Repromulgate the national coverage determination on gender reassignment surgery

Research notes

• CMS’s Medicare Coverage Database has an open data service, and it is the only machine-readable way to answer ‘has this NCD changed’. https://api.coverage.cms.gov/v1/reports/national-coverage-ncd?pageSize=1000 returns all 345 NCDs with the date each was last updated; https://api.coverage.cms.gov/v1/data/ncd?ncdid=368&ncdver=1 returns NCD 140.9 with an effective date of 08/30/2016, document version 1, an implementation date of 04/04/2017 and no end date. The human page, https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=368, opens but its content is drawn in by the browser, so the data-service record is what was actually read.
• Not cited as Evidence: NCD 140.9 itself, because its date (2016) is outside the evidence window.
• Why not started: the ask is that CMS repromulgate the 2016 decision. Neither of the 2025-12-19 proposed rules is a coverage determination and both are limited to children, so neither delivers a piece of this ask; not started with the nearest in-window instrument attached for the reader.
• Unified Agenda, checked 2026-09-01. Checked against the full HHS agenda on reginfo.gov (183 active RINs in the 2026 Unified Agenda, published 2026-08-14), not the abbreviated version the Federal Register prints. The nearest entries are recorded here; neither names this ask’s object, so the Status is unchanged: an agenda entry, like a strategic plan, counts only when it names what the ask asks for.
  • The two sex-rejecting-procedure rulemakings both act elsewhere: 0938-AV73 (Prohibition on Federal Medicaid and CHIP Funding for Specified Sex-Rejecting Procedures Furnished to Children and Youth, CMS-2451, NPRM published 2025-12-19, final action 09/2026) and 0938-AV87 (Hospital Condition of Participation: Prohibiting Sex-Rejecting Procedures for Children, CMS-3481, NPRM published 2025-12-19, final action 12/2026). Neither is a Medicare national coverage determination. Note the structural limit: an NCD is not a rulemaking, carries no RIN and never appears on a Unified Agenda, so the agenda cannot answer this ask in either direction — the coverage database’s data service (api.coverage.cms.gov) remains the instrument that can.