<enum>I</enum><header>Gender-affirming care on minors prohibited</header><section id="H85E77865CE204DC39FDF723232190134"><enum>101.</enum><header>Gender-affirming care on minors prohibited</header><text display-inline="no-display-inline">Chapter 110 of title 18, United States Code, is amended—</text><paragraph id="H8F49B3CA374847CCA19851A8CC6AE6D3"><enum>(1)</enum><text>by adding at the end the following: </text><quoted-block style="USC" display-inline="no-display-inline" id="H9CD70980F0864C53B38730F02864ADDA"><section id="H2FD4E27E008B450F9F7F48F2CFE703DD"><enum>2260B.</enum><header>Gender-affirming care on minors</header><subsection id="H8ED45820C52A45F6AB808AE88CA936DC"><enum>(a)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this section:</text><paragraph id="H49A7493EF0B44140ACE62E15FD94C0AE"><enum>(1)</enum><header>Biological sex</header><text display-inline="yes-display-inline">The term <term>biological sex</term> 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.</text></paragraph><paragraph id="HB433DC0B2A154725808767F0FD46908B"><enum>(2)</enum><header>Gender-affirming care</header><subparagraph id="HF89D98F490C44BBCA30C22DE30E5BE68"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">Except as provided in subparagraph (B), the term <term>gender-affirming care</term> means, with respect to an individual, any of the following:</text><clause id="H1F9F65EC9171406AB43F0DBE31DB32B7"><enum>(i)</enum><text display-inline="yes-display-inline">Performing any surgery for the purpose of changing the body of the individual to correspond to a sex that differs from the individual's biological sex, including—</text><subclause id="H6B17113B405E475F9C5E56509EA6CC68"><enum>(I)</enum><text>castration;</text></subclause><subclause id="HA199D62528D94A049F86C7AC363FC383"><enum>(II)</enum><text>orchiectomy;</text></subclause><subclause id="H05C11618A394495ABA7EADB79E003F59"><enum>(III)</enum><text>scrotoplasty;</text></subclause><subclause id="HC8D8EA6D4F7D415EAE5D8A3AC6CB2C30"><enum>(IV)</enum><text>vasectomy;</text></subclause><subclause id="H7A844DDF583849EC8D3BC924BF3E221E"><enum>(V)</enum><text>hysterectomy;</text></subclause><subclause id="HC3EE907514DD419F837C1F537DA6FCA7"><enum>(VI)</enum><text>oophorectomy;</text></subclause><subclause id="H30E7E54DAA8A4E8F816C3A8C13F5B1C6"><enum>(VII)</enum><text>ovariectomy;</text></subclause><subclause id="HD57EC7D621FD4220990CA6A88A422EF9"><enum>(VIII)</enum><text>metoidioplasty; </text></subclause><subclause id="H3B04D899D288467A91D30165642597D2"><enum>(IX)</enum><text>penectomy; </text></subclause><subclause id="H04E0B90491E0421280AD93F91AAF9917"><enum>(X)</enum><text>phalloplasty; </text></subclause><subclause id="H60EBACE5D04D4E0DA81CB0CDF70B9FA3"><enum>(XI)</enum><text>vaginoplasty; </text></subclause><subclause id="H6D1E050274094644BE324A7FDD96BA0E"><enum>(XII)</enum><text>vaginectomy; </text></subclause><subclause id="H48949869B3A84E43993188BAB86B17CC"><enum>(XIII)</enum><text>vulvoplasty; </text></subclause><subclause id="HB2BBFC0827EA4BD3AA25C2E8013FACA8"><enum>(XIV)</enum><text>reduction thyrochondroplasty;</text></subclause><subclause id="H88F715DB6A834A11BDFC94628EAB044B"><enum>(XV)</enum><text>chondrolaryngoplasty; and</text></subclause><subclause id="H1FAA08EE25A44D0AA4AC5E18F658B36A"><enum>(XVI)</enum><text>mastectomy.</text></subclause></clause><clause id="H07E95F031FC04BEC949891EAA9EE8E3F"><enum>(ii)</enum><text>Any plastic surgery that feminizes or masculinizes the facial features of the individual for the purposes described in clause (i).</text></clause><clause id="HCA95453149AE4EF5864E82FF71098725"><enum>(iii)</enum><text display-inline="yes-display-inline">Any placement of chest implants in the individual to create feminine breasts for the purposes described in clause (i).</text></clause><clause id="H0A3DA48A293441B4BF353859A158219D"><enum>(iv)</enum><text display-inline="yes-display-inline">Any placement of fat or artificial implants in the gluteal region of the individual for the purposes described in clause (i).</text></clause><clause id="HE1A823F9639C4CEFA557C2A8852B3157"><enum>(v)</enum><text display-inline="yes-display-inline">Administering, supplying, prescribing, dispensing, distributing, or otherwise conveying to the individual medications for the purposes described in clause (i), including—</text><subclause id="HD076C64B1BD4499EB7AC10272B974D64"><enum>(I)</enum><text>gonadotropin-releasing hormone (commonly known as <quote>GnRH</quote>) analogues or other puberty-blocking drugs to stop or delay normal puberty;</text></subclause><subclause id="H7B17F565ABAC4389BAFF71787B77D794"><enum>(II)</enum><text>testosterone or other androgens to a biological female at doses that are supraphysiologic to the female sex; and</text></subclause><subclause id="H21296292034145EB85739D7E4483C44D"><enum>(III)</enum><text>estrogen to a biological male at doses that are supraphysiologic to the male sex.</text></subclause></clause></subparagraph><subparagraph id="H0F612985B24847D88DFF736343595C8F"><enum>(B)</enum><header>Exception</header><text display-inline="yes-display-inline">Subparagraph (A) shall not apply to conduct with respect to the following individuals:</text><clause id="HB10A850F7FCD417D87E52294C9CA60F0"><enum>(i)</enum><text display-inline="yes-display-inline">An individual with both ovarian and testicular tissue.</text></clause><clause id="HDE004BCB4CB54921ABF72D2376D341C2"><enum>(ii)</enum><text>An individual who does not have normal sex chromosome structure, sex steroid hormone production, or sex steroid hormone action, as determined by a physician through genetic or biochemical testing.</text></clause><clause id="HABBE80ECD6FB46C9B7F2E88CDBAD8BB9"><enum>(iii)</enum><text>An individual experiencing infection, disease, injury, or disorder caused or exacerbated by previous gender transition procedures.