Florida Senate - 2023                          SENATOR AMENDMENT
       Bill No. CS for SB 254
       
       
       
       
       
       
                                Ì442004fÎ442004                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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                Floor: 2/F/2R          .                                
             04/03/2023 03:01 PM       .                                
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       Senator Berman moved the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete lines 62 - 301
    4  and insert:
    5  procedures.—Notwithstanding any other provision of this part, a
    6  court of this state has jurisdiction to enter, modify, or stay a
    7  child custody determination relating to a child who is present
    8  in this state to the extent necessary to protect the child from
    9  being subjected to sex-reassignment procedures, as defined in s.
   10  456.001, in another state.
   11         Section 2. Section 286.31, Florida Statutes, is created to
   12  read:
   13         286.31Prohibited use of state funds.—
   14         (1)As used in this section, the term “governmental entity”
   15  means the state or any political subdivision thereof, including
   16  the executive, legislative, and judicial branches of government;
   17  the independent establishments of the state, counties,
   18  municipalities, districts, authorities, boards, or commissions;
   19  and any agencies that are subject to chapter 286.
   20         (2)A governmental entity, the state group health insurance
   21  program, a managing entity as defined in s. 394.9082, or a
   22  managed care plan providing services under part IV of chapter
   23  409 may not expend state funds as described in s. 215.31 for
   24  sex-reassignment procedures as defined in s. 456.001.
   25         Section 3. Present subsections (6) through (10) of section
   26  395.003, Florida Statutes, are redesignated as subsections (7)
   27  through (11), respectively, a new subsection (6) is added to
   28  that section, and present subsections (9) and (10) of that
   29  section are amended, to read:
   30         395.003 Licensure; denial, suspension, and revocation.—
   31         (6) By July 1, 2023, each licensed facility must provide a
   32  signed attestation to the agency stating that the facility does
   33  not offer or provide sex-reassignment procedures, as defined in
   34  s. 456.001, to patients younger than 18 years of age and does
   35  not refer such patients to other providers for such procedures.
   36  Beginning July 1, 2023, each licensed facility shall provide the
   37  signed attestation to the agency upon initial licensure and as a
   38  requirement for each licensure renewal. Under the due process
   39  requirements provided in chapter 120, the agency must revoke the
   40  license of any licensed facility that fails to provide the
   41  attestation required by this subsection.
   42         (10)(9) A hospital licensed as of June 1, 2004, shall be
   43  exempt from subsection (9) (8) as long as the hospital maintains
   44  the same ownership, facility street address, and range of
   45  services that were in existence on June 1, 2004. Any transfer of
   46  beds, or other agreements that result in the establishment of a
   47  hospital or hospital services within the intent of this section,
   48  shall be subject to subsection (9) (8). Unless the hospital is
   49  otherwise exempt under subsection (9) (8), the agency shall deny
   50  or revoke the license of a hospital that violates any of the
   51  criteria set forth in that subsection.
   52         (11)(10) The agency may adopt rules implementing the
   53  licensure requirements set forth in subsection (9) (8). Within
   54  14 days after rendering its decision on a license application or
   55  revocation, the agency shall publish its proposed decision in
   56  the Florida Administrative Register. Within 21 days after
   57  publication of the agency’s decision, any authorized person may
   58  file a request for an administrative hearing. In administrative
   59  proceedings challenging the approval, denial, or revocation of a
   60  license pursuant to subsection (9) (8), the hearing must be
   61  based on the facts and law existing at the time of the agency’s
   62  proposed agency action. Existing hospitals may initiate or
   63  intervene in an administrative hearing to approve, deny, or
   64  revoke licensure under subsection (9) (8) based upon a showing
   65  that an established program will be substantially affected by
   66  the issuance or renewal of a license to a hospital within the
   67  same district or service area.
