The Nebraska Department of Health and Human Services is proposing permanent gender-affirming care restrictions for minors that are virtually the same as temporary regulations that left transgender rights activists feeling cautiously optimistic earlier this month.
The regulations are a statutory requirement under LB574, which was signed into law earlier this year. The permanent regulations have not taken effect yet, but a public hearing is scheduled for Nov. 28 at the Lancaster Event Center.
Nebraska's Chief Medical Officer Timothy Tesmer proposed the temporary regulations to take effect Oct. 1 to prevent a potential full ban on puberty blockers and hormone therapy that was set to take effect the same day. Gov. Jim Pillen approved the regulations, which are now in place for 90 days.Â
The temporary regulations require patients under 19 undergo at least 40 hours of therapy and wait another seven days after having their prescription approved before receiving any medication. The patient must also have lived six consecutive months as their preferred gender.
The permanent regulations maintain all these requirements, plus others that were included in the temporary regulations. Among some of the other requirements:
* Providers who prescribe puberty blockers or hormone therapy must complete a three-hour training.
*Â A patient undergoing treatment must continue to receive at least one hour of therapy every 90 days.
*Â Providers must receive a signed document of informed consent from a parent or guardian, or from the patient if they are an emancipated minor.
*Â If the medication comes via injection, it must be administered by a credentialed professional with the prescribed practitioner's office, or the patient's primary care provider.
One change in the permanent regulations imposes an additional requirement that the person picking up the medication from a pharmacy — either the parent or guardian, or the patient if they are an emancipated minor — provide a valid identification such as a state ID or driver's license.
Under a grandfather clause in LB574, the new regulations would not apply to patients who were already taking either puberty blockers or hormone therapy before Oct. 1.
When the temporary regulations were revealed, some transgender rights activists who had protested against LB574 expressed cautious optimism. Alex Dworak, a family medicine physician who works frequently with LGBTQ+ patients, said the rules align with best medical practices and will not change how he does his job.
LB574's introducer, state Sen. Kathleen Kauth of Omaha, held a different view, saying the regulations weren't strong enough.
"I'm very hopeful that medical professionals will stand up to protect kids and advise Dr. Tesmer to strengthen them significantly," Kauth said.
Meanwhile, Grant Friedman, legal fellow with the American Civil Liberties Union of Nebraska, said the proposals would make the path to treatment too narrow and burdensome for patients.
"These regulations come after a year of lawmakers trying to erase trans people from public life," Friedman said in an email. "LB574 has the explicit goal of denying trans youth access to life-saving gender-related care that is based on individual needs and medical expertise.â€
LB574 was one of the most controversial bills of this year's legislative session. Kauth initially proposed a full ban on puberty blockers, hormone therapy and gender-affirming surgeries for people under 19, but that was changed after the bill adopted a major amendment that also added an abortion ban at 12 weeks based on gestational age.
The final version imposed a full ban on surgeries for that age group, but directed the chief medical officer to develop the regulations for puberty blockers and hormone therapy.
According to department officials, Tesmer is working with a group of experts on drafting the regulations, all of whom will remain anonymous until the drafting is complete. After the hearing, the regulations will go through several groups for review, including the Board of Health and the Attorney General’s Office, before finally going to Pillen’s desk for approval.
Photos and video: Scene at Nebraska Capitol as lawmakers pass LB574