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Post-DOMA rule proposed for hospice care, nursing homes

Administration seeks to ensure same-sex marriages recognized regardless of state of residence

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Centers for Medicare & Medicaid Services, gay news, Washington Blade

The Centers for Medicare & Medicaid has proposed a new rule for hospice care and nursing homes. (Image public domain).

The Obama administration on Thursday announced a proposed rule that aims to ensure medical care for individuals in same-sex marriages — regardless of the state in which they live — following the Supreme Court decision against the Defense of Marriage Act.

The Centers for Medicare & Medicaid proposes the rule to change conditions for medical care providers and suppliers receiving support from Medicare and Medicaid, including hospitals and hospice care, as well as the requirements for long-term care facilities, or nursing homes.

The thrust of the proposed rule is to ensure same-sex marriages are recognized nationwide, even in states without marriage equality, for programs that in some aspects are administered by the states.

“This proposed rule addresses certain regulations governing Medicare and Medicaid participating providers and suppliers where current regulations look to state law in a matter that implicates (or may implicate) a marital relationship,” the rule states. “Our goal is to provide equal treatment to spouses, regardless of their sex, whenever the marriage was valid in the jurisdiction in which it was entered into, without regard to whether the marriage is also recognized in the state of residence or the jurisdiction in which the health care provider or supplier is located, and where the Medicare program explicitly or impliedly provides for specific treatment of spouses.”

The proposed rule, which can found here, is set for publication in the Federal Register on Friday. Once it’s published, comments must be received by 60 days to be assured consideration before the rule is made final.

Karen Loewy, senior attorney and seniors program strategist for the LGBT group Lambda Legal, said the proposed rules are “a very welcome development” and would “amend references to discriminatory state laws to provide equal treatment to spouses.”

“In practical terms, these changes will mean that a patient’s same-sex spouse will have the same right to access information, make decisions, and be part of admissions processes that a different-sex has in hospitals, hospice care, surgical care centers, long term care settings, labs, and community mental health centers that receive Medicare or Medicaid dollars, even when the laws of the state would not recognize their right to do so,” Loewy said. “These rules would provide important automatic protections for same-sex spouses, ensuring that a patient’s spouse gets to be by his or her side, be informed, and make those difficult decisions in vulnerable health care situations.”

In summary, the proposed rule seeks to established a same-sex spouse should be considered a person’s representative — regardless of state law — for the purposes for care from ambulatory surgical centers, hospice care, exercising a patient’s rights, informing patients of their rights, notification for laboratory services to screen blood and blood products for potentially infectious diseases like HIV and Hepatitis C, care in long-term facilities, pre-admission screening and resident review for long-term care, findings of these evaluations, care in Community Mental Health Centers and client rights at these facilities.

Mark Daley, a spokesperson for the National LGBTQ Task Force, said changes in proposed rule are “common-sense” and would help elders in the LGBT community ensure they receive equal care in medical facilities.

“These new policies help ensure that one of the most vulnerable populations in our country, LGBTQ elders, are able to access federal programs in the same way that non-LGBTQ people access programs,” Daley said. “This means ensuring that same-sex spouses will be treated exactly the same as different-sex spouses in programs like long-term care facilities, Hospice care, and hospitals. What this really means for LGBTQ folks is that same-sex spouses will be able to visit and make medical decisions on behalf of their spouse, just like different-sex couples. It means that LGBTQ elders will have legal rights in the health care context, regardless of whether your state continues to discriminate against you by refusing to recognize your marriage.”

After the Supreme Court decision against DOMA, the Centers for Medicare & Medicaid already issued guidance — once in September 2013 and again in May 2014 — to ensure same-sex marriages are recognized in determining eligibility for Medicaid and the Children’s Health Insurance Program. But the proposed rule says it’s needed because policies it addresses “are administered by different statutes and are administered by state Medicaid agencies and CMS.”

Sarah Warbelow, legal director for the Human Rights Campaign, said the proposed rule will help individuals in same-sex marriages in the medical care situations when they need assistance the most.

“When people are at their most vulnerable, from hospitals to hospice care to nursing homes, they need to know that their spouse will be fully informed, be able to help them make decisions, and be fully regarded as their spouse,” Warbelow said. “The rule proposed by the Centers for Medicare and Medicaid will help to ensure that the marriages of same-sex couples are treated equally regardless of where the couple lives.”

