HLT-44-15-00003-A Transgender Related Care and Services
4/27/16 N.Y. St. Reg. HLT-44-15-00003-A
NEW YORK STATE REGISTER
VOLUME XXXVIII, ISSUE 17
April 27, 2016
RULE MAKING ACTIVITIES
DEPARTMENT OF HEALTH
NOTICE OF ADOPTION
I.D No. HLT-44-15-00003-A
Filing No. 370
Filing Date. Apr. 12, 2016
Effective Date. Apr. 27, 2016
Transgender Related Care and Services
PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:
Action taken:
Amendment of section 505.2(l) of Title 18 NYCRR.
Statutory authority:
Public Health Law, sections 201 and 206; Social Services Law, sections 363-a and 365-a(2)
Subject:
Transgender Related Care and Services.
Purpose:
To amend provisions regarding Medicaid coverage of transition-related transgender care and services.
Text or summary was published
in the November 4, 2015 issue of the Register, I.D. No. HLT-44-15-00003-P.
Final rule as compared with last published rule:
No changes.
Text of rule and any required statements and analyses may be obtained from:
Katherine Ceroalo, DOH, Bureau of House Counsel, Reg. Affairs Unit, Room 2438, ESP Tower Building, Albany, NY 12237, (518) 473-7488, email: regsqna@health.ny.gov
Assessment of Public Comment
Separate letters with comments were received from nine individuals, one advocacy organization, and one professional association. In addition, two legal aid organizations and a law firm provided joint comments.
The proposed regulations would establish a minimum age of 18 for Medicaid coverage of gender reassignment surgery (GRS), even in instances where sterilization will result, and would add psychiatric nurse practitioners to the list of medical professionals who can provide referral letters establishing the appropriateness of GRS for a particular individual. All commenters approved of these proposed changes.
However, all of the commenters urged that the list of individuals who can provide referral letters for GRS be further expanded. Suggestions included general nurse practitioners, licensed clinical social workers, licensed masters of social work under clinical supervision, mental health counselors, and individuals with a master’s degree or its equivalent in a clinical behavioral science field. Some commenters suggested that under the current regulation, Medicaid recipients in some areas of the State would have difficulty finding qualified clinicians nearby to provide the required letters, and would have to travel to places where there are more qualified clinicians. In response, the Department notes Medicaid payment is available for transportation to and from the offices of qualified clinicians in order to obtain medically necessary services, and is available for certain medically necessary telemedicine consultations. In addition, the regulation is intended to strike a balance between enabling access to services and ensuring that Medicaid coverage of GRS is based on determinations of medical necessity made by individuals qualified to make such determinations. The Department will take the commenters’ suggestions under advisement, but continues to believe the current requirement is reasonable and is not a barrier to transgender individuals accessing necessary care. No changes were made to the proposed regulation as a result of these comments.
All of the commenters offered comments on provisions of 18 NYCRR 505.2(l) not affected by the proposed regulatory amendment. For example, commenters objected to existing provisions restricting coverage of transgender care and services to individuals 18 years of age or older, and prohibiting coverage for services provided for the sole purpose of improving an individual’s appearance. Because these comments do not pertain to the amendments proposed in the current rulemaking, the Department will not address them, and no changes were made to the proposed regulation in response to these comments. The Department notes, however, that these objections were raised when it adopted the new section 505.2(l) in 2015, and were addressed in the Assessment of Public Comment accompanying that adoption.
