88R4402 EAS-F
	By: Oliverson	H.B. No. 1686

	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.