,i #aah? ,,congress #a/ ,session ,h4 ,r4 #acii ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,m>* #g1 #bjbc ,ms4 ,gre5e ( ,georgia 7= h]self1 ,mrs4 ,mill] ( ,ill9ois1 ,mr4 ,gos>1 ,mr4 ,good5 ( ,texas1 ,mr4 ,gro?man1 ,mr4 ,duncan1 ,mrs4 ,luna1 ,mrs4 ,h>%b>g]1 ,mr4 ,norman1 ,mr4 ,nehls1 ,mr4 ,good ( ,virg9ia1 ,mr4 ,h]n1 ,mr4 ,ros5dale1 ,mr4 ,bab91 ,mr4 ,lamborn1 ,mr4 ,higg9s ( ,l\isiana1 ,mr4 ,/eube1 ,ms4 ,hageman1 ,mrs4 ,lesko1 & ,mr4 ,biggs7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ! ,judici>y1 & 9 addition to ! ,committees on ,ways & ,means1 ,en]gy & ,comm]ce1 & ,education & ! ,work=ce1 = 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 am5d *apt] #aaj ( title #ah1 ,unit$ ,/ates ,code1 to prohibit g5d]-affirm+ c>e on m9ors1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,protect ,*ildr5's ,innoc5ce ,act4 ,i ,g5d]-affirm+ c>e on m9ors prohibit$ #aja4 ,g5d]-affirm+ c>e on m9ors prohibit$ ,*apt] #aaj ( title #ah1 ,unit$ ,/ates ,code1 is am5d$-- 7#a7 by add+ at ! end ! foll[+3 #bbfj;,b4 ,g5d]-affirm+ c>e on m9ors 7a7 ,9 g5]al ,:oev]1 9 any circum/ance describ$ 9 subsection 7e71 kn[+ly p]=ms any g5d]-affirm+ c>e on a m9or is guilty ( a class ,c felony4 7b7 ,prohibition on prosecution ( p]son on :om int]v5tion is p]=m$ ,no p]son on :om ! g5d]-affirm+ c>e "u subsection 7a7 is p]=m$ may be arre/$ or prosecut$ = an (f5se "u ?is section4 7c7 ,civil action ,a p]son on :om g5d]-affirm+ c>e is p]=m$ "u ?is section may br+ a civil action = appropriate relief1 includ+ comp5satory & punitive damages1 aga9/ ea* p]son :o p]=m$ ! g5d]-affirm+ c>e4 7d7 ,def9itions ,9 ?is section3 7#a7 ,g5d]-affirm+ c>e 7,a7 ,9 g5]al ,= purposes ( ?is *apt]1 except z provid$ 9 subp>agraph 7,b71 ! t]m g5d]-affirm+ c>e means1 ) respect to an individual1 any ( ! foll[+3 7i7 ,p]=m+ any surg]y = ! purpose ( *ang+ ! body ( su* individual to correspond to a sex t diff]s f _! biological sex1 includ+-- 7,i7 ca/ration2 7,,ii7 or*iectomy2 7,,iii7 scrotopla/y2 7,,iv7 vasectomy2 7,v7 hy/]ectomy2 7,,vi7 oophorectomy2 7,,vii7 ov>iectomy2 7,,viii7 metoidiopla/y2 7,,ix7 p5ectomy2 7,x7 phallopla/y2 7,,xi7 vag9opla/y2 7,,xii7 vag9ectomy2 7,,xiii7 vulvopla/y2 7,,xiv7 r$uction ?yro*ondropla/y2 7,,xv7 *ondrol>yngopla/y2 & 7,,xvi7 ma/ectomy4 7ii7 ,any pla/ic surg]y t fem9izes or mascul9izes ! facial features = ! purposes describ$ 9 clause 7i74 7iii7 ,any placem5t ( *e/ implants to create fem99e brea/s = ! purposes describ$ 9 clause 7i74 7iv7 ,any placem5t ( fat or artificial implants 9 ! gluteal region = ! purposes describ$ 9 clause 7i74 7v7 ,adm9i/]+1 supply+1 prescrib+1 disp5s+1 di/ribut+1 or o!rwise convey+ to an individual m$ications = ! purposes describ$ 9 clause 7i71 includ+-- 7,i7 gonadotrop9-releas+ hormone 7,gn,r,h7 analogues or o!r pub]ty-block+ drugs to /op or delay normal pub]ty2 7,,ii7 te/o/]one or o!r &rog5s to