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Proposed Rules 360-725-1254

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Proposed Rules 360-725-1254 Washington State Register, Issue 21-01 WSR 21-01-012 WSR 21-01-012 Schuffenhauer, P.O. Box 45502, Olympia, WA 98504-5502, PROPOSED RULES 360-725-1254. HEALTH CARE AUTHORITY A school district fiscal impact statement is not required [Filed December 3, 2020, 9:49 a.m.] under RCW 28A.305.135. Original Notice. A cost-benefit analysis is not required under RCW Preproposal statement of inquiry was filed as WSR 19- 34.05.328. RCW 34.05.328 does not apply to HCA rules 24-054. unless requested by the joint administrative rules review Title of Rule and Other Identifying Information: WAC committee or applied voluntarily. 182-531-1675 Washington apple health—Gender affirming The proposed rule does not impose more-than-minor interventions for gender dysphoria. costs on businesses. Following is a summary of the agency's Hearing Location(s): On January 26, 2021, at 10:00 a.m. analysis showing how costs were calculated. These rules do In response to the coronavirus disease 2019 (COVID-19) not impose costs on businesses. public health emergency, the agency will not provide a phys- December 3, 2020 ical location for this hearing. This promotes social distancing Wendy Barcus and the safety of the citizens of Washington state. A virtual Rules Coordinator public hearing, without a physical meeting space, will be held instead. To attend the virtual public hearing, you must regis- ter at the following link https://attendee.gotowebinar.com/ AMENDATORY SECTION (Amending WSR 15-16-084, register/5895859935949871883. Webinar ID: 563-710-843. filed 7/31/15, effective 8/31/15) After registering, you will receive a confirmation email con- WAC 182-531-1675 Washington apple health—Gen- taining the information about joining the webinar. der affirming interventions for gender dysphoria ((treat- Date of Intended Adoption: Not sooner than January 27, ment program)). (1) Overview of ((the gender dysphoria)) 2021. treatment program. Submit Written Comments to: Health Care Authority (a) Medicaid agency coverage. The medicaid agency (HCA), Rules Coordinator, P.O. Box 42716, Olympia, WA covers the ((following services, consistent with the program 98504-2716, email [email protected], fax 360-586-9727, by rules described in Title 182 WAC, to treat gender dysphoria: January 26, 2021. (i))) services listed in (b) of this subsection to treat gen- Assistance for Persons with Disabilities: Contact Amber der dysphoria (also referred to as gender incongruence) under Lougheed, phone 360-725-1349, fax 360-586-9727, telecom- WAC 182-501-0050 and 182-531-0100. These services munication[s] relay service 711, email amber.lougheed@ include life-changing procedures that may not be reversible. hca.wa.gov, by January 8, 2021. (b) Medical services covered. Medical services Purpose of the Proposal and Its Anticipated Effects, ((including, but)) covered by the agency include, but are not Including Any Changes in Existing Rules: The agency is limited to: revising this rule to: (((A))) (i) Presurgical and postsurgical hormone therapy; (((B) Prepuberty)) (ii) Puberty suppression therapy; • Remove the list of noncovered services and clarify that (((ii) Mental)) (iii) Behavioral health services; and requests will be evaluated for medical necessity; (((iii))) (iv) Surgical and ancillary services including, but • Remove barriers and unnecessary administrative pro- cesses for the client and provider; and not limited to: • Streamline the authorization process. (A) Anesthesia; (B) Labs; The proposed rule: (C) Pathology; (D) Radiology; • Provides that psychosocial evaluations shall be effective (E) Hospitalization; for eighteen months instead of twelve; (F) Physician services; and • Allows clients to document safety concerns that have (G) Hospitalizations and physician services required to prevented them from living full time in the desired gen- treat postoperative complications of procedures performed der; and under ((component four. • Includes alternate requirements for clients who have not (b) The agency's gender dysphoria treatment program met the standard documentation requirements for sur- has four components. Prior authorization is required for ser- gery. vices provided in component four only. Any medicaid pro- Reasons Supporting Proposal: See purpose. vider can refer a client to component one. These components Statutory Authority for Adoption: RCW 41.05.021, are not intended to be sequential and may run concurrently to 41.05.160. meet the client's medical needs. The components are as fol- Statute Being Implemented: RCW 41.05.021, 41.05.160. lows: Rule is not necessitated by federal law, federal or state (i) Component one - Initial assessment and diagnosis of court decision. gender dysphoria; Name of Proponent: HCA, governmental. (ii) Component two - Mental health and medical treat- Name of Agency Personnel Responsible for Drafting: ment; Melinda Froud, P.O. Box 42716, Olympia, WA 98504-2716, (iii) Component three - Presurgical requirements for 360-725-1408; Implementation and Enforcement: Annette prior authorization for component four; and [ 1 ] Proposed WSR 21-01-012 Washington State Register, Issue 21-01 (iv) Component four - Gender reassignment surgery. (E) Have completed continuing education in the assess- (c) All services under this program must be delivered by ment and treatment of gender dysphoria. This may include providers who meet the qualifications in subsection (2) of attending relevant professional meetings, workshops, or sem- this section. inars; obtaining supervision from a mental health profes- (d) The agency evaluates requests for clients under age sional with relevant experience; or participating in research twenty-one according to the early and periodic screening, related to gender nonconformity and gender dysphoria; and diagnosis, and treatment (EPSDT) program described in (iii) Be a board certified psychiatrist, a psychologist, or a chapter 182-534 WAC. Under the EPSDT program, a service licensed: may be covered if it is medically necessary, safe, effective, (A) Psychiatric ARNP; and not experimental. (B) Psychiatric mental health nurse practitioner; (e) The agency covers transportation services under the (C) Mental health counselor; provisions of chapter 182-546 WAC. (D) Independent clinical social worker; (f) Any out-of-state care, including a presurgical consul- (E) Advanced social worker; or tation, must be approved as an out-of-state service under (F) Marriage and family therapist. WAC 182-501-0182. (e) Any surgeon who performs gender reassignment sur- (2) Qualified health care providers for gender dys- gery must: phoria treatment. (i) Be a board certified or board qualified: (a) Providers must meet the qualifications outlined in (A) Urologist; chapter 182-502 WAC. (B) Gynecologist; (b) Each provider must be recognized as an agency-des- (C) Plastic surgeon; ignated center of excellence (COE). COE is defined in WAC (D) Cosmetic surgeon; or 182-531-0050. To be a COE, all providers must complete an (E) General surgeon; agency form attesting that they: (ii) Have a valid medical license in the state where the (i) Possess knowledge about current community, advo- surgery is performed; and cacy, and public policy issues relevant to transgender people (iii) Sign the agency's form (HCA 18-492) attesting to and their families (knowledge about sexuality, sexual health specialized abilities in genital reconstructive techniques and concerns, and the assessment and treatment of sexual disor- produce documentation showing that they have received ders is preferred); supervised training with a more experienced surgeon. (ii) Endorse the Standards of Care for the Health of (f) Any medical provider managing hormone therapy, Transsexual, Transgender, and Gender-Nonconforming Peo- androgen suppression, or puberty suppression for clients ple, Version 7 as developed by the World Professional Asso- diagnosed with gender dysphoria must: ciation for Transgender Health (WPATH); and (i) Be either of the following: (iii) Agree to provide services consistent with this sec- (A) A licensed, board certified, or board qualified: tion. The agency's forms are available online at http://www. (I) Endocrinologist; hca.wa.gov/medicaid/forms/Pages/index.aspx. (II) Family practitioner; (c) Diagnosis in component one must be made or con- (III) Internist; firmed by a COE provider who is a board certified physician, (IV) Obstetrician/gynecologist; a psychologist, a board certified psychiatrist, or a licensed (V) Pediatrician; advanced registered nurse practitioner (ARNP). (VI) Naturopath; or (d) Mental health professionals who provide component (B) A licensed ARNP or a licensed physician's assistant; two mental health treatment described in subsection (4)(d) of and this section, or who perform the psychosocial evaluation (ii) Sign the agency's form (HCA 18-494) attesting to described in subsection (5)(a)(iii) of this section must: specialized abilities managing hormone therapy in treating (i) Meet the requirements described in WAC 182-531- gender dysphoria. The specialized abilities may be proved by 1400; producing documentation showing supervised training with a (ii) Sign the agency's form (HCA 18-493) attesting that more experienced physician, and attesting attendance at rele- they: vant professional meetings, workshops, or seminars. (A) Are competent in using the Diagnostic Statistical (3) Component one - Initial assessment and diagnosis Manual of Mental Disorders, Fifth Edition (DSM-5) and the of gender dysphoria. The purpose of component one is to International Classification of Diseases for diagnostic
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