,,ii #aaith ,,congress #b;d ,session ,s4 #eeic ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,september #bi1 #bjbf,mr4 ,schmitt introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to prevent the removal of children for sex-rejecting interventions4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,yaeli ,martinez ,child ,protection ,act4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4,sec4 #b4 ,findings4,sec4 #c4 ,intent2 authority4,sec4 #d4 ,rules of ,construction4,sec4 #e4 ,severability4,,title ,i--,amendments to the ,child ,abuse ,prevention and ,treatment ,act,sec4 #aja4 ,grants to ,states for child abuse or neglect prevention and treatment programs4,sec4 #ajb4 ,restrictions on uses of funds2 protection of parental rights4,sec4 #ajc4 ,reports4,sec4 #ajd4 ,definitions4,sec4 #aje4 ,rule of construction4,sec4 #ajf4 ,private right of action4,,title ,,ii--,amendments to the ,social ,security ,act,sec4 #bja4 ,amendments to part ,b of title ,,iv of the ,social ,security ,act4,sec4 #bjb4 ,amendments to part ,e of title ,,iv of the ,social ,security ,act4,sec4 #bjc4 ,amendments to the ,john ,h4 ,chafee ,foster ,care ,program for ,successful ,transition to ,adulthood4,sec4 #bjd4 ,rules of construction2 application to funding restrictions under parts ,b and ,e of title ,,iv of the ,social ,security ,act4,sec4 #bje4 ,amendment to section #dgh of the ,social ,security ,act4,,title ,,iii--,amendments to the full faith and credit for child custody determinations,sec4 #cja4 ,full faith and credit for child custody determinations4 #b4 ,findings ,congress finds as follows3 7#a7 ,parents have the fundamental right under the ,constitution of the ,united ,states to direct the care1 upbringing1 education1 and welfare of their children1 including raising1 treating1 caring for1 and referring to a child in a manner consistent with the child's sex4 7#b7 ,parents have the fundamental right to make health care decisions for the purpose of protecting their child's bodily integrity1 development1 and emotional and mental health4 7#c7 ,parents have a right under the ,first ,amendment to the ,constitution of the ,united ,states to direct the religious upbringing of their children1 including to inculcate the belief that all humans are created male or female and to raise their child as the child's sex in accordance with their religious beliefs4 7#d7 ,no child should be removed from his or her family by the ,state1 or denied foster or adoptive placement1 for the purpose of subjecting the child to social1 medical1 or surgical sex-rejecting interventions by the ,state4 7#e7 ,raising a child according to his or her sex is not abuse4 7#f7 ,congress and the ,supreme ,court have long recognized that parents possess the fundamental right to raise their children in accordance with their beliefs1 including through ,meyer v4 ,nebraska1 #bfb ,u4,s4 #cij 7#aibc71 ,pierce v4 ,society of ,sisters1 #bfh ,u4,s4 #eaj 7#aibe71 ,quilloin v4 ,walcott1 #dcd ,u4,s4 #bdf 7#aigh71 ,parham v4 ,j4,r41 #ddb ,u4,s4 #ehd 7#aigi71 ,troxel v4 ,granville1 #ecj ,u4,s4 #eg 7#bjjj71 and ,mahmoud v4 ,taylor1 #fjf ,u4,s4 #ebb 7#bjbe74 ,the ,supreme ,court1 in ,troxel v4 ,granville1 #ecj ,u4,s4 #eg 7#bjjj71 held that the interest of parents in the care1 custody1 and control of their children--is perhaps the oldest of the fundamental liberty interests recognized by this ,court4 7#g7 ,the right of parents to direct the upbringing and care of their children1 including the right to make medical decisions on behalf of their children1 is a fundamental liberty interest protected by the ,due ,process ,clause of the ,fourteenth ,amendment to the ,constitution of the ,united ,states1 including through ,meyer v4 ,nebraska1 #bfb ,u4,s4 #cij 7#aibc71 ,pierce v4 ,society of ,sisters1 #bfh ,u4,s4 #eaj 7#aibe71 ,parham v4 ,j4,r41 #ddb ,u4,s4 #ehd 7#aigi71 and ,troxel v4 ,granville1 #ecj ,u4,s4 #eg 7#bjjj74 7#h7 ,the ,supreme ,court has recognized that these constitutional protections rest on the presumption that parents love their children and possess what a child lacks in maturity1 experience1 and capacity for judgment4 ,the ,supreme ,court1 in ,parham v4 ,j4,r41 #ddb ,u4,s4 #ehd 7#aigi71 affirmed that parents have always been presumed to act in the best interests of their children in making medical decisions4 7#i7 ,the ,supreme ,court has stated1 in ,quilloin v4 ,walcott1 #dcd ,u4,s4 #bdf 7#aigh71 that1 absent a clear and convincing finding of unfitness of parental abuse1 neglect1 or abandonment1 the ,state may not lawfully intervene in the parent-child relationship4 ,the ,supreme ,court has held that-- 7,a7 the ,due ,process ,clause does not permit a ,state to infringe on the fundamental right of parents to make child rearing decisions simply because a state judge believes a better decision could be made 7,troxel v4 ,granville1 #ecj ,u4,s4 #eg 7#bjjj772 and 7,b7 simply because the decision of a parent is not agreeable to a child or because it involves risks does not automatically transfer the power to make that decision from the parents to some agency or officer of the state 7,parham v4 ,j4,r41 #ddb ,u4,s4 #ehd 7#aigi774 7#aj7 ,a parent's decision to affirm a child's sex and protect him or her from the harms of sex-rejecting interventions is an exercise of fundamental parental rights4 ,raising a child according to his or her sex is not abuse1 neglect1 or maltreatment4 7#aa7 ,the ,supreme ,court has recognized in ,united ,states v4 ,skrmetti1 #fje ,u4,s4 #die 7#bjbe7 that sex-rejecting interventions are not settled science1 that the gender distress of a child is not immutable1 and that the state may reasonably protect a child from the harms of sex-rejecting interventions4 ,likewise1 parents have the right to make a reasonable choice in the best interest of their child1 to preserve for that child a future free from these harms4 7#ab7 ,the ,supreme ,court has recognized in ,mahmoud v4 ,taylor1 #fjf ,u4,s4 #ebb 7#bjbe71 the rights of parents to direct the religious upbringing of their children and that those rights are violated by government policies that substantially interfere with the religious development of children1 including where promotion of gender ideology would impose a substantial burden on their religious beliefs4 7#ac7 ,and yet1 parents across the ,united ,states have suffered grievous interference with their constitutional rights4 ,state child protection agencies and courts have intervened forcefully to remove children from fit parents and deny placement of children with foster and adoptive parents simply because parents refuse to affirm a child's rejection of his or her sex1 or consent to social1 medical or surgical sex-rejecting interventions4 7#ad7 ,state and ,federal policies that require parental affirmation of a child's rejection of his or her sex are at odds with the best available science1 which recognizes the evidence for sex-rejecting interventions is weak while the risks of physical and psychological harm are high4 ,this unfavorable risk-benefit ratio has been clearly established in the #bjbe report of the ,department of ,health and ,human ,services1 titled ,treatment for ,pediatric ,gender ,dysphoria3 ,review of ,evidence and ,best ,practices1 and through multiple systematic reviews conducted in the ,united ,kingdom1 ,sweden1 ,finland1 and other countries4 ,risks include cancer1 loss of bone density1 impaired cognitive development1 adverse psychiatric events1 loss of sexual function1 and infertility and sterility4 7#ae7 ,the scientific literature shows that1 in most children1 gender dysphoria resolves by adulthood if the child is not medicalized or treated as the opposite sex4 ,affirmation of a child's sex is consistent with both long-term health outcomes and the child's natural developmental trajectory4 7#af7 ,federal funds should not be used to mandate1 promote1 or implement protocols treating sex-rejecting interventions as evidence-based1 safe1 or in the best interests of children4 7#ag7 ,despite the lack of evidence for sex-rejecting interventions1 for many years1 ,state child welfare systems have trained personnel1 from social workers to judges1 to treat as unsafe or abusive parents who decline to consent to these interventions for their child4 7#ah7 ,this training has resulted in ,states removing children from loving families and denying the placement of children with prospective foster and adoptive parents1 on the sole or primary basis that they affirm the child's sex4 7#ai7 ,removal from fit parents is contrary to the best interests of children1 creates trauma for the child1 damages familial bonds1 and exposes the child to well-documented risks in state custody4 ,children have suffered great harm and even have died after being removed from loving families by the state for sex-rejecting interventions4 7#bj7 ,where ,states have banned placement with foster and adoptive parents on the grounds of their scientific or religious convictions about sexuality1 thousands of safe and welcoming homes have been lost to the foster system1 further endangering children in desperate need4 7#ba7 ,children in foster care and ,state residential settings are among the most vulnerable populations in the ,nation2 many have experienced prior abuse or trauma4 ,sex-separated facilities provide an essential safeguard for these children's safety and well-being1 and yet many ,state foster facilities now house minor females with males4 7#bb7 ,many ,states have passed laws or enacted polices arrogating custody to themselves if a child runs to or is taken by an adult to the ,state for sex-rejecting interventions in gross disregard of lawful custody orders and parental rights in another ,state4 7#bc7 ,these measures amount to ,state-sanctioned kidnapping and directly conflict with the ,full ,faith and ,credit ,clause and the ,supremacy ,clause of the ,constitution of the ,united ,states and the amendments made by the ,parental ,kidnapping ,prevention ,act of #aihj 7,public ,law #if-faa2 #id ,stat4 #cefh74 7#bd7 ,state policies offering free sex-rejecting interventions to children have enticed many children to run away from fit and loving parents who seek to protect them4 ,nonprofit entities1 including ,state and ,federal-funded entities1 have encouraged and aided children in running away to avoid the lawful authority and care of their parents4 7#be7 ,federal funds provided under the ,child ,abuse ,prevention and ,treatment ,act 7#db ,u4,s4,c4 #eaja et seq47 and subtitles ,b and ,e of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq47 have been used1 directly or indirectly1 to fund investigations1 removals1 trainings1 and programs that treat parental affirmation of a child's sex as evidence of child abuse1 neglect1 emotional abuse1 or parental unfitness or incapacity4 7#bf7 ,such uses of ,federal funds are inconsistent with ,federal law1 interstate compacts on juvenile runaways1 multi-,state laws governing court jurisdiction over child custody matters1 the constitutional rights of parents1 and the best interests of children4 7#bg7 ,the ,federal child welfare system is premised on the principle that child removal from parents is an extreme measure of last resort1 to be employed only when the child faces a genuine risk of abuse or neglect that cannot be remediated through less drastic means4 ,employing that system to remove children from parents who are exercising their fundamental constitutional right to raise their children in a manner consistent with their sex distorts the purpose of the system1 causes serious harm to families1 and undermines public confidence in child welfare institutions4 7#bh7 ,parents and children have suffered unwarranted but irreparable harm when their own or another ,state has wrongfully asserted authority over the child in order to provide sex-rejecting interventions against the parent's will4 7#bi7 ,existing ,state remedies and administrative processes have failed to provide timely or effective relief for violations of fundamental parental rights by public officials or private entities exercising ,state-derived authority4 ,child welfare systems and courts have compounded these violations by drawing out proceedings past the age of majority1 rendering cases moot and injustice permanent4 7#cj7 ,congress must act to prevent the ongoing misuse of public funds1 harm to children in ,state care1 and destruction of families by the ideological weaponization child welfare systems4 ,clear national standards for the use of ,federal child welfare funds1 public accountability1 and the establishment of a clear cause of action against ,state child welfare services and their employees and contractors are necessary to deter harm to children and violations of parental rights and to ensure meaningful remedies4 #c4 ,intent2 authority 7a7 ,intent ,it is the intent of ,congress-- 7#a7 to reaffirm and protect the fundamental right of parents to direct the care1 upbringing1 education1 and welfare of their children1 including the right to raise1 care for1 treat1 and refer to them in a manner consistent with the child's sex2 7#b7 to stop the weaponization of the child welfare system against parents who affirm their child's sex or decline to consent to sex-rejecting interventions2 7#c7 to deter violations of parental rights by ,state actors1 nonprofit entities or other entities and persons exercising ,state-delegated authority over child custody1 placement1 or care2 7#d7 to protect children in foster care1 residential placements1 and other out-of-home settings from being subjected to sex-rejecting interventions or endangered by failure to provide sex-separated sleeping1 toileting1 bathing1 and other facilities in which a child may be in a state of undress2 7#e7 to provide clear notice and training of constitutional obligations within child welfare systems2 7#f7 to ensure that ,federal funds are not used by ,states or by private ,state-designated or ,state-funded entities to violate the fundamental rights of parents or to enforce or further the provision of sex-rejecting interventions to minors2 7#g7 to ensure that professional training1 clinical protocols1 and administrative guidance funded with ,federal monies do not characterize parental affirmation of a child's sex as child abuse1 neglect1 emotional abuse1 or evidence of parental unfitness or incapacity2 7#h7 to ensure that ,federal funds are spent in accordance with evidence-based practices that support child safety1 family preservation1 and child well-being1 and not on programs1 trainings1 or protocols that promote sex-rejecting interventions for children or that treat parental affirmation of a child's sex as harmful to the child2 7#i7 to ensure that children in ,state care are housed on the basis of their immutable sex2 7#aj7 to provide parents1 legal guardians1 caregivers1 and children with access to meaningful and timely judicial relief when rights recognized and established by this ,act1 including the amendments made by this ,act1 are infringed through the express provision of a right of action2 7#aa7 to affirm that referring to the child by pronouns or titles consistent with the child's sex1 declining to consent to puberty-blocking drugs or cross-sex hormones1 and declining to facilitate social1 medical1 or surgical sex-rejecting interventions do not constitute child abuse1 neglect1 emotional