1| STATE OF OKLAHOMA | | | 2| 1st Session of the 59th Legislature (2023) | | | 3|SENATE BILL 129 By: Bullard | | | 4| | | | 5| | | | 6| AS INTRODUCED | | | 7| An Act relating to health care; creating the | | Millstone Act of 2023; defining terms; prohibiting | 8| provision of or referral for gender transition | | procedures; providing exceptions; prohibiting certain | 9| uses of public funds, public facilities, public | | employees, and state Medicaid program; providing for | 10| criminal, administrative, and civil enforcement; | | authorizing certain civil actions and relief; | 11| providing certain construction; providing for | | codification; and declaring an emergency. | 12| | | | 13| | | | 14|BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: | | | 15| SECTION 1. NEW LAW A new section of law to be codified | | | 16|in the Oklahoma Statutes as Section 2607.1 of Title 63, unless there | | | 17|is created a duplication in numbering, reads as follows: | | | 18| This act shall be known and may be cited as the Millstone Act of | | | 19|2023. | | | 20| SECTION 2. NEW LAW A new section of law to be codified | | | 21|in the Oklahoma Statutes as Section 2607.2 of Title 63, unless there | | | 22|is created a duplication in numbering, reads as follows: | | | 23| As used in this act: | | | 24| | | | Req. No. 3 Page 1 ___________________________________________________________________________
1| 1. "Biological sex" means the biological indication of male and | | | 2|female in the context of reproductive potential or capacity, such as | | | 3|sex chromosomes, naturally occurring sex hormones, gonads, and | | | 4|nonambiguous internal and external genitalia present at birth, | | | 5|without regard to an individual's psychological, chosen, or | | | 6|subjective experience of gender; | | | 7| 2. "Cross-sex hormones" means: | | | 8| a. testosterone or other androgens given to biological | | | 9| females in amounts that are larger or more potent than | | | 10| would normally occur naturally in healthy biological | | | 11| sex females, and | | | 12| b. estrogen given to biological males in amounts that | | | 13| are larger or more potent than would normally occur | | | 14| naturally in healthy biological sex males; | | | 15| 3. "Gender" means the psychological, behavioral, social, and | | | 16|cultural aspects of being male or female; | | | 17| 4. "Gender reassignment surgery" means any medical or surgical | | | 18|service that seeks to surgically alter or remove healthy physical or | | | 19|anatomical characteristics or features that are typical for the | | | 20|individual's biological sex, in order to instill or create | | | 21|physiological or anatomical characteristics that resemble a sex | | | 22|different from the individual's biological sex, including but not | | | 23|limited to genital or nongenital gender reassignment surgery | | | 24| | | | Req. No. 3 Page 2 ___________________________________________________________________________
1|performed for the purpose of assisting an individual with a gender | | | 2|transition; | | | 3| 5. "Gender transition" means the process in which a person goes | | | 4|from identifying with and living as a gender that corresponds to his | | | 5|or her biological sex to identifying with and living as a gender | | | 6|different from his or her biological sex, and may involve social, | | | 7|legal, or physical changes; | | | 8| 6. a. "Gender transition procedures" means any medical or | | | 9| surgical service, including but not limited to | | | 10| physician's services, inpatient and outpatient | | | 11| hospital services, or prescribed drugs related to | | | 12| gender transition that seeks to: | | | 13| (1) alter or remove physical or anatomical | | | 14| characteristics or features that are typical for | | | 15| the individual's biological sex, or | | | 16| (2) instill or create physiological or anatomical | | | 17| characteristics that resemble a sex different | | | 18| from the individual's biological sex, including | | | 19| but not limited to medical services that provide | | | 20| puberty-blocking drugs, cross-sex hormones, or | | | 21| other mechanisms to promote the development of | | | 22| feminizing or masculinizing features in the | | | 23| opposite biological sex, or genital or nongenital | | | 24| | | | Req. No. 3 Page 3 ___________________________________________________________________________
1| gender reassignment surgery performed for the | | | 2| purpose of assisting an individual with a gender | | | 3| transition. | | | 4| b. Gender transition procedures do not include: | | | 5| (1) services to persons born with a medically | | | 6| verifiable disorder of sex development, including | | | 7| a person with external biological sex | | | 8| characteristics that are irresolvably ambiguous, | | | 9| such as those born with 46 XX chromosomes with | | | 10| virilization, 46 XY chromosomes with | | | 11| undervirilization, or having both ovarian and | | | 12| testicular tissue, | | | 13| (2) services provided when a physician has otherwise | | | 14| diagnosed a disorder of sexual development that | | | 15| the physician has determined through genetic or | | | 16| biochemical testing that the person does not have | | | 17| normal sex chromosome structure, sex steroid | | | 18| hormone production, or sex steroid hormone | | | 19| action, | | | 20| (3) the treatment of any infection, injury, disease, | | | 21| or disorder that has been caused by or | | | 22| exacerbated by the performance of gender | | | 23| transition procedures, whether or not the gender | | | 24| | | | Req. No. 3 Page 4 ___________________________________________________________________________
