SEC. 3. STATES REQUIRED TO PROHIBIT SPECIFIED SUR-
GERIES ON FOSTER CHILDREN WITH VARI-
ATIONS IN SEX CHARACTERISTICS WHO ARE 
UNDER 6 YEARS OF AGE, AS A CONDITION OF 
PARTICIPATION IN THE FEDERAL FOSTER 
CARE AND ADOPTION ASSISTANCE PROGRAM. 
(a) STATE PLAN REQUIREMENT.—Section 471 of the 
Social Security Act (42 U.S.C. 671) is amended— 
(1) in subsection (a)— 
(A) by striking ‘‘and’’ at the end of para-
graph (36); 
(B) by striking the period at the end of 
paragraph (37) and inserting ‘‘; and’’; and 
(C) by adding at the end, the following: 
‘‘(38) provides that the State shall have in ef-
fect the laws and procedures described in subsection 
(f), which shall specify appropriate penalties and en-
forcement mechanisms described in subsection (f)(3) 
to ensure compliance with the laws and proce-
dures.’’; and 
(2) by adding at the end the following: 
‘‘(f) STATE LAWS AND PROCEDURES TO PROHIBIT 
GENITAL SURGERY ON FOSTER CHILDREN BORN WITH 
VARIATIONS IN THEIR PHYSICAL SEX CHARACTERISTICS 
WHO ARE UNDER 6 YEARS OF AGE.— 
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‘‘(1) IN GENERAL.—The laws and procedures 
described in this subsection are laws and procedures 
which prohibit a physician who is licensed to provide 
medical care under State law from performing any 
of the following surgeries on a foster child who has 
not attained 6 years of age and who is an individual 
born with variations in their physical sex character-
istics: 
‘‘(A) Clitoroplasty, clitoral reduction, or 
clitoral recession, including corporal-sparing 
procedures. 
‘‘(B) Gonadectomy. 
‘‘(C) Vaginoplasty, urogenital sinus mobili-
zation, or vaginal exteriorization. 
‘‘(2) DEFINITIONS.—In paragraph (1): 
‘‘(A) INDIVIDUAL BORN WITH VARIATIONS 
IN THEIR PHYSICAL SEX CHARACTERISTICS.— 
The term ‘individual born with variations in 
their physical sex characteristics’ means an in-
dividual born with physical traits, including 
genitals, gonads, hormone function, or chromo-
somal patterns, that vary from stereotypical no-
tions regarding the development, appearance, or 
function of sex characteristics. 
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‘‘(B) SURGERY REQUIRED TO ADDRESS AN 
IMMEDIATE
RISK
OF
PHYSICAL
HARM.—The 
term ‘surgery required to address an immediate 
risk of physical harm’ means— 
‘‘(i) surgery to remove tissue that is 
malignant; 
‘‘(ii) surgery to create an opening to 
allow urine or feces to exit the body where 
an opening is underdeveloped or not 
present; 
‘‘(iii) surgery to reposition internal or-
gans that formed outside of the body; 
‘‘(iv) surgery that is required to treat 
complications of a previous surgery and 
cannot be delayed without increasing phys-
ical health risks to the patient; and 
‘‘(v) any other surgery necessary to 
preserve life in the event of a medical 
emergency. 
‘‘(3) ENFORCEMENT.— 
‘‘(A) IN GENERAL.—The relevant licensing 
entity of the State shall consider a violation of 
a State law or procedure described in para-
graph (1) to be unprofessional conduct, and 
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shall discipline any violator of such a law or 
procedure accordingly. 
‘‘(B) CONCURRENT AUTHORITY.—The rel-
evant department of health or regulatory body 
of a State shall have concurrent authority to 
initiate proceedings to address violations of a 
State law or procedure described in paragraph 
(1). 
‘‘(4) RULE
OF
INTERPRETATION.—This sub-
section shall not be interpreted to require a State to 
impose liability on a hospital at which a violation of 
a State law or procedure described in paragraph (1) 
occurs.’’. 
(b) EFFECTIVE DATE.— 
(1) IN GENERAL.—The amendments made by 
subsection (a) shall take effect on the 1st day of the 
1st calendar quarter that begins 1 year or more 
after the date of the enactment of this Act, and shall 
apply to payments under part E of title IV of the 
Social Security Act for calendar quarters beginning 
on or after such date. 
(2) DELAY PERMITTED IF STATE LEGISLATION 
REQUIRED.—If the Secretary of Health and Human 
Services determines that State legislation (other 
than legislation appropriating funds) is required in 
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order for a State plan developed pursuant to part E 
of title IV of the Social Security Act to meet the ad-
ditional requirements imposed by the amendments 
made by subsection (a), the plan shall not be re-
garded as failing to meet any of the additional re-
quirements before the 1st day of the 1st calendar 
quarter beginning after the 1st regular session of 
the State legislature that begins 1 year or more 
after the date of the enactment of this Act. For pur-
poses of the preceding sentence, if the State has a 
2-year legislative session, each year of the session is 
deemed to be a separate regular session of the State 
legislature. 
Æ 
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