Transgender Students and Title IX: Biden Administration Signals Shift

President Biden issued Executive Order (EO) on Preventing and Combating Discrimination Based on Gender Identity or Sexual Orientation on Jan. 20, 2021.[1] While the EO itself is a high level policy statement and does not, in and of itself, immediately change any practices for public school districts, it likely signals a significant shift in how the Biden administration will interpret and enforce the rights of transgender and other LGBTQ students.

What policy is asserted in the EO?

The Executive Order asserts that “[a]ll persons should receive equal treatment under the law without regard to their gender identity or sexual orientation”, including that “[c]hildren should be able to learn without worrying about whether they will be denied access to the restroom, locker room, or school sports.” Additionally the EO provides: “[e]very person should be treated with respect and dignity without regard to who they are or whom they love; “[a]dults should be able to earn a living without worrying about being fired or demoted because of who they go home to or whether their dress conforms to sex-based stereotypes”; and “[p]eople should have access to healthcare and be able to put a roof over their heads without being subjected to sex discrimination.”

The EO bases its reasoning on Title VII of the Civil Rights Act of 1964 and the Supreme Court’s recent case of Bostock v. Clayton County, which held that Title VII’s prohibition against “sex discrimination” includes a prohibition against discrimination based on sexual orientation and gender identity. The EO asserts that Bostock’s reasoning also applies to other laws, including Title IX, that prohibit sex discrimination.

What does the EO require federal entities to do?

It requires the head of every federal agency (including the U.S. Department of Education) to:

  • Consult with the United States Attorney General as soon as practicable;
  • Review all existing orders, regulations, guidance documents, policies, programs, or other agency actions under any statute or regulation that prohibits sex discrimination and determine whether those items are consistent with the EO; and
  • Within 100 days of the Order, work with the Attorney General to implement an action plan to carry out the actions identified in its review of its policies, programs, guidance, rules, or regulations and that may be inconsistent with the Order’s stated policy.

How are the stated policy and required action different from the past?

The EO’s language stands in direct contrast with the prior administration’s stance on legal protections for students based on sexual orientation and gender identity. For example, under the prior administration, the U.S. Department of Education took the position that Bostock’s reasoning did not apply to Title IX and specifically reaffirmed its position that public school districts may exclude students from athletic teams based on gender identity and could require students to use bathrooms based on biological sex, rather than gender identity.

In fact, the prior administration issued correspondence explicitly disagreeing with how two federal circuit courts interpreted Title IX. In Grimm v. Gloucester County School Board and in Adams v. School Board of St. Johns County, the Fourth Circuit (covering Maryland, North Carolina, South Carolina, Virginia and West Virginia) and Eleventh Circuit (covering Alabama, Florida, and Georgia) held that public school students have the right, under both Title IX and the Equal Protection Clause of the Fourteenth Amendment, to use bathrooms consistent with their gender identity. The Eleventh Circuit, in particular, relied on Bostock to interpret Title IX’s prohibition against sex discrimination.[2] The new EO rejects the previous administration’s assertion that the Bostock decision does not apply to agency interpretation of Title IX.

While the EO does not specifically rescind any specific order or action, its broad mandate that agencies review existing programs and policies likely will lead to updated guidance, enforcement priorities, and rules implementing Title IX and other laws prohibiting sex discrimination.

What should schools do now?

The current administration will likely implement major changes related to discrimination on the basis of sexual orientation or transgender status. This may include requiring schools to allow students to use bathrooms and locker rooms that are consistent with their gender identity, and to play on athletic teams that are consistent with their gender identity. Additionally, schools can expect more robust federal agency investigation of complaints of discrimination based on gender identity and sexual orientation.

In light of Bostock, all schools subject to Title VII of the Civil Rights Act should ensure that their employment policies prohibit discrimination on the basis of sexual orientation and gender identity, in conformity with Bostock. In addition, all colleges and universities, as well as all public K-12 school districts, in the Fourth and Eleventh circuits should ensure that their bathroom policies allow students to use bathrooms consistent with their gender identity.

Finally, colleges and universities, as well as public K-12 school districts, should review their practices and procedures to determine how to best support the rights of transgender students in their programs and activities. They should prepare for greater scrutiny at the federal level and be prepared to defend their practices.


