| 7 | 6 | | ANACT |
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| 8 | 7 | | Torepealsection191.1720,RSMo,andtoenactinlieuthereofonenewsectionrelatingto |
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| 9 | 8 | | gendertransitionprocedures. |
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| 10 | 9 | | BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows: |
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| 11 | 10 | | SectionA.Section191.1720,RSMo,isrepealedandonenewsectionenactedinlieu |
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| 12 | 11 | | 2thereof,tobeknownassection191.1720,toreadasfollows: |
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| 13 | 12 | | 191.1720.1.Thissectionshallbeknownandmaybecitedasthe"MissouriSave |
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| 14 | 13 | | 2AdolescentsfromExperimentation(SAFE)Act". |
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| 15 | 14 | | 3 2.Forpurposesofthissection,thefollowingtermsmean: |
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| 16 | 15 | | 4 (1)"Biologicalsex",thebiologicalindicationofmaleorfemaleinthecontextof |
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| 17 | 16 | | 5reproductivepotentialorcapacity,suchassexchromosomes,naturallyoccurringsex |
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| 18 | 17 | | 6hormones,gonads,andnonambiguousinternalandexternalgenitaliapresentatbirth,without |
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| 19 | 18 | | 7regardtoanindividual'spsychological,chosen,orsubjectiveexperienceofgender; |
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| 20 | 19 | | 8 (2)"Cross-sexhormones",testosterone,estrogen,orotherandrogensgiventoan |
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| 21 | 20 | | 9individualinamountsthataregreaterormorepotentthanwouldnormallyoccurnaturallyina |
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| 22 | 21 | | 10healthyindividualofthesameageandsex; |
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| 23 | 22 | | 11 (3)"Gender",thepsychological,behavioral,social,andculturalaspectsofbeingmale |
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| 24 | 23 | | 12orfemale; |
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| 25 | 24 | | 13 (4)"Gendertransition",theprocessinwhichanindividualtransitionsfrom |
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| 26 | 25 | | 14identifyingwithandlivingasagenderthatcorrespondstohisorherbiologicalsexto |
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| 27 | 26 | | 15identifyingwithandlivingasagenderdifferentfromhisorherbiologicalsex,andmay |
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| 28 | 27 | | 16involvesocial,legal,orphysicalchanges; |
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| 29 | 28 | | EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis |
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| 30 | 29 | | intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 17 (5)"Gendertransitionsurgery",asurgicalprocedureperformedforthepurposeof |
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| 31 | 30 | | 18assistinganindividualwithagendertransition,including,butnotlimitedto: |
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| 32 | 31 | | 19 (a)Surgicalproceduresthatsterilize,including,butnotlimitedto,castration, |
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| 33 | 32 | | 20vasectomy,hysterectomy,oophorectomy,orchiectomy,orpenectomy; |
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| 34 | 33 | | 21 (b)Surgicalproceduresthatartificiallyconstructtissuewiththeappearanceof |
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| 35 | 34 | | 22genitaliathatdiffersfromtheindividual'sbiologicalsex,including,butnotlimitedto, |
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| 36 | 35 | | 23metoidioplasty,phalloplasty,orvaginoplasty;or |
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| 37 | 36 | | 24 (c)Augmentationmammoplastyorsubcutaneousmastectomy; |
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| 38 | 37 | | 25 (6)"Healthcareprovider",anindividualwhoislicensed,certified,orotherwise |
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| 39 | 38 | | 26authorizedbythelawsofthisstatetoadministerhealthcareintheordinarycourseofthe |
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| 40 | 39 | | 27practiceofhisorherprofession; |
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| 41 | 40 | | 28 (7)"Puberty-blockingdrugs",gonadotropin-releasinghormoneanaloguesorother |
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| 42 | 41 | | 29syntheticdrugsusedtostopluteinizinghormonesecretionandfolliclestimulatinghormone |
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| 43 | 42 | | 30secretion,syntheticantiandrogendrugstoblocktheandrogenreceptor,oranyotherdrugused |
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| 44 | 43 | | 31todelayorsuppresspubertaldevelopmentinchildrenforthepurposeofassistingan |
