,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #ccbi  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,may #ae1 #bjbc,mr4   
,la,malfa 7= himself1 ,mrs4 ,boeb]t1    
,mr4 ,lamborn1 ,mr4 ,gos>1 ,mr4 ,banks1 
,mr4 ,duncan1 ,mr4 ,bab91 ,mr4 ,r\z]1   
,mr4 ,b>r1 ,mr4 ,ros5dale1 ,mr4 ,web] ( 
,texas1 ,mr4 ,bre*e51 ,mr4 ,norman1     
,mrs4 ,mill] ( ,ill9ois1 ,mr4 ,gro?man1 
,mr4 ,wilson ( ,s\? ,c>ol9a1 ,mr4       
,mills1 ,mr4 ,burlison1 ,mr4 ,smi? (    
,new ,j]sey1 ,mr4 ,ad]holt1 ,mrs4       
,mc,clain1 ,mrs4 ,lesko1 ,mrs4 ,h>%b>g]1
 ,mr4 ,nehls1 ,mr4 ,kelly (             
,mississippi1 ,mr4 ,ogles1 ,mr4 ,fallon1
 ,mr4 ,la,turner1 ,mr4 ,davidson1 ,mr4  
,gaetz1 ,ms4 ,t5ney1 ,mr4 ,all51 ,mr4   
,roy1 & ,mr4 ,mooney7 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]
 transition proc$ures1 & = o!r purposes4
  #a4 ,%ort title2 table ( cont5ts  7a7 
,%ort title ,?is ,act may be cit$ z !   
,end ,taxpay] ,fund+ ( ,g5d]            
,exp]im5tation ,act ( #bjbc4  7b7 ,table
 ( cont5ts ,! table ( cont5ts ( ?is ,act
 are z foll[s3 ,sec4 #a4 ,%ort title2   
table ( cont5ts4,title ,i--,prohibit+   
,f$]ally ,fund$ ,g5d] ,transition       
,procedures,sec4 #aja4 ,prohibit+       
taxpay]-fund$ g5d] transition           
proc$ures4,sec4 #ajb4 ,am5dm5t to table 
( *apt]s4,title ,,ii--,application ,"u !
 ,af=dable ,c>e ,act,sec4 #bja4 ,cl>ify+
 application ( prohibition to premium   
cr$its & co/-%>+ r$uctions "u ,,aca4  ,i
 ,prohibit+ ,f$]ally ,fund$ ,g5d]       
,transition ,proc$ures  #aja4 ,prohibit+
 taxpay]-fund$ g5d] transition proc$ures
 ,title #a1 ,unit$ ,/ates ,code1 is     
am5d$ by add+ at ! end ! foll[+ new     
*apt]3  #d ,prohibit+ ,taxpay]-,fund$   
,g5d] ,transition ,proc$ures  #cja4     
,prohibition on fund+ = g5d] transition 

proc$ures4 #cjb4 ,prohibition on fund+ =
 heal? b5efits plans t cov] g5d]        
transition proc$ures4 #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] transition   
proc$ures4 #cjg4 ,def9itions4  #cja4    
,prohibition on fund+ = g5d] transition 
proc$ures ,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] transition    
proc$ures4  #cjb4 ,prohibition on fund+ 
= heal? b5efits plans t cov] g5d]       
transition proc$ures ,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] transition     
proc$ures4  #cjc4 ,limitation on ,f$]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$]al      
,gov]nm5t to provide heal? c>e s]vices  
)9 ! scope ( ! physician's or           
individual's employm5t1  may include    
g5d] transition proc$ures4  #cjd4       
,con/ruction relat+ to sep>ate cov]age  
,no?+ 9 ?is *apt] %all be con/ru$ z     
prohibit+ any individual1 entity1 ,/ate1
 or locality f pur*as+ sep>ate cov]age =
 g5d] transition proc$ures or heal?     
b5efits cov]age t include g5d]          
transition proc$ures s long z su*       
cov]age is paid = entirely ) funds n    
au?oriz$ or appropriat$ by ,f$]al law1 &
 su* cov]age %all n be pur*as$ us+ mat*+
 funds requir$ = a f$]ally subsidiz$    
program1 includ+ a ,/ate 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$]al heal? b5efits  
cov]age provid] f (f]+ cov]age = g5d]   
transition proc$ures1 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$1 & su* cov]age %all n
 be pur*as$ us+ mat*+ funds requir$ = a 
f$]ally subsidiz$ program1 includ+ a    
,/ate or locality's contribution (      
,m$icaid mat*+ funds4  #cjf4            
,con/ruction relat+ to complications    
aris+ f g5d] transition proc$ures ,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]     
transition proc$ure4  #cjg4 ,def9itions 
,= purposes ( ?is *apt]3 7#a7           
,biological sex ,! t]m biological sex   
means ! biological indication ( male or 
female 9 ! context ( reproductive       
pot5tial or capacity1 su* z sex         
*romosomes1 naturally occurr+ sex       
hormones1 gonads1 & non-ambigu\s int]nal