[1] https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order-preventing-and-combating-discrimination-on-basis-of-gender-identity-or-sexual-orientation/

[2] Note, though, that the School Board of St. Johns County has petitioned for an en banc hearing. That petition has not yet been ruled upon.

Copyright ©2021 Nelson Mullins Riley & Scarborough LLP


For more, visit the NLR Public Education & Services section.

New Policy to Remove Barriers to COVID-19 Testing

On February 26, 2021, the Centers for Medicare & Medicaid Services, Department of Labor and Department of Treasury issued guidance removing barriers to COVID-19 diagnostic testing and vaccinations and strengthening requirements that plans and issuers cover diagnostic testing without cost sharing. This guidance makes clear that private group health plans and issuers generally cannot use medical screening criteria to deny coverage for COVID-19 diagnostic tests for individuals with health coverage who are asymptomatic, and who have no known or suspected exposure to COVID-19. Such testing must be covered without cost sharing, prior authorization, or other medical management requirements imposed by the plan or issuer. For example, covered individuals wanting to ensure they are COVID-19 negative prior to visiting a family member would be able to be tested without paying cost sharing.  The guidance also includes information for providers on how to get reimbursed for COVID-19 diagnostic testing or for administering the COVID-19 vaccine to those who are uninsured.  Click here for the newly issued guidance.  See press release here.

The new guidance should encourage providers to offer COVID-19 testing at their offices and outpatient locations since private group health plans and issuers must cover and reimburse for COVID-19 testing of asymptomatic individuals and defers to the provider’s individual clinical assessment of the patient to determine whether the patient should be tested for COVID-19.  This new guidance should also increase patient access to testing and remove barriers to encourage patients to be tested prior to travel without fears of large out of pocket payment for testing.  The provider should check with health plans to confirm that they have implemented this policy prior to starting to administer the test to the newly covered group.  Likewise, patients should check their coverage under their health plans.

© 2020 Giordano, Halleran & Ciesla, P.C. All Rights Reserved


For more, visit the NLR Health Law & Managed Care section

UK Imposes Strict Quarantine Requirements for Passengers From ‘Red List’ Countries

On 15 February 2021, the UK government imposed stricter requirements on individuals travelling or transiting from any of the 33 countries (‘red list countries’) that have had a travel ban to England applied. Separate advice applies to Scotland, Wales, and Northern Ireland.

Only British citizens, Irish citizens, and those with UK residence rights are able to enter the United Kingdom if they have visited or transited through a red list country in the 10 days prior to entry to England.

These individuals will need to quarantine in a government-managed hotel for 10 days (11 nights) from the date of their arrival. They must also abide by the following requirements.

  • Individuals must only arrive at an authorised airport. According to the guidance, authorised aiports include only Heathrow Airport, Gatwick Airport, London City Airport, Birmingham-Shuttlesworth International Airport, and Farnborough Airport, although ‘[o]ther ports of entry may be added in the future.’ Passengers whose flights are due to arrive at a different airport must reschedule them to an authorised airport.
  • Individuals must provide a negative COVID-19 test to travel to the UK. The test must be taken in the three days prior to departure, and must be negative in order to travel or board the plane. Their results will need to be provided upon arrival in the UK, or else a fine of £500 could be imposed.
  • Individuals must reside in a government-managed hotel. The 10-day quarantine period must be in one of the government-managed hotels and reserved via the booking portal (before arriving in England). The fee for the ‘quarantine package’ for one adult is £1,750. To add another person over the age of 12 to the booking will cost £650, or £325 for a child between the ages of 5 and 12. This price includes transport to and from the hotel, meals, and COVID-19 testing on the second and eighth days of the 10-day quarantine period.
  • Individuals must complete an online ‘passenger locator form’ in the 48 hours prior to travelling to the UK. The form is intended to provide a passenger’s journey and contact details. Passengers who do not complete the form may face delays in entering England or they could be fined or refused entry. Once the form has been completed, passengers will receive a confirmation email with a document attached. The document will contain a QR code that will be scanned by the Border Force to confirm that the form has been completed successfully.

Sanctions may be imposed on passengers who provide false or deliberately misleading information on the passenger locator form. Passengers who provide inaccurate information may be fined ‘up to £10,000, imprisoned for up to 10 years, or both’. If the quarantine rules are broken, fines of up to £10,000 may be imposed.

