,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #bchg  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,m>* #bf1 #bjbe,mr4   
,ond] 7= himself1 ,mr4 ,h>ris ( ,m>yl&1 
,mrs4 ,mill] ( ,ill9ois1 & ,mrs4 ,biggs 
( ,s\? ,c>ol9a7 introduc$ ! foll[+ bill2
 :i* 0 ref]r$ to ! ,committee on ,en]gy 
& ,comm]ce1 & 9 addition to !           
,committees on ! ,judici>y1 ,education &
 ,work=ce1 & ,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 ,f$]al funds f be+ us$ =       
sex-trait alt]+ treatm5ts = m9ors1 & =  
o!r purposes4  #a4 ,%ort title ,?is ,act
 may be cit$ z ! ,no ,h>m ,act4  #b4    
,prohibition on use ( ,f$]al funds =    
c]ta9 treatm5ts  7a7 ,9 g5]al ,not)/&+  
any o!r provision ( law1 no ,f$]al funds
 may be made available = purposes ( pay+
 =1 sponsor+1 promot+1 assi/+1 or       
support+ ! furni%+ ( a sex-trait alt]+  
treatm5t to a m9or4  7b7 ,civil action  

,any p]son1 includ+ a taxpay]1 may br+ a
 civil action = violation ( subsection  
7a7 = legal damages & equitable relief  
aga9/ ! ,unit$ ,/ates1 or ! appropriate 
,dep>tm5t or ,ag5cy disburs+ f$]al funds
 9 violation ( subsection 7a71 9 an     
appropriate di/rict c\rt ( ! ,unit$     
,/ates4  #c4 ,prohibition on use (      
,f$]al funds = c]ta9 actions  7a7 ,9    
g5]al ,not)/&+ any o!r provision ( law1 
no ,f$]al funds may be made available = 
purposes ( tak+ any regulatory or       
subregulatory action to promote         
sex-trait alt]+ treatm5ts to m9ors4  7b7
 ,civil action ,any p]son1 includ+ a    
taxpay]1 may br+ a civil action =       
violation ( subsection 7a7 = legal      
damages & equitable relief aga9/ !      
,unit$ ,/ates1 or ! appropriate         
,dep>tm5t or ,ag5cy disburs+ f$]al funds
 9 violation ( subsection 7a71 9 an     
appropriate di/rict c\rt ( ! ,unit$     
,/ates4  #d4 ,female g5ital mutilation  
to include provision ( sex-trait alt]+  
treatm5t to m9ors ,section #aaf ( title 

#ah1 ,unit$ ,/ates ,code1 is am5d$ by   
add+ at ! end ! foll[+3 ,= ! purpose (  
subsection 7b77#a71 ! phrase 8necess>y  
to ! heal? ( ! p]son0 %all n include    
*ange ( g5d] or sex1 or affirmation (   
g5d] or sex44  #e4 ,prohibition on fund+
 c]ta9 in/itutions ,not)/&+ any o!r     
provision ( law1 no ,f$]al funds may be 
made available to a m$ical in/itution   
7includ+ a hospital1 m$ical s*ool1      
cl9ic1 public heal? organization1       
f$]ally qualifi$ heal? c5t]1 rural heal?
 c5t]1 or m$ical practice7 if su*       
in/itution provides sex-trait alt]+     
treatm5ts to m9ors4  #f4 ,"r to decl9e  
treatm5ts  7a7 ,9 g5]al ,! p>5t ( a m9or
 %all h ! "r to decl9e any sex-trait    
alt]+ treatm5t = su* m9or4 ,likewise1 no
 specifi$ ,f$]al funds %all be made     
available to a ,/ate t has 9 place a    
policy to provide sex-trait alt]+       
treatm5t = a m9or )\t ! cons5t ( bo?    
p>5ts4  7b7 ,/ate requirem5t  7#a7 ,9   
g5]al ,no specifi$ ,f$]al funds may be  
made available to a ,/ate t has 9 place 

a policy to sep>ate a m9or f su* m9or's 
p>5t bas$ solely on su* p>5t's refusal  
to cons5t to a sex-trait alt]+ treatm5t 
= su* m9or4  7#b7 ,specifi$ ,f$]al funds
 def9$ ,= purposes ( ?is section1 ! t]m 
specifi$ ,f$]al funds means ,f$]al funds
 made available "u title ,,xix ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acif et seq47 or "u "p ,a ( title ,,iv 
( su* ,act 7#db ,u4,s4,c4 #fja et seq474
  7c7 ,civil action  7#a7 ,9 g5]al ,a   
m9or or a p>5t ( a m9or :o is h>m$ by a 
violation ( ?is section may br+ a civil 
action aga9/ ! ,unit$ ,/ates & aga9/ any
 ,/ate ) a policy 9 place 9 violation ( 
?is section 9 an appropriate di/rict    
c\rt ( ! ,unit$ ,/ates to obta9         
appropriate relief4  7#b7 ,/atute (     
limitations ,an action "u ?is subsection
 may be br\ght at any "t prior to #cj   
ye>s aft] ! date on :i* ! m9or atta9s ! 
age ( majority4  #g4 ,requirem5t to     
receive in=m$ cons5t  7a7 ,9 g5]al ,no  
heal? c>e provid] may furni% any        
sex-trait alt]+ treatm5t to a m9or      

