HR5592-119

1. Short title This Act may be cited as the Childhood Genital Mutilation Prevention Act.

2. Prohibiting gender-related medical treatment for minors Chapter 7 of title 18, United States Code, is amended by inserting after section 116 the following new section: Subject to subsection (c), whoever, in a circumstance described in subsection (b), knowingly performs or attempts to perform a gender-related medical treatment on a minor, shall be fined under this title, imprisoned not more than 10 years, or both. For the purposes of subsection (a), the circumstances described in this subsection are that— the offender or victim traveled in interstate or foreign commerce, or traveled using a means, channel, facility, or instrumentality of interstate or foreign commerce, in furtherance of or in connection with the conduct described in subsection (a); the offender used a means, channel, facility, or instrumentality of interstate or foreign commerce in furtherance of or in connection with the conduct described in subsection (a); any payment of any kind was made, directly or indirectly, in furtherance of or in connection with the conduct described in subsection (a) using any means, channel, facility, or instrumentality of interstate or foreign commerce or in or affecting interstate or foreign commerce; the offender transmitted in interstate or foreign commerce any communication relating to or in furtherance of the conduct described in subsection (a) using any means, channel, facility, or instrumentality of interstate or foreign commerce or in or affecting interstate or foreign commerce by any means or in manner, including by computer, mail, wire, or electromagnetic transmission; any instrument, item, substance, or other object that has traveled in interstate or foreign commerce was used to perform the conduct described in subsection (a); the conduct described in subsection (a) occurred within the special maritime and territorial jurisdiction of the United States, or any territory or possession of the United States; or the conduct described in subsection (a) otherwise occurred in or affected interstate or foreign commerce. An individual who provides gender-related medical treatment to a minor shall not be considered to have violated the prohibition in subsection (a) if such medical treatment is provided to such minor for purposes of treating— a disorder of sex development, diagnosed by a physician after such physician has determined through genetic or biochemical testing that such minor does not have normal sex chromosome structure, sex steroid hormone production, or sex steroid hormone action; irresolvably ambiguous biological sex characteristics of such minor, including the presence of— 46 XX chromosomes with virilization; 46 XY chromosomes with undervirilization; or both ovarian and testicular tissue; or an infection, injury, disease, or disorder caused or exacerbated by gender-related medical treatment that was furnished to such minor. A minor who seeks gender-related medical treatment, or on whom gender-related medical treatment was performed, shall not be considered to have violated the prohibition in subsection (a). In this section: The term gender-related medical treatment means— with respect to a female individual, medical treatments provided for purposes of addressing the perception of such individual that the gender or sex of such individual is not female, including— surgical procedures, including— vaginectomy; hysterectomy; oophorectomy; reconstruction of the urethra; metoidioplasty; phalloplasty; salpingo-oophorectomy; scrotoplasty; implantation of erection or testicular protheses; subcutaneous mastectomy; vocal cord surgery; pectoral implants; and penile transplantation; exogenous doses of testosterone or other androgens; and puberty blockers, including— GnRH agonists; and synthetic drugs that suppress the production of estrogen and progesterone or delay or suppress pubertal development in female individuals; and with respect to a male individual, medical treatments provided for purposes of addressing the perception of such individual that the gender or sex of such individual is not male, including— surgical procedures, including— penectomy; orchiectomy; vaginoplasty; clitoroplasty; vulvoplasty; augmentation mammoplasty; facial feminization surgery; vocal cord surgery; chondrolaryngoplasty; gluteal augmentation; and uterine transplantation; exogenous doses of estrogen; and puberty blockers, including— GnRH agonists; and synthetic drugs that suppress the production of testosterone or delay or suppress pubertal development in male individuals. The term female means an individual who naturally has, had, will have, or would have, but for a developmental or genetic anomaly or historical accident, the reproductive system that at some point produces, transports, and utilizes eggs for fertilization. The term gender— means— males, females, or the natural differences between males and females, unless such term is otherwise specified or used alone, rather than with or as an adjective modifying other words; and a synonym for sex; and does not mean gender identity, experienced gender, gender expression, or gender roles. The term male means an individual who naturally has, had, will have, or would have, but for a developmental or genetic anomaly or historical accident, the reproductive system that at some point produces, transports, and utilizes sperm for fertilization. The term minor means an individual under 18 years of age. The term sex means the biological determination as to whether an individual is male or female. The table of sections for such chapter is amended by inserting after the item relating to section 116 the following new item: 116A.Gender-related medical treatment furnished