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Corinne Green Profile picture
@gaynarcan
Apr 26 • 49 tweets • 12 min read • Read on X
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HOLY SHIT 1557 JUST DROPPED
federalregister.gov/public-inspect…
reading it now but this is not inspiring confidence! Image
lol this looks probably bad too why not go with discriminatory impact analysis?? Image
also bad?? why do this In § 92.2(b), we proposed that this regulation would not apply to an employer with regard to its employment practices, including the provision of employee health benefits. We noted that, although the 2016 and 2020 Rules applied to employment in very limited circumstances, OCR determined that the proposed approach would minimize confusion among individuals seeking relief under Federal Equal Employment Opportunity laws and would promote clarity regarding the filing and processing of employment discrimination complaints. We stated our belief that, as is the case with employment discrimination ...
also bad lol Response: We appreciate commenters' views on this issue. As we noted in the 2022 NPRM, OCR considered applying the rule to all programs and activities of the Department and sought comment on this issue. 87 FR 47838. Based on comments received and additional consideration, we are applying 17 See, e.g., Griffin v. Breckenridge, 403 U.S. 88, 97 (1971) (civil rights statutes should be construed broadly); U.S. v. Price, 383 U.S. 787, 801 (1966) (same); see also N. Haven Bd. of Educ. v. Bell, 456 U.S. 512, 521 (1982) ("[I]f we are to give Title IX the scope that its origins dictate, we mus...
everything these fuckers do is pre-compromised down like forty levels wtf Comment: A few commenters opined that the rule should apply broadly to recipients of Federal financial assistance from any executive agency, not just the Department. These commenters noted that nothing in the statute suggests that Congress intended to limit the scope of section 1557's application in such a way. Response: It is OCR's longstanding position that section 1557's discrimination prohibition is not limited to recipients of Federal financial assistance from the Department, but rather covers recipients' health programs or activities regardless of the executive agency providing the ...
worse than Obama's so far despite having bostock. incredible
first explicit mention of trans people and it's the same states rights shit as the title ix sports nprm this is so fucking offensive Comment: Many commenters raised concerns about the potential conflicts of State and Federal laws. Some commenters expressed that any conflict between State and Federal law or policy would be inconsistent with the principles of federalism. Some commenters had specific concerns regarding the final rule's application to State laws that prohibit transgender patients from receiving certain medically necessary gender-affirming care or those that protect religious freedom and conscience. Other commenters suggested that OCR should include a subsection in the final rule that addresses the interactio...
why would you do this if not to abdicate enforcement responsibility?? 1557. When OCR receives a complaint alleging discrimination related to a group health plan, we will conduct a fact-specific analysis to determine if the group health plan is a recipient or subrecipient of Federal financial assistance. We decline to take the position that a group health plan is an indirect recipient of Federal financial assistance whenever the plan sponsor receives Federal financial assistance. Determining whether an entity is an indirect recipient requires a fact-specific inquiry. 49
more abdication specifically for us. neato Response: OCR complies with court orders, including court-ordered injunctions. If a recipient third party administrator is covered by any current court order or court-ordered injunction, OCR would not find the third party administrator to be in violation of section 1557 or this rule for its activities that are covered by the injunction, and such an entity would not need to provide an assurance under § 92.5 to the extent it conflicts with a current court order or court-ordered injunction by which they are covered.
more abdication lol. they are terrified of accidentally committing to help trans people Image
they're so scared of using the words "gender identity" they literally scrapped it everywhere but one spot and just reference it repeatedly. this is fucking insane Availability (§ 92.11). Comment: Many commenters noted that the parenthetical for sex discrimination included in proposed § 92.1(a)(1)(i) differs from the language of § 92.101(a)(2) and that it should be consistent, such that it should include sexual orientation and gender identity as well as pregnancy-related conditions. Response: OCR appreciates the need for consistency across the regulation, and to ensure that the public is aware of the various bases for discrimination included under the umbrella of sex discrimination. As such, OCR has revised the parenthetical in 92.1(a)(1)(i) to dire...
"can you at least have them tell us when you've given them permission not to treat us?"