unless1 at lea/ #gb h\rs prior to       
furni%+ su* treatm5t1 su* provid]-- 7#a7
 holds a consultation appo9tm5t ) !     
p>5ts ( su* m9or to discuss su*         
treatm5t2  7#b7 provides to ! p>5ts (   
su* m9or a complete1 pr9t$ li/ (        
pot5tial side effects ( su* treatm5t1   
includ+ any p]man5t risks relat+ to     
f]tility & sexual function2 &  7#c7     
receiv$ ! writt51 in=m$ cons5t ( ! p>5ts
 ( su* m9or = su* treatm5t4  7b7 ,civil 
action  7#a7 ,9 g5]al ,a m9or or a p>5t 
( a m9or :o is h>m$ by a violation ( ?is
 section may br+ a civil action aga9/ ! 
heal? c>e provid] 9 an appropriate      
di/rict c\rt ( ! ,unit$ ,/ates to obta9 
appropriate relief4  7#b7 ,/atute (     
limitations ,an action "u ?is subsection
 may be br\ght at any "t prior to #cj   
ye>s aft] ! date on :i* ! m9or atta9s ! 
age ( majority4  #h4 ,m$ical malpractice
 liability  7a7 ,9 g5]al ,an individual 
may br+ a civil action 9 an appropriate 
di/rict c\rt ( ! ,unit$ ,/ates to obta9 
appropriate relief = any physical1      

psy*ological1 or physiological h>m caus$
 by a sex-trait alt]+ treatm5t p]=m$ on 
! individual :5 ! individual 0 a m9or   
aga9/ a m$ical practition]1 hospital1   
cl9ic1 surg]y c5t] or o!r provid] t     
p]=m$ or prescrib$ su* treatm5t4 ,if    
said civil action is successful1 !      
individual w be aw>d$ attorney's fees & 
litigation co/s1 & treble damages4  7b7 
,/atute ( limitations ,an action "u ?is 
subsection may be br\ght at any "t prior
 to #cj ye>s aft] ! date on :i* ! m9or  
atta9s ! age ( majority4  #i4 ,"r (     
consci5ce = heal? c>e provid]s  7a7 ,9  
g5]al ,a heal? c>e provid] may n be     
p5aliz$1 retaliat$ aga9/1 or o!rwise    
discrim9at$ aga9/ on ! basis t ! provid]
 does n or decl9es to-- 7#a7 p]=m1 ref] 
=1 pay =1 or o!rwise p>ticipate 9       
sex-trait alt]+ treatm5t2  7#b7 provide 
or sponsor sex-trait alt]+ treatm5t     
cov]age2 or  7#c7 facilitate or make    
arrangem5ts = sex-trait alt]+ treatm5t4 
7b7 ,/ate requirem5t  7#a7 ,9 g5]al ,no 
specifi$ ,f$]al funds 7z def9$ 9        

p>agraph 7#b77 may be made available to 
a ,/ate t requires a heal? c>e provid]  
to provide sex-trait alt]+ treatm5ts4   
7#b7 ,specifi$ ,f$]al funds def9$ ,=    
purposes ( ?is subsection1 ! t]m        
specifi$ ,f$]al funds means any ,f$]al  
funds made available "u a program       
adm9i/]$ by ! ,dep>tm5t ( ,heal? &      
,human ,s]vices4  7c7 ,civil action ,a  
heal? c>e provid] :o is h>m$ by a       
violation ( subsection 7a7 may1 9 a     
civil action1 obta9 all appropriate     
relief1 includ+ injunctive relief1      
decl>atory relief1 & comp5satory damages
 to prev5t ! occurr5ce1 cont9uance1 or  
repetition ( su* violation & to         
comp5sate = losses result+ f !          
violation4  7d7 ,def9ition ,! t]m heal? 
c>e provid] includes-- 7#a7 an          
individual physician1 heal? c>e         
assi/ant1 nurse1 ph>maci/1 heal?        
rese>*]1 or o!r heal? c>e p]sonnel2     
7#b7 a hospital1 laboratory1 ph>macy1   
heal? sy/em1 or o!r heal? c>e or m$ical 
rese>* facility or organization 7includ+

