Text of IN HB 1231 (2023)

Introduced Version HOUSE BILL No. 1231 _____ DIGEST OF INTRODUCED BILL Citations Affected: IC 12-15-1-23; IC 16-18-2; IC 16-35-12; IC 27-2-28; IC 34-18-1-1. Synopsis: Gender transition procedures for minors. Prohibits specified health care professionals from providing gender transition procedures to a minor that are intended to alter the gender of the minor or delay puberty. Provides for certain medical exceptions. Prohibits public funds, Medicaid, or a health carrier from providing reimbursement or coverage for gender transition procedures to a minor. Creates a civil cause of action. Makes conforming changes. Effective: July 1, 2023. Lauer January 10, 2023, read first time and referred to Committee on Public Health. 2023 IN 1231—LS 7276/DI 147 Introduced First Regular Session of the 123rd General Assembly (2023) PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in this style type. Additions: Whenever a new statutory provision is being enacted (or a new constitutional provision adopted), the text of the new provision will appear in this style type. Also, the word NEW will appear in that style type in the introductory clause of each SECTION that adds a new provision to the Indiana Code or the Indiana Constitution. Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts between statutes enacted by the 2022 Regular Session of the General Assembly. HOUSE BILL No. 1231 A BILL FOR AN ACT to amend the Indiana Code concerning health. Be it enacted by the General Assembly of the State of Indiana: 1 SECTION 1. IC 12-15-1-23 IS ADDED TO THE INDIANA CODE 2 AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 3 1, 2023]: Sec. 23. The office may not use federal or state funds 4 under the Medicaid program to pay or provide coverage for 5 gender transition procedures (as defined by IC 16-35-12-6) to an 6 individual who is less than eighteen (18) years of age. 7 SECTION 2. IC 16-18-2-36.1 IS ADDED TO THE INDIANA 8 CODE AS A NEW SECTION TO READ AS FOLLOWS 9 [EFFECTIVE JULY 1, 2023]: Sec. 36.1. "Biological sex", for 10 purposes of IC 16-35-12, has the meaning set forth in 11 IC 16-35-12-1. 12 SECTION 3. IC 16-18-2-88.7 IS ADDED TO THE INDIANA 13 CODE AS A NEW SECTION TO READ AS FOLLOWS 14 [EFFECTIVE JULY 1, 2023]: Sec. 88.7. "Cross sex hormones", for 15 purposes of IC 16-35-12, has the meaning set forth in 16 IC 16-35-12-2. 17 SECTION 4. IC 16-18-2-144.2 IS ADDED TO THE INDIANA 2023 IN 1231—LS 7276/DI 147 2 1 CODE AS A NEW SECTION TO READ AS FOLLOWS 2 [EFFECTIVE JULY 1, 2023]: Sec. 144.2. "Gender", for purposes of 3 IC 16-35-12, has the meaning set forth in IC 16-35-12-3. 4 SECTION 5. IC 16-18-2-144.3 IS ADDED TO THE INDIANA 5 CODE AS A NEW SECTION TO READ AS FOLLOWS 6 [EFFECTIVE JULY 1, 2023]: Sec. 144.3. "Gender reassignment 7 surgery", for purposes of IC 16-35-12, has the meaning set forth in 8 IC 16-35-12-4. 9 SECTION 6. IC 16-18-2-144.4 IS ADDED TO THE INDIANA 10 CODE AS A NEW SECTION TO READ AS FOLLOWS 11 [EFFECTIVE JULY 1, 2023]: Sec. 144.4. "Gender transition", for 12 purposes of IC 16-35-12, has the meaning set forth in 13 IC 16-35-12-5. 14 SECTION 7. IC 16-18-2-144.5 IS ADDED TO THE INDIANA 15 CODE AS A NEW SECTION TO READ AS FOLLOWS 16 [EFFECTIVE JULY 1, 2023]: Sec. 144.5. "Gender transition 17 procedures", for purposes of IC 16-35-12, has the meaning set 18 forth in IC 16-35-12-6. 19 SECTION 8. IC 16-18-2-148.2 IS ADDED TO THE INDIANA 20 CODE AS A NEW SECTION TO READ AS FOLLOWS 21 [EFFECTIVE JULY 1, 2023]: Sec. 148.2. "Genital gender 22 reassignment surgery", for purposes of IC 16-35-12, has the 23 meaning set forth in IC 16-35-12-7. 24 SECTION 9. IC 16-18-2-157.2 IS ADDED TO THE INDIANA 25 CODE AS A NEW SECTION TO READ AS FOLLOWS 26 [EFFECTIVE JULY 1, 2023]: Sec. 157.2. "Harm", for purposes of 27 IC 16-35-12, has the meaning set forth in IC 16-35-12-8. 28 SECTION 10. IC 16-18-2-162, AS AMENDED BY P.L.212-2005, 29 SECTION 5, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE 30 JULY 1, 2023]: Sec. 162. (a) "Health care professional", for purposes 31 of IC 16-27-1 and IC 16-27-4, has the meaning set forth in 32 IC 16-27-1-1. 33 (b) "Health care professional", for purposes of IC 16-27-2, has the 34 meaning set forth in IC 16-27-2-1. 35 (c) "Health care professional", for purposes of IC 16-35-12, has 36 the meaning set forth in IC 16-35-12-9. 