Text of MO SB 598 (2023)

FIRST REGULAR SESSION SENATE BILL NO. 598 102ND GENERAL ASSEMBLY INTRODUCED BY SENATOR BRATTIN. 2176S.01I KRISTINA MARTIN, Secretary AN ACT To amend chapter 191, RSMo, by adding thereto seven new sections relating to gender transition procedures, with a delayed effective date. Be it enacted by the General Assembly of the State of Missouri, as follows: Section A. Chapter 191, RSMo, is amended by adding thereto 1 seven new sections, to be known as sections 191.1720, 191.1725, 2 191.1730, 191.1735, 191.1740, 191.1742, and 191.1745, to read 3 as follows: 4 191.1720. Sections 191.1720 to 191.1745 shall be known 1 and may be cited as the "Missouri Child and Adolescent 2 Protection (MCAP) Act". 3 191.1725. For purposes of sections 191.1720 to 1 191.1745, the following terms mean: 2 (1) "Biological sex", the biological indication of 3 male or female in the context of reproductive potential or 4 capacity, such as sex chromosomes, naturally occurring sex 5 hormones, gonads, and nonambiguous internal and external 6 genitalia present at birth, without regard to an 7 individual's psychological, chosen, or subjective experience 8 of gender; 9 (2) "Cross-sex hormones": 10 (a) Testosterone or other androgens given to 11 biological sex females in amounts that are larger or more 12 potent than would normally occur naturally in healthy 13 biological sex females; and 14 SB 598 2 (b) Estrogen given to biological sex males in amounts 15 that are larger or more potent than would normally occur 16 naturally in healthy biological sex males; 17 (3) "Gender", the psychological, behavioral, social, 18 and cultural aspects of being male or female; 19 (4) "Gender transition", the process in which an 20 individual transitions from identifying with and living as a 21 gender that corresponds to his or her biological sex to 22 identifying with and living as a gender different from his 23 or her biological sex and may involve social, legal, or 24 physical changes; 25 (5) "Gender transition procedure": 26 (a) Any medical or surgical service, including, but 27 not limited to, physician's services, inpatient and 28 outpatient hospital services, or prescribed drugs, related 29 to gender transition that seeks to: 30 a. Alter or remove physical or anatomical 31 characteristics or features that are typical for the 32 individual's biological sex; or 33 b. Instill or create physiological or anatomical 34 characteristics that resemble a sex different from the 35 individual's biological sex, including, but not limited to: 36 (i) Medical services that provide puberty-blocking 37 drugs, cross-sex hormones, or other mechanisms to promote 38 the development of features commonly associated with members 39 of the opposite sex; or 40 (ii) Genital or nongenital gender reassignment surgery 41 performed for the purpose of assisting an individual with a 42 gender transition; 43 (b) The term "gender transition procedure" shall not 44 include: 45 SB 598 3 a. Services to individuals born with a medically 46 verifiable disorder of sex development, including, but not 47 limited to, an individual with external biological sex 48 characteristics that are irresolvably ambiguous, such as 49 those born with 46,XX chromosomes with virilization, 46,XY 50 chromosomes with undervirilization, or having both ovarian 51 and testicular tissue; 52 b. Services provided when a physician has otherwise 53 diagnosed an individual with a disorder of sex development 54 and determined through genetic or biochemical testing that 55 the individual does not have normal sex chromosome 56 structure, sex steroid hormone production, or sex steroid 57 hormone action; 58 c. The treatment of any infection, injury, disease, or 59 disorder that has been caused by or exacerbated by the 60 performance of gender transition procedures regardless of 61 whether the gender transition procedure was performed in 62 accordance with state and federal law; or 63 d. Any procedure undertaken because the individual 64 suffers from a physical disorder, physical injury, or 65 physical illness that would, as certified by a physician, 66 place the individual in imminent danger of death or 67 impairment of a major bodily function unless surgery is 68 performed; 69 (6) "Genital gender reassignment surgery", a medical 70 procedure performed for the purpose of assisting an 71 individual with a gender transition, including, but not 72 limited to: 73 (a) Surgical procedures such as penectomy, 74 orchiectomy, vaginoplasty, clitoroplasty, or vulvoplasty for 75 biologically male patients or hysterectomy or ovariectomy 76 for biologically female patients; 77 SB 598 4 (b) Reconstruction of the fixed part of the urethra 78 with or without a metoidioplasty; or 79 (c) Phalloplasty, vaginectomy, scrotoplasty, or 80 implantation of erection or testicular prostheses for 81 biologically female patients; 82 (7) "Health care provider", an individual who is 83 licensed, certified, or otherwise authorized by the laws of 84 this state to administer health care in the ordinary course 85 of the practice of his or her profession, including mental 86 health care providers; 87 (8) "Nongenital gender reassignment surgery", a 88 medical procedure performed for the purpose of assisting an 89 individual with a gender transition, including, but not 90 limited to: 91 (a) Surgical procedures for biologically male 92 patients, such as augmentation mammoplasty, facial 93 feminization surgery, liposuction, lipofilling, voice 94 surgery, thyroid cartilage reduction, gluteal augmentation, 95 hair reconstruction, or various aesthetic procedures; or 96 (b) Surgical procedures for biologically female 97 patients, such as subcutaneous mastectomy, voice surgery, 98 