SECONDREGULARSESSION
HOUSECOMMITTEESUBSTITUTEFOR
HOUSEBILLNOS.1520,1519,2355&
2357
102NDGENERALASSEMBLY
3009H.03C DANARADEMANMILLER,ChiefClerk
ANACT
Torepealsection191.1720,RSMo,andtoenactinlieuthereoftwonewsectionsrelatingto
gendertransitionprocedures,withadelayedeffectivedateforacertainsection.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Section191.1720,RSMo,isrepealedandtwonewsectionsenactedinlieu
2thereof,tobeknownassections191.1705and191.1720,toreadasfollows:
191.1705.1.Asusedinthissection,thefollowingtermsmean:
2 (1)"Healthcareinstitution",anypublicorprivatehospital,outpatientcenter
3forprimarycare,medicalcenter,physicianorganization,healthcareprofessional
4association,outpatientcenterforsurgicalservices,privatephysician'soffice,pharmacy,
5long-termcarefacility,medicalschool,nursingschool,medicaltrainingfacility,orother
6entityorlocationinwhichhealthcareservicesareperformed;
7 (2)"Healthcareprofessional",anyphysician;nursepractitionerorothernurse;
8physicianassistant;nurse'saide;alliedhealthprofessional;medicalassistant;employee
9ofahospital,outpatientcenterforprimarycare,outpatientcenterforsurgicalservices,
10long-termcarefacility,orpharmacy;pharmacist;pharmacytechnician;medicalschool
11facultymemberorstudent;nursingschoolfacultymemberorstudent;psychologyor
12counselingfacultymemberorstudent;medicalresearcher;laboratorytechnician;
13counselor;socialworker;orotherpersonwhofacilitatesorparticipatesinahealthcare
14service;
15 (3)"Sexreassignmentorgenderidentitytransitioning",theprocessinwhicha
16persontransitionsfromidentifyingwithandlivingasagenderthatcorrespondstohis
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 17orherbiologicalsextoidentifyingwithandlivingasagenderdifferentfromhisorher
18biologicalsexandmayinvolvesocial,legal,orphysicalchanges.
19 2.(1)Nohealthcareinstitutionorhealthcareprofessionalshallberequiredto
20perform,assist,orparticipateinsexreassignmentorgenderidentitytransitioning
21medicalprocedures,treatments,counseling,prescriptions,orsurgeriesifsuch
22procedures,treatments,counseling,prescriptions,orsurgeriesarecontrarytothe
23establishedpolicyof,orthemoral,ethical,orreligiousbeliefsof,suchhealthcare
24institutionorhealthcareprofessional.
25 (2)Nocauseofactionshallaccrueagainstanysuchhealthcareinstitutionor
26healthcareprofessionalonaccountofsuchrefusaltoperform,assist,orparticipatein
27sexreassignmentorgenderidentitytransitioningmedicalprocedures,treatments,
28counseling,prescriptions,orsurgeries.Thissectionmaybeusedasadefenseinany
29purportedactionrelatedtoorarisingoutoftheexerciseoftherightsprotectedbythis
30section.
31 3.Nohealthcareinstitutionorhealthcareprofessionalshallbe:
32 (1)Deniedordiscriminatedagainstinthereceiptofanypublicbenefit,
33assistance,orprivilegewhatsoever;or
34 (2)Deniedordiscriminatedagainstinanypublicorprivateemploymentbyany
35meansincluding,butnotlimitedto,anyadverseactionrelatedtohiring,promotion,
36advancement,transfer,licensing,education,training,orgrantingofhospitalprivileges
37orstaffappointments
38
39onthegroundsthatthehealthcareinstitutionorhealthcareprofessionalrefusesto
40perform,assist,orparticipateinsexreassignmentorgenderidentitytransitioning
41medicalprocedures,treatments,counseling,prescriptions,orsurgeries.
42 4.Anypersonwhodeniesordiscriminatesagainstahealthcareinstitutionor
43healthcareprofessionalforrefusaltoperform,assist,orparticipateinsexreassignment
44orgenderidentitytransitioningmedicalprocedures,treatments,counseling,
45prescriptions,orsurgeriesshallbeliabletothepartyinjuredinanactionatlaw,suit
46inequity,orotherformofredress.Aprevailingpartywhoestablishesaviolationofthe
47rightsprotectedbythissectionshallbeawardedreasonableattorney'sfees.
48 5.Nothinginthissectionshallbeconstruedtoallowanypersontodeny
49visitation,recognitionofadesignatedrepresentativeforhealthcaredecision-making,or
50emergencymedicaltreatmentnecessarytocureanillnessorinjuryasrequiredbylawin
51accordancewiththeEmergencyMedicalTreatmentandLaborAct,42U.S.C.Section
521395dd,ineffectonJanuary1,2024.