The situation with COVID-19 and pre-entry requirements to the UK is constantly changing, and it is also likely that other countries may be added (or removed) from the red list. Individuals may want to review the guidance for updates and further information on how to quarantine when arriving in England.

The government also provides guidance for passengers who are not travelling to England from red list countries.

Wales

Passengers may not directly travel to Wales if they have visited or passed through a red list country in the previous 10 days. They must arrive through one of the designated ports of entry to the UK in England or Scotland and ‘isolate for 10 days in a managed quarantine hotel.’

They must also complete a passenger locator form, have proof of a negative COVID-19 test (taken no more than 72 hours before departure), and also take a test on or before the second day and on or after the eighth day of quarantining.

Scotland

Although part of the UK, different rules apply regarding quarantine for individuals arriving in Scotland. All travellers flying into Scotland from outside the Common Travel Area (not just the red-list countries) must book and pay for managed isolation in quarantine hotels. The Common Travel Area comprises of the United Kingdom, Ireland, the Isle of Man, and the Channel Islands.

The following requirements apply for individuals arriving by air into Scotland.

  • Individuals must provide a negative COVID-19 result during the three days before travel.
  • Individuals must ‘book and pay for managed isolation in a quarantine hotel for at least 10 days from the point of arrival’.
  • Individuals must ‘complete an online passenger locator form before travelling, and provide contact details, travel details and the address of [the] final destination’.
  • Individuals will also need to provide the booking reference for the quarantine package.
  • Individuals must be tested on the second and eighth days of the 10-day quarantine period.
  • Individuals must follow the national rules on ‘Coronavirus in Scotland.’
    © 2020, Ogletree, Deakins, Nash, Smoak & Stewart, P.C., All Rights Reserved.

For more, visit the NLR Immigration section.

Second Draw Paycheck Protection Program Loans: Answers to Employers’ Frequently Asked Questions

The Consolidated Appropriations Act (CAA), 2021 includes a provision that modified and extended the Small Business Administration’s (SBA) Paycheck Protection Program (PPP). Specifically, Section 311 of the Additional Coronavirus Response and Relief provisions of the CAA provides for PPP second draw loans for eligible businesses. Employers seeking a PPP loan may apply through March 31, 2021. Below are answers to some key questions regarding second draw PPP loans.

Question 1. What are some key distinctions between first and second draw PPP loans?

Answer 1. Second draw PPP loans are intentionally narrower and smaller in terms of eligibility and amount. In order to be eligible, businesses must be able to demonstrate that they experienced a 25 percent reduction in gross receipts in a 2020 calendar quarter compared to the same quarter in 2019. While first draw PPP loans were capped at $10 million per borrower based on payroll costs in 2019, second draw PPP loans have a maximum of $2 million per borrower based on payroll costs in either 2019 or 2020. Additionally, first draw PPP loans were subject to a $20 million maximum for businesses that were part of a single corporate group, but second draw loans are subject to a $4 million maximum.

Q2. What employer missteps may impact forgiveness for PPP loans?

A2. A common mistake is not looking at the loan forgiveness application or their own data until after the conclusion of the “covered period.” This may limit a borrower’s ability to implement strategies that take advantage of the various safe harbors or exceptions to rules that reduce the amount of the loan that may be forgiven.

Another common mistake occurs when borrowers do not maintain PPP loan records in a centralized location, which may cause them to scramble to collect the information needed when they are completing the loan forgiveness application. In some instances, employers may not be able to find documents to substantiate unique situations, such as bona fide offers to rehire terminated employees that were refused or employee requests for reduced hours.

Q3. What steps might employers take to aid in managing the requirements for loan forgiveness?

A3. Borrowers may want to start contemplating loan forgiveness before they receive their loan disbursements. For example, in order to properly account for these funds, consider setting up a separate bank account to receive the PPP loan distribution. This step will streamline a borrower’s ability to track how each dollar of the loan is spent.

Borrowers may also want to contact their vendors shortly after receiving their loans to determine what type of reporting features may be available to help them document the permitted payroll and non-payroll costs during the covered period. Many vendors are producing standardized PPP loan reports that facilitate a borrower’s ability to complete the loan forgiveness application.

Q4. Are there any special considerations in the PPP loan process?

A4. In an effort to provide targeted relief to businesses that have been hardest hit by the pandemic, there are special rules in place for determining eligibility and the maximum amount of the PPP loans for borrowers that are in the hotel or restaurant industries (those with an NAICS code beginning with 72).

