,i  #aah? ,,congress  #b;d ,session  ,h4
 ,r4 #ihgd  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,septemb] #bg1        
#bjbd,ms4 ,mace 7= h]self1 ,mr4 ,gos>1  
,mrs4 ,lesko1 ,mr4 ,web] ( ,texas1 &    
,mr4 ,bur*ett7 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 ! p]=mance ( g5d]-relat$ m$ical
 treatm5t on m9ors1 to am5d title       
,,xviii ( ! ,social ,security ,act to   
prohibit paym5t & p>ticipation "u !     
,m$ic>e program ) respect to su*        
treatm5t1 & = o!r purposes4  #a4 ,%ort  
title ,?is ,act may be cit$ z !         
,*ildhood ,g5ital ,mutilation ,prev5tion
 ,act4  #b4 ,prohibit+ g5d]-relat$      
m$ical treatm5t = m9ors  7a7 ,9 g5]al   
,*apt] #g ( title #ah1 ,unit$ ,/ates    
,code1 is am5d$ by ins]t+ aft] section  

#aaf ! foll[+ new section3  #aaf;,a4    
,g5d]-relat$ m$ical treatm5t furni%$ to 
m9ors4  7a7 ,9 g5]al ,subject to        
subsection 7c71 :oev]1 9 a circum/ance  
describ$ 9 subsection 7b71 kn[+ly p]=ms 
or attempts to p]=m a g5d]-relat$ m$ical
 treatm5t on a m9or1 %all be f9$ "u ?is 
title1 imprison$ n m ?an #aj ye>s1 or   
bo?4  7b7 ,circum/ances describ$ ,= !   
purposes ( subsection 7a71 !            
circum/ances describ$ 9 ?is subsection  
are t-- 7#a7 ! (f5d] 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 ! (f5d] 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
 ! (f5d] 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  7c7 ,exceptions  7#a7 ,9 g5]al
 ,an individual :o provides g5d]-relat$ 

m$ical treatm5t to a m9or %all n be     
consid]$ to h violat$ ! prohibition 9   
subsection 7a7 if su* m$ical treatm5t is
 provid$ to su* m9or = purposes (       
treat+-- 7,a7 a disord] ( sex           
developm5t1 diagnos$ by a physician aft]
 su* physician has det]m9$ ?r\gh g5etic 
or bio*emical te/+ t su* m9or does n h  
normal sex *romosome /ructure1 sex /]oid
 hormone production1 or sex /]oid       
hormone action2  7,b7 irresolvably      
ambigu\s biological sex *>act]i/ics (   
su* m9or1 includ+ ! pres5ce (-- 7i7 #df 
,,xx *romosomes ) virilization2  7ii7   
#df ,,xy *romosomes ) und]virilization2 
or  7iii7 bo? ov>ian & te/icul> tissue2 
or  7,c7 an infection1 injury1 disease1 
or disord] caus$ or exac]bat$ by        
g5d]-relat$ m$ical treatm5t t 0 furni%$ 
to su* m9or4  7#b7 ,exception = m9ors ,a
 m9or :o seeks g5d]-relat$ m$ical       
treatm5t1 or on :om g5d]-relat$ m$ical  
treatm5t 0 p]=m$1 %all n be consid]$ to 
h violat$ ! prohibition 9 subsection    
7a74  7d7 ,def9itions ,9 ?is section3   

