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Medicare beneficiaries seeking coverage for sexual reassignment surgery will no longer be automatically denied, thanks to a ruling from a federal appeals board.
On May 30, the Department of Health and Human Services departmental appeal board overturned a Medicare national coverage determination issued in 1989 that stated that transsexual surgery for sex reassignment would not be covered by the government because it was "experimental" and had a high rate of serious complications.
The appeals board ruled that the national coverage determination was no longer valid because it was based primarily on outdated scientific information from 1981.
Officials at the Centers for Medicare & Medicaid Services have 30 days to implement the decision. Aaron Albright, director of media relations at the CMS, said Medicare administrative contractors will make coverage decisions on a case by case basis or under a local coverage determination based on clinical evidence.
The decision does not address other treatments, including hormone therapy.
The ACLU, Gay & Lesbian Advocates & Defenders, and National Center for Lesbian Rights filed an administrative challenge to the Medicare national coverage policy in 2013 on behalf of Denee Mallon, a transgender woman who has been seeking surgery for severe gender dysphoria.
The groups praised the decision for removing a "threshold barrier" to medical care for transgender people who are covered by Medicare.
"It is consistent with the consensus of the medical and scientific community that access to gender transition–related care is medically necessary for many people with gender dysphoria," the groups said in a statement. "The removal of the exclusion of coverage for surgical care for Medicare recipients means that individuals will not automatically have claims of coverage for gender transition–related surgeries denied. They should either get coverage, or at a minimum, receive an individualized review of the medical need for the specific procedure they seek, just like anyone seeking coverage for any other medical treatment."
On Twitter @maryellenny
Medicare beneficiaries seeking coverage for sexual reassignment surgery will no longer be automatically denied, thanks to a ruling from a federal appeals board.
On May 30, the Department of Health and Human Services departmental appeal board overturned a Medicare national coverage determination issued in 1989 that stated that transsexual surgery for sex reassignment would not be covered by the government because it was "experimental" and had a high rate of serious complications.
The appeals board ruled that the national coverage determination was no longer valid because it was based primarily on outdated scientific information from 1981.
Officials at the Centers for Medicare & Medicaid Services have 30 days to implement the decision. Aaron Albright, director of media relations at the CMS, said Medicare administrative contractors will make coverage decisions on a case by case basis or under a local coverage determination based on clinical evidence.
The decision does not address other treatments, including hormone therapy.
The ACLU, Gay & Lesbian Advocates & Defenders, and National Center for Lesbian Rights filed an administrative challenge to the Medicare national coverage policy in 2013 on behalf of Denee Mallon, a transgender woman who has been seeking surgery for severe gender dysphoria.
The groups praised the decision for removing a "threshold barrier" to medical care for transgender people who are covered by Medicare.
"It is consistent with the consensus of the medical and scientific community that access to gender transition–related care is medically necessary for many people with gender dysphoria," the groups said in a statement. "The removal of the exclusion of coverage for surgical care for Medicare recipients means that individuals will not automatically have claims of coverage for gender transition–related surgeries denied. They should either get coverage, or at a minimum, receive an individualized review of the medical need for the specific procedure they seek, just like anyone seeking coverage for any other medical treatment."
On Twitter @maryellenny
Medicare beneficiaries seeking coverage for sexual reassignment surgery will no longer be automatically denied, thanks to a ruling from a federal appeals board.
On May 30, the Department of Health and Human Services departmental appeal board overturned a Medicare national coverage determination issued in 1989 that stated that transsexual surgery for sex reassignment would not be covered by the government because it was "experimental" and had a high rate of serious complications.
The appeals board ruled that the national coverage determination was no longer valid because it was based primarily on outdated scientific information from 1981.
Officials at the Centers for Medicare & Medicaid Services have 30 days to implement the decision. Aaron Albright, director of media relations at the CMS, said Medicare administrative contractors will make coverage decisions on a case by case basis or under a local coverage determination based on clinical evidence.
The decision does not address other treatments, including hormone therapy.
The ACLU, Gay & Lesbian Advocates & Defenders, and National Center for Lesbian Rights filed an administrative challenge to the Medicare national coverage policy in 2013 on behalf of Denee Mallon, a transgender woman who has been seeking surgery for severe gender dysphoria.
The groups praised the decision for removing a "threshold barrier" to medical care for transgender people who are covered by Medicare.
"It is consistent with the consensus of the medical and scientific community that access to gender transition–related care is medically necessary for many people with gender dysphoria," the groups said in a statement. "The removal of the exclusion of coverage for surgical care for Medicare recipients means that individuals will not automatically have claims of coverage for gender transition–related surgeries denied. They should either get coverage, or at a minimum, receive an individualized review of the medical need for the specific procedure they seek, just like anyone seeking coverage for any other medical treatment."
On Twitter @maryellenny