Borrowers that receive a loan in excess of $2 million are subject to a higher level of scrutiny and review following submission of their loan forgiveness applications. In addition to a mandatory SBA audit, such borrowers also need to complete an additional loan necessity questionnaire on SBA Form 3508 or 3509 (depending on their for-profit status).

© 2020, Ogletree, Deakins, Nash, Smoak & Stewart, P.C., All Rights Reserved.


For more, visit the NLR Coronavirus News section.

Flying Car Receives EASA Certification in Europe

AL-V, the first flying car to be allowed on the road in Europe, is now also the first flying car to complete full certification with European Union Aviation Safety Agency (EASA). The PAL-V Liberty (flying car) went through 10 years of testing, and now is in the final phase of compliance demonstration before becoming available to its customers.

PAL-V CEO, Robert Dingemanse, said, “Although we are experienced entrepreneurs, we learned that in aviation everything is exponentially stricter. Next to the aircraft, all aspects of the organization, including suppliers and maintenance parties must be certified.”

In 2009, PAL-V worked with EASA to amend the Certification Specifications for Small Rotorcraft, CS-27, as a starting point for certification of its flying car. Ultimately, together they amended the complete list of more than 1,500 criteria to make it applicable for PAL-V. The final version of these criteria was published last week. Note that this development only occurred after more than 10 years of analysis, test data, flight tests, and drive tests.

This EASA certificate is valid in Europe AND is also accepted in about 80 percent of the world’s market, including the United States and China.

Copyright © 2020 Robinson & Cole LLP. All rights reserved.


Vaccine Volunteers: Is “Thank You” Sufficient Compensation?

The Fair Labor Standards Act (FLSA) requires employers to pay nonexempt employees at least minimum wage for all hours worked up to 40 hours in a workweek and time and one-half for all hours worked over 40 hours in the same workweek. An exception to this rule exists for volunteers, who are not categorized as “employees” under the statute. Typically, volunteers are individuals who donate their time to non-profit, civic, religious, and other charitable organizations.

In light of the COVID-19 pandemic and the urgency to administer vaccines as quickly as possible, hospitals and healthcare facilities are relying on volunteers to assist in organizing vaccine distribution. Employers may want to review their program to ensure volunteers are donating their time in a way that does not run afoul of the FLSA.

Unfortunately, no bright-line rule exists to determine whether an individual is volunteering his or her time or performing compensable work under the FLSA. Instead, this determination hinges, in large part, on the type of work performed by the individual.

If an individual is performing service that relates to commercial activities, he or she will likely be considered an employee under the FLSA, and therefore entitled to wages. For example, an individual who “volunteers” his or her time working at the hospital gift shop may be entitled to compensation under the FLSA. Further, if a volunteer performs tasks on a full-time schedule, is retained for an indefinite period, or displaces a regular employee, it is likely the FLSA would categorize this individual as an employee who should be paid wages for all hours worked.

Recently, some hospitals have been faced with situations in which employees offered to volunteer their time after their shifts to perform the same types of services they are otherwise employed to provide. For example, a nurse employed at a hospital to administer the COVID-19 vaccine to patients during her regular working hours may volunteer to continue vaccinating patients after her assigned shift. Because this is likely impermissible “volunteer” work under the FLSA, the nurse may be entitled to compensation for any hours worked after her shift.

Another similar situation would be when a retired nurse wants to assist with clinical aspects or vaccine administration on a volunteer basis. For the same reasons noted above, this may also be problematic. Employers may want to review each situation on a case-by-case basis and proceed with caution. At a minimum, the employer may want to consider the below recommendations before classifying the returning nurse as a volunteer—who will likely be working alongside paid employees performing the same tasks.

So how can hospitals and similar facilities potentially use volunteers? Some ideas that may be permissible under the FLSA include: organizing the hospital’s vaccine distribution process, including ensuring patients waiting for their vaccine are wearing masks and staying six-feet apart in a line (among other safety recommendations); helping with check-in and other administrative work; and answering questions from patients.

If permitting volunteer work, healthcare employers may want to consider asking volunteers to sign authorization or other written forms that acknowledge the volunteers are knowingly and willingly donating their time to specific tasks and that the duration of the work is temporary. This type of acknowledgment may help to verify that the volunteer and employer are aligned in terms of the work performed, their relative expectations, and the (lack of) compensation provided.

