SEC. 2. PROGRAM OF PAYMENTS TO CHILDREN’S HOS-
PITALS THAT OPERATE GRADUATE MEDICAL 
EDUCATION PROGRAMS. 
Section 340E of the Public Health Service Act (42 
U.S.C. 256e) is amended— 
(1) in subsection (a), by striking ‘‘2023’’ and 
inserting ‘‘2028’’; 
(2) in subsection (b)(3)(D), by inserting ‘‘and 
the end of fiscal year 2028,’’ after ‘‘fiscal year 
2022,’’; 
(3) in subsection (e), by adding at the end the 
following new paragraph: 
‘‘(4) PROHIBITION
ON
PAYMENTS
TO
HOS-
PITALS FURNISHING GENDER-AFFIRMING CARE TO 
MINORS.— 
‘‘(A) IN GENERAL.—Notwithstanding any 
other provision of this section, no payment may 
be made under this section to a children’s hos-
pital for a fiscal year (beginning with fiscal year 
2024) if, at any point during the preceding fis-
cal year, such hospital furnished gender-affirm-
ing care (as defined in subsection (g)) to an in-
dividual under 18 years of age. 
‘‘(B) SPECIAL
RULE
FOR
FISCAL
YEAR 
2024.—In applying subparagraph (A) with re-
spect to payments described in such subpara-
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graph for fiscal year 2024, the reference to ‘the 
preceding fiscal year’ shall be treated as a ref-
erence to ‘the period beginning on July 1, 2023, 
and ending on September 30, 2023’. 
‘‘(C) RULE OF CONSTRUCTION.—Nothing 
in this paragraph shall be construed as prohib-
iting payments for a fiscal year to a hospital 
that, during the preceding fiscal year (or, in the 
case of payments for fiscal year 2024, during 
the period described in subparagraph (B)), fur-
nished mental or behavioral health services to 
individuals under 18 years of age for the treat-
ment of gender dysphoria not consisting of gen-
der-affirming care.’’; 
(4) in subsection (f)— 
(A) in paragraph (1)(A)(vi), by striking 
‘‘2023’’ and inserting ‘‘2028’’; and 
(B) in paragraph (2)(F), by striking 
‘‘2023’’ and inserting ‘‘2028’’; and 
(5) in subsection (g), by adding at the end the 
following new paragraph: 
‘‘(4) GENDER-AFFIRMING CARE.— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), the term ‘gender-affirming 
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care’ means, with respect to an individual, any 
of the following: 
‘‘(i) Performing any surgery for the 
purpose of changing the body of such indi-
vidual to correspond to a sex that differs 
from their biological 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; and 
‘‘(XVI) mastectomy. 
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‘‘(ii) Any plastic surgery that femi-
nizes or masculinizes the facial features for 
the purposes described in clause (i). 
‘‘(iii) Any placement of chest implants 
to create feminine breasts for the purposes 
described in clause (i). 
‘‘(iv) Any placement of fat or artificial 
implants in the gluteal region for the pur-
poses described in clause (i). 
‘‘(v) Administering, supplying, pre-
scribing, dispensing, distributing, or other-
wise conveying to an individual medications 
for the purposes described in clause (i), in-
cluding— 
‘‘(I) gonadotropin-releasing hor-
mone (GnRH) analogues or other pu-
berty-blocking drugs to stop or delay 
normal puberty; 
‘‘(II) 
testosterone 
or 
other 
androgens to biological females at 
doses that are supraphysiologic to the 
female sex; and 
‘‘(III) 
estrogen 
to 
biological 
males 
at 
doses 
that 
are 
supraphysiologic to the male sex. 
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‘‘(B) 
EXCEPTION.—Subparagraph 
(A) 
shall not apply to the following individuals: 
‘‘(i) An individual with both ovarian 
and testicular tissue. 
‘‘(ii) An individual with respect to 
whom a physician has determined through 
genetic or biochemical testing that the in-
dividual does not have normal sex chro-
mosome structure, sex steroid hormone 
production, or sex steroid hormone action. 
‘‘(iii) An individual experiencing infec-
tion, disease, injury, or disorder caused or 
exacerbated by previous gender transition 
procedures. 
‘‘(iv) An individual suffering from a 
physical disorder, physical injury, or phys-
ical 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 per-
formed. 
‘‘(C) BIOLOGICAL SEX.—For purposes of 
subparagraph (A), the term ‘biological sex’ 
means the indication of male or female sex by 
reproductive potential or capacity, sex chro-
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mosomes, naturally occurring sex hormones, go-
nads, or internal or external genitalia present at 
birth.’’. 
Æ 
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