,,ii #aaith ,,congress #b;d ,session ,s4 #ddbf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,april #bi1 #bjbf,mr4 ,marshall 7for himself and ,mr4 ,lee7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to prohibit gender transition procedures on minors1 to authorize the ,secretary of ,health and ,human ,services to impose civil penalties on persons who perform gender transition procedures on minors1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,safeguarding ,the ,overall ,protection of ,minors ,act or the ,,stop ,act4 #b4 ,definitions ,in this ,act3 7#a7 ,caretaker ,the term caretaker means an adult1 who is not a parent of a child1 with whom a child resides and who provides that child with the care1 maintenance1 and supervision consistent with the duties and responsibilities of a parent of the child4 7#b7 ,detransition treatment ,the term detransition treatment means any treatment1 including mental health services1 medical intervention1 or surgery1 that does any of the following3 7,a7 ,stops or reverses the effects of a gender transition procedure4 7,b7 ,helps an individual cope with the effects of a prior gender transition procedure4 7#c7 ,female ,the term female1 when used to refer to a natural person1 means an individual who naturally has1 had1 will have1 or would have1 but for a congenital anomaly or intentional or unintentional disruption1 the reproductive system that at some point produces1 transports1 and utilizes eggs for fertilization4 7#d7 ,gender transition ,the term gender transition means the process1 which may be accompanied with social1 legal1 or physical changes-- 7,a7 in which an individual-- 7i7 intentionally halts the natural development of the individual's body so that the body no longer corresponds to the individual's sex2 or 7ii7 intentionally transforms the individual's physical appearance to confirm the individual's physical appearance to be of the alternate sex2 or 7,b7 that alters or removes sexual organs as part of chemical or surgical mutilation4 7#e7 ,gender transition procedure 7,a7 ,in general ,the term gender transition procedure means any hormonal1 pharmaceutical1 or surgical intervention for the purpose of gender transition1 including-- 7i7 gonadotropin-releasing hormone 7,gn,r,h7 agonists or other puberty-blocking or suppressing drugs to stop or delay normally timed puberty2 7ii7 testosterone1 estrogen1 progesterone1 androgen blockers1 or other sex hormones to an individual at doses that are supraphysiologic to what would normally be produced endogenously in a healthy individual of the same age and sex2 7iii7 procedures that attempt to transform an individual's physical appearance to confirm the individual's physical appearance to be of the alternate sex1 or that alter or remove sexual organs as part of chemical or surgical mutilation2 7iv7 castration2 7v7 orchiectomy2 7vi7 scrotoplasty2 7vii7 implantation of erection or testicular prostheses2 7viii7 vasectomy2 7ix7 hysterectomy2 7x7 oophorectomy2 7xi7 ovariectomy2 7xii7 reconstruction of the fixed part of the urethra with or without a metoidioplasty or a phalloplasty2 7xiii7 metoidioplasty2 7xiv7 penectomy2 7xv7 phalloplasty2 7xvi7 vaginoplasty2 7xvii7 clitoroplasty2 7xviii7 vaginectomy2 7xix7 vulvoplasty2 7xx7 reduction thyrochondroplasty2 7xxi7 chondrolaryngoplasty2 7xxii7 mastectomy2 7xxiii7 tubal ligation2 7xxiv7 sterilization2 7xxv7 any plastic1 cosmetic1 or aesthetic surgery that feminizes or masculinizes the facial or other physiological features of an individual2 7xxvi7 any placement of chest implants to create feminine breasts2 7xxvii7 any placement of fat or artificial implants in the gluteal region2 7xxviii7 augmentation mammoplasty2 7xxix7 liposuction2 7xxx7 lipofilling2 7xxxi7 voice surgery2 7xxxii7 hair reconstruction2 7xxxiii7 pectoral implants2 and 7xxxiv7 the removal of any otherwise healthy or non-diseased body part or tissue4 7,b7 ,exclusions ,the term gender transition procedure does not include the following when furnished to an individual by a health care provider with the consent of such individual or1 if applicable1 such individual's parents or legal guardian3 7i7 ,services to individuals who have been diagnosed with a disorder of sex development by a licensed health care provider operating within their scope of practice1 including an individual with external sex characteristics that are irresolvably ambiguous1 such as an individual born with #df ,,xx chromosomes with virilization1 an individual born with #df ,,xy chromosomes with undervirilization1 or an individual born having both ovarian and testicular tissue4 