"no. they can just lie to you instead actually :)" Comment: Various commenters requested that OCR require any entity receiving a religious exemption to include notice of the exemption in the Notice of Nondiscrimination; they said it would be misleading to have a notice stating that the entity does not discriminate if it has been granted permission to do so in certain circumstances. They stated that the information is needed for LGBTQI+ persons seeking health care. Response: OCR appreciates these comments. OCR declines to revise § 92.10 to impose an affirmative obligation on a recipient to identify any exemptions it has received under appl...
btw for those of you who don't do policy it is policy best practice to embed something you care about everywhere you can to be clear and forceful. that's why switching to incorporation by reference hits hard - they do not want to deal with us
that is blatantly false. OCR is absolutely not doing this. go fuck yourselves Response: OCR is not including a data collection requirement in the final rule. OCR has the authority independent of this rulemaking to conduct data calls to ensure recipient compliance with Federal civil rights laws. 98 OCR is actively engaged with other agencies within the Department and throughout the Federal Government related to responsible data collection and recognizes the importance of data collection to meet its mission. We will continue to work with covered entities and beneficiaries to determine whether an additional data collection requirement is needed in a future rulemaking.
lol they finally said it Response: OCR is not including a data collection requirement in the final rule. OCR has the authority independent of this rulemaking to conduct data calls to ensure recipient compliance with Federal civil rights laws. 98 OCR is actively engaged with other agencies within the Department and throughout the Federal Government related to responsible data collection and recognizes the importance of data collection to meet its mission. We will continue to work with covered entities and beneficiaries to determine whether an additional data collection requirement is needed in a future rulemaking.
this is the guy telling you to vote for him to protect abortion access lmao Several commenters stated that OCR should clarify that this provision protects patients from discrimination on the basis of actual or perceived prior abortions. Several commenters stated that, as a result of abortion bans that have gone into effect post-Dobbs, women have been denied critical care, such as cancer treatment, because of abortion-related concerns. A commenter wrote that abortion is often necessary to save patients' lives, especially from complications like ectopic pregnancy or premature rupture of membrane. Response: OCR appreciates commenters' concerns and recognizes that the...
they do not want to go to bat for ANYBODY lol Response: OCR acknowledges the unique challenges faced by LGBTQI+ individuals seeking fertility treatment. Individuals are protected from discrimination regardless of the type of health care they seek, and we have concluded it is unnecessary to provide provisions for each specific form of health care available. Whether discrimination on the basis of sexual orientation or gender identity occurred in the provision or coverage of assistive reproductive technology-such as IVF is necessarily fact specific. However, if a covered entity elects to provide or cover fertility services but categorical...
"disparate impact analysis is how you do your job"
"yeah we know. we are very specifically not going to do that. trump didn't so we won't either" Comment: A commenter stated that OCR should exercise its authority to enforce disparate impact claims in order to address systemic discrimination in health care. 127 Another commenter supported the approach taken by OCR in the Proposed Rule to not include the site location provision from the 2016 Rule, stating they believed section 1557's context, structure, and text make evident that Congress did not intend to import multiple, piecemeal legal standards and burdens of proof derived from different statutory contexts into the doctrinal patchwork; and that section 1557 provides the full range ...
hey trans ppl! get fucked! what's happening to you rn may be discrimination. it's impossible for us to say even though it's our job. but keep submitting those OCR complaints and we'll keep putting them in the trashcan :) Comment: Multiple commenters expressed support for the rule's prohibition on denying or limiting care on the basis of a patient's assigned sex at birth, gender identity, or gender otherwise 157 See, e.g., Bostock v. Clayton Cnty., Georgia, 590 U.S. 644, 658-59 (2020); Doe v. Mass. Dep't of Correction, No. CV 17- 12255-RGS, 2018 WL 2994403 (D. Mass. June 14, 2018); Whitaker v. Kenosha Unified Sch. Dist. No. 1 Bd. of Educ., 858 F.3d 1034 (7th Cir. 2017). recorded at § 92.206(b)(2). A commenter expressed support for the rule's prohibition on covered entities denying or limiting a clinician's...
if you've followed along with things I've yelled at HHS to do, here is them saying they won't protect doctors who provide care contrary to state law even though they could Comment: Multiple commenters expressed support for the rule's prohibition on denying or limiting care on the basis of a patient's assigned sex at birth, gender identity, or gender otherwise 157 See, e.g., Bostock v. Clayton Cnty., Georgia, 590 U.S. 644, 658-59 (2020); Doe v. Mass. Dep't of Correction, No. CV 17- 12255-RGS, 2018 WL 2994403 (D. Mass. June 14, 2018); Whitaker v. Kenosha Unified Sch. Dist. No. 1 Bd. of Educ., 858 F.3d 1034 (7th Cir. 2017). recorded at § 92.206(b)(2). A commenter expressed support for the rule's prohibition on covered entities denying or limiting a clinician's...
just like the tix athlete rule this is just a blueprint for how to legally discriminate against trans people. because they don't want to touch us after 3 years of dehumanization. fucking bonkers shit that directly violates numerous promises we were given. patient's preferences about roommate assignments. A covered entity will be in violation of this rule if they refuse to admit a transgender person for care or refuse to place them in facilities consistent with their gender identity, because doing so would result in more than de minimis harm. We also note that no application of this rule shall be required insofar as it would violate Federal religious freedom and conscience laws. Recipients may rely on those protections directly, see § 92.3(c), or they may seek an assurance of a religious freedom or conscience exemption, see § 92.302(b).
