Texas 2023 - 88th Regular

Texas House Bill HB4754 Compare Versions

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1	1	88R10180 MCF-D
2	2	By: Tinderholt H.B. No. 4754
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to health benefit plan coverage for and prohibitions on
8	8	gender transitioning procedures and treatments provided to certain
9	9	individuals; creating a criminal offense.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. This Act may be cited as the Texas Millstone Act.
12	12	SECTION 2. Chapter 161, Health and Safety Code, is amended
13	13	by adding Subchapter X to read as follows:
14	14	SUBCHAPTER X. GENDER TRANSITION PROCEDURES OR TREATMENTS
15	15	Sec. 161.701. DEFINITIONS. In this subchapter:
16	16	(1) "Biological sex" means the biological indication
17	17	of male or female in the context of reproductive potential or
18	18	capacity, such as sex chromosomes, naturally occurring sex
19	19	hormones, gonads, and nonambiguous internal and external genitalia
20	20	present at birth, without regard to an individual's psychological,
21	21	chosen, or subjective experience of gender.
22	22	(2) "Cross-sex hormones" means:
23	23	(A) testosterone or other androgens provided to a
24	24	biological female in a more potent amount than would naturally
25	25	occur in a healthy biological female; or
26	26	(B) estrogen provided to a biological male in a
27	27	more potent amount than would naturally occur in a healthy
28	28	biological male.
29	29	(3) "Gender" means the psychological, behavioral,
30	30	social, and cultural aspects of being male or female.
31	31	(4) "Gender reassignment surgery" means a medical
32	32	procedure performed for the purpose of surgically altering or
33	33	removing healthy anatomical characteristics typical for the
34	34	individual's biological sex to instill physiological or anatomical
35	35	characteristics that resemble a sex different than the individual's
36	36	biological sex. The term includes genital or nongenital gender
37	37	reassignment surgery performed for the purpose of assisting an
38	38	individual with a gender transition.
39	39	(5) "Gender transition" means the process by which an
40	40	individual progresses from identifying with and living as the
41	41	gender that corresponds to the individual's biological sex to
42	42	identifying with and living as a gender different than the
43	43	individual's biological sex. The term includes social, legal, or
44	44	physical changes to an individual.
45	45	(6) "Gender transition procedure or treatment" means a
46	46	medical or surgical procedure or treatment, including a physician's
47	47	services, inpatient and outpatient hospital services, and
48	48	prescription drugs, related to gender transition that seeks to:
49	49	(A) alter or remove anatomical characteristics
50	50	typical for the individual's biological sex; or
51	51	(B) instill physiological or anatomical
52	52	characteristics that resemble a sex different from the individual's
53	53	biological sex, including:
54	54	(i) medical services that provide
55	55	puberty-blocking drugs, cross-sex hormones, or other mechanisms to
56	56	promote the development of feminizing or masculinizing features in
57	57	the opposite biological sex; and
58	58	(ii) genital or nongenital gender
59	59	reassignment surgery performed for the purpose of assisting an
60	60	individual with a gender transition.
61	61	(7) "Genital gender reassignment surgery" means a
62	62	medical procedure related to an individual's genitals and performed
63	63	for the purpose of assisting the individual with a gender
64	64	transition, including:
65	65	(A) surgical procedures such as penectomy,
66	66	orchiectomy, vaginoplasty, clitoroplasty, or vulvoplasty for
67	67	biologically male patients or hysterectomy or oophorectomy for
68	68	biologically female patients;
69	69	(B) reconstruction of the fixed part of the
70	70	urethra with or without a metoidioplasty; or
71	71	(C) phalloplasty, vaginectomy, scrotoplasty, or
72	72	implantation of erection or testicular prostheses for biologically
73	73	female patients.
74	74	(8) "Health care professional" means an individual
75	75	other than a physician who is licensed, certified, or otherwise
76	76	authorized by this state's laws to administer health care in the
77	77	ordinary course of business or practice of a profession.
78	78	(9) "Nongenital gender reassignment surgery" means a
79	79	medical procedure that is not a genital gender reassignment surgery
80	80	and is performed for the purpose of assisting an individual with a
81	81	physical gender transition, including the following surgical
82	82	procedures:
83	83	(A) for either a biological male or female:
84	84	(i) liposuction or lipofilling; or
85	85	(ii) various aesthetic procedures;
86	86	(B) for a biological male:
87	87	(i) augmentation mammoplasty;
88	88	(ii) facial feminization surgery;
89	89	(iii) voice feminization surgery;
90	90	(iv) thyroid cartilage reduction;
91	91	(v) gluteal augmentation; or
92	92	(vi) hair reconstruction; or
93	93	(C) for a biological female:
94	94	(i) subcutaneous mastectomy;
95	95	(ii) voice masculinization surgery; or
96	96	(iii) pectoral implants.
97	97	(10) "Physician" means a person licensed to practice
98	98	medicine in this state.
99	99	(11) "Puberty-blocking drug" means a drug used to
100	100	delay or suppress normal puberty development in children for the
101	101	purpose of assisting an individual with a gender transition,
102	102	including:
103	103	(A) for a biological male, a
104	104	gonadotropin-releasing hormone analogue or other synthetic drug
105	105	prescribed to stop luteinizing hormone secretion and testosterone
106	106	secretion; or
107	107	(B) for a biological female, a synthetic drug
108	108	prescribed to stop the production of estrogen and progesterone.
109	109	(12) "Public money" means money of this state, a state
110	110	agency, or a political subdivision.