 & ext]nal g5italia pres5t at bir?1 )\t 
reg>d to an individual's psy*ological1  
*os51 or subjective exp]i5ce ( g5d]4    
7#b7 ,cross-sex hormones ,! t]m         
cross-sex hormones means-- 7,a7         
te/o/]one or o!r &rog5s giv5 to         
biological females at doses t are       
pr(\ndly l>g] or m pot5t ?an w\ld       
naturally occur 9 heal?y biological     
females2 or  7,b7 e/rog5 giv5 to        
biological males at doses t are pr(\ndly
 l>g] or m pot5t ?an w\ld naturally     
occur 9 heal?y biological males4  7#c7  
,g5d] ,! t]m g5d] means ! psy*ological1 
behavioral1 social1 & cultural aspects (
 be+ male or female4  7#d7 ,g5d]        
transition ,! t]m g5d] transition means 
! process 9 :i* a p]son goes f id5tify+ 
) & liv+ z a g5d] t corresponds to 8 or 
h] biological sex to id5tify+ ) & liv+ z
 a g5d] diff]5t f 8 or h] biological    
sex1 & may involve social1 legal1 or    
physical *anges4  7#e7 ,g5d] transition 
proc$ure  7,a7 ,9 g5]al ,! t]m g5d]     
transition proc$ure means any m$ical or 

surgical s]vice1 includ+ physician's    
s]vices1 inpati5t & outpati5t hospital  
s]vices1 or prescrib$ drugs relat$ to   
g5d] transition1 t seek to alt] or      
remove physical or anatomical           
*>act]i/ics or features t are typical = 
an individual's biological sex1 or to   
in/ill or create physiological or       
anatomical *>act]i/ics t resemble a sex 
diff]5t f an individual's bir? sex1     
includ+1 )\t limitation1 m$ical s]vices 
t provide pub]ty-block+ drugs1 cross-sex
 hormones1 or o!r me*anisms to promote !
 developm5t ( fem9iz+ or mascul9iz+     
features 79 ! opposite sex71 or g5ital  
g5d] transition surg]y or nong5ital g5d]
 transition surg]y p]=m$ = ! purpose (  
assi/+ an individual ) a g5d]           
transition4  7,b7 ,exceptions ,! t]m    
g5d] transition proc$ure does n         
include-- 7i7 s]vices to ^? born ) a    
m$ically-v]ifiable disord] ( sex        
developm5t1 includ+ a p]son ) 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> tissue2 or   
s]vices provid$ :5 a physician has      
o!rwise diagnos$ a disord] ( sexual     
developm5t1 9 :i* su* physician has     
det]m9$ ?r\gh g5etic or bio*emical te/+ 
t ! p]son does n h normal sex *romosome 
/ructure1 sex /]oid hormone production1 
or sex /]oid hormone action = a         
biological male or biological female2 or
  7ii7 ! treatm5t ( any infection1      
injury1 disease1 or disord] t has be5   
caus$ by or exac]bat$ by ! p]=mance ( a 
g5d] transition proc$ure1 :e!r or n su* 
proc$ure 0 p]=m$ 9 accordance ) ,/ate or
 ,f$]al law1 or :e!r fund+ = su*        
proc$ure 0 p]missible "u ?is *apt]4     
7#f7 ,g5d] transition surg]y  7,a7 ,9   
g5]al ,! t]m g5d] transition surg]y     
means any m$ical or surgical s]vice t   
seeks to surgically alt] or remove      
heal?y physical or anatomical           
*>act]i/ics or features t are typical = 
an individual's biological sex 9 ord] to

 in/ill or create physiological or      
anatomical *>act]i/ics t resemble a sex 
diff]5t f an individual's bir? sex1     
includ+1 )\t limitation1 g5ital g5d]    
reassignm5t surg]y or non-g5ital g5d]   
reassignm5t surg]y p]=m$ = ! purpose (  
assi/+ an individual ) a g5d]           
transition4  7,b7 ,exception ,g5d]      
transition surg]y does n include any    
proc$ure und]tak5 because ! individual  
suff]s f a physical disord]1 physical   
injury1 or physical illness t w\ld1 z   
c]tifi$ by a physician1 place !         
individual 9 imm95t dang] ( dea? or     
impairm5t ( major bodily function unless
 surg]y is p]=m$4  7#g7 ,g5ital g5d]    
transition surg]y ,! t]m g5ital g5d]    
transition surg]y includes surgical     
proc$ures su* z p5ectomy1 or*iectomy1   
vag9opla/y1 clitoropla/y1 or vulvopla/y 
= biologically male pati5ts1 or         
hy/]ectomy_/ov>iectomy1 recon/ruction ( 
! fix$ "p ( ! ure?ra ) or )\t a         
metoidiopla/y or a phallopla/y1         
vag9ectomy1 scrotopla/y1 or implantation

