Trans­gen­der rules add am­bi­gu­ity

Modern Healthcare - - NEWS - By Vir­gil Dick­son

Pro­gres­sive healthcare providers say re­cent HHS rules ban­ning dis­crim­i­na­tion against trans­gen­der peo­ple raise more ques­tions about how to ad­e­quately serve that com­mu­nity.

Pre­vi­ously, civil rights laws en­forced by HHS’ Of­fice for Civil Rights were based specif­i­cally on race, color, na­tional ori­gin, dis­abil­ity and age.

The re­cent rules clar­ify that civil rights pro­tec­tions will fur­ther block dis­crim­i­na­tion based on sex, which the agency says in­cludes gen­der iden­tity.

The rules ap­ply to any provider or pro­gram that ac­cepts fed­eral dol­lars and car­ries out the anti-bias pro­vi­sions of the Af­ford­able Care Act.

In­sur­ers will not be re­quired to cover gen­der tran­si­tion treat­ments like surgery. But they could face ques­tions if they deny med­i­cally nec­es­sary ser­vices re­lated to gen­der tran­si­tion.

In larger states, like Cal­i­for­nia and New York, which have rel­a­tively strin­gent anti-dis­crim­i­na­tion laws, in­dus­try stake­hold­ers say they need more guid­ance for dis­crim­i­na­tion gray ar­eas.

For in­stance, if a male to fe­male in­di­vid­ual shares a hos­pi­tal room with a woman and that per­son still looks no­tice­ably male, the hos­pi­tal can­not an­swer any ques­tions about the per­son’s gen­der, since that is pri­vate med­i­cal in­for­ma­tion, said Lois Richard­son, an at­tor­ney and vice pres­i­dent at the Cal­i­for­nia Hos­pi­tal As­so­ci­a­tion.

In re­gards to cov­er­age, health plans in New York state are al­ready re­quired to cover med­i­cally nec­es­sary pro­ce­dures for trans­gen­dered in­di­vid­u­als. Still, the state’s providers have ques­tions.

“Es­pe­cially re­gard­ing teenagers,” said Les­lie Moran, a se­nior vice pres­i­dent with the New York Health Plan As­so­ci­a­tion, “At what age do you start re­im­burs­ing for hor­mone ther­apy, for in­stance?”

The new anti-dis­crim­i­na­tion rules are ex­pected to cost the healthcare in­dus­try, as well as state and fed­eral agen­cies, $558 mil­lion in staff train­ing and ad­min­is­tra­tive costs over the first few years of im­ple­men­ta­tion, the agency es­ti­mated.

But many in the LGBT com­mu­nity say it’s worth it.

“This will help re­duce rates of de­pres­sion, sui­cide and sub­stance abuse among trans­gen­der peo­ple, as well as al­le­vi­ate stress-re­lated health con­di­tions that all peo­ple have when they aren’t get­ting the care they need,” Mara Keis­ling, ex­ec­u­tive di­rec­tor of the Na­tional Cen­ter for Trans­gen­der Equal­ity, said in a state­ment.

The Of­fice for Civil Rights says that de­spite nu­mer­ous of­fi­cial anti-dis­crim­i­na­tory poli­cies and laws, they still re­ceive 3,000 com­plaints a year.

The pro­posed rules are open for public com­ment through Nov. 6.

The rules ap­ply to any provider or pro­gram that ac­cepts fed­eral dol­lars and car­ries out the anti-bias pro­vi­sions of the Af­ford­able Care Act.

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