Text of US HB 1399 (2023)

I 118TH CONGRESS 1ST SESSION H. R. 1399 To amend chapter 110 of title 18, United States Code, to prohibit gender- affirming care on minors, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MARCH 7, 2023 Ms. GREENE of Georgia (for herself, Mrs. MILLER of Illinois, Mr. GOSAR, Mr. GOODEN of Texas, Mr. GROTHMAN, Mr. DUNCAN, Mrs. LUNA, Mrs. HARSHBARGER, Mr. NORMAN, Mr. NEHLS, Mr. GOOD of Virginia, Mr. HERN, Mr. ROSENDALE, Mr. BABIN, Mr. LAMBORN, Mr. HIGGINS of Louisiana, Mr. STEUBE, Ms. HAGEMAN, Mrs. LESKO, and Mr. BIGGS) introduced the following bill; which was referred to the Committee on the Judiciary, and in addition to the Committees on Ways and Means, En- ergy and Commerce, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consider- ation of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend chapter 110 of title 18, United States Code, to prohibit gender-affirming care on minors, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Protect Children’s In- 4 nocence Act’’. 5 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 1399 IH TITLE I—GENDER-AFFIRMING 1 CARE ON MINORS PROHIBITED 2 SEC. 101. GENDER-AFFIRMING CARE ON MINORS PROHIB- 3 ITED. 4 Chapter 110 of title 18, United States Code, is 5 amended— 6 (1) by adding at the end the following: 7 ‘‘§ 2260B. Gender-affirming care on minors 8 ‘‘(a) IN GENERAL.—Whoever, in any circumstance 9 described in subsection (e), knowingly performs any gen- 10 der-affirming care on a minor is guilty of a class C felony. 11 ‘‘(b) PROHIBITION ON PROSECUTION OF PERSON ON 12 WHOM INTERVENTION IS PERFORMED.—No person on 13 whom the gender-affirming care under subsection (a) is 14 performed may be arrested or prosecuted for an offense 15 under this section. 16 ‘‘(c) CIVIL ACTION.—A person on whom gender-af- 17 firming care is performed under this section may bring 18 a civil action for appropriate relief, including compen- 19 satory and punitive damages, against each person who 20 performed the gender-affirming care. 21 ‘‘(d) DEFINITIONS.—In this section: 22 ‘‘(1) GENDER-AFFIRMING CARE.— 23 ‘‘(A) IN GENERAL.—For purposes of this 24 chapter, except as provided in subparagraph 25 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 1399 IH (B), the term ‘gender-affirming care’ means, 1 with respect to an individual, any of the fol- 2 lowing: 3 ‘‘(i) Performing any surgery for the 4 purpose of changing the body of such indi- 5 vidual to correspond to a sex that differs 6 from their biological sex, including— 7 ‘‘(I) castration; 8 ‘‘(II) orchiectomy; 9 ‘‘(III) scrotoplasty; 10 ‘‘(IV) vasectomy; 11 ‘‘(V) hysterectomy; 12 ‘‘(VI) oophorectomy; 13 ‘‘(VII) ovariectomy; 14 ‘‘(VIII) metoidioplasty; 15 ‘‘(IX) penectomy; 16 ‘‘(X) phalloplasty; 17 ‘‘(XI) vaginoplasty; 18 ‘‘(XII) vaginectomy; 19 ‘‘(XIII) vulvoplasty; 20 ‘‘(XIV) reduction 21 thyrochondroplasty; 22 ‘‘(XV) chondrolaryngoplasty; and 23 ‘‘(XVI) mastectomy. 24 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 1399 IH ‘‘(ii) Any plastic surgery that femi- 1 nizes or masculinizes the facial features for 2 the purposes described in clause (i). 3 ‘‘(iii) Any placement of chest implants 4 to create feminine breasts for the purposes 5 described in clause (i). 6 ‘‘(iv) Any placement of fat or artificial 7 implants in the gluteal region for the pur- 8 poses described in clause (i). 9 ‘‘(v) Administering, supplying, pre- 10 scribing, dispensing, distributing, or other- 11 wise conveying to an individual medications 12 for the purposes described in clause (i), in- 13 cluding— 14 ‘‘(I) gonadotropin-releasing hor- 15 mone (GnRH) analogues or other pu- 16 berty-blocking drugs to stop or delay 17 normal puberty; 18 ‘‘(II) testosterone or other 19 androgens to biological females at 20 doses that are supraphysiologic to the 21 female sex; and 22 ‘‘(III) estrogen to biological 23 males at doses that are 24 supraphysiologic to the male sex. 25 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 1399 IH ‘‘(B) EXCEPTION.—Subparagraph (A) 1 shall not apply to the following individuals: 2 ‘‘(i) An individual with both ovarian 3 and testicular tissue. 4 ‘‘(ii) An individual with respect to 5 whom a physician has determined through 6 genetic or biochemical testing that the in- 7 dividual does not have normal sex chro- 8 mosome structure, sex steroid hormone 9 production, or sex steroid hormone action. 