88R10180 MCF-D     By: Tinderholt H.B. No. 4754       A BILL TO BE ENTITLED   AN ACT   relating to health benefit plan coverage for and prohibitions on   gender transitioning procedures and treatments provided to certain   individuals; creating a criminal offense.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  This Act may be cited as the Texas Millstone Act.          SECTION 2.  Chapter 161, Health and Safety Code, is amended   by adding Subchapter X to read as follows:   SUBCHAPTER X. GENDER TRANSITION PROCEDURES OR TREATMENTS          Sec. 161.701.  DEFINITIONS. In this subchapter:                (1)  "Biological sex" means the biological indication   of male or female in the context of reproductive potential or   capacity, such as sex chromosomes, naturally occurring sex   hormones, gonads, and nonambiguous internal and external genitalia   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 provided to a   biological female in a more potent amount than would naturally   occur in a healthy biological female; or                      (B)  estrogen provided to a biological male in a   more potent amount than would naturally occur in a healthy   biological male.                (3)  "Gender" means the psychological, behavioral,   social, and cultural aspects of being male or female.                (4)  "Gender reassignment surgery" means a medical   procedure performed for the purpose of surgically altering or   removing healthy anatomical characteristics typical for the   individual's biological sex to instill physiological or anatomical   characteristics that resemble a sex different than the individual's   biological sex. The term includes genital or nongenital gender   reassignment surgery performed for the purpose of assisting an   individual with a gender transition.                (5)  "Gender transition" means the process by which an   individual progresses from identifying with and living as the   gender that corresponds to the individual's biological sex to   identifying with and living as a gender different than the   individual's biological sex. The term includes social, legal, or   physical changes to an individual.                (6)  "Gender transition procedure or treatment" means a   medical or surgical procedure or treatment, including a physician's   services, inpatient and outpatient hospital services, and   prescription drugs, related to gender transition that seeks to:                      (A)  alter or remove anatomical characteristics   typical for the individual's biological sex; or                      (B)  instill physiological or anatomical   characteristics that resemble a sex different from the individual's   biological sex, including:                            (i)  medical services that provide   puberty-blocking drugs, cross-sex hormones, or other mechanisms to   promote the development of feminizing or masculinizing features in   the opposite biological sex; and                            (ii)  genital or nongenital gender   reassignment surgery performed for the purpose of assisting an   individual with a gender transition.                (7)  "Genital gender reassignment surgery" means a   medical procedure related to an individual's genitals and performed   for the purpose of assisting the individual with a gender   transition, including:                      (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, scrotoplasty, or   implantation of erection or testicular prostheses for biologically   female patients.                (8)  "Health care professional" means an individual   other than a physician who is licensed, certified, or otherwise   authorized by this state's laws to administer health care in the   ordinary course of business or practice of a profession.                (9)  "Nongenital gender reassignment surgery" means a   medical procedure that is not a genital gender reassignment surgery   and is performed for the purpose of assisting an individual with a   physical gender transition, including the following surgical   procedures:                      (A)  for either a biological male or female:                            (i)  liposuction or lipofilling; or                            (ii)  various aesthetic procedures;                      (B)  for a biological male:                            (i)  augmentation mammoplasty;                            (ii)  facial feminization surgery;                            (iii)  voice feminization surgery;                            (iv)  thyroid cartilage reduction;                            (v)  gluteal augmentation; or                            (vi)  hair reconstruction; or                      (C)  for a biological female:                            (i)  subcutaneous mastectomy;                            (ii)  voice masculinization surgery; or                            (iii)  pectoral implants.                (10)  "Physician" means a person licensed to practice   medicine in this state.                (11)  "Puberty-blocking drug" means a drug used to   delay or suppress normal puberty development in children for the   purpose of assisting an individual with a gender transition,   including:                      (A)  for a biological male, a   gonadotropin-releasing hormone analogue or other synthetic drug   prescribed to stop luteinizing hormone secretion and testosterone   secretion; or                      (B)  for a biological female, a synthetic drug   prescribed to stop the production of estrogen and progesterone.                (12)  "Public money" means money of this state, a state   agency, or a political subdivision.          Sec. 161.702.  APPLICABILITY. This subchapter does not   apply to:                (1)  a procedure, treatment, or service provided to an   individual who is born with a medically verifiable genetic disorder   of sex development, including:                      (A)  46,XX chromosomes with virilization;                      (B)  46,XY chromosomes with undervirilization; or                      (C)  both ovarian and testicular tissue;                (2)  a procedure, treatment, or service provided to an   individual who does not have the normal sex chromosome structure,   sex steroid production, or sex steroid hormone action for male or   female as determined by a physician through genetic testing or   biochemical testing;                 (3)  treatment of an infection, injury, disease, or   disorder that has been caused by or exacerbated by the performance   of a gender transition procedure or treatment, regardless of   whether:                      (A)  the gender transition procedure or treatment   was performed in accordance with state and federal law; or                      (B)  funding for the gender transition procedure   or treatment is permissible under this subchapter; or                (4)  a procedure undertaken because the individual   suffers from a physical disorder, injury, or illness that would, as   certified by a physician, place the individual in imminent danger   of death or impairment of a major bodily function unless the   procedure is performed.          Sec. 161.703.  CONSTRUCTION OF SUBCHAPTER. This subchapter   may not be construed to deny, impair, or otherwise affect any right   or authority of the attorney general, this state, or any agency,   officer, or employee of this state, acting under any law other than   this subchapter, to bring or intervene in an action brought under   this subchapter.          Sec. 161.704.  PROHIBITED PROVISION OF GENDER TRANSITION   PROCEDURES OR TREATMENTS. A physician or health care professional,   including a physician or health care professional employed by or   practicing in a facility owned by this state or a political   subdivision, may not:                (1)  provide a gender transition procedure or treatment   to an individual younger than 26 years of age; or                (2)  refer an individual younger than 26 years of age to   a physician or health care professional for a gender transition   procedure or treatment.          Sec. 161.705.  PROHIBITED USE OF PUBLIC MONEY. Public money   may not directly or indirectly be used, granted, paid, or otherwise   distributed to a person who provides gender transition procedures   or treatment to individuals younger than 26 years of age.          Sec. 161.706.  PROHIBITED MEDICAID REIMBURSEMENT. The   commission may not provide Medicaid reimbursement to a provider for   a gender transition procedure or treatment to an individual younger   than 26 years of age.          Sec. 161.707.  CRIMINAL OFFENSE.  (a) A physician or health   care professional who knowingly violates Section 161.704 commits an   offense.          (b)  An offense under this section is a state jail felony.          (c)  An indictment for an offense under this section must be   presented within 40 years from the date of the commission of the   offense, and not afterward.          Sec. 161.708.  DISCIPLINARY ACTION.  (a)  The Texas Medical   Board or another state regulatory agency with jurisdiction over a   health care provider subject to Section 161.704 shall revoke the   license, certification, or authorization of a physician or health   care provider who the board or agency determines has violated that   section.          (b)  Disciplinary action described by Subsection (a) must be   taken not later than the 40th anniversary of the date of the   violation of Section 161.704.          Sec. 161.709.  CIVIL ACTION. (a) Notwithstanding any other   law, an individual may bring an action for damages incurred as a   result of a gender transition procedure or treatment performed on   the individual:                (1)  through the individual's parent, guardian, or next   friend, if the individual is under 18 years of age; and                (2)  in the individual's own name, not later than the   40th anniversary after the date the individual attains 18 years of   age.          (b)  A court may award to the prevailing claimant:                (1)  compensatory damages;                (2)  injunctive relief;                (3)  declaratory relief; and                (4)  any other appropriate relief.          (c)  A court shall award a claimant prevailing in an action   brought under this section reasonable attorney's fees incurred in   bringing the action.          (d)  Notwithstanding any other law, an action brought under   this section may be commenced, and relief may be granted, in a   judicial proceeding without regard to whether the individual   commencing the action has sought or exhausted available   administrative remedies.          Sec. 161.710.  ATTORNEY GENERAL ENFORCEMENT. (a) The   attorney general may bring an action to enforce this subchapter.          (b)  In an action brought under this section, the court may   award the attorney general injunctive or declaratory relief and   reasonable attorney's fees and costs incurred in bringing the   action.          SECTION 3.  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 4.  This Act takes effect September 1, 2023.