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STATE OF OKLAHOMA
1st Session of the 59th Legislature (2023)
SENATE BILL 129 By: Bullard
AS INTRODUCED
An Act relating to health care; creating the
Millstone Act of 2023 ; defining terms; prohibiting
provision of or referral for gender transition
procedures; providing exceptions; pro hibiting certain
uses of public funds, public facilities , public
employees, and state Medicaid program ; providing for
criminal, administrative, and civil enforcement;
authorizing certain civil actions and relief;
providing certain construction; providing for
codification; and declari ng an emergency.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new s ection of law to be codified
in the Oklahoma Statut es as Section 2607.1 of Title 63, unless there
is created a duplication in numbering, reads as follows:
This act shall be known and may be cited as the Millstone Act o f
2023.
SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 2607.2 of Title 63, unless there
is created a duplication in numbering, reads as follows:
As used in this act:
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1. “Biological sex” means the biological indication of male and
female in the context of reproductive potentia l or capacity, such as
sex chromosomes, naturally occurring sex hormones, gonads, and
nonambiguous internal and external genita lia present at birth,
without regard to an individual’s psychological, chosen, or
subjective experience of gender;
2. “Cross-sex hormones” means:
a. testosterone or other androgens given to biological
females in amounts that are larger or more potent than
would normally occur naturally in healt hy biological
sex females, and
b. estrogen given to biological males in amounts that are
larger or more potent than would normally occur
naturally in healthy biological sex males;
3. “Gender” means the psychological , behavioral, social, and
cultural aspects of being male or female;
4. “Gender reassignment surgery ” means any medical or surgic al
service that seeks to surgically alter or remove healthy physical or
anatomical characteristics or features that are typical for the
individual’s biological sex, in order to instill or create
physiological or anatomical characteristics that resemble a s ex
different from the individual ’s biological sex, including but not
limited to genital or nongenital gender reassignment surge ry
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performed for the purpose of assisti ng an individual with a gender
transition;
5. “Gender transition” means the process in wh ich a person goes
from identifying with and living as a gender that corresponds to his
or her biological sex to identifying wit h and living as a gender
different from his or her biological sex, and may inv olve social,
legal, or physical changes;
6. a. “Gender transition procedures ” means any medical or
surgical service, including but not limited to
physician’s services, inpatient and outpatient
hospital services, or pr escribed drugs related to
gender transition that seeks to:
(1) alter or remove physica l or anatomical
characteristics or features that are typical for
the individual’s biological sex, or
(2) instill or create physiological or anatomical
characteristics that resemble a sex different
from the individual’s biological sex, including
but not limited to medical services that provide
puberty-blocking drugs, cross -sex hormones, or
other mechanisms to promote the development of
feminizing or masculinizing features i n the
opposite biological sex, or gen ital or nongenital
gender reassignment surgery pe rformed for the
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purpose of assisting an individual with a gender
transition.
b. Gender transition procedures do not include:
(1) services to persons born with a medically
verifiable disorder of sex developme nt, including
a person with external biological s ex
characteristics that are irresolvably ambiguous,
such as those born with 46 XX chromosomes with
virilization, 46 XY chromosomes with
undervirilization, or having both ovarian and
testicular tissue,
(2) services provided when a physician has otherwise
diagnosed a disorder of sexual development that
the physician has determined through genetic or
biochemical testing that the person does not have
normal sex chromosome stru cture, sex steroid
hormone production, or sex steroid hormone
action,
(3) the treatment of any infection, injury, disease,
or disorder that has been caused by or
exacerbated by the performance of gender
transition procedures, whether or not the gender
transition procedure was performed in acc ordance
with state and federal law, or
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(4) any procedure undertaken because the individual
suffers from a physical disorder, physical
injury, or physical illness that would, as
certified by a physician, place the indivi dual in
imminent danger of death or i mpairment of major
bodily function unless surgery is performed;
7. “Genital gender reassignment surgery ” means a medical
procedure performed for the purpose of assisting an individual with
a gender transition, includin g but not limited to:
a. surgical procedures such as penectomy, orchiectomy,
vaginoplasty, clitoroplasty, or vulvoplasty for
biologically male patients or hysterectomy or
oophorectomy for biologically female patients,
b. reconstruction of the fixed part of the urethra with
or without a metoidioplasty, or
c. phalloplasty, vaginectomy, scroto plasty, or
implantation of erection or testicular prostheses for
biologically female patients;
8. “Healthcare professional ” means a person who is licensed,
certified, or otherwise authorized by the laws of this state to
administer health care in the ordin ary course of the practice of his
or her profession;
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9. “Nongenital gender reassignment surgery ” means medical
procedures performed for the purpose of assisting an indiv idual with
a gender transition includ ing but not limited to:
a. surgical procedures fo r biologically male patients,
such as augmentation mammoplasty, facial feminization
surgery, liposuction, lipofilling, voice surgery,
thyroid cartilage reduction, gluteal augmentation,
hair reconstruction, o r various aesthetic procedures,
or
b. surgical procedures for biologically female patients,
such as subcutaneous mastectomy, voice surgery,
liposuction, lipofilling, pectoral implants, or
various aesthetic procedures;
10. “Physician” means a person who is licensed to practice
medicine in this state;
11. “Puberty-blocking drugs” means gonadotropin-releasing
hormone analogues or other synthetic drugs used in biological males
to stop luteinizing hormone secretion and ther efore testosterone
secretion, or synthetic drugs used in biological females which stop
the production of estrogens and progesterone, when used to delay or
suppress pubertal development in children for the purpose of
assisting an individual with a gender tr ansition; and
12. “Public funds” means state, county, or local government
monies, in addition to any department, agency, or instrumentality
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authorized or appropriated under state law or derived from any fund
in which such moneys are deposited.
