this browser, this device and this 2022, with exceptions for employees with medical and religious exemptions. If you have previously submitted a religious or medical exemption request, you need to re-submit using ACMS. 601 et seq.) 3597 (protecting objectors to participation in Federal executions based on moral or religious convictions); 20 U.S.C. 26 U.S.C. The Guidelines issued in 2011 included, under Contraceptive methods and counseling, [a]ll Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity. The previous regulations concerning the exemption and the accommodation used the terms contraceptive services and contraceptive coverage as catch-all terms to encompass all of those Guidelines' requirements. The Task Force aligns its COVID-19 vaccination requirements with the federal employee vaccine mandate required under September 9, 2021 Executive Order 14043, "Requiring Coronavirus Disease 2019 Vaccination for Federal Employees." The Task Force's Guidance does not contemplate a testing option, but rather requires vaccination, subject only to medical and religious accommodations. Some religious third party administrators have brought suit in conjunction with suits brought by organizations enrolled in ERISA-exempt church plans. Document Drafting Handbook The expanded exemptions finalized in these rules are generally consistent with the scope of exemptions that Congress has established in similar contexts. 69. [118] Supervisors ensure employees submit requests for medical or religious exemptions from the vaccination requirements to the supervisor NLT 8 Nov 2021. The rules are necessary to expand the protections for the sincerely held religious objections of certain entities and individuals. . These are not toll-free numbers. This removes a possible barrier to diversity in the nation's higher education system, and makes it more possible for students to attend institutions of higher education that hold those views. The Religious IFC and these final rules expand the kinds of entities that may use the optional accommodation, by expanding the exemptions and allowing any exempt entities to opt to make use of the accommodation. Some commenters suggested that the expanded religious exemptions should include government entities. Commenters cited Oral Contraceptives and Cancer Risk (Mar. The Religious IFC and these final rules expand the exemption from the requirement to provide coverage for contraceptives and sterilization, established under the HRSA Guidelines, promulgated under section 2713(a)(4) of the PHS Act, section 715(a)(1) of ERISA, and section 9815(a)(1) of the Code, to include certain entities and individuals with objections to compliance with the Mandate based on sincerely held religious beliefs, and they revise the accommodation process to make it optional for eligible organizations. Moreover, the previous church exemption, which applied automatically to all churches whether or not they had even asserted a religious objection to contraception, 45 CFR 147.141(a), is not tailored to any plausible free-exercise concerns. REQUEST FOR COVID-19 VACCINE EXCEPTION FOR RELIGIOUS REASONS/ RELIGIOUS ACCOMMODATION The Department of the Navy (DON) is committed to providing equal employment opportunities (EEO) without regard to any protected status and a work environment that is free of unlawful harassment, discrimination, and retaliation. documents in the last year, 65 may be used by those companies to build a profile of your interests and show you relevant adverts on other The Departments do not take a position on the empirical question of whether contraception has caused certain reductions in teen pregnancy. Those commenters further contended that because, in their view, section 2713(a)(4) does not authorize the Start Printed Page 57545expanded exemptions, no statutory authority exists for the Departments to finalize the expanded exemptions. HHS's Title X program provides contraceptive coverage in a way that is not necessarily seamless with beneficiaries' employer sponsored insurance plans. Some commenters suggested that the individual exemption should not allow the offering of a separate group health plan, as set forth in the version found in 147.133(b), because doing so could cause various administrative burdens. (2) If an issuer receives a copy of the self-certification from an eligible organization or the notification from the Department of Health and Human Services as described in paragraph (c)(2)(ii) of this section and does not have its own objection as described in 45 CFR 147.132 to providing the contraceptive services to which the eligible organization objects, then the issuer will provide payments for contraceptive services as follows. Executive Orders Place US Federal Contractors And The accommodation provides contraceptive access, which is a result many opponents of the expanded exemptions said they desire. 3d at 1017, and March for Life, 128 F. Supp. [84] See Guttmacher Institute, Insurance Coverage of Contraceptives (June 11, 2018); Kaiser Family Foundation, State Requirements for Insurance Coverage of Contraceptives, Henry J Kaiser Family Foundation (Jan. 1, 2018), https://www.kff.org/other/state-indicator/state-requirements-for-insurance-coverage-of-contraceptives/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Therefore, entities using contraceptive user fees adjustments received approximately $239 per year per woman of childbearing age that used contraception covered by the Guidelines and covered in their plans. Possible Sources of Information for Estimating Impact, iv. In order to request a religious exception, please fill out this form. 39. Some said that the Departments should not exempt various kinds of entities such as businesses, health insurance issuers, or other plan sponsors that are not nonprofit entities. Some commenters said that the expanded exemptions and accommodation are consistent with RFRA. Solely for the purposes of determining whether the rules have a significant economic impact under Executive Order 12,866, and in order to estimate the broadest possible impact so as to determine the applicability of the procedures set forth in that Executive Order, the Departments propose that the rules will affect no more than 126,400 women of childbearing age who use contraceptives covered by the Guidelines, and conclude the economic impact falls well below $100 million. Pop. [81] Certain commenters urged the Departments to clarify that the final rules do not permit employers to exclude from coverage medically necessary prescription drugs used for non-preventive services. The previous regulations included a reliance clause in the accommodation provisions, but did not specify further details regarding the relationship between exempt entities and their issuers or third party administrators. 