With hospitals and other healthcare distribution facilities maintaining a commitment to administer the vaccine as effectively and efficiently as possible, volunteers are a key part of this mission. Many roles may exist for volunteers that comply with the FLSA and applicable state laws. While employers may want to carefully consider each situation and take precautions, the additional assistance provided by volunteers may be worthwhile to service communities and provide a quick and seamless process to administer vaccinations. At the very least, employers may want to ensure that volunteers are receiving proper recognition and resources for their time, even if it is a simple “thank you.”

© 2020, Ogletree, Deakins, Nash, Smoak & Stewart, P.C., All Rights Reserved

USDA Certified Organic Ciders: One of a Kind?

Anheuser-Busch introduced its Michelob Ultra Organic Seltzer last month, advertising the beverage as the “First-of-its-kind organic option to the hard seltzer category,” “First USDA-certified organic seltzer,” “First National USDA Certified Organic Hard Seltzer,” and “First-ever national USDA certified organic hard seltzer.” Anheuser-Busch even aired commercials during the nationally televised, highly viewed NFL Division Championship games, along with the Super Bowl that took place on Sunday, February 7. But now the question before an Oregon Court is whether these advertisements imply that it is the first and only kind in the country.

USDA Certified Organic Ciders

Suzie’s Brewery Company brews and packages Organic Hard Seltzer in Pendleton, Oregon. Suzie’s Brewery first launched its product line in July 2020 after obtaining its national organic certification from the USDA’s National Organic Program in June 2020. This program grants businesses the right to display the “USDA Organic” seal on their products should the business meet specific national standards. It also allows certified businesses to represent in advertising that their products have received national USDA organic certification. While most alcoholic beverages are regulated by the Federal Tax and Trade Bureau (“TTB”), and sugar fermented seltzers by the Food and Drug Administration (“FDA”), the USDA governs any food or beverage products that bear the “organic” label.

On February 2, 2021, Suzie’s Brewery sued Anheuser-Busch for false advertising and filed a motion for a temporary restraining order that would keep it from airing ads that Suzie’s Brewery claims are false. “Suzie’s Seltzer also has a national USDA organic certification, and was available on the market well before ULTRA Seltzer,” argued the attorney for Suzie’s Brewery, “In addition, there are several other hard seltzer brands on the market that have USDA organic certification.” Suzie’s Brewery further claims multiple consumers and product distributors contacted them regarding the Michelob Ultra Organic Seltzer advertisements, confused about it being the “first” or “only” USDA Organic certified seltzer. Others questioned the veracity of Suzie’s Brewery and their seltzers being USDA Certified organic, since Anheuser-Busch had claimed to be the “only” one on the market.

One of a Kind?

“Using the bully-pulpit its massive national advertising budget allows, Anheuser-Busch has premiered a new false and misleading advertising campaign aimed at convincing health-conscious drinkers that its new organic hard seltzer is a unique, one-of-a-kind product. To be clear, it is not,” Suzie’s Brewery stated, “and Anheuser-Busch will continue to pursue its strategy of unfairly squeezing out its smaller competitors in the organic hard seltzer market (like Suzie’s Brewery) unless this court puts a stop to its misconduct.”

On February 9, 2021, Judge Michael H. Simon of the United States District Court for the District of Oregon granted the temporary restraining order requiring Anheuser-Busch to immediately stop falsely claiming that its product – Michelob ULTRA Organic Hard Seltzer – is the only or first national USDA certified organic hard seltzer on the market. “It is false for Anheuser-Busch to say this,” the judge said, “because Suzie’s Organic Hard Seltzer is certified organic under the USDA’s National Organic Program and was certified under the national program before Michelob Ultra was.” This temporary restraining order will remain in effect until June 2, 2021, when Judge Simon is scheduled to rule on a motion for preliminary injunction filed by Suzie’s Brewery.

©2020 Norris McLaughlin P.A., All Rights Reserved
For more, visit the NLR Corporate & Business Organizations section.

Food & Food Packaging Is Unlikely to Spread COVID-19

The U.S. Food and Drug Administration (FDA) and Department of Agriculture (USDA) published a press release yesterday underscoring the international consensus that no credible evidence shows that food or food packaging is a source of viral transmission of SARS-CoV-2, the virus that causes COVID-19.

