Text of WA HB 1214 (2024)

AN ACT Relating to enacting the protecting children's bodies act; 1 amending RCW 48.43.0128 and 74.09.675; adding a new section to 2 chapter 43.70 RCW; creating a new section; and prescribing penalties. 3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON: 4 NEW SECTION. Sec. 1. A new section is added to chapter 43.70 5 RCW to read as follows: 6 (1) A health care provider may not provide gender transition 7 procedures to any individual who is under 18 years of age. A health 8 care provider may not refer any individual who is under 18 years of 9 age to any health care provider for gender transition procedures. A 10 health care provider is not prohibited from providing any of the 11 following procedures that are not gender transition procedures to an 12 individual who is under 18 years of age: 13 (a) Services to persons born with a medically verifiable disorder 14 of sex development, including a person with external biological sex 15 characteristics that are irresolvably ambiguous, such as being born 16 with 46 xx chromosomes with virilization or 46 xy chromosomes with 17 undervirilization or having both ovarian and testicular tissue; 18 (b) Services provided when a physician has otherwise diagnosed a 19 disorder of sexual development and has determined through genetic or 20 biochemical testing that the person does not have normal sex 21 H-0367.2 HOUSE BILL 1214 State of Washington 68th Legislature 2023 Regular Session By Representative Walsh p. 1 HB 1214 chromosome structure, sex steroid hormone production, or sex steroid 1 hormone action; 2 (c) The treatment of any infection, injury, disease, or disorder 3 that has been caused by or exacerbated by the performance of gender 4 transition procedures, whether or not the gender transition procedure 5 was performed in accordance with state and federal law or whether or 6 not funding for the gender transition procedure is allowable under 7 this section; and 8 (d) Any procedure undertaken because the individual suffers from 9 a physical disorder, physical injury, or physical illness that would, 10 as certified by a physician, place the individual in imminent danger 11 of death or impairment of major bodily function unless surgery is 12 performed. 13 (2) Public funds may not be directly or indirectly used, granted, 14 paid, or distributed to any entity, organization, or individual that 15 provides gender transition procedures to an individual who is under 16 18 years of age. Health care services furnished in the following 17 situations may not include gender transition procedures to an 18 individual who is under 18 years of age: 19 (a) By or in a health care facility owned by this state or a 20 county or local government; and 21 (b) By a health care provider employed by the state or a county 22 or local government. 23 (3) Any referral for or provision of gender transition procedures 24 to an individual who is under 18 years of age is unprofessional 25 conduct and is subject to discipline by the appropriate disciplining 26 authority. 27 (4) A person may assert an actual or threatened violation of this 28 section as a claim or defense in a judicial or administrative 29 proceeding and obtain compensatory damages, injunctive relief, 30 declaratory relief, or any other appropriate relief. A person must 31 bring a claim for a violation of this section no later than two years 32 after the day the cause of action accrues. An individual who is under 33 18 years of age may bring an action throughout the individual's 34 minority through a parent or next friend and may bring an action in 35 the individual's own name on reaching 18 years of age until 20 years 36 after reaching 18 years of age. 37 (5) Notwithstanding any other law, an action under this section 38 may be commenced, and relief may be granted, in a judicial proceeding 39 without regard to whether the person commencing the action has sought 40 p. 2 HB 1214 or exhausted available administrative remedies. In any action or 1 proceeding to enforce this section, a prevailing party who 2 establishes a violation of this section shall recover reasonable 3 attorney fees. 4 (6) The attorney general may bring an action to enforce 5 compliance with this section. This section does not deny, impair, or 6 otherwise affect any right or authority of the attorney general, this 7 state, or any agency, officer, or employee of this state, acting 8 under any law other than this section, to institute or intervene in 9 any proceeding. 10 (7) A violation of this section is a class C felony. 