,i  #aaf? ,,congress  #b;d ,session  ,h4
 ,r4 #hjac  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,augu/ #aa1 #bjbj,mr4 
,la,malfa 7= himself1 ,mr4 ,norman1 ,mr4
 ,ad]holt1 ,mr4 ,lamborn1 ,mr4 ,all51   
,mr4 ,k+ ( ,i[a1 ,mr4 ,/eube1 ,mr4      
,bab91 ,mr4 ,flores1 & ,mr4 ,hice (     
,georgia7 introduc$ ! foll[+ bill2 :i* 0
 ref]r$ to ! ,committee on ,en]gy &     
,comm]ce1 & 9 addition to ! ,committees 
on ! ,judici>y1 & ,ways & ,means1 = a   
p]iod to be subsequ5tly det]m9$ by !    
,speak]1 9 ea* case = consid]ation ( su*
 provisions z fall )9 ! jurisdiction ( !
 committee conc]n$  ,a ,,bill  ,to      
prohibit taxpay]-fund$ g5d] reassignm5t 
m$ical int]v5tions1 & = o!r purposes4   
#a4 ,%ort title2 table ( cont5ts  7a7   
,%ort title ,?is ,act may be cit$ z !   
,end ,taxpay] ,fund+ ( ,g5d]            
,exp]im5tation ,act ( #bjbj4  7b7 ,table
 ( cont5ts ,! table ( cont5ts ( ?is ,act
 is z foll[s3 ,sec4 #a4 ,%ort title2    
table ( cont5ts4,title ,i--,prohibit+   
,f$]ally ,fund$ ,g5d] ,reassignm5t      

,m$ical ,interventions,sec4 #aja4       
,prohibit+ taxpay]-fund$ g5d]           
reassignm5t m$ical int]v5tions4,sec4    
#ajb4 ,am5dm5t to table ( *apt]s4,title 
,,ii--,application "u ! ,af=dable ,c>e  
,act,sec4 #bja4 ,cl>ify+ application (  
prohibition to premium cr$its & co/-%>+ 
r$uctions "u ,,aca4  ,i ,prohibit+      
,f$]ally ,fund$ ,g5d] ,reassignm5t      
,m$ical ,int]v5tions  #aja4 ,prohibit+  
taxpay]-fund$ g5d] reassignm5t m$ical   
int]v5tions ,title #a1 ,unit$ ,/ates    
,code1 is am5d$ by add+ at ! end !      
foll[+ new *apt]3  #d ,prohibit+        
taxpay]-fund$ g5d] reassignm5t m$ical   
int]v5tions  #cja4 ,prohibition on fund+
 = g5d] reassignm5t m$ical int]v5tions4 
#cjb4 ,prohibition on fund+ = heal?     
b5efits plans t cov] g5d] reassignm5t   
m$ical int]v5tions4 #cjc4 ,limitation on
 ,f$]al facilities & employees4 #cjd4   
,con/ruction relat+ to sep>ate cov]age4 
#cje4 ,con/ruction relat+ to ! use (    
non-,f$]al funds = heal? cov]age4 #cjf4 
,con/ruction relat+ to complications    

aris+ f g5d] reassignm5t m$ical         
int]v5tions4 #cjg4 ,treatm5t (          
individuals born ) m$ically v]ifiable   
disord] ( sex developm5t4 #cjh4 ,g5d]   
reassignm5t m$ical int]v5tion def9$4    
#cja4 ,prohibition on fund+ = g5d]      
reassignm5t m$ical int]v5tions ,no funds
 au?oriz$ or appropriat$ by ,f$]al law1 
& none ( ! funds 9 any tru/ fund to :i* 
funds are au?oriz$ or appropriat$ by    
,f$]al law1 %all be exp5d$ = any g5d]   
reassignm5t m$ical int]v5tion4  #cjb4   
,prohibition on fund+ = heal? b5efits   
plans t cov] g5d] reassignm5t m$ical    
int]v5tions ,no funds au?oriz$ or       
appropriat$ by ,f$]al law1 & none ( !   
funds 9 any tru/ fund to :i* funds are  
au?oriz$ or appropriat$ by ,f$]al law1  
%all be exp5d$ = heal? b5efits cov]age t
 includes cov]age ( g5d] reassignm5t    
m$ical int]v5tions4  #cjc4 ,limitation  
on ,f$]al facilities & employees ,no    
heal? c>e s]vice furni%$-- 7#a7 by or 9 
a heal? c>e facility own$ or op]at$ by !
 ,f$]al ,gov]nm5t2 or  7#b7 by any      