MORE THAN HALF THE TRANS KIDS IN THE COUNTRY HAVE ZERO HEALTHCARE and HHS says they'll only consider discrimination on an INDIVIDUAL CASE BY CASE BASIS. this is FUCKED. FUCK YOU Response: OCR appreciates these comments and agrees that the nondiscrimination protections are important to transgender and nonbinary people's ability to access clinically appropriate care, especially those who may face elevated risk of harm due to discrimination on multiple protected bases. In determining whether a covered entity violated section 1557 by denying or limiting a health service sought for the purpose of gender-affirming care, OCR will continue to consider evidence that the covered entity would provide that same service for other purposes. Evidence that OCR may consider to est...
again this is literally just telling states how to discriminate against us in ways HHS will consider legal: go the florida route and set up your own fucked "standard of care." these people are fucking freaks who do not care about anyone or anything you love Response: This final rule prohibits discrimination on the basis of sex, consistent with Federal law. As such, nothing in this rule impedes covered entities from taking nondiscriminatory actions based on current medical standards and evidence, such as making decisions about the timing or type of protocols appropriate for care. The rule does not (and cannot) require a specific standard of care or course of treatment for any individual, minor or adult. Section 1557 prohibits discrimination on certain prohibited bases, and does not interfere with individualized clinical judgment about the appro...
can't be much clearer than this! #section1557 #ppaca Response: As with the 2016 Rule, 81 FR 31435, OCR declines to provide a regulatory definition for gender-affirming care. However, when we used the term "gender-affirming care" in both §§ 92.206 and 92.207, we are generally referring to care designed to treat gender dysphoria that may include, but is not necessarily limited to, counseling, hormone therapy, surgery, and other related services. 87 FR 47834 n.139. As noted elsewhere, the rule does not impose a categorical requirement that covered entities must provide gender-affirming care. Further, while we acknowledge comments in su...
brb conducting a fact-specific analysis of every trans kid in louisiana. ok i'm done they're being discriminated against have no implications for the provision of gender-affirming care. A fact-specific analysis is necessary to determine whether prohibited discrimination has occurred, but the rejection of a practice closely linked with a protected status may, in conjunction with other evidence, lead to a finding of discrimination. This rule does not require or mandate the provision of any particular medical service. Section 1557 prohibits discrimination on certain prohibited bases, and does not interfere with individualized clinical judgment about the appropriate course of care for a patient. OCR has a general...
just like the title ix rule they're laying the groundwork to leave trans healthcare to states rights. once a segregationist always a segregationist. this is incredibly offensive
lol they actually made this part even worse than the nprm. amazing Response: OCR appreciates commenters' views on proposed § 92.206(c). In light of comments received, we are modifying the language in this provision to provide additional specificity regarding how OCR will evaluate a covered entity's proffered legitimate, nondiscriminatory reason for denying care. We also add a reference to § 92.302 to make clear that this provision does not limit a recipient's ability to seek assurance of an exemption based on religious freedom or conscience laws. Also, we note that while many commenters specifically discuss providers' personal beliefs, these changes clarif...
just keep sending those OCR complaints straight into the HHS trashcan. who can say if a state is a whole is discriminating against all its trans people! certainly not us, the OFFICE OF CIVIL RIGHTS First, many commenters strongly urged OCR to consider that providers may have a nondiscriminatory reason to not provide some aspects of or all gender-affirming care. OCR understands that a provider may have a legitimate nondiscriminatory reason not to provide a health service, which the newly revised § 92.206(c) makes clear. While this section has application in the gender-affirming care context, the revised language is also intended to make clear that it is not limited to that context. When OCR investigates claims of discrimination based on the denial of care, OCR will consider the covered...
Q: can you please tell states that they can't discriminate against trans people because federalism?
