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  • ACA Anti-Discrimination Rule for Health Care Providers, Payers Takes Effect July 18

    In a combination of changes that codify longstanding guidance and expand definitions, the Department of Health and Human Services (HHS) will very soon implement an anti-discrimination rule that could alter the ways some providers and payers manage care.

    Beginning July 18, health care providers and payers that accept federal dollars will be subject to a provision of the Affordable Care Act barring discrimination in care and coverage on the basis of race, color, national origin, age, disability, and sex. As with other similar changes at the federal level, the new rules include gender identity discrimination in the definition of sex discrimination—meaning, among other things, that individuals must be allowed to enter the restrooms, hospital wards, or other gender-restricted areas that are consistent with their gender identity.

    Although the subject of media attention, the clarifications around facility use are just a small part of a rule that also codifies guidance to ensure access (including free language assistance services) to individuals with limited proficiency in English, prohibits health insurance benefit designs that discriminate against individuals who are transgender, and calls for "reasonable" accessibility changes to avoid discrimination based on disability.

    The Kaiser Family Foundation reports that the new rule does not resolve whether the definition of sex discrimination includes discrimination based on sexual orientation alone, nor does it set specific standards for medical equipment for people with disabilities.

    "The rule does not explicitly require insurers to cover gender-transition treatments such as surgery," according to an article in Modern Healthcare. "But insurers could face questions if they deny medically necessary services related to gender transition for a man who identifies as a woman, or a woman who identifies as a man."

    How can physical therapists and physical therapist assistants best respond to the needs of a patient or client who is transgender? Check out the open-access cover story on working with this population in the July issue of PT in Motion magazine.


    • However, providers may still discriminate based on the type of health plan one has. This is the underlying loophole that needs to be addressed. The net effect is that providers choose patients with the most lucrative health plans and refuse services to those with plans with less optimal reimbursement that tends to be the individuals with most needs and least amount of options. Since all providers received Federal funds for their education they should be mandated to accept all plans without discrimination.

      Posted by James Ronan on 3/19/2017 12:02 PM

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