The “Principal Purpose” Driven Life: How Hospitals Should Apply ERISA’s Church Plan Exemption After Advocate v. Stapleton

The United States’ health care industry is filled with numerous protections for individuals and entities who have objections based on religious beliefs and moral convictions. For example, there is a long history of conscience protections for individuals that object to performing or assisting in the performance of abortion or sterilization procedures or assisted suicide (including euthanasia or mercy killing). Over time, as more medical entities declare affiliation with religious entities, Congress has expanded conscience protections to cover more than just the daily activities of medical professionals. Generally, churches have to comply with the Employee Retirement Income Security Act (ERISA or the Act) just like any other employer. Yet, Congress provided an exception from ERISA for the administration of “church plans.” This exemption has existed for many years without issue until recently, when this exemption became the subject of increased litigation. ERISA defines “church plan” to apply more broadly than merely to plans covering people who work in houses of worship; schools, nursing homes, and hospitals may also comply if they are controlled or owned by religious entities. Most recently, questions have risen regarding whether the employee pension plans used by religiously-affiliated hospitals have been correctly classified as “church plans” exempt from ERISA. The answers to these questions carry with it large consequences because qualified church plans are excused from certain coverage, vesting, benefit accrual, and funding requirements of ERISA and the Internal Revenue Code (IRC) that otherwise apply to tax-qualified plans. In the 2017 landmark case Advocate Health Care Network v. Stapleton, one question that had long been debated between circuit courts regarding the extent of this exemption was resolved; the Court determined that a plan established and maintained by a church includes a plan maintained by a principal purpose organization. This ruling means that any religiously-controlled entity that manages an employee benefit plan no longer must be created by a religious entity in order to qualify for this exemption. Regardless of how (and by whom) the entity was first established, an organization may still take advantage of this exemption from ERISA as long as the entity is maintained by a principal purpose organization. This Supreme Court ruling is far from a full resolution of the issue. Advocate left a few issues unresolved, such as the definition of “principle purpose organization.” This leaves religiously-affiliated hospitals in a sticky place: unsure if they qualify for—and therefore can rely on—the ERISA church exemption. Since there are many potentially devastating effects on non-qualifying hospitals that mistakenly relied on this exemption, it is important for the qualifying factors to be clear. No longer should religiously-affiliated hospitals seek and rely on non-binding (and sometimes inaccurate) private letter rulings (PLRs) issued by the IRS in order to determine their exemption status. In Part I, this Comment will discuss ERISA’s church plan exemption pre- and post-Advocate. Additionally, it will cover a brief overview of the history of employee benefit plans in the healthcare system and describe the roles of different governmental entities. In Part II, this Comment will discuss the landmark case Advocate v. Stapleton and its impact on the employee benefit industry, and the current status of ERISA’s principal purpose requirement. Last, Part III will suggest a new set of factors that each religiously-controlled hospital and its employee benefit subcommittees can rely on in determining if it meets the “principal purpose” requirement

Global Citizenship for the Non-Traditional Student

After taking students from The Ohio State University at Newark to Berlin and New Orleans, we recognized the many obstacles nontraditional students face in participating in such programs, and we sought innovative ways to overcome those difficulties and prepare participants for cross-cultural encounters. We developed an approach grounded in the concept of what we call cosmopolitan courtesy. Blending the notion of everyday “civility” with the philosophical and intellectual background of the concept of cosmopolitanism, we crafted a set of classroom exercises and discussion prompts that encourage students to articulate and practice strategies for coping with unfamiliar and potentially unsettling cross-cultural experiences. This preparation positions students to take full advantage of study abroad, service learning, or domestic travel courses by inviting them to see themselves as global citizens

Disrupting the Cycle of Medical Distrust Between Caregivers and the Health Care System For Persons Living With Serious Mental Illness: What Does Misinformation Have To Do With It?