</text></clause><clause id="H3F80489420EE44039A2B8D8E47470C09"><enum>(iv)</enum><text>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 a procedure described in that subparagraph is performed.</text></clause></subparagraph></paragraph><paragraph id="HF11EDCC7FCCA4004B8CA7CDBC162FE09"><enum>(3)</enum><header>Minor</header><text display-inline="yes-display-inline">The term <term>minor</term> means any individual under the age of 18 years.</text></paragraph></subsection><subsection id="H5D5CF1E2BD52431799D0BE79214A61FB"><enum>(b)</enum><header>Prohibition on performing gender-affirming care on minors</header><paragraph commented="no" display-inline="no-display-inline" id="id9f2a4b61932a447c89ea4f1b8332b1dc"><enum>(1)</enum><header display-inline="yes-display-inline">Offense</header><text display-inline="yes-display-inline">It shall be unlawful, in any circumstance described in subsection (e), to knowingly perform any gender-affirming care on a minor.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ide4568e0974ec404e9121675f4a6d7c89"><enum>(2)</enum><header>Penalty</header><text display-inline="yes-display-inline">Any person who violates paragraph (1) shall be fined under this title, imprisoned for not more than 12 years, or both.</text></paragraph></subsection><subsection id="H0202BF56243B4C51BCF6AB1515E6C262"><enum>(c)</enum><header>Prohibition on prosecution of person on whom intervention is performed</header><text>A person on whom gender-affirming care is performed may not be arrested or prosecuted for an offense under subsection (b).</text></subsection><subsection id="H33E2C958183E4509BEE1379C928D91EC"><enum>(d)</enum><header>Civil action</header><text display-inline="yes-display-inline">A person on whom gender-affirming care is performed in violation of subsection (b) may bring a civil action in an appropriate district court of the United States for appropriate relief, including compensatory and punitive damages, against each person who performed the gender-affirming care.</text></subsection><subsection commented="no" id="HB4AC6BA0E19646B2B0D849F2FADA46A6"><enum>(e)</enum><header>Circumstances described</header><text>The circumstances referred to in subsection (b) are that—</text><paragraph commented="no" id="H62167EB8277846A49D2C8C1F7F709AC8"><enum>(1)</enum><text>the defendant or victim traveled in interstate or foreign commerce, or traveled using a means, channel, facility, or instrumentality of interstate or foreign commerce, in furtherance of or in connection with the conduct described in that subsection;</text></paragraph><paragraph commented="no" id="HAF46BCBF5AAC4285BE948CAB7BE21B98"><enum>(2)</enum><text>the defendant used a means, channel, facility, or instrumentality of interstate or foreign commerce in furtherance of or in connection with the conduct described in that subsection;</text></paragraph><paragraph commented="no" id="H91232894407B4D71B27D6A223AAB22D2"><enum>(3)</enum><text>any payment of any kind was made, directly or indirectly, in furtherance of or in connection with the conduct described in that subsection using any means, channel, facility, or instrumentality of interstate or foreign commerce or in or affecting interstate or foreign commerce;</text></paragraph><paragraph commented="no" id="H201F52FB0F374523AEBBC7AB88034657"><enum>(4)</enum><text>the defendant transmitted in interstate or foreign commerce any communication relating to or in furtherance of the conduct described in that subsection—</text><subparagraph commented="no" display-inline="no-display-inline" id="idf7079294a5794f879c3cc725db1f9acd"><enum>(A)</enum><text display-inline="yes-display-inline">using any means, channel, facility, or instrumentality of interstate or foreign commerce; or</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="iddcfb8478686c48759ba1f3a40e66f3c6"><enum>(B)</enum><text display-inline="yes-display-inline">in or affecting interstate or foreign commerce by any means or in any manner, including by computer, mail, wire, or electromagnetic transmission;</text></subparagraph></paragraph><paragraph commented="no" id="HBE0218C0DD974105913DE48A979FF165"><enum>(5)</enum><text>any instrument, item, substance, or other object that has traveled in interstate or foreign commerce was used to perform the conduct described in that subsection;</text></paragraph><paragraph commented="no" id="HEC4AF64410724CBABCC1ADA41B970FD7"><enum>(6)</enum><text>the conduct described in that subsection occurred in—</text><subparagraph commented="no" display-inline="no-display-inline" id="idd667a2276c054c5e89e9d28834483a8b"><enum>(A)</enum><text display-inline="yes-display-inline">the special maritime and territorial jurisdiction of the United States; or</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="iddf6ee601c07f464aa87d7374172a490d"><enum>(B)</enum><text display-inline="yes-display-inline">a territory or possession of the United States; or</text></subparagraph></paragraph><paragraph commented="no" id="H856A8F83DCE44B308CB92C8A71C84275"><enum>(7)</enum><text>the conduct described in that subsection otherwise occurred in or affected interstate or foreign commerce.</text></paragraph></subsection><subsection id="HE25421102A1447D5B0D68F6279407987"><enum>(f)</enum><header>Rule of construction</header><text display-inline="yes-display-inline">Nothing in this section shall be construed as prohibiting provision of the medical services described in subsection (a)(2)(A) to address legitimate health issues, such as any male or female reproductive cancers, apart from changing the body of an individual to correspond to a sex that differs from the individual's biological sex.</text></subsection></section><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph><paragraph id="H8DF9AE5E1F28400498348779805C8832"><enum>(2)</enum><text>in the table of sections, by adding at the end the following:</text><quoted-block style="USC" display-inline="no-display-inline" id="H63F5CA630D70483198DE71640F49D497"><toc regeneration="no-regeneration"><toc-entry level="section">2260B. Gender-affirming care on minors.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section>

