Text of IN SB 480 (2023)

Introduced Version SENATE BILL No. 480 _____ DIGEST OF INTRODUCED BILL Citations Affected: IC 25-1-22. Synopsis: Gender transition procedures for minors. Prohibits a physician or other practitioner from knowingly providing gender transition procedures to an individual who is less than 18 years of age (minor) that are intended to alter the gender of the minor or delay puberty. Provides for certain medical exceptions. Establishes civil enforcement actions. Effective: July 1, 2023. Johnson T, Byrne, Donato, Doriot, Gaskill, Buck, Ford Jon, Freeman, Raatz, Zay, Walker G, Messmer, Sandlin, Rogers, Tomes, Niemeyer, Buchanan, Alexander January 19, 2023, read first time and referred to Committee on Health and Provider Services. 2023 IN 480—LS 7334/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. SENATE BILL No. 480 A BILL FOR AN ACT to amend the Indiana Code concerning professions and occupations. Be it enacted by the General Assembly of the State of Indiana: 1 SECTION 1. IC 25-1-22 IS ADDED TO THE INDIANA CODE AS 2 A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY 3 1, 2023]: 4 Chapter 22. Gender Transition Procedures for Minors 5 Sec. 1. As used in this chapter, "cross sex hormones" means the 6 following: 7 (1) Testosterone or other androgens given to a female sex 8 individual in an amount that are larger or more potent than 9 would normally occur naturally in a healthy female sex 10 individual. 11 (2) Estrogen given to a male sex individual in an amount that 12 is larger or more potent than would normally occur naturally 13 in a healthy male sex individual. 14 Sec. 2. As used in this chapter, "gender" means the 15 psychological, behavioral, social, and cultural aspects of being male 16 or female. 17 Sec. 3. As used in this chapter, "gender reassignment surgery" 2023 IN 480—LS 7334/DI 147 2 1 means any medical or surgical service that seeks to surgically alter 2 or remove healthy physical or anatomical characteristics or 3 features that are typical for the individual's sex, in order to instill 4 or create physiological or anatomical characteristics that resemble 5 a sex different from the individual's sex, including genital gender 6 reassignment surgery or nongenital gender reassignment surgery 7 knowingly performed for the purpose of assisting an individual 8 with a gender transition. 9 Sec. 4. As used in this chapter, "gender transition" means the 10 process in which an individual shifts from identifying with and 11 living as a gender that corresponds to his or her sex to identifying 12 with and living as a gender different from his or her sex, and may 13 involve social, legal, or physical changes. 14 Sec. 5. (a) As used in this chapter, "gender transition 15 procedures" means any medical or surgical service, including 16 physician's services, inpatient and outpatient hospital services, or 17 prescribed drugs related to gender transition, that seeks to: 18 (1) alter or remove physical or anatomical characteristics or 19 features that are typical for the individual's sex; or 20 (2) instill or create physiological or anatomical characteristics 21 that resemble a sex different from the individual's sex, 22 including medical services that provide puberty blocking 23 drugs, cross sex hormones, or other mechanisms to promote 24 the development of feminizing or masculinizing features in the 25 opposite sex, or genital gender reassignment surgery or 26 nongenital gender reassignment surgery knowingly 27 performed for the purpose of assisting an individual with a 28 gender transition. 29 (b) The term does not include the following: 30 (1) Services to an individual born with a medically verifiable 31 disorder of sex development, including an individual with: 32 (A) external sex characteristics that are irresolvably 33 ambiguous; 34 (B) forty-six (46) XX chromosomes with virilization; 35 (C) forty-six (46) XY chromosomes with undervirilization; 36 or 37 (D) both ovarian and testicular tissue. 38 (2) Services provided when a physician has diagnosed a 39 disorder of sexual development that the physician has 40 determined through genetic or biochemical testing that the 41 individual does not have normal sex chromosome structure, 42 sex steroid hormone production, or sex steroid hormone 2023 IN 480—LS 7334/DI 147 3 1 action. 2 (3) The treatment of any infection, injury, disease, or disorder 3 that has been caused by or exacerbated by the performance of 4 gender transition procedures. 5 (4) Any procedure undertaken because the individual suffers 6 from a physical disorder, physical injury, or physical illness 7 that would, as certified by a physician, place the individual in 8 imminent danger of death or impairment of major bodily 9 function unless surgery is performed. 10 Sec. 6. As used in this chapter, "genital gender reassignment 11 surgery" means a medical procedure knowingly performed for the 12 purpose of assisting an individual with a gender transition, 13 including the following: 14 (1) Surgical procedures, including a penectomy, orchiectomy, 15 vaginoplasty, clitoroplasty, or vulvoplasty for a male sex 16 patient or hysterectomy or ovariectomy for a female sex 17 patient. 18 (2) Reconstruction of the fixed part of the urethra with or 19 without a metoidioplasty. 20 (3) Phalloplasty, vaginectomy, scrotoplasty, or implantation 21 of erection or testicular prostheses for a female sex patient. 