Overview
On March 5, 2025, the Center for Clinical Standards and Quality (CCSQ) within the Centers for Medicare & Medicaid Services (CMS) released a Quality & Safety Special Alert Memo for hospitals related to President Trump’s executive order (EO) “Protecting Children from Chemical and Surgical Mutilation.”
In Depth
In the memo, CMS notes that it “may begin taking steps in the future to align policy, including CMS-regulated provider requirements and agreements, with the highest-quality medical evidence in the treatment of the nation’s children in order to protect children from harmful, often irreversible mutilation, including sterilization practices.” CMS says that it will “follow any applicable substantive and procedural requirements in taking any future action.”
The memo does not call for any immediate change in action, but it strongly suggests that hospitals will see future action from CMS on this topic to enforce the terms of the EO.
The next day, the Health Resources and Services Administration (HRSA) sent a letter to hospital administrators and others noting the CCSQ memo and stating that HRSA would review its policies, grants, and programs in light of the concerns CMS identified in the CCSQ Memo and may take steps in the future to update its policies to comply with the EO. HRSA also stated that it would review its Children’s Hospitals Graduate Medical Education (CHGME) Payment Program that awarded $367.2 million in fiscal year (FY) 2024 to 59 free-standing children’s hospitals nationwide and that it may consider re-scoping, delaying, or potentially canceling new grants in the future depending on the nature of the work and any future policy change(s) HRSA may make.
The gender-affirming care EO has been subject to litigation, and federal judges in PFLAG v. Trump and Washington v. Trump have issued preliminary injunctions against Section 4, which directs agencies that provide grants to medical institutions to “immediately take appropriate steps to ensure that institutions receiving Federal research or education grants end the chemical and surgical mutilation of children.” It is questionable whether these actions – particularly the HRSA letter – comply with the terms of the preliminary injunctions insofar as they may be viewed to threaten federal research and education grants. However, Section 5 of the EO remains in effect and may be the section upon which the US Department of Health and Human Services (HHS) would claim to be acting. Section 5 directs HHS to take actions to “end the chemical and surgical mutilation of children, including regulatory and sub-regulatory actions,” including “Medicare or Medicaid conditions of participation or conditions for coverage, clinical-abuse or inappropriate-use assessments relevant to State Medicaid programs, and quality, safety, and oversight memoranda.”
CCSQ serves as the focal point for all quality, clinical, and medical science issues and policies for CMS programs. It oversees the planning, policy, coordination, and implementation of the survey, certification, and enforcement programs for all Medicare and Medicaid providers and suppliers, and develops requirements of participation for providers and plans in Medicare and Medicaid. HRSA is a separate agency within HHS that administers an extensive federal grant program. In FY 2024, HRSA awarded more than $12.2 billion in grants, making more than 6,000 grant awards focused on improving healthcare services.
McDermott continues to monitor developments surrounding the EO, including the ongoing litigation. We are in the process of updating our FAQs to provide additional analysis of the issues the EO presents. If you have any questions, please contact the authors of this article or your regular McDermott lawyer.