abuse1 or maltreatment under ,federal law2 and 7#ab7 to preserve the integrity of interstate custody proceedings and prohibit courts of another ,state from assuming jurisdiction over child custody or visitation on the basis of a parent's or child's desire to obtain sex-rejecting interventions4 7b7 ,authority ,this ,act is enacted pursuant to the following authorities of ,congress3 7#a7 ,section #e of the ,fourteenth ,amendment to the ,constitution of the ,united ,states1 to enforce the guarantees of due process and equal protection for fundamental rights1 specifically the fundamental parental right to custody and care of their child and to direct the upbringing1 care1 and control of their child4 7#b7 ,the ,spending ,clause under section #h of article ,i of the ,constitution of the ,united ,states1 by which ,congress may condition the receipt of ,federal funds on ,states' agreement to comply with specific requirements related to the purposes of the funded programs 7,south ,dakota v4 ,dole1 #dhc ,u4,s4 #bjc 7#aihg774 ,the conditions established by this ,act1 including the amendments made by this ,act relate to the ,federal interest in child welfare1 child safety1 family preservation1 and the protection of parental rights4 7#c7 ,the ,full ,faith and ,credit ,clause of section #a of article ,,iv of the ,constitution of the ,united ,states1 which grants ,congress the power to prescribe the manner in which full faith and credit shall be given to the public acts1 records1 and judicial proceedings of each ,state4 7#d7 ,the ,commerce ,clause of section #h of article ,i of the ,constitution of the ,united ,states1 to the extent that the activities regulated substantially affect interstate commerce1 including the interstate movement of children across ,state lines in the context of custody proceedings1 foster care placements1 and the administration of federally funded child welfare programs4 #d4 ,rules of ,construction 7a7 ,in general ,this ,act shall be construed-- 7#a7 broadly1 with respect to the protection of constitutional parental rights2 and 7#b7 narrowly1 with respect to any asserted justification for government interference with constitutional parental rights4 7b7 ,effect on other laws ,nothing in this ,act shall-- 7#a7 limit the authority of child protective services agencies to investigate or respond to genuine reports of physical abuse1 sexual abuse1 or neglect of children2 or 7#b7 preempt any ,state law that provides greater protection to parents1 legal guardians1 or children than the rights established by this ,act1 including the amendments made by this ,act4 7c7 ,construction of terms relating to child welfare and affirmation of a child's sex ,for purposes of this ,act1 including the amendments made by this ,act1 the terms child abuse1 emotional abuse1 neglect1 maltreatment1 mistreatment1 parental unfitness or incapacity1 and abandonment shall not be construed to include affirming a child's sex1 nor shall affirming a child's sex be construed as contrary to the best interest of the child1 or as contrary to a child's safety1 health1 well-being1 or welfare4 #e4 ,severability ,if any provision of this ,act1 an amendment made by this ,act1 or the application of such provision or amendment to any person or circumstance is held to be invalid or unenforceable by any court of competent jurisdiction1 the remainder of this ,act1 the amendments made by this ,act1 and the application of such provision or amendment to any other person or circumstance shall not be affected thereby4 ,i ,amendments to the ,child ,abuse ,prevention and ,treatment ,act #aja4 ,grants to ,states for child abuse or neglect prevention and treatment programs ,section #ajf of the ,child ,abuse ,prevention and ,treatment ,act 7#db ,u4,s4,c4 #eajf;a7 is amended-- 7#a7 in subsection 7b7-- 7,a7 in paragraph 7#b7-- 7i7 in subparagraph 7,b7-- 7,i7 in clause 7vii71 by inserting 1 except to the extent that such report relates to a claim or suspicion of child abuse based on a parent or guardian affirming a child's sex before the semicolon at the end2 7,,ii7 in clause 7xxiv71 by striking 2 and and inserting a semicolon2 and 7,,iii7 by adding at the end the following3 7xxvi7 provisions and procedures for-- 7,i7 protecting and promoting children's right to be free from sex-rejecting interventions2 and 7,,ii7 protecting children from the use1 without express parental consent1 of pronouns or titles that do not correspond to the child's sex2 7xxvii7 provisions and procedures for training child protective service workers1 guardians ad litem1 minor's counsel1 court appointed special advocates1 judges1 and other individuals providing services to children and families on-- 7,i7 the medical1 psychological1 and developmental harms of sex-rejecting interventions to children and the harms of using pronouns or titles that do not correspond to a child's sex2 7,,ii7 the right of a parent or legal guardian to affirm a child's sex and of a parent1 legal guardian1 caregiver1 foster parent1 or prospective foster or adoptive parent to be free from discrimination or adverse ,state actions for affirming a child's sex2 7,,iii7 the principle that affirmation of a child's sex by a parent1 legal guardian1 caregiver1 foster parent1 or prospective foster or adoptive parent is not child abuse1 emotional abuse1 neglect1 maltreatment1 abandonment1 contrary to the child's best interest1 contrary to the child's health1 safety1 or welfare1 or an indication of parental unfitness or incapacity2 and 7,,iv7 the principle that affirmation of a child's sex is consistent with the child's best interests1 health1 safety1 and welfare2 and 7xxviii7 provisions and procedures requiring any covered entity described in section #aaa7;a77#e77;,a7 to have in effect policies and procedures that protect and promote the right of a parent1 legal guardian1 or caregiver to be free from any adverse ,state action4 2 7ii7 in subparagraph 7,f71 by striking 2 and and inserting a semicolon2 7iii7 in subparagraph 7,g71 by striking the period and inserting a semicolon2 and 7iv7 by adding at the end the following3 7,h7 an assurance in the form of a certification by the governor of the ,state that the programs1 projects1 or trainings conducted or funded under this title do not violate the limitations set forth in section #aae2 and 7,i7 an assurance in the form of a certification by the governor of the ,state that the programs1 projects1 or trainings conducted under this subchapter comply with clauses 7xxvi7 through 7xxviii7 of subparagraph 7,b74 2 and 7,b7 in paragraph 7#c7-- 7i7 by striking such a disclosure where a court orders and inserting 8such a disclosure where-- 7,a7 a court orders 2 7ii7 by striking the period and inserting a semicolon2 and 7iii7 by adding at the end the following3 7,b7 a report includes an allegation that the child is being affirmed as his or her sex2 or 7,c7 the child has expressed a desire to be treated in a manner that does not correspond to his or her sex or has requested sex-rejecting interventions4 2 7#b7 in subsection 7c77#d77;,b77i77,i71 by inserting 1 except as requested by the ,secretary before the semicolon2 7#c7 in subsection 7d71 by adding at the end the following3 7#ai7 ,of the number of children described in paragraph 7#a71 the number who identify in a manner that does not correspond to their sex and-- 7,a7 who were reported to the ,state to have run away from home or eloped from a placement2 7,b7 who have been given a placement outside of the home2 7,c7 who were removed from parent1 legal guardian1 or caregiver2 or 7,d7 whose parents had their parental rights terminated4 2 and 7#d7 by adding at the end the following3 7g7 ,scope of application ,for purposes of clauses 7xxvi7 through 7xxviii7 of subsection 7b77#b77;,b71 if any covered entity described in section #aaa7;a77#e77;,a7 receives funds under this title1 directly or as a recipient of a subgrant1 the provisions and procedures described in such clauses shall apply to all of the operations1 divisions1 facilities1 or programs of that covered entity1 regardless of whether the specific operation1 division1 facility1 or program received such funds4 4 #ajb4 ,restrictions on uses of funds2 protection of parental rights ,title ,i of the ,child ,abuse ,prevention and ,treatment ,act 7#db ,u4,s4,c4 #eaja et seq47 is amended by adding at the end the following3 #aae4 ,restrictions on uses of funds2 protection of parental rights 7a7 ,in general ,in administering1 enforcing1 or awarding funds under this title1 the ,secretary shall not treat affirmation of a child's sex by a parent1 legal guardian1 caregiver1 foster parent1 or prospective foster or adoptive parent as child abuse1 emotional abuse1 neglect1 maltreatment1 abandonment1 contrary to the child's best interests1 contrary to a child's health1 safety1 or welfare1 or an indication of parental unfitness or incapacity4 7b7 ,condition on receipt of funds2 rights protected ,as a condition of receiving funds under this title1 including any grants1 subgrants1 or other allocations1 a covered entity shall protect the following rights and shall not discriminate or take an adverse ,state action against an individual because such individual exercises1 has exercised1 or intends to exercise any such right3 7#a7 ,a parent or legal guardian has the right to affirm a child's sex1 including the right for the child not to be subjected by any covered entity1 even if the child is in the legal or physical custody of the covered entity1 to-- 7,a7 the provision1 facilitation1 funding1 authorization1 or permission of any sex-rejecting intervention for the child2 7,b7 the use of pronouns or titles that do not correspond to the child's sex1 without the express written consent of the child's parent or legal guardian2 or 7,c7 if the child is #d years of age or older1 being permitted or assigned the use of sleeping quarters 7other than sleeping quarters shared only with a sibling71 bathrooms1 showers1 locker rooms1 changing rooms1 or any other area in which the child would be in a state of undress1 with individuals of the opposite sex4 7#b7 ,a parent or legal guardian has the right not to be required to consent to the child being subjected to any of the actions described in subparagraph 7,a71 7,b71 or 7,c7 of paragraph 7#a7 as a condition of custody or return of the child1 or visitation1 communication1 or reunification with the child4 7#c7 ,a parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 or prospective adoptive parent has a right to be free from discrimination or adverse ,state action for affirming or intending to affirm a child's sex4 7#d7 ,a child has the right not to be subjected by any covered entity1 even if the child is in the legal or physical custody of the covered entity1 to any sex-rejecting intervention4 7c7 ,prohibited uses of funds ,the ,secretary shall ensure that no funds provided under this title1 including any grants1 subgrants1 and other allocations to ,states1 ,indian ,tribes or ,tribal organizations1 and public and private agencies and organizations1 are used for any of the following3 7#a7 ,conducting1 supporting or promoting any program1 project1 curriculum1 guidance1 protocol1 or training that supports or promotes a principle that-- 7,a7 sex-rejecting interventions are in the best interest of the child or consistent with the health1 safety1 and welfare of the child2 7,b7 affirmation of a child's sex by a parent1 legal guardian1 caregiver1 foster parent1 or prospective foster or adoptive parent is child abuse1 emotional abuse1 neglect1 maltreatment1 abandonment1 contrary to a child's best interests1 contrary to a child's health1 safety1 or welfare1 or an indication of parental unfitness or incapacity2 or 7,c7 a child's expression of psychological distress1 including a statement or report of suicidal ideation1 related to the affirmation of a child's sex is grounds for removal of the child from the home1 intervention by a child welfare agency1 or any other adverse ,state action4 7#b7 ,conducting1 supporting1 or promoting any adverse ,state action4 7#c7 ,providing1 facilitating1 funding1 authorizing1 or permitting any sex-rejecting intervention for a child1 or referring a child for a sex-rejecting intervention4 7#d7 ,removing children from parents1 legal guardians1 or caregivers and placing children into any home1 institution1 or other placement setting that facilitates or provides sex-rejecting interventions1 or without parental consent1 uses pronouns or titles that do not correspond to the child's sex4 7d7 ,obligations on recipients and subrecipients ,a ,state1 ,indian ,tribe or ,tribal organization1 or public or private agency or organization receiving an award under this title1 or a recipient of a subgrant of such an award1 may not use such award for programs1 trainings1 or other activities that violate any of the restrictions on uses of funds set forth in subsection 7b7 or 7c74 7e7 ,withholding and recoupment for noncompliance 7#a7 ,authority to withhold and recover funds 7,a7 ,in general ,if the ,secretary determines that any ,state1 ,indian ,tribe or ,tribal organization1 or public or private agency or organization1 including any recipient of a subgrant1 has violated the conditions under subsection 7b7 or used funds in violation of subsection 7c71 the ,secretary shall disallow the costs associated with such violation1 withhold funds as described in subparagraph 7,b7 or recover funds as described in subparagraph 7,c71 as applicable1 and impose the applicable penalty amount determined under paragraph 7#c74 7,b7 ,withholding of funds ,in the case of a violation described in subparagraph 7,a71 the ,secretary shall withhold from the recipient any future payments or funding tranches not yet disbursed until the ,secretary certifies that the violation has been remediated and that the recipient has adopted policies and procedures sufficient to prevent recurrence4 7,c7 ,recovery of funds ,in the case of a violation described in subparagraph 7,a71 the ,secretary shall recover grant funds already disbursed to the recipient1 and such disbursed funds shall constitute a debt to the ,federal ,government as of the date of the ,secretary's written determination of noncompliance1 collectible in accordance with parts #bjj and #cjj of title #b1 ,code of ,federal ,regulations 7or any successor regulations71 including through administrative offset against any other ,federal payments owed to the entity under this title or any other ,federal program administered by the ,department of ,health and ,human ,services4 7,d7 ,basis for determination ,in making a determination under subparagraph 7,a71 a violation described in any of clauses 7xxvi7 through 7xxviii7 of section #ajf7;b77#b77;,b7 includes a ,state's failure to-- 7i7 include in its ,state plan under section #ajf7;b71 the certification and assurance required under such clauses2 or 7ii7 adequately enforce1 or maintain in effect1 programs certified under any such clause4 7#b7 ,subgrants ,the direct recipient of an award under this title shall be responsible for ensuring that recipients of subgrants awarded by such direct recipient complies with this section1 and any violation by a recipient of such a subgrant shall be attributed to the direct recipient of the award from the ,secretary4 7#c7 ,penalties 7,a7 ,in general ,the penalty