California Senate Bill No. 923 (SB 923), passed by the California legislature in 2022, represents a significant step towards ensuring that healthcare providers deliver culturally competent, gender-affirming care for transgender, gender-diverse, and intersex (TGI) individuals. This legislation mandates comprehensive training for healthcare staff, updates to provider directories, and enhancements to continuing medical education (CME) requirements, all aimed at addressing healthcare disparities faced by TGI individuals.
Training Requirement for Healthcare Staff
Mandatory Cultural Competency Training
Starting in 2025, SB 923 requires all healthcare service plans, health insurers, Medi-Cal managed care plans, and Programs of All-Inclusive Care for the Elderly (PACE) organizations in California to ensure that their staff, who have direct contact with enrollees, receive evidence-based cultural competency training. This training focuses on TGI-inclusive healthcare, emphasizing the use of appropriate terminology, techniques for respectful and affirming interactions, and understanding the influence of family and community acceptance on TGI health outcomes.
The intent is to reduce the biases and prejudices that often affect the quality of care provided to TGI individuals. Training modules will include case studies, role-playing scenarios, and lectures by experts in transgender health to ensure comprehensive understanding and practical application. This measure acknowledges that healthcare interactions can profoundly impact the overall well-being and trust TGI individuals place in medical institutions. By preparing staff to engage respectfully and knowledgeably, SB 923 aims to build a more inclusive, competent, and empathetic healthcare environment.
Refresher Training and Compliance
The legislation also mandates refresher training for staff members in cases where complaints about non-inclusive care are upheld. This ensures that healthcare providers remain up-to-date with best practices and continue to offer respectful and affirming care to TGI patients. Compliance with these training requirements is crucial, as noncompliance may result in sanctions or penalties from regulators.
Refresher courses will be scheduled every two years, and additional modules will be added to address emerging concerns and evolving best practices in TGI medical care. Regular assessments will gauge staff understanding and implementation of the training, and any gaps will be promptly addressed. This structured approach to ongoing education underlines the commitment to maintaining high standards of care for TGI individuals, reinforcing the importance of continuous learning and application of inclusive practices within healthcare settings.
Provider Directories Update
Identifying Gender-Affirming Service Providers
By March 1, 2025, health plans, insurers, and Medi-Cal managed care plans must update their provider directories to identify in-network providers who offer gender-affirming services. These services include hormone therapy, gender-confirming surgeries, and voice therapy. This update aims to facilitate TGI patients’ access to appropriate care by making it easier for them to find providers who are experienced in delivering gender-affirming services.
The objective is to streamline the process for patients seeking specialized care, eliminating the often arduous task of finding knowledgeable practitioners. Detailed information about services offered, provider qualifications, and patient reviews will be accessible, aiding TGI individuals in making informed choices about their healthcare. Transparency in provider capabilities is essential to foster trust and ensure that patients can easily access the services they need without excessive effort and frustration.
Enhancing Access to Inclusive Care
Updating provider directories is a critical step in enhancing access to inclusive care for TGI individuals. By clearly identifying providers who offer gender-affirming services, the legislation helps to ensure that TGI patients can receive the specialized care they need without facing unnecessary barriers or delays. This initiative is part of a broader effort to create a more inclusive and supportive healthcare environment for TGI individuals.
The update also aims to encourage providers who may not yet be offering such services to obtain the necessary training and qualifications, thus expanding the overall network of competent providers. This broadened access is expected to decrease wait times and improve the continuity of care for TGI patients. Additionally, health plans will be required to ensure that their networks have an adequate number of TGI-competent providers to meet demand, further enhancing the accessibility and quality of care.
Continuing Medical Education (CME) Requirements
Expanding CME Curricula
SB 923 builds on previous mandates requiring physicians and surgeons to complete CME courses that include cultural and linguistic competency. The legislation expands these requirements to include TGI-related health needs, ensuring that healthcare professionals are educated on the unique challenges and barriers faced by TGI patients. Key elements of the updated CME curricula include the appropriate use of names, pronouns, and gender-neutral language, as well as the avoidance of assumptions regarding gender or sexual orientation.