biological females at doses t are supraphysiologic to ! female sex2 & 7,,iii7 e/rog5 to biological males at doses t are supraphysiologic to ! male sex4 7,b7 ,exception ,subp>agraph 7,a7 %all n apply to ! foll[+ individuals3 7i7 ,an individual ) bo? ov>ian & te/icul> tissue4 7ii7 ,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 action4 7iii7 ,an individual exp]i5c+ infection1 disease1 injury1 or disord] caus$ or exac]bat$ by previ\s g5d] transition proc$ures4 7iv7 ,an individual suff]+ f a physical disord]1 physical injury1 or physical illness t w\ld1 z c]tifi$ by a physician1 place ! individual 9 imm95t dang] ( dea? or impairm5t ( a major bodily function unless ! proc$ure is p]=m$4 7#b7 ,biological sex ,! t]m biological sex means ! indication ( male or female sex by reproductive pot5tial or capacity1 sex *romosomes1 naturally occurr+ sex hormones1 gonads1 or int]nal or ext]nal g5italia pres5t at bir?4 7#c7 ,m9or ,! t]m m9or means any p]son "u ! age ( eighte5 ye>s4 7e7 ,circum/ances describ$ ,= purposes ( subsection 7a71 ! circum/ances describ$ 9 ?is subsection are t-- 7#a7 ! def5dant or victim travel$ 9 int]/ate or =eign comm]ce1 or travel$ us+ a means1 *annel1 facility1 or in/rum5tality ( int]/ate or =eign comm]ce1 9 fur!rance ( or 9 connection ) ! conduct describ$ 9 subsection 7a72 7#b7 ! def5dant us$ a means1 *annel1 facility1 or in/rum5tality ( int]/ate or =eign comm]ce 9 fur!rance ( or 9 connection ) ! conduct describ$ 9 subsection 7a72 7#c7 any paym5t ( any k9d 0 made1 directly or indirectly1 9 fur!rance ( or 9 connection ) ! conduct describ$ 9 subsection 7a7 us+ any means1 *annel1 facility1 or in/rum5tality ( int]/ate or =eign comm]ce or 9 or affect+ int]/ate or =eign comm]ce2 7#d7 ! def5dant transmitt$ 9 int]/ate or =eign comm]ce any communication relat+ to or 9 fur!rance ( ! conduct describ$ 9 subsection 7a7 us+ any means1 *annel1 facility1 or in/rum5tality ( int]/ate or =eign comm]ce or 9 or affect+ int]/ate or =eign comm]ce by any means or 9 mann]1 includ+ by comput]1 mail1 wire1 or electromagnetic transmission2 7#e7 any in/rum5t1 item1 sub/ance1 or o!r object t has travel$ 9 int]/ate or =eign comm]ce 0 us$ to p]=m ! conduct describ$ 9 subsection 7a72 7#f7 ! conduct describ$ 9 subsection 7a7 occurr$ )9 ! special m>itime & t]ritorial jurisdiction ( ! ,unit$ ,/ates1 or any t]ritory or possession ( ! ,unit$ ,/ates2 or 7#g7 ! conduct describ$ 9 subsection 7a7 o!rwise occurr$ 9 or affect$ int]/ate or =eign comm]ce4 7f7 ,rule ( con/ruction ,no?