GenderAffirming Health Care: Provider Considerations

The federal government has taken measures to protect LGBTQ+ people's access to health care and prohibited discrimination based on gender identity, and some states have taken measures to protect access to gender-affirming health care. At the same time, however, many states have banned gender-affirming health services, creating many challenges for providers of these services as they try to adapt to the ever-changing legal landscape.

This article describes the key issues that healthcare providers (including physicians, hospitals, clinics, pharmacies, non-physicians, mental health professionals, and pharmacists) must understand under federal law and state policy when providing gender-affirming healthcare services. and treatments for gender dysphoria (including drugs to delay puberty, hormone therapy, mastectomy, mammoplasty, vaginoplasty, and voice therapy).

(For a customizable comparison table of gender-affirming care laws and regulations by state, legal challenges, and protections and penalties for providers, see State Gender-Affirming Care Laws in the Law to Practice section.)

While federal laws and regulations do not explicitly protect gender-affirming health care, the federal government has taken steps to protect access to gender-affirming health care and prevent discrimination on the basis of gender identity, including issuing directives directing federal agencies to take certain Actions. .

For example, on January 20, 2021, President Biden issued an executive order directing federal agencies to review existing regulations and policies to prevent and eliminate discrimination on the basis of gender identity and sexual orientation (Executive Order No. 13988, 86 Fed. Reg. 7023). )..). (January 20, 2021)).

Additionally, on March 31, 2022, the White House released a fact sheet summarizing actions the Administration is taking to protect access to gender-affirming health care and prevent discrimination on the basis of gender identity ( White House: Fact Sheet: Biden-⁠Harris ). Administration Promotes Equality, Visibility for Transgender Americans (March 31, 2022)).

Federal agencies have also taken steps to prohibit discrimination based on gender identity and protect access to gender-affirming health care. For example:

• Ministry of Defense (MoD):
• • prohibits discrimination based on a person's gender identity or identification as transgender; AND
  • provides service members with a path to medical care, gender reassignment, and recognition of their self-identified gender (Department of Defense: Department of Defense Announces Update to Policy on Transgender Military Service (March 31, 2021)).
• The Department of Justice (DOJ) sent a letter to state attorneys general reminding them of their constitutional and statutory obligations to ensure that transgender youth are not subjected to unlawful discrimination on the basis of their gender identity, including when requiring oversight of gender affirmation (Letter). ). Kristen Clark, Deputy Attorney General, Civil Rights Division, Department of Justice, to State Attorneys General (March 31, 2022).

Section 1557 of the Affordable Care Act (ACA) establishes a nondiscrimination requirement that prohibits exclusion from participation in, denial of benefits from, or discrimination against individuals associated with a federally funded program or activity on certain grounds (42 USC § 18116; for more information on the ACA, see the Affordable Care Act (ACA) Law Review.

Article 1557 contains the following prohibited grounds of discrimination:

• VI of the Civil Rights Act of 1964. Section (Title VI) (prohibiting discrimination on the basis of race, color, or national origin) (42 USC § 2000d–2000d-7).
• IX Education Amendments of 1972. Title (Title IX) (prohibition of sex discrimination) (20 USC § 1681–1688).
• Age Discrimination Act of 1975 (Age Act) (prohibiting age discrimination) (42 USC § 6101-6107 and final regulations (82 Fed. 47107 (Oct. 11, 2017))).
• Section 504 of the Rehabilitation Act of 1973 (prohibiting discrimination on the basis of disability) (29 USC § 794).

Collectively, these provisions prohibit discrimination on the basis of race, color, national origin, sex, age, or disability (45 CFR § 92.1).