to minors. (a)In generalSubject to subsection (c), whoever, in a circumstance described in subsection (b), knowingly performs or attempts to perform a gender-related medical treatment on a minor, shall be fined under this title, imprisoned not more than 10 years, or both. (b)Circumstances describedFor the purposes of subsection (a), the circumstances described in this subsection are that— (1)the offender or victim traveled in interstate or foreign commerce, or traveled using a means, channel, facility, or instrumentality of interstate or foreign commerce, in furtherance of or in connection with the conduct described in subsection (a); (2)the offender used a means, channel, facility, or instrumentality of interstate or foreign commerce in furtherance of or in connection with the conduct described in subsection (a); (3)any payment of any kind was made, directly or indirectly, in furtherance of or in connection with the conduct described in subsection (a) using any means, channel, facility, or instrumentality of interstate or foreign commerce or in or affecting interstate or foreign commerce; (4)the offender transmitted in interstate or foreign commerce any communication relating to or in furtherance of the conduct described in subsection (a) using any means, channel, facility, or instrumentality of interstate or foreign commerce or in or affecting interstate or foreign commerce by any means or in manner, including by computer, mail, wire, or electromagnetic transmission; (5)any instrument, item, substance, or other object that has traveled in interstate or foreign commerce was used to perform the conduct described in subsection (a); (6)the conduct described in subsection (a) occurred within the special maritime and territorial jurisdiction of the United States, or any territory or possession of the United States; or (7)the conduct described in subsection (a) otherwise occurred in or affected interstate or foreign commerce. (c)Exceptions (1)In generalAn individual who provides gender-related medical treatment to a minor shall not be considered to have violated the prohibition in subsection (a) if such medical treatment is provided to such minor for purposes of treating— (A)a disorder of sex development, diagnosed by a physician after such physician has determined through genetic or biochemical testing that such minor does not have normal sex chromosome structure, sex steroid hormone production, or sex steroid hormone action; (B)irresolvably ambiguous biological sex characteristics of such minor, including the presence of— (i)46 XX chromosomes with virilization; (ii)46 XY chromosomes with undervirilization; or (iii)both ovarian and testicular tissue; or (C)an infection, injury, disease, or disorder caused or exacerbated by gender-related medical treatment that was furnished to such minor. (2)Exception for minorsA minor who seeks gender-related medical treatment, or on whom gender-related medical treatment was performed, shall not be considered to have violated the prohibition in subsection (a). (d)DefinitionsIn this section: (1)Gender-related medical treatmentThe term gender-related medical treatment means— (A)with respect to a female individual, medical treatments provided for purposes of addressing the perception of such individual that the gender or sex of such individual is not female, including— (i)surgical procedures, including— (I)vaginectomy; (II)hysterectomy; (III)oophorectomy; (IV)reconstruction of the urethra; (V)metoidioplasty; (VI)phalloplasty; (VII)salpingo-oophorectomy; (VIII)scrotoplasty; (IX)implantation of erection or testicular protheses; (X)subcutaneous mastectomy; (XI)vocal cord surgery; (XII)pectoral implants; and (XIII)penile transplantation; (ii)exogenous doses of testosterone or other androgens; and (iii)puberty blockers, including— (I)GnRH agonists; and (II)synthetic drugs that suppress the production of estrogen and progesterone or delay or suppress pubertal development in female individuals; and (B)with respect to a male individual, medical treatments provided for purposes of addressing the perception of such individual that the gender or sex of such individual is not male, including— (i)surgical procedures, including— (I)penectomy; (II)orchiectomy; (III)vaginoplasty; (IV)clitoroplasty; (V)vulvoplasty; (VI)augmentation mammoplasty; (VII)facial feminization surgery; (VIII)vocal cord surgery; (IX)chondrolaryngoplasty; (X)gluteal augmentation; and (XI)uterine transplantation; (ii)exogenous doses of estrogen; and (iii)puberty blockers, including— (I)GnRH agonists; and (II)synthetic drugs that suppress the production of testosterone or delay or suppress pubertal development in male individuals. (2)FemaleThe term female means an individual who naturally has, had, will have, or would have, but for a developmental or genetic anomaly or historical accident, the reproductive system that at some point produces, transports, and utilizes eggs for fertilization. (3)GenderThe term gender— (A)means— (i)males, females, or the natural differences between males and females, unless such term is otherwise specified or used alone, rather than with or as an adjective modifying other words; and (ii)a synonym for sex; and (B)does not mean gender identity, experienced gender, gender expression, or gender roles. (4)MaleThe term male means an individual who naturally has, had, will have, or would have, but for a developmental or genetic anomaly or historical accident, the reproductive system that at some point produces, transports, and utilizes sperm for fertilization. (5)MinorThe term minor means an individual under 18 years of age. (6)SexThe term sex means the biological determination as to whether an individual is male or female.. 116A. Gender-related medical treatment for minors..

