Text of AR HB 1570 (2021)

Stricken language would be deleted from and underlined language would be added to present law. Act 626 of the Regular Session *JMB259* 03-08-2021 11:23:08 JMB259 State of Arkansas As Engrossed: H3/2/21 H3/8/21 1 93rd General Assembly A Bill 2 Regular Session, 2021 HOUSE BILL 1570 3 4 By: Representatives Lundstrum, Barker, Bentley, Brown, Bryant, Cavenaugh, Cloud, Coleman, C. 5 Cooper, Cozart, Crawford, Dalby, Dotson, C. Fite, Furman, Gazaway, Gonzales, M. Gray, Haak, 6 Hollowell, Ladyman, Lowery, Lynch, J. Mayberry, McGrew, McNair, S. Meeks, Miller, Payton, Penzo, 7 Pilkington, Ray, Richmond, Slape, B. Smith, Speaks, Tollett, Tosh, Underwood, Vaught, Warren, 8 Watson, Wing, Bragg, Hillman, Wooten 9 By: Senators A. Clark, B. Ballinger, Beckham, Bledsoe, B. Davis, J. English, Gilmore, K. Hammer, Hill, 10 Irvin, B. Johnson, M. Johnson, Rapert, Rice, G. Stubblefield, D. Wallace, D. Sullivan, Hester, T. Garner 11 12 For An Act To Be Entitled 13 AN ACT TO CREATE THE ARKANSAS SAVE ADOLESCENTS FROM 14 EXPERIMENTATION (SAFE) ACT; AND FOR OTHER PURPOSES. 15 16 17 Subtitle 18 TO CREATE THE ARKANSAS SAVE ADOLESCENTS 19 FROM EXPERIMENTATION (SAFE) ACT. 20 21 22 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 23 24 SECTION 1. Title. 25 This act shall be known and may be cited as the "Arkansas Save 26 Adolescents from Experimentation (SAFE) Act". 27 28 SECTION 2. Legislative findings. 29 The General Assembly finds that: 30 (1) Arkansas has a compelling government interest in protecting 31 the health and safety of its citizens, especially vulnerable children; 32 (2)(A) Only a small percentage of the American population 33 experiences distress at identifying with their biological sex. 34 (B) According to the American Psychiatric Association, 35 “For natal adult males, prevalence ranges from 0.005% to 0.014%, and for 36 As Engrossed: H3/2/21 H3/8/21 HB1570 2 03-08-2021 11:23:08 JMB259 natal females, from 0.002% to 0.003%.”; 1 (3) For the small percentage of children who are gender 2 nonconforming or experience distress at identifying with their biological 3 sex, studies consistently demonstrate that the majority come to identify with 4 their biological sex in adolescence or adulthood, thereby rendering most 5 physiological interventions unnecessary; 6 (4) Furthermore, scientific studies show that individuals 7 struggling with distress at identifying with their biological sex often have 8 already experienced psychopathology, which indicates these individuals should 9 be encouraged to seek mental health services to address comorbidities and 10 underlying causes of their distress before undertaking any hormonal or 11 surgical intervention; 12 (5) Even among people who have undergone inpatient gender 13 reassignment procedures, suicide rates, psychiatric morbidities, and 14 mortality rates remain markedly elevated above the background population; 15 (6)(A) Some healthcare providers are prescribing puberty- 16 blocking drugs, such as gonadotropin-releasing hormone analogues, in order to 17 delay the onset or progression of puberty in children who experience distress 18 at identifying with their biological sex. 19 (B) The prescribing of puberty-blocking drugs is being 20 done despite the lack of any long-term longitudinal studies evaluating the 21 risks and benefits of using these drugs for the treatment of such distress or 22 gender transition; 23 (7) Healthcare providers are also prescribing cross-sex hormones 24 for children who experience distress at identifying with their biological 25 sex, despite the fact that no randomized clinical trials have been conducted 26 on the efficacy or safety of the use of cross-sex hormones in adults or 27 children for the purpose of treating such distress or gender transition; 28 (8) The use of cross-sex hormones comes with serious known 29 risks, such as: 30 (A) For biological females: 31 (i) Erythrocytosis, which is an increase in red 32 blood cells; 33 (ii) Severe liver dysfunction; 34 (iii) Coronary artery disease, including heart 35 attacks; 36 As Engrossed: H3/2/21 H3/8/21 HB1570 3 03-08-2021 11:23:08 JMB259 (iv) Cerebrovascular