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| 45 | 44 | | 32individualwithagendertransition. |
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| 46 | 45 | | 33 3.Ahealthcareprovidershallnotknowinglyperformagendertransitionsurgeryon |
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| 47 | 46 | | 34anyindividualundereighteenyearsofage. |
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| 48 | 47 | | 35 4.(1)Ahealthcareprovidershallnotknowinglyprescribeoradministercross-sex |
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| 49 | 48 | | 36hormonesorpuberty-blockingdrugsforthepurposeofagendertransitionforanyindividual |
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| 50 | 49 | | 37undereighteenyearsofage. |
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| 51 | 50 | | 38 (2)UntilMarch1,2026,theprovisionsofthissubsectionshallnotapplytothe |
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| 52 | 51 | | 39prescriptionoradministrationofcross-sexhormonesorpuberty-blockingdrugsforany |
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| 53 | 52 | | 40individualundereighteenyearsofagewhowasprescribedoradministeredsuchhormonesor |
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| 54 | 53 | | 41drugspriortoAugust28,2023,forthepurposeofassistingtheindividualwithagender |
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| 55 | 54 | | 42transition. |
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| 56 | 55 | | 43 [(3)TheprovisionsofthissubsectionshallexpireonAugust28,2027.] |
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| 57 | 56 | | 44 5.Theperformanceofagendertransitionsurgeryortheprescriptionor |
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| 58 | 57 | | 45administrationofcross-sexhormonesorpuberty-blockingdrugstoanindividualunder |
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| 59 | 58 | | 46eighteenyearsofageinviolationofthissectionshallbeconsideredunprofessionalconduct |
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| 60 | 59 | | 47andanyhealthcareproviderdoingsoshallhavehisorherlicensetopracticerevokedbythe |
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| 61 | 60 | | 48appropriatelicensingentityordisciplinaryreviewboardwithcompetentjurisdictioninthis |
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| 62 | 61 | | 49state. |
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| 63 | 62 | | 50 6.(1)Theprescriptionoradministrationofcross-sexhormonesorpuberty-blocking |
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| 64 | 63 | | 51drugstoanindividualundereighteenyearsofageforthepurposeofagendertransitionshall |
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| 65 | 64 | | 52beconsideredgroundsforacauseofactionagainstthehealthcareprovider.Theprovisions |
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| 66 | 65 | | 53ofchapter538shallnotapplytoanyactionbroughtunderthissubsection. |
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| 68 | 67 | | 55oftheindividualinjuredattainingtheageoftwenty-oneorofthedatethetreatmentofthe |
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| 69 | 68 | | 56injuryatissueintheactionbythedefendanthasceased,whicheverislater. |
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| 70 | 69 | | 57 (3)Anindividualbringinganactionunderthissubsectionshallbeentitledtoa |
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| 71 | 70 | | 58rebuttablepresumptionthattheindividualwasharmediftheindividualisinfertilefollowing |
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| 72 | 71 | | 59theprescriptionoradministrationofcross-sexhormonesorpuberty-blockingdrugsandthat |
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| 73 | 72 | | 60theharmwasadirectresultofthehormonesordrugsprescribedoradministeredbythehealth |
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| 74 | 73 | | 61careprovider.Suchpresumptionmayberebuttedonlybyclearandconvincingevidence. |
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| 75 | 74 | | 62 (4)Inanyactionbroughtpursuanttothissubsection,aplaintiffmayrecover |
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| 76 | 75 | | 63economicandnoneconomicdamagesandpunitivedamages,withoutlimitationtotheamount |
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| 77 | 76 | | 64andnolessthanfivehundredthousanddollarsintheaggregate.Thejudgmentagainsta |
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| 78 | 77 | | 65defendantinanactionbroughtpursuanttothissubsectionshallbeinanamountofthreetimes |
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| 79 | 78 | | 66theamountofanyeconomicandnoneconomicdamagesorpunitivedamagesassessed.Any |
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| 80 | 79 | | 67awardofdamagesinanactionbroughtpursuanttothissubsectiontoaprevailingplaintiff |
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| 81 | 80 | | 68shallincludeattorney'sfeesandcourtcosts. |
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| 82 | 81 | | 69 (5)Anactionbroughtpursuanttothissubsectionmaybebroughtinanycircuitcourt |