37 SECTION 11. IC 16-18-2-250.5 IS ADDED TO THE INDIANA 38 CODE AS A NEW SECTION TO READ AS FOLLOWS 39 [EFFECTIVE JULY 1, 2023]: Sec. 250.5. "Nongenital gender 40 reassignment surgery", for purposes of IC 16-35-12, has the 41 meaning set forth in IC 16-35-12-11. 42 SECTION 12. IC 16-18-2-296.7 IS ADDED TO THE INDIANA 2023 IN 1231—LS 7276/DI 147 3 1 CODE AS A NEW SECTION TO READ AS FOLLOWS 2 [EFFECTIVE JULY 1, 2023]: Sec. 296.7. "Puberty blocking drugs", 3 for purposes of IC 16-35-12, has the meaning set forth in 4 IC 16-35-12-12. 5 SECTION 13. IC 16-18-2-297.2 IS ADDED TO THE INDIANA 6 CODE AS A NEW SECTION TO READ AS FOLLOWS 7 [EFFECTIVE JULY 1, 2023]: Sec. 297.2. "Public funds", for 8 purposes of IC 16-35-12, has the meaning set forth in 9 IC 16-35-12-13. 10 SECTION 14. IC 16-35-12 IS ADDED TO THE INDIANA CODE 11 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE 12 JULY 1, 2023]: 13 Chapter 12. Gender Transition Procedures for Minors 14 Sec. 1. As used in this chapter, "biological sex" means the 15 biological indication of male and female in the context of 16 reproductive potential or capacity, including sex chromosomes, 17 naturally occurring sex hormones, gonads, and nonambiguous 18 internal and external genitalia present at birth, without regard to 19 an individual's psychological, chosen, or subjective experience of 20 gender. 21 Sec. 2. As used in this chapter, "cross sex hormones" means the 22 following: 23 (1) Testosterone or other androgens given to biological sex 24 females in amounts that are larger or more potent than would 25 normally occur naturally in healthy biological sex females. 26 (2) Estrogen given to biological sex males in amounts that are 27 larger or more potent than would normally occur naturally in 28 healthy biological sex males. 29 Sec. 3. As used in this chapter, "gender" means the 30 psychological, behavioral, social, and cultural aspects of being male 31 or female. 32 Sec. 4. As used in this chapter, "gender reassignment surgery" 33 means any medical or surgical service that seeks to surgically alter 34 or remove healthy physical or anatomical characteristics or 35 features that are typical for the individual's biological sex, in order 36 to instill or create physiological or anatomical characteristics that 37 resemble a sex different from the individual's biological sex, 38 including genital gender reassignment surgery or nongenital 39 gender reassignment surgery performed for the purpose of 40 assisting an individual with a gender transition. 41 Sec. 5. As used in this chapter, "gender transition" means the 42 process in which an individual shifts from identifying with and 2023 IN 1231—LS 7276/DI 147 4 1 living as a gender that corresponds to his or her biological sex to 2 identifying with and living as a gender different from his or her 3 biological sex, and may involve social, legal, or physical changes. 4 Sec. 6. (a) As used in this chapter, "gender transition 5 procedures" means any medical or surgical service, including 6 physician's services, inpatient and outpatient hospital services, or 7 prescribed drugs related to gender transition that seeks to: 8 (1) alter or remove physical or anatomical characteristics or 9 features that are typical for the individual's biological sex; or 10 (2) instill or create physiological or anatomical characteristics 11 that resemble a sex different from the individual's biological 12 sex, including medical services that provide puberty blocking 13 drugs, cross sex hormones, or other mechanisms to promote 14 the development of feminizing or masculinizing features in the 15 opposite biological sex, or genital gender reassignment 16 surgery or nongenital gender reassignment surgery 17 performed for the purpose of assisting an individual with a 18 gender transition. 19 (b) The term does not include the following: 20 (1) Services to an individual born with a medically verifiable 21 disorder of sex development, including an individual with: 22 (A) external biological sex characteristics that are 23 irresolvably ambiguous; 24 (B) forty-six (46) XX chromosomes with virilization; 25 (C) forty-six (46) XY chromosomes with undervirilization; 26 or 27 (D) both ovarian and testicular tissue. 