(Bloomberg) — Religious nonprofit groups must formally opt out of a U.S. Department of Health and Human Services mandate if they wish to avoid a requirement that employers provide health insurance coverage for birth control, a federal appeals court said.

The decision is the second major win for Patient Protection and Affordable Care Act implementers at HHS in three weeks. On June 25, the Supreme Court upheld a core component of PPACA, backing the ability of HHS to offer PPACA premium tax credits through the public exchanges it runs.

In Tuesday’s case, the nonprofits said their religious and free-speech rights were violated by an HHS mandate requiring them to actively opt out of a rule requiring them to provide contraceptive coverage as a form of preventive care. HHS established the rule when it developed regulations implementing PPACA preventive services coverage provisions.

The nonprofits cited last year’s ruling in another Supreme Court case, in which the high court said closely held companies can refuse on religious grounds to offer birth-control coverage to their workers. The Denver-based appeals court said that decision didn’t directly apply to religious nonprofits.

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

“The accommodation relieves plaintiffs of their obligation to provide, pay for or facilitate contraceptive coverage, and does so without substantially burdening their religious exercise,” the appeals court ruled.

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

The case is Little Sisters of the Poor v. Burwell (Case Number 13-1540), 10th Circuit U.S. Court of Appeals (Denver). The Supreme Court case is Burwell v. Hobby Lobby Stores (Case Number 13-354).

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Religious groups must comply with birth control mandate

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