,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #bbjb  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,m>* #ah1 #bjbe,mr4   
,la,malfa 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 (    
#bjbe4  7b7 ,table ( cont5ts ,! table ( 
cont5ts ( ?is ,act is z foll[s3  ,sec4  
#a4 ,%ort title2 table ( cont5ts4       
,,title ,i--,prohibit+ f$]ally fund$    
g5d] transition proc$ures ,sec4 #aja4   
,prohibit+ taxpay]-fund$ 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$ures 
,sec4 #cja4 ,prohibition on fund+ = g5d]
 transition proc$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 or    
,/ate or locality f pur*as+ sep>ate     
cov]age = g5d] transition proc$ures or  
heal? b5efits cov]age t includes g5d]   

transition proc$ures s long z su*       
cov]age is paid = entirely us+ only     
funds n au?oriz$ 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$]al heal? b5efits  
cov]age provid] f (f]+ cov]age = g5d]   
transition proc$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$]al law are us$ & 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$icaid mat*+ funds4  #cjf4            
,con/ruction relat+ to complications    
aris+ f g5d] transition proc$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$ure4  #cjg4 ,def9itions 
,= purposes ( ?is *apt]3  7#a7 ,female  
,! t]m female1 :5 us$ to ref] to a      
natural p]son1 means an individual :o   
naturally has1 _h1 w h1 or w\ld h1 b = a
 cong5ital anomaly1 hi/orical accid5t1  
or int5tional or un9t5tional disruption1
 ! reproductive sy/em t at "s po9t      
produces1 transports1 & utilizes eggs = 
f]tilization4  7#b7 ,g5d] transition ,! 
t]m g5d] transition means ! process 9   
:i* an individual goes f id5tify+ ) or  
pres5t+ z 8 or h] sex to id5tify+ ) or  
pres5t+ a self-proclaim$ id5tity t does 
n correspond ) or is diff]5t f 8 or h]  
sex1 & may be accompani$ ) social1      
legal1 or physical *anges4  7#c7 ,g5d]  
transition proc$ure  7,a7 ,9 g5]al ,!   
t]m g5d] transition proc$ure means any  
hormonal or surgical int]v5tion = !     
purpose ( g5d] transition1 includ+-- 7i7
 gonadotrop9-releas+ hormone 7,gn,r,h7  

agoni/s or any o!r pub]ty-block+ or     
suppress+ drugs to /op or delay normal  
pub]ty2  7ii7 te/o/]one1 e/rog51        
proge/]one1 or o!r &rog5s to an         
individual at doses t are               
supraphysiologic to :at w\ld normally be
 produc$ endog5\sly 9 a heal?y          
individual ( ! same age & sex2  7iii7   
ca/ration2  7iv7 or*iectomy2  7v7       
scrotopla/y2  7vi7 implantation (       
erection or te/icul> pro/heses2  7vii7  
vasectomy2  7viii7 hy/]ectomy2  7ix7    
oophorectomy2  7x7 ov>iectomy2  7xi7    
recon/ruction ( ! fix$ "p ( ! ure?ra )  
or )\t a metoidiopla/y or a phallopla/y2
  7xii7 metoidiopla/y2  7xiii7 p5ectomy2
  7xiv7 phallopla/y2  7xv7 vag9opla/y2  
7xvi7 clitoropla/y  7xvii7 vag9ectomy2  
7xviii7 vulvopla/y2  7xix7 r$uction     
?yro*ondropla/y2  7xx7                  
*ondrol>yngopla/y2  7xxi7 ma/ectomy2    
7xxii7 tubal ligation2  7xxiii7         
/]ilization2  7xxiv7 any pla/ic1        
cosmetic1 or ae/hetic surg]y t fem9izes 
or mascul9izes ! facial or o!r          