Developing transition planning for youth living with severe and persistent mental illness requires the creation, memorialization, and retrieval of appropriate and responsive treatment preferences to meet their needs, especially during a mental health crisis. Regrettably, transition-aged youth at the age of 18 can no longer rely on their support persons (typically family caregivers) to consent to care during a mental health crisis. Due to this, caregivers expressed challenges conveying information about their loved one’s preferences for care (Lavoie, 2018) during a crisis. This lack of access to patient information exchange during a mental health crisis can effect treatment decisions. Caregivers report a range of negative outcomes including traumatic events resulting in distrust of the health care system (Lester et al., 2005). While misinformation is typically thought of as the deliberate falsification of information, we explore misinformation as both omission and lack of access to patient information, in this case health information. But what happens when a caregiver is distrustful of the health care system? What influence does distrust have on disclosure of health information? The purpose of this paper is to understand how caregivers trust of the healthcare system effects their decision regarding the sharing of health information on behalf of a person experiencing a mental health crisis. Using a mixed methods approach, this paper provides the results of Texas wide online survey regarding disclosure of healthcare information during a mental health crisis. This study expands the understanding of misinformation and the consequence of when information is withheld from individuals and healthcare systems, that can result in clinical decisions based on misinformation. The data provides preliminary evidence to suggest that the role of distrust of the medical system plays a part of the decision to not disclose health information. Open ended responses also suggest a relationship of how lack of information can lead to misinformed decisions. Practical recommendations call for applications in which capacitated persons living with serious mental illness and their caregivers collaborate on the sharing and memorialization using a psychiatric advance directive (PAD). A psychiatric advance directive (PAD) is not only a communication tool it is a medical-legal document that promotes patients’ autonomy giving capacitated adults living with serious mental illnesses the ability to record their preferences for care during a mental health crisis (Table et al., 2020)

Do 2 with VCU: A Community Engagement Initiative

Do 2 with VCU will be a day-long Expo highlighting volunteer activities and opportunities with up to 100 community partners. VCU faculty and staff will be encouraged to collaborate with these community partners by using their 16 hours of community service leave provided by VCU. The Expo will culminate with a Keynote Speaker for this inaugural event. This year we have selected author and activist, Elaine Brown; she will deliver an address on the importance of community activism and service which will be marketed to the greater Richmond area. This project was designed around Theme IV of the VCU Quest for Distinction: “Become a national model for community engagement and regional impact.

Valuing Adjuncts as Liaisons for University Excellence (VALUE) Program

Adjuncts are increasingly becoming more important in higher education and make up nearly onethird of VCU’s teaching faculty. While VCU has made strides in increasing the number of tenuretrack and term professors, the size and needs of certain departments will always make adjunct instructors necessary. A number of schools on both the Monroe Park and MCV campuses utilize professionals from the Richmond community to enhance experiential learning, thereby making a university investment in adjunct faculty a means by which to elevate VCU’s strategic mission. Adjuncts often provide a community perspective that comes from the professional work they do outside of the university setting and as a whole are reflective of VCU’s diverse student population. As a result, they serve a critical role in student success and diversity initiatives. Keeping adjuncts connected with campus resources and engaged with the larger VCU community is also an important step in making the university more inclusive. This project will study opportunities associated with the orientation and support of adjunct faculty at VCU on both Monroe Park and MCV campuses. This project is research-oriented and will serve as an important foundation for developing and implementing a plan for institutionalized adjunct support. To develop a detailed proposal for implementation, our team consulted with several key stakeholders including: academic leaders who hire and support adjuncts in the current decentralized process students who have taken classes with adjunct instructors adjunct faculty who have recently taught at VCU Through a combination of methods, we aim to determine how adjuncts are utilized across the university, identify resources currently provided, and assess additional resource needs in an effort to inform a new orientation and support program for adjunct faculty at VCU

Using a Computer Simulation in the Research, Training, and Evaluation of School Psychologists

A computer program, School Psychologist Simulation, is described. The program presents users with information and events such as might be encountered in a real school setting regarding schoolchildren referred to the school psychologist; users can practice the skills needed by a school psychologist in the assessment of the case. The participant then submits a report detailing assessment, recommendations, and reasoning for the case in either essay or multiple-choice format. An additional program permits the instructor to customize the material presented to the user by modifying the case material of a specific child and/or by altering the forms displayed to the user in all cases

SB 909/HB 1408 Virginia Fair Housing Law; unlawful discriminatory housing practices

This report provides a legislative racial impact analysis of Senate Bill (SB) 909, a proposed bill in the Virginia General Assembly, to expand the Virginia Fair Housing Law to include lawful sources of income. Specifically, this report examines state and county source of income laws and their variances by race and ethnicity