amount applicable to a recipient of a grant under this title awarded by the ,secretary and who has violated subsection 7b7 or 7c7 shall be as follows3 7i7 ,for the first finding of such a violation by the recipient within a grant period1 #e percent of the total funds provided to the recipient under this title for the applicable grant period4 7ii7 ,for the second finding of such a violation by the recipient within a grant period1 #aj percent of the total funds provided to the recipient under this title for the applicable grant period4 7iii7 ,for the third or any subsequent finding of violation by the recipient within a grant period1 #ae percent of the total funds provided to the direct recipient under this title for the applicable grant period4 7,b7 ,limitation ,in no case shall the total penalty imposed against a single direct recipient for all findings within a single grant period exceed #ae percent of the total funds provided to the recipient for the applicable grant period4 7,c7 ,required penalty ,the penalties described in this paragraph are mandatory and the ,secretary has no discretion to waive or reduce such a penalty except through the appeals process under subparagraph 7,d74 7,d7 ,appeals ,a direct recipient of a grant who is assessed a penalty under this paragraph may file an appeal of such penalty with the ,secretary4 ,appeals from any determination of noncompliance or penalty amount under this subsection shall be governed by part #af of title #de ,code of ,federal ,regulations 7or any successor regulations74 ,the filing of an appeal shall not stay the withholding of future payments or funding tranches pending resolution of the appeal1 but any amounts recovered by the ,secretary from already-disbursed funds shall not be collected pending final resolution of the appeal4 7#d7 ,regulations ,the ,secretary shall issue such regulations as are necessary and appropriate to carry out this subsection1 including regulations establishing procedures for written notice of noncompliance1 opportunity to respond1 and administrative review prior to any final determination under paragraph 7#a74 7#e7 ,clarifications ,nothing in this subsection shall be construed to limit the authority of the ,secretary to pursue any other remedy available under part #bjj or #cjj of title #b1 ,code of ,federal ,regulations 7or any successor regulations7 or any other applicable ,federal law with respect to violations of any other provision of this title1 or to limit the ,secretary's authority to impose remedies in addition to the penalties prescribed in paragraph 7#c7 for violations of subsection 7b7 or 7c7 where the ,secretary determines that additional remedies are necessary to protect ,federal funds4 4 #ajc4 ,reports ,section #ajg of the ,child ,abuse ,prevention and ,treatment ,act 7#db ,u4,s4,c4 #eajf;c7 is amended-- 7#a7 in subsection 7e77#b77;,a71 by inserting 1 provided the alternative does not violate the limitations set forth in subsection 7f7 before the semicolon2 7#b7 by redesignating subsection 7f7 as subsection 7g72 and 7#c7 by inserting after subsection 7e7 the following3 7f7 ,limitations 7#a7 ,in general ,no ,state task force review or recommendation made pursuant to this section shall-- 7,a7 recommend any reform of ,state law1 ordinance1 regulation1 protocol1 or procedure that would expand the definition of child abuse1 child neglect1 parental unfitness or incapacity to encompass a parent's1 legal guardian's1 or caregiver's affirmation of the child's sex2 or 7,b7 recommend1 promote1 facilitate or endorse the use of any training program1 clinical protocol1 or professional standard that is inconsistent with section #aae4 7#b7 ,withholding and recoupment for noncompliance ,a ,state task force that issues any recommendation prohibited as described in paragraph 7#a7 shall be deemed to be in noncompliance with this section1 and the ,secretary shall-- 7,a7 withhold any further assistance until such prohibited recommendation is formally rescinded by the ,state task force and the ,secretary certifies that the task force is in compliance with paragraph 7#a72 and 7,b7 if the funds have already been disbursed during the period of noncompliance1 recover such funds in accordance with the graduated penalty formula set forth in section #aae7;e77#c7 for the total funds provided for that grant period4 4 #ajd4 ,definitions ,subsection 7a7 of section #aaa of the ,child ,abuse ,prevention and ,treatment ,act 7#db ,u4,s4,c4 #eajf;g7 is amended to read as follows3 7a7 ,definitions ,for purposes of this title3 7#a7 7,a7 ,the term adverse ,state action means any covered action taken by a covered entity1 if any of the following was a motivating factor1 without regard to how the covered entity characterizes the reason for the covered action3 7i7 ,affirmation of1 or intent to affirm1 the child's sex by the parent1 legal guardian1 or caregiver4 7ii7 ,the child's request to be treated in a manner inconsistent with the child's sex or the child's request for1 or attempt to obtain1 sex-rejecting interventions4 7iii7 ,the child's expression of psychological distress1 including suicidal ideation or threat of self-harm1 related to affirmation of the child's sex by the parent1 legal guardian1 or caregiver4 7iv7 ,that the child ran away1 threatens to run away1 or intends to run away from or requests no contact with a parent1 legal guardian1 or caregiver because of a circumstance described in clause 7i71 7ii71 or 7iii74 7,b7 ,for purposes of subparagraph 7,a71 a covered action includes any of the following3 7i7 ,the removal or threat of removal of a child from the home1 or the removal or threat of removal of a parent1 legal guardian1 or caregiver from the home1 including removal of the child or such parent1 legal guardian1 or caregiver pursuant to any safety plan or other protective-services action by a covered entity4 7ii7 ,any assessment1 investigation1 or inquiry conducted for the purpose of determining the existence of child abuse1 neglect1 or parental unfitness or incapacity4 7iii7 ,any dependency1 child welfare1 or juvenile court proceeding1 including any investigation1 removal proceeding1 proceeding to limit or condition the exercise of parental rights1 proceeding relating to visitation1 proceeding to terminate parental rights1 or other related child welfare or court proceeding4 7iv7 ,denying1 impeding1 interfering with or unreasonably delaying-- 7,i7 the parent's1 legal guardian's1 or caregiver's visitation1 communication1 or meeting with the child2 7,,ii7 the parent's1 legal guardian's1 or caregiver's scheduled meeting1 case conference1 or other planned communication with an employee or agent of a covered entity regarding the child2 or 7,,iii7 the return of the child to the parent1 legal guardian1 or caregiver4 7v7 ,the making of any finding or substantiation of child abuse1 neglect1 or parental unfitness or incapacity4 7vi7 ,any case plan1 safety plan1 service plan1 or reunification plan recommendation or requirement imposed by a covered entity as a condition of visitation1 communication1 or meeting with a child1 reunification1 return of a child1 or continued family preservation4 7vii7 ,the involuntary termination of parental rights to a child or to a sibling of a child4 7viii7 ,placement on a ,state child abuse registry or index4 7ix7 ,the delay or denial of foster-care placement or adoption4 7#b7 ,the terms affirm1 affirmed1 and affirmation1 with respect to the sex of a child1 mean referring to or raising the child1 or intending to refer to or raise the child1 as his or her sex1 including refusing to consent to sex-rejecting interventions for the child4 7#c7 ,the term ,alaska ,native has the meaning given the term ,native in section #c of the ,alaska ,native ,claims ,settlement ,act 7#dc ,u4,s4,c4 #afjb74 7#d7 ,the term caregiver means any person who provides ongoing care1 supervision1 and decision-making for a child on a regular basis1 including a licensed foster parent1 kinship caregiver1 pre-adoptive foster parent1 or person acting in loco parentis1 but does not include any person who is a parent or legal guardian4 7#e7 ,the term covered entity means-- 7,a7 an entity that has received funds under this title1 directly or as a recipient of a subgrant1 including-- 7i7 any ,state1 and any agency of a ,state that administers child protective services1 child welfare services1 or related functions2 7ii7 any ,indian ,tribe or ,tribal organization2 or 7iii7 any public or private agency or organization that contracts with any entity listed in clause 7i7 or 7ii72 or 7,b7 any individual who is a contractor1 employee1 or agent of any of the entities described in subparagraph 7,a74 7#f7 ,the term disorder of sex development means a congenital condition involving atypical complement or structure or development of sex chromosomes1 gonads1 internal genital ducts1 or external genitalia1 including disorders of sex hormone synthesis or action1 but does not include psychological or behavioral conditions1 nor typical male or female sex development with distress regarding sexed anatomy4 7#g7 ,the term infant or toddler with a disability has the meaning given the term in section #fcb of the ,individuals with ,disabilities ,education ,act 7#bj ,u4,s4,c4 #adcb74 7#h7 ,the term ,native ,hawaiian has the meaning given the term in section #fbjg of the ,elementary and ,secondary ,education ,act of #aife4 7#i7 ,the term sex means an individual's immutable biological sex1 either-- 7,a7 male1 whereby the individual naturally has1 had1 will have1 or would have1 but for a disorder of sex development or an intentional or unintentional disruption1 the reproductive system that produces1 transports1 and utilizes the small gamete 7sperm7 for fertilization2 or 7,b7 female1 whereby the individual naturally has1 had1 will have1 or would have1 but for a disorder of sex development or an intentional or unintentional disruption1 the reproductive system that produces1 transports1 and utilizes the large gamete 7ova7 for fertilization4 7#aj7 ,the term sex-rejecting intervention-- 7,a7 means a psychological1 medical1 or surgical intervention that is intended to promote1 endorse1 or enable a child's rejection of the child's sex1 to promote1 endorse1 or enable a child to adopt an appearance that does not correspond to the child's sex1 or to intentionally change the body of a child1 including the child's external appearance or biological functions1 to no longer correspond to the child's sex1 including-- 7i7 intentionally delaying1 halting1 or disrupting the natural development of the child's body1 including the onset or progression of puberty1 so that the child's body does not develop or halts developing to correspond to the child's sex1 which may include the use of puberty blocking drugs1 such as gonadotropin releasing hormone agonists or antagonists2 7ii7 prescribing1 administering1 or dispensing to the child androgen blockers or sex hormones such as estrogen1 progesterone1 or testosterone2 7iii7 prescribing or performing any surgical procedure that attempts to transform the physical appearance1 or that attempts to alter or remove the tissues1 cavities1 bone1 cartilage1 or organs1 of a child2 7iv7 providing compression materials or garments that are designed to constrict female breasts1 or that flatten or tuck a male's genitals1 prosthetic breasts1 genitals1 or hips1 or any other materials that enable the child to conceal his or her sex or to simulate the physical characteristics of the opposite sex2 or 7v7 permitting or assigning a child who is #d years of age or older to-- 7,i7 use sleeping quarters1 bathrooms1 locker rooms1 changing rooms1 or other areas in which a child may be in a state of undress1 with individuals of the opposite sex2 or 7,,ii7 participate in sex-separated activities designated for individuals of the opposite sex2 and 7,b7 does not include the treatment of a disorder of sex development or the treatment of any infection1 injury1 disease1 or disorder that has been caused or exacerbated by the performance of an intervention described in any of clauses 7i7 through 7iv7 of subparagraph 7,a74 7#aa7 ,the term sexual abuse includes-- 7,a7 the employment1 use1 persuasion1 inducement1 enticement1 or coercion of any child to engage in1 or assist any other person to engage in1 any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct2 or 7,b7 the rape1 and in cases of caretaker or inter-familial relationships1 statutory rape1 molestation1 prostitution1 or other form of sexual exploitation of children1 or incest with children4 7#ab7 ,the term withholding of medically indicated treatment means the failure to respond to the infant's life-threatening conditions by providing treatment 7including appropriate nutrition1 hydration1 and medication7 which1 in the treating physician's or physicians' reasonable medical judgment1 will be most likely to be effective in ameliorating or correcting all such conditions1 except that the term does not include the failure to provide treatment 7other than appropriate nutrition1 hydration1 or medication7 to an infant when1 in the treating physician's or physicians' reasonable medical judgment-- 7,a7 the infant is chronically and irreversibly comatose2 7,b7 the provision of such treatment would-- 7i7 merely prolong dying2 7ii7 not be effective in ameliorating or correcting all of the infant's life-threatening conditions2 or 7iii7 otherwise be futile in terms of the survival of the infant2 or 7,c7 the provision of such treatment would be virtually futile in terms of the survival of the infant and the treatment itself under such circumstances would be inhumane4 4 #aje4 ,rule of construction ,section #aac7;a7 of the ,child ,abuse ,prevention and ,treatment ,act 7#db ,u4,s4,c4 #eajf;i7a77 is amended-- 7#a7 in paragraph 7#a71 by striking 2 and and inserting a semicolon2 7#b7 in paragraph 7#b71 by striking the period and inserting a semicolon2 and 7#c7 by adding at the end the following3 7#c7 as establishing a ,federal requirement that a parent1 legal guardian or caregiver provide a child any medical service or treatment against the religious beliefs of the parent or legal guardian2 or 7#d7 as establishing that affirmation of a child's sex by a parent1 legal guardian1 caregiver1 foster parent1 or prospective foster or adoptive parent is child abuse1 emotional abuse1 neglect1 maltreatment1 abandonment1 contrary to the child's best interests1 contrary to a child's health1 safety or welfare1 or indication of parental unfitness or incapacity4 4 #ajf4 ,private right of action ,title ,i of ,child ,abuse ,prevention and ,treatment ,act 7#db ,u4,s4,c4 #eaja et seq471 as amended by section #ajc1 is further amended by adding at the end the following3 #aaf4 ,private right of action 7a7 ,cause of ,action ,any parent1 legal guardian1 caregiver1 or child who is aggrieved by an adverse ,state action alleged to have been taken by a covered entity1 or any parent1 legal guardian1 or caregiver who is aggrieved by a violation of section #aae7;b7 may bring a civil action seeking relief in any ,united ,states district court1 regardless of whether the specific operation1 division1 facility1 or program of the covered entity that was engaged in such adverse ,state action was itself funded1 in whole or in part1 by an award under this title4 7b7 ,liability of a