S.B. No. 14
AN ACT
relating to prohibitions on the provision to certain children of
procedures and treatments for gender transitioning, gender
reassignment, or gender dysphoria and on the use of public money or
public assistance to provide those procedures and treatments.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 62.151, Health and Safety Code, is
amended by adding Subsection (g) to read as follows:
(g) The child health plan may not provide coverage for
services prohibited by Section 161.702 that are intended to
transition a child's biological sex as determined by the child's sex
organs, chromosomes, and endogenous profiles.
SECTION 2. Chapter 161, Health and Safety Code, is amended
by adding Subchapter X to read as follows:
SUBCHAPTER X. GENDER TRANSITIONING AND GENDER REASSIGNMENT
PROCEDURES AND TREATMENTS FOR CERTAIN CHILDREN
Sec. 161.701. DEFINITIONS. In this subchapter:
(1) "Child" means an individual who is younger than 18
years of age.
(2) "Health care provider" means a person other than a
physician who is licensed, certified, or otherwise authorized by
this state's laws to provide or render health care or to dispense or
prescribe a prescription drug in the ordinary course of business or
practice of a profession.
(3) "Medicaid" means the medical assistance program
established under Chapter 32, Human Resources Code.
(4) "Physician" means a person licensed to practice
medicine in this state.
Sec. 161.702. PROHIBITED PROVISION OF GENDER TRANSITIONING
OR GENDER REASSIGNMENT PROCEDURES AND TREATMENTS TO CERTAIN
CHILDREN. For the purpose of transitioning a child's biological
sex as determined by the sex organs, chromosomes, and endogenous
profiles of the child or affirming the child's perception of the
child's sex if that perception is inconsistent with the child's
biological sex, a physician or health care provider may not
knowingly:
(1) perform a surgery that sterilizes the child,
including:
(A) castration;
(B) vasectomy;
(C) hysterectomy;
(D) oophorectomy;
(E) metoidioplasty;
(F) orchiectomy;
(G) penectomy;
(H) phalloplasty; and
(I) vaginoplasty;
(2) perform a mastectomy;
(3) provide, prescribe, administer, or dispense any of
the following prescription drugs that induce transient or permanent
infertility:
(A) puberty suppression or blocking prescription
drugs to stop or delay normal puberty;
(B) supraphysiologic doses of testosterone to
females; or
(C) supraphysiologic doses of estrogen to males;
or
(4) remove any otherwise healthy or non-diseased body
part or tissue.
Sec. 161.703. EXCEPTIONS. (a) Section 161.702 does not
apply to the provision by a physician or health care provider, with
the consent of the child's parent or legal guardian, of:
(1) puberty suppression or blocking prescription
drugs for the purpose of normalizing puberty for a minor
experiencing precocious puberty; or
(2) appropriate and medically necessary procedures or
treatments to a child who:
(A) is born with a medically verifiable genetic
disorder of sex development, including:
(i) 46,XX chromosomes with virilization;
(ii) 46,XY chromosomes with
undervirilization; or
(iii) both ovarian and testicular tissue;
or
(B) does not have the normal sex chromosome
structure for male or female as determined by a physician through
genetic testing.
(b) Section 161.702 does not apply to the provision of a
prescription drug to a child that is otherwise prohibited by that
section if:
(1) the prescription drug is part of a continuing
course of treatment that the child began before June 1, 2023; and
(2) the child attended 12 or more sessions of mental
health counseling or psychotherapy during a period of at least six
months before the date the course of treatment described by
Subdivision (1) began.
(c) A child to whom the exception under Subsection (b)
applies:
(1) shall wean off the prescription drug over a period
of time and in a manner that is safe and medically appropriate and
that minimizes the risk of complications; and
(2) may not switch to or begin a course of treatment on
another prescription drug that a physician or health care provider
is prohibited from providing to the child under Section 161.702 or
otherwise receive a procedure or treatment prohibited by that
section.
Sec. 161.704. PROHIBITED USE OF PUBLIC MONEY. Public money
may not directly or indirectly be used, granted, paid, or
distributed to any health care provider, medical school, hospital,
physician, or any other entity, organization, or individual that
provides or facilitates the provision of a procedure or treatment
to a child that is prohibited under Section 161.702.
Sec. 161.705. PROHIBITED STATE HEALTH PLAN REIMBURSEMENT.
The commission may not provide Medicaid reimbursement and the child
health plan program established by Chapter 62 may not provide
reimbursement to a physician or health care provider for provision
of a procedure or treatment to a child that is prohibited under
Section 161.702.
Sec. 161.706. ATTORNEY GENERAL ENFORCEMENT. (a) If the
attorney general has reason to believe that a person is committing,
has committed, or is about to commit a violation of Section 161.702,
the attorney general may bring an action to enforce this subchapter
to restrain or enjoin the person from committing, continuing to
commit, or repeating the violation.
(b) Venue for an action brought under this section is in a
district court of Travis County or the county where the violation
occurred or is about to occur.
SECTION 3. Section 32.024, Human Resources Code, is amended
by adding Subsection (pp) to read as follows:
(pp) The medical assistance program may not provide
coverage for services prohibited by Section 161.702, Health and
Safety Code, that are intended to transition a child's biological
sex as determined by the child's sex organs, chromosomes, and
endogenous profiles.
SECTION 4. Section 164.052(a), Occupations Code, is amended
to read as follows:
(a) A physician or an applicant for a license to practice
medicine commits a prohibited practice if that person:
(1) submits to the board a false or misleading
statement, document, or certificate in an application for a
license;
(2) presents to the board a license, certificate, or
diploma that was illegally or fraudulently obtained;
(3) commits fraud or deception in taking or passing an
examination;
(4) uses alcohol or drugs in an intemperate manner
that, in the board's opinion, could endanger a patient's life;
(5) commits unprofessional or dishonorable conduct
that is likely to deceive or defraud the public, as provided by
Section 164.053, or injure the public;
(6) uses an advertising statement that is false,
misleading, or deceptive;
(7) advertises professional superiority or the
performance of professional service in a superior manner if that
advertising is not readily subject to verification;
(8) purchases, sells, barters, or uses, or offers to
purchase, sell, barter, or use, a medical degree, license,
certificate, or diploma, or a transcript of a license, certificate,
or diploma in or incident to an application to the board for a
license to practice medicine;
(9) alters, with fraudulent intent, a medical license,
certificate, or diploma, or a transcript of a medical license,
certificate, or diploma;
(10) uses a medical license, certificate, or diploma,
or a transcript of a medical license, certificate, or diploma that
has been:
(A) fraudulently purchased or issued;
(B) counterfeited; or
(C) materially altered;
(11) impersonates or acts as proxy for another person
in an examination required by this subtitle for a medical license;
(12) engages in conduct that subverts or attempts to
subvert an examination process required by this subtitle for a
medical license;
(13) impersonates a physician or permits another to
use the person's license or certificate to practice medicine in
this state;
(14) directly or indirectly employs a person whose
license to practice medicine has been suspended, canceled, or
revoked;
(15) associates in the practice of medicine with a
person:
(A) whose license to practice medicine has been
suspended, canceled, or revoked; or
(B) who has been convicted of the unlawful
practice of medicine in this state or elsewhere;
(16) performs or procures a criminal abortion, aids or
abets in the procuring of a criminal abortion, attempts to perform
or procure a criminal abortion, or attempts to aid or abet the
performance or procurement of a criminal abortion;
(17) directly or indirectly aids or abets the practice
of medicine by a person, partnership, association, or corporation
that is not licensed to practice medicine by the board;
(18) performs an abortion on a woman who is pregnant
with a viable unborn child during the third trimester of the
pregnancy unless:
(A) the abortion is necessary to prevent the
death of the woman;
(B) the viable unborn child has a severe,
irreversible brain impairment; or
(C) the woman is diagnosed with a significant
likelihood of suffering imminent severe, irreversible brain damage
or imminent severe, irreversible paralysis;
(19) performs an abortion on an unemancipated minor
without the written consent of the child's parent, managing
conservator, or legal guardian or without a court order, as
provided by Section 33.003 or 33.004, Family Code, unless the
abortion is necessary due to a medical emergency, as defined by
Section 171.002, Health and Safety Code;
(20) otherwise performs an abortion on an
unemancipated minor in violation of Chapter 33, Family Code;
(21) performs or induces or attempts to perform or
induce an abortion in violation of Subchapter C, F, or G, Chapter
171, Health and Safety Code;
(22) in complying with the procedures outlined in
Sections 166.045 and 166.046, Health and Safety Code, wilfully
fails to make a reasonable effort to transfer a patient to a
physician who is willing to comply with a directive; [or]
(23) performs or delegates to another individual the
performance of a pelvic examination on an anesthetized or
unconscious patient in violation of Section 167A.002, Health and
Safety Code; or
(24) performs a gender transitioning or gender
reassignment procedure or treatment in violation of Section
161.702, Health and Safety Code.
SECTION 5. Subchapter B, Chapter 164, Occupations Code, is
amended by adding Section 164.0552 to read as follows:
Sec. 164.0552. PROHIBITED ACTS REGARDING GENDER
TRANSITIONING OR GENDER REASSIGNMENT PROCEDURES AND TREATMENTS ON
CERTAIN CHILDREN. (a) The board shall revoke the license or other
authorization to practice medicine of a physician who violates
Section 161.702, Health and Safety Code. The board shall refuse to
admit to examination or refuse to issue a license or renewal license
to a person who violates that section.
(b) The sanctions provided by Subsection (a) are in addition
to any other grounds for revocation of a license or other
authorization to practice medicine or for refusal to admit persons
to examination under this subtitle or to issue a license or renew a
license to practice medicine under this subtitle.
SECTION 6. Section 164.052, Occupations Code, as amended by
this Act, and Section 164.0552, Occupations Code, as added by this
Act, apply only to conduct that occurs on or after the effective
date of this Act. Conduct that occurs before the effective date of
this Act is governed by the law in effect on the date the conduct
occurred, and the former law is continued in effect for that
purpose.
SECTION 7. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 8. If any provision of this Act or its application
to any person or circumstance is held invalid, the invalidity does
not affect other provisions or applications of this Act that can be
given effect without the invalid provision or application, and to
this end the provisions of this Act are declared to be severable.
SECTION 9. This Act takes effect September 1, 2023.
______________________________ ______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 14 passed the Senate on
April 4, 2023, by the following vote: Yeas 19, Nays 12; and that
the Senate concurred in House amendments on May 17, 2023, by the
following vote: Yeas 19, Nays 12.
______________________________
Secretary of the Senate
I hereby certify that S.B. No. 14 passed the House, with
amendments, on May 15, 2023, by the following vote: Yeas 87,
Nays 56, two present not voting.
______________________________
Chief Clerk of the House
Approved:
______________________________
Date
______________________________
Governor