116A. Gender-related medical treatment furnished to minors. Subject to subsection (c), whoever, in a circumstance described in subsection (b), knowingly performs or attempts to perform a gender-related medical treatment on a minor, shall be fined under this title, imprisoned not more than 10 years, or both. For the purposes of subsection (a), the circumstances described in this subsection are that— the offender or victim traveled in interstate or foreign commerce, or traveled using a means, channel, facility, or instrumentality of interstate or foreign commerce, in furtherance of or in connection with the conduct described in subsection (a); the offender used a means, channel, facility, or instrumentality of interstate or foreign commerce in furtherance of or in connection with the conduct described in subsection (a); any payment of any kind was made, directly or indirectly, in furtherance of or in connection with the conduct described in subsection (a) using any means, channel, facility, or instrumentality of interstate or foreign commerce or in or affecting interstate or foreign commerce; the offender transmitted in interstate or foreign commerce any communication relating to or in furtherance of the conduct described in subsection (a) using any means, channel, facility, or instrumentality of interstate or foreign commerce or in or affecting interstate or foreign commerce by any means or in manner, including by computer, mail, wire, or electromagnetic transmission; any instrument, item, substance, or other object that has traveled in interstate or foreign commerce was used to perform the conduct described in subsection (a); the conduct described in subsection (a) occurred within the special maritime and territorial jurisdiction of the United States, or any territory or possession of the United States; or the conduct described in subsection (a) otherwise occurred in or affected interstate or foreign commerce. An individual who provides gender-related medical treatment to a minor shall not be considered to have violated the prohibition in subsection (a) if such medical treatment is provided to such minor for purposes of treating— a disorder of sex development, diagnosed by a physician after such physician has determined through genetic or biochemical testing that such minor does not have normal sex chromosome structure, sex steroid hormone production, or sex steroid hormone action; irresolvably ambiguous biological sex characteristics of such minor, including the presence of— 46 XX chromosomes with virilization; 46 XY chromosomes with undervirilization; or both ovarian and testicular tissue; or an infection, injury, disease, or disorder caused or exacerbated by gender-related medical treatment that was furnished to such minor. A minor who seeks gender-related medical treatment, or on whom gender-related medical treatment was performed, shall not be considered to have violated the prohibition in subsection (a). In this section: The term gender-related medical treatment means— with respect to a female individual, medical treatments provided for purposes of addressing the perception of such individual that the gender or sex of such individual is not female, including— surgical procedures, including— vaginectomy; hysterectomy; oophorectomy; reconstruction of the urethra; metoidioplasty; phalloplasty; salpingo-oophorectomy; scrotoplasty; implantation of erection or testicular protheses; subcutaneous mastectomy; vocal cord surgery; pectoral implants; and penile transplantation; exogenous doses of testosterone or other androgens; and puberty blockers, including— GnRH agonists; and synthetic drugs that suppress the production of estrogen and progesterone or delay or suppress pubertal development in female individuals; and with respect to a male individual, medical treatments provided for purposes of addressing the perception of such individual that the gender or sex of such individual is not male, including— surgical procedures, including— penectomy; orchiectomy; vaginoplasty; clitoroplasty; vulvoplasty; augmentation mammoplasty; facial feminization surgery; vocal cord surgery; chondrolaryngoplasty; gluteal augmentation; and uterine transplantation; exogenous doses of estrogen; and puberty blockers, including— GnRH agonists; and synthetic drugs that suppress the production of testosterone or delay or suppress pubertal development in male individuals. The term female means an individual who naturally has, had, will have, or