,,ii #aaith ,,congress #ast ,session ,s4 #igg ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #ab1 #bjbe,mr4 ,marshall 7for himself1 ,mrs4 ,hyde-,smith1 ,mr4 ,cramer1 ,mr4 ,hawley1 ,mr4 ,budd1 ,mr4 ,graham1 ,mr4 ,sheehy1 ,mrs4 ,blackburn1 ,mr4 ,banks1 ,mr4 ,wicker1 ,mr4 ,lee1 ,ms4 ,lummis1 and ,mr4 ,risch7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to prohibit taxpayer-funded gender transition procedures1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,end ,taxpayer ,funding of ,gender ,experimentation ,act of #bjbe4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4,,title ,i--,prohibiting federally funded gender transition procedures,sec4 #aja4 ,prohibiting taxpayer-funded gender transition procedures4,sec4 #ajb4 ,amendment to table of chapters4,,title ,,ii--,application under the ,affordable ,care ,act,sec4 #bja4 ,clarifying application of prohibition to premium credits and cost-sharing reductions under ,,aca4 ,i ,prohibiting federally funded gender transition procedures #aja4 ,prohibiting taxpayer-funded gender transition procedures ,title #a1 ,united ,states ,code1 is amended by adding at the end the following new chapter3 #d ,prohibiting taxpayer-funded gender transition procedures ,sec4 #cja4 ,prohibition on funding for gender transition procedures4 #cjb4 ,prohibition on funding for health benefits plans that cover gender transition procedures4 #cjc4 ,limitation on ,federal facilities and employees4 #cjd4 ,construction relating to separate coverage4 #cje4 ,construction relating to the use of non-,federal funds for health coverage4 #cjf4 ,construction relating to complications arising from gender transition procedures4 #cjg4 ,definitions4 #cja4 ,prohibition on funding for gender transition procedures ,no funds authorized or appropriated by ,federal law1 and none of the funds in any trust fund to which funds are authorized or appropriated by ,federal law1 shall be expended for any gender transition procedures4 #cjb4 ,prohibition on funding for health benefits plans that cover gender transition procedures ,no funds authorized or appropriated by ,federal law1 and none of the funds in any trust fund to which funds are authorized or appropriated by ,federal law1 shall be expended for health benefits coverage that includes coverage of gender transition procedures4 #cjc4 ,limitation on ,federal facilities and employees ,no health care service furnished-- 7#a7 by or in a health care facility owned or operated by the ,federal ,government2 or 7#b7 by any physician or other individual employed by the ,federal ,government to provide health care services within the scope of the physician's or individual's employment1 may include gender transition procedures4 #cjd4 ,construction relating to separate coverage ,nothing in this chapter shall be construed as prohibiting any individual1 entity1 or ,state or locality from purchasing separate coverage for gender transition procedures or health benefits coverage that includes gender transition procedures so long as such coverage is paid for entirely using only funds not authorized or appropriated by ,federal law and such coverage shall not be purchased using matching funds required for a federally subsidized program1 including a ,state's or locality's contribution of ,medicaid matching funds4 #cje4 ,construction relating to the use of non-,federal funds for health coverage ,nothing in this chapter shall be construed as restricting the ability of any non-,federal health benefits coverage provider from offering coverage for gender transition procedures1 or the ability of a ,state or locality to contract separately with such a provider for such coverage1 so long as only funds not authorized or appropriated by ,federal law are used and such coverage shall not be purchased using matching funds required for a federally subsidized program1 including a ,state's or locality's contribution of ,medicaid matching funds4 #cjf4 ,construction relating to complications arising from gender transition procedures ,nothing in this chapter shall be construed to apply to the treatment of any infection1 injury1 disease1 or disorder that has been caused by or exacerbated by the performance of a gender transition procedure4 #cjg4 ,definitions ,for purposes of this chapter3 7#a7 ,female ,the term female1 when used to refer to a natural person1 means an individual who naturally has1 had1 will have1 or would have1 but for a congenital anomaly1 historical accident1 or intentional or unintentional disruption1 the reproductive system that at