HCSHBs1520,1519,2355&2357 2 191.1720.1.Thissectionshallbeknownandmaybecitedasthe"MissouriSave
2AdolescentsfromExperimentation(SAFE)Act".
3 2.Forpurposesofthissection,thefollowingtermsmean:
4 (1)"Biologicalsex",thebiologicalindicationofmaleorfemaleinthecontextof
5reproductivepotentialorcapacity,suchassexchromosomes,naturallyoccurringsex
6hormones,gonads,andnonambiguousinternalandexternalgenitaliapresentatbirth,without
7regardtoanindividual'spsychological,chosen,orsubjectiveexperienceofgender;
8 (2)"Cross-sexhormones",testosterone,estrogen,orotherandrogensgiventoan
9individualinamountsthataregreaterormorepotentthanwouldnormallyoccurnaturallyina
10healthyindividualofthesameageandsex;
11 (3)"Gender",thepsychological,behavioral,social,andculturalaspectsofbeingmale
12orfemale;
13 (4)"Gendertransition",theprocessinwhichanindividualtransitionsfrom
14identifyingwithandlivingasagenderthatcorrespondstohisorherbiologicalsexto
15identifyingwithandlivingasagenderdifferentfromhisorherbiologicalsex,andmay
16involvesocial,legal,orphysicalchanges;
17 (5)"Gendertransitionsurgery",asurgicalprocedureperformedforthepurposeof
18assistinganindividualwithagendertransition,including,butnotlimitedto:
19 (a)Surgicalproceduresthatsterilize,including,butnotlimitedto,castration,
20vasectomy,hysterectomy,oophorectomy,orchiectomy,orpenectomy;
21 (b)Surgicalproceduresthatartificiallyconstructtissuewiththeappearanceof
22genitaliathatdiffersfromtheindividual'sbiologicalsex,including,butnotlimitedto,
23metoidioplasty,phalloplasty,orvaginoplasty;or
24 (c)Augmentationmammoplastyorsubcutaneousmastectomy;
25 (6)"Healthcareprovider",anindividualwhoislicensed,certified,orotherwise
26authorizedbythelawsofthisstatetoadministerhealthcareintheordinarycourseofthe
27practiceofhisorherprofession;
28 (7)"Puberty-blockingdrugs",gonadotropin-releasinghormoneanaloguesorother
29syntheticdrugsusedtostopluteinizinghormonesecretionandfolliclestimulatinghormone
30secretion,syntheticantiandrogendrugstoblocktheandrogenreceptor,oranyotherdrugused
31todelayorsuppresspubertaldevelopmentinchildrenforthepurposeofassistingan
32individualwithagendertransition.
33 3.Ahealthcareprovidershallnotknowinglyperformagendertransitionsurgeryon
34anyindividualundereighteenyearsofage.
35 4.[(1)]Ahealthcareprovidershallnotknowinglyprescribeoradministercross-sex
36hormonesorpuberty-blockingdrugsforthepurposeofagendertransitionforanyindividual
37undereighteenyearsofage.
HCSHBs1520,1519,2355&2357 3 38 [(2)Theprovisionsofthissubsectionshallnotapplytotheprescriptionor
39administrationofcross-sexhormonesorpuberty-blockingdrugsforanyindividualunder
40eighteenyearsofagewhowasprescribedoradministeredsuchhormonesordrugspriorto
41August28,2023,forthepurposeofassistingtheindividualwithagendertransition.
42 (3)TheprovisionsofthissubsectionshallexpireonAugust28,2027.]
43 5.Theperformanceofagendertransitionsurgeryortheprescriptionor
44administrationofcross-sexhormonesorpuberty-blockingdrugstoanindividualunder
45eighteenyearsofageinviolationofthissectionshallbeconsideredunprofessionalconduct
46andanyhealthcareproviderdoingsoshallhavehisorherlicensetopracticerevokedbythe
47appropriatelicensingentityordisciplinaryreviewboardwithcompetentjurisdictioninthis
48state.
49 6.(1)Theprescriptionoradministrationofcross-sexhormonesorpuberty-blocking
50drugstoanindividualundereighteenyearsofageforthepurposeofagendertransitionshall
51beconsideredgroundsforacauseofactionagainstthehealthcareprovider.Theprovisions
52ofchapter538shallnotapplytoanyactionbroughtunderthissubsection.