28 (2) Services provided when a physician has diagnosed a 29 disorder of sexual development that the physician has 30 determined through genetic or biochemical testing that the 31 individual does not have normal sex chromosome structure, 32 sex steroid hormone production, or sex steroid hormone 33 action. 34 (3) The treatment of any infection, injury, disease, or disorder 35 that has been caused by or exacerbated by the performance of 36 gender transition procedures. 37 (4) Any procedure undertaken because the individual suffers 38 from a physical disorder, physical injury, or physical illness 39 that would, as certified by a physician, place the individual in 40 imminent danger of death or impairment of major bodily 41 function unless surgery is performed. 42 Sec. 7. As used in this chapter, "genital gender reassignment 2023 IN 1231—LS 7276/DI 147 5 1 surgery" means a medical procedure performed for the purpose of 2 assisting an individual with a gender transition, including the 3 following: 4 (1) Surgical procedures, including a penectomy, orchiectomy, 5 vaginoplasty, clitoroplasty, or vulvoplasty for biological sex 6 male patients or hysterectomy or ovariectomy for biological 7 sex female patients. 8 (2) Reconstruction of the fixed part of the urethra with or 9 without a metoidioplasty. 10 (3) Phalloplasty, vaginectomy, scrotoplasty, or implantation 11 of erection or testicular prostheses for biological sex female 12 patients. 13 Sec. 8. As used in this chapter, "harm" includes the following: 14 (1) Physical injury. 15 (2) Psychological harm or impairment. 16 (3) Emotional distress. 17 Sec. 9. As used in this chapter, "health care professional" refers 18 to the following: 19 (1) A physician licensed under IC 25-22.5. 20 (2) A nurse, including an advanced practice registered nurse, 21 licensed under IC 25-23. 22 (3) Any of the behavioral health or human services 23 professionals licensed under IC 25-23.6. 24 (4) A physician assistant licensed under IC 25-27.5. 25 (5) A psychologist licensed under IC 25-33. 26 Sec. 10. As used in this chapter, "minor" means an individual 27 who is less than eighteen (18) years of age. 28 Sec. 11. As used in this chapter, "nongenital gender 29 reassignment surgery" means medical procedures performed for 30 the purpose of assisting an individual with a gender transition, 31 including the following: 32 (1) Surgical procedures for biological sex male patients, 33 including augmentation mammoplasty, facial feminization 34 surgery, liposuction, lipofilling, voice surgery, thyroid 35 cartilage reduction, gluteal augmentation, hair 36 reconstruction, or associated aesthetic procedures. 37 (2) Surgical procedures for biological sex female patients, 38 including subcutaneous mastectomy, voice surgery, 39 liposuction, lipofilling, pectoral implants, or associated 40 aesthetic procedures. 41 Sec. 12. As used in this chapter, "puberty blocking drugs" 42 means: 2023 IN 1231—LS 7276/DI 147 6 1 (1) gonadotropin releasing hormone analogs or other 2 synthetic drugs used in biological sex males to stop luteinizing 3 hormone secretion and testosterone secretion; or 4 (2) synthetic drugs used in biological sex females that stop the 5 production of estrogens and progesterone; 6 when used to delay or suppress pubertal development in a minor 7 for the purpose of assisting an individual with a gender transition. 8 Sec. 13. As used in this chapter, "public funds" means state, 9 county, or local government funds, in addition to any department, 10 agency, or instrumentality authorized or appropriated funds under 11 state law or derived from any fund in which the funds are 12 deposited. 13 Sec. 14. (a) Except as provided in subsection (c), a health care 14 professional may not provide gender transition procedures to a 15 minor. 16 (b) Except as provided in subsection (c), a health care 17 professional may not refer a minor to any practitioner for gender 18 transition procedures. 19 (c) This section does not prohibit a health care professional from 20 providing any of the following procedures to a minor: 21 (1) Services to individuals born with a medically verifiable 22 disorder of sex development, including individuals having: 23 (A) both ovarian and testicular tissue; or 24 (B) external biological characteristics that are ambiguous 25 resulting from having a 46,XX karyotype with virilization 26 or 46,XY karyotype with undervirilization. 