,,ib ,union ,calendar ,no4 #fbi #aahth  
,,congress  #b;d ,session  ,h4 ,r4 #chhg
 ,report ,no4 #aah-geh ,,in ,,the       
,,house ,,of ,,representatives  ,june   
#g1 #bjbc,mr4 ,crenshaw introduced the  
following bill2 which was referred to   
the ,committee on ,energy and ,commerce 
,november #bj1 #bjbd;,additional        
sponsors3 ,mr4 ,johnson of ,ohio1 ,mrs4 
,miller-,meeks1 ,mrs4 ,harshbarger1 ,mr4
 ,pfluger1 ,mr4 ,babin1 ,mr4 ,self1     
,mrs4 ,miller of ,west ,virginia1 ,ms4  
,tenney1 ,mr4 ,santos1 ,mr4 ,van ,drew1 
,mr4 ,grothman1 ,mr4 ,scott ,franklin of
 ,florida1 ,mr4 ,gaetz1 ,mr4 ,nehls1    
,mrs4 ,cammack1 ,mr4 ,stauber1 ,mr4     
,williams of ,texas1 ,mr4 ,arrington1   
,mr4 ,mann1 ,mr4 ,norman1 ,mr4 ,posey1  
,mr4 ,steube1 ,mr4 ,ellzey1 ,mr4 ,carter
 of ,georgia1 ,mr4 ,green of ,tennessee1
 ,mr4 ,jackson of ,texas1 ,mr4 ,mooney1 
,mr4 ,duncan1 ,mrs4 ,miller of          
,illinois1 ,mr4 ,moran1 ,mr4 ,finstad1  
and ,mr4 ,rouzer  ,november #bj1        
#bjbd,reported with an amendment1       

committed to the ,committee of the      
,whole ,house on the ,state of the      
,union1 and ordered to be printed,strike
 out all after the enacting clause and  
insert the part printed in italic,for   
text of introduced bill1 see copy of    
bill as introduced on ,june #g1 #bjbc   
,a ,,bill  ,to amend title ,,iii of the 
,public ,health ,service ,act to        
reauthorize the program of payments to  
children's hospitals that operate       
graduate medical education programs1 and
 for other purposes4  #a4 ,short title  
,this ,act may be cited as the          
,children's ,hospital ,,gme ,support    
,reauthorization ,act of #bjbc4  #b4    
,program of payments to children's      
hospitals that operate graduate medical 
education programs ,section #cdj;,e of  
the ,public ,health ,service ,act 7#db  
,u4,s4,c4 #bef;e7 is amended-- 7#a7 in  
subsection 7a71 by striking #bjbc and   
inserting #bjbh2  7#b7 in subsection    
7b77#c77;,d71 by inserting and the end  
of fiscal year #bjbh1 after fiscal year 

#bjbb12  7#c7 in subsection 7e71 by     
adding at the end the following new     
paragraph3  7#d7 ,prohibition on        
payments to hospitals furnishing        
specified procedures and drugs to minors
  7,a7 ,in general ,notwithstanding any 
other provision of this section1 no     
payment may be made under this section  
to a children's hospital for a fiscal   
year 7beginning with fiscal year #bjbd7 
if1 at any point during the preceding   
fiscal year1 such hospital furnished    
specified procedures and drugs 7as      
defined in subsection 7g77 to an        
individual under #ah years of age4  7,b7
 ,special rule for fiscal year #bjbd ,in
 applying subparagraph 7,a7 with respect
 to payments described in such          
subparagraph for fiscal year #bjbd-- 7i7
 the reference to for a fiscal year     
shall be treated as a reference to for  
any portion of fiscal year #bjbd        
occurring after ,december #ca1 #bjbc2   
and  7ii7 the reference to the preceding
 fiscal year shall be treated as a      