Short title

This Act may be cited as the

Protect Children’s Innocence Act

<enum>I</enum><header>Gender-affirming care on minors prohibited</header><section id="H85E77865CE204DC39FDF723232190134"><enum>101.</enum><header>Gender-affirming care on minors prohibited</header><text display-inline="no-display-inline">Chapter 110 of title 18, United States Code, is amended—</text><paragraph id="H8F49B3CA374847CCA19851A8CC6AE6D3"><enum>(1)</enum><text>by adding at the end the following: </text><quoted-block style="USC" display-inline="no-display-inline" id="H9CD70980F0864C53B38730F02864ADDA"><section id="H2FD4E27E008B450F9F7F48F2CFE703DD"><enum>2260B.</enum><header>Gender-affirming care on minors</header><subsection id="H8ED45820C52A45F6AB808AE88CA936DC"><enum>(a)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this section:</text><paragraph id="H49A7493EF0B44140ACE62E15FD94C0AE"><enum>(1)</enum><header>Biological sex</header><text display-inline="yes-display-inline">The term <term>biological sex</term> 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.</text></paragraph><paragraph id="HB433DC0B2A154725808767F0FD46908B"><enum>(2)</enum><header>Gender-affirming care</header><subparagraph id="HF89D98F490C44BBCA30C22DE30E5BE68"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">Except as provided in subparagraph (B), the term <term>gender-affirming care</term> means, with respect to an individual, any of the following:</text><clause id="H1F9F65EC9171406AB43F0DBE31DB32B7"><enum>(i)</enum><text display-inline="yes-display-inline">Performing any surgery for the purpose of changing the body of the individual to correspond to a sex that differs from the individual's biological sex, including—</text><subclause id="H6B17113B405E475F9C5E56509EA6CC68"><enum>(I)</enum><text>castration;</text></subclause><subclause id="HA199D62528D94A049F86C7AC363FC383"><enum>(II)</enum><text>orchiectomy;</text></subclause><subclause id="H05C11618A394495ABA7EADB79E003F59"><enum>(III)</enum><text>scrotoplasty;</text></subclause><subclause id="HC8D8EA6D4F7D415EAE5D8A3AC6CB2C30"><enum>(IV)</enum><text>vasectomy;</text></subclause><subclause id="H7A844DDF583849EC8D3BC924BF3E221E"><enum>(V)</enum><text>hysterectomy;</text></subclause><subclause id="HC3EE907514DD419F837C1F537DA6FCA7"><enum>(VI)</enum><text>oophorectomy;</text></subclause><subclause id="H30E7E54DAA8A4E8F816C3A8C13F5B1C6"><enum>(VII)</enum><text>ovariectomy;</text></subclause><subclause id="HD57EC7D621FD4220990CA6A88A422EF9"><enum>(VIII)</enum><text>metoidioplasty; </text></subclause><subclause id="H3B04D899D288467A91D30165642597D2"><enum>(IX)</enum><text>penectomy; </text></subclause><subclause id="H04E0B90491E0421280AD93F91AAF9917"><enum>(X)</enum><text>phalloplasty; </text></subclause><subclause id="H60EBACE5D04D4E0DA81CB0CDF70B9FA3"><enum>(XI)</enum><text>vaginoplasty; </text></subclause><subclause id="H6D1E050274094644BE324A7FDD96BA0E"><enum>(XII)</enum><text>vaginectomy; </text></subclause><subclause id="H48949869B3A84E43993188BAB86B17CC"><enum>(XIII)</enum><text>vulvoplasty; </text></subclause><subclause id="HB2BBFC0827EA4BD3AA25C2E8013FACA8"><enum>(XIV)</enum><text>reduction thyrochondroplasty;</text></subclause><subclause id="H88F715DB6A834A11BDFC94628EAB044B"><enum>(XV)</enum><text>chondrolaryngoplasty; and</text></subclause><subclause id="H1FAA08EE25A44D0AA4AC5E18F658B36A"><enum>(XVI)</enum><text>mastectomy.</text></subclause></clause><clause id="H07E95F031FC04BEC949891EAA9EE8E3F"><enum>(ii)</enum><text>Any plastic surgery that feminizes or masculinizes the facial features of the individual for the purposes described in clause (i).</text></clause><clause id="HCA95453149AE4EF5864E82FF71098725"><enum>(iii)</enum><text display-inline="yes-display-inline">Any placement of chest implants in the individual to create feminine breasts for the purposes described in clause (i).</text></clause><clause id="H0A3DA48A293441B4BF353859A158219D"><enum>(iv)</enum><text display-inline="yes-display-inline">Any placement of fat or artificial implants in the gluteal region of the individual for the purposes described in clause (i).</text></clause><clause id="HE1A823F9639C4CEFA557C2A8852B3157"><enum>(v)</enum><text display-inline="yes-display-inline">Administering, supplying, prescribing, dispensing, distributing, or otherwise conveying to the individual medications for the purposes described in clause (i), including—</text><subclause id="HD076C64B1BD4499EB7AC10272B974D64"><enum>(I)</enum><text>gonadotropin-releasing hormone (commonly known as <quote>GnRH</quote>) analogues or other puberty-blocking drugs to stop or delay normal puberty;</text></subclause><subclause id="H7B17F565ABAC4389BAFF71787B77D794"><enum>(II)</enum><text>testosterone or other androgens to a biological female at doses that are supraphysiologic to the female sex; and</text></subclause><subclause id="H21296292034145EB85739D7E4483C44D"><enum>(III)</enum><text>estrogen to a biological male at doses that are supraphysiologic to the male sex.</text></subclause></clause></subparagraph><subparagraph id="H0F612985B24847D88DFF736343595C8F"><enum>(B)</enum><header>Exception</header><text display-inline="yes-display-inline">Subparagraph (A) shall not apply to conduct with respect to the following individuals:</text><clause id="HB10A850F7FCD417D87E52294C9CA60F0"><enum>(i)</enum><text display-inline="yes-display-inline">An individual with both ovarian and testicular tissue.