22 Sec. 7. As used in this chapter, "minor" means an individual 23 who is less than eighteen (18) years of age. 24 Sec. 8. As used in this chapter, "nongenital gender reassignment 25 surgery" means medical procedures knowingly performed for the 26 purpose of assisting an individual with a gender transition, 27 including the following: 28 (1) Surgical procedures for a male sex patient, including 29 augmentation mammoplasty, facial feminization surgery, 30 liposuction, lipofilling, voice surgery, thyroid cartilage 31 reduction, gluteal augmentation, hair reconstruction, or 32 associated aesthetic procedures. 33 (2) Surgical procedures for a female sex patient, including 34 subcutaneous mastectomy, voice surgery, liposuction, 35 lipofilling, pectoral implants, or associated aesthetic 36 procedures. 37 Sec. 9. As used in this chapter, "physician" means an individual 38 who is licensed under IC 25-22.5. 39 Sec. 10. As used in this chapter, "practitioner" means an 40 individual who provides health services and holds: 41 (1) an unlimited license, certificate, or registration; 42 (2) a limited or probationary license, certificate, or 2023 IN 480—LS 7334/DI 147 4 1 registration; 2 (3) a temporary license, certificate, registration, or permit; 3 (4) an intern permit; or 4 (5) a provisional license; 5 issued by a board regulating the profession in question. 6 Sec. 11. As used in this chapter, "puberty blocking drugs" 7 means: 8 (1) gonadotropin releasing hormone analogues or other 9 synthetic drugs used in a male sex individual to stop 10 luteinizing hormone secretion and testosterone secretion; or 11 (2) synthetic drugs used in a female sex individual that stop 12 the production of estrogens and progesterone; 13 when used to delay or suppress pubertal development in a minor 14 for the purpose of assisting an individual with a gender transition. 15 Sec. 12. As used in this chapter, "sex" means the biological state 16 of being male or female, based on the individual's sex organs, 17 chromosomes, and endogenous hormone profiles. 18 Sec. 13. (a) Except as provided in subsections (c) and (d), a 19 physician or other practitioner may not knowingly provide gender 20 transition procedures to a minor. 21 (b) Except as provided in subsection (c), a physician or other 22 practitioner may not refer a minor to any practitioner for gender 23 transition procedures. 24 (c) This section does not prohibit a physician or other 25 practitioner from providing any of the following procedures to a 26 minor: 27 (1) Services to individuals born with a medically verifiable 28 disorder of sex development, including an individual with 29 external biological sex characteristics that are irresolvably 30 ambiguous, including individuals born with forty-six (46) XX 31 chromosomes with virilization, born with forty-six (46) XY 32 chromosomes with undervirilization, or having both ovarian 33 and testicular tissue. 34 (2) Services provided when a physician has diagnosed a 35 disorder of sexual development that the physician has 36 determined through genetic or biochemical testing that the 37 individual does not have normal sex chromosome structure, 38 sex steroid hormone production, or sex steroid hormone 39 action. 40 (3) The treatment of any infection, injury, disease, or disorder 41 that has been caused by or exacerbated by the performance of 42 gender transition procedures. 2023 IN 480—LS 7334/DI 147 5 1 (4) Any procedure undertaken because the individual suffers 2 from a physical disorder, physical injury, or physical illness 3 that would, as certified by a physician, place the individual in 4 imminent danger of death or impairment of major bodily 5 function unless surgery is performed. 6 (d) A physician may continue to prescribe to an individual, who 7 was taking a cross sex hormone on June 30, 2023, as part of a 8 gender transition procedure, cross sex hormones until December 9 31, 2023. This subsection expires January 1, 2024. 10 Sec. 14. Health care services furnished in the following 11 situations may not include gender transition procedures to a 12 minor: 13 (1) By or in a health care facility owned by the state, a county, 14 or a municipality. 15 (2) By a physician or other practitioner employed by state, 16 county, or local government. 17 Sec. 15. Any referral for or provision of gender transition 18 procedures by a practitioner for a minor is a violation of standards 19 of practice under IC 25-1-9 and is subject to discipline by the board 20 regulating the practitioner. 21 Sec. 16. A person may assert an actual or threatened violation 22 of this chapter as a claim or defense in a judicial or administrative 23 proceeding and may seek to obtain compensatory damages, 24 injunctive relief, declaratory relief, or any other appropriate relief. 25 Sec. 17. (a) Except as provided in subsections (b) and (c), an 26 individual must bring a claim for a violation of this chapter not 27 more two (2) years after the day the cause of action accrues. 28 (b) A minor, through a parent, guardian, custodian, or next 29 friend, may bring an action for a violation of this chapter. 30 (c) If an individual was less than eighteen (18) years of age when 31 the cause of action for a violation of this chapter accrued, when the 32 individual is eighteen (18) years of age or older, the individual may 33 bring a cause of action at any time until the individual reaches 34 thirty-eight (38) years of age. 35 Sec. 18. (a) Notwithstanding any other law, an action under this 36 chapter may be commenced, and relief may be granted, in a 37 judicial proceeding without regard to whether the person 38 commencing the action has sought or exhausted available 39 administrative remedies. 40 (b) In an action or proceeding to enforce a provision of this 41 chapter, a prevailing party who establishes a violation of this 42 chapter is entitled to recover reasonable attorney's fees. 2023 IN 480—LS 7334/DI 147 6 1 Sec. 19. (a) The attorney general may investigate and bring an 2 action to enforce compliance with this chapter. 3 (b) Nothing in this chapter denies, impairs, or affects any right 4 or authority of the attorney general or any agency, officer, or 5 employee of the state acting under any law to institute or intervene 6 in any proceeding. 2023 IN 480—LS 7334/DI 147