A: no. every single individual trans person must put their OCR complaint in our trashcan where we totally promise to review the facts on an individual basis Comment: Many commenters supported the inclusion of § 92.206(c) but recommended that OCR strengthen the language pertaining to providers complying with a State or local law as a justification for denying gender-affirming care, abortions, or other reproductive health care to clarify that as a Federal civil rights law, the rule preempts any such State or local law restricting access to such care. Some commenters suggested including language in the preamble to make clear that the majority of States' policies that restrict transgender and nonbinary people's access to health care would be barred...
this is goddamned obscene
IT IS NOT "FACT INTENSIVE ANALYSIS" TO LOOK AT LAWS THAT SAY "NO TRANS HEALTHCARE" AND FIGURE OUT THEY MADE TRANS HEALTHCARE ILLEGAL GO FUCK YOURSELVES Response: OCR declines to provide specific examples of presumptively discriminatory benefit designs in the rule due to the fact-intensive analysis needed to determine whether a particular benefit design feature is discriminatory under this section. We also decline to give examples of presumptively
I WILL SHOW YOU THE LAWS BANNING TRANS CARE FROM MEDICAID AND TELL YOU THEY BAN TRANS CARE FROM MEDICAID FOR FREE. I CAN PROVIDE THIS "FACT-SPECIFIC" SERVICE WITH NATIONWIDE COVERAGE AND 100% ACCURACY IN LESS THAN HALF AN HOUR We also decline to incorporate examples of presumptively discriminatory benefit designs similar to those in EHB regulations applicable to non-grandfathered health insurance coverage184 in the individual and small group markets that CMS finalized in the preamble of its Notice of Benefit and Payment Parameters for 2023 final rule. Essential health benefits are governed by CMS regulations and are not addressed by this final rule. While many of the practices cited by CMS would raise concerns of prohibited discrimination under this rule, OCR's determinations that a particular benefit design is d...
CASE
BY
CASE Comment: Commenters noted that even plans without categorical exclusions will exclude certain types of gender-affirming care as "cosmetic." Commenters noted that categorizing procedures as cosmetic when needed for gender-affirming care is contrary to established standards of care for the treatment of gender dysphoria and urged OCR to explicitly prohibit such procedure-specific exclusions. Some commenters further noted that plans will often consider these procedures on a case-by-case basis when not related to gender transition but will not do so when the care is related to gender t...
they're literally just saying they'll accept trans bans that pretend to be based on evidence. same as athlete bans. bonkers transphobia
lol let's bring back gender marker mismatch denials why not Response: OCR appreciates commenters' concerns about coverage denials due to a sex mismatch in claims processing procedures, which can result in transgender patients being denied coverage for a medically necessary and clinically appropriate services. However, we decline to categorically state that sex mismatch denials are always discriminatory. Instead, OCR will consider and investigate complaints raising this issue on a case-by-case basis under § 92.207(b)(3). While we refrain from categorically stating that initial sex mismatch or coding denials are prohibited under this rule, we caution ...
lol. after every trans person in a state files their OCR complaint into our trashcan, we will ask the people mulching them to link us their favorite mumsnet studies saying it's fine, trans people enjoy being mulched actually Comment: Commenters recommended that OCR specify in the final rule that a nondiscriminatory benefit design is one that is clinically based. While expressing support for OCR considering clinical guidelines and standards of care when evaluating plan benefit designs, these same commenters also cautioned that OCR should not exclusively rely on clinical guidelines and journal articles in its analysis of discriminatory design because clinical guidelines may perpetuate racial bias and health disparities, and entities could cite a single peer-reviewed article as a shield to escape valid claims of...
bro you just said like thirty times you aren't going to do this. your entire reg is written to avoid doing this. nobody believes you will do this because. you also already have not been doing this Comment: Commenters noted that OCR could ensure higher quality health care for all enrollees through stronger oversight and regulation. These commenters urged OCR not to rely solely on complaints and to engage in proactive oversight by affirmatively reviewing covered entities' plan designs. Response: We agree that robust enforcement of section 1557 is critical to ensure individuals' ability to receive medically necessary health services, unencumbered by discriminatory conduct. OCR will employ all available means of investigating health insurance coverage and other health-related coverage u...
like the only good thing in this so far is tentative expansion of 1557 into ERISA
compare how clearly they write about denying healthcare to non-trans queer ppl to how absurdly they write about us Comment: Some commenters supported § 92.208 because in their view, a medical practice cannot refuse a female patient solely because she has a female spouse or partner, as this could constitute a denial on the basis of association. Response: OCR agrees that a medical practice may not refuse to see a prospective female patient based solely on the fact that the patient has a female spouse if they otherwise accept married individuals into their practice. This is because the refusal would be based on the sex of the prospective patient and would therefore constitute sex discrimination related to...