</text></clause><clause id="HDE004BCB4CB54921ABF72D2376D341C2"><enum>(ii)</enum><text>An individual who does not have normal sex chromosome structure, sex steroid hormone production, or sex steroid hormone action, as determined by a physician through genetic or biochemical testing.</text></clause><clause id="HABBE80ECD6FB46C9B7F2E88CDBAD8BB9"><enum>(iii)</enum><text>An individual experiencing infection, disease, injury, or disorder caused or exacerbated by previous gender transition procedures.</text></clause><clause id="H3F80489420EE44039A2B8D8E47470C09"><enum>(iv)</enum><text>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 a procedure described in that subparagraph is performed.</text></clause></subparagraph></paragraph><paragraph id="HF11EDCC7FCCA4004B8CA7CDBC162FE09"><enum>(3)</enum><header>Minor</header><text display-inline="yes-display-inline">The term <term>minor</term> means any individual under the age of 18 years.</text></paragraph></subsection><subsection id="H5D5CF1E2BD52431799D0BE79214A61FB"><enum>(b)</enum><header>Prohibition on performing gender-affirming care on minors</header><paragraph commented="no" display-inline="no-display-inline" id="id9f2a4b61932a447c89ea4f1b8332b1dc"><enum>(1)</enum><header display-inline="yes-display-inline">Offense</header><text display-inline="yes-display-inline">It shall be unlawful, in any circumstance described in subsection (e), to knowingly perform any gender-affirming care on a minor.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ide4568e0974ec404e9121675f4a6d7c89"><enum>(2)</enum><header>Penalty</header><text display-inline="yes-display-inline">Any person who violates paragraph (1) shall be fined under this title, imprisoned for not more than 12 years, or both.</text></paragraph></subsection><subsection id="H0202BF56243B4C51BCF6AB1515E6C262"><enum>(c)</enum><header>Prohibition on prosecution of person on whom intervention is performed</header><text>A person on whom gender-affirming care is performed may not be arrested or prosecuted for an offense under subsection (b).</text></subsection><subsection id="H33E2C958183E4509BEE1379C928D91EC"><enum>(d)</enum><header>Civil action</header><text display-inline="yes-display-inline">A person on whom gender-affirming care is performed in violation of subsection (b) may bring a civil action in an appropriate district court of the United States for appropriate relief, including compensatory and punitive damages, against each person who performed the gender-affirming care.</text></subsection><subsection commented="no" id="HB4AC6BA0E19646B2B0D849F2FADA46A6"><enum>(e)</enum><header>Circumstances described</header><text>The circumstances referred to in subsection (b) are that—</text><paragraph commented="no" id="H62167EB8277846A49D2C8C1F7F709AC8"><enum>(1)</enum><text>the defendant or victim traveled in interstate or foreign commerce, or traveled using a means, channel, facility, or instrumentality of interstate or foreign commerce, in furtherance of or in connection with the conduct described in that subsection;</text></paragraph><paragraph commented="no" id="HAF46BCBF5AAC4285BE948CAB7BE21B98"><enum>(2)</enum><text>the defendant used a means, channel, facility, or instrumentality of interstate or foreign commerce in furtherance of or in connection with the conduct described in that subsection;</text></paragraph><paragraph commented="no" id="H91232894407B4D71B27D6A223AAB22D2"><enum>(3)</enum><text>any payment of any kind was made, directly or indirectly, in furtherance of or in connection with the conduct described in that subsection using any means, channel, facility, or instrumentality of interstate or foreign commerce or in or affecting interstate or foreign commerce;</text></paragraph><paragraph commented="no" id="H201F52FB0F374523AEBBC7AB88034657"><enum>(4)</enum><text>the defendant transmitted in interstate or foreign commerce any communication relating to or in furtherance of the conduct described in that subsection—</text><subparagraph commented="no" display-inline="no-display-inline" id="idf7079294a5794f879c3cc725db1f9acd"><enum>(A)</enum><text display-inline="yes-display-inline">using any means, channel, facility, or instrumentality of interstate or foreign commerce; or</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="iddcfb8478686c48759ba1f3a40e66f3c6"><enum>(B)</enum><text display-inline="yes-display-inline">in or affecting interstate or foreign commerce by any means or in any manner, including by computer, mail, wire, or electromagnetic transmission;</text></subparagraph></paragraph><paragraph commented="no" id="HBE0218C0DD974105913DE48A979FF165"><enum>(5)</enum><text>any instrument, item, substance, or other object that has traveled in interstate or foreign commerce was used to perform the conduct described in that subsection;</text></paragraph><paragraph commented="no" id="HEC4AF64410724CBABCC1ADA41B970FD7"><enum>(6)</enum><text>the conduct described in that subsection occurred in—</text><subparagraph commented="no" display-inline="no-display-inline" id="idd667a2276c054c5e89e9d28834483a8b"><enum>(A)</enum><text display-inline="yes-display-inline">the special maritime and territorial jurisdiction of the United States; or</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="iddf6ee601c07f464aa87d7374172a490d"><enum>(B)</enum><text display-inline="yes-display-inline">a territory or possession of the United States; or</text></subparagraph></paragraph><paragraph commented="no" id="H856A8F83DCE44B308CB92C8A71C84275"><enum>(7)</enum><text>the conduct described in that subsection otherwise occurred in or affected interstate or foreign commerce.