+ 9 ?is section %all be con/ru$ z prohibit+ provision ( ! m$ical s]vices describ$ 9 subsection 7d77#a77;,a7 to address legitimate heal? issues1 su* z any male or female reproductive canc]s1 ap>t f *ang+ ! body to correspond to a sex t diff]s f "o's biological sex4 2 & 7#b7 by am5d+ ! table ( sections = su* *apt] by add+ at ! end ! foll[+3 #bbfj;,b4 ,g5d]-affirm+ c>e on m9ors4 4 ,,ii ,prohibit+ ,f$]ally ,fund$ ,g5d]-,affirm+ ,c>e #bja4 ,prohibit+ taxpay]-fund$ g5d]-affirm+ c>e ,title #a1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+ new *apt]3 #d ,prohibit+ taxpay]-fund$ g5d]-affirm+ c>e #cja4 ,prohibition on fund+ = g5d]-affirm+ c>e4 #cjb4 ,prohibition on fund+ = heal? b5efits plans t cov] g5d]-affirm+ c>e4 #cjc4 ,limitation on ,f$]al facilities & employees1 ,f$]al l&s & t]ritories1 & ,tribal t]ritories4 #cjd4 ,con/ruction relat+ to sep>ate cov]age4 #cje4 ,con/ruction relat+ to ! use ( non-,f$]al funds = heal? cov]age4 #cjf4 ,con/ruction relat+ to complications aris+ f g5d]-affirm+ c>e4 #cjg4 ,treatm5t ( individuals born ) m$ically v]ifiable disord] ( sex developm5t4 #cjh4 ,g5d]-affirm+ c>e def9$4 #cji4 ,rule ( con/ruction4 #cja4 ,prohibition on fund+ = g5d]-affirm+ c>e ,no funds au?oriz$ or appropriat$ by ,f$]al law1 & none ( ! funds 9 any tru/ fund to :i* funds are au?oriz$ or appropriat$ by ,f$]al law1 includ+ funds provid$ "u titles ,,xviii1 ,,xix1 & ,,xxi ( ! ,social ,security ,act1 %all be exp5d$ = any g5d]-affirm+ c>e4 #cjb4 ,prohibition on fund+ = heal? b5efits plans t cov] g5d]-affirm+ c>e ,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]-affirm+ c>e4 #cjc4 ,limitation on ,f$]al facilities & employees1 ,f$]al l&s & t]ritories1 & ,tribal t]ritories ,no heal? c>e s]vice furni%$-- 7#a7 by or 9 a heal? c>e facility own$ or op]at$ by ! ,f$]al ,gov]nm5t1 ,f$]al l& or t]ritory1 or a ,tribal t]ritory2 or 7#b7 by any physician or o!r individual employ$ by ! ,f$]al ,gov]nm5t1 ,f$]al l& or t]ritory1 or a ,tribal t]ritory to provide heal? c>e s]vices )9 ! scope ( ! physician's or individual's employm5t1 may include g5d]-affirm+ c>e4 #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]-affirm+ c>e or heal? b5efits cov]age t includes g5d]-affirm+ c>e s long z su* cov]age is paid = entirely us+ only funds n au?oriz$ or appropriat$ by ,f$]al law1 f$]al programs1 plat=ms1 or infra/ructure1 su* cov]age does n cov] any practice t w\ld be subject to p5alty "u section #bbfj;,b ( title #ah1 ,unit$ ,/ates ,code1 & 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$]al heal? b5efits cov]age provid] f (f]+ cov]age = g5d]-affirm+ c>e1 or ! ability ( a ,/ate or locality to contract sep>ately ) su* a provid] = su* cov]age1 s long z only funds n au?oriz$ or appropriat$ by ,f$]al law are us$1 su* cov]age does n cov] any practice t w\ld be subject to p5alty "u section #bbfj;,b ( title #ah1 ,unit$ ,/ates ,code1 & 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$icaid mat*+ funds4 #cjf4 ,con/ruction relat+ to complications aris+ f g5d]-affirm+ c>e ,no?