SECTION 3. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 2607. 3 of Title 63, unless there
is created a duplication in numbering, reads as follows:
A. A physician or other healthcare professional shall not
provide gender transition procedures to any individual under twenty-
six (26) years of age.
B. A physician or other healthcare professional shall not refer
any individual under twenty-six (26) years of age to any healthcare
professional for gender transition procedures.
C. A physician or other healthcare professional is not
prohibited from providing any of the following procedures which are
not gender transition procedures to an individual under twenty-six
(26) years of age:
1. Services to persons born with a medically verifiable
disorder of sex development, including a person with exter nal
biological sex characteristics that are irresolvably ambiguous, such
as those born with 46 XX chromosomes with virilization, 46 XY
chromosomes with undervirilization, or h aving both ovarian and
testicular tissue;
2. Services provided when a physician has otherwise diagnosed a
disorder of sexual development that the physician has determined
through genetic or biochemical testing that the person does not have
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normal sex chromosome structure, sex steroid hormone production, or
sex steroid hormone action;
3. The treatment of any infection, injury, disease, or disorder
that has been caused by or exacerbated by the performance of gender
transition procedures, whether or not the gender transition
procedure was performed in accordance with state and federal la w or
whether or not funding for the gender transition procedure is
permissible under Section 4 of this act; or
4. Any procedure undertaken because the individual suffers 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 major bodily function unless
surgery is performed.
SECTION 4. NEW LAW A new section of law to be codifi ed
in the Oklahoma Statutes as Section 2607.4 of Title 63, unless there
is created a duplication in numbering, reads as follows:
A. Public funds shall not be directly or indirectly used,
granted, paid, or distributed to a ny entity, organization, or
individual that provides gender transition pr ocedures to an
individual under twenty-six (26) years of age.
B. Healthcare services furnished in the following situations
shall not include gender transition procedures to an indivi dual
under twenty-six (26) years of age:
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1. By or in a healthcare facility o wned by the state or a
county or local government; or
2. By a physician or other healthcare professional employed by
the state or a county or local government.
C. The state Medicaid program shall not reimburse o r provide
coverage for gender transition procedures to an individual under
twenty-six (26) years of age.
SECTION 5. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 26 07.5 of Title 63, unless there
is created a duplication in numbering, reads as follow s:
A. 1. A physician or other healthcare professional found to
have knowingly referred for or provided gender transition procedures
to an individual under twenty-six (26) years of age shall, upon
conviction, be guilty of a felony.
2. Prosecution for a criminal violation of this subsection must
be commenced within forty (40) years after the commission of such
offense.
B. 1. Any referral for or provision of gender transiti on
procedures to an individual u nder twenty-six (26) years of age is
unprofessional conduct and shall, upon an adverse ruling by the
appropriate licensing board, result in immediate revocation of the
license or certificate of the physician or othe r healthcare
professional.
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2. Disciplinary proceedings against the physician or other
healthcare professional must be commenced within forty (40) years
after the commission of such offens e.
C. 1. A person may assert a n actual or threatened violation of
this act as a claim or defense in a j udicial or administrative
proceeding and obtain compens atory damages, injunctive relief,
declaratory relief, or any other appropriate relief.
2. A person shall bring a claim for a vi olation of this act no
later than forty (40) years after the day the cause of action
accrues.
3. An individual under eighteen (18) years of age may bring an
action throughout their minority through a parent or next friend,
and may bring an action in their o wn name upon reaching majority at
any time from that point until forty (40) years after reaching the
age of majority.
4. Notwithstanding any other provision of law, an action under
this subsection may be commenced, and relief may be granted, in a
judicial proceeding without regard to whether the person commencing
the action has sought or exhausted available administrative
remedies.
5. In any action or proceeding to enforce a provision of this
act, a prevailing party who establishes a violation of this act
shall recover reasonable attorney fe es.
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D. 1. The Attorney General ma y bring an action to enforce
compliance with this act.
2. This act does not deny, impair, or otherwise affect any
right or authority of the Attorney General, this state, or any
agency, officer, or employee of the state, acting under any law
other than this act, to institute or intervene in any proceeding.
SECTION 6. It being immediately necessary for the pr eservation
of the public peace, health or safety, an emergency is hereby
declared to exist, by reason whereof this act shall ta ke effect and
be in full force from and after i ts passage and approval.
59-1-3 DC 1/4/2023 11:25:39 AM