HR2107-119

2. Program of payments to children's hospitals that operate graduate medical education programs Section 340E of the Public Health Service Act (42 U.S.C. 256e) is amended— in subsection (a), by striking 2023 and inserting 2030; in subsection (b)(3)(D), by inserting and the end of fiscal year 2030, after fiscal year 2022,; in subsection (e), by adding at the end the following new paragraph: Notwithstanding any other provision of this section, no payment may be made under this section to a children’s hospital for a fiscal year (beginning with fiscal year 2026) if, at any point during the preceding fiscal year, such hospital furnished specified procedures and drugs (as defined in subsection (g)) to an individual under 18 years of age. In applying subparagraph (A) with respect to payments described in such subparagraph for fiscal year 2026— the reference to for a fiscal year shall be treated as a reference to for any portion of fiscal year 2026 occurring after December 31, 2025; and the reference to the preceding fiscal year shall be treated as a reference to the period beginning on September 1, 2025, and ending on December 31, 2025. Nothing in this paragraph shall be construed as prohibiting payments for a fiscal year (or, in the case of payments for fiscal year 2026, during the portion of such fiscal year described in subparagraph (B)(i)) to a hospital that, during the preceding fiscal year (or, in the case of payments for fiscal year 2026, during the period described in subparagraph (B)(ii)), furnished mental or behavioral health services to individuals under 18 years of age for the treatment of gender dysphoria not consisting of specified procedures and drugs. in subsection (f)— in paragraph (1)(A)— in clause (v), by striking and at the end; in clause (vi), by striking the period at the end and inserting ; and; and by adding at the end the following: for each of fiscal years 2026 through 2030, $124,000,000. in paragraph (2)— in subparagraph (E), by striking and at the end; in subparagraph (F), by striking the period at the end and inserting ; and; and by adding at the end the following: for each of fiscal years 2026 through 2030, $261,000,000 in subsection (g), by adding at the end the following new paragraph: Except as provided in subparagraph (B), the term specified procedures and drugs means, with respect to an individual, any of the following: Performing any surgery for the purpose of changing the body of such individual to no longer correspond to the individual’s sex, including— castration; orchiectomy; scrotoplasty; vasectomy; hysterectomy; oophorectomy; ovariectomy; metoidioplasty; penectomy; phalloplasty; vaginoplasty; vaginectomy; vulvoplasty; reduction thyrochondroplasty; chondrolaryngoplasty, or any plastic surgery that feminizes or masculinizes the facial features; mastectomy, or any placement of chest implants to create feminine breasts; and Any placement of fat or artificial implants in the gluteal region. Administering, supplying, prescribing, dispensing, distributing, or otherwise conveying to an individual medications for the purposes described in clause (i), including gonadotrophin releasing hormone (GnRH) analogues or other puberty-blocking drugs to stop or delay normal puberty, and estrogen, testosterone, progesterone, or other androgens to an individual in an amount greater than would normally be produced endogenously in a healthy individual of that individual’s age and sex. Subparagraph (A) shall not apply to the provision by a physician or health care provider, with the consent of the child’s parent or legal guardian, of— puberty suppression or blocking prescription drugs for the purpose of normalizing puberty for a minor experiencing precocious puberty; appropriate and medically necessary procedures or treatments to correct for— a medically verifiable genetic disorder of sex development, including— 46,XX chromosomes with virilization; 46,XY chromosomes with undervirilization; and both ovarian and testicular tissue; or sex chromosome structure, sex steroid hormone production, or sex hormone action, if determined to be abnormal by a physician through genetic or biochemical testing; infection, disease, injury, or disorder caused or exacerbated by previous medical procedures as defined in subsection (g)(4)(A); or 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 a major bodily function unless the procedure is performed, not including if the procedure or drug is for the purpose described in subsection (g)(4)(A)(i). For purposes of subparagraph (A), the term sex means the indication of male or female sex by reproductive potential or capacity, sex chromosomes, naturally occurring sex hormones, gonads, or internal or external genitalia present at birth. (4)Prohibition on payments to hospitals furnishing specified procedures and drugs to minors(A)In generalNotwithstanding any other provision of this section, no payment may be made under this section to a children’s hospital for a fiscal year (beginning with fiscal year 2026) if, at any point during the preceding fiscal year, such hospital furnished specified procedures and drugs (as defined in subsection (g)) to an individual under 18 years of age.(B)Special rule for fiscal year 2026In applying subparagraph (A) with respect to payments described in such subparagraph for fiscal year 2026—(i)the reference to for a fiscal year shall be treated as a reference to for any portion of fiscal year 2026 occurring after December 31, 2025; and (ii)the reference to the preceding fiscal year shall be treated as a reference to the period beginning on September 1, 2025, and ending on December 31, 2025.(C)Rule of constructionNothing in this paragraph shall be construed as prohibiting payments for a fiscal year (or, in the case of payments for fiscal year 2026, during the portion of such fiscal year described in subparagraph (B)(i)) to a hospital that, during the preceding fiscal year (or, in the case of payments for fiscal year 2026, during the period described in subparagraph (B)(ii)), furnished mental or behavioral health services to individuals under 18 years of age for the treatment of gender dysphoria not consisting of specified procedures and drugs.; (vii)for each of fiscal years 2026 through 2030, $124,000,000.; and (G)for each of fiscal years 2026 through 2030, $261,000,000; and (4)Specified procedures and drugs(A)In generalExcept as provided in subparagraph (B), the term specified procedures and drugs means, with respect to an individual, any of the following:(i)Performing any surgery for the purpose of changing the body of such individual to no longer correspond to the individual’s sex, including—(I)castration;(II)orchiectomy;(III)scrotoplasty;(IV)vasectomy;(V)hysterectomy;(VI)oophorectomy;(VII)ovariectomy;(VIII)metoidioplasty; (IX)penectomy; (X)phalloplasty; (XI)vaginoplasty; (XII)vaginectomy; (XIII)vulvoplasty; (XIV)reduction thyrochondroplasty;(XV)chondrolaryngoplasty, or any plastic surgery that feminizes or masculinizes the facial features;(XVI)mastectomy, or any placement of chest implants to create feminine breasts; and(XVII)Any placement of fat or artificial implants in the gluteal region. (ii)Administering, supplying, prescribing, dispensing, distributing, or otherwise conveying to an individual medications for the purposes described in clause (i), including gonadotrophin releasing hormone (GnRH) analogues or other puberty-blocking drugs to stop or delay normal puberty, and estrogen, testosterone, progesterone, or other androgens to an individual in an amount greater than would normally be produced endogenously in a healthy individual of that individual’s age and sex.(B)ExceptionSubparagraph (A) shall not apply to the provision by a physician or health care provider, with the consent of the child’s parent or legal guardian, of—(i)puberty suppression or blocking prescription drugs for the purpose of normalizing puberty for a minor experiencing precocious puberty;(ii)appropriate and medically necessary procedures or treatments to correct for—(I)a medically verifiable genetic disorder of sex development, including—(aa)46,XX chromosomes with virilization;(bb)46,XY chromosomes with undervirilization; and(cc)both ovarian and testicular tissue; or(II)sex chromosome structure, sex steroid hormone production, or sex hormone action, if determined to be abnormal by a physician through genetic or biochemical testing; (iii)infection, disease, injury, or disorder caused or exacerbated by previous medical procedures as defined in subsection (g)(4)(A); or (iv)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 a major bodily function unless the procedure is performed, not including if the procedure or drug is for the purpose described in subsection (g)(4)(A)(i).(C)SexFor purposes of subparagraph (A), the term sex means the indication of male or female sex by reproductive potential or capacity, sex chromosomes, naturally occurring sex hormones, gonads, or internal or external genitalia present at birth..