Final Health Reform Rule Prohibits Discrimination for Transgender-Related Services on Health Plans

Q&A with Wayne Pettigrew of Vanguard Benefits Groupon New Health Care Regulations

·         By Paula Burkes – The Daily OklahomanBusiness Editorial Page August 9, 2016

Q: Can you explain the recently issued final rule to Section 1557 of the Affordable Care Act?

A: On May 18, the U.S. Department of Health and Human Services published a final rule to implement Section 1557 of the Affordable Care Act, which prohibits discrimination in health coverage and care based on race, color, national origin, age, disability, and sex. These provisions incorporate existing federal nondiscrimination law and policy and also contain some new protections. The final rule specifically addresses discrimination against transgender individuals and established certain accessibility standards for individuals with limited English proficiency.

Q: What does this mean for insured group health plans?

A: Beginning with their plan years that occur after Jan. 1, insured group health plans no longer can have blanket exclusions for transgender related services when medically necessary. Self-insured groups must generally amend their plan documents and submit any limitations on such services to reinsurance carriers for approval.

Q: So does this mandate transgender services?

A: No. It does prohibit discriminatory exclusions or limitations from being placed on such benefits. Fully insured groups may not exclude gender reassignment surgery or other benefits based on a discriminatory factor, but they could be limited on a nondiscriminatory factor such as clinical criteria.

Q: Does the final rule include a religious exemption?

A: No. But the final rule doesn't displace existing protections for religious freedom and conscience.

Q: What other provisions are included in Section 1557?

A: The final rule requires entities with 15 or more employees to have a grievance procedure and compliance coordinator. The final rule also requires that entities post notices of nondiscrimination in at least the top 15 non-English languages spoken in the state in which an entity does business. The HHS Office of Civil Rights will provide sample notices in all languages.

PAULA BURKES, BUSINESS WRITER for THE DAILY OKLAHOMAN