Submitted Electronically

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Room 445-G, Hubert Humphrey Building
200 Independence Avenue, SW
Washington, DC 20201

April 8, 2013

LSP Comments on HHS Mandate: Notice of Proposed Rulemaking

Dear Sir or Madam:

On behalf of the Little Sisters of the Poor, we respectfully submit the following comments on the Notice of Proposed Rulemaking on preventive services.1

The Little Sisters of the Poor are an international Congregation of Catholic women religious serving 13,000 needy elderly people of all faiths in thirty-one countries around the world. Thirty of our homes for the aged, which together care for over 2,500 elderly poor, are located in the United States.z We are filing these comments because the HHS Mandate threatens the operation of these homes. After the safe harbor ends, we may be subjected to steep financial penalties for not changing our health coverage arrangements at these homes to ensure coverage of female sterilization and all FDA-approved contraceptives, including abortifacient drugs and devices.

We have explained our religiously based objections to the HHS Mandate in our public statements, which we have included with these comments. 3 These comments do not repeat these objections, but instead explain why the proposed exemption and proposed accommodation do not alleviate the burden that the HHS Mandate imposes on our religious exercise. By describing how the proposed exemption excludes our homes and by explaining why the proposed accommodation does not address our situation, these comments amplify and illustrate the more extensive and more detailed comments separately filed by the United States Conference of Catholic Bishops and by the Church Alliance, among others.

The proposed "religious employer" exemption does not cover our homes because the exemption extends only to group health plans offered by a nonprofit entity referred to in 26 U.S.C. ยง 6033(a)(3)(A)(i) or (iii).4 Those provisions relate to the obligation to file an informational return and exempt "churches, their integrated auxiliaries, and conventions or associations of churches"5 and "the exclusively religious activities of any religious order"6 from this obligation. Each of our homes is a separate corporate entity that files an annual Form 990 for purposes of compliance with the tax code. Because each home is a "large employer" under the Patient Protection and Affordable Care Act and is not exempt from filing under the Code provision that currently defines the scope of the proposed "religious employer" exemption, the group health plan offered by each home is not exempt from the HHS Mandate under the proposed exemption.

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