IB 
Union Calendar No. 629 
118TH CONGRESS 
2D SESSION 
H. R. 3887 
[Report No. 118–758] 
To amend title III of the Public Health Service Act to reauthorize the 
program of payments to children’s hospitals that operate graduate med-
ical education programs, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 7, 2023 
Mr. CRENSHAW introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
NOVEMBER 20, 2024 
Additional sponsors: Mr. JOHNSON of Ohio, Mrs. MILLER-MEEKS, Mrs. 
HARSHBARGER, Mr. PFLUGER, Mr. BABIN, Mr. SELF, Mrs. MILLER of 
West Virginia, Ms. TENNEY, Mr. SANTOS, Mr. VAN
DREW, Mr. 
GROTHMAN, Mr. SCOTT FRANKLIN of Florida, Mr. GAETZ, Mr. NEHLS, 
Mrs. CAMMACK, Mr. STAUBER, Mr. WILLIAMS of Texas, Mr. ARRINGTON, 
Mr. MANN, Mr. NORMAN, Mr. POSEY, Mr. STEUBE, Mr. ELLZEY, Mr. 
CARTER of Georgia, Mr. GREEN of Tennessee, Mr. JACKSON of Texas, 
Mr. MOONEY, Mr. DUNCAN, Mrs. MILLER of Illinois, Mr. MORAN, Mr. 
FINSTAD, and Mr. ROUZER 
NOVEMBER 20, 2024 
Reported with an amendment, committed to the Committee of the Whole 
House on the State of the Union, and ordered to be printed 
[Strike out all after the enacting clause and insert the part printed in italic] 
[For text of introduced bill, see copy of bill as introduced on June 7, 2023] 
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A BILL 
To amend title III of the Public Health Service Act to 
reauthorize the program of payments to children’s hos-
pitals that operate graduate medical education programs, 
and for other purposes. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Children’s Hospital 
GME Support Reauthorization Act of 2023’’. 
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 in-
serting ‘‘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 HOSPITALS 
FURNISHING SPECIFIED PROCEDURES AND DRUGS 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 specified proce-
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dures and drugs (as defined in subsection (g)) to 
an individual 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-
graph for fiscal year 2024— 
‘‘(i) the reference to ‘for a fiscal year’ 
shall be treated as a reference to ‘for any 
portion of fiscal year 2024 occurring after 
December 31, 2023’; and 
‘‘(ii) the reference to ‘the preceding fis-
cal year’ shall be treated as a reference to 
‘the period beginning on September 1, 2023, 
and ending on December 31, 2023’. 
‘‘(C) RULE OF CONSTRUCTION.—Nothing in 
this paragraph shall be construed as prohibiting 
payments for a fiscal year (or, in the case of 
payments for fiscal year 2024, during the por-
tion of such fiscal year described in subpara-
graph (B)(i)) to a hospital that, during the pre-
ceding fiscal year (or, in the case of payments 
for fiscal year 2024, during the period described 
in subparagraph (B)(ii)), furnished mental or 
behavioral health services to individuals under 
18 years of age for the treatment of gender dys-
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phoria not consisting of specified procedures and 
drugs.’’; 
(4) in subsection (f)— 
(A) in paragraph (1)(A)— 
(i) in clause (v), by striking ‘‘and’’ at 
the end; 
(ii) in clause (vi), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(iii) by adding at the end the fol-
lowing: 
‘‘(vii) for each of fiscal years 2024 
through 2028, $124,000,000.’’; and 
(B) in paragraph (2)— 
(i) in subparagraph (E), by striking 
‘‘and’’ at the end; 
(ii) in subparagraph (F), by striking 
the period at the end and inserting ‘‘; and’’; 
and 
(iii) by adding at the end the fol-
lowing: 
‘‘(G) for each of fiscal years 2024 through 
2028, $261,000,000.’’; and 
(5) in subsection (g), by adding at the end the 
following new paragraph: 
‘‘(4) SPECIFIED PROCEDURES AND DRUGS.— 
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‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), the term ‘specified procedures 
and drugs’ 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 medica-
tions for the purposes described in clause 
(i), including— 
‘‘(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 indi-
vidual does not have normal sex chro-
mosome structure, sex steroid hormone pro-
duction, or sex steroid hormone action. 
‘‘(iii) An individual experiencing in-
fection, disease, injury, or disorder caused 
or exacerbated by previous medical proce-
dures as defined in subsection (g)(4)(A). 
‘‘(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 immi-
nent danger of death or impairment of a 
major bodily function unless the procedure 
is performed. 
‘‘(C) BIOLOGICAL
SEX.—For purposes of 
subparagraph (A), the term ‘biological sex’ 
means the indication of male or female sex by re-
productive potential or capacity, sex chro-
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mosomes, naturally occurring sex hormones, go-
nads, or internal or external genitalia present at 
birth.’’. 
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Union Calendar No. 629 
118TH CONGRESS 
2D SESSION 
H. R. 3887 
[Report No. 118–758] 
A BILL 
To amend title III of the Public Health Service Act 
to reauthorize the program of payments to chil-
dren’s hospitals that operate graduate medical 
education programs, and for other purposes. 
NOVEMBER 20, 2024 
Reported with an amendment, committed to the Com-
mittee of the Whole House on the State of the Union, 
and ordered to be printed 
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