[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3887 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 3887

To amend title III of the Public Health Service Act to reauthorize the 
   program of payments to children's hospitals that operate graduate 
          medical education programs, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              June 7, 2023

 Mr. Crenshaw introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
To amend title III of the Public Health Service Act to reauthorize the 
   program of payments to children's hospitals that operate graduate 
          medical education programs, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Children's Hospital GME Support 
Reauthorization Act of 2023''.

SEC. 2. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT OPERATE 
              GRADUATE MEDICAL EDUCATION PROGRAMS.

    Section 340E of the Public Health Service Act (42 U.S.C. 256e) is 
amended--
            (1) in subsection (a), by striking ``2023'' and inserting 
        ``2028'';
            (2) in subsection (b)(3)(D), by inserting ``and the end of 
        fiscal year 2028,'' after ``fiscal year 2022,'';
            (3) in subsection (e), by adding at the end the following 
        new paragraph:
            ``(4) Prohibition on payments to hospitals furnishing 
        gender-affirming care to minors.--
                    ``(A) In general.--Notwithstanding any other 
                provision of this section, no payment may be made under 
                this section to a children's hospital for a fiscal year 
                (beginning with fiscal year 2024) if, at any point 
                during the preceding fiscal year, such hospital 
                furnished gender-affirming care (as defined in 
                subsection (g)) to an individual under 18 years of age.
                    ``(B) Special rule for fiscal year 2024.--In 
                applying subparagraph (A) with respect to payments 
                described in such subparagraph for fiscal year 2024, 
                the reference to `the preceding fiscal year' shall be 
                treated as a reference to `the period beginning on July 
                1, 2023, and ending on September 30, 2023'.
                    ``(C) Rule of construction.--Nothing in this 
                paragraph shall be construed as prohibiting payments 
                for a fiscal year to a hospital that, during the 
                preceding fiscal year (or, in the case of payments for 
                fiscal year 2024, during the period described in 
                subparagraph (B)), furnished mental or behavioral 
                health services to individuals under 18 years of age 
                for the treatment of gender dysphoria not consisting of 
                gender-affirming care.'';
            (4) in subsection (f)--
                    (A) in paragraph (1)(A)(vi), by striking ``2023'' 
                and inserting ``2028''; and
                    (B) in paragraph (2)(F), by striking ``2023'' and 
                inserting ``2028''; and
            (5) in subsection (g), by adding at the end the following 
        new paragraph:
            ``(4) Gender-affirming care.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), the term `gender-affirming care' 
                means, with respect to an individual, any of the 
                following:
                            ``(i) Performing any surgery for the 
                        purpose of changing the body of such individual 
                        to correspond to a sex that differs from their 
                        biological sex, including--
                                    ``(I) castration;
                                    ``(II) orchiectomy;
                                    ``(III) scrotoplasty;
                                    ``(IV) vasectomy;
                                    ``(V) hysterectomy;
                                    ``(VI) oophorectomy;
                                    ``(VII) ovariectomy;
                                    ``(VIII) metoidioplasty;
                                    ``(IX) penectomy;
                                    ``(X) phalloplasty;
                                    ``(XI) vaginoplasty;
                                    ``(XII) vaginectomy;
                                    ``(XIII) vulvoplasty;
                                    ``(XIV) reduction 
                                thyrochondroplasty;
                                    ``(XV) chondrolaryngoplasty; and
                                    ``(XVI) mastectomy.
                            ``(ii) Any plastic surgery that feminizes 
                        or masculinizes the facial features for the 
                        purposes described in clause (i).
                            ``(iii) Any placement of chest implants to 
                        create feminine breasts for the purposes 
                        described in clause (i).
                            ``(iv) Any placement of fat or artificial 
                        implants in the gluteal region for the purposes 
                        described in clause (i).
                            ``(v) Administering, supplying, 
                        prescribing, dispensing, distributing, or 
                        otherwise conveying to an individual 
                        medications for the purposes described in 
                        clause (i), including--
                                    ``(I) gonadotropin-releasing 
                                hormone (GnRH) analogues or other 
                                puberty-blocking drugs to stop or delay 
                                normal puberty;
                                    ``(II) testosterone or other 
                                androgens to biological females at 
                                doses that are supraphysiologic to the 
                                female sex; and
                                    ``(III) estrogen to biological 
                                males at doses that are 
                                supraphysiologic to the male sex.
                    ``(B) Exception.--Subparagraph (A) shall not apply 
                to the following individuals:
                            ``(i) An individual with both ovarian and 
                        testicular tissue.
                            ``(ii) An individual with respect to whom a 
                        physician has determined through genetic or 
                        biochemical testing that the individual does 
                        not have normal sex chromosome structure, sex 
                        steroid hormone production, or sex steroid 
                        hormone action.
                            ``(iii) An individual experiencing 
                        infection, disease, injury, or disorder caused 
                        or exacerbated by previous gender transition 
                        procedures.
                            ``(iv) An individual suffering from a 
                        physical disorder, physical injury, or physical 
                        illness that would, as certified by a 
                        physician, place the individual in imminent 
                        danger of death or impairment of a major bodily 
                        function unless the procedure is performed.
                    ``(C) Biological sex.--For purposes of subparagraph 
                (A), the term `biological sex' means the indication of 
                male or female sex by reproductive potential or 
                capacity, sex chromosomes, naturally occurring sex 
                hormones, gonads, or internal or external genitalia 
                present at birth.''.
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