ORS 414.769 Payment for gender-affirming treatment; rules

As used in this section, “gender-affirming treatment” means a procedure, service, drug, device or product that a physical or behavioral health care provider prescribes to treat an individual for incongruence between the individual’s gender identity and the individual’s sex assignment at birth.

Notwithstanding ORS 414.065 and 414.690, medical assistance provided to a member of a coordinated care organization or a medical assistance recipient who is not enrolled in a coordinated care organization shall include gender-affirming treatment.

The Oregon Health Authority or a coordinated care organization may not:

Deny or limit gender-affirming treatment that is:

Medically necessary as determined by the physical or behavioral health care provider who prescribes the treatment; and

Prescribed in accordance with accepted standards of care.

Deny as a cosmetic service a medically necessary procedure prescribed by a physical or behavioral health care provider as gender-affirming treatment, including but not limited to:

Tracheal shave;

Hair electrolysis;

Facial feminization surgery or other facial gender-affirming treatment;

Revisions to prior forms of gender-affirming treatment; and

Any combination of gender-affirming treatment procedures.

Deny or limit gender-affirming treatment unless a physical or behavioral health care provider with experience prescribing or delivering gender-affirming treatment has first reviewed and approved the denial of or the limitation on the treatment.

A coordinated care organization must:

Contract with a network of gender-affirming treatment providers that is sufficient in numbers and geographic locations to meet the network adequacy standards prescribed by ORS 414.609 (1); and

Ensure that gender-affirming treatment services are accessible to all of the coordinated care organization’s members without unreasonable delay; or

Ensure that all members have geographical access to non-contracting providers of gender-affirming treatment services without unreasonable delay.

The authority shall monitor coordinated care organization compliance with the requirements of this section and may adopt rules necessary to carry out the provisions of this section.