covered entity for the conduct of others ,for purposes of subsection 7a71 a covered entity described in section #aaa7;a77#e77;,a7 waives any defense based on the absence of respondeat superior liability1 and shall be vicariously liable under this section for any adverse ,state action1 or any violation of the right protected under section #aae7;b71 that is committed by any employee1 contractor1 or agent of such covered entity1 without regard to whether such adverse ,state action or violation-- 7#a7 resulted from an official policy or custom of the covered entity2 7#b7 was known to any supervisory official of the covered entity2 or 7#c7 was within the scope of such covered entity's employment1 contract1 or agency4 7c7 ,rebuttable presumption 7#a7 ,in general ,for purposes of any action brought under this section1 there is a rebuttable presumption that an adverse ,state action or a violation of the right protected under section #aae7;b7 was because of the affirmation of a child's sex if-- 7,a7 a case record1 report1 petition1 recommendation1 or other agency or court document includes the affirmation of the child's sex as a basis for1 contributing factor in1 or concern related to the adverse ,state action2 or 7,b7 a recommendation1 order1 or agreement has been made that a child be removed from a parent1 legal guardian1 or caregiver and be placed in a home1 institution1 or other placement setting that-- 7i7 provides1 permits or encourages the child to undergo any sex-rejecting intervention1 or 7ii7 without parental consent1 uses pronouns or titles that do not correspond to the child's sex4 7#b7 ,rebuttal ,a covered entity bears the burden of rebutting the presumption described in paragraph 7#a7 by clear and convincing evidence that the affirmation of the child's sex was not a factor in the adverse ,state action or violation of the right protected under section #aae7;b74 7d7 ,nonapplication of exhaustion of ,remedies ,the exhaustion of any ,state or administrative remedies is not required as a condition of filing an action described in this section4 7e7 ,relief ,as a condition of accepting funds under this title1 each of the remedies described in this subsection is available to a prevailing parent1 legal guardian1 caregiver1 or child4 ,in any such action1 the court may award-- 7#a7 declaratory relief2 7#b7 preliminary and permanent injunctive relief1 including an order enjoining1 vacating1 or prohibiting the enforcement of any adverse ,state action or any violation of the right protected under section #aae7;b71 notwithstanding section #bbhc of title #bh1 ,united ,states ,code1 except where the covered entity demonstrates by clear and convincing evidence that such relief would create an imminent risk of serious physical harm to the child based on conduct independent of the adverse ,state action or violation2 7#c7 compensatory damages2 and 7#d7 damages for emotional distress suffered by a parent1 legal guardian1 caregiver1 or child4 7f7 ,costs and attorney's fees ,in any action brought under this section1 the court shall award the prevailing parent1 legal guardian1 caregiver1 or child costs of litigation and attorney's fees4 7g7 ,abrogation of qualified immunity ,in any action brought under this section against an employee1 contractor1 or agent of a covered entity1 qualified immunity shall not be available as a defense4 ,to satisfy the requirement that the law be clearly established at the time of the violation1 it is sufficient that the conduct constituted an adverse ,state action or violated the right protected under section #aae7;b74 ,the absence of an express policy1 procedure1 or protocol by the ,state or a covered entity described in section #aaa7;a77#e77;,a7 shall not preclude a finding that the law was clearly established or that the employee1 contractor1 or agent of a covered entity knew or should have known that the conduct was unlawful4 7h7 ,waiver of sovereign immunity 7#a7 ,in general 7,a7 ,state immunity ,by accepting funds under this title1 a ,state and any covered entity described in section #aaa7;a77#e77;,a77i7 shall waive immunity under the ,eleventh ,amendment to the ,constitution of the ,united ,states from suit in ,federal court for any adverse ,state action or for any violation of the right protected under section #aae7;b74 7,b7 ,tribal immunity ,by accepting funds under this title1 a covered entity described in section #aaa7;a77#e77;,a77ii7 shall waive immunity from suit in ,federal court for any adverse ,state action or for any violation of the right protected under section #aae7;b74 7#b7 ,remedies available 7,a7 ,state defendants ,in an action against a ,state or covered entity described in section #aaa7;a77#e77;,a77i7 for any adverse ,state action or for any violation of the right protected under section #aae7;b71 remedies 7including remedies both at law and in equity7 are available to the same extent as such remedies are available in an action against any public or private entity other than a ,state4 7,b7 ,tribal defendants ,in an action against an ,indian ,tribe or ,tribal organization for any adverse ,state action or for any violation of the right protected under section #aae7;b71 remedies 7including remedies both at law and in equity7 are available to the same extent as such remedies are available in an action against any public or private entity other than an ,indian ,tribe or ,tribal organization4 7i7 ,statute of limitations 7#a7 ,in general ,except as provided in paragraph 7#c71 an action under this section shall commence not later than #d years after the date on which the cause of action accrues4 7#b7 ,accrual ,for purposes of paragraph 7#a71 a cause of action accrues on the date a parent1 legal guardian1 caregiver1 or child knew or reasonably should have known of the violation giving rise to the claim1 or1 in the case of an ongoing violation1 on the date the violation ceases4 7#c7 ,tolling ,the limitations period under paragraph 7#a7 shall be tolled-- 7,a7 with respect to a claim brought on behalf of a minor child until the later of-- 7i7 the date the child attains the age of #ah2 or 7ii7 the date that is #d years after the date the violation occurred2 and 7,b7 during the pendency of any ,state or ,indian child welfare proceeding arising from the same facts as the ,federal claim1 and for the #b-year period following the final resolution of such proceeding4 7j7 ,relationship to other laws 7#a7 ,non-preemption ,nothing in this section shall be construed to preempt any ,state law that provides greater protection than the rights established under this section4 7#b7 ,other applicable laws ,the rights established under this section are in addition to1 and not in lieu of1 any rights available under the ,constitution of the ,united ,states1 section #aigi of the ,revised ,statutes 7#db ,u4,s4,c4 #aihc71 this ,act1 or any other ,federal or ,state law4 7#c7 ,jurisdiction ,federal courts shall have original jurisdiction over any civil action brought under this section4 ,no action shall be dismissed1 stayed or otherwise abated on the basis of-- 7,a7 the pendency of a ,state court proceeding2 7,b7 any ,state court judgment or order2 7,c7 any doctrine of equitable restraint1 abstention1 or comity1 including any doctrine under which a court declines to exercise jurisdiction because of the pendency or potential pendency of a ,state judicial or administrative proceeding2 or 7,d7 the domestic relations exception in ,federal jurisdiction1 if the action seeks enforcement of a right established under this section1 and does not seek the issuance of an original divorce1 alimony or child custody decree in a domestic-relations proceeding between private parties4 7#d7 ,other relief ,the relief available under this section is in addition to1 and not in lieu of1 any remedy available to the ,secretary under section #aae4 4 ,,ii ,amendments to the ,social ,security ,act #bja4 ,amendments to part ,b of title ,,iv of the ,social ,security ,act 7a7 ,stephanie ,tubbs ,jones ,child ,welfare ,services ,program ,state plan requirements ,section #dbb7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fbb7;b77 is amended-- 7#a7 in paragraph 7#ae77;,a7-- 7,a7 in clause 7vii71 by striking and after the semicolon2 and 7,b7 by inserting after clause 7viii7 the following new clause3 7ix7 the procedures and protocols the ,state has established to ensure that sex-rejecting interventions are not initiated or continued when a child is removed from the custody1 care1 or control of the parent or placed in foster care2 and 2 7#b7 in paragraph 7#ah71 by striking and after the semicolon2 7#c7 in paragraph 7#ai77;,b71 by striking the period at the end and inserting a semicolon2 and 7#d7 by inserting after paragraph 7#ai77;,b7 the following new paragraphs3 7#bj7 provide that no placement of a child for adoption or into foster care is prevented1 denied1 or delayed because the foster parent1 prospective foster parent1 or prospective adoptive parent may affirm a child's sex2 7#ba7 provide that children who are #d years of age or older in foster care placement are housed in accordance with their sex1 including-- 7,a7 requirements that a foster family home provide either single occupancy or sex-separated multi-occupancy sleeping quarters 7other than sleeping quarters shared only with a sibling71 bathrooms1 showers1 locker rooms1 changing rooms1 or any other areas in which a child would be in a state of undress when in use by the child2 7,b7 requirements that a child-care institution 7including any group home1 residential treatment center1 shelter1 qualified residential treatment program1 settings for pregnant or parenting foster youth described in section #dgb7k77#b77;,b71 setting for sex trafficking victims described in section #dgb7k77#b77;,d7 or other congregate care setting7 assign a child to and provide either single occupancy or sex-separated multi-occupancy sleeping quarters 7other than sleeping quarters shared only with a sibling71 bathrooms1 showers1 locker rooms1 changing rooms1 or any other areas in which a child would be in a state of undress1 when in use by the child2 and 7,c7 requirements that licensing standards for foster family homes1 child-care institutions1 or other placement settings1 include compliance with this paragraph as a condition of licensure for any foster family home1 child-care institution1 or other placement setting receiving funds under this part or part ,e2 7#bb7 provide and have in effect policies and procedures1 and require any covered entity to have in effect policies and procedures that-- 7,a7 protect and promote a child's right to be free from sex-rejecting interventions2 and 7,b7 protect1 without express parental consent1 a child from the use of pronouns or titles that do not correspond to the child's sex2 7#bc7 provide for training for child protective services workers1 caseworkers1 guardians ad litem1 minor's counsel1 court appointed special advocates1 judges1 other individuals providing services to children and families1 foster parents1 prospective foster parents1 prospective adoptive parents1 and parents that includes-- 7,a7 the medical1 psychological1 and developmental harms of sex-rejecting interventions and the harms of using pronouns or titles that do not correspond to the child's sex2 7,b7 the right of a parent or legal guardian to affirm a child's sex and of a parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 or prospective adoptive parent to be free from discrimination or adverse ,state action for affirming or intending to affirm a child's sex2 7,c7 the principle that affirmation of a child's sex by a parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 or prospective adoptive parent is not child abuse1 emotional abuse1 neglect1 maltreatment1 abandonment1 contrary to the child's best interests1 contrary to a child's health1 safety1 or welfare1 or indication of parental unfitness or incapacity2 7,d7 the principle that affirmation of a child's sex is consistent with the child's best interests1 health1 safety1 and welfare2 7,e7 the prohibition under this part and part ,e on-- 7i7 providing1 initiating1 or continuing sex-rejecting interventions to children in foster care placements2 and 7ii7 without parental consent1 the use of pronouns or titles that do not correspond to the child's sex2 and 7,f7 the prohibition under this part and part ,e on denying and delaying the placement of a child in a foster or adoptive home placement because a foster parent1 prospective foster parent or prospective adoptive parent may affirm the child's sex2 7#bd7 provide that the ,state shall have in effect policies and procedures1 and require any covered entity to have in effect policies and procedures that protect and promote the right of a parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 or prospective adoptive parent to be free from discrimination for affirming or intending to affirm a child's sex and from any adverse ,state action2 7#be7 provide that the ,state shall have in effect policies and procedures1 and shall require any covered entity to have in effect policies and procedures1 that no child1 foster parent1 prospective foster parent1 or prospective adoptive parent may be denied a foster care or adoptive placement because the foster parent1 prospective foster parent1 or prospective adoptive parent may affirm a child's sex2 and 7#bf7 provide that the ,state shall have in effect policies and procedures that protect and promote the right of children in foster care placements to be free from sex-rejecting interventions and require any covered entity to have in effect policies and procedures that include-- 7,a7 requirements ensuring that no child in foster care under the supervision of the ,state is subjected to sex-rejecting interventions2 7,b7 requirements that no funds under this part or part ,e shall be used to provide1 facilitate1 refer1 or permit sex-rejecting interventions for any child placed in the covered entity's care2 7,c7 requirements that no foster family home1 child-care institution1 or other placement setting receiving funds under this part or part ,e shall provide1 facilitate1 fund1 permit1 aid or refer for sex-rejecting interventions for any child placed in the foster family home1 child-care institution1 or other placement setting2 7,d7 training for child protective service workers1 foster care caseworkers1 supervisors1 foster parents1 guardians ad litem1 court-appointed special advocates1 minor's counsel1 judges1 and other individuals providing services to children and families1 prospective foster parents1 prospective adoptive parents1 and parents on-- 7i7 the medical1 psychological1 and developmental harms of sex-rejecting interventions and the harms of using pronouns or titles that do not correspond to the child's sex2 7ii7 the right of a parent or legal guardian to affirm a child's sex and of a parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 or prospective adoptive parent to be free from discrimination or adverse ,state action for affirming or intending to affirm a child's sex2 7iii7 the principle that affirmation of a child's sex by a parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 or prospective adoptive parent is not child abuse1 emotional abuse1 neglect1 maltreatment1 abandonment1 contrary to the child's best interests1 contrary