 a p>ty to a propos$ m]g] or o!r        
collaborative arrangem5t relat+ to heal?
 s]vices1 & an entity result+ !refrom72 
7#c7 a provid]-sponsor$ organization1 an
 acc\ntable c>e organization1 or a heal?
 ma9t5ance organization2  7#d7 a social 
s]vices provid] t provides or au?orizes 
ref]rals = heal? c>e s]vices2  7#e7 a   
program ( tra9+ or education 9 ! heal?  
pr(essions or m$ical rese>*1 a          
p>ticipant 9 su* a program1 or any      
individual apply+ or o!rwise aspir+ to  
p>ticipate 9 su* a program2  7#f7 an    
issu] ( heal? insurance cov]age or ( a  
heal? plan2  7#g7 a heal? c>e %>+       
m9i/ry2  7#h7 a heal? insurance plan1   
includ+ gr\p1 individual1 or /ud5t heal?
 plans1 or a sponsor or adm9i/rator     
!re(2 &  7#i7 any o!r heal? c>e         
organization1 program1 facility1 or     
plan4  #aj4 ,prohibition on ,f$]al funds
 = provid+ sex-trait alt]+ treatm5t to  
/ud5ts )\t p>5tal cons5t  7a7 ,9 g5]al  
,not)/&+ any o!r provision ( law1 no    
,f$]al funds may be provid$ to an       

elem5t>y s*ool or second>y s*ool t all[s
 s*ool p]sonnel to provide1 assi/ 9     
provid+1 or o!rwise support ! provision 
( sex-trait alt]+ treatm5t to a /ud5t   
)\t notify+ ! p>5ts ( ! /ud5t & receiv+ 
writt5 approval f su* p>5ts4  7b7       
,def9itions ,9 ?is section3 7#a7 ,,esea 
t]ms ,! t]ms elem5t>y s*ool1            
p>apr(essional1 p>5t1 s*ool lead]1      
second>y s*ool1 & specializ$            
in/ructional support p]sonnel h ! mean+s
 giv5 ! t]ms 9 section #haja ( !        
,elem5t>y & ,second>y ,education ,act ( 
#aife 7#bj ,u4,s4,c4 #ghja74  7#b7      
,s*ool p]sonnel ,! t]m s*ool p]sonnel   
includes-- 7,a7 tea*]s2  7,b7           
p>apr(essionals2  7,c7 s*ool lead]s2    
7,d7 specializ$ in/ructional support    
p]sonnel2  7,e7 volunte]s p]=m+ s]vices 
= a s*ool2 &  7,f7 o!r support /aff :o  
are employ$ by a s*ool or :o p]=m       
s]vices = a s*ool on a contractual      
basis4  #aa4 ,def9itions ,9 ?is ,act3   
7#a7 ,sex-trait alt]+ treatm5t ,! t]m   
sex-trait alt]+ treatm5t means any      

m$ical or surgical s]vice1 includ+      
physician's s]vices1 practition]'s      
s]vices1 inpati5t & outpati5t hospital  
s]vices1 or prescrib$ drugs relat$ to   
g5d] transition1 o!r ?an an except$     
s]vice1 t seeks to3 7,a7 ,alt] or remove
 physical or anatomical *>act]i/ics or  
features t are typical = ! individual's 
sex2 or  7,b7 ,in/ill or create         
physiological or anatomical *>act]i/ics 
t resemble a sex diff]5t f !            
individual's sex1 includ+ m$ical s]vices
 t provide pub]ty block+ drugs1 g5d]    
transition hormone !rapy1 or g5ital g5d]
 reassignm5t surg]y or nong5ital g5d]   
reassignm5t surg]y kn[+ly p]=m$ = !     
purpose ( assi/+ an individual ) a g5d] 
transition4  7#b7 ,sex ,! t]m sex means 
! biological indication ( be+ male or   
female1 includ+ sex *romosomes1 &       
naturally occurr+ sex hormones1 gonads1 
& nonambigu\s int]nal & ext]nal g5italia
 pres5t at bir?4  7#c7 ,g5d] transition 
hormone !rapy ,! t]m g5d] transition    
hormone !rapy means te/o/]one1 e/rog51  

or proge/]one giv5 to an individual 9 an
 am\nt great] ?an w\ld normally be      
produc$ endog5\sly 9 a heal?y individual
 ( t individual's age & sex4  7#d7 ,g5d]
 ,! t]m g5d] means ! psy*ological1      
behavioral1 social1 & cultural aspects (
 be+ male or female4  7#e7 ,g5d]        
reassignm5t surg]y ,! t]m g5d]          
reassignm5t surg]y means any m$ical or  
surgical s]vice t seeks to surgically   
alt] or remove heal?y physical or       
anatomical *>act]i/ics or features t are
 typical = ! individual's sex1 9 ord] to
 in/ill or create physiological or      
anatomical *>act]i/ics t resemble a sex 
diff]5t f ! individual's sex1 includ+   
g5ital g5d] reassignm5t surg]y or       
nong5ital g5d] reassignm5t surg]y kn[+ly
 p]=m$ = ! purpose ( assi/+ an          
individual ) a g5d] transition4  7#f7   
,g5d] transition ,! t]m g5d] transition 
means ! process 9 :i* an individual     
%ifts f id5tify+ ) & liv+ z a g5d] t    
corresponds to 8 or h] sex to id5tify+ )
 & liv+ z a g5d] diff]5t f 8 or h] sex1 