111	111	Sec. 161.702. APPLICABILITY. This subchapter does not
112	112	apply to:
113	113	(1) a procedure, treatment, or service provided to an
114	114	individual who is born with a medically verifiable genetic disorder
115	115	of sex development, including:
116	116	(A) 46,XX chromosomes with virilization;
117	117	(B) 46,XY chromosomes with undervirilization; or
118	118	(C) both ovarian and testicular tissue;
119	119	(2) a procedure, treatment, or service provided to an
120	120	individual who does not have the normal sex chromosome structure,
121	121	sex steroid production, or sex steroid hormone action for male or
122	122	female as determined by a physician through genetic testing or
123	123	biochemical testing;
124	124	(3) treatment of an infection, injury, disease, or
125	125	disorder that has been caused by or exacerbated by the performance
126	126	of a gender transition procedure or treatment, regardless of
127	127	whether:
128	128	(A) the gender transition procedure or treatment
129	129	was performed in accordance with state and federal law; or
130	130	(B) funding for the gender transition procedure
131	131	or treatment is permissible under this subchapter; or
132	132	(4) a procedure undertaken because the individual
133	133	suffers from a physical disorder, injury, or illness that would, as
134	134	certified by a physician, place the individual in imminent danger
135	135	of death or impairment of a major bodily function unless the
136	136	procedure is performed.
137	137	Sec. 161.703. CONSTRUCTION OF SUBCHAPTER. This subchapter
138	138	may not be construed to deny, impair, or otherwise affect any right
139	139	or authority of the attorney general, this state, or any agency,
140	140	officer, or employee of this state, acting under any law other than
141	141	this subchapter, to bring or intervene in an action brought under
142	142	this subchapter.
143	143	Sec. 161.704. PROHIBITED PROVISION OF GENDER TRANSITION
144	144	PROCEDURES OR TREATMENTS. A physician or health care professional,
145	145	including a physician or health care professional employed by or
146	146	practicing in a facility owned by this state or a political
147	147	subdivision, may not:
148	148	(1) provide a gender transition procedure or treatment
149	149	to an individual younger than 26 years of age; or
150	150	(2) refer an individual younger than 26 years of age to
151	151	a physician or health care professional for a gender transition
152	152	procedure or treatment.
153	153	Sec. 161.705. PROHIBITED USE OF PUBLIC MONEY. Public money
154	154	may not directly or indirectly be used, granted, paid, or otherwise
155	155	distributed to a person who provides gender transition procedures
156	156	or treatment to individuals younger than 26 years of age.
157	157	Sec. 161.706. PROHIBITED MEDICAID REIMBURSEMENT. The
158	158	commission may not provide Medicaid reimbursement to a provider for
159	159	a gender transition procedure or treatment to an individual younger
160	160	than 26 years of age.
161	161	Sec. 161.707. CRIMINAL OFFENSE. (a) A physician or health
162	162	care professional who knowingly violates Section 161.704 commits an
163	163	offense.
164	164	(b) An offense under this section is a state jail felony.
165	165	(c) An indictment for an offense under this section must be
166	166	presented within 40 years from the date of the commission of the
167	167	offense, and not afterward.
168	168	Sec. 161.708. DISCIPLINARY ACTION. (a) The Texas Medical
169	169	Board or another state regulatory agency with jurisdiction over a
170	170	health care provider subject to Section 161.704 shall revoke the
171	171	license, certification, or authorization of a physician or health
172	172	care provider who the board or agency determines has violated that
173	173	section.
174	174	(b) Disciplinary action described by Subsection (a) must be
175	175	taken not later than the 40th anniversary of the date of the
176	176	violation of Section 161.704.
177	177	Sec. 161.709. CIVIL ACTION. (a) Notwithstanding any other
178	178	law, an individual may bring an action for damages incurred as a
179	179	result of a gender transition procedure or treatment performed on
180	180	the individual:
181	181	(1) through the individual's parent, guardian, or next
182	182	friend, if the individual is under 18 years of age; and
183	183	(2) in the individual's own name, not later than the
184	184	40th anniversary after the date the individual attains 18 years of
185	185	age.
186	186	(b) A court may award to the prevailing claimant:
187	187	(1) compensatory damages;
188	188	(2) injunctive relief;
189	189	(3) declaratory relief; and
190	190	(4) any other appropriate relief.
191	191	(c) A court shall award a claimant prevailing in an action
192	192	brought under this section reasonable attorney's fees incurred in
193	193	bringing the action.
194	194	(d) Notwithstanding any other law, an action brought under
195	195	this section may be commenced, and relief may be granted, in a
196	196	judicial proceeding without regard to whether the individual
197	197	commencing the action has sought or exhausted available
198	198	administrative remedies.
199	199	Sec. 161.710. ATTORNEY GENERAL ENFORCEMENT. (a) The
200	200	attorney general may bring an action to enforce this subchapter.
201	201	(b) In an action brought under this section, the court may
202	202	award the attorney general injunctive or declaratory relief and
203	203	reasonable attorney's fees and costs incurred in bringing the
204	204	action.
205	205	SECTION 3. If before implementing any provision of this Act
206	206	a state agency determines that a waiver or authorization from a
207	207	federal agency is necessary for implementation of that provision,
208	208	the agency affected by the provision shall request the waiver or
209	209	authorization and may delay implementing that provision until the
210	210	waiver or authorization is granted.
211	211	SECTION 4. This Act takes effect September 1, 2023.