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| 83 | 82 | | 70ofthisstate. |
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| 84 | 83 | | 71 (6)Nohealthcareprovidershallrequireawaiveroftherighttobringanaction |
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| 85 | 84 | | 72pursuanttothissubsectionasaconditionofservices.Therighttobringanactionbyor |
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| 86 | 85 | | 73throughanindividualundertheageofeighteenshallnotbewaivedbyaparentorlegal |
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| 87 | 86 | | 74guardian. |
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| 88 | 87 | | 75 (7)Aplaintifftoanactionbroughtunderthissubsectionmayenterintoavoluntary |
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| 89 | 88 | | 76agreementofsettlementorcompromiseoftheaction,butnoagreementshallbevaliduntil |
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| 90 | 89 | | 77approvedbythecourt.Noagreementallowedbythecourtshallincludeaprovisionregarding |
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| 91 | 90 | | 78thenondisclosureorconfidentialityofthetermsofsuchagreementunlesssuchprovisionwas |
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| 92 | 91 | | 79specificallyrequestedandagreedtobytheplaintiff. |
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| 93 | 92 | | 80 (8)Ifrequestedbytheplaintiff,anypleadings,attachments,orexhibitsfiledwiththe |
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| 94 | 93 | | 81courtinanyactionbroughtpursuanttothissubsection,aswellasanyjudgmentsissuedbythe |
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| 95 | 94 | | 82courtinsuchactions,shallnotincludethepersonalidentifyinginformationoftheplaintiff. |
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| 96 | 95 | | 83Suchinformationshallbeprovidedinaconfidentialinformationfilingsheet |
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| 97 | 96 | | 84contemporaneouslyfiledwiththecourtorenteredbythecourt,whichshallnotbesubject |
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| 98 | 97 | | 85topublicinspectionoravailability. |
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| 99 | 98 | | 86 7.TheprovisionsofthissectionshallnotapplytoanyspeechprotectedbytheFirst |
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| 100 | 99 | | 87AmendmentoftheUnitedStatesConstitution. |
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| 101 | 100 | | 88 8.Theprovisionsofthissectionshallnotapplytothefollowing: |
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| 102 | 101 | | 89 (1)Servicestoindividualsbornwithamedically-verifiabledisorderofsex |
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| 103 | 102 | | 90development,including,butnotlimitedto,anindividualwithexternalbiologicalsex |
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| 105 | 104 | | 92withvirilization,46,XYchromosomeswithundervirilization,orhavingbothovarianand |
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| 106 | 105 | | 93testiculartissue; |
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| 107 | 106 | | 94 (2)Servicesprovidedwhenaphysicianhasotherwisediagnosedanindividualwitha |
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| 108 | 107 | | 95disorderofsexdevelopmentanddeterminedthroughgeneticorbiochemicaltestingthatthe |
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| 109 | 108 | | 96individualdoesnothavenormalsexchromosomestructure,sexsteroidhormoneproduction, |
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| 110 | 109 | | 97orsexsteroidhormoneaction; |
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| 111 | 110 | | 98 (3)Thetreatmentofanyinfection,injury,disease,ordisorderthathasbeencausedby |
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| 112 | 111 | | 99orexacerbatedbytheperformanceofgendertransitionsurgeryortheprescriptionor |
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| 113 | 112 | | 100administrationofcross-sexhormonesorpuberty-blockingdrugsregardlessofwhetherthe |
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| 114 | 113 | | 101surgerywasperformedorthehormonesordrugswereprescribedoradministeredin |
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| 115 | 114 | | 102accordancewithstateandfederallaw;or |
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| 116 | 115 | | 103 (4)Anyprocedureundertakenbecausetheindividualsuffersfromaphysicaldisorder, |
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| 117 | 116 | | 104physicalinjury,orphysicalillnessthatwould,ascertifiedbyaphysician,placetheindividual |
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| 118 | 117 | | 105inimminentdangerofdeathorimpairmentofamajorbodilyfunctionunlesssurgeryis |
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| 119 | 118 | | 106performed. |
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| 120 | 119 | | âś” |
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