Changed Laws and Regulations Impact Reproductive Health Care Providers | Harris Beach Murtha PLLC

Within the past few months, the legal landscape for reproductive health care law has changed on both the federal and state levels. The Trump Administration has changed its approach, revising positions in administrative guidance and its stance in federal courts. Meanwhile, various states, including Connecticut, have prioritized reproductive health care rights as an area of focus and are actively issuing guidance and passing legislation.

CMS Revokes Previous Administration’s HHS EMTALA Guidance

On May 29, 2025, the Centers for Medicare & Medicaid Services (“CMS”) and the Department of Health and Human Services (“HHS”) rescinded previous Emergency Medical Treatment & Labor Act (“EMTALA”) letters of guidance issued in 2022 by the Biden administration in the wake of the Supreme Court’s Dobbs v. Jackson Women’s Health Organization (“Dobbs”) reversal of Roe v. Wade The 2022 guidance made clear that federal law under EMTALA would override any conflicting state abortion restrictions in the event a physician determines abortion was a stabilizing treatment medically necessary to combat an emergency medical condition.

The withdrawal of the 2022 guidance was issued with a brief but direct statement that “[the 2022 guidance] do[es] not reflect the policy of this Administration.” The primary objection to the 2022 policy stems from the current administration’s belief that HHS lacks the authority to mandate abortion as a stabilizing treatment under EMTALA, and that EMTALA should not supersede state abortion laws.

The 2022 guidance had resulted in significant litigation, particularly in Texas and Idaho, as the courts wrestled with how to interpret state abortion bans in relation to EMTALA. Even with the 2022 guidance now withdrawn, litigation on this issue is likely to continue.

On June 24, 2025, a coalition of 22 attorneys general, including the attorneys general of Connecticut, New York and Massachusetts, issued a letter to the American Hospital Association communicating that hospitals must comply with EMTALA as if the 2022 guidance had never been rescinded. In summary, the attorneys general explained “[t]he law is clear: Hospitals subject to EMTALA have an obligation to provide timely abortion care when necessary to stabilize a patient experiencing an emergency medical condition.” Further, in Connecticut, Section 171 of Public Act 25-168, requires emergency departments of licensed hospitals to provide reproductive health care services related to pregnancy complications that are legal in the state and necessary to treat the patient, including services related to miscarriage management and treatment for ectopic pregnancies.

In Connecticut, New York and Massachusetts, the withdrawal of the guidance should not affect compliance with EMTALA, as abortion continues to be a legal procedure.

Federal District Court Vacates a HIPAA Reproductive Health Care Privacy Rule

On June 18, 2025, the U.S. District Court for the Northern District of Texas vacated a majority of the requirements under the Health Insurance Portability and Accountability Act (“HIPAA”) Privacy Rule to Support Reproductive Health Care Privacy (“Final Rule”) in its decision of Purl v. United States Department of Health and Human Services (“Purl”).

The Final Rule was issued in the wake of Dobbs and prohibited HIPAA covered entities from disclosing Reproductive Health Care (“RHC”) information for certain purposes. These purposes include conducting a criminal, civil or administrative investigation into any person for the mere act of (1) seeking, obtaining, providing or facilitating legally rendered reproductive health care, (2) imposing criminal, civil or administrative liability on any person for the mere act of seeking, obtaining, providing or facilitating legally rendered reproductive health care, or (3) to identify any person for these purposes. As part of the Final Rule, a person or organization seeking disclosure of RHC needed to provide an attestation indicating the information would not be used for one of the prohibited purposes.

In Purl, the Final Rule was found as invalid on three separate fronts. The court first determined the Final Rule improperly limited state laws mandating potential child abuse reporting. Second, the court found HHS exceeded its authority by impermissibly redefining key words such as “person” and “public health.” Last, the court determined HHS was using HIPAA to set special protections for politically favored medical procedures, triggering the major questions doctrine which limits agencies from deciding issues of major national significance without clear congressional authorization. The court held that HHS lacked such clear congressional authorization to implement these special protections.

Covered entities that updated their policies and procedures in connection with the Final Rule will once again need to make changes in light of Purl.

State Laws May Continue to Provide Additional Protections for Reproductive Health Information

Although the Final Rule is now inapplicable nationwide, state privacy requirements are still applicable where more stringent than HIPAA. Specifically in Connecticut, health service providers should comply with Conn. Gen. Stat. § 52-146w, otherwise known as the Reproductive Freedom Defense Act (“RFDA”).

The RFDA protects Reproductive Health Care Services (“RHCS”) information. Like the Final Rule’s definition of RHC, the RFDA’s definition of RHCS is broad and includes “medical, surgical, counseling or referral services relating to the human reproductive system, including, but not limited to, services relating to pregnancy, contraception or the termination of a pregnancy and all medical care relating to treatment of gender dysphoria … and gender incongruence.” Conn. Gen. Stat. § 52-571m

Under the RFDA, a HIPAA-covered entity is prohibited from disclosing records containing RHCS information for the purposes of any (1) civil action, (2) civil probate, (3) legislative proceeding or (4) administrative proceeding, unless it obtains explicit patient consent. Patient consent is not required for a narrow set of exceptions, including when mandated by the laws of Connecticut or rules of the Connecticut Judicial Branch or for abuse reporting purposes.

Therefore, although HIPAA’s Final Rule is no longer in effect, covered entities in Connecticut should continue to ensure compliance with the RFDA when deciding whether to disclose RHCS information.

As of June 9, 2025, Connecticut has also expanded minors’ rights to privacy regarding RHCS through Public Act No. 25-28 (“PA 25-28”). This creates an additional category of services to which minors can consent and for which minors hold privacy rights.

Following PA 25-28, pregnancy and pregnancy prevention services do not require parental consent. Such services include (1) contraceptive counseling, (2) prenatal care, (3) pain management and appropriate care during labor and delivery. However, sterilization of a minor still requires the consent of a parent.

Further, unless a minor gives explicit permission, the law bars physicians and health care providers from disclosing any information regarding the related services, consultations or billing details, to a parent or guardian. However, it is important to understand that since parents are not informed about these services, they are not legally responsible for covering the costs.
PA 25-28 does not relieve providers of their duty to report abuse or to make any other disclosures required by state law.

Summer Law Clerk Alexander J. Marciniak contributed to this legal alert.