disease, including strokes; 1 (v) Hypertension; 2 (vi) Increased risk of breast and uterine cancers; 3 and 4 (vii) Irreversible infertility; and 5 (B) For biological males: 6 (i) Thromboembolic disease, including blood clots; 7 (ii) Cholelithiasis, including gallstones; 8 (iii) Coronary artery disease, including heart 9 attacks; 10 (iv) Macroprolactinoma, which is a tumor of the 11 pituitary gland; 12 (v) Cerebrovascular disease, including strokes; 13 (vi) Hypertriglyceridemia, which is an elevated 14 level of tryglycerides in the blood; 15 (vii) Breast cancer; and 16 (viii) Irreversible infertility; 17 (9) Genital and nongenital gender reassignment surgeries are 18 generally not recommended for children, although evidence indicates referrals 19 for children to have such surgeries are becoming more frequent; 20 (10)(A) Genital gender reassignment surgery includes several 21 irreversible invasive procedures for males and females and involves the 22 alteration of biologically healthy and functional body parts. 23 (B) For biological males, surgery may involve: 24 (i) Genital reconstruction including penectomy, 25 which is the removal of the penis; 26 (ii) Orchiectomy, which is the removal of the 27 testicles; 28 (iii) Vaginoplasty, which is the construction of a 29 vagina-like structure, typically through a penile inversion procedure; 30 (iv) Clitoroplasty, which is the construction of a 31 clitoris-like structure; and 32 (v) Vulvoplasty, which is the construction of a 33 vulva-like structure. 34 (C) For biological females, surgery may involve: 35 (i) A hysterectomy or oophorectomy; 36 As Engrossed: H3/2/21 H3/8/21 HB1570 4 03-08-2021 11:23:08 JMB259 (ii) Reconstruction of the urethra; 1 (iii) Genital reconstruction including 2 metoidioplasty or phalloplasty, which is the construction of a penis-like 3 structure; 4 (iv) Vaginectomy, which is the removal of the 5 vagina; 6 (v) Scrotoplasty, which is the construction of a 7 penis-like and scrotum-like structure; and 8 (vi) Implantation of erection or testicular 9 prostheses; 10 (11) The complications, risks, and long-term care concerns 11 associated with genital gender reassignment surgery for both males and 12 females are numerous and complex; 13 (12)(A) Nongenital gender reassignment surgery includes various 14 invasive procedures for males and females and also involves the alteration or 15 removal of biologically normal and functional body parts. 16 (B) For biological males, this surgery may involve: 17 (i) Augmentation mammoplasty; 18 (ii) Facial feminization surgery; 19 (iii) Liposuction; 20 (iv) Lipofilling; 21 (v) Voice surgery; 22 (vi) Thyroid cartilage reduction; 23 (vii) Gluteal augmentation; 24 (viii) Hair reconstruction; and 25 (ix) Other aesthetic procedures. 26 (C) For biological females, this surgery may involve: 27 (i) A subcutaneous mastectomy; 28 (ii) Voice surgery; 29 (iii) Liposuction; 30 (iv) Lipofilling; 31 (v) Pectoral implants; and 32 (vi) Other aesthetic procedures; 33 (13)(A) It is an accepted principle of economics and public 34 policy that when a service or product is subsidized or reimbursed, demand for 35 that service or product is increased. 36 As Engrossed: H3/2/21 H3/8/21 HB1570 5 03-08-2021 11:23:08 JMB259 (B) Between 2015 and 2016, gender reassignment surgeries 1 increased by nearly twenty percent (20%) in the United States; 2 (14) It is of grave concern to the General Assembly that the 3 medical community is allowing individuals who experience distress at 4 identifying with their biological sex to be subjects of irreversible and 5 drastic nongenital gender reassignment surgery and irreversible, permanently 6 sterilizing genital gender reassignment surgery, despite the lack of studies 7 showing that the benefits of such extreme interventions outweigh the risks; 8 and 9 (15) The risks of gender transition procedures far outweigh any 10 benefit at this stage of clinical study on these procedures. 11 12 SECTION 3. Arkansas Code Title 20, Chapter 9, is amended to add an 13 additional subchapter to read as follows: 14 15 Subchapter 15 — Arkansas Save Adolescents from Experimentation (SAFE) Act 16 17 20-9-1501. Definitions. 