The Trans Health Program at Fenway Health supports members of trans and gender diverse communities, their families, and the providers who serve them. We provide patient-centered, evidence-based care to ensure trans and gender diverse people are informed and affirmed in their gender and healthcare needs.
The Trans Health Program Newsletter is a tool for proactive communication with patients and community members about all things trans and gender diverse health. We are particularly attuned to the needs of people given the political climate and intend to use this tool to communicate proactively about government policies, medical care updates, and important resources. In this issue are commonly asked questions since the election, a message from our CEO, and resources for care and support.
We extend warm wishes, comfort, rest, and joy to each of you during this uncertain time. We know that accessing care and community can be difficult for many. We’re here for you. Please reach out if you need help. Rest assured, leadership at Fenway is planning and coordinating with community, state, and federal officials to protect access to care. We’re in this together.
Many of you have had questions about what the current political environment might mean for gender-affirming care and services at Fenway Health. We will be answering these questions to the best of our ability on this FAQ page.
CareEverywhere is an application Epic uses to share patient data between health care institutions. Its goal is to provide a comprehensive picture of a patient’s chart. If your Fenway Health providers can see the care you or your child receives at an outside hospital or clinic, that helps us understand how to deliver the best care for you.
Massachusetts is an OPT-OUT state for CareEverywhere. This means once your chart is set up at Fenway, the system searches for your information at surrounding facilities and pulls it into the chart. This allows anyone on your care team (at Fenway or otherwise) to get a better picture of your overall healthcare journey.
If you are a Fenway Health patient and do NOT want your Fenway record to be shared with your other health care providers, let anyone on your care team know. We can turn off this setting for you at any time.
CareEverywhere (CE) is an application Epic uses to share patient data between healthcare institutions. Its goal is to provide a comprehensive picture of a patient’s chart, and in turn serve you better. If your Fenway Health providers can see the care you received at BILH, MGB, or Atrius, that helps us understand your care and deliver a better experience for you.
Massachusetts is an opt-OUT state for CareEverywhere. This means once your chart is set up at Fenway, the system searches for matching patients at surrounding facilities and pulls them into the chart. This allows anyone on your care team (at Fenway or otherwise) to get a better picture of your overall healthcare journey.
If you are a Fenway Health patient and want your Fenway record to NOT be shared with other healthcare sites you attend, let anyone on your care team know – we can turn off this setting for you at any time.
It’s important to note that while communications like these are not legally binding, they serve as an indication of CMS’s guidance and the direction they prefer programs to head. These letters offer evolving guidance and insight, often preceding formal rulemaking. They are a preparatory step for upcoming changes or new thinking in the field. While there are no current changes in access to care, Fenway is continuing to prepare financial plans and models to ensure that patients on federally funded insurance plans can continue to have access to gender affirming care.
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An executive order is a directive issued by the President of the United States to manage and direct the operations of the federal government. However, executive orders are limited in that they can only apply to federal agencies and cannot override laws passed by Congress or the Constitution. They can also be challenged in court or reversed by future presidents. Executive orders are not laws and can be interpreted as wishes or directives of the President.
In short, while an executive order is a powerful tool, it has its boundaries and is meant to inform the operations of the executive branch (office of the President) and enforcement of laws.
The recent executive orders addressing binary sex; diversity, equity, and inclusion; and gender affirming care are enforceable within federal agencies such as Health and Human Services so long as they are lawful. That is why we’ve seen litigation recently to challenge executive orders in the courts.
While we acknowledge the heightened anxiety, there is no immediate impact to care, and we will continue to provide gender-affirming care and services.
Our leadership is working diligently with our local, state, and federal politicians and partner organizations across the country to anticipate any attacks on gender affirming care – or other medically necessary care –to prevent any disruption in services. Currently there are a lot of unknowns about potential federal policy changes, but here at Fenway Health we are doing our best to anticipate possible attempts at restricting access to care. Fenway is dedicated to keeping our communities updated on our response to any proposed policy changes as well as how and where we are advocating.
Medical records are protected under HIPAA to limit government overreach. Local and federal governments are able to serve court orders for medical records in the case of criminal investigations or if a patient is believed to be a foreign agent. All government requests for medical records are reviewed by Fenway’s legal team and we have been reassured that if any requests appear to be nefarious, they will be reviewed with outside counsel and possibly the Mass Attorney General’s Office. Additionally, the Massachusetts government is highly protective of gender affirming care, and they will continue to be.
Learn more about HIPPA here.
We understand the desire to remove gender dysphoria from your chart, but removing a diagnosis code may not be as helpful or straightforward as it seems.
Massachusetts-based insurance plans cover gender-affirming care. However, in order for the insurance company to recognize the request or service as medically necessary for gender-affirming purposes, we typically need to use the diagnosis code F64.9, or gender dysphoria. This specific coding for insurance coverage often applies to things like surgery or expensive medications. Given the new administration and possible policy changes, Fenway is working with policy makers and MA insurances to recognize alternative codes to reduce any potential risk to patients.
We can sometimes use another, more vague diagnosis code if it is on your list (for example, Hormone Disorder), but we cannot guarantee there will not be any issues with insurance coverage. It is not legal for us to use codes that may be considered clinically inaccurate under the Federal False Claims Act.
Removing a diagnosis code such a gender dysphoria also would not remove other information specific to your trans or gender diverse identity from the chart, such as the content of notes, MyChart messages, medications, and medical/surgical histories.
Alternatively, or additionally, you can choose to restrict access of your medical record to other linked institutions via Care Everywhere. If you do choose this, remember that other health centers where you may see specialists or seek emergency services will not have access to your medications or problem lists, which may restrict or slow down access to these other services.
Massachusetts is one of 17 states in the US that has a Shield Law as protection related to the provision of gender-affirming health care. The Shield Law protects providers who are physically located in Massachusetts from the consequences of civil and criminal actions in other states that restrict or criminalize gender-affirming or reproductive health care. This law in MA extends protections for care provided by a MA provider regardless of the patient’s location at the time the care is provided. However, the Shield Laws will not protect providers who are providing care when physically out of the state of MA.
Shield Laws have yet to be tested in the US. Fenway is working with our local policy makers to ensure that our state’s laws are strong, ready to be tested, and have the broad protections that we, as providers, need to feel safe and protected providing this medically necessary care.
Learn more at Know Your Rights: Shield Law
857.313.6589 or [email protected]
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