to the child's health1 safety1 or welfare1 or indication of parental unfitness or incapacity2 7iv7 the principle that affirmation of a child's sex is consistent with the child's best interests1 and the child's health1 safety1 and welfare2 7v7 the prohibition on providing sex-rejecting interventions to children in foster care placements2 7vi7 the prohibition on the use of pronouns or titles that do not correspond to the child's sex without the parent's express consent2 and 7vii7 the prohibition on denying1 delaying or conditioning the placement of a child in a foster or adoptive home placement because a foster parent1 prospective foster parent1 or prospective adoptive parent may affirm the child's sex2 and 7,e7 procedures to prevent sex marker changes 7meaning the designation of the child's sex on any official record1 including records maintained under this part or part ,e7 to the child's records that differ from the child's sex while the child is in foster care4 4 7b7 ,marylee ,allen ,promoting ,safe and ,stable ,families ,program ,state plan requirements ,section #dcb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fbi;b7a77 is amended-- 7#a7 in paragraph 7#aj71 by striking and after the semicolon2 7#b7 in paragraph 7#aa71 by striking the period at the end and inserting 2 and2 and 7#c7 by inserting after paragraph 7#aa71 the following new paragraph3 7#ab7 complies with the requirements of paragraphs 7#bj7 through 7#bf7 of section #dbb7;b71 as applicable to the services funded under this subpart4 4 7c7 ,common provisions ,subpart #c of part ,b of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fbik et seq47 is amended by adding at the end the following new sections3 #ddd4 ,limitations on the ,secretary2 obligations on recipients and subrecipients2 noncompliance 7a7 ,limitations on the ,secretary ,the ,secretary shall ensure that no funds provided under this part1 including any grants1 subgrants and other allocations of funding made pursuant to this part to ,states1 ,indian tribes1 or tribal organizations1 and public and private agencies and organizations1 including subrecipients1 are used to fund any of the following3 7#a7 ,conducting1 supporting1 or promoting any program1 project1 curriculum1 guidance1 protocol or training that-- 7,a7 sex-rejecting interventions are in the best interests of the child or consistent with the health1 safety1 and welfare of the child2 7,b7 affirmation of a child's sex by a parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 or prospective adoptive parent is child abuse1 emotional abuse1 neglect1 maltreatment1 abandonment1 contrary to the child's best interests1 contrary to the child's health1 safety or welfare1 or indication of parental unfitness or incapacity2 or 7,c7 a child's expression of psychological distress1 including a statement or report of suicidal ideation1 related to the affirmation of a child's sex is grounds for removal of the child from the home1 intervention by a welfare agency1 or any other adverse ,state action4 7#b7 ,discriminating against1 or taking an adverse ,state action against1 a parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 or prospective adoptive parent because such individual affirms1 has affirmed1 or intends to affirm a child's sex4 7#c7 ,conducting1 supporting1 or promoting any adverse ,state action4 7#d7 ,providing1 facilitating1 funding1 authorizing1 permitting for a child1 or referring a child for any sex-rejecting intervention4 7#e7 ,removing a child from a parent1 legal guardian1 or caregiver and placing the child in a foster family home1 child-care institution1 or other placement setting that-- 7,a7 provides1 permits1 or encourages the child to undergo any sex-rejecting intervention2 or 7,b7 without parental consent1 uses pronouns or titles that do not correspond to the child's sex4 7#f7 ,placing a child in a foster care placement that fails to provide either single occupancy or sex-separated multi-occupancy spaces in compliance with section #dbb7;b77#ba74 7b7 ,obligations on recipients and subrecipients ,any ,state1 ,indian tribe or tribal organization1 or public and private agency or organization1 including any subrecipient that receives funds under this part1 shall not use such funds for any program1 training1 or other activity that violates any of the limitations set forth in subsection 7a74 7c7 ,withholding and recoupment for noncompliance 7#a7 ,in general ,if the ,secretary determines that any ,state1 ,indian tribe1 tribal organization1 or public or private agency or organization1 including any subrecipient1 has used funds in violation of the limitations or obligations set forth in subsection 7a7 or 7b71 paragraphs 7#bj7 through 7#bf7 of section #dbb7;b71 or section #dcb7;a77#ab71 or in violation of any right1 restriction1 limitation1 obligation1 or condition established under section #dgi;,c as applicable to this part or part ,e1 the ,secretary shall disallow the costs associated with such violation and shall impose the applicable penalty amount determined under paragraph 7#b74 ,such withholding shall apply to any future payments or funding tranches not yet disbursed and shall remain in effect until the ,secretary certifies that the violation has been remediated and that the direct recipient has adopted policies and procedures sufficient to prevent recurrence4 ,recovery shall apply to funds already disbursed1 which shall constitute a debt to the ,federal ,government as of the date of the ,secretary's written determination of noncompliance1 collectible in accordance with parts #bjj and #cjj of title #b1 ,code of ,federal ,regulations 7or any successor regulation71 including through administrative offset against any other ,federal payments owed to the entity under this or any other ,federal program administered by the ,department of ,health and ,human ,services4 7#b7 ,direct recipients 7,a7 ,in general ,the direct recipient of funds provided under this part shall be strictly responsible for ensuring compliance with this part by all subrecipients to which it passes such funds1 and any violation by a subrecipient shall be attributed to the direct recipient4 ,the penalty amount subject to disallowance1 withholding1 and recovery under paragraph 7#a7 shall be-- 7i7 for the first finding of violation by the direct recipient within a grant period1 #e percent of the total funds provided to the direct recipient for that grant period2 7ii7 for the second finding of violation by the direct recipient within a grant period1 #aj percent of the total funds provided to the direct recipient for that grant period2 and 7iii7 for the third or any subsequent finding of violation by the direct recipient within a grant period1 #ae percent of the total funds provided to the direct recipient under this part for that grant period4 7,b7 ,maximum penalty ,in no case shall the total penalty imposed against a single direct recipient for all findings within a single grant period exceed #ae percent of the total funds provided to that direct recipient for that grant period4 7,c7 ,no waiver ,a penalty required by this subsection is mandatory and the ,secretary shall not have any discretion to waive or reduce the penalty applicable except through the appeals process provided in paragraph 7#c74 7#c7 ,appeals ,appeals from any determination of noncompliance or penalty amount under this subsection shall be governed by part #af of title #de1 ,code of ,federal ,regulations 7or any successor regulation74 ,the filing of an appeal shall not stay the withholding of future payments or funding tranches pending resolution of the appeal1 but any amounts recovered by the ,secretary from already-disbursed funds shall not be collected pending final resolution of the appeal4 7#d7 ,regulations ,the ,secretary shall issue such regulations as are necessary and appropriate to carry out this subsection1 including regulations establishing procedures for written notice of noncompliance1 opportunity to respond1 and administrative review prior to any final determination under paragraph 7#a74 7#e7 ,other remedies ,nothing in this subsection shall be construed to limit the authority of the ,secretary to pursue any other remedy available under parts #bjj and #cjj of title #b1 ,code of ,federal ,regulations 7or any successor regulation7 or any other applicable ,federal law with respect to violations of any other provision of this part1 or to limit the ,secretary's authority to impose remedies in addition to the penalties prescribed in paragraph 7#b7 for violations described in paragraph 7#a7 where the ,secretary determines that additional remedies are necessary to protect ,federal funds4 #dde4 ,private right of action 7a7 ,causes of action 7#a7 ,in general ,any parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 prospective adoptive parent1 or child who is aggrieved by an adverse ,state action or1 in the case of a parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 or prospective adoptive parent1 a violation of a right protected under section #dgi;,c7b71 that is alleged to have been taken by a covered entity may bring an action seeking relief from a covered entity in any ,united ,states district court regardless of whether the specific operation1 division1 facility1 or program of the covered entity that engaged in such adverse ,state action was itself funded1 in whole or in part1 by an award or payment made under this part or part ,e4 7#b7 ,liability of a covered entity for conduct of others ,for purposes of paragraph 7#a71 a covered entity described in subparagraph 7,a71 7,b71 or 7,c7 of section #dge7ai7 waives any defense based on the absence of respondeat superior liability1 and shall be vicariously liable under this section for any adverse ,state action or any violation of the right protected under section #dgi;,c7b7 that is committed by any employee1 contractor1 or agent of such covered entity1 without regard to whether such adverse ,state action or violation-- 7,a7 resulted from an official policy or custom of the covered entity2 7,b7 was known to any supervisory official of the covered entity2 or 7,c7 was within the scope of such covered entity's employment1 contract1 or agency4 7#c7 ,rebuttable presumption ,for purposes of any action brought under this section1 there is a rebuttable presumption that an adverse ,state action or a violation of the right protected under section #dgi;,c7b7 was because of the affirmation of a child's sex if-- 7,a7 a case record1 report1 petition1 recommendation1 or other agency or court document includes the affirmation of the child's sex as a basis for1 contributing factor in1 or concern related to the adverse ,state action2 or 7,b7 a recommendation1 order1 or agreement has been made that a child be removed from a parent1 legal guardian1 or caregiver and be placed in a foster family home1 child-care institution1 or other placement setting that-- 7i7 provides1 permits1 or encourages the child to undergo any sex-rejecting intervention2 or 7ii7 without parental consent1 uses pronouns or titles that do not correspond to the child's sex4 7#d7 ,rebuttal ,a covered entity bears the burden of rebutting the presumption described in paragraph 7#c7 by clear and convincing evidence that the affirmation of the child's sex was not a factor in the adverse ,state action or violation of the rights protected under section #dgi;,c7b74 7b7 ,nonapplication of exhaustion of remedies ,exhaustion of any ,state or administrative remedies shall not be required as a condition of bringing an action described in subsection 7a74 7c7 ,relief 7#a7 ,in general ,as a condition of accepting funds under this part1 each of the remedies described in paragraph 7#b7 is available to a prevailing parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 prospective adoptive parent1 or child in an action brought under this section4 7#b7 ,remedies ,the remedies described in this paragraph are-- 7,a7 declaratory relief2 7,b7 preliminary and permanent injunctive relief1 including an order enjoining1 vacating1 or prohibiting the enforcement of any adverse ,state action or any violation of the right protected under section #dgi;,c7b71 notwithstanding section #bbhc of title #bh1 ,united ,states ,code1 except where the covered entity demonstrates by clear and convincing evidence that such relief would create an imminent risk of serious physical harm to the child based on conduct independent of the adverse ,state action or violation2 7,c7 compensatory damages2 and 7,d7 damages for emotional distress suffered by a parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 prospective adoptive parent1 or child4 7d7 ,costs and attorney's fees ,in any action brought under this section1 the court shall award the prevailing parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 prospective adoptive parent1 or child1 costs of litigation and attorney's fees4 7e7 ,abrogation of qualified immunity ,in any action brought under this section against an employee1 contractor1 or agent of a covered entity described in subparagraph 7,d7 of section #dge7ai71 qualified immunity shall not be available as a defense4 ,to satisfy the requirement that the law be clearly established at the time of the violation1 it is sufficient that the conduct constituted an adverse ,state action or violated the right protected under section #dgi;,c7b74 ,the absence of an express policy1 procedure1 or protocol by a covered entity described in subparagraph 7,a71 7,b71 or 7,c7 of section #dge7ai7 shall not preclude a finding that the law was clearly established or that the employee1 contractor1 or agent of a covered entity described in subparagraph 7,d7 of section #dge7ai7 knew or should have known that the conduct was unlawful4 7f7 ,waiver of sovereign immunity 7#a7 ,in general 7,a7 ,state immunity ,a covered entity described in subparagraph 7,a7 of section #dge7ai71 as a condition of accepting funds under this part1 shall waive immunity under the ,eleventh ,amendment to the ,constitution of the ,united ,states from suit in ,federal court for any adverse ,state action or any violation of the right protected under section #dgi;,c7b74 7,b7 ,tribal immunity ,a covered entity described in subparagraph 7,b7 of section #dge7ai71 as a condition of accepting funds under this part1 shall waive immunity from suit in ,federal court for any adverse ,state action or any violation of the right protected under section #dgi;,c7b74 7#b7 ,remedies available ,in any action against a ,state or ,indian tribe or tribal organization for any adverse ,state action or any violation of the right protected under section #dgi;,c7b71 remedies 7including remedies both at law and in equity7 are available in a suit against any public or private entity other than a ,state or ,indian tribe1 or tribal organization4 7g7 ,statute of limitations 7#a7 ,in general ,except as provided in paragraph 7#c71 an action under this section may not be commenced later than #d years after the date on which the cause of action accrues4 7#b7 ,accrual ,for purposes of paragraph 7#a71 a cause of action accrues on the date a parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 prospective adoptive parent1 or child knew or reasonably should have known of the violation giving rise to the claim1 or1 in the case of an ongoing violation1 on the date the