reference to the period beginning on    
,september #a1 #bjbc1 and ending on     
,december #ca1 #bjbc4  7,c7 ,rule of    
construction ,nothing in this paragraph 
shall be construed as prohibiting       
payments for a fiscal year 7or1 in the  
case of payments for fiscal year #bjbd1 
during the portion of such fiscal year  
described in subparagraph 7,b77i77 to a 
hospital that1 during the preceding     
fiscal year 7or1 in the case of payments
 for fiscal year #bjbd1 during the      
period described in subparagraph        
7,b77ii771 furnished mental or          
behavioral health services to           
individuals under #ah years of age for  
the treatment of gender dysphoria not   
consisting of specified procedures and  
drugs4  2  7#d7 in subsection 7f7-- 7,a7
 in paragraph 7#a77;,a7-- 7i7 in clause 
7v71 by striking and at the end2  7ii7  
in clause 7vi71 by striking the period  
at the end and inserting 2 and2 and     
7iii7 by adding at the end the          
following3  7vii7 for each of fiscal    

years #bjbd through #bjbh1 #abd1jjj1jjj4
  2 and  7,b7 in paragraph 7#b7-- 7i7 in
 subparagraph 7,e71 by striking and at  
the end2  7ii7 in subparagraph 7,f71 by 
striking the period at the end and      
inserting 2 and2 and  7iii7 by adding at
 the end the following3  7,g7 for each  
of fiscal years #bjbd through #bjbh1    
#bfa1jjj1jjj4  2 and  7#e7 in subsection
 7g71 by adding at the end the following
 new paragraph3  7#d7 ,specified        
procedures and drugs  7,a7 ,in general  
,except as provided in subparagraph     
7,b71 the term specified procedures and 
drugs means1 with respect to an         
individual1 any of the following3 7i7   
,performing any surgery for the purpose 
of changing the body of such individual 
to correspond to a sex that differs from
 their biological sex1 including-- 7,i7 
castration2  7,,ii7 orchiectomy2        
7,,iii7 scrotoplasty2  7,,iv7 vasectomy2
  7,v7 hysterectomy2  7,,vi7            
oophorectomy2  7,,vii7 ovariectomy2     
7,,viii7 metoidioplasty2  7,,ix7        

penectomy2  7,x7 phalloplasty2  7,,xi7  
vaginoplasty2  7,,xii7 vaginectomy2     
7,,xiii7 vulvoplasty2  7,,xiv7 reduction
 thyrochondroplasty2  7,,xv7            
chondrolaryngoplasty2 and  7,,xvi7      
mastectomy4  7ii7 ,any plastic surgery  
that feminizes or masculinizes the      
facial features for the purposes        
described in clause 7i74  7iii7 ,any    
placement of chest implants to create   
feminine breasts for the purposes       
described in clause 7i74  7iv7 ,any     
placement of fat or artificial implants 
in the gluteal region for the purposes  
described in clause 7i74  7v7           
,administering1 supplying1 prescribing1 
dispensing1 distributing1 or otherwise  
conveying to an individual medications  
for the purposes described in clause    
7i71 including-- 7,i7                   
gonadotropin-releasing hormone 7,gn,r,h7
 analogues or other puberty-blocking    
drugs to stop or delay normal puberty2  
7,,ii7 testosterone or other androgens  
to biological females at doses that are 

supraphysiologic to the female sex2 and 
7,,iii7 estrogen to biological males at 
doses that are supraphysiologic to the  
male sex4  7,b7 ,exception ,subparagraph
 7,a7 shall not apply to the following  
individuals3 7i7 ,an individual with    
both ovarian and testicular tissue4     
7ii7 ,an individual with respect to whom
 a physician has determined through     
genetic or biochemical testing that the 
individual does not have normal sex     
chromosome structure1 sex steroid       
hormone production1 or sex steroid      
hormone action4  7iii7 ,an individual   
experiencing infection1 disease1 injury1
 or disorder caused or exacerbated by   
previous medical procedures as defined  
in subsection 7g77#d77;,a74  7iv7 ,an   
individual suffering from a physical    
disorder1 physical injury1 or physical  
illness that would1 as certified by a   
physician1 place the individual in      
imminent danger of death or impairment  
of a major bodily function unless the   
procedure is performed4  7,c7           

,biological sex ,for purposes of        
subparagraph 7,a71 the term biological  
sex means the indication of male or     
female sex by reproductive potential or 
capacity1 sex chromosomes1 naturally    
occurring sex hormones1 gonads1 or      
internal or external genitalia present  
at birth4  4  ,november #bj1            
#bjbd,reported with an amendment1       
committed to the ,committee of the      
,whole ,house on the ,state of the      
,union1 and ordered to be printed