</text></paragraph></subsection><subsection id="HE25421102A1447D5B0D68F6279407987"><enum>(f)</enum><header>Rule of construction</header><text display-inline="yes-display-inline">Nothing in this section shall be construed as prohibiting provision of the medical services described in subsection (a)(2)(A) to address legitimate health issues, such as any male or female reproductive cancers, apart from changing the body of an individual to correspond to a sex that differs from the individual's biological sex.</text></subsection></section><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph><paragraph id="H8DF9AE5E1F28400498348779805C8832"><enum>(2)</enum><text>in the table of sections, by adding at the end the following:</text><quoted-block style="USC" display-inline="no-display-inline" id="H63F5CA630D70483198DE71640F49D497"><toc regeneration="no-regeneration"><toc-entry level="section">2260B. Gender-affirming care on minors.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section><enum>II</enum><header>Prohibiting federally funded gender-affirming care</header><section id="HF979018DA1624241A5383C28AE76FA39"><enum>201.</enum><header>Prohibiting taxpayer-funded gender-affirming care</header><text display-inline="no-display-inline">Title 1, United States Code, is amended by adding at the end the following: </text><quoted-block style="USC" display-inline="no-display-inline" id="HF82193EFF75746E2B3867B75C6818B0F"><chapter id="H39DD071589B14FF4AC24BFEBE615D7DF"><enum>4</enum><header>Prohibiting taxpayer-funded gender-affirming care</header><toc><toc-entry level="section" idref="HC0D0E4CFA1774AF580F5DE81A76B8713">301. Prohibition on funding for gender-affirming care. </toc-entry><toc-entry level="section" idref="H0E2686DA27D14781A312F479DE79F137">302. Prohibition on funding for health benefits plans that cover gender-affirming care. </toc-entry><toc-entry level="section" idref="H197C81D8D77744E997B6613FF5E56D41">303. Limitation on Federal facilities and employees, Federal land and territories, and Tribal territories. </toc-entry><toc-entry level="section" idref="H8C907ABA8150433BA2256CFA3BE0C0BC">304. Effect on separate coverage. </toc-entry><toc-entry level="section" idref="H4D82C0550D30427FB13873BC1B164400">305. Effect on use of non-Federal funds for health coverage. </toc-entry><toc-entry level="section" idref="H18DECF912539404385BC0E009EAD230F">306. Application to complications arising from gender-affirming care. </toc-entry><toc-entry level="section" idref="H5D81A2C946F24EF1BB9CECBBBBA0E34E">307. Application to individuals born with medically verifiable disorder of sex development. </toc-entry><toc-entry level="section" idref="H6EED0846721C4E5D90AD4A75F55A40CA">308. Gender-affirming care defined. </toc-entry><toc-entry level="section" idref="HAA233D95114C4E959D178996542ED282">309. Effect of chapter. </toc-entry></toc><section id="HC0D0E4CFA1774AF580F5DE81A76B8713"><enum>301.</enum><header>Prohibition on funding for gender-affirming care</header><text display-inline="no-display-inline">No funds authorized or appropriated by Federal law, and none of the funds in any trust fund to which funds are authorized or appropriated by Federal law, including funds provided under titles XVIII, XIX, and XXI of the Social Security Act, shall be expended for any gender-affirming care.</text></section><section id="H0E2686DA27D14781A312F479DE79F137"><enum>302.</enum><header>Prohibition on funding for health benefits plans that cover gender-affirming care</header><text display-inline="no-display-inline">No funds authorized or appropriated by Federal law, and none of the funds in any trust fund to which funds are authorized or appropriated by Federal law, shall be expended for health benefits coverage that includes coverage of gender-affirming care.</text></section><section id="H197C81D8D77744E997B6613FF5E56D41"><enum>303.</enum><header>Limitation on Federal facilities and employees, Federal land and territories, and Tribal territories</header><text display-inline="no-display-inline">Gender-affirming care may not be included in any health care service furnished by—</text><paragraph id="H8F9A19204B7F4A4FB2E6109A337DE360"><enum>(1)</enum><text display-inline="yes-display-inline">a health care facility owned or operated by the Federal Government;</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idd7f545301c3d4bf79a90ed20c0db96ee"><enum>(2)</enum><text display-inline="yes-display-inline">a health care facility operated on Federal land, in a territory, or in a Tribal territory; or</text></paragraph><paragraph id="HB87014CDDF514118AE6A9215EE9A6AAB"><enum>(3)</enum><text display-inline="yes-display-inline">any physician or other individual providing health care services within the scope of the physician’s or individual’s employment who is—</text><subparagraph commented="no" display-inline="no-display-inline" id="ida18184ced02a423a83184b96289c6015"><enum>(A)</enum><text display-inline="yes-display-inline">employed by the Federal Government; or</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id06f985cd7bd4483c9ab953e9d9076fb3"><enum>(B)</enum><text display-inline="yes-display-inline">employed by a health care facility operated on Federal land, in a territory, or in a Tribal territory. </text></subparagraph></paragraph></section><section id="H8C907ABA8150433BA2256CFA3BE0C0BC"><enum>304.