10 ‘‘(iii) An individual experiencing infec- 11 tion, disease, injury, or disorder caused or 12 exacerbated by previous gender transition 13 procedures. 14 ‘‘(iv) An individual suffering from a 15 physical disorder, physical injury, or phys- 16 ical illness that would, as certified by a 17 physician, place the individual in imminent 18 danger of death or impairment of a major 19 bodily function unless the procedure is per- 20 formed. 21 ‘‘(2) BIOLOGICAL SEX.—The term ‘biological 22 sex’ means the indication of male or female sex by 23 reproductive potential or capacity, sex chromosomes, 24 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HR 1399 IH naturally occurring sex hormones, gonads, or inter- 1 nal or external genitalia present at birth. 2 ‘‘(3) MINOR.—The term ‘minor’ means any per- 3 son under the age of eighteen years. 4 ‘‘(e) CIRCUMSTANCES DESCRIBED.—For purposes of 5 subsection (a), the circumstances described in this sub- 6 section are that— 7 ‘‘(1) the defendant or victim traveled in inter- 8 state or foreign commerce, or traveled using a 9 means, channel, facility, or instrumentality of inter- 10 state or foreign commerce, in furtherance of or in 11 connection with the conduct described in subsection 12 (a); 13 ‘‘(2) the defendant used a means, channel, fa- 14 cility, or instrumentality of interstate or foreign 15 commerce in furtherance of or in connection with 16 the conduct described in subsection (a); 17 ‘‘(3) any payment of any kind was made, di- 18 rectly or indirectly, in furtherance of or in connec- 19 tion with the conduct described in subsection (a) 20 using any means, channel, facility, or instrumen- 21 tality of interstate or foreign commerce or in or af- 22 fecting interstate or foreign commerce; 23 ‘‘(4) the defendant transmitted in interstate or 24 foreign commerce any communication relating to or 25 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HR 1399 IH in furtherance of the conduct described in subsection 1 (a) using any means, channel, facility, or instrumen- 2 tality of interstate or foreign commerce or in or af- 3 fecting interstate or foreign commerce by any means 4 or in manner, including by computer, mail, wire, or 5 electromagnetic transmission; 6 ‘‘(5) any instrument, item, substance, or other 7 object that has traveled in interstate or foreign com- 8 merce was used to perform the conduct described in 9 subsection (a); 10 ‘‘(6) the conduct described in subsection (a) oc- 11 curred within the special maritime and territorial ju- 12 risdiction of the United States, or any territory or 13 possession of the United States; or 14 ‘‘(7) the conduct described in subsection (a) 15 otherwise occurred in or affected interstate or for- 16 eign commerce. 17 ‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec- 18 tion shall be construed as prohibiting provision of the med- 19 ical services described in subsection (d)(1)(A) to address 20 legitimate health issues, such as any male or female repro- 21 ductive cancers, apart from changing the body to cor- 22 respond to a sex that differs from one’s biological sex.’’; 23 and 24 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •HR 1399 IH (2) by amending the table of sections for such 1 chapter by adding at the end the following: 2 ‘‘2260B. Gender-affirming care on minors.’’. TITLE II—PROHIBITING FEDER- 3 ALLY FUNDED GENDER-AF- 4 FIRMING CARE 5 SEC. 201. PROHIBITING TAXPAYER-FUNDED GENDER-AF- 6 FIRMING CARE. 7 Title 1, United States Code, is amended by adding 8 at the end the following new chapter: 9 ‘‘CHAPTER 4—PROHIBITING TAXPAYER- 10 FUNDED GENDER-AFFIRMING CARE 11 ‘‘301. Prohibition on funding for gender-affirming care. ‘‘302. Prohibition on funding for health benefits plans that cover gender-affirm- ing care. ‘‘303. Limitation on Federal facilities and employees, Federal lands and terri- tories, and Tribal territories. ‘‘304. Construction relating to separate coverage. ‘‘305. Construction relating to the use of non-Federal funds for health coverage. ‘‘306. Construction relating to complications arising from gender-affirming care. ‘‘307. Treatment of individuals born with medically verifiable disorder of sex de- velopment. ‘‘308. Gender-affirming