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.     * * * * *