The guideline, as it will appear in the OHP ICD-10 Prioritized List, Line 521 states:
"Hormone treatment is included on this line only for use in delaying the onset of puberty and/or continued pubertal development with GnRH analogues for gender questioning children and adolescents. This therapy should be initiated at the first physical changes of puberty, confirmed by pubertal levels of estradiol or testosterone, but no earlier than Tanner stages 2-3. Prior to initiation of puberty suppression therapy, adolescents must fulfill eligibility and readiness criteria and must have a comprehensive mental health evaluation. Ongoing psychological care is strongly encouraged for continued puberty suppression therapy."
Beginning October 1, 2014, Oregon Health Plan will cover:
• Mental health counseling (applies to children, youth and adults)
• Evaluation by a pediatric specialist in advance of pubertal suppression treatment
• Procedures, medication and follow-up monitoring related to pubertal suppression
The coverage will not take effect until October 1, 2014 and will not apply to treatment or services rendered or billed prior to that date.
"The $1,000 “out-of-pocket”
"Pubertal suppression provides transgender adolescents the option of avoiding unwanted, irreversible and deeply distressing changes that come with birth-sex pubertal development"
"Thanks to this common sense, safe and medically recommended action by the Oregon Health Plan, lives will be saved and TransActive is extremely grateful to have been able to play a part in this victory and to be a regional and national center for providing the care needed by these kids and their families."
This landmark, first-of-a-kind decision came after more than a year of meetings and review of the testimony and evidence provided to the OHP Values-based Benefits Subcommittee by a team consisting of TransActive staff and members of the TransActive Advisory Board Medical Committee. The team included:
Heidi Allen, PhD (Columbia University)
Carol Blenning, M.D. (Family Practice-Oregon Health & Science University)
Bruce Boston, M.D. (Chief-Pediatric Endocrinology, Oregon Health & Science University
Jenn Burleton (Founder & Executive Director, TransActive)
Sheryl Rindel, LPC, NCC (Client Services Program Manager, TransActive)
Karin Selva, M.D. (Pediatric Endocrinology, Randall Children's Hospital)
Lending invaluable support in this effort, particularly regarding the inclusion of mental health care coverage for adults was staff and members of the Basic Rights Oregon Trans Justice Working Group (TJWG). In particular, TransActive thanks the TJWG’S Program Director and TransActive Advisory Board member, Aubrey Harrison.
TransActive is a non-profit organization and is a recognized leader in trans youth care, services, education and advocacy. For more information please visit our website http://www.transactiveonline.org or email us at: firstname.lastname@example.org.