507(d), Public Law115-31. By specifying that paragraph (a)(1)(iv) concerning the women's preventive services Guidelines encompasses such additional preventive care and screenings not described in paragraph (a)(1)(i) of this section as provided for in comprehensive guidelines supported by the Health Resources and Services Administration for purposes of section 2713(a)(4) of the Public Health Service Act, subject to 147.131 and 147.132, the regulatory text also better tracks the statutory language that the Guidelines are for such additional preventive services as HRSA may provide[] for and support[]. This text also eliminates language, not found in the statute, that the Guidelines are evidence-informed and binding. Congress did not include the word binding in PHS Act section 2713, and did include the words evidence-based or evidence-informed in section 2713(a)(1) and (a)(3), but omitted such terms from section 2713(a)(4). Christian Brothers is a plan that covers Catholic churches and integrated auxiliaries and has said in litigation that it covers about 500 additional entities that are not exempt as churches. . To invoke the optional accommodation process: (i) The eligible organization or its plan must contract with one or more third party administrators. 1182(g) (protecting vaccination objections by aliens due to religious beliefs or moral convictions); 18 U.S.C. These commenters also objected that including such employers, along with closely held businesses, would extend the exemptions to all or virtually all employers. content and messages you see on other websites you visit. As discussed below, although the Departments do not know how many entities will use the accommodation, it is reasonably likely that some entities previously using it will continue to do so, while others will choose the expanded exemption, leading to an overall reduction in the use of the accommodation. 79. DOI will start collecting vaccination information from . Alternatively, such eligible organization may revoke its use of the accommodation process effective on the first day of the first plan year that begins on or after 30 days after the date of the revocation. Instead, through longstanding federal conscience statutes, Congress has established consistent principles concerning respect for religious beliefs in the context of certain Federal health care requirements. The ACA did not require contraceptives to be included in HRSA's Guidelines, and it did not require any preventive services required under PHS Start Printed Page 57550Act section 2713 to be covered by grandfathered plans. We also received public comments from organizations of similar nonprofit employers indicating that the accommodation satisfied their religious objections. A group of Texas doctors is calling on Governor Greg Abbott to rescind his executive order banning vaccine mandates. Commenters cited, for example, the 2011 IOM Report's discussions of the negative effects associated with unintended pregnancies, as well as other studies. at 603. 8. The Departments have examined the impacts of the Religious IFC and the final rules as required by Executive Order 12866 on Regulatory Planning and Review (September 30, 1993), Executive Order 13563 on Improving Regulation and Regulatory Review (January 18, 2011), the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. The briefing shed some light on how the Administration plans to . services we are able to offer. In the past, the Departments had stated in our regulations and court briefs that the previous accommodation process required contraceptive coverage or payments in a way that is seamless with the coverage provided by the objecting employer. Whether, given the broad availability of contraceptives and their relatively low cost, such women will obtain and use contraception even if it is not covered. The degree to which such women are in the category of women identified by IOM as most at risk of unintended pregnancy. OFCCP Rescinds EO 11246's Nondiscrimination Req. Religious . E, Sec. However, it is worth noting that, while less than 100 for-profit entities challenged the Mandate in court (and an unknown number joined two newly formed associational organizations bringing suit on their behalf), there are more than 3 million for-profit private sector establishments in the United States that offer health insurance. You can set your browser to block or alert you about these cookies, but some parts 3501 et seq. The methodology of both reports do not fully correspond to the number the Departments seek to estimate here for the purposes of Executive Orders 12866 and 13563. Previous versions of these rules had varied from the statutory language. 