I 118th CONGRESS 2d Session H. R. 9874 IN THE HOUSE OF REPRESENTATIVES September 27, 2024 Ms. Mace (for herself, Mr. Gosar , Mrs. Lesko , Mr. Weber of Texas , and Mr. Burchett ) introduced the following bill; which was referred to the Committee on Energy and Commerce , and in addition to the Committees on the Judiciary , and Ways and Means , for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To prohibit the performance of gender-related medical treatment on minors, to amend title XVIII of the Social Security Act to prohibit payment and participation under the Medicare program with respect to such treatment, and for other purposes.

1. Short title This Act may be cited as the Childhood Genital Mutilation Prevention Act . 2. Prohibiting gender-related medical treatment for minors (a) In general Chapter 7 of title 18, United States Code, is amended by inserting after section 116 the following new section: 116A. Gender-related medical treatment furnished to minors. (a) In general Subject to subsection (c) , whoever, in a circumstance described in subsection (b) , knowingly performs or attempts to perform a gender-related medical treatment on a minor, shall be fined under this title, imprisoned not more than 10 years, or both. (b) Circumstances described For the purposes of subsection (a), the circumstances described in this subsection are that— (1) the offender or victim traveled in interstate or foreign commerce, or traveled using a means, channel, facility, or instrumentality of interstate or foreign commerce, in furtherance of or in connection with the conduct described in subsection (a); (2) the offender used a means, channel, facility, or instrumentality of interstate or foreign commerce in furtherance of or in connection with the conduct described in subsection (a); (3) any payment of any kind was made, directly or indirectly, in furtherance of or in connection with the conduct described in subsection (a) using any means, channel, facility, or instrumentality of interstate or foreign commerce or in or affecting interstate or foreign commerce; (4) the offender transmitted in interstate or foreign commerce any communication relating to or in furtherance of the conduct described in subsection (a) using any means, channel, facility, or instrumentality of interstate or foreign commerce or in or affecting interstate or foreign commerce by any means or in manner, including by computer, mail, wire, or electromagnetic transmission; (5) any instrument, item, substance, or other object that has traveled in interstate or foreign commerce was used to perform the conduct described in subsection (a); (6) the conduct described in subsection (a) occurred within the special maritime and territorial jurisdiction of the United States, or any territory or possession of the United States; or (7) the conduct described in subsection (a) otherwise occurred in or affected interstate or foreign commerce. (c) Exceptions (1) In general An individual who provides gender-related medical treatment to a minor shall not be considered to have violated the prohibition in subsection (a) if such medical treatment is provided to such minor for purposes of treating— (A) a disorder of sex development, diagnosed by a physician after such physician has determined through genetic or biochemical testing that such minor does not have normal sex chromosome structure, sex steroid hormone production, or sex steroid hormone action; (B) irresolvably ambiguous biological sex characteristics of such minor, including the presence of— (i) 46 XX chromosomes with virilization; (ii) 46 XY chromosomes with undervirilization; or (iii) both ovarian and testicular tissue; or (C) an infection, injury, disease, or disorder caused or exacerbated by gender-related medical treatment that was furnished to such minor. (2) Exception for minors A minor who seeks gender-related medical treatment, or on whom gender-related medical treatment was performed, shall not be considered to have violated the prohibition in subsection (a). (d) Definitions In this section: (1) Gender-related medical treatment The term gender-related medical treatment means— (A) with respect to a female individual, medical treatments provided for purposes of addressing the perception of such individual that the gender or sex of such individual is not female, including— (i) surgical procedures, including— (I) vaginectomy; (II) hysterectomy; (III) oophorectomy; (IV) reconstruction of the urethra; (V) metoidioplasty; (VI) phalloplasty; (VII) salpingo-oophorectomy; (VIII) scrotoplasty; (IX) implantation of erection or testicular protheses; (X) subcutaneous mastectomy; (XI) vocal cord surgery; (XII) pectoral implants; and (XIII) penile transplantation; (ii) exogenous doses of testosterone or other androgens; and (iii) puberty blockers, including— (I) GnRH agonists; and (II) synthetic drugs that suppress the production of estrogen and progesterone or delay or suppress pubertal development in female