The press release highlights a September 2020 opinion from the International Commission on Microbiological Specifications for Foods that stated, “Despite the billions of meals and food packages handled since the beginning of the COVID-19 pandemic, to date there has not been any evidence that food, food packaging or food handling is a source or important transmission route for SARS-CoV-2 resulting in COVID-19.”  This consensus is consistent with literature reviews and research in other countries, and the fact that in the 100 million cases of COVID-19 worldwide, no epidemiological evidence suggests food or food packaging is a source of transmission to humans.

The U.S. Centers for Disease Control and Prevention (CDC) together with the U.S. Occupational Safety and Health Administration (OSHA) have provided guidance for food manufacturers to reduce the risk of spreading COVID-19 between workers. These guidelines complement the USDA and FDA food safety requirements that all U.S. food manufacturers must follow, such as the current Good Manufacturing Practices and preventative controls that focus on good hygiene practices and worker safety.

© 2020 Keller and Heckman LLP
For more, visit the NLR Biotech, Food, Drug section.

The Carbon Tax Checklist

Many stakeholders have called for the United States to adopt a carbon tax. Such a tax could raise billions of dollars in annual revenue while simultaneously reducing greenhouse gas emissions. Several carbon tax proposals were introduced in the last Congress (2019-2020 term), and it is likely that several more will be introduced in the new Congress. Several conservative economists have endorsed the idea, as has Janet Yellen, President Biden’s Secretary of the Treasury. But the details of a carbon tax matter—for revenue generation, emissions reductions and fairness. Because Congress is likely to consider several competing carbon tax proposals this year, this article provides a way to compare proposals with a checklist of 10 questions to ask about any specific legislative carbon tax proposal, to help understand that proposal’s design and implications.

1. What form does the tax take: Is it an emissions tax, a fuel tax or a production tax?

The point of a carbon tax is to reduce greenhouse gas emissions by imposing a price on those emissions. But there is more than one way to impose that price. Critically, the range of options depends, to a very large degree, on the type of greenhouse gas the tax is trying to address.

The most ubiquitous greenhouse gas is carbon dioxide (CO2) and the largest source of CO2 emissions is the combustion of fossil fuels. Those emissions can be addressed by imposing a fee on each individual emission source or by taxing the carbon content of the fuel—because carbon content is a reliable predictor of CO2 emissions across different combustion circumstances. Most carbon tax proposals are fuel tax proposals; they impose a tax on fuel sales, corresponding to the amount of CO2 that will be emitted when the fuel is burned.

For CO2 emissions, the fuel tax approach has one significant advantage over the emissions fee approach. The fuel tax can be imposed “upstream,” rather than “downstream,” thereby reducing the total number of taxpayers and the overall administrative burdens associated with collecting the tax. A tax imposed on petroleum products as they leave the refinery, for example, is a way to address CO2 emissions from motor vehicles without the need to tax every individual owner of a gasoline-powered car. Most CO2-related carbon tax proposals work that way—they are upstream fuel taxes rather than downstream emissions taxes.

But not all greenhouse gas emissions can be addressed through a fuel tax, because not all greenhouse gas emissions come from fossil fuel combustion. Methane, for example, is released in significant quantities from cows, coal mines and natural gas production systems. A carbon tax directed at those emissions is likely to take the form of an emissions fee imposed on the owner or operator of the emission source. Many carbon tax proposals, however, simply ignore methane emissions or expressly exempt agricultural sources.

Fluorinated gases are yet another type of greenhouse. If they are subjected to a carbon tax, that tax is likely to take the form of a production tax, which would be imposed at the point of production and/or importation into the United States. (Fluorinated gases are used in a variety of refrigerant and cooling applications and contribute to global warming when they leak out of those applications). However, the prospect of such a tax is less likely now because Congress recently adopted legislation imposing a phase-down of domestic hydrofluorocarbon gas production over the next 15 years.

2. Which greenhouse gases are covered? Which sources (if any) are exempt?

The answer to this question dictates, to a large degree, which particular form a carbon tax takes. Legislative proposals that address more than one type of greenhouse gas will very likely include more than one type of tax mechanism. Just as important, the range of greenhouse gases covered by a proposal is relevant to evaluating the proposal’s environmental and economic impacts. A carbon tax that addresses only CO2 emissions from fossil fuel combustion will cover the largest segment of US greenhouse gas emissions but will still omit several other significant greenhouse gas sources. Sources omitted from a federal carbon tax may become targets for other types of regulation.

3. Who pays the tax?

Most carbon tax proposals address CO2 emissions through an upstream fuel tax—a tax that is based on the carbon content of the fuel and that is imposed at the refinery (for petroleum products), the coal mine (for coal) and the compressor station (for natural gas). But that still leaves the question of who pays the tax. Some carbon tax proposals dictate exactly who pays. They specify, for example, that the taxable event is the delivery of crude oil to the refinery and that the taxpayer is the refinery operator. Other proposals specify only the taxable event (such as the first sale of natural gas extracted from a well) without saying which person or entity (the seller or buyer) is responsible for paying the tax. If Congress enacts a carbon tax that specifies the taxable event but not the taxpayer, it will likely fall to the Treasury Department to make that decision, through rulemaking.

4. How much is the tax, how is it set and how does it change over time?

One potential approach is to link the tax rate to the “social cost of carbon,” a dollar figure intended to express the harm associated with emitting one ton of CO2.** But the more fundamental question to ask of any carbon tax proposal is whether the tax rate (or “carbon fee,” as some proposals call it) is linked to any specific environmental goals or metrics. Many proposals set an initial tax rate (such as $50 per ton of CO2 emitted) and increase that rate every year until a specific level of emissions reduction has been achieved (such as a 90% reduction in domestic CO2 emissions compared to 2005 levels). Other proposals base the yearly tax increases (or decreases) on inflation or other economic measures, rather than environmental measures.

**The Obama administration published social cost of carbon (SCC) figures. The Trump administration did not and actually disbanded the interagency task force that had previously been charged with developing the SCC. The Biden administration has re-established that task force and directed it to publish new SCC figures by no later than January 2022.

5. How is the revenue used?

A carbon tax could raise billions of dollars for the federal government every year. In 2018, fossil fuel combustion in the United States produced more than five billion metric tons of CO2 emissions. A carbon tax of $50 per ton would have raised $250 billion that year, assuming emissions held steady (although the point of a carbon tax is to drive emissions down). What should the government do with the money?

Many commentators have argued for a “carbon dividend”—that is, that the revenue should be returned to American citizens in the form of a quarterly or annual rebate. (The Climate Leadership Council, of which Janet Yellen was a founding member, has called for such an approach.) Congress will not necessarily take that approach. Some alternatives for the revenue include: using it to reduce income taxes, spending it on social justice initiatives of various kinds and funding career transition services for oil and gas industry workers. Another approach is to use the revenue to fund green infrastructure, such as electric vehicle charging stations along interstate highways. Some proposals call for a combination of these approaches.

6. Does the tax include a border adjustment?

One concern frequently raised about a carbon tax is that unless other countries also impose a tax, certain domestic manufacturing activities may move overseas to areas without a tax, reducing domestic US employment without reducing overall global emissions. A border adjustment is one way to address that concern.

A border adjustment would apply a carbon tariff to imported goods and, very likely, exempt exported goods from the US carbon tax (i.e., by providing a tax credit or refund to exporters). Most, if not all, carbon tax proposals introduced in Congress to date have included some form of border adjustment. The details of the border adjustment can be critical, with the export provisions posing a particularly tricky set of issues. Exempting exports may protect US competitiveness but it also means that some emissions are not taxed, thereby undermining the tax’s environmental goals. Exempting exports also requires a mechanism for refunding, or crediting, exporters.

7. Does the tax modify or replace existing carbon-related tax credits?

Section 45Q of the US tax code currently provides a substantial tax credit for qualifying carbon capture and sequestration activities. The tax code also includes tax incentives for investing in solar energy, producing wind energy and blending biodiesel into diesel fuel. An important question for any legislative carbon tax proposal is whether it adjusts, modifies, expands or repeals any of those other carbon-related tax provisions.

8. Does the tax replace or preempt existing greenhouse gas regulations?

If domestic greenhouse gas emissions are addressed through a carbon tax, it may not be necessary to regulate those emissions under the federal Clean Air Act and other statutory programs. Indeed, the Climate Leadership Council, a leading proponent of enacting a carbon tax, has expressly called for the tax to replace federal regulation of CO2 emissions (albeit while retaining the Clean Air Act’s greenhouse gas reporting rule). A critical question for any legislative carbon tax proposal is whether it addresses other federal regulatory programs or is silent about those programs, leaving debate over their fate for another day. A closely related question is whether the proposal addresses state regulatory programs. Some of those programs, such as California’s cap-and-trade program and the northeast’s Regional Greenhouse Gas Initiative, have reduced emissions substantially while raising billions of dollars for renewable energy and energy efficiency programs. A federal proposal that preempted those programs might encounter substantial opposition from state officials and other stakeholders.

