Dive Brief:
- As a new HHS rule barring discrimination in healthcare for transgender people is finalized, insurers suggest it will not end denials of claims, reports Modern Healthcare.
- The rule does not require insurers to pay for gender transition services such as surgeries, but does require coverage of medically necessary services that relate to gender transition.
- Plans have responded they are attempting to interpret the rules and plan changes, but are looking to CMS for further guidance.
Dive Insight:
The new rules to be enforced by HHS will apply to all plans and providers accepting federal money, and more than 2,000 affected organizations submitted letters during the comment period that ended Nov. 9.
Among the concerns are that HHS' Office for Civil Rights will offer good faith compliance protection as insurers work to implement changes, Kris Haltmeyer, vice president, Health Policy and Analysis at the Blue Cross Blue Shield Association, was quoted in Modern Healthcare. Those cited for non-compliance could be fined or lose Medicaid and Medicare funds.
One of the difficulties will be in adapting policies currently restricted by gender, partly as a result of data limitations that force enrollees to identify as male or female. When a transgender person indicates one gender but still requires some services limited to the other gender, denials may result "through no fault of the health plan or individual seeking coverage,” wrote Jeff Myers, CEO of Medicaid Health Plans of America, in a comment letter.
Commenters noted Medicare and Medicaid would also have to update their policies, and suggested that HHS' OCR would need to collaborate with the CMS to establish universal guidelines so other plans could follow.