physician or o!r individual employ$ by !
 ,f$]al ,gov]nm5t to provide heal? c>e  
s]vices )9 ! scope ( ! physician's or   
individual's employm5t1  may include    
g5d] reassignm5t m$ical int]v5tions4    
#cjd4 ,con/ruction relat+ to sep>ate    
cov]age ,no?+ 9 ?is *apt] %all be       
con/ru$ z prohibit+ any individual1     
entity1 or ,/ate or locality f pur*as+  
sep>ate cov]age = g5d] reassignm5t      
m$ical int]v5tions or heal? b5efits     
cov]age t includes g5d] reassignm5t     
m$ical int]v5tions s long z su* cov]age 
is paid = entirely us+ only funds n     
au?oriz$ or appropriat$ by ,f$]al law & 
su* cov]age %all n be pur*as$ us+ mat*+ 
funds requir$ = a f$]ally subsidiz$     
program1 includ+ a ,/ate's or locality's
 contribution ( ,m$icaid mat*+ funds4   
#cje4 ,con/ruction relat+ to ! use (    
non-,f$]al funds = heal? cov]age ,no?+ 9
 ?is *apt] %all be con/ru$ z re/rict+ ! 
ability ( any non-,f$]al heal? b5efits  
cov]age provid] f (f]+ cov]age = g5d]   
reassignm5t m$ical int]v5tions1 or !    

ability ( a ,/ate or locality to        
contract sep>ately ) su* a provid] = su*
 cov]age1 s long z only funds n au?oriz$
 or appropriat$ by ,f$]al law are us$ & 
su* cov]age %all n be pur*as$ us+ mat*+ 
funds requir$ = a f$]ally subsidiz$     
program1 includ+ a ,/ate's or locality's
 contribution ( ,m$icaid mat*+ funds4   
#cjf4 ,con/ruction relat+ to            
complications aris+ f g5d] reassignm5t  
m$ical int]v5tions ,no?+ 9 ?is *apt]    
%all be con/ru$ to apply to ! treatm5t (
 any infection1 injury1 disease1 or     
disord] t has be5 caus$ by or exac]bat$ 
by ! p]=mance ( a g5d] reassignm5t      
m$ical int]v5tion4 ,?is rule (          
con/ruction %all be applicable )\t reg>d
 to :e!r ! g5d] reassignm5t m$ical      
int]v5tion 0 p]=m$ 9 accord ) ,f$]al or 
,/ate law1 & )\t reg>d to :e!r fund+ = !
 g5d] reassignm5t m$ical int]v5tion is  
p]missible "u section #cjg4  #cjg4      
,treatm5t ( individuals born ) m$ically 
v]ifiable disord] ( sex developm5t ,!   
limitations e/abli%$ 9 sections #cja1   