violation ceases4 7#c7 ,tolling ,the limitations period under paragraph 7#a7 shall be tolled-- 7,a7 with respect to a claim brought on behalf of a minor child1 until the later of-- 7i7 the date the child attains the age of #ah2 or 7ii7 the date that is #d years after the date the violation occurred2 and 7,b7 during the pendency of any ,state or ,indian child welfare proceeding arising from the same facts as the ,federal claim1 and for the #b-year period following the final resolution of such proceeding4 7h7 ,relationship to other laws 7#a7 ,non-preemption ,nothing in this section shall be construed to preempt any ,state law that provides greater protection than the rights established under this section4 7#b7 ,other applicable laws ,the rights established under this section are in addition to1 and not in lieu of1 any rights available under the ,constitution of the ,united ,states1 section #aigi of the ,revised ,statues 7commonly referred to as section #aihc7 7#db ,u4,s4,c4 #aihc71 the ,yaeli ,martinez ,child ,protection ,act1 or any other ,federal or ,state law4 7#c7 ,jurisdiction ,federal courts shall have original jurisdiction over any civil action brought under this section4 ,no action shall be dismissed1 stayed or otherwise abated on the basis of-- 7,a7 the pendency of a ,state court proceeding2 7,b7 any ,state court judgment or order2 7,c7 any doctrine of equitable restraint1 abstention1 or comity1 including any doctrine under which a court declines to exercise jurisdiction because of the pendency or potential pendency of a ,state judicial or administrative proceeding2 or 7,d7 the domestic relations exception in ,federal jurisdiction1 if the action seeks enforcement of a right established under this section1 and does not seek the issuance of an original divorce1 alimony1 or child custody decree in a domestic-relations proceeding between private parties4 4 #bjb4 ,amendments to part ,e of title ,,iv of the ,social ,security ,act 7a7 ,state plan requirements ,section #dga7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fga7;a77 is amended-- 7#a7 in paragraph 7#aj7-- 7,a7 in subparagraph 7,a71 by inserting 1 and which do not violate paragraphs 7#ch7 through 7#db7 after prudent parenting standard2 and 7,b7 in subparagraph 7,d71 by inserting 1 except that there can be no waiver of the requirements of paragraphs 7#ch7 through 7#db7 after children in care2 7#b7 in paragraph 7#ae7-- 7,a7 in subparagraph 7,a71 by inserting 1 and that1 in determining such reasonable efforts to be made with respect to a child1 and in making such reasonable efforts1 a parent's1 legal guardian's1 or caregiver's affirmation of a child's sex shall be considered in furtherance of the child's health and safety1 and affirmation of a child's sex1 shall not serve as a basis to limit or deny reasonable efforts to preserve and reunify families after paramount concern2 and 7,b7 in paragraph 7,d77iii71 by inserting 1 except if the termination was because the parent affirmed the sibling's sex after involuntarily2 7#c7 in paragraph 7#ah7-- 7,a7 in the matter preceding subparagraph 7,a71 by inserting 7in the case of subparagraphs 7,a7 and 7,b71 and in the case of subparagraph 7,c71 not later than #a year after the date of enactment of the ,yaeli ,martinez ,child ,protection ,act7 after ,january #a1 #aiig12 7,b7 in subparagraph 7,a71 by striking or after the semicolon2 7,c7 in subparagraph 7,b71 by adding or after the semicolon2 and 7,d7 by inserting after subparagraph 7,b71 the following new subparagraph3 7,c7 delay or deny to any person the opportunity to become an adoptive or foster parent because the person may affirm the child's sex2 2 7#d7 in paragraph 7#bb71 by inserting 1 and1 not later than #a year after the date of enactment of the ,yaeli ,martinez ,child ,protection ,act1 that comply with paragraphs 7#ch7 through 7#db71 and that protect against the use of pronouns or titles1 without express parental consent1 that do not correspond to the child's sex after safety and health of the children2 7#e7 in paragraph 7#cf77;,d71 by striking and after the semicolon2 7#f7 in paragraph 7#cg71 by striking the period at the end and inserting a semicolon2 and 7#g7 by inserting after paragraph 7#cg71 the following new paragraphs3 7#ch7 provides that the ,state shall have in effect policies and procedures1 and require that any covered entity have in effect policies and procedures that protect and promote the right of a parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 or prospective adoptive parent to be free from discrimination for affirming or intending to affirm a child's sex and from any adverse ,state action2 7#ci7 has in effect policies and procedures1 and requires any covered entity to have in effect policies and procedures1 ensuring that foster care or adoptive placement of a child shall not be denied or delayed because a foster parent1 prospective foster parent1 or prospective adoptive parent may affirm a child's sex2 7#dj7 provides1 and has in effect policies and procedures1 and requires any covered entity to have in effect policies and procedures that-- 7,a7 protect and promote a child's right to be free from sex-rejecting interventions1 and without express parental consent1 protect a child from the use of pronouns or titles that do not correspond to the child's sex2 7,b7 require ensuring that no child in foster care under the supervision of the ,state is subjected to sex-rejecting interventions2 7,c7 require that no funds under this part shall be used1 for any child placed in the covered entity's care1 to provide1 facilitate1 fund1 authorize1 permit for the child1 or refer the child for1 any sex-rejecting intervention2 7,d7 require that no foster family home1 child-care institution1 or other placement setting receiving funds under this part shall provide1 facilitate1 fund1 permit1 aid1 or refer sex-rejecting interventions for any child placed in the foster family home1 child-care institution1 or other placement setting2 7,e7 require training for child protective services workers1 foster care caseworkers1 supervisors1 foster parents1 guardians ad litem1 court-appointed special advocates1 minor's counsel1 judges1 and other individuals providing services to children and families1 prospective foster parents1 prospective adoptive parents1 and parents on-- 7i7 the medical1 psychological1 and developmental harms of sex-rejecting interventions and the harms of using pronouns or titles that do not correspond to the child's sex2 7ii7 the right of a parent or legal guardian to affirm a child's sex and the right of a parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 or prospective adoptive parent to be free from discrimination or adverse ,state action for affirming or intending to affirm a child's sex2 7iii7 the principle that affirmation of a child's sex by a parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 or prospective adoptive parent is not child abuse1 emotional abuse1 neglect1 maltreatment1 abandonment1 contrary to the child's best interests1 contrary to a child's health1 safety or welfare1 or indication of parental unfitness or incapacity2 7iv7 the principle that affirmation of a child's sex is consistent with the child's best interests2 7v7 the prohibition on providing sex-rejecting interventions to children in foster care placements2 7vi7 the prohibition on the use of pronouns or titles that do not correspond to the child's sex without the parent's express consent2 and 7vii7 the prohibition on denying1 delaying or conditioning the placement of a child in a foster or adoptive home placement because a foster parent1 prospective foster parent1 or prospective adoptive parent may affirm the child's sex2 and 7,f7 procedures to prevent sex marker changes 7meaning the designation of the child's sex on any official record1 including records maintained under this part or part ,b7 to the child's records case that differ from the child's sex1 while the child is in foster care2 7#da7 has in effect procedures and requirements ensuring that children who are #d years of age or older in foster care placements are housed in accordance with their sex1 including-- 7,a7 requirements that a foster family home provide either single occupancy or sex-separated multi-occupancy sleeping quarters 7other than sleeping quarters shared only with a sibling71 bathrooms1 showers1 locker rooms1 changing rooms1 or any other areas in which a child would be in a state of undress when in use by the child2 7,b7 requirements that a child-care institution 7including any group home1 residential treatment center1 shelter1 qualified residential treatment program1 settings for pregnant or parenting foster youth described in section #dgb7k77#b77;,b71 setting for sex trafficking victims described in section #dgb7k77#b77;,d7 or other congregate care setting7 assign the child to and provide either single occupancy or sex-separated multi-occupancy sleeping quarters 7other than sleeping quarters shared only with a sibling71 bathrooms1 showers1 locker rooms1 changing rooms1 or any other areas in which a child would be in a state of undress1 when in use by the child2 and 7,c7 requirements that licensing standards for foster family homes1 child-care institutions1 and other placement settings include compliance with subparagraphs 7,a7 and 7,b7 as a condition of licensure for any foster family home1 child-care institution1 or other placement setting receiving funds under this part2 and 7#db7 has in effect procedures and requirements ensuring that no sex-rejecting interventions are initiated or continued when the child is removed from the custody1 care1 or control of the parent4 4 7b7 ,prevention and family services and programs ,section #dga7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fga7;e77 is amended-- 7#a7 in paragraph 7#d71 by adding at the end the following new subparagraph3 7,f7 ,limitations ,state expenditures for services or programs that facilitate1 promote1 provide1 fund1 or authorize sex-rejecting interventions shall not be eligible for a ,federal matching payment under section #dgd7;a77#f77;,a7 and shall not be treated as meeting the requirements of evidence-based or medically-proven practices4 2 7#b7 in paragraph 7#e77;,c7-- 7,a7 in clause 7i71 by inserting and does not include promoting1 facilitating1 or providing sex-rejecting interventions1 referring to or treating the child in a manner that does not correspond to the child's sex1 or without express parental consent1 using pronouns or titles that do not correspond to the child's sex after strategy for that practice2 and 7,b7 in clause 7ii71 by inserting 1 except for the requirement that the practice may not include promoting1 facilitating1 or providing sex-rejecting interventions1 referring to or treating the child in a manner that does not correspond to the child's sex1 or without express parental consent1 using pronouns or titles that do not correspond to the child's sex after with regard to the practice4 7c7 ,foster care maintenance payments ,section #dgb of the ,social ,security ,act 7#db ,u4,s4,c4 #fgb7 is amended-- 7#a7 in subsection 7a77#b77;,a7-- 7,a7 in clause 7i71 by striking or after the semicolon2 7,b7 in clause 7ii71 by adding or after the semicolon2 and 7,c7 by inserting after clause 7ii71 the following new clause3 7iii7 the limitations and requirements provided in paragraphs 7#ch7 through 7#db7 of section #dga7;a72 2 and 7#b7 in subsection 7c77#a77;,a77ii77,i71 by inserting and capable of housing the child in compliance with the requirements of section #dga7;a77#da7 after prudent parent standard4 7d7 ,payments ,section #dgd of the ,social ,security ,act 7#db ,u4,s4,c4 #fgd7 is amended-- 7#a7 in subsection 7d7-- 7,a7 in paragraph 7#a71 in the matter preceding subparagraph 7,a7-- 7i7 by inserting ,reduction for violation of plan requirement2 private right of action4-- before ,if1 during2 7ii7 by striking or 7#bc7 of section #dga7;a7 and inserting 1 7#bc71 7#ch71 7#ci71 7#dj71 7#da71 or 7#db7 of section #dga7;a71 or any right1 restriction1 limitation1 obligation1 or condition established under section #dgi;,c as applicable to this part or part ,b12 and 7iii7 by striking such violation and inserting violations of paragraphs 7#ah7 and 7#bc7 of section #dga7;a71 and not to exceed #cj days with respect to violations of paragraphs 7#ch7 through 7#db7 of section #dga7;a7 or of any right1 restriction1 limitation1 obligation1 or condition established under section #dgi;,c as applicable to this part or part ,b2 7,b7 in paragraph 7#b7-- 7i7 by inserting 7,a7 after 7#b72 7ii7 by striking or 7#bc7 of section #dga7;a7 and inserting 1 7#bc71 7#ch71 7#ci71 7#dj71 7#da71 or 7#db7 of section #dga7;a71 or any right1 restriction1 limitation1 obligation1 or condition established under section #dgi;,c as applicable to this part or part ,b12 and 7iii7 by adding at the end the following3 7,b7 ,for purposes of this subsection1 a failure to comply substantially with paragraph 7#ch71 7#ci71 7#dj71 7#da71 or 7#db7 of section #dga7;a71 or with any right1 restriction1 limitation1 obligation1 or condition established under section #dgi;,c as applicable to this part or part ,b1 shall be treated as a failure subject to the reductions and remedies provided under this subsection4 2 and 7,c7 by adding at the end the following new paragraph3 7#e7 ,private right of action 7,a7 ,in general ,by accepting funds under this part1 the ,state and any covered entity agree to be bound by the following provisions of this paragraph4 7,b7 ,cause of action ,any parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 prospective adoptive parent1 or child who is aggrieved by an adverse ,state action or1 in the case of a parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 or prospective adoptive parent1 a violation of a right protected under section #dgi;,c7b71 that is alleged to have been taken by a covered entity may bring an action seeking relief from a covered entity in any ,united ,states district court regardless of whether the specific operation1 division1 facility1 or program of the covered entity that engaged in such adverse ,state action was itself funded1 in whole or in part1 by an award or payment made under this part or part ,b4 7,c7 ,liability of a covered entity for conduct of others ,for purposes of subparagraph 7,b71 a covered entity described in subparagraph 7,a71 7,b71 or 7,c7 of section #dge7ai7 waives any defense based on the absence of respondeat superior liability1 and shall be vicariously liable under this paragraph for any adverse ,state action or any violation of the right protected under section #dgi;,c7b7 that is committed by any employee1 contractor1 or agent of such covered entity1 without regard to whether such adverse ,state action or violation-- 7i7 resulted from an official policy or custom of the covered entity2 7ii7 was known to any supervisory official of the covered entity2 or 7iii7 was within the scope of such covered entity's employment1 contract1 or agency4 7,d7 ,rebuttable presumption ,for purposes of any action brought under this paragraph1 there is a rebuttable presumption that an adverse ,state action or a violation of the right protected under section #dgi;,c7b7 was because of the affirmation of a child's sex if-- 7i7 a case record1 report1 petition1 recommendation1 or