liposuction, lipofilling, pectoral implants, or various 99 aesthetic procedures; 100 (9) "Physician", an individual who is licensed as a 101 physician under chapter 334; 102 (10) "Puberty-blocking drugs", gonadotropin-releasing 103 hormone analogues or other synthetic drugs used in 104 biological sex males to stop luteinizing hormone secretion 105 and therefore testosterone secretion, or synthetic drugs 106 used in biological sex females that stop the production of 107 estrogens and progesterone, when used to delay or suppress 108 SB 598 5 pubertal development in children for the purpose of 109 assisting an individual with a gender transition; 110 (11) "Public funds", any funds received or controlled 111 by this state or any agency or political subdivision 112 thereof, including, but not limited to, funds derived from 113 federal, state or local taxes, gifts or grants from any 114 source, public or private, federal grants or payments, or 115 intergovernmental transfers. 116 191.1730. A physician or other health care provider 1 shall not knowingly provide gender transition procedures to 2 any individual under eighteen years of age and shall not 3 refer any individual under eighteen years of age to any 4 health care provider for gender transition procedures. 5 191.1735. 1. Public funds shall not be directly or 1 indirectly used, granted, paid, or distributed to any 2 individual, entity, or organization that provides gender 3 transition procedures to an individual under eighteen years 4 of age. 5 2. The MO HealthNet program shall not reimburse or 6 provide coverage for gender transition procedures to an 7 individual under eighteen years of age. 8 3. The provisions of this section shall not apply to 9 any speech protected by the First Amendment of the United 10 States Constitution. 11 191.1740. Any referral for or provision of gender 1 transition procedures to an individual under eighteen years 2 of age shall be considered unprofessional conduct and any 3 health care provider doing so may be subject to discipline 4 by the appropriate licensing entity or disciplinary review 5 board with competent jurisdiction in this state. 6 191.1742. Sections 191.1720 to 191.1745 shall not 1 apply to the provision of cross-sex hormones to any 2 SB 598 6 individual under eighteen years of age who was prescribed 3 cross-sex hormones before January 1, 2024, to treat an 4 inconsistency between the individual's biological sex and 5 the individual's perceived gender or perceived sex. 6 191.1745. 1. The provision of a gender transition 1 procedure to an individual under eighteen years of age in 2 violation of sections 191.1720 to 191.1745 shall be 3 considered grounds for a cause of action against the 4 physician or health care provider. 5 2. The provisions of chapter 538 shall not apply to 6 any action brought under this section. 7 3. (1) An individual under eighteen years of age may 8 bring an action under this section throughout the 9 individual's minority through a parent or next friend and 10 may bring an action under this section in the individual's 11 own name upon reaching the age of majority at any time from 12 that point until twenty years after reaching the age of 13 majority or four years from the time of discovery by the 14 injured party of both the injury and the causal relationship 15 between the treatment and the injury, whichever date is 16 later. 17 (2) If, at the time the individual described in 18 subsection 1 of this section attains eighteen years of age, 19 he or she is under a legal disability, the limitation period 20 under subdivision (1) of this subsection shall not begin to 21 run until the removal of the disability. 22 (3) The limitation period in subdivision (1) of this 23 subsection shall not run during a time period when the 24 individual is subject to threats, intimidation, 25 manipulation, fraudulent concealment, or fraud perpetrated 26 by the physician or other health care professional who 27 prescribed or otherwise provided gender transition 28 SB 598 7 procedures or by any person acting in the interest of the 29 physician or other health care professional. 30 4. (1) An individual may assert an actual or 31 threatened violation of sections 191.1720 to 191.1745 as a 32 claim or defense in a judicial proceeding. 33 (2) The following damages may be awarded to a claimant 34 described in subdivision (1) of this subsection: 35 (a) Compensatory damages including, but not limited to: 36 a. Pain and suffering; 37 b. Loss of reputation; 38 c. Loss of income; and 39 d. Loss of consortium including, but not limited to, 40 the loss of expectation of sharing parenthood; 41 (b) Injunctive relief; 42 (c) Declaratory judgment; 43 (d) Punitive damages; and 44 (e) Any other appropriate relief. 45 (3) A prevailing party who establishes a violation of 46 sections 191.1720 to 191.1745 shall recover reasonable 47 attorney's fees. 48 5. Notwithstanding any other provision of law to the 49 contrary, an action under this section may be commenced, and 50 relief may be granted, in a judicial proceeding without 51 regard to whether the individual commencing the action has 52 sought or exhausted available administrative remedies. 53 6. The attorney general may bring an action to enforce 54 compliance with sections 191.1720 to 191.1745. 55 7. Sections 191.1720 to 191.1745 do not deny, impair, 56 or otherwise affect any right or authority of the attorney 57 general, the state, or any agency, officer, or employee of 58 the state, acting under any law other than sections 191.1720 59 to 191.1745, to institute or intervene in any proceeding. 60 SB 598 8 Section B. The enactment of sections 191.1720 to 1 191.1745 of this act shall become effective on January 1, 2 2024. 3 