+ 9 ?is *apt] %all be con/ru$ to apply to ! treatm5t ( any infection1 injury1 disease1 or disord] t has be5 caus$ by or exac]bat$ by ! p]=mance ( a g5d]-affirm+ c>e4 ,?is rule ( con/ruction %all be applicable )\t reg>d to :e!r ! g5d]-affirm+ c>e 0 p]=m$ 9 accord ) ,f$]al or ,/ate law1 & )\t reg>d to :e!r fund+ = ! g5d]-affirm+ c>e is p]missible "u section #cjg4 #cjg4 ,treatm5t ( individuals born ) m$ically v]ifiable disord] ( sex developm5t ,! limitations e/abli%$ 9 sections #cja1 #cjb1 & #cjc %all n apply ) respect to an individual describ$ 9 section #bbfj;,b7d77#a77;,b7 ( title #ah1 ,unit$ ,/ates ,code4 #cjh4 ,g5d]-affirm+ c>e def9$ ,= purposes ( ?is *apt]1 ! t]m g5d]-affirm+ c>e has ! mean+ giv5 su* t]m 9 section #bbfj;,b7d77#a7 ( title #ah1 ,unit$ ,/ates ,code4 #cji4 ,rule ( con/ruction ,no?+ 9 ?is *apt] %all be con/ru$ z prohibit+ provision ( ! m$ical s]vices describ$ 9 section #bbfj;,b7d77#a77;,a7 ( title #ah1 ,unit$ ,/ates ,code1 to address any male or female reproductive canc]s1 ap>t f *ang+ ! body to correspond to a sex t diff]s f "o's biological sex4 4 #bjb4 ,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]-affirm+ c>e#cja 4 ,,iii ,application "u ! ,af=dable ,c>e ,act #cja4 ,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]-affirm+ c>e 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]-affirm+ c>e 7o!r ?an any g5d]-affirm+ c>e 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]-affirm+ c>e 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]-affirm+ c>e describ$ 9 su* subp>agraph1 or a heal? plan t includes su* g5d]-affirm+ c>e1 s long z no cr$it is all[$ "u ?is section ) respect to ! premiums = su* cov]age or plan & su* cov]age or plan does n cov] any practice t w\ld be subject to p5alty "u section #bbfj;,b ( title #ah1 ,unit$ ,/ates ,code4 7ii7 ,option to (f] cov]age or plan ,no?+ 9 subp>agraph 7,a7 %all re/rict any non-,f$]al heal? insurance issu] (f]+ a heal? plan f (f]+ sep>ate cov]age = g5d]-affirm+ c>e describ$ 9 su* subp>agraph1 or a plan t includes su* g5d]-affirm+ c>e1 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$it "u section #adab ( ! ,pati5t ,protection & ,af=dable ,c>e ,act7 & su* cov]age or plan does n cov] any practice t w\ld be subject to p5alty "u section #bbfj;,b ( title #ah1 ,unit$ ,/ates ,code4 4 7#b7 ,disall[ance ( small employ] heal? insurance exp5se cr$it = plan :i* includes cov]age = g5d]-affirm+ c>e ,subsection 7h7 ( section #de,r ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$-- 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]-affirm+ c>e 7,a7 ,9 g5]al ,! t]m qualifi$ heal? plan does n include any heal? plan t includes cov]age = g5d]-affirm+ c>e 7o!r ?an any g5d]-affirm+ c>e or treatm5t describ$ 9 section #cjf or #cjg ( title #a1 ,unit$ ,/ates ,code74 7,b7 ,sep>ate cov]age or plan = g5d]-affirm+ c>e 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]-affirm+ c>e describ$ 9 su* subp>agraph1 or a heal? plan t includes su* g5d]-affirm+ c>e1 s long z no cr$it is all[$ "u ?is section ) respect to ! employ] contributions = su* cov]age or plan & su* cov]age does n cov] any practice t w\ld be subject to p5alty "u section #bbfj;,b ( title #ah1 ,unit$ ,/ates ,code4 7ii7 ,option to (f] cov]age or plan ,no?