(Bloomberg) — Religious nonprofit groups must formally opt outof a U.S. Department of Health and Human Services mandate if theywish to avoid a requirement that employers provide health insurancecoverage for birth control, a federal appeals courtsaid.

The decision is the second major win for Patient Protection andAffordable Care Act implementers at HHS in three weeks. OnJune 25, the Supreme Court upheld a core component ofPPACA, backing the ability of HHS to offer PPACA premium taxcredits through the public exchanges it runs.

In Tuesday’s case, the nonprofits said their religious andfree-speech rights were violated by an HHS mandate requiring themto actively opt out of a rule requiring them to providecontraceptive coverage as a form of preventive care. HHSestablished the rule when it developed regulations implementingPPACA preventive services coverage provisions.

The nonprofits cited last year’s ruling in another Supreme Courtcase, in which the high court said closely held companies canrefuse on religious grounds to offer birth-control coverage totheir workers. The Denver-based appeals court said that decisiondidn’t directly apply to religious nonprofits.

Under an “accommodation” in HHS implementation of theregulation, religious nonprofits won’t be penalized if they notifytheir group health plan or the government of their opt-out, theappeals court said.

“The accommodation relieves plaintiffs of their obligation toprovide, pay for or facilitate contraceptive coverage, and does sowithout substantially burdening their religious exercise,” theappeals court ruled.

Kevin Walsh, a lawyer for the lead plaintiff, Denver-basednonprofit Little Sisters of the Poor, didn’t immediately respond toa call and e-mail after regular business hours seeking comment onthe decision.

The case is Little Sisters of the Poor v. Burwell (Case Number13-1540), 10th Circuit U.S. Court of Appeals (Denver). The SupremeCourt case is Burwell v. Hobby Lobby Stores (Case Number13-354).

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