18 As used in this subchapter: 19 (1) "Biological sex” means the biological indication of male and 20 female in the context of reproductive potential or capacity, such as sex 21 chromosomes, naturally occurring sex hormones, gonads, and nonambiguous 22 internal and external genitalia present at birth, without regard to an 23 individual’s psychological, chosen, or subjective experience of gender; 24 (2) “Cross-sex hormones” means: 25 (A) Testosterone or other androgens given to biological 26 females in amounts that are larger or more potent than would normally occur 27 naturally in healthy biological sex females; and 28 (B) Estrogen given to biological males in amounts that are 29 larger or more potent than would normally occur naturally in healthy 30 biological sex males; 31 (3) “Gender” means the psychological, behavioral, social, and 32 cultural aspects of being male or female; 33 (4) “Gender reassignment surgery” means any medical or surgical 34 service that seeks to surgically alter or remove healthy physical or 35 anatomical characteristics or features that are typical for the individual’s 36 As Engrossed: H3/2/21 H3/8/21 HB1570 6 03-08-2021 11:23:08 JMB259 biological sex, in order to instill or create physiological or anatomical 1 characteristics that resemble a sex different from the individual’s 2 biological sex, including without limitation, genital or nongenital gender 3 reassignment surgery performed for the purpose of assisting an individual 4 with a gender transition; 5 (5) “Gender transition” means the process in which a person goes 6 from identifying with and living as a gender that corresponds to his or her 7 biological sex to identifying with and living as a gender different from his 8 or her biological sex, and may involve social, legal, or physical changes; 9 (6)(A) “Gender transition procedures” means any medical or 10 surgical service, including without limitation physician's services, 11 inpatient and outpatient hospital services, or prescribed drugs related to 12 gender transition that seeks to: 13 (i) Alter or remove physical or anatomical 14 characteristics or features that are typical for the individual’s biological 15 sex; or 16 (ii) Instill or create physiological or anatomical 17 characteristics that resemble a sex different from the individual’s 18 biological sex, including without limitation medical services that provide 19 puberty-blocking drugs, cross-sex hormones, or other mechanisms to promote 20 the development of feminizing or masculinizing features in the opposite 21 biological sex, or genital or nongenital gender reassignment surgery 22 performed for the purpose of assisting an individual with a gender 23 transition. 24 (B) “Gender transition procedures” do not include: 25 (i) Services to persons born with a medically 26 verifiable disorder of sex development, including a person with external 27 biological sex characteristics that are irresolvably ambiguous, such as those 28 born with 46 XX chromosomes with virilization, 46 XY chromosomes with 29 undervirilization, or having both ovarian and testicular tissue; 30 (ii) Services provided when a physician has 31 otherwise diagnosed a disorder of sexual development that the physician has 32 determined through genetic or biochemical testing that the person does not 33 have normal sex chromosome structure, sex steroid hormone production, or sex 34 steroid hormone action; 35 (iii) The treatment of any infection, injury, 36 As Engrossed: H3/2/21 H3/8/21 HB1570 7 03-08-2021 11:23:08 JMB259 disease, or disorder that has been caused by or exacerbated by the 1 performance of gender transition procedures, whether or not the gender 2 transition procedure was performed in accordance with state and federal law 3 or whether not funding for the gender transition procedure is permissible 4 under this subchapter; or 5 (iv) Any procedure undertaken because the individual 6 suffers from a physical disorder, physical injury, or physical illness that 7 would, as certified by a physician, place the individual in imminent danger 8 of death or impairment of major bodily function