7#a7 ,g5d]-relat$ m$ical treatm5t ,! t]m
 g5d]-relat$ m$ical treatm5t means--    
7,a7 ) respect to a female individual1  
m$ical treatm5ts provid$ = purposes (   
address+ ! p]ception ( su* individual t 
! g5d] or sex ( su* individual is n     
female1 includ+-- 7i7 surgical          
proc$ures1 includ+-- 7,i7 vag9ectomy2   
7,,ii7 hy/]ectomy2  7,,iii7             
oophorectomy2  7,,iv7 recon/ruction ( ! 
ure?ra2  7,v7 metoidiopla/y2  7,,vi7    
phallopla/y2  7,,vii7                   
salp+o-oophorectomy2  7,,viii7          
scrotopla/y2  7,,ix7 implantation (     
erection or te/icul> pro!ses2  7,x7     
subcutane\s ma/ectomy2  7,,xi7 vocal    
cord surg]y2  7,,xii7 pectoral implants2
 &  7,,xiii7 p5ile transplantation2     
7ii7 exog5\s doses ( te/o/]one or o!r   
&rog5s2 &  7iii7 pub]ty block]s1        
includ+-- 7,i7 ,gn,r,h agoni/s2 &       
7,,ii7 syn!tic drugs t suppress !       
production ( e/rog5 & proge/]one or     
delay or suppress pub]tal developm5t 9  
female individuals2 &  7,b7 ) respect to

 a male individual1 m$ical treatm5ts    
provid$ = purposes ( address+ !         
p]ception ( su* individual t ! g5d] or  
sex ( su* individual is n male1         
includ+-- 7i7 surgical proc$ures1       
includ+-- 7,i7 p5ectomy2  7,,ii7        
or*iectomy2  7,,iii7 vag9opla/y2  7,,iv7
 clitoropla/y2  7,v7 vulvopla/y2  7,,vi7
 augm5tation mammopla/y2  7,,vii7 facial
 fem9ization surg]y2  7,,viii7 vocal    
cord surg]y2  7,,ix7 *ondrol>yngopla/y2 
7,x7 gluteal augm5tation2 &  7,,xi7     
ut]9e transplantation2  7ii7 exog5\s    
doses ( e/rog52 &  7iii7 pub]ty block]s1
 includ+-- 7,i7 ,gn,r,h agoni/s2 &      
7,,ii7 syn!tic drugs t suppress !       
production ( te/o/]one or delay or      
suppress pub]tal developm5t 9 male      
individuals4  7#b7 ,female ,! t]m       
female-- 7,a7 means an individual :o1 "u
 normal developm5t-- 7i7 has ,,xx       
*romosomes2  7ii7 produces oocytes2 &   
7iii7 has a reproductive & endocr9e     
sy/em ori5t$ ar\nd ! production ( su*   
oocytes2 &  7,b7 includes an individual 

:o w\ld o!rwise fall )9 ?is def9ition b 
= a biological or g5etic condition      
describ$ 9 subp>agraph 7,a7 or 7,b7 (   
subsection 7c77#a74  7#c7 ,g5d] ,! t]m  
g5d] means1 ) respect to an individual1 
! psy*ological1 behavioral1 social1 &   
cultural aspects ( be+ male or female4  
7#d7 ,male ,! t]m male-- 7,a7 means an  
individual :o1 "u normal developm5t--   
7i7 has ,,xy *romosomes2  7ii7 produces 
sp]m2 &  7iii7 has a reproductive &     
endocr9e sy/em ori5t$ ar\nd ! production
 ( su* sp]m2 &  7,b7 includes an        
individual :o w\ld o!rwise fall )9 ?is  
def9ition b = a biological or g5etic    
condition describ$ 9 subp>agraph 7,a7 or
 7,b7 ( subsection 7c77#a74  7#e7 ,m9or 
,! t]m m9or means an individual "u #ah  
ye>s ( age4  7#f7 ,sex ,! t]m sex means 
! biological & g5etic indication ( :e!r 
an individual is male or female1 z      
det]m9$ by ! organization ( body p>ts & 
gametes = reproduction 7includ+ sex     
*romosomes1 naturally occurr+ sex       
*romosomes1 gonads1 & nonambigu\s       