11 (8) For the purposes of this section: 12 (a) "Biological sex" means the biological indication of male and 13 female in the context of reproductive potential or capacity, such as 14 sex chromosomes, naturally occurring sex hormones, gonads and 15 nonambiguous internal and external genitalia present at birth, 16 without regard to an individual's psychological, chosen, or 17 subjective experience of gender. 18 (b) "Cross-sex hormones" means either of the following: 19 (i) Testosterone or other androgens given to biological females 20 in amounts that are larger or more potent than would normally occur 21 naturally in healthy biological sex females; or 22 (ii) Estrogen given to biological males in amounts that are 23 larger or more potent than would normally occur naturally in healthy 24 biological sex males. 25 (c) "Gender" means the psychological, behavioral, social, and 26 cultural aspects of being male or female. 27 (d) "Gender reassignment surgery" means any medical or surgical 28 service that seeks to surgically alter or remove healthy physical or 29 anatomical characteristics or features that are typical for an 30 individual's biological sex in order to instill or create 31 physiological or anatomical characteristics that resemble a sex 32 different from the individual's biological sex. "Gender reassignment 33 surgery" includes genital or nongenital gender reassignment surgery 34 performed for the purpose of assisting an individual with a gender 35 transition. 36 (e) "Gender transition" means the process in which a person goes 37 from identifying with and living as a gender that corresponds to the 38 person's biological sex to identifying with and living as a gender 39 p. 3 HB 1214 different from the person's biological sex and may involve social, 1 legal, or physical changes. 2 (f) "Gender transition procedures": 3 (i) Means any medical or surgical service, including physician 4 services, inpatient and outpatient hospital services, or prescribed 5 drugs related to gender transition, that seeks to either: 6 (A) Alter or remove physical or anatomical characteristics or 7 features that are typical for the individual's biological sex; or 8 (B) Instill or create physiological or anatomical characteristics 9 that resemble a sex different from the individual's biological sex, 10 including medical services that provide puberty-blocking drugs, 11 cross-sex hormones, or other mechanisms to promote the development of 12 feminizing or masculinizing features in the opposite biological sex 13 or genital or nongenital gender reassignment surgery performed for 14 the purpose of assisting an individual with a gender transition. 15 (ii) Does not include any of the following: 16 (A) Services to persons born with a medically verifiable disorder 17 of sex development, including a person with external biological sex 18 characteristics that are irresolvably ambiguous, such as being born 19 with 46 xx chromosomes with virilization or 46 xy chromosomes with 20 undervirilization or having both ovarian and testicular tissue; 21 (B) Services provided when a physician has otherwise diagnosed a 22 disorder of sexual development and has determined through genetic or 23 biochemical testing that the person does not have normal sex 24 chromosome structure, sex steroid hormone production, or sex steroid 25 hormone action; 26 (C) The treatment of any infection, injury, disease, or disorder 27 that has been caused by or exacerbated by the performance of gender 28 transition procedures, whether or not the gender transition procedure 29 was performed in accordance with state and federal law or whether or 30 not funding for the gender transition procedure is allowable under 31 this section; and 32 (D) Any procedure undertaken because the individual suffers from 33 a physical disorder, physical injury, or physical illness that would, 34 as certified by a physician, place the individual in imminent danger 35 of death or impairment of major bodily function unless surgery is 36 performed. 37 (g) "Genital gender reassignment surgery" means a medical 38 procedure performed for the purpose of assisting an individual with a 39 gender transition, including any of the following: 40 p. 4 HB 1214 (i) Surgical procedures such as penectomy, orchiectomy, 1 vaginoplasty, clitoroplasty, or vulvoplasty for biologically male 2 patients or hysterectomy or ovariectomy for biologically female 3 patients; 4 (ii) Reconstruction of the fixed part of the urethra with or 5 without a metoidioplasty; 6 (iii) Phalloplasty, vaginectomy, scrotoplasty, or implantation of 7 erection or testicular prostheses for biologically female patients; 8 and 9 (iv) Removing any healthy or nondiseased body part. 10 (h) "Health care provider" means a person regulated under Title 11 18 RCW to practice health or health-related services or otherwise 12 practicing health care services in this state consistent with state 13 law. 14 (i) "Nongenital gender reassignment surgery" means medical 15 procedures performed for the purpose of assisting an individual with 16 a gender transition, including either of the following: 17 (i) Surgical procedures for biologically male patients, such as 18 augmentation mammoplasty, facial feminization surgery, liposuction, 19 lipofilling, voice surgery, thyroid cartilage reduction, gluteal 20 augmentation, hair reconstruction, or various aesthetic procedures; 21 and 22 (ii) Surgical procedures for biologically female patients, such 23 as subcutaneous mastectomy, voice surgery, liposuction, lipofilling, 24 pectoral implants, or various aesthetic procedures. 