This expanded curriculum seeks to arm physicians and surgeons with a deeper understanding and sensitivity towards TGI patients’ needs, promoting an environment where patients feel seen, respected, and properly cared for. Additionally, the CME updates will address systemic issues within healthcare practices that often marginalize TGI individuals, advocating for more inclusive and equitable medical practices. By integrating these insights into regular training, SB 923 aims to cultivate a generation of healthcare practitioners who are not just aware but also skilled in delivering TGI-affirming care.
Addressing Implicit Bias and Barriers
The updated CME requirements also emphasize the importance of understanding the impact of implicit bias on clinical decisions and the barriers faced by TGI patients. By educating healthcare professionals on these issues, the legislation aims to improve the quality of care provided to TGI individuals and reduce health disparities. Additionally, administrative changes for inclusivity, such as updating intake forms, are encouraged to create a more welcoming environment for TGI patients.
Healthcare systems will undergo assessments to identify existing biases and implement strategies to mitigate them. This includes revising patient intake processes to ensure they are inclusive of all gender identities and simplifying procedures for TGI individuals to update their medical records. These efforts seek to remove systemic obstacles and promote a healthcare experience that acknowledges and respects the identities of TGI patients. Collectively, these initiatives contribute to better health outcomes and an improved sense of belonging within the medical community.
Compliance Deadlines and Enforcement
Compliance Deadlines
While the statute specifies March 1, 2025, as the compliance deadline, the California Department of Managed Health Care (DMHC) requires compliance by February 14, 2025, for full-service healthcare service plans. Health insurers regulated by the Department of Insurance or Medi-Cal managed care plans overseen by the Department of Health Care Services (DHCS) have until March 1, 2025, to comply unless further guidance is issued. These deadlines ensure that healthcare providers have sufficient time to implement the necessary training and updates.
The staggered deadlines reflect the logistical needs of various types of healthcare providers, giving them ample time to align their policies and practices with the new mandates. Healthcare organizations are expected to develop comprehensive implementation plans, addressing aspects like training schedules, resource allocation, and internal assessments to ensure compliance. Proactive steps toward piloting these initiatives will be crucial in meeting the stipulated deadlines without compromising the quality of care.
Enforcement and Penalties
The training must be completed by staff members with direct enrollee contact within 45 days of hire and every two years afterward. Noncompliance with these requirements may result in sanctions or penalties from regulators, underscoring the importance of adhering to the legislation. This enforcement mechanism ensures that healthcare providers remain accountable for delivering inclusive and culturally competent care to TGI individuals.
Regulatory bodies will conduct regular audits and inspections to verify compliance, and failure to meet the standards may lead to substantial penalties. Enforcement policies will be designed to encourage adherence through a combination of educational and punitive measures, emphasizing the crucial nature of these regulations. The ultimate goal of this legislation and its enforcement is to uplift the standard of care provided to TGI individuals, ensuring they receive fair, respectful, and competent medical attention in all settings.
Application and Impact on Healthcare Systems
Integration into Larger Health Systems
Larger health systems have already started incorporating the training requirements mandated by SB 923. These systems often have more resources and infrastructure to implement comprehensive training programs and update their provider directories. By integrating these requirements, larger health systems can set a precedent for inclusive care and serve as models for smaller practices.
These institutions are leveraging their existing educational frameworks and technological platforms to seamlessly incorporate the new training modules, ensuring timely compliance while maintaining operational efficiency. By doing so, they are paving the way for a healthcare environment where inclusivity is ingrained in standard medical practice. The proactive involvement of these larger systems not only facilitates a swifter rollout of SB 923’s mandates but also sets a benchmark for other healthcare entities to follow.
Challenges for Smaller Practices
Smaller practices may face challenges in meeting the requirements of SB 923 due to limited resources and staff. However, the legislation aims to provide support by offering access to training programs and materials, helping smaller practices to uphold the same standards of care. Collaboration with larger health systems and professional organizations can also aid smaller practices in fulfilling these new obligations. Overcoming these challenges is essential for creating a truly inclusive healthcare system across all levels of care provision. By working together, healthcare providers of all sizes can ensure that TGI individuals receive the respectful, knowledgeable, and gender-affirming care they deserve.