1688 (prohibiting sex discrimination law to be used to require assistance in abortion for any reason); 22 U.S.C. Some commenters suggested the expanded exemptions Start Printed Page 57551would discriminate on bases such as race, disability, or LGBT status, or that they would disproportionately burden certain persons in such categories. Executive Order No. E, Sec. 35. better and aid in comparing the online edition to the print edition. [115] After reviewing public comments, both those supporting and those disagreeing with these estimates and similar estimates from the Religious IFC, and because the Departments do not have sufficient data to precisely Start Printed Page 57582estimate the amount by which these factors render our estimate too high, or too low, the Departments simply conclude that the financial transfer falls substantially below the $100 million threshold for an economically significant rule based on the calculations set forth above. It is estimated that each issuer or third party administrator will need approximately 1 hour of clerical labor (at $55.68 per hour) and 15 minutes of management review (at $117.40 per hour) to prepare the notices. a. That is especially true for HHS, as HRSA is a component of HHS that was unilaterally created by the agency and thus is subject to the agency's general supervision, see 47 FR 38,409 (August 31, 1982). Nevertheless, by virtue of expanding the exemptions to encompass all entities that were eligible for the accommodation process under the previous regulations, in addition to other newly exempt entities, the Religious IFC rendered the accommodation process optional. Under ERISA, the plan document identifies what benefits are provided to participants and beneficiaries under the plan; if an objecting employer would like to exclude all or a subset of contraceptive services, it must ensure that the exclusion is clear in the plan document. and that contraceptives treat such conditions as endometriosis, polycystic ovarian syndrome, migraines, pre-menstrual pain, menstrual regulation, and pelvic inflammatory disease. Where Congress left so many matters concerning section 2713(a)(4) to agency discretion, the Departments consider it appropriate to implement these expanded exemptions in light of Congress's long history of respecting religious beliefs in the context of certain federal health care requirements. (AP) South Dakota Gov. To the extent those comments apply to the following regulatory text, the Departments have responded to them above. Some commenters contended that the contraceptive Mandate promotes the health and equality of women, especially low income women and promotes female participation and equality in the workforce. doi: 10.1002/14651858.CD010813.pub2, available at https://www.ncbi.nlm.nih.gov/pubmed?term=24590565; L.J Havrilesky et al., Oral Contraceptive User for the Primary Prevention of Ovarian Cancer, Agency for Healthcare Research and Quality, Report No. The final rule specifies that the individual exemption ensures that the HRSA Guidelines do not prevent a willing health insurance issuer offering group or individual health insurance coverage, and as applicable, a willing plan sponsor of a group health plan, from offering a separate policy, certificate or contract of insurance or a separate group health plan or benefit package option, to any group health plan sponsor (with respect to an individual) or individual, as applicable, who objects to coverage or payments for some or all contraceptive services based on sincerely held religious beliefs. Those entities will be subject to the self-certification or notice requirement. This suggests that if these rules have any impact on state or local governments, it will be statistically de minimus. In accordance with the requirements of the PRA, the ICR for the EBSA Form 700 and alternative notice have previously been approved by OMB under control numbers 1210-0150 and 1210-0152. Questions by commenters about the scope of the description suggests that we should restructure the description, in a non-substantive way, to provide more clarity. a. Revising paragraph (a)(1) introductory text; b. Redesignating paragraphs (a)(1)(ii) and (iii) as paragraphs (iii) and (iv); d. Revising newly designated paragraph (a)(1)(iii); e. Revising newly designated paragraph (a)(1)(iv); and. See also 26 CFR 54.9815-2715(b); 29 CFR 2590.715-2715(b); 45 CFR 147.200(b). If an eligible organization wishes to revoke its use of the accommodation, it can do so under these rules, and operate under its exempt status. The Departments have concluded that withholding an exemption from those entities has imposed a substantial burden on their exercise of religion, either by compelling an act inconsistent with that observance or practice, or by substantially pressuring the adherents to modify such observance or practice. The plans of governmental employers are not covered by the plan sponsor exemption in 147.132(a)(1)(i). In addition, the Departments have deemed some other entities as being subject to the accommodation through their litigation filings, but that might not have led to contraceptive coverage being provided to persons covered in some of those plans, either because they are exempt as houses of worship or integrated auxiliaries, they are in self-insured church plans, or the Departments were not aware of their issuers or third party administrators so as to send them letters obligating them to provide such coverage. 3, 2014). The Departments believe it is appropriate to consider the government's interest in Start Printed Page 57548the contraceptive coverage requirement using the definition that formed the basis of that requirement and the justifications the Departments have offered for it since 2011. The Departments, therefore, find it appropriate to use the regulatory process to issue these expanded exemptions and accommodation, to better address concerns about religious exercise. The ACA did not apply the preventive services mandate to the many grandfathered health plans among closely held as well as publicly traded for-profit entities, encompassing tens of millions of women. Total Respondents: 114[122] 512(d), Pub. Still other commenters took the view that other laws or protections, such as those found in the First or Fifth Amendments, prohibit the expanded exemptions, which those commenters view as Start Printed Page 57549prioritizing religious liberty of exempted entities over the religious liberty, conscience, or choices of women who would not receive contraceptive coverage where an exemption is used. Guidestone Financial Resources, Who We Serve, available at https://www.guidestone.org/AboutUs/WhoWeServe. There, in the second sentence, instead of saying the plan remains subject to any requirement to provide coverage for contraceptive services, the exemption