some point produces1 transports1 and utilizes eggs for fertilization4 7#b7 ,gender transition ,the term gender transition means the process in which an individual goes from identifying with or presenting as his or her sex to identifying with or presenting a self-proclaimed identity that does not correspond with or is different from his or her sex1 and may be accompanied with social1 legal1 or physical changes4 7#c7 ,gender transition procedure 7,a7 ,in general ,the term gender transition procedure means any hormonal or surgical intervention for the purpose of gender transition1 including-- 7i7 gonadotropin-releasing hormone 7,gn,r,h7 agonists or other puberty-blocking or suppressing drugs to stop or delay normal puberty2 7ii7 testosterone1 estrogen1 progesterone1 or other androgens to an individual at doses that are supraphysiologic to what would normally be produced endogenously in a healthy individual of the same age and sex2 7iii7 castration2 7iv7 orchiectomy2 7v7 scrotoplasty2 7vi7 implantation of erection or testicular prostheses2 7vii7 vasectomy2 7viii7 hysterectomy2 7ix7 oophorectomy2 7x7 ovariectomy2 7xi7 reconstruction of the fixed part of the urethra with or without a metoidioplasty or a phalloplasty2 7xii7 metoidioplasty2 7xiii7 penectomy2 7xiv7 phalloplasty2 7xv7 vaginoplasty2 7xvi7 clitoroplasty 7xvii7 vaginectomy2 7xviii7 vulvoplasty2 7xix7 reduction thyrochondroplasty2 7xx7 chondrolaryngoplasty2 7xxi7 mastectomy2 7xxii7 tubal ligation2 7xxiii7 sterilization2 7xxiv7 any plastic1 cosmetic1 or aesthetic surgery that feminizes or masculinizes the facial or other physiological features of an individual2 7xxv7 any placement of chest implants to create feminine breasts2 7xxvi7 any placement of fat or artificial implants in the gluteal region2 7xxvii7 augmentation mammoplasty2 7xxviii7 liposuction2 7xxix7 lipofilling2 7xxx7 voice surgery2 7xxxi7 hair reconstruction2 7xxxii7 pectoral implants2 and 7xxxiii7 the removal of any otherwise healthy or non-diseased body part or tissue4 7,b7 ,exclusions ,the term gender transition procedure does not include the following when furnished to an individual by a health care provider with the consent of such individual or1 if applicable1 such individual's parents or legal guardian3 7i7 ,services to individuals born with a medically verifiable disorder of sex development1 including an individual with external sex characteristics that are irresolvably ambiguous1 such as an individual born with #df ,,xx chromosomes with virilization1 an individual born with #df ,,xy chromosomes with undervirilization1 or an individual born having both ovarian and testicular tissue4 7ii7 ,services provided when a physician has otherwise diagnosed a disorder of sexual development in which the physician has determined through genetic or biochemical testing that the individual does not have normal sex chromosome structure1 sex steroid hormone production1 or sex steroid hormone action for a healthy individual of the same sex and age4 7iii7 ,the treatment of any infection1 injury1 disease1 or disorder that has been caused by or exacerbated by the performance of gender transition procedures1 whether or not the gender transition procedure was performed in accordance with ,state and ,federal law or whether or not funding for the gender transition procedure is permissible under this section4 7iv7 ,any procedure undertaken because the individual suffers from a physical disorder1 physical injury1 or physical illness 7but not mental1 behavioral1 or emotional distress or a mental1 behavioral1 or emotional disorder7 that would1 as certified by a physician1 place the individual in imminent danger of death or impairment of major bodily function1 unless the procedure is performed4 7v7 ,puberty suppression or blocking prescription drugs for the purpose of normalizing puberty for a minor experiencing precocious puberty4 7vi7 ,male circumcision4 7#d7 ,male ,the term male1 when used to refer to a natural person1 means an individual who naturally has1 had1 will have1 or would have1 but for a congenital anomaly1 historical accident1 or intentional or unintentional disruption1 the reproductive system that at some point produces1 transports1 and utilizes sperm for fertilization4 7#e7 ,sex ,the term sex1 when referring to an individual's sex1 means to refer to either male or female1 as biologically determined4 4 #ajb4 ,amendment to table of chapters ,the table of chapters for title #a1 ,united ,states ,code1 is amended by adding at the end the following new item3 #d4 ,prohibiting taxpayer-funded gender transition procedures#cja 4 ,,ii ,application under the ,affordable ,care ,act #bja4 ,clarifying application of prohibition to premium credits and cost-sharing reductions under ,,aca 7a7 ,in general 7#a7 ,disallowance of refundable credit and cost-sharing reductions for coverage under qualified health plan which provides coverage for gender procedures 7,a7 ,in general ,subparagraph 7,a7 of section #cf;,b7c77#c7 of the ,internal ,revenue ,code of #aihf is amended by inserting before the period at the end the following3 or any health plan that includes coverage for gender transition procedures1 as defined in section #cjg of title #a1 ,united ,states ,code 7other than any procedure described in section #cjf of such title74 7,b7 ,option to purchase or offer separate coverage or plan ,paragraph 7#c7 of section #cf;,b7c7 of such ,code is amended by adding at the end the following new subparagraph3 7,c7 ,separate coverage or plan for gender transition procedures allowed 7i7 ,option to purchase separate coverage or plan ,nothing in subparagraph 7,a7 shall be construed as prohibiting any individual from purchasing separate coverage for gender transition procedures described in such subparagraph1 or a health plan that includes such gender transition procedures1 so long as no credit is allowed under this section with respect to the premiums for such coverage or plan4 7ii7 ,option to offer coverage or plan ,nothing in subparagraph 7,a7 shall restrict any non-,federal health insurance issuer offering a health plan from offering separate coverage for gender transition procedures described in such subparagraph1 or a plan that includes such gender transition procedures1 so long as premiums for such separate coverage or plan are not paid for with any amount attributable to the credit allowed under this section 7or the amount of any advance payment of the credit under section #adab of the ,patient ,protection and ,affordable ,care ,act74 4 7#b7 ,disallowance of small employer health insurance expense credit for plan which includes coverage for gender transition procedures ,subsection 7h7 of section #de,r of the ,internal ,revenue ,code of #aihf is amended-- 7,a7 by striking ,any term and inserting the following3 7#a7 ,in general ,any term 2 and 7,b7 by adding at the end the following new paragraph3 7#b7 ,exclusion of health plans including coverage for gender transition procedures 7,a7 ,in general ,in this section1 the term qualified health plan does not include any health plan that includes coverage for gender transition procedures1 as defined in section #cjg of title #a1 ,united ,states ,code 7other than any procedure described in section #cjf of such title74 7,b7 ,separate coverage or plan for gender transition procedures allowed 7i7 ,option to purchase separate coverage or plan ,nothing in subparagraph 7,a7 shall be construed as prohibiting any employer from purchasing for its employees separate coverage for gender transition procedures described in such subparagraph1 or a health plan that includes such gender transition procedures1 so long as no credit is allowed under this section with respect to the employer contributions for such coverage or plan4 7ii7 ,option to offer coverage or plan ,nothing in subparagraph 7,a7 shall restrict any non-,federal health insurance issuer offering a health plan from offering separate coverage for gender transition procedures described in such subparagraph1 or a plan that includes such gender transition procedures1 so long as such separate coverage or plan is not paid for with any employer contribution eligible for the credit allowed under this section4 4 7b7 ,application to multi-,state plans ,section #accd7;a7 of ,public ,law #aaa-adh 7#db ,u4,s4,c4 #ahjed7;a77 is amended by adding at the end the following new paragraph3 7#h7 ,coverage consistent with ,federal policy regarding gender transition procedures ,in entering into contracts under this subsection1 the ,director shall ensure that no multi-,state qualified health plan offered in an ,exchange provides health benefits coverage for which the expenditure of ,federal funds is prohibited under chapter #d of title #a1 ,united ,states ,code4 4 7c7 ,effective date ,the amendments made by subsection 7a7 shall apply to taxable years ending after the date that is #a year after the date of enactment of this ,act1 but only with respect to plan years beginning after such date1 and the amendment made by subsection 7b7 shall apply to plan years beginning after such date4