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. SENATE ENROLLED ACT No. 480 AN ACT to amend the Indiana Code concerning professions and occupations. Be it enacted by the General Assembly of the State of Indiana: SECTION 1. IC 25-1-22 IS ADDED TO THE INDIANA CODE AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2023]: Chapter 22. Gender Transition Procedures for Minors Sec. 1. As used in this chapter, "gender" means the psychological, behavioral, social, and cultural aspects of being male or female. Sec. 2. As used in this chapter, "gender reassignment surgery" means any medical or surgical service that seeks to surgically alter or remove healthy physical or anatomical characteristics or features that are typical for the individual's sex, in order to instill or create physiological or anatomical characteristics that resemble a sex different from the individual's sex, including genital gender reassignment surgery or nongenital gender reassignment surgery knowingly performed for the purpose of assisting an individual with a gender transition. Sec. 3. As used in this chapter, "gender transition" means the process in which an individual shifts from identifying with and living as a gender that corresponds to his or her sex to identifying with and living as a gender different from his or her sex, and may involve social, legal, or physical changes. SEA 480 2 Sec. 4. As used in this chapter, "gender transition hormone therapy" means: (1) testosterone; (2) estrogen; or (3) progesterone; given to an individual in an amount greater than would normally be produced endogenously in a healthy individual of that individual's age and sex. Sec. 5. (a) As used in this chapter, "gender transition procedures" means any medical or surgical service, including physician's services, practitioner's services, inpatient and outpatient hospital services, or prescribed drugs related to gender transition, that seeks to: (1) alter or remove physical or anatomical characteristics or features that are typical for the individual's sex; or (2) instill or create physiological or anatomical characteristics that resemble a sex different from the individual's sex, including medical services that provide puberty blocking drugs, gender transition hormone therapy, or genital gender reassignment surgery or nongenital gender reassignment surgery knowingly performed for the purpose of assisting an individual with a gender transition. (b) The term does not include the following: (1) Medical or surgical services to an individual born with a medically verifiable disorder of sex development, including an individual with: (A) external sex characteristics that are irresolvably ambiguous; (B) forty-six (46) XX chromosomes with virilization; (C) forty-six (46) XY chromosomes with undervirilization; or (D) both ovarian and testicular tissue. (2) Medical or surgical services provided when a physician or practitioner has diagnosed a disorder or condition of sexual development that the physician or practitioner 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. (3) The treatment of any infection, injury, disease, or disorder that has been caused by or exacerbated by the performance of gender transition procedures. SEA 480 3 (4) Any medical or surgical service undertaken because the individual suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician or practitioner, place the individual in imminent danger of death or impairment of major bodily function unless the medical or surgical service is performed. (5) Mental health or social services other than gender transition procedures as defined in subsection (a). (6) Services for a disorder or condition of sexual development that is unrelated to a diagnosis of gender dysphoria or gender identity disorder. Sec. 6. As used in this chapter, "genital gender reassignment surgery" means a medical procedure knowingly performed for the purpose of assisting an individual with a gender transition, including the following: (1) Surgical procedures, including a penectomy, orchiectomy, vaginoplasty, clitoroplasty, or vulvoplasty for a male sex patient or hysterectomy or ovariectomy for a female sex patient. (2) Reconstruction of the fixed part of the urethra with or without a metoidioplasty. (3) Phalloplasty, vaginectomy, scrotoplasty, or implantation of erection or testicular prostheses for a female sex patient. Sec. 7. As used in this chapter, "minor" means an individual who is less than eighteen (18) years of age. Sec. 8. As used in this chapter, "nongenital gender reassignment surgery" means medical procedures knowingly performed for the purpose of assisting an individual with a gender transition, including the following: (1) Surgical procedures for a male sex