always fun when the APA requires them to say to your face that their rule is worse than Obama's and Trump's Notification of views regarding application of Federal religious freedom and conscience laws (§ 92.302) In proposed § 92.302, OCR proposed an administrative process under which recipients can notify OCR of their views that they are exempt from certain provisions of section 1557 due to an applicable Federal conscience or religious freedom law. This proposed provision was not in either the 2016 or 2020 Rule.
love when the OFFICE OF CIVIL RIGHTS brags about violating trans civil rights. this is what they do with the OCR complaints i guess! To take an example drawn from enforcement experience, OCR investigated allegations that a Catholic hospital discriminated against the complainant when it refused to allow his physician to perform a hysterectomy as a form of gender affirming care at their facility. The hospital confirmed during the investigation: (1) it did not perform the particular type of care or procedure (hysterectomy) on any patient under the circumstances (as it performs "direct sterilization" only for "the cure or alleviation of a present and serious pathology and a simpler treatment is not available&q...
translation from policy-speak: we will not protect trans youth if states pretend they're following junk science subject to all of the provisions. As finalized, these CMS regulations provide that discrimination based on "sex" includes discrimination based on sex characteristics, including intersex traits; pregnancy or related conditions; sexual orientation; gender identity; and sex stereotypes. The list in the regulation text is not an exhaustive one that outlines all the ways (or the only ways) that discrimination can be based on sex but, rather, it only identifies examples; CMS interprets these regulations accordingly. However, nothing in this rule impedes regulated entities from taking no...
there is no more laser-guided way to target trans youth for discrimination than that. "timing of care" lol. someone who isn't a dork like i am please tell me if that reads as obvious to non-dorks as i think it does
this terrible shit would not be happening if ncte hadn't imploded. can you imagine a dem admin getting away with this if harper jean were still there? i fucking can't Issuers generally have discretion in designing their benefits packages, and this rule does not require entities to cover any particular procedure or treatment. We clarify that, in finalizing the prohibition against discrimination on the basis of sex, the Department is not mandating that health insurance issuers include coverage for any particular item or service not already covered. However, to the extent a covered entity provides coverage for a particular health service, the covered entity must provide coverage for the health service to all individuals in a neutral, nondiscriminatory manne...
y'all know the chorus by now:
STATES RIGHTS
CASE BY CASE
THE EVIDENCE IS INCONCLUSIVE WE'LL LET JEFF LANDRY DECIDE Claims made by opposing commenters regarding assertions of patient harm resulting from gender-affirming care, purported lack of evidence demonstrating efficacy of such care, alleged differences between "biological sex" and gender, and hypothetical medical scenarios are not germane to the proposed regulatory text acknowledging that sex discrimination includes discrimination on the basis of sexual orientation or gender identity. While claims about medical evidence and specific treatments may be relevant in evaluating whether a particular action constitutes unlawful discrimination, o...
they refuse to say we need our fucking healthcare in the FUCKING REG ABOUT NONDISCRIMINATION IN HEALTHCARE
DONE. summary: same as the athlete ban tix rule, this firmly establishes a framework to allow healthcare bans, rejects its enforcement authority, and asks trans people to keep sending OCR reports into the HHS trash compactor. i suspect Rachel Levine is secretly cis
also i just realized that doing it this shitty way is probably worse for us in a severabilty scenario and that's probably why they did it, so they wouldn't have to fight for us multiple times. don't quote me on that though i'd need to look it up to be sure

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Corinne Green Profile picture
Jan 19
cis libs who don't know how govt works shouldn't be allowed to community note trans ppl. biden 100% has the authority to enforce federal nondiscrimination protections in healthcare and education in FL - he just hasn't. it's my job to know this and i'm very good at my job maria @mangosocialism In 2020, I voted for Biden. Since then, my state banned gender-affirming care for minors, censored LGBTQ studies, and made it a criminal misdemeanor for me to use the women's restroom at my college. We're done hearing "vote harder." It's time to organize: actionnetwork.org/events/dsa-tra... Peter Wolf @peterawolf Jan 17 The Democratic Party is actually the largest organized group of unwaveringly pro-trans people in America, but your book club sounds very ambitious. twitter.com/atgenevieve/st... Show this thread Readers added context they thought people might ...
fun fact: stating this in a policy analysis FL had me do on S 254 (that the federal govt could step in to stop implementation but likely wouldn't) is what made the white house call my bosses to have me disciplined and later fired for being uppity. (they still didn't do anything!)
ask these libs where our PPACA Section 1557 reg is and if they don't even know what that is, let alone have a coherent explanation for why we don't have it 3yrs into his term, they're people you can safely ignore
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