stated, the group health plan established or maintained by the plan sponsor with which the health insurance issuer contracts remains subject to any requirement to provide coverage for contraceptive services. Some commenters took note of this difference, and asked the Departments to clarify which language applies, and whether the Departments intended any difference in the operation of the two paragraphs. Others disagreed. Finally, some commenters argued that birth control access generally has led to social and economic equality for women. . The Guttmacher Institute recently published a study that concluded, [b]etween 2008 and 2014, there were no significant changes in the overall proportion of women who used a contraceptive method both among all women and among women at risk of unintended pregnancy, and there was no significant increase in the use of methods that would have been covered under the ACA (most or moderately effective methods) during the most recent time period (2012-2014) excepting small increases in implant use.[21] They also said that other protections for religious beliefs in federal health care conscience statutes do not preclude the application of such protections to certain entities on the basis that they are not closely held, and federal law defines persons, protected under RFRA, to include corporations at 1 U.S.C. Based on these data points, we believe the impact of the extension of the exemption to publicly traded for-profit organizations will not be significant. provided a staff-level briefing on 1President Biden's Executive Orders 14042 and 14043. These rules focus on what religious exemptions and accommodations shall apply if Guidelines issued under section 2713(a)(4) include contraceptives or items considered to be abortifacients. Some commenters contended that even the previous regulations allowing an exemption and accommodation were too broad, and said that no exemptions to the Mandate should exist, in order that contraceptive coverage would be provided to as many women as possible. Instead they allow entities that have sincerely held religious objections to providing some or all contraceptives included in the Mandate to not be forced to provide coverage of those items to anyone. Enjoining the mandatory vaccination requirements of Executive Order 14043 risks not only the health of federal agency employees, but also the health of those around them. Other commenters disagreed, suggesting that the expanded exemptions risked removing contraceptive coverage from more than 55 million women receiving the benefits of the preventive services Guidelines, or even risked removing contraceptive coverage from over 100 million women. Melnikas, Teen fertility in transition: recent and historic trends in the United States, 31 Ann. Congress did not intend to require coverage of preventive services for every type of plan that is subject to the ACA. An additional but unknown number of persons were likely covered in fully insured plans using the accommodation. The Departments finalize the prefatory text of 147.132(a)(1)(i) without change. Pew Research Center, Where the Public Stands on Religious Liberty vs. Nondiscrimination at page 26 (Sept. 28, 2016), available at http://assets.pewresearch.org/wp-content/uploads/sites/11/2016/09/Religious-Liberty-full-for-web.pdf. We estimate that in no event will they be more than $68.9 million. In accordance with Executive Order 14043 and Department of the Air Force (DAF) guidance, all DAF civilian employees assigned to the United States Air Force Academy (USAFA) must be fully vaccinated against COVID-19 no later than November 22, 2021, unless the employee has an approved exemption or pending exemption request based on religious reasons or medical conditions. They do not store directly personal information, but are based on uniquely identifying your browser and Under that theory, Hobby Lobby itself, and RFRA (on which Hobby Lobby' s holding was based), which provided a religious exemption to this Mandate for many businesses, would be deemed discriminatory against women because the underlying women's preventive services requirement is a benefit for women, not for men. R.R. The Department of Labor regulations are adopted pursuant to the authority contained in 29 U.S.C. These cases where plans did not need to comply with the Mandate, and the Departments' previous accommodation process allowing coverage not to be provided in certain self-insured church plans, together show that the importance of a uniform health coverage system is not significantly harmed by allowing plans to omit contraception in some contexts.[56]. According to data from the National Telecommunications and Information Agency (NTIA), 36.0 percent of individuals age 25 and over have access to the internet at work. 99. 300gg-92. The Departments, in previous regulations, exempted houses of worship and integrated auxiliaries from the Mandate. For example, sections (a)(1) and (a)(3) require evidence-based or evidence-informed coverage, while section (a)(4) does not. Government records and those groups' websites also often reflect those groups' religious character. [77] Although recognizing the limited data available for our estimates, the Departments estimate that 100 of the 209 entities that were using the accommodation under the previous regulations will continue to opt into it under these final rules and that those entities will cover the substantial majority of persons previously covered in accommodated plans. 19. Found inside Page 742 exemptions , 26 $ 4282 Affiliated individual , housing , crime victims , rights , 42 14043e - 11 Affiliates 26 $ 6109 Applicable disposable device , Medicare , payment , 42 $ 1395m Applicable Executive order , North Korea Committee Opinion Number 615: Access to Contraception. As discussed below regarding their anticipated effects, the Religious IFC and these rules are not likely to have economic impacts of $100 million or more in any one year, and therefore do not meet the definition of economically significant under Executive Order 12866.
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