CMSA Today - Issue 8, 2013 - (Page 25)

CMSA Case Management and the Law U.S. Supreme Court Rules on Federal Marriage Act Decision impacts benefit plan offerings & related services BY GARRY CARNEAL, JD, MA T he U.S. Supreme Court made headlines in June 2013 when it struck down Section 3 of the federal Defense of Marriage Act (DOMA), which prohibited the federal government from acknowledging marriages between same-sex couples, in United States v. Windsor. Section 3 defined "marriage" as the legal union of one man and one woman, and "spouse" as a person of the opposite sex who is a husband or wife. This ruling impacts most types of health and benefit coverage, and it will have ramifications for case managers and others who help coordinate insurance coverage and services for legally married, same-sex couples. In 1996, the passage of DOMA necessitated interpretation of federal law in a manner consistent with these definitions. For example, in 1998 the Department of Labor issued an opinion letter stating that only the federal definitions of marriage and spouse established under DOMA would apply for purposes of leave under the Family and Medical Leave Act (FMLA). Thus, the invalidation of DOMA's initial definition of marriage stands to affect thousands of federal statutes and regulations. In situations where a legally married, same-sex couple resides in a state that recognizes same-sex marriage, the decision raises several issues that plan sponsors, benefits professionals, and others should carefully consider. For example, FMLA benefits will now extend to samesex spouses, and benefits for federally recognized spouses are not taxable. The Consolidated Omnibus Budget Reconciliation Act, also known as COBRA, requires plans to provide continuation coverage to spouses. With the invalidation of Section 3 of DOMA, this coverage will be available to same-sex spouses. The same principle applies to a myriad of other health insurance arrangements including health savings accounts, and wellness and prevention services. CASE MANAGEMENT INSIGHTS Regardless of a person's political, legal, or religious beliefs, it is important to fully understand how laws and court decisions can impact the practice of case management. The new DOMA ruling should allow patients, their case managers, and others to have access to more resources when working with an individual who is part of a legally married, same-sex couple. For example, a dependent care assistance program allows employees to reduce their taxable income by setting aside money from each paycheck before taxes to pay for dependent care expenses. An employee can now use such a program to pay a caregiver who is the employee's same-sex spouse. Case managers overseeing specific populations may see more same-sex married couples in groups they manage, where one partner formerly did not qualify to participate in that group. Case managers working with these individuals should leverage supplemental resources and strategies in support of same-sex couples, especially in cases where one or both individuals are dealing with chronic conditions or other medical challenges. Transition of care strategies can also be enhanced through expanded hospital visitation rights, exchange of protected health information (PHI), and other opportunities that were formerly only available to heterosexual married couples. UNRESOLVED ISSUES The Windsor decision leaves some key questions unanswered. For instance, the U.S. Supreme Court did not rule on Section 2 of DOMA, which allows states to refuse recognition of same-sex marriages performed under other state laws. Without such a ruling, questions linger as to the treatment of same-sex couples who marry in one state and then move to another state that does not recognize same-sex marriage. Many legal experts assert that the Equal Protection Clause of the U.S. Constitution would protect these couples no matter where they live. Others argue that a state should retain the rights to ban same-sex marriages even with the Supreme Court's ruling on Section 3. Several federal agencies have stated that they will review affected federal statutes and issue guidance to implement the Supreme Court's decision. In the meantime, case managers should move forward to serve the best interest of their patients as health policy and legal experts fill in the details of the Windsor decision. ■ Garry Carneal, JD, MA, is president & CEO, Schooner Healthcare Services and RadSite. This article is for informational purposes only. For specific legal advice on any issue, please consult a licensed attorney or other applicable professional in your state or jurisdiction. Issue 8 * 2013 CMSA TODAY 25

Table of Contents for the Digital Edition of CMSA Today - Issue 8, 2013

Where Was Care Coordination?
Preparing Patients for Their Journey Ahead

CMSA Today - Issue 8, 2013