1| transition procedure was performed in accordance | | | 2| with state and federal law, or | | | 3| (4) any procedure undertaken because the individual | | | 4| suffers from a physical disorder, physical | | | 5| injury, or physical illness that would, as | | | 6| certified by a physician, place the individual in | | | 7| imminent danger of death or impairment of major | | | 8| bodily function unless surgery is performed; | | | 9| 7. "Genital gender reassignment surgery" means a medical | | | 10|procedure performed for the purpose of assisting an individual with | | | 11|a gender transition, including but not limited to: | | | 12| a. surgical procedures such as penectomy, orchiectomy, | | | 13| vaginoplasty, clitoroplasty, or vulvoplasty for | | | 14| biologically male patients or hysterectomy or | | | 15| oophorectomy for biologically female patients, | | | 16| b. reconstruction of the fixed part of the urethra with | | | 17| or without a metoidioplasty, or | | | 18| c. phalloplasty, vaginectomy, scrotoplasty, or | | | 19| implantation of erection or testicular prostheses for | | | 20| biologically female patients; | | | 21| 8. "Healthcare professional" means a person who is licensed, | | | 22|certified, or otherwise authorized by the laws of this state to | | | 23|administer health care in the ordinary course of the practice of his | | | 24|or her profession; | | | Req. No. 3 Page 5 ___________________________________________________________________________
1| 9. "Nongenital gender reassignment surgery" means medical | | | 2|procedures performed for the purpose of assisting an individual with | | | 3|a gender transition including but not limited to: | | | 4| a. surgical procedures for biologically male patients, | | | 5| such as augmentation mammoplasty, facial feminization | | | 6| surgery, liposuction, lipofilling, voice surgery, | | | 7| thyroid cartilage reduction, gluteal augmentation, | | | 8| hair reconstruction, or various aesthetic procedures, | | | 9| or | | | 10| b. surgical procedures for biologically female patients, | | | 11| such as subcutaneous mastectomy, voice surgery, | | | 12| liposuction, lipofilling, pectoral implants, or | | | 13| various aesthetic procedures; | | | 14| 10. "Physician" means a person who is licensed to practice | | | 15|medicine in this state; | | | 16| 11. "Puberty-blocking drugs" means gonadotropin-releasing | | | 17|hormone analogues or other synthetic drugs used in biological males | | | 18|to stop luteinizing hormone secretion and therefore testosterone | | | 19|secretion, or synthetic drugs used in biological females which stop | | | 20|the production of estrogens and progesterone, when used to delay or | | | 21|suppress pubertal development in children for the purpose of | | | 22|assisting an individual with a gender transition; and | | | 23| 12. "Public funds" means state, county, or local government | | | 24|monies, in addition to any department, agency, or instrumentality | | | Req. No. 3 Page 6 ___________________________________________________________________________
1|authorized or appropriated under state law or derived from any fund | | | 2|in which such moneys are deposited. | | | 3| SECTION 3. NEW LAW A new section of law to be codified | | | 4|in the Oklahoma Statutes as Section 2607.3 of Title 63, unless there | | | 5|is created a duplication in numbering, reads as follows: | | | 6| A. A physician or other healthcare professional shall not | | | 7|provide gender transition procedures to any individual under | | | 8|twenty-six (26) years of age. | | | 9| B. A physician or other healthcare professional shall not refer | | | 10|any individual under twenty-six (26) years of age to any healthcare | | | 11|professional for gender transition procedures. | | | 12| C. A physician or other healthcare professional is not | | | 13|prohibited from providing any of the following procedures which are | | | 14|not gender transition procedures to an individual under twenty-six | | | 15|(26) years of age: | | | 16| 1. Services to persons born with a medically verifiable | | | 17|disorder of sex development, including a person with external | | | 18|biological sex characteristics that are irresolvably ambiguous, such | | | 19|as those born with 46 XX chromosomes with virilization, 46 XY | | | 20|chromosomes with undervirilization, or having both ovarian and | | | 21|testicular tissue; | | | 22| 2. Services provided when a physician has otherwise diagnosed a | | | 23|disorder of sexual development that the physician has determined | | | 24|through genetic or biochemical testing that the person does not have | | | Req. No. 3 Page 7 ___________________________________________________________________________