25 (j) "Puberty-blocking drugs" means gonadotropin-releasing hormone 26 analogues or other synthetic drugs used in biological males to stop 27 luteinizing hormone secretion and testosterone secretion, or 28 synthetic drugs used in biological females which stop the production 29 of estrogens and progesterone, when used to delay or suppress 30 pubertal development in children for the purpose of assisting an 31 individual with a gender transition. 32 (k) "Public funds" means state, county, or local government 33 moneys, in addition to any department, agency, or instrumentality 34 authorized or appropriated under state law or derived from any fund 35 in which such moneys are deposited. 36 Sec. 2. RCW 48.43.0128 and 2021 c 280 s 3 are each amended to 37 read as follows: 38 p. 5 HB 1214 (1) A health carrier offering a nongrandfathered health plan or a 1 plan deemed by the commissioner to have a short-term limited purpose 2 or duration, or to be a student-only plan that is guaranteed 3 renewable while the covered person is enrolled as a regular, full- 4 time undergraduate student at an accredited higher education 5 institution may not: 6 (a) In its benefit design or implementation of its benefit 7 design, discriminate against individuals because of their age, 8 expected length of life, present or predicted disability, degree of 9 medical dependency, quality of life, or other health conditions; and 10 (b) With respect to the health plan or plan deemed by the 11 commissioner to have a short-term limited purpose or duration, or to 12 be a student-only plan that is guaranteed renewable while the covered 13 person is enrolled as a regular, full-time undergraduate student at 14 an accredited higher education institution, discriminate on the basis 15 of race, color, national origin, disability, age, sex, gender 16 identity, or sexual orientation. 17 (2) Nothing in this section may be construed to prevent a carrier 18 from appropriately utilizing reasonable medical management 19 techniques. 20 (3) ((For)) Except as provided in subsection (9) of this section, 21 for health plans issued or renewed on or after January 1, 2022: 22 (a) A health carrier may not deny or limit coverage for gender 23 affirming treatment when that treatment is prescribed to an 24 individual because of, related to, or consistent with a person's 25 gender expression or identity, as defined in RCW 49.60.040, is 26 medically necessary, and is prescribed in accordance with accepted 27 standards of care. 28 (b) A health carrier may not apply categorical cosmetic or 29 blanket exclusions to gender affirming treatment. When prescribed as 30 medically necessary gender affirming treatment, a health carrier may 31 not exclude as cosmetic services facial feminization surgeries and 32 other facial gender affirming treatment, such as tracheal shaves, 33 hair electrolysis, and other care such as mastectomies, breast 34 reductions, breast implants, or any combination of gender affirming 35 procedures, including revisions to prior treatment. 36 (c) A health carrier may not issue an adverse benefit 37 determination denying or limiting access to gender affirming 38 services, unless a health care provider with experience prescribing 39 p. 6 HB 1214 or delivering gender affirming treatment has reviewed and confirmed 1 the appropriateness of the adverse benefit determination. 2 (d) Health carriers must comply with all network access rules and 3 requirements established by the commissioner. 4 (4) For the purposes of this section, "gender affirming 5 treatment" means a service or product that a health care provider, as 6 defined in RCW 70.02.010, prescribes to an individual to treat any 7 condition related to the individual's gender identity and is 8 prescribed in accordance with generally accepted standards of care. 9 Gender affirming treatment must be covered in a manner compliant with 10 the federal mental health parity and addiction equity act of 2008 and 11 the federal affordable care act. Gender affirming treatment can be 12 prescribed to two spirit, transgender, nonbinary, intersex, and other 13 gender diverse individuals. 