27 (2) Services provided to a minor who has an abnormal sex 28 chromosome structure that has been diagnosed using genetic 29 testing by a physician licensed under IC 25-22.5. 30 (3) The treatment of any infection, injury, disease, or disorder 31 that has been caused by or exacerbated by the performance of 32 gender transition procedures. 33 (4) Any procedure undertaken because the individual suffers 34 from a physical disorder, physical injury, or physical illness 35 that would, as certified by a physician, place the individual in 36 imminent danger of death or impairment of major bodily 37 function unless surgery is performed. 38 Sec. 15. Public funds may not be directly or indirectly used, 39 granted, paid, or distributed to any entity, organization, or 40 individual that provides gender transition procedures to a minor. 41 Sec. 16. Health care services furnished in the following 42 situations may not include gender transition procedures to a 2023 IN 1231—LS 7276/DI 147 7 1 minor: 2 (1) By or in a health care facility owned by the state, a county, 3 or a municipality. 4 (2) By a physician or other practitioner employed by state, 5 county, or local government. 6 Sec. 17. (a) An individual, or the individual's parent or guardian 7 if the individual is a minor, who suffers harm as a result of a 8 gender transition procedure provided in violation of this chapter 9 may bring a cause of action against the health care professional 10 who provided the procedure. 11 (b) An action described in subsection (a) must be commenced 12 not later than fifteen (15) years after the individual becomes 13 eighteen (18) years of age. 14 (c) A court may award reasonable attorney's fees, litigation 15 expenses, and costs to a person who prevails in an action under 16 subsection (a). 17 SECTION 15. IC 27-2-28 IS ADDED TO THE INDIANA CODE 18 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE 19 JULY 1, 2023]: 20 Chapter 28. Gender Transition Procedures 21 Sec. 1. As used in this chapter, "coverage" means the right of an 22 individual to receive: 23 (1) health care services; or 24 (2) payment or reimbursement for health care services; 25 from a health carrier. 26 Sec. 2. As used in this section, "gender transition procedures" 27 has the meaning set forth in IC 16-35-12-6. 28 Sec. 3. (a) As used in this chapter, "health carrier" means an 29 entity: 30 (1) that is subject to this title and the administrative rules 31 adopted under this title; and 32 (2) that enters into a contract to: 33 (A) provide health care services; 34 (B) deliver health care services; 35 (C) arrange for health care services; or 36 (D) pay for or reimburse any of the costs of health care 37 services. 38 (b) The term includes the following: 39 (1) An insurer, as defined in IC 27-1-2-3(x), that issues a 40 policy of accident and sickness insurance, as defined in 41 IC 27-8-5-1(a). 42 (2) A health maintenance organization, as defined in 2023 IN 1231—LS 7276/DI 147 8 1 IC 27-13-1-19. 2 (3) An administrator (as defined in IC 27-1-25-1(a)) that is 3 licensed under IC 27-1-25. 4 (4) A state employee health plan offered under IC 5-10-8. 5 (5) A short term insurance plan (as defined by IC 27-8-5.9-3). 6 (6) Any other entity that provides a plan of health insurance, 7 health benefits, or health care services. 8 (c) The term does not include: 9 (1) an insurer that issues a policy of accident and sickness 10 insurance; 11 (2) a limited service health maintenance organization (as 12 defined in IC 27-13-34-4); or 13 (3) an administrator; 14 that only provides coverage for, or processes claims for, dental or 15 vision care services. 16 Sec. 4. (a) A health plan may not include coverage or 17 reimbursement for gender transition procedures for an individual 18 who is less than eighteen (18) years of age. 19 (b) A health plan is not required to provide coverage for gender 20 transition procedures. 21 SECTION 16. IC 34-18-1-1 IS AMENDED TO READ AS 22 FOLLOWS [EFFECTIVE JULY 1, 2023]: Sec. 1. This article does not 23 apply to: 24 (1) an act of malpractice that occurred before July 1, 1975; or 25 (2) an action brought under IC 16-35-12 (gender transition 26 procedures for minors). 2023 IN 1231—LS 7276/DI 147