7ii7 ,services provided when a health care professional has otherwise diagnosed a disorder of sexual development in which the health care professional 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 action for a healthy individual of the same sex and age4 7iii7 ,the treatment of any infection1 injury1 disease1 or disorder that has been caused by or exacerbated by the performance of gender transition procedures1 whether or not the gender transition procedure was performed in accordance with ,state and ,federal law or whether or not funding for the gender transition procedure is permissible under this section4 7iv7 ,any procedure undertaken because the individual suffers from a physical disorder1 physical injury1 or physical illness 7but not mental1 behavioral1 or emotional distress or a mental1 behavioral1 or emotional disorder7 that would1 as certified by a health care professional1 place the individual in imminent danger of death or impairment of major bodily function1 unless the procedure is performed1 which may include the following3 7,i7 ,traumatic bodily injuries 7such as fractures1 organ rupture1 or penetrating trauma74 7,,ii7 ,congenital structural anomalies of major organs or systems1 including the cardiovascular1 respiratory1 renal1 hepatic1 neurological1 or musculoskeletal systems4 7,,iii7 ,acute illnesses with a high probability of imminent mortality4 7v7 ,any procedure to restore or reconstruct the body of the individual in order to correspond to the individual's sex after one or more previous gender transition procedures1 which may include the removal of a pseudo phallus or breast augmentation4 7vi7 ,puberty suppression or blocking prescription drugs for the purpose of normalizing puberty for a minor experiencing precocious puberty4 7vii7 ,male circumcision4 7#f7 ,male ,the term male1 when used to refer to a natural person1 means an individual who naturally has1 had1 will have1 or would have1 but for a congenital anomaly or intentional or unintentional disruption1 the reproductive system that at some point produces1 transports1 and utilizes sperm for fertilization4 7#g7 ,minor ,the term minor means an individual under the age of #ah4 7#h7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#i7 ,sex ,the term sex1 when referring to a natural person's sex1 means the person's immutable biological classification as either male or female1 as biologically determined and defined by this section4 #c4 ,gender transition procedures on minors 7a7 ,prohibition 7#a7 ,in general ,no person may1 in any circumstance described in paragraph 7#b71 knowingly perform1 attempt to perform1 conspire to perform1 or otherwise aid or abet the performance of any gender transition procedure on a minor4 7#b7 ,circumstances described ,a circumstance referred to in paragraph 7#a7 is any of the following3 7,a7 ,the person1 or the minor on whom the gender transition procedure was performed1 attempted to be performed1 or conspired to be performed or on whom the performance of any gender transition procedure was aided or abetted1 traveled in interstate or foreign commerce1 or traveled using a means1 channel1 facility1 or instrumentality of interstate or foreign commerce1 in furtherance of or in connection with the conduct described in paragraph 7#a74 7,b7 ,the person1 or the minor on whom the gender transition procedure was performed1 attempted to be performed1 or conspired to be performed or on whom the performance of any gender transition procedure was aided or abetted1 used a means1 channel1 facility1 or instrumentality of interstate or foreign commerce in furtherance of or in connection with the conduct described in paragraph 7#a74 7,c7 ,a payment of any kind was made1 directly or indirectly1 in furtherance of or in connection with the conduct described in paragraph 7#a71 using any means1 channel1 facility1 or instrumentality of interstate or foreign commerce or in interstate or foreign commerce4 7,d7 ,the person1 or the minor on whom the gender transition procedure was performed1 attempted to be performed1 or conspired to be performed or on whom the performance of any gender transition procedure was aided or abetted1 transmitted in interstate or foreign commerce any communication relating to or in furtherance of the conduct described in paragraph 7#a7 using any means1 channel1 facility1 or instrumentality of interstate or foreign commerce or in interstate or foreign commerce by any means or in manner1 including by computer1 mail1 wire1 or electromagnetic transmission4 7,e7 ,any instrument1 item1 substance1 or other object that has traveled in interstate