& may involve social1 legal1 or physical
 *anges4  7#g7 ,g5ital g5d] reassignm5t 
surg]y ,! t]m g5ital g5d] reassignm5t   
surg]y means a m$ical proc$ure kn[+ly   
p]=m$ = ! purpose ( assi/+ an individual
 ) a g5d] transition1 includ+ ! foll[+3 
7,a7 ,surgical proc$ures1 includ+ a     
p5ectomy1 or*iectomy1 vag9opla/y1       
clitoropla/y1 or vulvopla/y = a male sex
 pati5t or hy/]ectomy or ov>iectomy = a 
female sex pati5t4  7,b7 ,recon/ruction 
( ! fix$ "p ( ! ure?ra ) or )\t a       
metoidiopla/y4  7,c7 ,phallopla/y1      
vag9ectomy1 scrotopla/y1 or implantation
 ( erection or te/icul> pro/heses = a   
female sex pati5t4  7#h7 ,nong5ital g5d]
 reassignm5t surg]y ,! t]m nong5ital    
g5d] reassignm5t surg]y means m$ical    
proc$ures kn[+ly p]=m$ = ! purpose (    
assi/+ an individual ) a g5d]           
transition1 includ+ ! foll[+3 7,a7      
,surgical proc$ures = a male sex pati5t1
 includ+ augm5tation mammopla/y1 facial 
fem9ization surg]y1 liposuction1        
lip(ill+1 voice surg]y1 ?yroid c>tilage 

r$uction1 gluteal augm5tation1 hair     
recon/ruction1 or associat$ ae/hetic    
proc$ures4  7,b7 ,surgical proc$ures = a
 female sex pati5t1 includ+ subcutane\s 
ma/ectomy1 voice surg]y1 liposuction1   
lip(ill+1 pectoral implants1 or         
associat$ ae/hetic proc$ures4  7#i7     
,pub]ty block+ drugs ,! t]m pub]ty      
block+ drugs means ! foll[+ :5 us$ = !  
purpose ( assi/+ an individual ) a g5d] 
transition4 7,a7 ,gonadotrop9 releas+   
hormone analogues or o!r syn!tic drugs  
us$ to /op lute9iz+ hormone & follicle  
/imulat+ hormone secretion2 or  7,b7    
,syn!tic anti&rog5 drugs us$ to block ! 
&rog5 receptor4  7#aj7 ,except$ s]vice  
,! t]m except$ s]vice means any ( !     
foll[+3 7,a7 ,m$ical or surgical s]vices
 furni%$ to an individual born ) a      
m$ically v]ifiable disord] ( sex        
developm5t1 includ+ an individual )3 7i7
 ,ext]nal sex *>act]i/ics t are         
irresolvably ambigu\s2  7ii7 ,=ty-six   
,,xx *romosomes ) virilization2  7iii7  
,=ty-six ,,xy *romosomes )              

und]virilization2 or  7iv7 ,bo? ov>ian &
 te/icul> tissue4  7,b7 ,m$ical or      
surgical s]vices provid$ :5 a physician 
or practition] has diagnos$ a disord] or
 condition ( sexual developm5t t !      
physician or practition] 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  7,c7 ,!  
treatm5t ( any infection1 injury1       
disease1 or disord] t has be5 caus$ by  
or exac]bat$ by ! p]=mance ( sex-trait  
alt]+ treatm5ts4  7,d7 ,any m$ical or   
surgical s]vice und]tak5 because !      
individual suff]s f a physical disord]1 
physical injury1 or physical illness t  
w\ld1 z c]tifi$ by a physician or       
practition]1 place ! individual 9 imm95t
 dang] ( dea? or impairm5t ( major      
bodily function unless ! m$ical or      
surgical s]vice is p]=m$4  7,e7 ,m5tal  
heal? or social s]vices1 o!r ?an        
sex-trait alt]+ treatm5ts4  7,f7        
,s]vices = a disord] or condition (     

sexual developm5t t is unrelat$ to a    
diagnosis ( g5d] dysphoria or g5d]      
id5tity disord]4  7#aa7 ,m9or ,! t]m    
m9or means an individual "u #ah ye>s (  
age4