#cjb1 & #cjc %all n apply ) respect to !
 foll[+ individuals3 7#a7 ,an individual
 ) ext]nal biological sex *>act]i/ics t 
are irresolvably ambigu\s1 su* z ^? born
 ) #df ,,xx *romosomes ) virilization1  
#df ,,xy *romosomes ) und]virilization1 
or hav+ bo? ov>ian & te/icul> tissue4   
7#b7 ,an individual ) respect to :om a  
physician has det]m9$ ?r\gh g5etic or   
bio*emical te/+ t ! individual does n h 
normal sex *romosome /ructure1 sex /]oid
 hormone production1 or sex /]oid       
hormone action = a biological male or   
female4  #cjh4 ,g5d] reassignm5t m$ical 
int]v5tion def9$ ,= purposes ( ?is      
*apt]1 ! t]m g5d] reassignm5t m$ical    
int]v5tion means-- 7#a7 p]=m+ a surg]y t
 /]ilizes an individual1 includ+        
ca/ration1 vasectomy1 hy/]ectomy1       
oophorectomy1 metoidiopla/y1 p5ectomy1  
phallopla/y1 & vag9opla/y1 to *ange !   
body ( su* individual to correspond to a
 sex t is discordant ) biological sex2  
7#b7 p]=m+ a ma/ectomy on an individual 
= ! purpose describ$ 9 p>agraph 7#a72 & 

7#c7 adm9i/]+ or supply+ to an          
individual m$ications = ! purpose       
describ$ 9 p>agraph 7#a71 includ+-- 7,a7
 ,gn,r,h agoni/s or o!r pub]ty-block+   
drugs to /op or delay normal pub]ty2    
7,b7 te/o/]one or o!r &rog5s to         
biological females at doses t are       
supraphysiologic to ! female sex2 &     
7,c7 e/rog5 to biological males at doses
 t are supraphysiologic to ! male sex4  
4  #ajb4 ,am5dm5t to table ( *apt]s ,!  
table ( *apt]s = title #a1 ,unit$ ,/ates
 ,code1 is am5d$ by add+ at ! end !     
foll[+ new item3  #d4,prohibit+         
taxpay]-fund$ g5d] reassignm5t m$ical   
int]v5tions#cja  4  ,,ii ,application "u
 ! ,af=dable ,c>e ,act  #bja4 ,cl>ify+  
application ( prohibition to premium    
cr$its & co/-%>+ r$uctions "u ,,aca  7a7
 ,9 g5]al  7#a7 ,disall[ance (          
refundable cr$it & co/-%>+ r$uctions =  
cov]age "u qualifi$ heal? plan :i*      
provides cov]age = g5d] reassignm5t     
m$ical int]v5tions  7,a7 ,9 g5]al       
,subp>agraph 7,a7 ( section             

#cf;,b7c77#c7 ( ! ,int]nal ,rev5ue ,code
 ( #aihf is am5d$ by ins]t+ be=e ! p]iod
 at ! end ! foll[+3 or any heal? plan t 
includes cov]age = g5d] reassignm5t     
m$ical int]v5tions 7o!r ?an any g5d]    
reassignm5t m$ical int]v5tion or        
treatm5t describ$ 9 section #cjf or #cjg
 ( title #a1 ,unit$ ,/ates ,code74  7,b7
 ,option to pur*ase or (f] sep>ate      
cov]age or plan ,p>agraph 7#c7 ( section
 #cf;,b7c7 ( su* ,code is am5d$ by add+ 
at ! end ! foll[+ new subp>agraph3  7,c7
 ,sep>ate cov]age or plan = g5d]        
reassignm5t m$ical int]v5tions all[$    
7i7 ,option to pur*ase sep>ate cov]age  
or plan ,no?+ 9 subp>agraph 7,a7 %all be
 con/ru$ z prohibit+ any individual f   
pur*as+ sep>ate cov]age = g5d]          
reassignm5t m$ical int]v5tions describ$ 
9 su* subp>agraph1 or a heal? plan t    
includes su* g5d] reassignm5t m$ical    
int]v5tions1 s long z no cr$it is all[$ 
"u ?is section ) respect to ! premiums =
 su* cov]age or plan4  7ii7 ,option to  
(f] cov]age or plan ,no?+ 9 subp>agraph 

