Oregon Statutes 414.769 – Payment for gender-affirming treatment; rules
(1) 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.
Terms Used In Oregon Statutes 414.769
- Contract: A legal written agreement that becomes binding when signed.
- Coordinated care organization: means an organization meeting criteria adopted by the Oregon Health Authority under ORS § 414. See Oregon Statutes 414.025
- Gender identity: means an individual's gender-related identity, appearance, expression or behavior, regardless of whether the identity, appearance, expression or behavior differs from that associated with the gender assigned to the individual at birth. See Oregon Statutes 174.100
- Medical assistance: includes any care or services for any individual who is a patient in a medical institution or any care or services for any individual who has attained 65 years of age or is under 22 years of age, and who is a patient in a private or public institution for mental diseases. See Oregon Statutes 414.025
(2) 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.
(3) The Oregon Health Authority or a coordinated care organization may not:
(a) Deny or limit gender-affirming treatment that is:
(A) Medically necessary as determined by the physical or behavioral health care provider who prescribes the treatment; and
(B) Prescribed in accordance with accepted standards of care.
(b) 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:
(A) Tracheal shave;
(B) Hair electrolysis;
(C) Facial feminization surgery or other facial gender-affirming treatment;
(D) Revisions to prior forms of gender-affirming treatment; and
(E) Any combination of gender-affirming treatment procedures.
(c) 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.
(4) A coordinated care organization must:
(a) 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
(b)(A) Ensure that gender-affirming treatment services are accessible to all of the coordinated care organization’s members without unreasonable delay; or
(B) Ensure that all members have geographical access to non-contracting providers of gender-affirming treatment services without unreasonable delay.
(5) 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. [2023 c.228 § 24]