 ( erection or te/icul> pro/heses =     
biologically female pati5ts :5 p]=m$ = !
 purpose ( assi/+ an individual ) a g5d]
 transition4  7#h7 ,non-g5ital g5d]     
transition surg]y ,! t]m non-g5ital g5d]
 transition surg]y means surgical       
proc$ures includ+ augm5tation           
mammopla/y1 facial fem9ization surg]y1  
liposuction1 lip(ill+1 voice surg]y1    
?yroid c>tilage r$uction1 gluteal       
augm5tation 7implants or lip(ill+71 hair
 recon/ruction1 or o!r ae/hetic         
proc$ures = biologically male pati5ts or
 subcutane\s ma/ectomy1 voice surg]y1   
liposuction1 lip(ill+1 pectoral         
implants1 or o!r ae/hetic proc$ures =   
biologically female pati5ts1 :5 p]=m$ = 
! purpose ( assi/+ an individual ) a    
g5d] transition4  7#i7 ,pub]ty-block+   
drugs ,! t]m pub]ty-block+ drugs means--
 7,a7 ,gonadotrop9-releas+ hormone      
7,gn,r,h7 analogues or o!r syn!tic drugs
 us$ 9 biological males to /op lute9iz+ 
hormone secretion & !re=e te/o/]one     
secretion2  7,b7 syn!tic drugs us$ 9    

biological females t /op ! production ( 
e/rog52 &  7,c7 proge/]one :5 us$ to    
delay or suppress pub]tal developm5t 9  
*ildr5 = ! purpose ( assi/+ an          
individual ) a g5d] transition4  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] transition           
proc$ures#cja  4  ,,ii ,application ,"u 
! ,af=dable ,c>e ,act  #bja4 ,cl>ify+   
application ( prohibition to premium    
cr$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] transition      
proc$ures  7,a7 ,9 g5]al ,section       
#cf;,b7c77#c77;,a7 ( ! ,int]nal ,rev5ue 
,code ( #aihf is am5d$ by ins]t+ be=e ! 
p]iod at ! end ! foll[+3 or any heal?   
plan t includes cov]age = g5d]          
transition proc$ures 7o!r ?an any       
proc$ure 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 ,section #cf;,b7c77#c7 (
 su* ,code is am5d$ by add+ at ! end !  
foll[+ new subp>agraph3  7,c7 ,sep>ate  
cov]age or plan = g5d] transition       
proc$ures all[$  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] transition       
proc$ures describ$ 9 su* subp>agraph1 or
 a heal? plan t includes su* g5d]       
transition proc$ures1 s long z no cr$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$]al heal? insurance issu] (f]+ a 
heal? plan f (f]+ sep>ate cov]age = g5d]
 transition proc$ures describ$ 9 su*    
subp>agraph1 or a plan t includes su*   
g5d] transition proc$ures1 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] transition      
proc$ures ,subsection 7h7 ( section     
#de,r ( ! ,int]nal ,rev5ue ,code ( #aihf
 is am5d$-- 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] transition 
proc$ures  7,a7 ,9 g5]al ,! t]m qualifi$
 heal? plan does n include any heal?    
plan t includes cov]age = g5d]          
transition proc$ures 7o!r ?an a proc$ure
 describ$ 9 section #cjf or #cjg ( title
 #a1 ,unit$ ,/ates ,code74  7,b7        
,sep>ate cov]age or plan = g5d]         
transition proc$ures all[$  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]        
transition proc$ures describ$ 9 su*     
subp>agraph1 or a heal? plan t includes 
su* g5d] transition proc$ures1 s long z 
no cr$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$]al heal?      
insurance issu] (f]+ a heal? plan f (f]+
 sep>ate cov]age = g5d] transition      
proc$ures describ$ 9 su* subp>agraph1 or
 a plan t includes su* g5d] transition  
proc$ures1 s long z su* sep>ate cov]age 
or plan is n paid = ) any employ]       
contribution eligible = ! cr$it all[$ "u
 ?is section4  4  7b7 ,application to   
multi-,/ate plans ,section #accd7;a7 ( !
 ,pati5t ,protection & ,af=dable ,c>e   
,act 7#db ,u4,s4,c4 #ahjed7;a77 is am5d$
 by add+ at ! end ! foll[+ new p>agraph3
  7#h7 ,cov]age consi/5t ) f$]al policy 
reg>d+ g5d] transition proc$ures ,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  7#a7    
,effective date ) respect to premium    
cr$its & co/ %>+ r$uctions ,! am5dm5ts  
made by subsection 7a7 %all apply to    
taxable ye>s aft] ! date t is "o ye>    
aft] ! date ( enactm5t ( ?is ,act1 b    
only ) respect to plan ye>s beg9n+ aft] 
su* date4  7#b7 ,effective date =       
application to multi-,/ate plans ,!     
am5dm5t made by subsection 7b7 %all     
apply to plan ye>s beg9n+ on ! date t is
 "o ye> aft] ! date ( enactm5t ( ?is    
,act4