care defined. ‘‘309. Rule of construction. ‘‘§ 301. Prohibition on funding for gender-affirming 12 care 13 ‘‘No funds authorized or appropriated by Federal 14 law, and none of the funds in any trust fund to which 15 funds are authorized or appropriated by Federal law, in- 16 cluding funds provided under titles XVIII, XIX, and XXI 17 of the Social Security Act, shall be expended for any gen- 18 der-affirming care. 19 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •HR 1399 IH ‘‘§ 302. Prohibition on funding for health benefits 1 plans that cover gender-affirming care 2 ‘‘No funds authorized or appropriated by Federal 3 law, and none of the funds in any trust fund to which 4 funds are authorized or appropriated by Federal law, shall 5 be expended for health benefits coverage that includes cov- 6 erage of gender-affirming care. 7 ‘‘§ 303. Limitation on Federal facilities and employ- 8 ees, Federal lands and territories, and 9 Tribal territories 10 ‘‘No health care service furnished— 11 ‘‘(1) by or in a health care facility owned or op- 12 erated by the Federal Government, Federal land or 13 territory, or a Tribal territory; or 14 ‘‘(2) by any physician or other individual em- 15 ployed by the Federal Government, Federal land or 16 territory, or a Tribal territory to provide health care 17 services within the scope of the physician’s or indi- 18 vidual’s employment, 19 may include gender-affirming care. 20 ‘‘§ 304. Construction relating to separate coverage 21 ‘‘Nothing in this chapter shall be construed as pro- 22 hibiting any individual, entity, or State or locality from 23 purchasing separate coverage for gender-affirming care or 24 health benefits coverage that includes gender-affirming 25 care so long as such coverage is paid for entirely using 26 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •HR 1399 IH only funds not authorized or appropriated by Federal law, 1 federal programs, platforms, or infrastructure, such cov- 2 erage does not cover any practice that would be subject 3 to penalty under section 2260B of title 18, United States 4 Code, and such coverage shall not be purchased using 5 matching funds required for a federally subsidized pro- 6 gram, including a State’s or locality’s contribution of Med- 7 icaid matching funds. 8 ‘‘§ 305. Construction relating to the use of non-Fed- 9 eral funds for health coverage 10 ‘‘Nothing in this chapter shall be construed as re- 11 stricting the ability of any non-Federal health benefits cov- 12 erage provider from offering coverage for gender-affirming 13 care, or the ability of a State or locality to contract sepa- 14 rately with such a provider for such coverage, so long as 15 only funds not authorized or appropriated by Federal law 16 are used, such coverage does not cover any practice that 17 would be subject to penalty under section 2260B of title 18 18, United States Code, and such coverage shall not be 19 purchased using matching funds required for a federally 20 subsidized program, including a State’s or locality’s con- 21 tribution of Medicaid matching funds. 22 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 11 •HR 1399 IH ‘‘§ 306. Construction relating to complications arising 1 from gender-affirming care 2 ‘‘Nothing in this chapter shall be construed to apply 3 to the treatment of any infection, injury, disease, or dis- 4 order that has been caused by or exacerbated by the per- 5 formance of a gender-affirming care. This rule of con- 6 struction shall be applicable without regard to whether the 7 gender-affirming care was performed in accord with Fed- 8 eral or State law, and without regard to whether funding 9 for the gender-affirming care is permissible under section 10 307. 11 ‘‘§ 307. Treatment of individuals born with medically 12 verifiable disorder of sex development 13 ‘‘The limitations established in sections 301, 302, 14 and 303 shall not apply with respect to an individual de- 15 scribed in section 2260B(d)(1)(B) of title 18, United 16 States Code. 17 ‘‘§ 308. Gender-affirming care defined 18 ‘‘For purposes of this chapter, the term ‘gender-af- 19 firming care’ has the meaning given such term in section 20 2260B(d)(1) of title 18, United States Code. 21 ‘‘§ 309. Rule of construction 22 ‘‘Nothing in this chapter shall be construed as pro- 23 hibiting provision of the medical services described in sec- 24 tion 2260B(d)(1)(A) of title 18, United States Code, to 25 address any male or female reproductive cancers, apart 26 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 12 •HR 1399 IH from changing the body to correspond to a sex that differs 1 from one’s biological sex.’’