</enum><header>Effect on separate coverage</header><text display-inline="no-display-inline">Nothing in this chapter prohibits any individual, entity, or State or locality from purchasing separate coverage for gender-affirming care or health benefits coverage that includes gender-affirming care, on the condition that such coverage—</text><paragraph commented="no" display-inline="no-display-inline" id="id8e8f577cf87a43aaaec366fa2e58ebac"><enum>(1)</enum><text display-inline="yes-display-inline">is paid for entirely using funds—</text><subparagraph commented="no" display-inline="no-display-inline" id="idd9e41fb19f8e4bf6a65576b22af54d19"><enum>(A)</enum><text display-inline="yes-display-inline">not authorized or appropriated by Federal law; or</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id17b1f2508abc4f36b087545a1e324835"><enum>(B)</enum><text display-inline="yes-display-inline">not received from Federal programs, platforms, or infrastructure; </text></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id52965557226941b2a39adac264d2bb64"><enum>(2)</enum><text display-inline="yes-display-inline">does not cover any practice that would be subject to penalty under section 2260B of title 18; and </text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id49c86836fb864d60953e13de2015819d"><enum>(3)</enum><text display-inline="yes-display-inline">is not purchased using matching funds required for a federally subsidized program, including a State’s or locality’s contribution of Medicaid matching funds.</text></paragraph></section><section id="H4D82C0550D30427FB13873BC1B164400"><enum>305.</enum><header>Effect on use of non-Federal funds for health coverage</header><text display-inline="no-display-inline">Nothing in this chapter restricts the ability of any non-Federal health benefits coverage provider from offering coverage for gender-affirming care, or the ability of a State or locality to contract separately with such a provider for such coverage, on the condition that such coverage—</text><paragraph commented="no" display-inline="no-display-inline" id="id346282F3BB37468FA3159F1AE8A38F5D"><enum>(1)</enum><text display-inline="yes-display-inline">is paid for entirely using funds—</text><subparagraph commented="no" display-inline="no-display-inline" id="id2FBFC9B067074E868104EC403873313D"><enum>(A)</enum><text display-inline="yes-display-inline">not authorized or appropriated by Federal law; or</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id4884BABE01A24C3DBF69EA98BD6C0085"><enum>(B)</enum><text display-inline="yes-display-inline">not received from Federal programs, platforms, or infrastructure;</text></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id82717876dea048b3a851c065386b0f19"><enum>(2)</enum><text display-inline="yes-display-inline">does not cover any practice that would be subject to penalty under section 2260B of title 18; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id7007108fab454b099e3fbbd85b265ddb"><enum>(3)</enum><text display-inline="yes-display-inline">is not purchased using matching funds required for a federally subsidized program, including a State’s or locality’s contribution of Medicaid matching funds.</text></paragraph></section><section id="H18DECF912539404385BC0E009EAD230F"><enum>306.</enum><header>Application to complications arising from gender-affirming care</header><text display-inline="no-display-inline">Nothing in this chapter applies to the treatment of any infection, injury, disease, or disorder that has been caused or exacerbated by the performance of a gender-affirming care, regardless of whether—</text><paragraph commented="no" display-inline="no-display-inline" id="id27da7f1d81fd4140b56aa2cbab288c7a"><enum>(1)</enum><text display-inline="yes-display-inline">the gender-affirming care was performed in accordance with Federal or State law; or</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ide0ebf69c52384b3d8048d3e34a8925fd"><enum>(2)</enum><text display-inline="yes-display-inline">funding for the gender-affirming care is permissible under section 307.</text></paragraph></section><section id="H5D81A2C946F24EF1BB9CECBBBBA0E34E"><enum>307.</enum><header>Application to individuals born with medically verifiable disorder of sex development</header><text display-inline="no-display-inline">The prohibitions and limitations described in sections 301, 302, and 303 shall not apply to conduct with respect to an individual described in section 2260B(a)(2)(B) of title 18.</text></section><section id="H6EED0846721C4E5D90AD4A75F55A40CA"><enum>308.</enum><header>Gender-affirming care defined</header><text display-inline="no-display-inline">For purposes of this chapter, the term <term>gender-affirming care</term> has the meaning given such term in section 2260B of title 18.</text></section><section id="HAA233D95114C4E959D178996542ED282"><enum>309.</enum><header>Effect of chapter</header><text display-inline="no-display-inline">Nothing in this chapter prohibits the provision of the medical services described in section 2260B(a)(2)(B) of title 18, to address any male or female reproductive cancers (other than medical services to change the body of an individual to correspond to a sex that differs from the individual’s biological sex).</text></section></chapter><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="H7992495B438C40E99A84A502FFA1048D"><enum>202.</enum><header>Amendment to table of chapters</header><text display-inline="no-display-inline">The table of chapters for title 1, United States Code, is amended by adding at the end the following:</text><quoted-block style="USC" display-inline="no-display-inline" id="H5412E77CE6E24B84B34DC559911E585E"><toc regeneration="no-regeneration"><multi-column-toc-entry bold="on" level="section"><toc-enum>4.</toc-enum><level-header bold="on" level="section">Prohibiting taxpayer-funded gender-affirming care</level-header><target>301</target></multi-column-toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></section><enum>III</enum><header>Application under the Affordable Care Act</header><section id="H2C1B94983C0C4F98BE544A344C19689E"><enum>301.