Three consecutive presidential administrations have issued major regulations to implement Section 1557. These implementing regulations are as follows:

• Final regulations issued by the Obama Administration in May 2016 (81 Fed. Reg. 31375 (May 18, 2016); for more information, see Nondiscrimination in Health Care Programs and Activities Related to the ACA Practices Act (Sec. 1557).
• The Trump Administration's June 2020 Final Rules, which replaced and significantly reduced the Obama-era rules (85 Fed. Reg. 37160 (June 19, 2020); for more information, see the June 2020 Final Rules under Section 1557 of the ACA: Nondiscrimination in health programs and legal practices).
• The Biden Administration has repurposed regulations issued in August 2022 that will reinstate certain provisions of the Obama Administration regulations and add new requirements (87 Fed. 47824 (Aug. 4, 2022); see Section 1557 Revised Provisions for additional information). this will apply to many insurance companies and will require the adoption of policies and procedures instead of practical law). These proposed new rules would impose increased requirements on providers receiving federal financial assistance.

Section 1557's nondiscrimination provisions were intended to combat discrimination against transgender people. In 2021 and 2022, the Department of Health and Human Services (HHS) issued advisories and guidance consistent with this position. However, the District Court of Texas reversed the notice and instructions, as discussed in more detail below (see Federal case below).

Specifically, in May 2021, HHS issued a notice stating that it intends to interpret and apply Section 1557's prohibition on gender discrimination to include discrimination on the basis of gender identity and sexual orientation. HHS stated that:

• The interpretation provides the agency with guidance on how to handle complaints and conduct investigations.
• The agency's implementation of section 1557, as described in the notice, will be consistent with the Religious Freedom Restoration Act and other statutory requirements, including “conflicts associated with section 1557” (HHS: Notice of Interpretation and Implementation). Section 1557 of the Affordable Care Act and Title IX of the Education Amendments of 1972. Title (May 10, 2021) (May 2021 Notice).

In March 2022, the HHS Office for Civil Rights (OCR) issued guidance stating:

• An individual's ability to receive (or limit a health care provider's ability to provide) sex-specific care based on sex at birth or gender identity likely violates Section 1557.
• Gender dysphoria may be considered a disability under the Americans with Disabilities Act (ADA), as amended.
• Preventing individuals from receiving gender affirmation care on the basis of gender dysphoria, a diagnosis of gender dysphoria, or a perception of gender dysphoria violates Section 504 of the Rehabilitation Act of 1973 and Title II of the ADA. (HHS: Tips and Guidance on Gender-Sensitive Care, Civil Rights, and Patient Privacy (March 2, 2022) (March 2022 Guidance).

March 2022 Interpretive Guidance on Section 1557 of the ACA:

• It said that flatly refusing to treat people on the basis of their gender identity is prohibited discrimination.
• Section 1557 prohibits federally funded entities from limiting the ability to receive needed health care (including gender-affirming health care) from a provider “solely on the basis of sex or assigned gender identity at birth".

Many cases have addressed the question of whether access to gender dysphoria or gender-affirming care is protected by civil rights laws that prohibit discrimination. Section 1557, both generally and specifically as it relates to gender identity, has been the subject of lengthy and significant litigation.

For example, in 2022, the United States District Court for the Northern District of Texas:

• Ignore the May 2021 HHS Notice. However, the court concluded that Section 1557 does not prohibit discrimination on the basis of sexual orientation or gender identity. The court also granted the plaintiffs' claim that Section 1557 does not prohibit discrimination on the basis of sexual orientation or gender identity. ( Niz v. Becerra , 640 F. Supp. 3d 668, 675, 684, 686-87 (ND Tex. 2022), Judicial Appeal No. 23-10078 (5th Cir. 25 2023).
• The March 2022 HHS guidance has been repealed. Texas sued HHS to declare and overturn the March 2022 guidelines as unconstitutional, and the court struck down the guidelines on the grounds that they were arbitrary and capricious and violated the Administrative Procedure Act (see Texas v .EEOC , 633 F. Supp.3d 824). ). , 838-41 (ND Tex. 2022)).

In contrast, a Maryland district court recently ruled that an academic health system and its hospital affiliate violated Section 1557 when they refused to authorize a hospital patient's hysterectomy for gender reassignment. The court found that the hospital discriminated on the basis of gender by allowing patients to undergo medically necessary hysterectomies unless it was necessary to treat gender dysphoria. ( Hammons v. University of Med. Med. Sys. Corp. , 2023 WL 121741, *5-10 (D. Md. Jan. 6, 2023), Appeal Recorded, No. 23-1452 (4th Cir.). May 26, 2023 ).