unless surgery is performed; 9 (7) “Genital gender reassignment surgery” means a medical 10 procedure performed for the purpose of assisting an individual with a gender 11 transition, including without limitation: 12 (A) Surgical procedures such as penectomy, orchiectomy, 13 vaginoplasty, clitoroplasty, or vulvoplasty for biologically male patients or 14 hysterectomy or ovariectomy for biologically female patients; 15 (B) Reconstruction of the fixed part of the urethra with 16 or without a metoidioplasty; or 17 (C) Phalloplasty, vaginectomy, scrotoplasty, or 18 implantation of erection or testicular prostheses for biologically female 19 patients; 20 (8) “Healthcare professional” a person who is licensed, 21 certified, or otherwise authorized by the laws of this state to administer 22 health care in the ordinary course of the practice of his or her profession; 23 (9) “Nongenital gender reassignment surgery” means medical 24 procedures performed for the purpose of assisting an individual with a gender 25 transition including without limitation: 26 (A) Surgical procedures for biologically male patients, 27 such as augmentation mammoplasty, facial feminization surgery, liposuction, 28 lipofilling, voice surgery, thyroid cartilage reduction, gluteal 29 augmentation, hair reconstruction, or various aesthetic procedures; or 30 (B) Surgical procedures for biologically female patients, 31 such as subcutaneous mastectomy, voice surgery, liposuction, lipofilling, 32 pectoral implants, or various aesthetic procedures; 33 (10) “Physician” means a person who is licensed to practice 34 medicine in this state; 35 (11) “Puberty-blocking drugs” means gonadotropin-releasing 36 As Engrossed: H3/2/21 H3/8/21 HB1570 8 03-08-2021 11:23:08 JMB259 hormone analogues or other synthetic drugs used in biological males to stop 1 luteinizing hormone secretion and therefore testosterone secretion, or 2 synthetic drugs used in biological females which stop the production of 3 estrogens and progesterone, when used to delay or suppress pubertal 4 development in children for the purpose of assisting an individual with a 5 gender transition; and 6 (12) “Public funds” means state, county, or local government 7 monies, in addition to any department, agency, or instrumentality authorized 8 or appropriated under state law or derived from any fund in which such moneys 9 are deposited. 10 11 20-9-1502. Prohibition of gender transition procedures for minors. 12 (a) A physician or other healthcare professional shall not provide 13 gender transition procedures to any individual under eighteen (18) years of 14 age. 15 (b) A physician, or other healthcare professional shall not refer any 16 individual under eighteen (18) years of age to any healthcare professional 17 for gender transition procedures. 18 (c) A physician or other healthcare professional is not prohibited 19 from providing any of the following procedures which are not gender 20 transition procedures to an individual under eighteen (18) years of age: 21 (1) Services to persons born with a medically verifiable 22 disorder of sex development, including a person with external biological sex 23 characteristics that are irresolvably ambiguous, such as those born with 46 24 XX chromosomes with virilization, 46 XY chromosomes with undervirilization, 25 or having both ovarian and testicular tissue; 26 (2) Services provided when a physician has otherwise diagnosed a 27 disorder of sexual development that the physician has determined through 28 genetic or biochemical testing that the person does not have normal sex 29 chromosome structure, sex steroid hormone production, or sex steroid hormone 30 action; 31 (3) The treatment of any infection, injury, disease, or disorder 32 that has been caused by or exacerbated by the performance of gender 33 transition procedures, whether or not the gender transition procedure was 34 performed in accordance with state and federal law or whether not funding for 35 the gender transition procedure is permissible under this subchapter; or 36 As Engrossed: H3/2/21 H3/8/21 HB1570 9 03-08-2021 11:23:08 JMB259 (4) Any procedure undertaken because the individual suffers from 1 a physical disorder, physical injury, or physical illness that would, as 2 certified by a physician, place the individual in imminent danger of death or 3 impairment of major bodily function unless surgery is performed. 