. 2 SEC. 202. AMENDMENT TO TABLE OF CHAPTERS. 3 The table of chapters for title 1, United States Code, 4 is amended by adding at the end the following new item: 5 ‘‘4. Prohibiting taxpayer-funded gender-affirming care ... 301’’. TITLE III—APPLICATION UNDER 6 THE AFFORDABLE CARE ACT 7 SEC. 301. CLARIFYING APPLICATION OF PROHIBITION TO 8 PREMIUM CREDITS AND COST-SHARING RE- 9 DUCTIONS UNDER ACA. 10 (a) IN GENERAL.— 11 (1) DISALLOWANCE OF REFUNDABLE CREDIT 12 AND COST-SHARING REDUCTIONS FOR COVERAGE 13 UNDER QUALIFIED HEALTH PLAN WHICH PROVIDES 14 COVERAGE FOR GENDER-AFFIRMING CARE.— 15 (A) IN GENERAL.—Subparagraph (A) of 16 section 36B(c)(3) of the Internal Revenue Code 17 of 1986 is amended by inserting before the pe- 18 riod at the end the following: ‘‘or any health 19 plan that includes coverage for gender-affirming 20 care (other than any gender-affirming care or 21 treatment described in section 306 or 307 of 22 title 1, United States Code)’’. 23 (B) OPTION TO PURCHASE OR OFFER SEP- 24 ARATE COVERAGE OR PLAN.—Paragraph (3) of 25 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 13 •HR 1399 IH section 36B(c) of such Code is amended by 1 adding at the end the following new subpara- 2 graph: 3 ‘‘(C) SEPARATE COVERAGE OR PLAN FOR 4 GENDER-AFFIRMING CARE ALLOWED.— 5 ‘‘(i) OPTION TO PURCHASE SEPARATE 6 COVERAGE OR PLAN.—Nothing in subpara- 7 graph (A) shall be construed as prohibiting 8 any individual from purchasing separate 9 coverage for gender-affirming care de- 10 scribed in such subparagraph, or a health 11 plan that includes such gender-affirming 12 care, so long as no credit is allowed under 13 this section with respect to the premiums 14 for such coverage or plan and such cov- 15 erage or plan does not cover any practice 16 that would be subject to penalty under sec- 17 tion 2260B of title 18, United States 18 Code. 19 ‘‘(ii) OPTION TO OFFER COVERAGE OR 20 PLAN.—Nothing in subparagraph (A) shall 21 restrict any non-Federal health insurance 22 issuer offering a health plan from offering 23 separate coverage for gender-affirming 24 care described in such subparagraph, or a 25 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 14 •HR 1399 IH plan that includes such gender-affirming 1 care, so long as premiums for such sepa- 2 rate coverage or plan are not paid for with 3 any amount attributable to the credit al- 4 lowed under this section (or the amount of 5 any advance payment of the credit under 6 section 1412 of the Patient Protection and 7 Affordable Care Act) and such coverage or 8 plan does not cover any practice that 9 would be subject to penalty under section 10 2260B of title 18, United States Code.’’. 11 (2) DISALLOWANCE OF SMALL EMPLOYER 12 HEALTH INSURANCE EXPENSE CREDIT FOR PLAN 13 WHICH INCLUDES COVERAGE FOR GENDER-AFFIRM- 14 ING CARE.—Subsection (h) of section 45R of the In- 15 ternal Revenue Code of 1986 is amended— 16 (A) by striking ‘‘Any term’’ and inserting 17 the following: 18 ‘‘(1) IN GENERAL.—Any term’’; and 19 (B) by adding at the end the following new 20 paragraph: 21 ‘‘(2) EXCLUSION OF HEALTH PLANS INCLUDING 22 COVERAGE FOR GENDER-AFFIRMING CARE.— 23 ‘‘(A) IN GENERAL.—The term ‘qualified 24 health plan’ does not include any health plan 25 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 15 •HR 1399 IH that includes coverage for gender-affirming care 1 (other than any gender-affirming care or treat- 2 ment described in section 306 or 307 of title 1, 3 United States Code). 4 ‘‘(B) SEPARATE COVERAGE OR PLAN FOR 5 GENDER-AFFIRMING CARE ALLOWED.— 6 ‘‘(i) OPTION TO PURCHASE SEPARATE 7 COVERAGE OR PLAN.—Nothing in subpara- 8 graph (A) shall be construed as prohibiting 9 any employer from purchasing for its em- 10 ployees separate coverage for gender-af- 11 firming care described in such subpara- 12 graph, or a health plan that includes such 13 gender-affirming care, so long as no credit 14 is allowed under this section with respect 15 to the employer contributions for such cov- 16 erage or plan and such coverage does not 17 cover any practice that would be subject to 18 penalty under section 2260B of title 18, 19 United States Code. 20 ‘‘(ii) OPTION TO OFFER COVERAGE OR 21 PLAN.