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  By: Campbell, et al.  S.B. No. 14
         (In the Senate - Filed March 8, 2023; March 9, 2023, read
  first time and referred to Committee on State Affairs;
  March 22, 2023, reported favorably by the following vote:  Yeas 8,
  Nays 3; March 22, 2023, sent to printer.)
Click here to see the committee vote
 
 
A BILL TO BE ENTITLED
 
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. 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.
         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.  This Act takes effect December 1, 2023.
 
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