HHS, CMS question hospitals on policies, finances for gender-affirming care to minors

 The Trump administration turned up the heat on healthcare organizations over gender-affirming care for children with warnings of future policy changes and direct information requests from hospitals providing the services.

On Wednesday afternoon, Health and Human Services Secretary Robert F. Kennedy Jr. penned a letter to healthcare providers, risk managers and state medical boards referring them to a recent evidence review published by the department.

Citing its findings of unclear benefits and likely risks—which have been contested by medical organizations and LGBTQ+ groups—Kennedy reaffirmed the department’s position that several “harmful interventions” that fall under the umbrella of gender-affirming care are not consistent with the delivery of quality care.

“HHS may soon undertake new policies and oversight actions, consistent with applicable law, to ensure the protection of children, and to hold providers that harm children accountable,” Kennedy wrote in the letter, which was published on social media. “Again, I urge you to read the review and expect you to update your treatment protocols and training to ensure that our nation’s children are protected from harm.”

Later that afternoon, Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz, M.D., sent a separate letter to "select hospitals performing pediatric sex trait modification procedures," according to the agency.

It similarly referenced the prior report as the basis for an “urgent review” of the hospitals’ quality standards and procedures, and outlined a slew of inquiries with a 30-day response deadline.

The first of these referenced the CMS’ obligation to monitor potential adverse outcomes in care delivery.

Specifically, the agency asked the hospitals to describe their informed consent protocols for children with gender dysphoria; whether there are any adverse events related to gender-affirming care services, “particularly children who later look to de-transition;” and any plans to change clinical practice guidelines and protocols in light of the HHS’ findings and guidance.

The second batch of inquiries reference an ongoing review of federal payment policies related to gender transition procedures for patients aged 19 years or younger.

Here the administrator listed dozens of diagnosis and procedure codes related to gender-affirming surgery, and requested “complete financial data” on the services paid in whole or in part by the federal government. The requested information includes all related billing codes used, facility- and provider-level revenues or utilization data, facility- and provider-level operating and profit margins for each procedure, and hospitals’ projected revenue forecasts for the relevant service lines.

“CMS takes these matters extremely seriously,” Oz wrote. “Our primary concern is ensuring that vulnerable pediatric populations receive evidence-based care that meets the highest quality standards while ensuring appropriate stewardship of federal healthcare resources.”

The letters are the latest in the administration’s pushback on gender-affirming care for children and adolescents. Executive orders signed during the opening days of President Trump’s second term made it the government’s official policy to recognizes two sexes, male and female, as unchangeable, to discard gender ideology as a “false claim that males can identify as and thus become women and vice versa” and recast hormone therapy and surgical procedures to affirm one’s gender identity as “chemical and surgical mutilation.”

Portions of the president’s order to stop funding organizations that research or deliver gender-affirming care have been temporarily blocked in the courts, though Wednesday’s letters, prior warnings to hospitals, promotion of a whistleblower submission portal and adjustments to HHS guidance suggest the administration is laying the groundwork for eventual policy changes. Some pediatric care providers have stopped delivering gender-affirming care, at least temporarily, in light of the actions.

Gender-affirming care comprises a range of social, behavioral and medical services that may include hormone therapy and, rarely, surgical procedures. It is recommended by major medical associations, including the American Academy of Pediatrics, the American Medical Association and the American Psychological Association. 

https://www.fiercehealthcare.com/providers/hhs-cms-question-hospitals-policies-finances-related-gender-affirming-care