other agency or court document includes the affirmation of the child's sex as a basis for1 contributing factor in1 or concern related to the adverse ,state action2 or 7ii7 a recommendation1 order1 or agreement has been made that a child be removed from a parent1 legal guardian1 or caregiver and be placed in a foster family home1 child-care institution1 or other placement setting that-- 7,i7 provides1 permits1 or encourages the child to undergo any sex-rejecting intervention2 or 7,,ii7 without parental consent1 uses pronouns or titles that do not correspond to the child's sex4 7,e7 ,rebuttal ,a covered entity bears the burden of rebutting the presumption described in subparagraph 7,d7 by clear and convincing evidence that the affirmation of the child's sex was not a factor in the adverse ,state action or violation of the rights protected under section #dgi;,c7b74 7,f7 ,nonapplication of exhaustion of remedies ,exhaustion of any ,state or administrative remedies shall not be required as a condition of bringing an action described in subparagraph 7,b74 7,g7 ,relief 7i7 ,in general ,as a condition of accepting funds under this part1 each of the remedies described in clause 7ii7 is available to a prevailing parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 prospective adoptive parent1 or child in an action brought under this paragraph4 7ii7 ,remedies ,the remedies described in this clause are-- 7,i7 declaratory relief2 7,,ii7 preliminary and permanent injunctive relief1 including an order enjoining1 vacating1 or prohibiting the enforcement of any adverse ,state action or any violation of the right protected under section #dgi;,c7b71 notwithstanding section #bbhc of title #bh1 ,united ,states ,code1 except where the covered entity demonstrates by clear and convincing evidence that such relief would create an imminent risk of serious physical harm to the child based on conduct independent of the adverse ,state action or violation2 7,,iii7 compensatory damages2 and 7,,iv7 damages for emotional distress suffered by a parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 prospective adoptive parent1 or child4 7,h7 ,costs and attorney's fees ,in any action brought under this paragraph1 the court shall award the prevailing parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 prospective adoptive parent1 or child costs of litigation and attorney's fees4 7,i7 ,abrogation of qualified immunity ,in any action brought under this paragraph against an employee1 contractor1 or agent of a covered entity described in subparagraph 7,d7 of section #dge7ai71 qualified immunity shall not be available as a defense4 ,to satisfy the requirement that the law be clearly established at the time of the violation1 it is sufficient that the conduct constituted an adverse ,state action or violated the right protected under section #dgi;,c7b74 ,the absence of an express policy1 procedure1 or protocol by a covered entity described in subparagraph 7,a71 7,b71 or 7,c7 of section #dge7ai7 shall not preclude a finding that the law was clearly established or that the employee1 contractor1 or agent of a covered entity described in subparagraph 7,d7 of section #dge7ai7 knew or should have known that the conduct was unlawful4 7,j7 ,waiver of sovereign immunity 7i7 ,state immunity ,a covered entity described in subparagraph 7,a7 of section #dge7ai71 as a condition of accepting funds under this part1 shall waive immunity under the ,eleventh ,amendment to the ,constitution of the ,united ,states from suit in ,federal court for any adverse ,state action or any violation of the right protected under section #dgi;,c7b74 7ii7 ,tribal immunity ,a covered entity described in subparagraph 7,b7 of section #dge 7#ai71 as a condition of accepting funds under this part1 shall waive immunity from suit in ,federal court for any adverse ,state action or any violation of the right protected under section #dgi;,c7b74 7iii7 ,remedies available ,in any action against a ,state or ,indian tribe or tribal organization for any adverse ,state action or any violation of the right protected under section #dgi;,c7b71 remedies 7including remedies both at law and in equity7 are available in a suit against any public or private entity other than a ,state or ,indian tribe1 or tribal organization4 7,k7 ,statute of limitations 7i7 ,in general ,except as provided in clause 7iii71 an action under subparagraph 7,b7 shall commence no later than #d years after the date on which the cause of action accrues4 7ii7 ,accrual ,for purposes of clause 7i71 a cause of action accrues on the date a parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 prospective adoptive parent1 or child knew or reasonably should have known of the violation giving rise to the claim1 or1 in the case of an ongoing violation1 on the date the violation ceases4 7iii7 ,tolling ,the limitations period under clause 7i7 shall be tolled-- 7,i7 with respect to a claim brought on behalf of a minor child1 until the later of-- 7aa7 the date the child attains the age of #ah2 or 7bb7 the date that is #d years after the date the violation occurred2 and 7,,ii7 during the pendency of any ,state or ,indian child welfare proceeding arising from the same facts as the ,federal claim1 and for the #b-year period following the final resolution of such proceeding4 7,l7 ,relationship to other laws 7i7 ,non-preemption ,nothing in this paragraph shall be construed to preempt any ,state law that provides greater protection than the rights established under this paragraph4 7ii7 ,other applicable laws ,the rights established under this paragraph are in addition to1 and not in lieu of1 any rights available under the ,constitution of the ,united ,states1 section #aigi of the ,revised ,statues 7commonly referred to as section #aihc7 7#db ,u4,s4,c4 #aihc71 the ,yaeli ,martinez ,child ,protection ,act1 or any other ,federal or ,state law4 7iii7 ,jurisdiction ,federal courts shall have original jurisdiction over any civil action brought under subparagraph 7,b74 ,no action shall be dismissed1 stayed or otherwise abated on the basis of-- 7,i7 the pendency of a ,state court proceeding2 7,,ii7 any ,state court judgment or order2 7,,iii7 any doctrine of equitable restraint1 abstention1 or comity1 including any doctrine under which a court declines to exercise jurisdiction because of the pendency or potential pendency of a ,state judicial or administrative proceeding2 or 7,,iv7 the domestic relations exception in ,federal jurisdiction1 if the action seeks enforcement of a right established under this section1 and does not seek the issuance of an original divorce1 alimony or child custody decree in a domestic-relations proceeding between private parties4 7iv7 ,other relief ,the relief available under this paragraph shall be in addition to any relief permitted by the ,secretary under this part4 2 and 7#b7 by adding at the end the following new subsection3 7h7 ,prohibition on ,sex-,rejecting ,interventions ,notwithstanding any other provision of law1 no payments shall be made to a ,state under this part for any amounts expended for sex-rejecting interventions4 4 7e7 ,definitions ,section #dge of the ,social ,security ,act 7#db ,u4,s4,c4 #fge7 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 by striking subparagraph 7,a7 and inserting the following3 7,a7 ,a description of-- 7i7 the type of home or institution in which a child is to be placed1 including a discussion of the safety and appropriateness of the placement1 how that placement complies with paragraphs 7#ch7 through 7#db7 of section #dga7;a71 and how the placement prohibits1 without the express consent of the parent1 the use of pronouns or titles that do not correspond to the child's sex2 and 7ii7 how the agency which is responsible for the child plans to carry out the voluntary placement agreement entered into or judicial determination made with respect to the child in accordance with section #dgb7;a77#b77;,a74 2 and 7,b7 in subparagraph 7,c7-- 7i7 in clause 7vi71 by striking and after the semicolon2 7ii7 by redesignating clause 7vii7 as clause 7viii72 and 7iii7 by inserting after clause 7vi71 the following new clause3 7vii7 the child's sex2 and 2 7#b7 in paragraph 7#b71 by striking 1 as determined by applicable ,state law2 7#c7 in paragraph 7#aj77;,a71 by inserting and the affirmation of the child as his or her sex after developmental growth of the child2 and 7#d7 by adding at the end the following new paragraphs3 7#ad7 7,a7 ,the term adverse ,state action means any covered action taken by a covered entity if any of the following was a motiving factor1 and without regard to how the covered entity characterizes the reason for the covered action3 7i7 ,affirmation of1 or intent to affirm1 the child's sex by the parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 or prospective adoptive parent4 7ii7 ,the child's request to be treated in a manner inconsistent with the child's sex1 or the child's request for or attempt to obtain sex-rejecting interventions4 7iii7 ,the child's expression of psychological distress1 including suicidal ideation or threat of self-harm1 related to affirmation of the child's sex by the parent1 legal guardian1 or caregiver4 7iv7 ,that the child ran away1 threatens to run away1 intends to run away from1 or requests no contact with1 a parent1 legal guardian1 or caregiver because of a circumstance described in clause 7i71 7ii71 or 7iii74 7,b7 ,for purposes of subparagraph 7,a71 a covered action includes any of the following3 7i7 ,the removal or threat of removal of a child from the home1 or the removal or threat of removal of a parent1 legal guardian1 or caregiver from the home1 including removal of the child or such parent1 legal guardian1 or caregiver pursuant to any safety plan or other protective-services action by a covered entity4 7ii7 ,any assessment1 investigation1 or inquiry conducted for the purpose of determining the existence of child abuse1 neglect1 or parental unfitness or incapacity4 7iii7 ,any dependency1 child welfare1 or juvenile court proceeding1 including any investigation1 removal proceeding1 proceeding to limit or condition the exercise of parental rights1 proceeding relating to visitation1 proceeding to terminate parental rights1 or other related child welfare or court proceeding4 7iv7 ,denying1 impeding1 interfering with1 or unreasonably delaying-- 7,i7 the parent's1 legal guardian's1 or caregiver's visitation1 communication1 or meeting with the child2 7,,ii7 the parent's1 legal guardian's1 or caregiver's scheduled meeting1 case conference1 or other planned communication with an employee or agent of a covered entity regarding the child2 or 7,,iii7 the return of the child to the parent1 legal guardian1 or caregiver4 7v7 ,the making of any finding or substantiation of child abuse1 neglect1 or parental unfitness or incapacity4 7vi7 ,any case plan1 safety plan1 service plan1 or reunification plan recommendation or requirement imposed by a covered entity as a condition of visitation1 communication1 or meeting with a child1 reunification1 return of a child1 or continued family preservation4 7vii7 ,the involuntary termination of parental rights to a child or to a sibling of a child4 7viii7 ,placement on a ,state child abuse registry or index4 7ix7 ,the delay or denial of foster care placement or adoption4 7#ae7 ,the terms affirmed as his or her sex1 affirm a child's sex1 affirm the child's sex1 affirmation of a child's sex1 affirmation of the child's sex1 and affirmed the sibling's sex mean referring to or raising the child1 or intending to refer to or raise the child1 as his or her sex1 including refusing to consent to sex-rejecting interventions for the child4 7#af7 ,the term disorder of sex development means a congenital condition involving atypical complement or structure or development of sex chromosomes1 gonads1 internal genital ducts1 or external genitalia1 including disorders of sex hormone synthesis or action1 but does not include psychological or behavioral conditions1 nor typical male or female sex development with distress regarding sexed anatomy4 7#ag7 ,the term sex means an individual's immutable biological sex1 either-- 7,a7 male1 whereby the individual naturally has1 had1 will have1 or would have1 but for a disorder of sex development or an intentional or unintentional disruption1 the reproductive system that produces1 transports1 and utilizes the small gamete 7sperm7 for fertilization2 or 7,b7 female1 whereby the individual naturally has1 had1 will have1 or would have1 but for a disorder of sex development or an intentional or unintentional disruption1 the reproductive system that produces1 transports1 and utilizes the large gamete 7ova7 for fertilization4 7#ah7 ,the term sex-rejecting interventions means a psychological1 medical1 or surgical intervention that is intended to promote1 endorse1 or enable a child's rejection of his or her sex1 to promote1 endorse1 or enable a child to adopt an appearance that does not correspond to his or her sex1 or to intentionally change the body of a child1 including the child's external appearance or biological functions1 to no longer correspond to his or her sex1 including-- 7,a7 intentionally delaying1 halting1 or disrupting the natural development of the child's body1 including the onset or progression of puberty1 so that it does not develop or halts developing to correspond to the child's sex1 including but not limited to the use of puberty blocking drugs1 such as gonadotropin releasing hormone agonists or antagonists2 7,b7 prescribing1 administering1 or dispensing to the child androgen blockers or sex hormones such as estrogen1 progesterone1 or testosterone2 7,c7 prescribing or performing any surgical procedure that attempts to transform the physical appearance or that attempts to alter or remove the tissues1 cavities1 bone1 cartilage1 or organs of a child2 7,d7 providing compression materials or garments that are designed to constrict female breasts1 or that flatten or tuck a male's genitals1 prosthetic breasts1 genitals1 or hips1 or any other materials that enable the child to conceal his or her sex or to simulate the physical characteristics of the opposite sex2 7,e7 permitting or assigning a child who is #d years of age or older to-- 7i7 use sleeping quarters1 bathrooms1 locker rooms1 changing rooms1 or other areas in which a child may be in a state of undress that are designated for individuals of the opposite sex2 or 7ii7 participate in sex-separated activities designated for individuals of the opposite sex4 ,nothing in this paragraph shall be construed as precluding the treatment of a disorder of sex development or the treatment of any infection1 injury1 disease1 or disorder that has been caused or exacerbated by the performance of an intervention described in subparagraph 7,a71 7,b71 7,c71 or 7,d74 7#ai7 ,the term covered entity means any of the following entities that has received funds under this part or part ,b directly or as a subrecipient3 7,a7 ,any ,state and any ,state or local agency4 7,b7 ,any ,indian tribe or tribal organization4 7,c7 ,any public or private agency or organization that contracts with any entity listed in subparagraph 7,a7 or 7,b74 7,d7 ,any individual who is a contractor1 employee1 or agent of any of the entities listed in subparagraphs 