—Nothing in subparagraph (A) shall 22 restrict any non-Federal health insurance 23 issuer offering a health plan from offering 24 separate coverage for gender-affirming 25 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 16 •HR 1399 IH care described in such subparagraph, or a 1 plan that includes such gender-affirming 2 care, so long as such separate coverage or 3 plan is not paid for with any employer con- 4 tribution eligible for the credit allowed 5 under this section and such coverage or 6 plan does not cover any practice that 7 would be subject to penalty under section 8 2260B of title 18, United States Code.’’. 9 (b) APPLICATION TO MULTI-STATE PLANS.—Section 10 1334(a) of Public Law 111–148 (42 U.S.C. 18054(a)) is 11 amended by adding at the end the following new para- 12 graph: 13 ‘‘(8) COVERAGE CONSISTENT WITH FEDERAL 14 POLICY REGARDING GENDER-AFFIRMING CARE.—In 15 entering into contracts under this subsection, the 16 Director shall ensure that no multi-State qualified 17 health plan offered in an Exchange provides health 18 benefits coverage for which the expenditure of Fed- 19 eral funds is prohibited under chapter 4 of title 1, 20 United States Code.’’. 21 (c) EFFECTIVE DATE.—The amendments made by 22 subsection (a) shall apply to taxable years ending after 23 the date that is one year after the date of enactment of 24 this Act, but only with respect to plan years beginning 25 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 17 •HR 1399 IH after such date, and the amendment made by subsection 1 (b) shall apply to plan years beginning after such date. 2 TITLE IV—ADDITIONAL 3 PROVISIONS 4 SEC. 401. PROHIBITION ON INSTITUTIONS OF HIGHER EDU- 5 CATION AND ACCREDITING AGENCIES OR AS- 6 SOCIATIONS. 7 (a) PROHIBITION ON INSTITUTIONS OF HIGHER 8 EDUCATION.—Section 487(a) of the Higher Education 9 Act of 1965 (20 U.S.C. 1094(a)) is amended by adding 10 at the end the following: 11 ‘‘(30) The institution will not offer instruction 12 in gender-affirming care (as defined in section 13 2260B(d) of title 18, United States Code).’’. 14 (b) PROHIBITION ON ACCREDITING AGENCIES OR AS- 15 SOCIATIONS.—Section 496(a) of the Higher Education 16 Act of 1965 (20 U.S.C. 1099b(a)) is amended— 17 (1) by striking ‘‘and’’ at the end of paragraph 18 (7); 19 (2) by striking the period at the end of para- 20 graph (8) and inserting ‘‘; and’’; and 21 (3) by adding at the end the following: 22 ‘‘(9) such agency or association does not ac- 23 credit any institution that offers instruction in gen- 24 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 18 •HR 1399 IH der-affirming care (as defined in section 2260B(d) 1 of title 18, United States Code).’’. 2 SEC. 402. IMMIGRATION CONSEQUENCES WITH RESPECT 3 TO PROVIDING GENDER-AFFIRMING CARE. 4 (a) DEFINITIONS.—Section 101(a) of the Immigra- 5 tion and Nationality Act (8 U.S.C. 1101(a)) is amended 6 by adding at the end the following: 7 ‘‘(53) The term ‘gender-affirming care’ shall 8 have the meaning given such term in section 9 2260B(d) of title 18, United States Code.’’. 10 (b) CLASSES OF ALIENS INELIGIBLE FOR VISAS OR 11 ADMISSION.—Section 212(a)(1)(A) of the Immigration 12 and Nationality Act (8 U.S.C. 1182(a)(1)(A)) is amend- 13 ed— 14 (1) in clause (iii)(II), strike ‘‘or’’ at the end; 15 (2) in clause (iv), strike the comma at the end 16 and insert ‘‘, or’’; and 17 (3) by adding at the end the following: 18 ‘‘(v) who is determined to have per- 19 formed gender-affirming care on a child 20 that has not attained the age of 18 years 21 old,’’. 22 (c) CLASSES OF DEPORTABLE ALIENS.—Section 23 237(a) of the Immigration and Nationality Act (8 U.S.C. 24 1227(a)) is amended by adding at the end the following: 25 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 19 •HR 1399 IH ‘‘(8) GENDER-AFFIRMING CARE.—Any alien 1 who has performed gender-affirming care on a child 2 that has not attained the age of 18 years old is de- 3 portable.’’. 4 Æ VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6301 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB