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Updates to Previously Shared Information

Additional guidance on HIPAA audits - As we shared with you in May, the Department of Health and Human Services (HHS) Office of Civil Rights (OCR) has implemented Phase 2 of its audit program. The intention is to use this audit program to ensure compliance with HIPAA’s Privacy, Security and Breach Notification Rules. In July, OCR released certain documents previously shared with those entities, and these are being audited to provide additional guidance regarding the audit process. You can access these documents via the links below:


  • Questions and Answers
  • Selected Protocol Elements
  • Webinar Slides

The guidance provides clarifications on what information to submit and how it should be submitted. Those under audit should consult with their own counsel if they have questions as to how best to respond to OCR.

IRS finalizes regulations to implement same-sex marriage decisions

On September 2, 2016, the Internal Revenue Service (IRS) issued their final regulations describing the marital status of taxpayers for federal tax purposes following the Obergefell and Windsor Supreme Court cases. The terms spouse, husband, and wife for federal tax purposes now mean an individual lawfully married to another individual. The term husband and wife means two individuals lawfully married to each other.


The final regulations clarify that a marriage of two individuals will be recognized for federal tax purposes if the marriage is recognized by the state, possession or territory of the United States in which the couple entered into the marriage. If married in a foreign country, the marriage will be recognized if the state, possession or territory recognizes the marital bond. 


Domestic partnerships, civil unions or similar relationships not recognized by the laws of the state, possession or territory of the United States where the couple began their relationship are not considered marriage for federal tax purposes.


Impact on plan’s ability to define spouse for health plan eligibility

The regulations apply for federal tax purposes only and do not impact an ERISA-governed plan’s ability to define spouse for health plan eligibility. A definition of spouse has not been added to ERISA, which means employers are free to continue to define spouse as they wish. Plans may wish to consult with independent benefits counsel if they choose to exclude same-sex spouses from coverage while covering opposite sex spouses to evaluate any risk that may exist under anti-discrimination or other applicable laws. Plans should consult with their advisors on issues of eligibility and plan design, and be sure to apply their plan eligibility rules consistently.


Compliance Quarterly is being provided as an informational tool. It is recommended that plans consult with their own experts or counsel to review all applicable federal and state legal requirements that may apply to their group health plan. By providing this publication and any attachments, Meritain Health is not exercising discretionary authority over the plan and is not assuming a plan fiduciary role, nor is Meritain Health providing legal advice.


Published November 15, 2016