1|normal sex chromosome structure, sex steroid hormone production, or | | | 2|sex steroid hormone action; | | | 3| 3. The treatment of any infection, injury, disease, or disorder | | | 4|that has been caused by or exacerbated by the performance of gender | | | 5|transition procedures, whether or not the gender transition | | | 6|procedure was performed in accordance with state and federal law or | | | 7|whether or not funding for the gender transition procedure is | | | 8|permissible under Section 4 of this act; or | | | 9| 4. Any procedure undertaken because the individual suffers from | | | 10|a physical disorder, physical injury, or physical illness that | | | 11|would, as certified by a physician, place the individual in imminent | | | 12|danger of death or impairment of major bodily function unless | | | 13|surgery is performed. | | | 14| SECTION 4. NEW LAW A new section of law to be codified | | | 15|in the Oklahoma Statutes as Section 2607.4 of Title 63, unless there | | | 16|is created a duplication in numbering, reads as follows: | | | 17| A. Public funds shall not be directly or indirectly used, | | | 18|granted, paid, or distributed to any entity, organization, or | | | 19|individual that provides gender transition procedures to an | | | 20|individual under twenty-six (26) years of age. | | | 21| B. Healthcare services furnished in the following situations | | | 22|shall not include gender transition procedures to an individual | | | 23|under twenty-six (26) years of age: | | | 24| | | | Req. No. 3 Page 8 ___________________________________________________________________________
1| 1. By or in a healthcare facility owned by the state or a | | | 2|county or local government; or | | | 3| 2. By a physician or other healthcare professional employed by | | | 4|the state or a county or local government. | | | 5| C. The state Medicaid program shall not reimburse or provide | | | 6|coverage for gender transition procedures to an individual under | | | 7|twenty-six (26) years of age. | | | 8| SECTION 5. NEW LAW A new section of law to be codified | | | 9|in the Oklahoma Statutes as Section 2607.5 of Title 63, unless there | | | 10|is created a duplication in numbering, reads as follows: | | | 11| A. 1. A physician or other healthcare professional found to | | | 12|have knowingly referred for or provided gender transition procedures | | | 13|to an individual under twenty-six (26) years of age shall, upon | | | 14|conviction, be guilty of a felony. | | | 15| 2. Prosecution for a criminal violation of this subsection must | | | 16|be commenced within forty (40) years after the commission of such | | | 17|offense. | | | 18| B. 1. Any referral for or provision of gender transition | | | 19|procedures to an individual under twenty-six (26) years of age is | | | 20|unprofessional conduct and shall, upon an adverse ruling by the | | | 21|appropriate licensing board, result in immediate revocation of the | | | 22|license or certificate of the physician or other healthcare | | | 23|professional. | | | 24| | | | Req. No. 3 Page 9 ___________________________________________________________________________
1| 2. Disciplinary proceedings against the physician or other | | | 2|healthcare professional must be commenced within forty (40) years | | | 3|after the commission of such offense. | | | 4| C. 1. A person may assert an actual or threatened violation of | | | 5|this act as a claim or defense in a judicial or administrative | | | 6|proceeding and obtain compensatory damages, injunctive relief, | | | 7|declaratory relief, or any other appropriate relief. | | | 8| 2. A person shall bring a claim for a violation of this act no | | | 9|later than forty (40) years after the day the cause of action | | | 10|accrues. | | | 11| 3. An individual under eighteen (18) years of age may bring an | | | 12|action throughout their minority through a parent or next friend, | | | 13|and may bring an action in their own name upon reaching majority at | | | 14|any time from that point until forty (40) years after reaching the | | | 15|age of majority. | | | 16| 4. Notwithstanding any other provision of law, an action under | | | 17|this subsection may be commenced, and relief may be granted, in a | | | 18|judicial proceeding without regard to whether the person commencing | | | 19|the action has sought or exhausted available administrative | | | 20|remedies. | | | 21| 5. In any action or proceeding to enforce a provision of this | | | 22|act, a prevailing party who establishes a violation of this act | | | 23|shall recover reasonable attorney fees. | | | 24| | | | Req. No. 3 Page 10 ___________________________________________________________________________
1| D. 1. The Attorney General may bring an action to enforce | | | 2|compliance with this act. | | | 3| 2. This act does not deny, impair, or otherwise affect any | | | 4|right or authority of the Attorney General, this state, or any | | | 5|agency, officer, or employee of the state, acting under any law | | | 6|other than this act, to institute or intervene in any proceeding. | | | 7| SECTION 6. It being immediately necessary for the preservation | | | 8|of the public peace, health or safety, an emergency is hereby | | | 9|declared to exist, by reason whereof this act shall take effect and | | | 10|be in full force from and after its passage and approval. | | | 11| | | | 12| 59-1-3 DC 1/4/2023 12:53:53 PM | | | 13| | | | 14| | | | 15| | | | 16| | | | 17| | | | 18| | | | 19| | | | 20| | | | 21| | | | 22| | | | 23| | | | 24| | | | Req. No. 3 Page 11