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District of Columbia

Both sides propose revised orders in Capital Pride stalking case

Defendant Darren Pasha agreed to accept less restrictive directive

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Darren Pasha (Washington Blade photo by Michael Key)

An evidentiary hearing in D.C. Superior Court on April 29 in which the Capital Pride Alliance presented three of four planned witnesses to testify in support of its civil complaint that D.C. gay activist Darren Pasha engaged in a year-long effort to harass, intimidate, and stalk its staff, board members, and volunteers ended abruptly at the direction of the judge.

Judge Robert D. Okun announced from the bench that the hearing, which was intended provide Capital Pride an opportunity to present evidence in support of its request to reinstate an anti-stalking order against Pasha that the judge temporarily rescinded on April 17, was no longer needed because Pasha stated at the hearing that he is willing to accept a revised, less restrictive temporary restraining order.

Pasha made that statement after two Capital Pride witnesses — June Crenshaw and Vincenzo Volpe — each testified in support of the stalking allegations against Pasha for over an hour under questioning from Capital Pride attorney Nick Harrison and under cross-examination from Pasha, who is representing himself without an attorney.

After Capital Pride’s third witness, Tifany Royster, testified for just a few minutes, and after the judge called a recess for lunch and to attend to an unrelated case, Pasha announced that after obtaining legal advice he determined that he was unsuited to continue cross-examining the witnesses. He said he would be willing to accept a significantly less restrictive temporary restraining order.

Okun then ruled that the evidentiary hearing was no longer needed and directed Capital Pride and Pasha to submit to him their version of a revised stay away order. He said he would use their proposed revisions to help him develop his own order, which he would issue after deliberating over the matter.

He also scheduled a mandatory remote mediation session for July 23, in which efforts would be made to resolve the case without going to trial. He then adjourned the hearing at 3:50 p.m.

The online Superior Court docket for the case stated after the hearing ended that the judge would issue “a new modified Temporary Protective Order,” but it did not say when it would be issued.   

Shortly before the April 29 hearing began at 11 a.m., Harrison filed a “Draft Temporary Anti-Stalking Order” that included a list of 34 “Protected Persons” that Harrison said during the hearing were affiliated with Capital Pride Alliance as staff and board members, volunteers, and others associated with the group.

The proposed order stated, “The defendant shall not contact, attempt to contact, harass, threaten, or otherwise communicate with any protected person, directly or indirectly, including through third parties, social media, electronic communications, or any other means.”

The proposal represented a significant change from Capital Pride’s initial civil complaint against Pasha filed in February that Pasha claimed called for him to stay away at least 200 yards from all Capital pride staff, board members, and volunteers without naming them. Okun granted that stay away request in February but reduced the stay away distance to 100 feet.

Capital Pride attorney Harrison disputes Pasha’s interpretation of the order, saying the 100-foot stay-away was for events, not for individual Capital Pride staff, volunteers, or board members. He said the order prohibited Pasha from engaging in any way with the Capital Pride staffers, volunteers or board members.

But the proposed order Capital Pride at first submitted at the April 29 hearing  also called for Pasha to stay away from and to not attend as many as 25 Capital Pride events scheduled to take place this year from April 30 through June 21 and for him to say away from the Capital Pride office located at 1827 Wiltberger St., N.W., which is the building in which it shares with the DC LGBTQ Community Center.

At the April 29 hearing, at Pasha’s request, Okun called on Capital Pride to consider allowing Pasha to attend at least the two largest events — the Capital Pride Parade and Festival — which draw over 500,000 participants.

Harrison said in a follow-up message to the judge following the hearing that Capital Pride would allow Pasha to attend those two events and one other as long as he stays away from “ticketed and controlled access areas.”

At an April 17 status hearing Okun rescinded the earlier stay away order at Pasha’s request, among other things, on grounds that it was too vague and didn’t provide Pasha with sufficient specific information on who to stay away from. It was at that hearing that Okun scheduled the April 29 evidentiary hearing, saying it would give Capital Pride a chance to provide sufficient evidence to justify an anti-stalking order and Pasha an opportunity to challenge the evidence.  

In his own response to the initial civil complaint filed in February and in subsequent court filings, Pasha has strongly denied he engaged in stalking and has alleged that the complaint was a form of retaliation against him over a dispute he has had with Capital Pride and its former board president, Ashley Smith.

Like its initial complaint filed in February, Capital Pride filed a multipage document at the start of the April 29 hearing with written testimony from staff members and volunteers who allege that Pasha did engage in stalking, harassment, and intimidating behavior toward them and others.

Like Capital Pride, Pasha following the April 29 hearing, filed his own proposed version of the stay away order with significantly less restrictions than the Capital Pride proposal. Among other things, it calls for him to restrict his contact with Capital Pride CEO Ryan Bos and Crenshaw but says it “does not by its terms restrict the defendant’s communications with any other person, entity, governmental body, or media outlet.”

“Darren Pasha sent multiple messages to us and to the court after the proceedings asking for further modifications — which we are not accepting or responding to,” Harrison told the Blade in response to a request for further comment on Judge’s request for each side to submit proposed revisions of the stay away order.

“We appreciate the court’s time and careful attention to the evidence presented today,” Harrison told the Washington Blade in a written statement after the hearing. “This process was about bringing forward the experiences of individuals who reported a pattern of conduct that caused fear, serious alarm, and emotional distress,” he said.

“Capital Pride Alliance remains committed to ensuring that our events and community spaces are safe, welcoming, and free from harassment and we will continue to take appropriate steps to support and protect our community,” his statement says.

“I am happy with what we have accomplished so far,” Pasha told the Blade after the hearing.  “I’m just waiting to see what will happen next. But I want to reiterate this goes back to when someone treats you wrong you speak up,” he said. “Even if I lose this case, I am glad that I spoke up and raised concerns.”

He added, “I will just be confident that in the next couple of months the truth will come out. But for now, I am happy with the progress that we have made regarding this.”

This story will be updated when the judge issues his revised stay away order.

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European Union

European Parliament backs EU-wide conversion therapy ban

More than 1.2 million people backed campaign

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(Photo by axelbueckert/Bigstock)

The European Parliament on Wednesday voted in favor of banning so-called conversion therapy across the European Union.

ACT (Against Conversion Therapy) LGBT in 2024 launched a campaign in support of the ban through the EU’s European Citizens Initiative framework. More than 1.2 million people ultimately signed it.

The proposed ban had the support of 405 MEPs. The European Commission is expected to formally respond to it by May 18.

Seven EU countries — Belgium, Cyprus, France, Malta, Norway, Portugal, and Spain — have banned conversion therapy outright.

Greece in 2022 banned the practice for minors. German lawmakers in 2020 passed a law that prohibits conversion therapy for minors and for adults who have not consented to undergoing the widely discredited practice.

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National

Advocacy groups issue US travel advisory ahead of World Cup

Renee Good’s death in Minneapolis among incidents cited

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(Photo by fifg/Bigstock)

More than 100 organizations have issued a travel advisory for the U.S. ahead of the 2026 World Cup.

The World Cup will take place in the U.S., Canada, and Mexico from June 11-July 19.

“In light of the deteriorating human rights situation in the United States and in the absence of meaningful action and concrete guarantees from FIFA, host cities, or the U.S. government, the undersigned organizations are issuing this travel advisory for fans, players, journalists, and other visitors traveling to and within the United States for the June 2026 FIFA Men’s World Cup. World Cup games will be played in 11 different cities across the United States, which, like many localities, have already been the target of the Trump administration’s violent and abusive immigration crackdown,” reads the advisory that the Council for Global Equality and other groups that include the American Civil Liberties Union issued on April 23.  “The impacts of these policies vary by locality.”

“While the Trump administration’s rising authoritarianism and increasing violence pose serious risks to all, those from immigrant communities, racial and ethnic minority groups, and LGBTQ+ individuals have been and continue to be disproportionately targeted and affected by the administration’s policies and, as such, are most vulnerable to serious harm when traveling to and/or within the United States,” it adds. “This travel advisory calls on fans, players, journalists, and other visitors to exercise caution.”

The advisory specifically mentions Renee Good.

A U.S. Immigration and Customs Enforcement agent on Jan. 7 shot and killed her in Minneapolis. Good, 37, left behind her wife and three children.

The full advisory can be read here.

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