4 5 20-9-1503. Prohibition on use of public funds for gender transition 6 procedures. 7 (a) Public funds shall not be directly or indirectly used, granted, 8 paid, or distributed to any entity, organization, or individual that provides 9 gender transition procedures to an individual under eighteen (18) years of 10 age. 11 (b) Healthcare services furnished in the following situations shall 12 not include gender transition procedures to an individual under eighteen (18) 13 years of age: 14 (1) By or in a healthcare facility owned by the state or a 15 county or local government; or 16 (2) By a physician or other healthcare professional employed by 17 state or a county or local government. 18 (c) Any amount paid by an individual or an entity during a taxable 19 year for provision of gender transition procedures or as premiums for health 20 care coverage that includes coverage for gender transition procedures is not 21 tax-deductible. 22 (d) The Arkansas Medicaid Program shall not reimburse or provide 23 coverage for gender transition procedures to an individual under eighteen 24 (18) years of age. 25 26 20-9-1504. Enforcement. 27 (a) Any referral for or provision of gender transition procedures to 28 an individual under eighteen (18) year of age is unprofessional conduct and 29 is subject to discipline by the appropriate licensing entity or disciplinary 30 review board with competent jurisdiction in this state. 31 (b) A person may assert an actual or threatened violation of this 32 subchapter as a claim or defense in a judicial or administrative proceeding 33 and obtain compensatory damages, injunctive relief, declaratory relief, or 34 any other appropriate relief. 35 (c)(1) A person shall bring a claim for a violation of this subchapter 36 As Engrossed: H3/2/21 H3/8/21 HB1570 10 03-08-2021 11:23:08 JMB259 no later than two (2) years after the day the cause of action accrues. 1 (2) An individual under eighteen (18) years of age may bring an 2 action throughout their minority through a parent or next friend, and may 3 bring an action in their own name upon reaching majority at any time from 4 that point until twenty (20) years after reaching the age of majority. 5 (d) Notwithstanding any other provision of law, an action under this 6 subchapter may be commenced, and relief may be granted, in a judicial 7 proceeding without regard to whether the person commencing the action has 8 sought or exhausted available administrative remedies. 9 (e) In any action or proceeding to enforce a provision of this 10 subchapter, a prevailing party who establishes a violation of this subchapter 11 shall recover reasonable attorneys’ fees. 12 (f)(1) The Attorney General may bring an action to enforce compliance 13 with this subchapter. 14 (2) This subchapter does not deny, impair, or otherwise affect 15 any right or authority of the Attorney General, the State of Arkansas, or any 16 agency, officer, or employee of the state, acting under any law other than 17 this subchapter, to institute or intervene in any proceeding. 18 19 SECTION 4. Arkansas Code Title 23, Chapter 79, Subchapter 1, is 20 amended to add an additional section to read as follows: 21 23-79-164. Insurance coverage of gender transition procedures for 22 minors prohibited. 23 (a) As used in this section, "gender transition procedures" means the 24 same as defined in § 20-9-1501. 25 (b) A health benefit plan under an insurance policy or other plan 26 providing healthcare coverage in this state shall not include reimbursement 27 for gender transition procedures for a person under eighteen (18) years of 28 age. 29 (c) A health benefit plan under an insurance policy or other plan 30 providing healthcare coverage in this state is not required to provide 31 coverage for gender transition procedures. 32 33 /s/Lundstrum 34 APPROVED: BECAME LAW ON 4/6/21 ON OVERRIDE OF GOVERNOR'S VETO. 35 36