14 (5) Nothing in this section may be construed to mandate coverage 15 of a service that is not medically necessary. 16 (6) By December 1, 2022, the commissioner, in consultation with 17 the health care authority and the department of health, must issue a 18 report on geographic access to gender affirming treatment across the 19 state. The report must include the number of gender affirming 20 providers offering care in each county, the carriers and medicaid 21 managed care organizations those providers have active contracts 22 with, and the types of services provided by each provider in each 23 region. The commissioner must update the report biannually and post 24 the report on its website. 25 (7) The commissioner shall adopt any rules necessary to implement 26 subsections (3), (4), and (5) of this section. 27 (8) Unless preempted by federal law, the commissioner shall adopt 28 any rules necessary to implement subsections (1) and (2) of this 29 section, consistent with federal rules and guidance in effect on 30 January 1, 2017, implementing the patient protection and affordable 31 care act. 32 (9) A health carrier may not reimburse or provide coverage for 33 gender affirming treatment to an individual who is under 18 years of 34 age. 35 Sec. 3. RCW 74.09.675 and 2021 c 280 s 4 are each amended to 36 read as follows: 37 (1) ((In)) Except as provided in subsection (6) of this section, 38 in the provision of gender affirming care services through programs 39 p. 7 HB 1214 under this chapter, the authority, managed care plans, and providers 1 that administer or deliver such services may not discriminate in the 2 delivery of a service provided through a program of the authority 3 based on the covered person's gender identity or expression. 4 (2) ((Beginning)) Except as provided in subsection (6) of this 5 section, beginning January 1, 2022: 6 (a) The authority and any managed care plans delivering or 7 administering services purchased or contracted for by the authority 8 may not apply categorical cosmetic or blanket exclusions to gender 9 affirming treatment. 10 (b) Facial feminization surgeries and facial gender affirming 11 treatment, such as tracheal shaves, hair electrolysis, and other care 12 such as mastectomies, breast reductions, breast implants, or any 13 combination of gender affirming procedures, including revisions to 14 prior treatment, when prescribed as gender affirming treatment, may 15 not be excluded as cosmetic. 16 (c) The authority and managed care plans administering services 17 purchased or contracted for by the authority may not issue an adverse 18 benefit determination denying or limiting access to gender affirming 19 treatment, unless a health care provider with experience prescribing 20 or delivering gender affirming treatment has reviewed and confirmed 21 the appropriateness of the adverse benefit determination. 22 (d) If the authority and managed care plans administering 23 services purchased or contracted for by the authority do not have an 24 adequate network for gender affirming treatment, they shall ensure 25 the delivery of timely and geographically accessible medically 26 necessary gender affirming treatment at no greater expense than if 27 they had an in-network, geographically accessible provider available. 28 This includes, but is not limited to, providing case management 29 services to secure out-of-network gender affirming treatment options 30 that are available to the enrollee in a timely manner within their 31 geographic region. The enrollee shall pay no more than the same cost 32 sharing that the enrollee would pay for the same covered services 33 received from an in-network provider. 34 (3) For the purposes of this section, "gender affirming 35 treatment" means a service or product that a health care provider, as 36 defined in RCW 70.02.010, prescribes to an individual to support and 37 affirm the individual's gender identity. Gender affirming treatment 38 includes, but is not limited to, treatment for gender dysphoria. 39 p. 8 HB 1214 Gender affirming treatment can be prescribed to two spirit, 1 transgender, nonbinary, and other gender diverse individuals. 2 (4) Nothing in this section may be construed to mandate coverage 3 of a service that is not medically necessary. 4 (5) The authority shall adopt rules necessary to implement this 5 section. 6 (6) The authority and managed care plans administering services 7 purchased or contracted for by the authority may not reimburse or 8 provide coverage for gender affirming treatment to an individual who 9 is under 18 years of age. 10 NEW SECTION. Sec. 4. This act may be known and cited as the 11 protecting children's bodies act. 12 --- END --- p. 9 HB 1214