7,a7 %all re/rict any non-,f$]al heal?  
insurance issu] (f]+ a heal? plan f (f]+
 sep>ate cov]age = g5d] reassignm5t     
m$ical int]v5tions describ$ 9 su*       
subp>agraph1 or a plan t includes su*   
g5d] reassignm5t m$ical int]v5tions1 s  
long z premiums = su* sep>ate cov]age or
 plan are n paid = ) any am\nt          
attributable to ! cr$it all[$ "u ?is    
section 7or ! am\nt ( any advance paym5t
 ( ! cr$it "u section #adab ( ! ,pati5t 
,protection & ,af=dable ,c>e ,act74  4  
7#b7 ,disall[ance ( small employ] heal? 
insurance exp5se cr$it = plan :i*       
includes cov]age = g5d] reassignm5t     
m$ical int]v5tions ,subsection 7h7 (    
section #de,r ( ! ,int]nal ,rev5ue ,code
 ( #aihf is am5d$-- 7,a7 by /rik+ ,any  
t]m & ins]t+ ! foll[+3  7#a7 ,9 g5]al   
,any t]m  2 &  7,b7 by add+ at ! end !  
foll[+ new p>agraph3  7#b7 ,exclusion ( 
heal? plans includ+ cov]age = g5d]      
reassignm5t m$ical int]v5tions  7,a7 ,9 
g5]al ,! t]m qualifi$ heal? plan does n 
include any heal? plan t includes       

cov]age = g5d] reassignm5t m$ical       
int]v5tions 7o!r ?an any g5d]           
reassignm5t m$ical int]v5tion or        
treatm5t describ$ 9 section #cjf or #cjg
 ( title #a1 ,unit$ ,/ates ,code74  7,b7
 ,sep>ate cov]age or plan = g5d]        
reassignm5t m$ical int]v5tions all[$    
7i7 ,option to pur*ase sep>ate cov]age  
or plan ,no?+ 9 subp>agraph 7,a7 %all be
 con/ru$ z prohibit+ any employ] f      
pur*as+ = its employees sep>ate cov]age 
= g5d] reassignm5t m$ical int]v5tions   
describ$ 9 su* subp>agraph1 or a heal?  
plan t includes su* g5d] reassignm5t    
m$ical int]v5tions1 s long z no cr$it is
 all[$ "u ?is section ) respect to !    
employ] contributions = su* cov]age or  
plan4  7ii7 ,option to (f] cov]age or   
plan ,no?+ 9 subp>agraph 7,a7 %all      
re/rict any non-,f$]al heal? insurance  
issu] (f]+ a heal? plan f (f]+ sep>ate  
cov]age = g5d] reassignm5t m$ical       
int]v5tions describ$ 9 su* subp>agraph1 
or a plan t includes su* g5d]           
reassignm5t m$ical int]v5tions1 s long z

 su* sep>ate cov]age or plan is n paid =
 ) any employ] contribution eligible = !
 cr$it all[$ "u ?is section4  4  7b7    
,application to multi-,/ate plans       
,section #accd7;a7 ( ,public ,law       
#aaa-adh 7#db ,u4,s4,c4 #ahjed7;a77 is  
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#g7 ,cov]age consi/5t )     
,f$]al policy reg>d+ g5d] reassignm5t   
m$ical int]v5tions ,9 ent]+ into        
contracts "u ?is subsection1 ! ,director
 %all ensure t no multi-,/ate qualifi$  
heal? plan (f]$ 9 an ,ex*ange provides  
heal? b5efits cov]age = :i* ! exp5diture
 ( ,f$]al funds is prohibit$ "u *apt] #d
 ( title #a1 ,unit$ ,/ates ,code4  4    
7c7 ,effective date ,! am5dm5ts made by 
subsection 7a7 %all apply to taxable    
ye>s end+ aft] ,decemb] #ca1 #bjai1 b   
only ) respect to plan ye>s beg9n+ aft] 
su* date1 & ! am5dm5t made by subsection
 7b7 %all apply to plan ye>s beg9n+ aft]
 su* date4