   68         Section 4. Subsections (8) and (9) are added to section
   69  456.001, Florida Statutes, to read:
   70         456.001 Definitions.—As used in this chapter, the term:
   71         (8) “Sex” means the classification of a person as either
   72  male or female based on the organization of the human body of
   73  such person for a specific reproductive role, as indicated by
   74  the person’s sex chromosomes, naturally occurring sex hormones,
   75  and internal and external genitalia present at birth.
   76         (9)(a)“Sex-reassignment procedures” means any medical
   77  procedure, including a surgical procedure, to affirm a person’s
   78  perception of his or her sex if that perception is inconsistent
   79  with the person’s sex as defined in subsection (8).
   80         (b)The term does not include:
   81         1.The prescription or administration of puberty blockers
   82  for the purpose of attempting to stop or delay normal puberty in
   83  order to affirm a person’s perception of his or her sex if that
   84  perception is inconsistent with the person’s sex as defined in
   85  subsection (8).
   86         2.The prescription or administration of hormones or
   87  hormone antagonists to affirm a person’s perception of his or
   88  her sex if that perception is inconsistent with the person’s sex
   89  as defined in subsection (8).
   90         3.Treatment provided by a physician who, in his or her
   91  good faith clinical judgment, performs procedures upon or
   92  provides therapies to a minor born with a medically verifiable
   93  genetic disorder of sexual development, including any of the
   94  following:
   95         a. External biological sex characteristics that are
   96  unresolvably ambiguous.
   97         b. A disorder of sexual development in which the physician
   98  has determined through genetic or biochemical testing that the
   99  patient does not have a normal sex chromosome structure, sex
  100  steroid hormone production, or sex steroid hormone action for a
  101  male or female, as applicable.
  102         4.Prescriptions or procedures to treat an infection, an
  103  injury, a disease, or a disorder that has been caused or
  104  exacerbated by the performance of any sex-reassignment
  105  procedure, regardless of whether such procedure was performed in
  106  accordance with state or federal law.
  107         5.Prescriptions or procedures provided to a patient for
  108  the treatment of a physical disorder, physical injury, or
  109  physical illness that would, as certified by a physician
  110  licensed under chapter 458 or chapter 459, place the individual
  111  in imminent danger of death or impairment of a major bodily
  112  function without the prescription or procedure.
  113         Section 5. Section 456.52, Florida Statutes, is created to
  114  read:
  115         456.52 Sex-reassignment procedures; prohibitions; informed
  116  consent.—
  117         (1) Sex-reassignment procedures are prohibited for patients
  118  younger than 18 years of age.
  119         (2)If sex-reassignment procedures are performed on
  120  patients 18 years of age or older, consent must be voluntary,
  121  informed, and in writing on forms approved by the department.
  122  Consent to sex-reassignment procedures is voluntary and informed
  123  only if the physician who is to perform the procedure has, at a
  124  minimum, while physically present in the same room:
  125         (a)Informed the patient of the nature and risks of the
  126  procedure in order for the patient to make a prudent decision;
  127         (b)Provided the informed consent form, as approved by the
  128  department, to the patient; and
  129         (c)Received the patient’s written acknowledgment, before
  130  the procedure is performed, that the information required to be
  131  provided under this subsection has been provided.
  132         (3)Sex-reassignment procedures may not be performed except
  133  by a physician. For the purposes of this section, the term
  134  “physician” is defined as a physician licensed under chapter 458
  135  or chapter 459 or a physician practicing medicine or osteopathic
  136  medicine in the employment of the Federal Government.
  137         (4)(a)Violation of this section constitutes grounds for
  138  disciplinary action under this chapter and chapter 458 or
  139  chapter 459, as applicable.
  140         (b)Any health care practitioner who willfully or actively
  141  participates in a violation of subsection (1) commits a felony
  142  of the third degree, punishable as provided in s. 775.082, s.
  143  775.083, or s. 775.084.
  144         (c)Any health care practitioner who violates subsection
  145  (2) or subsection (3) commits a misdemeanor of the first degree,
  146  punishable as provided in s. 775.082 or s. 775.083.