(For more information on the Texas and Maryland district court cases, see the June 2020 final order under ACA Section 1557: Nondiscrimination in Health Care Programs and the Practice of Law.)

Many cases have addressed the question of whether access to gender dysphoria or gender-affirming care is protected by civil rights laws that prohibit discrimination.

Additionally, there is legal controversy over whether gender dysphoria is protected as a disability. On first impression, the Fourth Circuit held that gender dysphoria falls outside the scope of the ADA's protections for “gender identity disorders not resulting from a physical disability” (42 USC § 12211(b)(1 )). The court ruled that the ADA protects gender dysphoria as a disability and that a person diagnosed with gender dysphoria can bring a disability discrimination claim. ( Williams v. Kincaid , 45 F.4th 759, 769, 773–74 (4th Cir. 2022).)

HHS has taken steps to protect the protected health information (PHI) of people receiving care based on gender.

The March 2022 guidance (relating to patient privacy regarding gender confirmation under the Health Insurance Portability and Accountability Act) reminded HIPAA covered entities (including providers) and partners that HIPAA allows , but does not require, disclosure. Disclosure of PHI if:

• This is required by another law.
• Complies with other laws.
• It limits itself to relevant information.

However, the Northern District of Texas suspended the March 2022 guidelines (see federal lawsuit above).

In April 2023, HHS proposed the HIPAA Reproductive Health Rules that would amend the HIPAA Privacy Rule to protect reproductive health privacy (Fed. Reg. 88 23,506 (April 17, 2023)). The proposed regulations add a definition of “reproductive health care” and define the term to include care, services, or supplies related to a person's reproductive health. HHS intends to interpret this term broadly to include all health care related to the human reproductive system. The proposed regulations also require HHS to interpret reproductive health care to include contraception (including emergency contraception), pregnancy-related health care, fertility or infertility-related health care, and other care, services or supplies intended for diagnosis and treatment. . among conditions associated with fertility or infertility. reproductive system (includes medical care related to the reproductive organs if the medical care is related to the person's pregnancy or if the person is of reproductive age). (88 Federal Regulation 23.527.)

Additionally, the proposed regulations would amend the privacy law to add new categories of prohibited uses and disclosures related to reproductive health. Specifically, the proposed regulations would prohibit entities from using or disclosing an individual's PHI to conduct a criminal, civil, or administrative investigation (or bring a proceeding) against the individual, other individuals, or a healthcare provider in the context of a request of health care. . , receiving, providing or facilitating reproductive health care:

• The investigation or procedure was conducted outside the State in which it was authorized and is legal in the State in which the medical care was provided.
• It is protected, mandated, or authorized by federal law (such as the Emergency Medical Treatment and Labor Act) regardless of the state in which the care is provided.
• An investigation or proceeding conducted in a state authorized and authorized by the laws of that state. (Fed Regulation 88 23.528.)

According to HHS, states have little interest in requiring disclosure of PHI in these three situations.

Although the proposed rule does not specifically mention gender-affirming care, the Mississippi Attorney General (along with 18 other state attorneys general) submitted comments opposing the proposed rule, stating that it exceeds HHS's statutory authority and any attempt to use the proposed standard. defining reproduction would make it illegal to see a doctor for gender-affirming care (letter from Mississippi Attorney General Lynn Fitch to Health and Human Services Secretary Xavier Becerra (June 16, 2023)).

Each state determines the legality and enforcement requirements for gender affirmation. Providers should be aware of laws regarding gender-affirming care services in states that:

• They are practicing.
• Their patients live.
• They pay attention.