patient, including augmentation mammoplasty, facial feminization surgery, liposuction, lipofilling, voice surgery, thyroid cartilage reduction, gluteal augmentation, hair reconstruction, or associated aesthetic procedures. (2) Surgical procedures for a female sex patient, including subcutaneous mastectomy, voice surgery, liposuction, lipofilling, pectoral implants, or associated aesthetic procedures. Sec. 9. As used in this chapter, "physician" means an individual who is licensed under IC 25-22.5. Sec. 10. As used in this chapter, "practitioner" means an individual who provides health services and holds: SEA 480 4 (1) an unlimited license, certificate, or registration; (2) a limited or probationary license, certificate, or registration; (3) a temporary license, certificate, registration, or permit; (4) an intern permit; or (5) a provisional license; issued by a board regulating the profession in question. Sec. 11. As used in this chapter, "puberty blocking drugs" means: (1) gonadotropin releasing hormone analogues or other synthetic drugs used to stop luteinizing hormone and follicle stimulating hormone secretion; or (2) synthetic antiandrogen drugs used to block the androgen receptor; when used for the purpose of assisting an individual with a gender transition. Sec. 12. As used in this chapter, "sex" means the biological state of being male or female, based on the individual's sex organs, chromosomes, and endogenous hormone profiles. Sec. 13. (a) Except as provided in subsections (c) and (d), a physician or other practitioner may not knowingly provide gender transition procedures to a minor. (b) Except as provided in subsection (c), a physician or other practitioner may not aid or abet another physician or practitioner in the provision of gender transition procedures to a minor. (c) This section does not prohibit a physician or other practitioner from providing any of the following to a minor: (1) Services to individuals born with a medically verifiable disorder of sex development, including an individual with external biological sex characteristics that are irresolvably ambiguous, including individuals born with forty-six (46) XX chromosomes with virilization, born with forty-six (46) XY chromosomes with undervirilization, or having both ovarian and testicular tissue. (2) Services provided when a physician or practitioner has diagnosed a disorder of sexual development that the physician or practitioner 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. (3) The treatment of any infection, injury, disease, or disorder that has been caused by or exacerbated by the performance of SEA 480 5 gender transition procedures. (4) Any medical or surgical service undertaken because the individual suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician or practitioner, place the individual in imminent danger of death or impairment of major bodily function unless the medical or surgical service is performed. (d) A physician or practitioner within the practitioner's scope of practice may continue to prescribe to an individual, who was taking a gender transition hormone therapy on June 30, 2023, as part of a gender transition procedure, gender transition hormone therapy until December 31, 2023. This subsection expires January 1, 2024. Sec. 14. Health care services furnished in the following situations may not include gender transition procedures to a minor: (1) By or in a health care facility owned by the state, a county, or a municipality. (2) By a physician or other practitioner employed by state, county, or local government. Sec. 15. A physician or practitioner that takes any action that aids or abets another physician or practitioner in the provision of gender transition procedures for a minor violates the standards of practice under IC 25-1-9 and is subject to discipline by the board regulating the physician or practitioner. Sec. 16. An: (1) individual who has received gender transition procedures in violation of this chapter; or (2) individual's parent or guardian; may assert an actual or threatened violation of this chapter as a claim or defense in a judicial or administrative proceeding and may seek to obtain compensatory damages, injunctive relief, declaratory relief, or any other appropriate relief. Sec. 17. (a) Except as provided in subsections (b) and (c), an individual must bring a claim for a violation of this chapter not more two (2) years after the day the cause of action accrues. (b) A minor, through a parent, guardian, custodian, or next friend, may bring an action for a violation of this chapter. (c) If an individual was less than eighteen (18) years of age when the cause of action for a violation of this chapter accrued, when the individual is eighteen (18) years of age or older, the individual may bring a cause of action at any time until the individual reaches SEA 480 6 twenty-eight (28) years of age. Sec. 18. (a) Notwithstanding any other law, an action under this chapter may be commenced, and relief may be granted, in a judicial proceeding without regard to whether the person commencing the action has sought or exhausted available administrative remedies. (b) In an action or proceeding to enforce a provision of this chapter, a prevailing party who establishes a violation of this chapter is entitled to recover reasonable attorney's fees. SEA 480 President of the Senate President Pro Tempore Speaker of the House of Representatives Governor of the State of Indiana Date: Time: SEA 480