Senate Bill 923: A step forward in trans-inclusive health care

Senate Bill 923: A step forward in trans-inclusive health care

Across the country, states are taking varied approaches to advance health equity. Some focus on mandating data collection on provider diversity, while others emphasize targeted education and culturally responsive network design. California, however, continues to set a national precedent.

With Senate Bill 923, California takes a bold step toward ensuring health care systems provide inclusive, affirming care for transgender, gender nonconforming, and intersex (TGI) individuals.

This legislation mandates comprehensive training for health care service plan staff and outlines new requirements for provider directories to improve access to gender-affirming services.

Cultural competence training for TGI-inclusive care

One of the key elements of Senate Bill 923 is Section 1367.043, which mandates that staff who interact directly with patients or provide enrollee services complete evidence-based cultural competency training. This training is critical for improving the quality of care for TGI individuals, focusing on both communication and understanding of the unique challenges faced by these communities.

The required training must include:

Historical and contemporary context: A deep dive into the personal and societal effects of historical exclusion and ongoing oppression of TGI communities.

Communication skills: Guidance on how to use inclusive language, including proper names and pronouns, even when records may not reflect these identities. It emphasizes the importance of avoiding assumptions about gender identity and using language that is respectful of diverse gender experiences.

Addressing health inequities: A discussion on the health disparities within TGI communities, highlighting the role of family and community acceptance in improving health outcomes.

Diverse perspectives: Inclusion of insights from local groups and organizations that serve the TGI community, such as the California Transgender Advisory Council.

Balancing personal values with professional responsibilities: Training on how providers can navigate personal beliefs while fulfilling their professional obligations to deliver inclusive care.

Facilitation by TGI-serving organizations: The training must be led by organizations with a core mission of serving the TGI community. These organizations must have at least 65% of their clients identifying as TGI.

The training is not merely a box to check but a fundamental shift toward fostering a more inclusive health care environment that recognizes the unique needs and challenges faced by TGI individuals.

Provider directory requirements for gender-affirming care

A key provision of the bill, Section 1367.28, mandates that by February 2025, healthcare service plans must increase the transparency of their provider directories. Specifically, directories must clearly indicate which in-network providers offer gender-affirming services.

These gender-affirming services are vital to the health and well-being of TGI individuals and include procedures such as:

  • Feminizing mammoplasty
  • Male chest reconstruction
  • Mastectomy
  • Gender-confirming facial surgery
  • Hysterectomy
  • Oophorectomy
  • Penectomy
  • Orchiectomy
  • Feminizing genitoplasty
  • Metoidioplasty
  • Phalloplasty
  • Scrotoplasty
  • Voice masculinization or feminization
  • Hormone therapy related to gender dysphoria or intersex conditions
  • Gender-affirming gynecological care 
  • Voice therapy related to gender dysphoria or intersex conditions

Health care plans must ensure that this information is readily available through their call centers and digital directories and regularly update it upon request from providers.

Implications for health plans and providers

For health plans, Senate Bill 923 signifies an important shift towards accountability in delivering trans-inclusive care. By requiring both cultural competence training and the clear identification of gender-affirming services, the bill pushes health plans to go beyond standard care and commit to fostering an environment that affirms the identities and health needs of TGI patients.

Violet’s TGNC Benchmarks & training

As Senate Bill 923 introduces important new standards for health plans, Violet is uniquely positioned to help plans not only meet but surpass these expectations. As the industry's first provider cultural competence analytics and training platform, Violet assesses and benchmarks cultural competence, including trans-inclusive care, and provides health plans with a clear way to highlight inclusive providers through our Verified Inclusive badges.

Our comprehensive training, developed with expert clinical educators and community-based TGI-certified organizations, goes beyond regulatory requirements to ensure providers have the tools to deliver genuinely affirming care. Violet’s CE/CME-accredited courses address the unique needs of TGI patients, covering critical topics like inclusive language, gender-affirming hormone therapy, support letter assistance, nutrition counseling, and more.

For health plans looking to streamline implementation, Violet has also partnered with industry leaders like Zelis Sapphire Digital and Kyruus HealthSparq to ensure the seamless integration of provider attestations and benchmarking data into provider directories. While Violet Benchmarks may not list specific gender-affirming procedures, utilizing our data ensures that patients can easily identify providers dedicated to trans-inclusive care.

If you're a health plan serving Californians and looking for solutions to comply with Senate Bill 923, book a demo today to see how Violet can support you.

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