Before providing gender-affirming care, providers must consider state laws:

• Criminalize gender-based surveillance, including:
• • what services may be billed (for example, surgical procedures, medications, or hormone treatments);
  • the minimum age at which a person can receive gender confirmation assistance;
  • what actions may be pursued (e.g., providing or assisting with gender affirmation services); AND
  • There are situations or cases that do not fall within the prohibition.
• Establish civil liability for gender-affirming health care providers.
• Disciplinary action or fines for addressing gender affirmation.
• Malpractice insurance for gender-affirming care.

Many state requirements changed rapidly after the passage of new state laws:

• Limit access to gender-affirming care (especially for minors) and impose sanctions on providers and others who may provide such care.
• Protects parties from foreign investigations if they engage in floor care that is legal in the state in which the care is provided but illegal in another state.

Some of these laws are challenged in state or federal courts.

Many states have passed gender-affirming access to care laws. Большинство законов, ограничивающих доступ к гендерно-подтвержда here's what you want to know about the story of the story рждающим лекарствам, гормонам и операциям (см. «Несовершеннолетние» ниже). Let's talk about the story of the story. Let's see what happened. The story, the story, the story of the story, the story and the story as soon as possible, after 18 months (as soon as possible) рыми исключениями) The last one was 18 months ago, after the first day of the month арства, подтверждающие пол. гормоны или медицинские процедуры (§ 456.52, Закон штата Флорида).

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• The story of the story, the story of the story дающей помощи конституционным правом (MGL c. 12, § 11I½(b)).
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• The story of the story, the story of the story and the story of the story ющей помощи законным правом штата (12 VSA § 7302).

In the end, the story of the story, the story of the story Let's talk, let's talk about what we've done та. Name:

• Read more I'm talking about it, I'm talking about it and I'm talking about it. ммладше 19 лет (Кодекс штата Алабама §§ 26-26-4, 26-26-3 and 43-8-1 ( ) 18) ).
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• Read more the story of the story, the story of the story гическое лечение лицам младше 18 лет (SF 538, 90-я Генеральная ассамблея А Today, 2023 January, 2023 January 2023); Код Айовы Энн. § 147.164).

Read more about the following:

• Несовершеннолетние с половым развитием .
• Let's talk about it, let's talk about it, let's talk about it, let's talk about it Here you can find out more about the story.
• Read more about the story of the story well, let's talk about it, let's talk about it again смерти или нарушения основных функций организма. (Кодекс Ala. §§ 26-26-4, 26-26-3 и 43-8-1(18); SF 538, 90-я Генеральная ассамблея Айовы. Пр Dates 2023 January (22 March 2023 January); Кодекс Айовы Ann § 147.164; HB 71, этап 67 штата Айдахо. еля 2023 г.); §§ 18-1506C и 19-5307 Кодекса штата Айдахо.)

In this case, you can read the story and read the story. овершеннолетних, получающих уход с учетом пола. Name:

• As of 18 June, 2019. The article was published in the Civil Code § 56.109; c); Калифорния Article 3421(d), 3424(a), 3427(f), 3428(d) and 3453.5; §§ 819 and 1326(c) кодекса Калифорнии).
• I'll tell you what I've done, I'll let you know I've read more about this for 16 months. асия родителей (HP 340/LD 535, Me. 131st Leg. First Spec. Sess. (11 July 2023 г.); 22 SARM § 1508).

In the end the story was told, the story was told термины, связанные с полом, присвоенным при рождении. Previous article:

• Who knows, who wrote the story of the story of the story апреля 2023 г.)
• More information Here's the story of the story of the story of the story психологического, поведенческого, или суб Кодекс Анна Монте § 1-1-201).
• Let's see what the story was about. here's the story of the story, the story of the story омосомах или гормональном профиле человека при рождении (NDCC §§ 1-01-49(18 ), 12.1-36.1). -01(3), 15-10.6-01(2), 15.1-41-01(2) and 23-02.1-25.1(3)).
• Let's talk about the story of the story here, after the story, after the story “(TCA §§ 1-3-105(c) и 49-2-802(4)).

Read more about the story of the story What's more, what's going on? that's what the story was about Let's talk about it, let's talk about it.