+ 9 subp>agraph 7,a7 %all re/rict any non-,f$]al heal? insurance issu] (f]+ a heal? plan f (f]+ sep>ate cov]age = g5d]-affirm+ c>e describ$ 9 su* subp>agraph1 or a plan t includes su* g5d]-affirm+ c>e1 s long z su* sep>ate cov]age or plan is n paid = ) any employ] contribution eligible = ! cr$it all[$ "u ?is section & su* cov]age or plan does n cov] any practice t w\ld be subject to p5alty "u section #bbfj;,b ( title #ah1 ,unit$ ,/ates ,code4 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#h7 ,cov]age consi/5t ) ,f$]al policy reg>d+ g5d]-affirm+ c>e ,9 ent]+ into contracts "u ?is subsection1 ! ,director %all ensure t no multi-,/ate qualifi$ 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] ! date t is "o ye> aft] ! date ( enactm5t ( ?is ,act1 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 ,,iv ,additional ,provisions #dja4 ,prohibition on in/itutions ( high] education & accr$it+ ag5cies or associations 7a7 ,prohibition on in/itutions ( high] education ,section #dhg7;a7 ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajid7;a77 is am5d$ by add+ at ! end ! foll[+3 7#cj7 ,! in/itution w n (f] in/ruction 9 g5d]-affirm+ c>e 7z def9$ 9 section #bbfj;,b7d7 ( title #ah1 ,unit$ ,/ates ,code74 4 7b7 ,prohibition on accr$it+ ag5cies or associations ,section #dif7;a7 ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajii;b7a77 is am5d$-- 7#a7 by /rik+ & at ! end ( p>agraph 7#g72 7#b7 by /rik+ ! p]iod at ! end ( p>agraph 7#h7 & ins]t+ 2 &2 & 7#c7 by add+ at ! end ! foll[+3 7#i7 su* ag5cy or association does n accr$it any in/itution t (f]s in/ruction 9 g5d]-affirm+ c>e 7z def9$ 9 section #bbfj;,b7d7 ( title #ah1 ,unit$ ,/ates ,code74 4 #djb4 ,immigration consequ5ces ) respect to provid+ g5d]-affirm+ c>e 7a7 ,def9itions ,section #aja7;a7 ( ! ,immigration & ,nationality ,act 7#h ,u4,s4,c4 #aaja7;a77 is am5d$ by add+ at ! end ! foll[+3 7#ec7 ,! t]m g5d]-affirm+ c>e %all h ! mean+ giv5 su* t]m 9 section #bbfj;,b7d7 ( title #ah1 ,unit$ ,/ates ,code4 4 7b7 ,classes ( ,ali5s ,ineligible = ,visas or ,admission ,section #bab7;a77#a77;,a7 ( ! ,immigration & ,nationality ,act 7#h ,u4,s4,c4 #aahb7;a77#a77;,a77 is am5d$-- 7#a7 9 clause 7iii77,,ii71 /rike or at ! end2 7#b7 9 clause 7iv71 /rike ! comma at ! end & ins]t 1 or2 & 7#c7 by add+ at ! end ! foll[+3 7v7 :o is det]m9$ to h p]=m$ g5d]-affirm+ c>e on a *ild t has n atta9$ ! age ( #ah ye>s old1 4 7c7 ,classes ( ,deportable ,ali5s ,section #bcg7;a7 ( ! ,immigration & ,nationality ,act 7#h ,u4,s4,c4 #abbg7;a77 is am5d$ by add+ at ! end ! foll[+3 7#h7 ,g5d]-affirm+ c>e ,any ali5 :o has p]=m$ g5d]-affirm+ c>e on a *ild t has n atta9$ ! age ( #ah ye>s old is deportable4 4