I 118th CONGRESS 1st Session H. R. 3887 IN THE HOUSE OF REPRESENTATIVES June 7, 2023 Mr. Crenshaw introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend title III of the Public Health Service Act to reauthorize the program of payments to children’s hospitals that operate graduate medical education programs, and for other purposes.

1. Short title This Act may be cited as the Children’s Hospital GME Support Reauthorization Act of 2023 . 2. Program of payments to children's hospitals 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 hospitals 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 hospital for a fiscal year (beginning with fiscal year 2024) if, at any point during the preceding fiscal year, such hospital furnished gender-affirming care (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 respect to payments described in such subparagraph for fiscal year 2024, the reference to the preceding fiscal year shall be treated as a reference 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 prohibiting 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)), furnished mental or behavioral health services to individuals under 18 years of age for the treatment of gender dysphoria not consisting of gender-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 care means, with respect to an individual, any of the following: (i) Performing any surgery for the purpose of changing the body of such individual 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. (ii) Any plastic surgery that feminizes 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 purposes described in clause (i). (v) Administering, supplying, prescribing, dispensing, distributing, or otherwise conveying to an individual medications for the purposes described in clause (i), including— (I) gonadotropin-releasing hormone (GnRH) analogues or other puberty-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. (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 individual does not have normal sex chromosome structure, sex steroid hormone production, or sex steroid hormone action. (iii) An individual experiencing infection, disease, injury, or disorder caused or exacerbated by previous gender transition procedures. (iv) An individual suffering from a physical disorder, physical injury, or physical 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 performed. (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 chromosomes, naturally occurring sex hormones, gonads, or internal or external genitalia present at birth. .