Let's talk about the story of the story. Here's what the story was about: Here's what happened and what happened. Let's look at the story of the story and the story Here's what the story is about: Let's see what the story was about. It's the same thing as the first one. Read more, here:

• In the end, I'll tell you what I've done. The first date was 19 June, the last one was the first time. and класса C (пункты Кодекса Алабамы 26-26-4, 26-26-3 and 43-). 8 -1 (18)).
• В The story of the story, the story of the story Let's go, let's go, let's go, let's go last month 18 months, last month the last month ю, let's see what the story was about. ча (OCGA §§ 31 -7- 3.5) . is 43-34-15).
• Today will be the first day of 2024, the next day. оставляет блокаторы полового созревания, подтверждающие пол, гормо Let's talk about the story, let's talk about it Previously, last month after 18 months:
• • where the story was told, the story was told и лет; Yes
  • Штраф до 5000 долларов США (HB 71, 67-й этап штата Айдахо. Первая регулярн today (4 April 2023 г.); §§ 18-1506C and 19-5307 Civil Code).
• В Теннесса процедуры, подтверждающие пол, или назначает, рописывает или ввод it's the story of the story, the story of the story, the story of the story 18 months, more than once:
• • лицензионные штрафы;
  • I'm talking about it, I'm talking about it, I'm talking about it дственниками; Yes
  • Гражданский иск, возбужденный Генеральным прокурором Теннесси, к I'll let you know what I've done. The amount paid for up to 25,000 euros (TCA §§ 68-33-1) 05–68-33-107).
• Here's the story of the story, the story of the story, the story Once again, it was announced on 18 June, 2019. ожет:
• • Let's talk about the story, let's talk about it ыв лицензии (Техасский Кодекс здоровья и безопасности, §§ 164.052(a)(34) и 1 64.0552);
  • Гражданский иск, возбужденный Генеральной прокуратурой Техаса (Ко декс здоровья и безопасности Техаса, § 161.706); Yes
  • возможное расследование жестокого обращения с детьми (Заключение Генеральной прокуратуры Техаса № KP-0401 (18 февраля 2022 г.); но см. In re Abbott , 645 SW3d 276, 281 (Техас, 2022 г.) (отмечено, что мнение Генерального прокурора не является обязательным против Эбботта , 2022 WL 3040297, at *2 (Техасский округ, штат Коннектикут, 16 сентября 2022 г.) (за исключением применения заключения Генерального прокурора о членстве в Техасской организации PFLAG, которая обеспечивает защиту ЛГБТК+ люди).
• В Оклахоме медицинский работник, который сознательно назначает лекарства, гормоны или хирургические процедуры и методы лечения, подтверждающие пол, лицам в возрасте до 18 лет, может включать в себя:
• • Дисциплинарное взыскание за непрофессиональное поведение (Закон штата Оклахома, раздел 59, §§ 509, 519.12, 567.8 и 637; Административный кодекс Оклахома, § 435:15-5-11);
  • уголовные сообщения;
  • Гражданский иск, возбужденный родителем, законным опекуном или родственником несовершеннолетнего о возмещении ущерба и штрафных санкциях, судебном запрете и других соответствующих средствах правовой защиты, судебных издержках и гонорарах адвокатов;
  • Гражданский иск, возбужденный несовершеннолетним с целью получения компенсации и штрафных санкций, судебного запрета и других соответствующих средств правовой защиты, судебных издержек и гонораров адвокатов за лекарственные, гормональные или хирургические процедуры или лечение; И
  • Иск Генеральной прокуратуры Оклахомы (Закон штата Оклахома, статья 63, § 2607.1).

Поставщики медицинских услуг, имеющие лицензию более чем в одном штате, должны рассмотреть вопрос о том, криминализует ли какой-либо из этих штатов поставщика услуг или других лиц, которые помогают пациенту в получении гендерно-подтверждающей помощи в штате, где предоставление гендерно-подтверждающей помощи является законным. Например, штат Индиана запрещает медицинским работникам предоставлять медицинские или хирургические услуги с учетом пола лицам в возрасте до 18 лет, а также помогать или помогать другому медицинскому работнику в проведении процедур смены пола (Кодекс штата Индиана 25-1-22-1). 25-1-22-18).

