Smart Benefits: CMS Issues Proposed Rule on Definition of Spouse

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Monday, December 22, 2014

Amy Gallagher, GoLocalWorcester Business/Health Expert

This month, the Centers for Medicare and Medicaid published a proposed rule that revises the definitions of “representative” and “spouse” in its Medicare and Medicaid conditions of participation and coverage. Now, all legally married same-sex spouses will have the same right to participate in various aspects of their spouse’s healthcare, including visitation and decision-making, in Medicare and Medicaid participating facilities.

The response follows a 2013 US Supreme Court decision that ruled a section of the Defense of Marriage Act (DOMA), which defined marriage as a legal union between one man and one woman as husband and wife and banned federal benefits for same-sex spouses, was unconstitutional. 

Under the proposed rule, which applies to all ambulatory surgical centers, hospices, hospitals, long-term care facilities, and community mental health centers that participate in Medicare and Medicaid, institutions must respect a same-sex spouse’s decisions to designate their spouse as a “representative” or “spouse” as long as the couple is legally married “under the law of the state, territory, or foreign jurisdiction where the marriage was entered into.” This rule extends to same-sex couples who reside in or seek treatment in a state that doesn’t legally recognize their marriage. 

This proposed rule is open for comment for 60 days.

Amy Gallagher has over 21 years of healthcare industry experience guiding employers and employees. As Vice President at Cornerstone Group, she advises large employers on all aspects of healthcare reform, benefit solutions, cost-containment strategies and results-driven wellness programs. Amy speaks regularly on a variety of healthcare-related topics, and is often quoted by national publications on the subject matter. Locally, Amy is a member of SHRM-RI, the Rhode Island Business Group on Health, and the Rhode Island Business Healthcare Advisory Council.

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