int]nal & ext]nal g5italia pres5t at    
bir?7 )\t reg>d to ! psy*ological1      
behavioral1 social1 cultural1 *os51 or  
subjective exp]i5ce ( g5d] ( su*        
individual4  4  7b7 ,cl]ical am5dm5t ,! 
table ( sections = su* *apt] is am5d$ by
 ins]t+ aft] ! item relat+ to section   
#aaf ! foll[+ new item3  #aaf;,a4       
,g5d]-relat$ m$ical treatm5t = m9ors4  4
  #c4 ,prohibit+ paym5t & p>ticipation  
"u ,m$ic>e ) respect to g5d]-relat$     
m$ical treatm5t = m9ors  7a7 ,exclud+ f 
cov]age g5d]-,relat$ m$ical treatm5t =  
m9ors ,section #ahfb7;a7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4 #aciey7a77
 is am5d$-- 7#a7 9 p>agraph 7#bd71 by   
/rik+ or at ! end2  7#b7 9 p>agraph     
7#be71 by /rik+ ! p]iod at ! end &      
ins]t+ 2 or2 &  7#c7 by ins]t+ aft]     
p>agraph 7#be7 ! foll[+ new p>agraph3   
7#bf7 beg9n+ on ! date t is #ij days    
aft] ! date ( ! enactm5t ( ! ,*ildhood  
,g5ital ,mutilation ,prev5tion ,act1 :i*
 con/itute g5d]-relat$ m$ical treatm5t =
 m9ors describ$ 9 section #aaf;,a (     

*apt] #g ( title #ah1 ,unit$ ,/ates     
,code1 & are n provid$ = ! purposes     
describ$ 9 subsection 7c77#a7 ( su*     
section4  4  7b7 ,exclud+ f p>ticipation
 provid]s furni%+ g5d]-,relat$ m$ical   
treatm5t = m9ors ,section #ahff ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acie;cc7 is am5d$ by add+ at ! end !   
foll[+ new subsection3  7l7 ,exclusion (
 provid]s furni%+ g5d]-,relat$ m$ical   
treatm5t = m9ors ,beg9n+ on ! date t is 
#ij days aft] ! date ( ! enactm5t ( !   
,*ildhood ,g5ital ,mutilation ,prev5tion
 ,act1 ) respect to a provid] ( s]vices 
or suppli] t1 on or aft] ! date t is #ij
 days aft] su* date ( enactm5t1 furni%es
 g5d]-relat$ m$ical treatm5t = m9ors1 z 
describ$ 9 section #aaf;,a ( *apt] #g ( 
title #ah1 ,unit$ ,/ates ,code to any   
individual 7o!r ?an su* a treatm5t t is 
furni%$ = ! purposes describ$ 9         
subsection 7c77#a7 ( su* section71      
reg>dless ( :e!r su* individual is      
entitl$ to b5efits "u "p ,a or enroll$  
"u "p ,b-- 7#a7 if su* provid] ( s]vices

 or suppli] is enroll$ 9 ! program "u   
?is title1 ! ,secret>y %all t]m9ate su* 
enrollm5t2 &  7#b7 ! ,secret>y may n    
enroll su* provid] ( s]vices or suppli] 
z a new provid] ( s]vices or suppli] 9 !
 program "u ?is title4  4  #d4          
,prohibition on ,f$]al fund+ =          
g5d]-relat$ m$ical treatm5t = m9ors ,no 
funds au?oriz$ or appropriat$ by ,f$]al 
law1 & none ( ! funds 9 any tru/ fund to
 :i* funds are au?oriz$ or appropriat$  
by ,f$]al law1 %all be obligat$ or      
exp5d$ = any g5d]-relat$ m$ical treatm5t
 furni%$ to a m9or 7z su* t]ms are us$ =
 purposes ( section #aaf;,a ( *apt] #g (
 title #ah1 ,unit$ ,/ates ,code7 or =   
any heal? b5efits cov]age t includes    
cov]age = g5d]-relat$ m$ical treatm5t   
furni%$ to a m9or4