Если поставщик имеет лицензию в штате, который ограничивает уход за выражением пола, лицензирующий орган этого штата может провести расследование и наказать поставщика за предоставление услуг по подтверждению пола в другом штате, где поставщик имеет лицензию, но где гендерное выражение является законным. . Расследование может также распространяться на другие штаты, в которых провайдер имеет лицензию, поскольку законы некоторых штатов о лицензировании разрешают или требуют, чтобы лицензирующий орган штата автоматически инициировал дисциплинарное разбирательство, если дисциплинарное взыскание было принято против провайдера другим государственным лицензирующим органом. Эти действия по лицензированию могут повлиять на регистрацию поставщика медицинских услуг в программах Medicare или Medicaid.

Кроме того, штаты, где гендерное выражение ограничено, могут попытаться принять законодательство, которое налагает штрафы или лицензии на поставщиков услуг, которые помогают пациенту получить доступ к гендерно-ориентированной помощи в другом штате. Некоторые штаты, похоже, рассматривают возможность принятия такого рода законов, хотя такие законы, вероятно, столкнутся с юридическими проблемами. (Чтобы узнать больше о требованиях к государственной медицинской лицензии, обратитесь к таблице требований к медицинской лицензии в Законе о практике.)

Примечательно, что поставщики услуг могут также обнаружить, что их страхование от профессиональной халатности не покрывает определенные услуги по подтверждению пола в штатах, которые ограничивают предоставление услуг по подтверждению пола.

Некоторые штаты приняли меры по защите поставщиков медицинских услуг, подтверждающих гендер. Например, Дэнс:

• Калифорния:
• • Суды и адвокаты штатов не могут принимать вызовы в суд на основании нарушений законов другого штата, которые нарушают право человека на опеку над ребенком (Cal Civ. Proc. Code §§ 2029.300 и 2029.350); И
  • Правоохранительные органы не могут заведомо арестовывать или экстрадировать лицо на основании иностранного ордера на арест на основании закона другого государства, запрещающего экстрадицию, с целью получения или разрешения на получение ребенком опеки по признаку пола (в том числе приемной семьи), психического здоровья). или участвовать в аресте. или экстрадиция человека. ) в Калифорнии (пункт 819 Уголовного кодекса Калифорнии).
• Мэриленд:
• • les agences d'État doivent prendre toutes les mesures necessaires dans toute la mesure de leur autorité pour protégé les individus et les entités du Maryland të përfshirë në des soins d'afirmation de gjinore; dhe
  • Komisionet Shtetërore të Licencimit të Mjekëve Shëndetësor nuk mund të marrin masa të pafavorshme ndaj një personi sepse ai ka marrë pjesë në kujdesin e autorizuar për afirmimin e gjinisë në Maryland (Urdhri Ekzekutiv Md. Nr. 01.01.2023.08 (5 qershor 2023)).
• Massachusetts, një palë nuk mund të dekurajojë, parandalojë, sanksionojë ose ndëshkojë një person që angazhohet në një aktivitet të kujdesit shëndetësor të mbrojtur ligjërisht duke u përpjekur ose duke ndjekur një veprim jashtë Massachusetts kur përgjegjësia bazohet në një aktivitet të kujdesit shëndetësor të mbrojtur ligjërisht në Massachusetts, ose qiramarrës de faire appliquer une loi extérieure. une urdhër ose gjykim të paligjshëm të shtetit ku përgjegjësia bazohet në një aktivitet të kujdesit shëndetësor të mbrojtur ligjërisht në Massachusetts. Veprimtaria e kujdesit shëndetësor të mbrojtur ligjërisht është ushtrimi, gëzimi, ndihma ose inkurajimi (ose përpjekja për të ushtruar, gëzuar, ndihmuar ose inkurajuar) të drejtat e një personi shërbimet e kujdesit shëndetësor riprodhues ose shërbimet e kujdesit shëndetësor që pohojnë gjininë që janë të ligjshme në Massachusetts. (MGL c. 12, § 11i 1/2 (a).)
• Oregon:
• • les assureurs contre la fault professionnelle ne peuvent pas prendre de mesures défavorables à l'encontre d'un professionnel de la santé që merr pjesë në shërbimet à des soins d'afirmation du gjinore;
  • les praticiens de la santé peuvent participer au programme de confidentialité des adresses de l'État, qui protège la confidentialité des adresses des prestataires de soins de santé (Or. Rev. Stat. §§ 192.820, 192.822 et 192.826) ; et
  • Les tribunaux de l'Oregon ne peuvent pas délivrer d'assignation à comparaître concernant les services de soins d'affirmation de genre qui sont légaux dans l'Oregon mais illégaux dans une autre juridiction (HB 2002, Or. 82nd Leg. Assemb. 2023 Reg. Sess. (13 juillet 2023)).
• Dans l'État de Washington, des protections sont accordées aux professionnels de la santé, à leurs affiliés et à leurs familles qui fournissent, aident ou tentent de fournir ou d'aider des soins d'affirmation de genre qui sont légaux à Washington (RCW 7.115.010 à 7.115.901).

