A Deeper Dive: Employers Receiving Federal Funding May Be Subject to ACA’s Nondiscrimination Rule and Need to Cover Transgender Benefits

Matthew P. Chiarello • September 19, 2016

In recent months, we have written a fair amount about providing transgender benefits in light of the nondiscrimination provisions of the Affordable Care Act. Our blogs of March 30, 2016 and June 22, 2016 highlight the key contours of the nondiscrimination rule.  In our June 22 post , we mention in passing that the final nondiscrimination rule applies to any health program or activity, any part of which receives funding from the Department of Health and Human Services (“HHS”).  This blog provides additional clarity on what it means for a group health plan or an employer to receive federal financial assistance (“FFA”) and, by consequence, become subject to the nondiscrimination provisions of the Affordable Care Act.

In general, the final nondiscrimination rule applies to (1) group health plans that receive FFA and (2) employers that both receive FFA and provide employee health benefit programs ( i.e. insured or self-funded plans, wellness programs, health clinics, long-term care coverage or insurance).  Employers not principally engaged in providing or administering health services or health insurance coverage would only be liable for discrimination under the rule with respect to an employee benefit program if the primary objective of the FFA is to fund such program.

Most self-funded employer-sponsored group health plans probably do not receive FFA from HHS, but this may occur, for example, if an employer sponsors a retiree prescription drug program or an employer group waiver program (“EGWP”). Other forms of FFA may exist and employers may wish to consider whether they receive funding from HHS that would subject them to the nondiscrimination provisions of the Affordable Care Act.

Being subject to the nondiscrimination rule may mean more than having to provide some level of transgender health coverage. It also subjects covered entities to certain notice requirements.  The Office of Civil Rights, which administers the nondiscrimination rule, has provided a sample notice to facilitate compliance.

Employee burnout: what it is and how to prevent it

By Mardy Gould • May 24, 2024
Employee burnout has become an epidemic in today’s modern workplace. So much so that the World Health Organization (WHO) officially recognizes it as an “occupational phenomenon.”1 While many used to consider mounting workplace stress an individual employee problem, these days, it’s become an employer’s responsibility to prevent burnout before it hurts productivity and business performance—not to mention your employees’ physical and mental health. Luckily, you can prevent burnout from affecting your workforce in several ways. This article will explore the causes and signs of employee burnout and the steps you can take to create a positive work environment where employees feel safe from toxic stress levels.

Form 720 and PCORI fee FAQs

By Mardy Gould • May 23, 2024
If you're a small business owner, you may have heard of the acronym PCORI and the fees that come with it. But what is PCORI, and how does it apply to your organization? Under the Affordable Care Act (ACA), sponsors of self-insured health plans must pay a fee to fund the federal Patient-Centered Outcomes Research Institute (PCORI). PCORI is an independent organization the ACA created to conduct research to help healthcare consumers make better decisions for their specific needs and outcomes. It also performs research related to clinical effectiveness. Employers offering a self-insured medical reimbursement health plan, such as a health reimbursement arrangement (HRA), must pay this fee by July 31 each year via Form 7201. This fee was initially set to expire in 2019, but Congress extended it through September 30, 20292, due to the Further Consolidated Appropriations Act of 20203.
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