9. How transparent is the legislative language?

There is a robust academic (and advocacy) literature about carbon taxes. But that does not mean that any specific federal legislative proposal is well designed, easy to understand or easy to implement. An important question to ask of any legislative carbon tax proposal is whether the specific language is clear enough to be implemented efficiently and effectively. Is it clear what gets taxed? Is it clear who actually pays the tax and files the tax forms? Is it clear how the tax rate is set and how that rate relates to emission reduction goals? Is it clear whether any emission sources are exempt? Is it clear to what extent other carbon-related tax provisions and regulatory programs are impacted? Is it clear how the tax will work based on the legislative language alone, or will it be necessary for the Treasury Department to issue regulations or guidance explaining the legislation? If regulations are required, will those regulations be implemented by the Treasury Department alone, or will the Department of Energy and/or the Environmental Protection Agency also be involved?

10. What does the modeling show?

Finally, what impact will the tax actually have on greenhouse gas emissions and the economy? This is not so much a question to ask of the legislative language but of the modeling that will almost certainly accompany it—modeling done by the Congressional Research Service, the Treasury Department, other federal agencies and/or the proposal’s advocates and opponents.

© 2020 McDermott Will & Emery


For more, visit the NLR Environmental, Energy & Resources section.

Bias in Healthcare Algorithms

The application of artificial intelligence technologies to health care delivery, coding and population management may profoundly alter the manner in which clinicians and others interact with patients, and seek reimbursement. While on one hand, AI may promote better treatment decisions and streamline onerous coding and claims submission, there are risks associated with unintended bias that may be lurking in the algorithms. AI is trained on data. To the extent that data encodes historical bias, that bias may cause unintended errors when applied to new patients. This can result in errors in utilization management, coding, billing and healthcare delivery.

The following hypothetical illustrates the problem.

A physician practice management service organization (MSO) adopts a third-party software tool to assist its personnel in make treatment decisions for both the fee-for-service population and a Medicare Advantage population for which the MSO is at financial risk. The tool is used for both pre-authorizations and ICD diagnostic coding for Medicare Advantage patients, without the need of human coders. 

 The MSO’s compliance officer observes two issues:

  1. It appears Native American patients seeking substance abuse treatment are being approved by the MSO’s team far more frequently than other cohorts who are seeking the same care, and
  2. Since the deployment of the software, the MSO is realizing increased risk adjustment revenue attributable to a significant increase in rheumatic condition codes being identified by the AI tool.

Though the compliance officer doesn’t have any independent studies to support it, she is comfortable that the program is making appropriate substance abuse treatment and utilization management recommendations because she believes that there may be a genetic reason why Native Americans are at greater risk than others. With regard to the diagnostic coding, she:

  1. is also comfortable with the vendor’s assurances that their software is more accurate than eyes-on coding;
  2. understands that prevalence data suggests that the elderly population in the United States likely has undiagnosed rheumatic conditions; and,
  3. finds through her own investigation that anecdotally it appears that the software, while perhaps over-inclusive, is catching some diagnoses that could have been missed by the clinician alone. 

 Is the compliance officer’s comfort warranted?

The short answer is, of course, no.

There are two fundamental issues that the compliance officer needs to identify and investigate – both related to possible bias. First, is the tool authorizing unnecessary substance use disorder treatments for Native Americans, (overutilization) and at the same time not approving medically necessary treatments for other ethnicities (underutilization)? Overutilization drives health spend and can result in payment errors, and underutilization can result in improper denials, patient harm and legal exposure. The second issue relates to the AI tool potentially “finding” diagnostic codes that, while statistically supportable based on population data the vendor used in the training set, might not be supported in the MSO’s population. This error can result in submission of unsupported codes that can drive risk adjustment payment, which can carry significant legal and financial exposure.

©2020 Epstein Becker & Green, P.C. All rights reserved.


For more, visit the NLR Health Law & Managed Care section