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HHS, Medicare & GLBTQ patients

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Denee Mallon

We should see a final rule on Section 1557 of the ACA in the early part of 2016. It will include discrimination based on the patient’s gender identity in the definition of sex discrimination. And:

The proposed rule makes clear HHS’s commitment, as a matter of policy, to banning discrimination based on sexual orientation, and requests comment on how a final rule can incorporate the most robust set of protections against discrimination that are supported by the courts on an ongoing basis.

Last year Medicare eliminated its ban on gender reassignment surgery. Tl;dr – Medicare had a 30+ year old national policy that deemed the treatments experimental and therefore non-covered. Denne Mallon challenged the policy, HHS declined to defend the policy. No more non-coverage policy.

Since that time, the only Medicare administrative contractor to create any sort of coverage guidance is the one for West Virginia, most of Virgina and the Carolinas. I think one other contractor is working on a coverage article, but it may not be necessary. Yesterday, Medicare announced that it is seeking  comments on a national coverage policy, which would create a single coverage policy for the entire nation:

Gender dysphoria (previously known as gender identity disorder) is a classification used to describe persons who experience significant discontent with their biological sex and/or birth gender. Therapeutic options for gender dysphoria include behavioral and psychotherapies, hormonal treatments, and a number of surgeries used for gender reassignment.

CMS received a request to review the available evidence and conduct a national coverage determination (NCD) review to determine whether health outcomes are improved from treatment for Gender Dysphoria and Gender Reassignment Surgery.

(Bonus Maryland Pride – Nehael Shields, the requester, is from Berlin, Md.)

One reason a national policy is preferable to a jurisdiction-by-jurisdiction policy is it means that if a patient moves from one Medicare jurisdiction to another during treatment, what is covered will remain consistent.

 

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  • BiloSagdiyev

    One reason a national policy is preferable to a jurisdiction-by-jurisdiction policy is it means that if a patient moves from one Medicare jurisdiction to another during treatment, what is covered will remain consistent.

    You could pitch it to the business wing of the GOP as promoting labor mobility! They like that, right?

    Somehow I think the 28% that holds America hostage will flip out. Just for fun, while they’re frothing and waving their arms, mention that US Marine rifleman MOS’s should be available to…

  • DrDick

    This is great news! I have several trans friends and this kind of thing really is vitally important for the whole community.

    • celticdragonchick

      Speaking as a trans woman who has begun looking for a surgeon and who also has medicare…not so much. As far as I can tell, no sex reassignment surgeons in the US are accepting Medicare. I have made rather a lot of calls. They all want cash up front.

      • DrDick

        Let me check with some of my trans friends and see if they know of anybody.

      • JL

        Would the surgeon of the woman who challenged the ban be an option? This article says that her surgeon was Dr. Loren Schecter of Weiss Memorial in Chicago, and the article also indicates that that doctor has performed gender affirming surgery at least twice for Medicare patients.

  • Steve LaBonne

    This is why the whole “states as laboratories of democracy” thing is such bullshit. They’ve again and again been laboratories of anything but.

    • Lee Rudolph

      They’re laboratories for the destructive testing of democracy!

      • You have to imagine Dr. rebRand Paul saying it a la evil scientist: “Labooooratory.”

        And then maniacal laughter that almost drowns out the screams of the victims.

    • Joe_JP

      Such a gross generalization that ignores all the times they HAVE been laboratories. Various national rules started in states. Eventually certain rules are rightly seen as worthwhile to be in place nation-wide.

      • Steve LaBonne

        Easy to say if you don’t belong to a group that some states want to experiment with oppressing.

    • Just_Dropping_By

      I guess all the marijuana dispensaries I walk past on my way to work each day in lovely Colorado are just a figment of my imagination, and what I was told about California legalizing interracial marriages nearly 20 years before Loving v. Virginia was a lie, and….

  • Gwen

    This is fantastic news.

  • Denverite

    Medicare had a 30+ year old national policy that deemed the treatments experimental and therefore non-covered.

    I’ll also note that a lot of states — including Colorado — piggybacked off of the Medicare excluded procedures list for Medicaid purposes. That was a biggish deal here because until about five years ago, Trinidad in southern Colorado was the sex change capital of the world.

  • Hogan

    OT but too cool not to share:

    Missouri Dem Proposes Placing Same Restrictions On Guns As Abortions

    Missouri state Rep. Stacey Newman (D) pre-filed a bill Tuesday that would restrict access to firearms in the same way her state restricts access to abortion.

    Newman’s bill includes a 72-hour waiting period for purchasing guns and watching a 30-minute video on firearms fatalities before purchasing. It also requires the firearms dealer be at least 120 miles from the purchaser’s residence.

    The bill would require that a gun purchaser visit an emergency room at the nearest “urban hospital” on a weekend between 10 p.m. and 6 a.m. “when gun violence victims are present.”

    Within 72 hours of their purchase, the individual also must meet with at least two families who have been victims of firearm violence and two faith leaders who have presided over funerals in the last year of a child gun violence victim.

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