53 (2)Anactionbroughtpursuanttothissubsectionshallbebroughtwithinfifteenyears
54oftheindividualinjuredattainingtheageoftwenty-oneorofthedatethetreatmentofthe
55injuryatissueintheactionbythedefendanthasceased,whicheverislater.
56 (3)Anindividualbringinganactionunderthissubsectionshallbeentitledtoa
57rebuttablepresumptionthattheindividualwasharmediftheindividualisinfertilefollowing
58theprescriptionoradministrationofcross-sexhormonesorpuberty-blockingdrugsandthat
59theharmwasadirectresultofthehormonesordrugsprescribedoradministeredbythehealth
60careprovider.Suchpresumptionmayberebuttedonlybyclearandconvincingevidence.
61 (4)Inanyactionbroughtpursuanttothissubsection,aplaintiffmayrecover
62economicandnoneconomicdamagesandpunitivedamages,withoutlimitationtotheamount
63andnolessthanfivehundredthousanddollarsintheaggregate.Thejudgmentagainsta
64defendantinanactionbroughtpursuanttothissubsectionshallbeinanamountofthreetimes
65theamountofanyeconomicandnoneconomicdamagesorpunitivedamagesassessed.Any
66awardofdamagesinanactionbroughtpursuanttothissubsectiontoaprevailingplaintiff
67shallincludeattorney'sfeesandcourtcosts.
68 (5)Anactionbroughtpursuanttothissubsectionmaybebroughtinanycircuitcourt
69ofthisstate.
70 (6)Nohealthcareprovidershallrequireawaiveroftherighttobringanaction
71pursuanttothissubsectionasaconditionofservices.Therighttobringanactionbyor
72throughanindividualundertheageofeighteenshallnotbewaivedbyaparentorlegal
73guardian.
HCSHBs1520,1519,2355&2357 4 74 (7)Aplaintifftoanactionbroughtunderthissubsectionmayenterintoavoluntary
75agreementofsettlementorcompromiseoftheaction,butnoagreementshallbevaliduntil
76approvedbythecourt.Noagreementallowedbythecourtshallincludeaprovisionregarding
77thenondisclosureorconfidentialityofthetermsofsuchagreementunlesssuchprovisionwas
78specificallyrequestedandagreedtobytheplaintiff.
79 (8)Ifrequestedbytheplaintiff,anypleadings,attachments,orexhibitsfiledwiththe
80courtinanyactionbroughtpursuanttothissubsection,aswellasanyjudgmentsissuedbythe
81courtinsuchactions,shallnotincludethepersonalidentifyinginformationoftheplaintiff.
82Suchinformationshallbeprovidedinaconfidentialinformationfilingsheet
83contemporaneouslyfiledwiththecourtorenteredbythecourt,whichshallnotbesubject
84topublicinspectionoravailability.
85 7.TheprovisionsofthissectionshallnotapplytoanyspeechprotectedbytheFirst
86AmendmentoftheUnitedStatesConstitution.
87 8.Theprovisionsofthissectionshallnotapplytothefollowing:
88 (1)Servicestoindividualsbornwithamedically-verifiabledisorderofsex
89development,including,butnotlimitedto,anindividualwithexternalbiologicalsex
90characteristicsthatareirresolvablyambiguous,suchasthosebornwith46,XXchromosomes
91withvirilization,46,XYchromosomeswithundervirilization,orhavingbothovarianand
92testiculartissue;
93 (2)Servicesprovidedwhenaphysicianhasotherwisediagnosedanindividualwitha
94disorderofsexdevelopmentanddeterminedthroughgeneticorbiochemicaltestingthatthe
95individualdoesnothavenormalsexchromosomestructure,sexsteroidhormoneproduction,
96orsexsteroidhormoneaction;
97 (3)Thetreatmentofanyinfection,injury,disease,ordisorderthathasbeencausedby
98orexacerbatedbytheperformanceofgendertransitionsurgeryortheprescriptionor
99administrationofcross-sexhormonesorpuberty-blockingdrugsregardlessofwhetherthe
100surgerywasperformedorthehormonesordrugswereprescribedoradministeredin
101accordancewithstateandfederallaw;or
102 (4)Anyprocedureundertakenbecausetheindividualsuffersfromaphysicaldisorder,
103physicalinjury,orphysicalillnessthatwould,ascertifiedbyaphysician,placetheindividual
104inimminentdangerofdeathorimpairmentofamajorbodilyfunctionunlesssurgeryis
105performed.
SectionB.Therepealandreenactmentofsection191.1720ofthisactshallbecome
2effectiveonMarch1,2025.
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HCSHBs1520,1519,2355&2357 5