Les prestataires doivent être agréés dans l'État où se trouve le patient lorsqu'ils fournissent des services de télésanté. Pendant la pandémie de COVID-19, de nombreux États ont temporairement levé les restrictions ou élargi l'emplacement des prestataires pour fournir des services de télésanté dans l'État. À mesure que les dérogations des États ont expiré, de nombreux prestataires se sont étendus là où ils sont autorisés à continuer à fournir des services de télésanté dans les États où ils ont des patients mais où ils ne se trouvent pas.

Les prestataires doivent connaître les lois de l'État où ils prodiguent des soins qui précisent si :

• Il est légal de prodiguer des soins affirmant le genre.
• Les praticiens non médecins peuvent prodiguer des soins affirmant le genre.

De plus, étant donné que les soins d'affirmation de genre peuvent être prescrits par télésanté, les prestataires doivent prendre en compte :

• L'emplacement du patient, tel que le régit la loi de l'État où se trouve le patient.
• Si l'État dans lequel ils sont agréés a des exigences applicables ou des interdictions pour les prestataires extérieurs à l'État de rédiger des ordonnances.

(Pour en savoir plus sur les services et les considérations de télésanté, voir Télésanté : aperçu et exigences nationales en matière de télésanté pour les payeurs privés, tableau sur le droit pratique.)

Les prestataires de soins de santé doivent comprendre comment l'environnement juridique actuel affecte les soins qu'ils peuvent prodiguer à leurs patients, y compris les effets disparates que les interdictions ou les protections des États sont susceptibles d'avoir sur leurs pratiques. Les prestataires devraient considérer :

• Quels services de soins d'affirmation de genre ils peuvent fournir et à quels patients.
• Quels conseils et conseils ils peuvent offrir aux patients.
• Comment gérer l'augmentation potentielle du nombre de patients hors de l'État.
• Comment assurer le suivi des soins mal gérés.

Les fournisseurs doivent se tenir au courant de toutes les exigences fédérales et étatiques (d'autant plus qu'il ya des changements rapides et continus et des contestations juridiques constantes concernant les exigences existantes) et mettre en œuvre des changements conformes à leurs pratiques, politiques et procédures. Les prestataires doivent également anticiper les changements dans leur relation avec les patients et la manière dont ils peuvent prodiguer des soins affirmant le genre.

Les avocats des prestataires de soins de santé devraient évaluer le risque pour les prestataires situés dans des États avec ou sans interdiction et avoir un patient dans un État avec interdiction. These providers may need to take certain actions, including:

• Informing the patient about options to access gender-affirming care.
• Providing logistical support or financial assistance to the patient to travel out of state for that care.
• Providing in-person or telehealth clinical services (before or after) a patient travels out of state for that care.

Basics of Gender Affirming Care for Health Professionals