Citing undue financial burdens placed on third-party administrators, the Self-Insurance Institute of America Inc. is urging federal regulators to revisit an accommodation for religious nonprofit organizations that object to providing contraceptive coverage for employees as mandated under the health care reform law.

In a letter sent Monday to the U.S. Health and Human Services, Treasury and Labor departments, the Simpsonville, South Carolina-based trade group said it was “deeply concerned” about the prospect of expanding the accommodation to include religiously inclined for-profit employers, as the U.S. Supreme Court suggested in its recent ruling in favor of family-owned companies seeking an exemption from the coverage rule.

The SIIA's letter argues that the accommodation already places third-party administrators for self-insured health care plans sponsored by nonprofits in an untenable position: either terminate their contracts with religious nonprofit clients or pay out of their own coffers for the coverage with, in the SIIA's view, little chance of being reimbursed in full.

“To date, the Departments have been unable to locate the necessary number of insurance issuers that could partner with all of the TPAs currently paying for certain contraceptive coverage services to facilitate reimbursements for amounts expended,” the SIIA said in its letter. “The inability to locate these carrier partners to facilitate reimbursements is having an adverse impact on many TPAs that remain committed to serving self-insured religious organizations, but that are void of any prospect of payments for these services.”

An HHS spokeswoman was not immediately available for comment.

Finalized in 2012 as a compromise with religious nonprofit employers claiming it would violate their religion to provide employees with no-cost insurance coverage for birth control prescriptions and contraceptive medical services, the Obama administration's accommodation allows religious nonprofits to pass the coverage requirement on to their insurer or, if they self-insure their health plan, a third-party administrator.

Last week, the Supreme Court ruled the federal government cannot force closely held private employers to directly provide prescription contraceptive coverage, largely because it was not the least restrictive means of broadening women's access to contraceptive medical services.

The court suggested that a system similar to the accommodation provided to nonprofit organizations could satisfy the same objective without infringing on employers' religious rights.

The SIIA said in its letter that unless the government begins directly reimbursing TPAs “that are undertaking good-faith efforts to comply with the contraceptive coverage, final regulations extending the above-stated rule to for-profit employers as suggested by the Supreme Court will only exacerbate the burdens TPAs are already facing.”

Whether the government will be able to offer third-party accommodations for private companies and/or nonprofit organizations going forward became much less clear last Thursday, as the Supreme Court issued an emergency injunction for a Christian college in Wheaton, Illinois, temporarily exempting it from having to participate in the very nonprofit accommodation arrangement it had endorsed in its ruling for Hobby Lobby Inc. just three days prior.