or foreign commerce was used to perform the conduct described in paragraph 7#a74 7,f7 ,the conduct described in paragraph 7#a7 occurred within the special maritime and territorial jurisdiction of the ,united ,states or any territory or possession of the ,united ,states4 7,g7 ,the conduct described in paragraph 7#a7 otherwise occurred in interstate or foreign commerce4 7#c7 ,knowingly ,for purposes of paragraph 7#a71 a person acts knowingly when-- 7,a7 the person has actual knowledge of the facts giving rise to the violation of the prohibition described in paragraph 7#a72 or 7,b7 a reasonable person acting in the circumstances and exercising reasonable care would have that knowledge4 7#d7 ,application to work arrangements 7,a7 ,in general ,a violation of paragraph 7#a7-- 7i7 by an employee acting in the scope of their employment for an employer shall also be considered a violation of such paragraph by such employer2 or 7ii7 by any other individual who is engaged by a person for the performance of labor or services for remuneration and who is acting in the scope of their performance of such labor or services for such person shall also be considered a violation of such paragraph by such person4 7,b7 ,liability 7i7 ,employee violations ,in the case of a violation that is described in subparagraph 7,a77i71 the employee and the employer described in such subparagraph shall be jointly and severally liable for any civil penalty under subsection 7b7 and any private right of action under subsection 7c74 7ii7 ,other worker violations ,in the case of a violation that is described in subparagraph 7,a77ii71 the individual and person described in such subparagraph shall be jointly and severally liable for any civil penalty under subsection 7b7 and any private right of action under subsection 7c74 7b7 ,civil monetary penalties 7#a7 ,in general ,the ,secretary may impose a civil monetary penalty on any person upon making a determination1 after written notice and an opportunity for a hearing1 that the person has violated a requirement of subsection 7a77#a74 7#b7 ,amount of civil monetary penalties 7,a7 ,in general ,the amount of a civil monetary penalty under paragraph 7#a7 shall be not less than #ajj1jjj for each violation4 7,b7 ,penalty considerations ,in determining the amount of a civil monetary penalty under this subsection1 the ,secretary shall consider-- 7i7 the nature1 circumstances1 extent1 and gravity of the violation2 and 7ii7 with respect to the violator1 the degree of culpability1 any history of prior violations1 and any effect on the ability to continue to do business4 7#c7 ,civil action to collect 7,a7 ,in general ,the ,attorney ,general may bring a civil action in an appropriate district court of the ,united ,states to collect a civil monetary penalty under this subsection and any accrued interest on the civil monetary penalty as assessed by the ,secretary4 ,in such a civil action1 the amount and appropriateness of the civil monetary penalty shall not be subject to review4 7,b7 ,compromise ,the ,secretary may compromise the amount of a civil monetary penalty imposed under this subsection before referral to the ,attorney ,general under subparagraph 7,a71 on the condition that such amount shall be not less than #ajj1jjj4 7#d7 ,liability for procedures required as a matter of standard practice ,it shall not be a defense in a hearing under this subsection that gender transition procedures are required as a matter of standard practice4 7#e7 ,prohibition on imposition of civil monetary penalty on a person on whom procedures are performed ,no person on whom a gender transition procedure is performed1 attempted to be performed1 or conspired to be performed or on whom the performance of any gender transition procedure was aided or abetted in violation of subsection 7a77#a71 and no parent1 guardian1 or caretaker of such a person1 may be held liable for a civil monetary penalty under this subsection4 7#f7 ,depositing amounts collected 7,a7 ,in general ,amounts collected under this subsection shall be deposited in the fund established under subparagraph 7,b74 7,b7 ,establishment of ,fund 7i7 ,in general ,there is established in the ,treasury of the ,united ,states a fund1 to be known as the ,victims of ,gender ,transition ,procedures ,compensation ,fund1 which shall consist of amounts deposited in the fund pursuant to subparagraph 7,a74 7ii7 ,availability of funds ,amounts in the fund established under clause 7i7 shall be made available for expenditure for fiscal year #bjbf and each fiscal year thereafter1 without further appropriation or fiscal year