Discrimination against patients based on their sexual orientation, gender identity or whether they conform to "sex stereotypes" are all banned under the final rule HHS released earlier today.
The rule, commonly known as section 1557 of the Affordable Care Act, applies to health care providers and health plans alike. The rule goes into effect July 18. However, health plans have until Jan. 1, 2017 to make any changes to the design of their programs that may be needed to accommodate the rule.
The rule directs covered entities to provide “equal access to its health programs or activities without discrimination on the basis of sex; and a covered entity shall treat individuals consistent with their gender identity, except that a covered entity may not deny or limit health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that the individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available.”
Examples of actions that could be prohibited under the rule include repeatedly and intentionally referring to transgender patients by the wrong pronoun or name. For example, calling a transgender man “she” or “ma’am” and addressing him by the name on his driver’s license, rather than his preferred name.
The rule also bars sex stereotyping, which HHS defines in part as “Stereotypical notions of masculinity or femininity, including expectations of how individuals represent or communicate their gender to others, such as behavior, clothing, hairstyles, activities, voice, mannerisms, or body characteristics.”
In a response to comments on sex stereotypes, HHS wrote “OCR recognizes that an individual’s gender identity involves the interrelationship between an individual’s biology, gender, internal sense of self and gender expression related to that perception; thus, the gender identity spectrum includes an array of possible gender identities beyond male and female.”
Covered entities will also need to post notices stating that they do not discriminate.
(Note: Some of the issues addressed in this rule are covered in a Part B News
story on treating LGBTQ patients, which can be found here.)