individuals; and (B) with respect to a male individual, medical treatments provided for purposes of addressing the perception of such individual that the gender or sex of such individual is not male, including— (i) surgical procedures, including— (I) penectomy; (II) orchiectomy; (III) vaginoplasty; (IV) clitoroplasty; (V) vulvoplasty; (VI) augmentation mammoplasty; (VII) facial feminization surgery; (VIII) vocal cord surgery; (IX) chondrolaryngoplasty; (X) gluteal augmentation; and (XI) uterine transplantation; (ii) exogenous doses of estrogen; and (iii) puberty blockers, including— (I) GnRH agonists; and (II) synthetic drugs that suppress the production of testosterone or delay or suppress pubertal development in male individuals. (2) Female The term female — (A) means an individual who, under normal development— (i) has XX chromosomes; (ii) produces oocytes; and (iii) has a reproductive and endocrine system oriented around the production of such oocytes; and (B) includes an individual who would otherwise fall within this definition but for a biological or genetic condition described in subparagraph (A) or (B) of subsection (c)(1) . (3) Gender The term gender means, with respect to an individual, the psychological, behavioral, social, and cultural aspects of being male or female. (4) Male The term male — (A) means an individual who, under normal development— (i) has XY chromosomes; (ii) produces sperm; and (iii) has a reproductive and endocrine system oriented around the production of such sperm; and (B) includes an individual who would otherwise fall within this definition but for a biological or genetic condition described in subparagraph (A) or (B) of subsection (c)(1) . (5) Minor The term minor means an individual under 18 years of age. (6) Sex The term sex means the biological and genetic indication of whether an individual is male or female, as determined by the organization of body parts and gametes for reproduction (including sex chromosomes, naturally occurring sex chromosomes, gonads, and nonambiguous internal and external genitalia present at birth) without regard to the psychological, behavioral, social, cultural, chosen, or subjective experience of gender of such individual. . (b) Clerical amendment The table of sections for such chapter is amended by inserting after the item relating to section 116 the following new item: 116A. Gender-related medical treatment for minors. . 3. Prohibiting payment and participation under Medicare with respect to gender-related medical treatment for minors (a) Excluding from coverage gender-Related medical treatment for minors Section 1862(a) of the Social Security Act ( 42 U.S.C. 1395y(a) ) is amended— (1) in paragraph (24), by striking or at the end; (2) in paragraph (25), by striking the period at the end and inserting ; or ; and (3) by inserting after paragraph (25) the following new paragraph: (26) beginning on the date that is 90 days after the date of the enactment of the Childhood Genital Mutilation Prevention Act, which constitute gender-related medical treatment for minors described in section 116A of chapter 7 of title 18, United States Code, and are not provided for the purposes described in subsection (c)(1) of such section. . (b) Excluding from participation providers furnishing gender-Related medical treatment for minors Section 1866 of the Social Security Act ( 42 U.S.C. 1395cc ) is amended by adding at the end the following new subsection: (l) Exclusion of providers furnishing gender-Related medical treatment for minors Beginning on the date that is 90 days after the date of the enactment of the Childhood Genital Mutilation Prevention Act, with respect to a provider of services or supplier that, on or after the date that is 90 days after such date of enactment, furnishes gender-related medical treatment for minors, as described in section 116A of chapter 7 of title 18, United States Code to any individual (other than such a treatment that is furnished for the purposes described in subsection (c)(1) of such section), regardless of whether such individual is entitled to benefits under part A or enrolled under part B— (1) if such provider of services or supplier is enrolled in the program under this title, the Secretary shall terminate such enrollment; and (2) the Secretary may not enroll such provider of services or supplier as a new provider of services or supplier in the program under this title. . 4. Prohibition on Federal funding for gender-related medical treatment for minors No funds authorized or appropriated by Federal law, and none of the funds in any trust fund to which funds are authorized or appropriated by Federal law, shall be obligated or expended for any gender-related medical treatment furnished to a minor (as such terms are used for purposes of section 116A of chapter 7 of title 18, United States Code) or for any health benefits coverage that includes coverage for gender-related medical treatment furnished to a minor.