limitation for expenditure by the ,secretary to carry out section #d4 7c7 ,private civil action 7#a7 ,in general ,an individual on whom a gender transition procedure is performed in violation of subsection 7a77#a71 or the parent1 guardian1 or caretaker of such an individual if such individual is a minor1 may bring a civil action in an appropriate district court of the ,united ,states against any person in violation of subsection 7a77#a7 for damages1 including damages described in paragraph 7#c74 7#b7 ,availability ,a cause of action described in paragraph 7#a7 shall be available regardless of whether the alleged violation occurred before1 on1 or after the date of enactment of this ,act4 7#c7 ,damages ,damages referred to in paragraph 7#a7 include-- 7,a7 compensatory damages1 including all economic damages associated with undoing1 correcting1 or ameliorating the effects or results of any gender transition procedure2 7,b7 non-economic damages for emotional distress and pain and suffering2 and 7,c7 punitive damages1 if the claimant proves by clear and convincing evidence that the defendant against whom punitive damages are sought acted maliciously1 intentionally1 fraudulently1 or recklessly4 7d7 ,penalty for obstruction of investigations 7#a7 ,in general ,the ,secretary may impose a civil penalty on any person who obstructs or prevents the ,secretary from carrying out an investigation into an alleged violation of subsection 7a77#a74 7#b7 ,definition of obstruct ,in this subsection1 the term obstruct means to take an action that was known1 or reasonably should have been known1 to prevent1 hinder1 or impede an investigation4 7e7 ,rules of construction 7#a7 ,in general ,in any proceeding described in subsection 7b7 or 7c7 any ambiguities shall be resolved against any person found to be in violation of subsection 7a77#a74 7#b7 ,health care professionals ,in any proceeding described in subsection 7b7 or 7c7 against a health care professional1 if a gender transition procedure of a minor is shown to have occurred before the date of enactment of this ,act1 limited deference shall be given to prevailing standards of care in effect at such time1 to the extent that such standards of care contradict the intent of this ,act and it is shown that such health care professional knew or should have known that such standards of care were in serious1 scientific1 and medical dispute at the time of the gender transition procedure4 7#c7 ,no liability for minors ,nothing in this ,act shall be construed to impose any liability whatsoever on a minor who is the individual on whom a gender transition procedure is performed1 attempted to be performed1 or conspired to be performed or on whom the performance of any gender transition procedure was aided or abetted4 7f7 ,effect ,nothing in this ,act-- 7#a7 establishes a private right of action based on counseling1 referrals to mental health professionals1 or discussions of treatment options 7including counseling1 referrals1 or options available upon reaching adulthood7 provided by health care professionals or mental health professionals or against health care professionals or mental health professionals based on circumstances not described in subsection 7a77#b71 on the condition that such actions do not constitute participation in a gender transition procedure2 7#b7 prohibits a health care professional or mental health professional from providing information about all available treatment options1 discussing risks and benefits1 or expressing professional medical opinions1 so long as such actions do not constitute participation in a gender transition procedure2 or 7#c7 waives liability for a health care professional4 7g7 ,statute of limitations ,an action under subsection 7c7 may be brought within #be years from the date of the eighteenth birthday of an individual on whom a gender transition procedure is performed as a minor or within #d years from the time the cost of a detransition treatment is incurred1 whichever date is later4 7h7 ,severability ,if any provision of this ,act1 or the application of such provision to any person or circumstance1 is held to be or made invalid1 the remainder of this ,act1 and the application of the provision to any other person or circumstance1 shall not be affected4 #d4 ,opening avenues for victims 7a7 ,purpose ,the purpose of this section is to support1 encourage1 and assist individuals in their efforts to reverse gender transition procedures4 7b7 ,establishment of grant program ,the ,secretary shall establish a grant program under which the ,secretary shall award grants to eligible entities