would have, but for a developmental or genetic anomaly or historical accident, the reproductive system that at some point produces, transports, and utilizes eggs for fertilization. The term gender— means— males, females, or the natural differences between males and females, unless such term is otherwise specified or used alone, rather than with or as an adjective modifying other words; and a synonym for sex; and does not mean gender identity, experienced gender, gender expression, or gender roles. The term male means an individual who naturally has, had, will have, or would have, but for a developmental or genetic anomaly or historical accident, the reproductive system that at some point produces, transports, and utilizes sperm for fertilization. The term minor means an individual under 18 years of age. The term sex means the biological determination as to whether an individual is male or female.

3. Prohibiting payment and participation under Medicare with respect to gender-related medical treatment for minors Section 1862(a) of the Social Security Act (42 U.S.C. 1395y(a)) is amended— in paragraph (24), by striking or at the end; in paragraph (25), by striking the period at the end and inserting ; or; and by inserting after paragraph (25) the following new paragraph: beginning on the date that is 90 days after the date of the enactment of the Childhood Genital Mutilation Prevention Act, which constitute gender-related medical treatment for minors described in section 116A of chapter 7 of title 18, United States Code, and are not provided for the purposes described in subsection (c)(1) of such section. Section 1866 of the Social Security Act (42 U.S.C. 1395cc) is amended by adding at the end the following new subsection: Beginning on the date that is 90 days after the date of the enactment of the Childhood Genital Mutilation Prevention Act, with respect to a provider of services or supplier that, on or after the date that is 90 days after such date of enactment, furnishes gender-related medical treatment for minors, as described in section 116A of chapter 7 of title 18, United States Code to any individual (other than such a treatment that is furnished for the purposes described in subsection (c)(1) of such section), regardless of whether such individual is entitled to benefits under part A or enrolled under part B— if such provider of services or supplier is enrolled in the program under this title, the Secretary shall terminate such enrollment; and the Secretary may not enroll such provider of services or supplier as a new provider of services or supplier in the program under this title. (26)beginning on the date that is 90 days after the date of the enactment of the Childhood Genital Mutilation Prevention Act, which constitute gender-related medical treatment for minors described in section 116A of chapter 7 of title 18, United States Code, and are not provided for the purposes described in subsection (c)(1) of such section.. (l)Exclusion of providers furnishing gender-Related medical treatment for minorsBeginning on the date that is 90 days after the date of the enactment of the Childhood Genital Mutilation Prevention Act, with respect to a provider of services or supplier that, on or after the date that is 90 days after such date of enactment, furnishes gender-related medical treatment for minors, as described in section 116A of chapter 7 of title 18, United States Code to any individual (other than such a treatment that is furnished for the purposes described in subsection (c)(1) of such section), regardless of whether such individual is entitled to benefits under part A or enrolled under part B— (1)if such provider of services or supplier is enrolled in the program under this title, the Secretary shall terminate such enrollment; and (2)the Secretary may not enroll such provider of services or supplier as a new provider of services or supplier in the program under this title..

4. Prohibition on Federal funding for gender-related medical treatment for minors No funds authorized or appropriated by Federal law, and none of the funds in any trust fund to which funds are authorized or appropriated by Federal law, shall be obligated or expended for any gender-related medical treatment furnished to a minor (as such terms are used for purposes of section 116A of chapter 7 of title 18, United States Code) or for any health benefits coverage that includes coverage for gender-related medical treatment furnished to a minor.