Gender Affirming Hormone Therapy

Funding for the initiation and subsequent maintenance of Gender-affirming Hormone Therapy (GAHT) in primary care is now available for extended consultations via POAC, for eligible patients 18 years and over.

Funding Criteria

·       A single extended consultation per patient can be claimed for the initiation of GAHT.  Initiation is considered the first GAHT appointment or reinstatement of GAHT with clinical discretion.

·       Up to four subsequent follow-up (maintenance) appointments can be claimed within the first 12 months following GAHT initiation.

·       The GAHT initiation must occur in a general practice to claim funding for subsequent follow-up appointments.

·       A patient co-payment may be charged at the practice’s discretion.

Funding and Competency

·       Funding can be claimed by General Practitioners and Nurse Practitioners, who are confident in their competencies to initiate GAHT in primary care, without a routine secondary care referral, and wish to do so, thereby following the Primary Care Gender Affirming Hormone Therapy Guidelines Primary-Care-GAHT-Guidelines_Web_29-Mar.pdf (otago.ac.nz) Otherwise, please request support from Hauora Tāhine – Pathways to Transgender Healthcare Services.

·       Any claims for the funding via POAC constitute an agreement to provide the services according to the accepted national guidance, and the funding specification (eligibility). Please note, these claims may be subject to clinical audit.

·       Further information about GAHT clinical guidelines, Gender Affirming Healthcare, and the Hauora Tāhine – Pathways to Transgender Healthcare Services is available on HealthPathways: Gender Diversity and Transgender Health Pathway

·       For information pertaining to training, please register interest via Qtopia: Primary Care Training (qtopia.org.nz)

Eligibility

·       Patients must be 18 years and over.

·       Patients are eligible for publicly funded health services in New Zealand (as per Te Whatu Ora criteria) https://www.tewhatuora.govt.nz/our-health-system/eligibility-for-publicly-funded-health-services/guide-to-eligibility-for-public-health-services/

·       Funded follow-up appointments must occur within 12 months of the initiation appointment.

·       Patients can be enrolled or casual.

·       Funding is available for all practices within the Auckland Metro Region (Te Toka Tumai Auckland, Counties Manukau, Waitemata districts)

Claiming

·       Claiming is via the POAC PMS claiming portal.

·       Submit a ‘New Referral’ using the date of initial consultation and select code ‘Gender Affirming Hormone Therapy.’  (Note that only one single referral is required and all subsequent invoices should be submitted under the original case number)

·       Following the consultation, submit an ‘invoice’ via the claiming portal and select from the two consult options:

1.      Initial appointment with hormone therapy initiated: $100.00 excl GST ($115)

2.      Initial appointment without hormone therapy: $100.00 excl GST ($115)

3.      Follow-up appointment with hormone therapy: $50.00 excl GST ($57.50)

4.      Follow-up appointment without hormone therapy: $50.00 excl GST ($57.50)

·       Claims can be backdated to 1st July 2024.

Clinicians are encouraged to refer to: Gender Diversity and Transgender Health Pathway