7,a71 7,b71 or 7,c74 4 #bjc4 ,amendments to the ,john ,h4 ,chafee ,foster ,care ,program for ,successful ,transition to ,adulthood ,section #dgg of the ,social ,security ,act 7#db ,u4,s4,c4 #fgg7 is amended-- 7#a7 in subsection 7b7-- 7,a7 in paragraph 7#b71 by adding at the end the following new subparagraphs3 7,g7 ,ensure that the programs comply with1 and require covered entities receiving funds under this section to comply with1 the requirements of paragraphs 7#ch7 through 7#db7 of section #dga7;a7 for any youth who has not attained the age of #ah receiving services under this section4 7,h7 ,ensure that any provider of transitional or independent living services shall comply with the housing requirements of paragraph 7#da7 of section #dga7;a7 with regard to any youth receiving such services who has not attained the age of #ah4 2 and 7,b7 in paragraph 7#c71 by adding at the end the following new subparagraphs3 7,l7 ,a certification by the chief executive officer of the ,state that the ,state's programs under this section comply with the requirements of paragraphs 7#ch7 through 7#db7 of section #dga7;a7 with respect to services provided to any youth who has not attained the age of #ah4 7,m7 ,a certification by the chief executive officer of the ,state that the ,state will ensure that any youth who has not attained the age of #ah and who is receiving independent living services funded under this section shall be housed in accordance with the requirements of paragraph 7#da7 of section #dga7;a74 2 and 7#b7 by adding at the end the following new subsection3 7k7 ,limitations ,no amount paid to a ,state and no amount received by a covered entity with such funds may be used to provide1 facilitate1 fund1 authorize1 or permit for a youth1 or refer a youth for1 any sex-rejecting intervention for any youth who has not attained the age of #ah and who is receiving services funded under this section4 4 #bjd4 ,rules of construction2 application to funding restrictions under parts ,b and ,e of title ,,iv of the ,social ,security ,act ,part ,e of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fgj et seq47 is amended by adding at the end the following new section3 #dgi;,c4 ,rules of construction2 application to funding restrictions under parts ,b and ,e 7a7 ,affirming a child's sex is not abuse ,in administering1 enforcing1 or awarding funds under this part or part ,b1 including under section #dgg1 the ,secretary shall not treat1 and shall ensure that no recipient or subrecipient uses funds awarded under such provisions to treat1 affirmation of a child's sex by a parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 or prospective adoptive parent as child abuse1 emotional abuse1 neglect1 maltreatment1 abandonment1 contrary to the child's best interests1 contrary to a child's health1 safety1 or welfare1 or as an indication of parental unfitness or incapacity4 7b7 ,condition on receipt of funds2 rights protected ,as a condition of receiving funds1 including any grants1 subgrants1 or other allocations1 under this part or part ,b1 including under section #dgg1 a covered entity shall protect the following rights and shall not discriminate or take an adverse ,state action against an individual because such individual exercises1 has exercised1 or intends to exercise any such right3 7#a7 ,a parent or legal guardian has the right to affirm a child's sex1 including the right for the child not to be subjected by any covered entity1 even if the child is in the legal or physical custody of the covered entity1 to-- 7,a7 the provision1 facilitation1 funding1 authorization1 or permission of any sex-rejecting intervention for the child2 7,b7 the use of pronouns or titles that do not correspond to the child's sex1 without the express written consent of such parent or legal guardian2 or 7,c7 if the child is #d years of age or older1 being permitted or assigned the use of sleeping quarters 7other than sleeping quarters shared only with a sibling71 bathrooms1 showers1 locker rooms1 changing rooms1 or any other area in which the child would be in a state of undress1 with individuals of the opposite sex4 7#b7 ,a parent or legal guardian has the right not to be required to consent to the child being subjected to any of the actions described in subparagraph 7,a71 7,b71 or 7,c7 of paragraph 7#a7 as a condition of custody or return of the child1 or visitation1 communication1 or reunification with the child4 7#c7 ,a parent1 legal guardian1 caregiver1 foster parent1 prospective foster parent1 or prospective adoptive parent has a right to be free from discrimination or adverse ,state action for affirming or intending to affirm a child's sex4 7#d7 ,a child has the right not to be subjected by any covered entity1 even if the child is in the legal or physical custody of the covered entity1 to any sex-rejecting intervention4 7c7 ,scope of application ,for purposes of the restrictions on the use of awards under this part or part ,b1 including under section #dgg1 if any covered entity receives funds under either such part or section1 directly or as a recipient of a subgrant1 contract1 or other allocation1 the requirements and prohibitions of such restrictions shall apply to all of the operations1 divisions1 facilities1 and programs of that covered entity1 regardless of whether the specific operation1 division1 facility1 or program that engages in the conduct described in such restrictions itself received such funds4 4 #bje4 ,amendment to section #dgh of the ,social ,security ,act ,section #dgh of the ,social ,security ,act 7#db ,u4,s4,c4 #fgh7 is amended-- 7#a7 by striking ,nothing in this part and inserting the following3 7a7 ,in general ,nothing in this part 2 and 7#b7 by adding at the end the following3 7b7 ,compliance with ,yaeli ,martinez ,child ,protection ,act ,notwithstanding subsection 7a71 as a condition of receiving payments under this part1 a ,state shall ensure that determinations concerning the health1 safety1 and best interests of a child comply with the requirements of1 and the amendments made by1 the ,yaeli ,martinez ,child ,protection ,act4 4 ,,iii ,amendments to the full faith and credit for child custody determinations #cja4 ,full faith and credit for child custody determinations ,section #agch;,a of title #bh1 ,united ,states ,code1 is amended-- 7#a7 in subsection 7a71 by striking subsections 7f71 7g71 and 7h7 and inserting subsections 7g7 through 7j72 7#b7 in subsection 7b7-- 7,a7 by redesignating paragraphs 7#h7 and 7#i7 as paragraphs 7#ag7 and 7#ah71 respectively2 7,b7 by redesignating paragraphs 7#e71 7#f71 and 7#g7 as paragraphs 7#aa71 7#ab71 and 7#ac71 respectively2 7,c7 by redesignating paragraph 7#d7 as paragraph 7#i72 7,d7 by redesignating paragraphs 7#a71 7#b71 and 7#c7 as paragraphs 7#c71 7#d71 and 7#e71 respectively2 7,e7 by inserting before paragraph 7#c71 as so redesignated1 the following3 7#a7 abuse1 neglect1 mistreatment1 abandonment1 endangerment1 parental unfitness or incapacity1 and any other similar claim relating to the health1 safety1 or welfare of the child1 however characterized under the law of the ,state asserting jurisdiction shall not be construed to include affirming a child's sex2 7#b7 affirming a child's sex-- 7,a7 means referring to and raising a child1 or intending to refer to or raise a child1 in accordance with his or her sex1 including refusing to consent to sex-rejecting interventions for the child2 and 7,b7 shall not be construed as contrary to the best interest of the child or contrary to the child's safety1 health1 well-being1 or welfare2 2 7,f7 by inserting after paragraph 7#e71 as so redesignated1 the following3 7#f7 disorder of sex development-- 7,a7 means a congenital condition involving atypical chromosome complement or structure or atypical development of sex chromosomes1 gonads1 internal genital ducts1 or external genitalia1 including disorders of sex hormone synthesis or action2 and 7,b7 does not include psychological or behavioral conditions or typical male or female sex development with distress regarding sexed anatomy2 7#g7 female means an individual who naturally has1 had1 will have1 or would have but for a disorder of sex development or intentional or unintentional disruption1 the reproductive system that produces1 transports1 and utilizes the large gamete 7commonly known as ova7 for fertilization2 7#h7 foreign ,state means a ,state that is not the home ,state2 2 7,g7 by inserting after paragraph 7#i71 as so redesignated1 the following3 7#aj7 male means an individual who naturally has1 had1 will have1 or would have but for a disorder of sex development or intentional or unintentional disruption1 the reproductive system that produces1 transports1 and utilizes the small gamete 7commonly known as sperm7 for fertilization2 2 7,h7 by inserting after paragraph 7#ac71 as so redesignated1 the following3 7#ad7 sex means a child's immutable biological sex1 either male or female2 7#ae7 sex-rejecting intervention-- 7,a7 means a psychological1 medical1 or surgical intervention that is intended to promote1 endorse1 or enable a child's rejection of his or her sex1 to promote1 endorse1 or enable a child to adopt an appearance that does not align with his or her sex1 or to intentionally change the body of a child1 including the child's external appearance or biological functions1 to no longer correspond to his or her sex1 including-- 7i7 intentionally delaying1 halting1 or disrupting the natural development of the child's body1 including the onset or progression of puberty1 so that it does not develop or halts developing to correspond to the child's sex1 including the use of puberty blocking drugs1 such as gonadotropin releasing hormone agonists2 7ii7 prescribing1 administering1 or dispensing to the child androgen blockers or sex hormones such as estrogen1 progesterone1 or testosterone2 7iii7 prescribing or performing any surgical procedure that attempts to transform the physical appearance or that attempts to alter or remove the tissues1 cavities1 bone1 cartilage1 or organs of a child2 7iv7 using pronouns or titles that do not align with the child's sex2 7v7 providing compression materials or garments that are designed to constrict female breasts or that flatten or tuck a male's genitals1 prosthetic breasts1 genitals1 or hips1 or any other materials that enable a child to conceal his or her sex or to simulate the physical characteristics of the opposite sex2 and 7vi7 permitting or assigning a child who is not less than #d years of age to-- 7,i7 use sleeping quarters1 bathrooms1 locker rooms1 changing rooms1 or other areas in which a child may be in a state of undress that are designated for individuals of the opposite sex2 or 7,,ii7 participate in sex-separated activities designated for individuals of the opposite sex2 7,b7 shall not be construed to include the treatment of a disorder of sex development2 and 7,c7 shall not be construed to include emergency medical care for a child1 unless the medical care is for the treatment of any infection1 injury1 disease1 or disorder that has been caused or exacerbated by the performance of an intervention described in subparagraph 7,a72 7#af7 sex-rejecting intervention kidnapping law means a ,state law that permits a foreign ,state to take temporary or permanent jurisdiction over a child custody or visitation determination because a contestant or a child is seeking a sex-rejecting intervention or a custodial parent is affirming the child's sex2 2 7#c7 in subsection 7c77#b7-- 7,a7 in subparagraph 7,a71 by inserting with the permission of each custodial parent after had been the child's home ,state2 7,b7 in subparagraph 7,b71 by striking training and inserting education2 and 7,c7 in subparagraph 7,e71 by striking subsection 7d7 and inserting subsections 7d7 and 7e72 7#d7 by redesignating subsection 7g7 as subsection 7j7 and transferring such subsection1 as so redesignated1 so as to appear after subsection 7h72 7#e7 by redesignating subsections 7d71 7e71 and 7f7 as subsections 7e71 7f71 and 7g71 respectively2 7#f7 by inserting before subsection 7e71 as so redesignated1 the following3 7d7 7#a7 ,notwithstanding any other provision of this section1 a court of a ,state shall not exercise jurisdiction to make a custody or visitation determination if-- 7,a7 7i7 the assumption of jurisdiction is based on a contestant or a child seeking a sex-rejecting intervention for the child2 and 7ii7 sex-rejecting interventions are available in such ,state2 or 7,b7 the assumption of jurisdiction is based on a claim that a child has been subjected to or threatened with abuse1 neglect1 mistreatment1 abandonment1 endangerment1 parental unfitness or incapacity1 or any other similar claim relating to the health1 safety1 or welfare of the child1 however characterized under the law of the ,state asserting jurisdiction1 if such claim is based on a contestant or a child seeking a sex-rejecting intervention for the child available in the ,state4 7#b7 ,for purposes of subparagraph 7,b7 of paragraph 7#a7-- 7,a7 notwithstanding the laws of the home ,state or the applicable foreign ,state-- 7i7 abuse1 neglect1 mistreatment1 abandonment1 endangerment1 parental unfitness or incapacity1 or any other similar claim relating to the health1 safety1 or welfare of the child1 however characterized under the law of the ,state asserting jurisdiction1 shall not include the refusal of a child's parent or legal guardian to consent to or provide a sex-rejecting intervention2 and 7ii7 the refusal of a child's parent or legal guardian to consent to a sex-rejecting intervention shall not be construed as creating an unsafe environment for a child2 and 7,b7 a court shall not determine that a court of another ,state is a more appropriate forum for custody or visitation determinations if a contestant or a child is seeking sex rejecting interventions and those sex rejecting interventions are not available in the ,state of the court making the jurisdictional determination4 7#c7 ,a custody or visitation determination made in violation of subparagraph 7,a7 or 7,b7 of paragraph 7#a7 is not entitled to full faith and credit1 enforcement1 or recognition under this section by any court and shall not be given effect as a custody or visitation determination for purposes of subsections 7a71 7e71 and 7g7 through 7j74 ,any ,state law that purports to authorize the exercise of jurisdiction over a custody or visitation determination on a basis prohibited by subparagraph 7,a7 or 7,b7 of paragraph 7#a7 is preempted and without effect4 2 7#g7 in subsection 7e71 as so redesignated1 by striking the requirement of subsection 7c77#a7 and inserting the requirements of subsections 7c7 and 7d72 7#h7 in paragraph 7#a7 of subsection 7g71 as so redesignated1 by inserting 1 unless a claim to such jurisdiction arises out of1 or is related to1 such ,state's sex-rejecting intervention kidnapping laws after determination2 and 7#i7 by inserting after subsection 7h7 the following3 7i7 ,no court of a ,state with a prohibition against a sex-rejecting intervention for children shall decline to exercise jurisdiction or be determined to have declined jurisdiction to determine a modification of custody or visitation under subsection 7g7 or 7h7 if the child has been provided or is seeking a sex-rejecting intervention in another ,state4 4