to carry out the activities described in subsection 7d74 7c7 ,eligibility 7#a7 ,eligible entities ,to be eligible for a grant under this section1 an entity-- 7,a7 shall be a private nonprofit entity2 7,b7 shall submit to the ,secretary an application at such time1 in such manner1 and containing such information and assurances as the ,secretary may require1 including an assurance that such entity will-- 7i7 submit to the ,secretary such reports of deidentified data1 information1 and metrics as the ,secretary may require to assess the entity's performance in carrying out activities under the grant and ensure the entity is in compliance with the terms and conditions of such grant2 7ii7 not charge individuals for services provided through the grant2 and 7iii7 provide each individual counseled through the grant with accurate information on the appropriate medical procedures to reverse gender transition procedures2 and 7,c7 shall agree to have a privacy policy and procedures in place to ensure that-- 7i7 the name1 address1 telephone number1 or any other information that might identify any individual seeking services supported through the grant is not made public or shared with any other entity without the written consent of the individual2 and 7ii7 the grantee adheres to requirements comparable to those applicable under the ,,hipaa privacy regulation 7as defined in section #aahj7;b77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;d-#i7;b77#c777 to covered entities 7as defined for purposes of such regulation74 7#b7 ,ineligible entities ,an entity shall be ineligible to receive a grant under this section if the entity or any affiliate1 subsidiary1 successor1 or clinic thereof-- 7,a7 performs1 induces1 refers for1 or counsels in favor of gender transition procedures2 7,b7 performs1 induces1 refers for1 or counsels in favor of an abortion1 except-- 7i7 if the pregnancy is the result of an act of rape or incest2 or 7ii7 in the case where a woman suffers from a physical disorder1 physical injury1 or physical illness1 including a life-endangering physical condition caused by or arising from the pregnancy itself1 that would1 as certified by a physician1 place the woman in danger of death unless an abortion is performed2 or 7,c7 provides financial support to any other entity that conducts any activity described in subparagraph 7,a7 or 7,b74 7d7 ,use of grant funds 7#a7 ,required information and referral ,for the purpose described in subsection 7a71 an eligible entity receiving a grant under this section shall use the grant funds to provide to individuals who are exploring detransition information on1 and referral to1 #a or more of the following services3 7,a7 ,medical advice and care to reverse a gender transition procedure4 7,b7 ,education and employment assistance1 including services that support the continuation and completion of high school4 7,c7 ,voluntary mental health and substance use disorder services4 7#b7 ,permissible direct provision of services ,for the purpose described in subsection 7a71 in addition to using grant funds under this section as described in paragraph 7#a71 an eligible entity receiving a grant under this section may use the grant funds for the direct provision of one or more services described in paragraph 7#a74 7e7 ,prohibited uses of funds ,none of the funds made available under this section shall be used for-- 7#a7 gender transition procedures2 7#b7 payment for an abortion1 except-- 7,a7 if the pregnancy is the result of an act of rape or incest2 or 7,b7 in the case where a woman suffers from a physical disorder1 physical injury1 or physical illness1 including a life-endangering physical condition caused by or arising from the pregnancy itself1 that would1 as certified by a physician1 place the woman in danger of death unless an abortion is performed2 or 7#c7 requiring any person to perform1 or facilitate in any way the performance of1 any abortion4 7f7 ,consideration ,in selecting the recipients of grants under this section1 the ,secretary shall consider each applicant's demonstrated capacity in providing services to assist individuals who are exploring and seeking medical advice in their efforts to reverse gender transition procedures4 7g7 ,monitoring and review ,the ,secretary shall-- 7#a7 monitor and review each program funded through a grant under this section to ensure that the grantee carefully adheres to-- 7,a7 the purpose described in subsection 7a72 and 7,b7 the requirements of this section2 and 7#b7 cease to fund a program under this section if the grantee fails to adhere to such purpose and requirements4