physiological features ( an individual2 
7xxv7 any placem5t ( *e/ implants to    
create fem99e brea/s2  7xxvi7 any       
placem5t ( fat or artificial implants 9 
! gluteal region2  7xxvii7 augm5tation  
mammopla/y2  7xxviii7 liposuction2      
7xxix7 lip(ill+2  7xxx7 voice surg]y2   
7xxxi7 hair recon/ruction2  7xxxii7     
pectoral implants2 &  7xxxiii7 ! removal
 ( any o!rwise heal?y or non-diseas$    
body "p or tissue4  7,b7 ,exclusions ,! 
t]m g5d] transition proc$ure does n     
include ! foll[+ :5 furni%$ to an       
individual by a heal? c>e provid] ) !   
cons5t ( su* individual or1 if          
applicable1 su* individual's p>5ts or   
legal gu>dian3 7i7 ,s]vices to          
individuals born ) a m$ically v]ifiable 
disord] ( sex developm5t1 includ+ an    
individual ) ext]nal sex *>act]i/ics t  
are irresolvably ambigu\s1 su* z an     
individual born ) #df ,,xx *romosomes ) 
virilization1 an individual born ) #df  
,,xy *romosomes ) und]virilization1 or  
an individual born hav+ bo? ov>ian &    

te/icul> tissue4  7ii7 ,s]vices provid$ 
:5 a physician has o!rwise diagnos$ a   
disord] ( sexual developm5t 9 :i* !     
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 heal?y individual ( !
 same sex & age4  7iii7 ,! treatm5t (   
any infection1 injury1 disease1 or      
disord] t has be5 caus$ by or exac]bat$ 
by ! p]=mance ( g5d] transition         
proc$ures1 :e!r or n ! g5d] transition  
proc$ure 0 p]=m$ 9 accordance ) ,/ate & 
,f$]al law or :e!r or n fund+ = ! g5d]  
transition proc$ure is p]missible "u ?is
 section4  7iv7 ,any proc$ure und]tak5  
because ! individual suff]s f a physical
 disord]1 physical injury1 or physical  
illness 7b n claim$ m5tal di/ress7 t    
w\ld1 z c]tifi$ by a physician1 place ! 
individual 9 imm95t dang] ( dea? or     
impairm5t ( major bodily function1      
unless ! proc$ure is p]=m$4  7v7 ,pub]ty
 suppression or block+ prescription     

drugs = ! purpose ( normaliz+ pub]ty = a
 m9or exp]i5c+ precoci\s pub]ty4  7vi7  
,male circumcision4  7#d7 ,male ,! t]m  
male1 :5 us$ to ref] to a natural p]son1
 means an individual :o naturally has1  
_h1 w h1 or w\ld h1 b = a cong5ital     
anomaly1 hi/orical accid5t1 or          
int5tional or un9t5tional disruption1 ! 
reproductive sy/em t at "s po9t         
produces1 transports1 & utilizes sp]m = 
f]tilization4  7#e7 ,sex ,! t]m sex1 :5 
ref]r+ to an individual's sex1 means to 
ref] to ei!r male or female1 z          
biologically det]m9$4  4  #ajb4 ,am5dm5t
 to table ( *apt]s ,! table ( *apt]s =  
title #a1 ,unit$ ,/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]  
proc$ures  7,a7 ,9 g5]al ,subp>agraph   
7,a7 ( section #cf;,b7c77#c7 ( !        
,int]nal ,rev5ue ,code ( #aihf is am5d$ 
by ins]t+ be=e ! p]iod at ! end !       
foll[+3 or any heal? plan t includes    
cov]age = g5d] transition proc$ures1 z  
def9$ 9 section #cjg ( title #a1 ,unit$ 
,/ates ,code 7o!r ?an any proc$ure      
describ$ 9 section #cjf ( su* title74   
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]        
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$ures  7,a7 ,9 g5]al ,9 ?is section1
 ! t]m qualifi$ heal? plan does n       

include any heal? plan t includes       
cov]age = g5d] transition proc$ures1 z  
def9$ 9 section #cjg ( title #a1 ,unit$ 
,/ates ,code 7o!r ?an any proc$ure      
describ$ 9 section #cjf ( su* title74   
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 (  
,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$]al policy reg>d+ g5d]    
transition proc$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 ,! am5dm5ts made by 
subsection 7a7 %all apply to taxable    
ye>s end+ aft] ! date t is #a 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