</enum><header>Clarifying application of prohibition to premium credits and cost-sharing reductions under ACA</header><subsection display-inline="no-display-inline" id="H3D80A7EE1D7648FEA518FFD1F436A2B6"><enum>(a)</enum><header>In general</header><paragraph id="H8F8D70047BE7451383C70A41E2549431"><enum>(1)</enum><header>Disallowance of refundable credit and cost-sharing reductions for coverage under qualified health plan which provides coverage for gender-affirming care</header><subparagraph id="H361999AC8A3541569B0D93D16B31E37D"><enum>(A)</enum><header>In general</header><text>Subparagraph (A) of section 36B(c)(3) of the Internal Revenue Code of 1986 is amended by inserting before the period at the end the following: <quote>or any health plan that includes coverage for gender-affirming care (other than any gender-affirming care or treatment described in section 306 or 307 of title 1, United States Code)</quote>.</text></subparagraph><subparagraph id="HD9AE43682A7B454CB7AEB055273FDE1F"><enum>(B)</enum><header>Option to purchase or offer separate coverage or plan</header><text display-inline="yes-display-inline">Paragraph (3) of section 36B(c) of such Code is amended by adding at the end the following new subparagraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="HB9E538ABB6AE4D549893325CB1A565F9"><subparagraph id="H927E927DD3574DF7B31451A2D73CD285"><enum>(C)</enum><header>Separate coverage or plan for gender-affirming care allowed</header><clause id="H7E09317F735D4C668671C544C7D9C1D4"><enum>(i)</enum><header>Option to purchase separate coverage or plan</header><text display-inline="yes-display-inline">Nothing in subparagraph (A) shall be construed as prohibiting any individual from purchasing separate coverage for gender-affirming care described in such subparagraph, or a health plan that includes such gender-affirming care, so long as no credit is allowed under this section with respect to the premiums for such coverage or plan and such coverage or plan does not cover any practice that would be subject to penalty under section 2260B of title 18, United States Code.</text></clause><clause id="HD8078F5AA2B941C582044B2E35EC9904"><enum>(ii)</enum><header>Option to offer coverage or plan</header><text display-inline="yes-display-inline">Nothing in subparagraph (A) shall restrict any non-Federal health insurance issuer offering a health plan from offering separate coverage for gender-affirming care described in such subparagraph, or a plan that includes such gender-affirming care, 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 (or the amount of any advance payment of the credit under section 1412 of the Patient Protection and Affordable Care Act) and such coverage or plan does not cover any practice that would be subject to penalty under section 2260B of title 18, United States Code.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="H3FBE78E1C9A441ADB099CDD065DBB819"><enum>(2)</enum><header>Disallowance of small employer health insurance expense credit for plan which includes coverage for gender-affirming care</header><text>Subsection (h) of section 45R of the Internal Revenue Code of 1986 is amended—</text><subparagraph display-inline="no-display-inline" id="H039252B567874040B23CA22521E438FC"><enum>(A)</enum><text>by striking <quote>Any term</quote> and inserting the following:</text><quoted-block style="OLC" display-inline="no-display-inline" id="H77688ABAAFEA4CE1BE6C1A6075BF13A4"><paragraph id="H80EA300A185C4AF0881BF8C4D34D73A9"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Any term</text></paragraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph><subparagraph id="H1F850FF5140749E38C1AC4A35F44B0CB"><enum>(B)</enum><text>by adding at the end the following new paragraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="H960B32381A5F479EA501AA3A62EB1BBA"><paragraph id="H3B78CF0C247D4396B37B333FD3005ABB"><enum>(2)</enum><header>Exclusion of health plans including coverage for gender-affirming care</header><subparagraph id="H2673DB69363B4F21A1CD52DF49EE4233"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">The term <term>qualified health plan</term> does not include any health plan that includes coverage for gender-affirming care (other than any gender-affirming care or treatment described in section 306 or 307 of title 1, United States Code).</text></subparagraph><subparagraph id="H017EB389FA494226AA40EFD85ED9E11E"><enum>(B)</enum><header>Separate coverage or plan for gender-affirming care allowed</header><clause display-inline="no-display-inline" id="H347C0C976A5F467C8973C5934122B136"><enum>(i)</enum><header>Option to purchase separate coverage or plan</header><text display-inline="yes-display-inline">Nothing in subparagraph (A) shall be construed as prohibiting any employer from purchasing for its employees separate coverage for gender-affirming care described in such subparagraph, or a health plan that includes such gender-affirming care, so long as no credit is allowed under this section with respect to the employer contributions for such coverage or plan and such coverage does not cover any practice that would be subject to penalty under section 2260B of title 18, United States Code.</text></clause><clause id="HC6EAB21E1582410E9FAAA53E48942AA1"><enum>(ii)</enum><header>Option to offer coverage or plan</header><text display-inline="yes-display-inline">Nothing in subparagraph (A) shall restrict any non-Federal health insurance issuer offering a health plan from offering separate coverage for gender-affirming care described in such subparagraph, or a plan that includes such gender-affirming care, so long as such separate coverage or plan is not paid for with any employer contribution eligible for the credit allowed under this section and such coverage or plan does not cover any practice that would be subject to penalty under section 2260B of title 18, United States Code.