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