</text></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph></subsection><subsection id="H54A2554307454A31AAC7BDFD053B5DF2"><enum>(b)</enum><header>Application to multi-State plans</header><text>Section 1334(a) of Public Law 111–148 (42 U.S.C. 18054(a)) is amended by adding at the end the following:</text><quoted-block style="OLC" display-inline="no-display-inline" id="H075E47E067764AD3A1EF88761A309A93"><paragraph id="HA95E07383AB44B45BC75A48BC4F98505"><enum>(8)</enum><header>Coverage consistent with Federal policy regarding gender-affirming care</header><text display-inline="yes-display-inline">In entering into contracts under this subsection, 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 4 of title 1, United States Code.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="H9EF6351EA8D24381A4CB6B5CF07EF2DF"><enum>(c)</enum><header>Effective date</header><text display-inline="yes-display-inline">The amendments made by subsection (a) shall apply to taxable years ending after the date that is one year after the date of enactment of this Act, but only with respect to plan years beginning after such date, and the amendment made by subsection (b) shall apply to plan years beginning after such date.</text></subsection></section><enum>IV</enum><header>Additional Provisions</header><section section-type="subsequent-section" id="H564C363F3B1D45EDA1D542F59C3839BB"><enum>401.</enum><header>Prohibition on institutions of higher education and accrediting agencies or associations</header><subsection id="HD19A420B7FC44C00ABD019DFEEC0AA4F"><enum>(a)</enum><header>Prohibition on institutions of higher education</header><text display-inline="yes-display-inline">Section 487(a) of the Higher Education Act of 1965 (20 U.S.C. 1094(a)) is amended by adding at the end the following: </text><quoted-block style="OLC" display-inline="no-display-inline" id="H5119C8834E414A5DB498E37587978C09"><paragraph id="H05C139553C444A3A906D301488EAFF54"><enum>(30)</enum><text display-inline="yes-display-inline">The institution will not offer instruction in gender-affirming care (as defined in section 2260B of title 18, United States Code).</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="H12375916DF534208BCD66F95BF002FF8"><enum>(b)</enum><header>Prohibition on accrediting agencies or associations</header><text display-inline="yes-display-inline">Section 496(a) of the Higher Education Act of 1965 (20 U.S.C. 1099b(a)) is amended—</text><paragraph id="H3E2B2F715AB340C782472E89016A44E3"><enum>(1)</enum><text>by striking <quote>and</quote> at the end of paragraph (7); </text></paragraph><paragraph id="HA05FFC58A3EA4F9BAEA32937DB1D0F56"><enum>(2)</enum><text>by striking the period at the end of paragraph (8) and inserting <quote>; and</quote>; and</text></paragraph><paragraph id="H4D42D46D5E134567A2C4AEA52E1F1EB5"><enum>(3)</enum><text>by adding at the end the following: </text><quoted-block style="OLC" display-inline="no-display-inline" id="H5C5B9B6E318142D2923E7C932AE2D735"><paragraph id="HBAC29DB7E0124C148317F7D23BFF6BD2"><enum>(9)</enum><text display-inline="yes-display-inline">such agency or association does not accredit any institution that offers instruction in gender-affirming care (as defined in section 2260B of title 18, United States Code).</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection></section><section id="HF10BE1A55B5744CA95AC81B25A7BA114"><enum>402.</enum><header>Immigration consequences with respect to providing gender-affirming care</header><subsection id="HD46791E477544CEC91795F6048354CEF"><enum>(a)</enum><header>Definition of gender-Affirming care</header><text display-inline="yes-display-inline">Section 101(a) of the Immigration and Nationality Act (8 U.S.C. 1101(a)) is amended by adding at the end the following:</text><quoted-block style="OLC" display-inline="no-display-inline" id="H1786CCC539174E7EAD003B3CB019AE22"><paragraph id="HA121B8155DB14E339AB9C06BE1BCF65C"><enum>(53)</enum><text display-inline="yes-display-inline">The term <term>gender-affirming care</term> shall have the meaning given such term in section 2260B of title 18, United States Code.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="H401A2A5B76B949A49C6692CCE2A13E26"><enum>(b)</enum><header>Classes of aliens ineligible for visas or admission</header><text display-inline="yes-display-inline">Section 212(a)(1)(A) of the Immigration and Nationality Act (8 U.S.C. 1182(a)(1)(A)) is amended—</text><paragraph id="H0CBA43E923A244E19C1D0754628CD289"><enum>(1)</enum><text>in clause (iii)(II), by striking <quote>or</quote> at the end; </text></paragraph><paragraph id="HB63F718D5BBA4620AEBE8E100C51F443"><enum>(2)</enum><text>in clause (iv), by striking the comma at the end and inserting <quote>, or</quote>; and </text></paragraph><paragraph id="HF2F2ECC68D164FCCB1DB8641BABD3954"><enum>(3)</enum><text>by inserting after clause (iv) the following:</text><quoted-block style="OLC" display-inline="no-display-inline" id="H0EB5B0FAA42A4D60ACD3DE1A0CD2B0F7"><clause id="H3A73B8B3EE7A4564B7E1CC212919E0FF"><enum>(v)</enum><text display-inline="yes-display-inline">who is determined to have performed gender-affirming care on a child that has not attained the age of 18 years old,</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="H73C4157603AA480FA57E22A2569D5D8F"><enum>(c)</enum><header>Classes of deportable aliens</header><text>Section 237(a) of the Immigration and Nationality Act (8 U.S.C. 1227(a)) is amended by adding at the end the following:</text><quoted-block style="OLC" display-inline="no-display-inline" id="H4E2CF4B4EE7A4A82B0326712FA671CDE"><paragraph id="H26DAC4F426C747038706C36B9D27CA74"><enum>(8)</enum><header>Gender-affirming care</header><text display-inline="yes-display-inline">Any alien who has performed gender-affirming care on a child who has not attained the age of 18 years old is deportable.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section>