  147         (5)(a)The department shall adopt emergency rules to
  148  implement this section.
  149         (b)Any emergency rules adopted under this section are
  150  exempt from s. 120.54(4)(c) and shall remain in effect until
  151  replaced by rules adopted under the nonemergency rulemaking
  152  procedures of the Administrative Procedure Act.
  153         Section 6. Present paragraphs (c) through (gg) of
  154  subsection (5) of section 456.074, Florida Statutes, are
  155  redesignated as paragraphs (d) through (hh), respectively, and a
  156  new paragraph (c) is added to that subsection, to read:
  157         456.074 Certain health care practitioners; immediate
  158  suspension of license.—
  159         (5) The department shall issue an emergency order
  160  suspending the license of any health care practitioner who is
  161  arrested for committing or attempting, soliciting, or conspiring
  162  to commit any act that would constitute a violation of any of
  163  the following criminal offenses in this state or similar
  164  offenses in another jurisdiction:
  165         (c) Section 456.52(4)(b), relating to performing sex
  166  reassignment procedures for a patient younger than 18 years of
  167  age.
  168         Section 7. Paragraph (c) of subsection (1) of section
  169  458.328, Florida Statutes, is amended to read:
  170         458.328 Office surgeries.—
  171         (1) REGISTRATION.—
  172         (c) Each of the following is As a condition of
  173  registration:,
  174         1.An each office must establish financial responsibility
  175  by demonstrating that it has met and continues to maintain, at a
  176  minimum, the same requirements applicable to physicians in ss.
  177  458.320 and 459.0085.
  178         2. Each physician practicing at an office registered under
  179  this section or s. 459.0138 must meet the financial
  180  responsibility requirements under s. 458.320 or s. 459.0085, as
  181  applicable.
  182         3.By July 1, 2023, each office registered under this
  183  section must provide a signed attestation to the department
  184  stating that the office does not offer or provide sex
  185  reassignment procedures, as defined in s. 456.001, to patients
  186  younger than 18 years of age and does not refer such patients to
  187  other providers for such services. Beginning July 1, 2023, any
  188  office seeking registration must provide such signed attestation
  189  to the department. An office’s failure to provide the signed
  190  attestation is grounds for denial of registration or the
  191  suspension or revocation of registration under paragraph (f).
  192         Section 8. Paragraph (c) of subsection (1) of section
  193  459.0138, Florida Statutes, is amended to read:
  194         459.0138 Office surgeries.—
  195         (1) REGISTRATION.—
  196         (c) Each of the following is As a condition of
  197  registration:,
  198         1.An each office must establish financial responsibility
  199  by demonstrating that it has met and continues to maintain, at a
  200  minimum, the same requirements applicable to physicians in ss.
  201  458.320 and 459.0085.
  202         2. Each physician practicing at an office registered under
  203  this section or s. 458.328 must meet the financial
  204  responsibility requirements under s. 458.320 or s. 459.0085, as
  205  applicable.
  206         3.By July 1, 2023, each office registered under this
  207  section must provide a signed attestation to the department
  208  stating that the office does not offer or provide sex
  209  reassignment procedures, as defined in s. 456.001, to patients
  210  younger than 18 years of age and does not refer such
  211  
  212  ================= T I T L E  A M E N D M E N T ================
  213  And the title is amended as follows:
  214         Delete lines 8 - 45
  215  and insert:
  216         procedures in another state; creating s. 286.31, F.S.;
  217         defining the term “governmental entity”; prohibiting
  218         certain public entities from expending state funds for
  219         the provision of sex-reassignment procedures; amending
  220         s. 395.003, F.S.; requiring certain licensed
  221         facilities, by a specified date and as a condition of
  222         licensure thereafter, to provide a signed attestation
  223         of specified information to the Agency for Health Care
  224         Administration; requiring the agency to revoke a
  225         facility’s license for failure to provide such
  226         attestation, subject to the due process procedures of
  227         ch. 120, F.S.; amending s. 456.001, F.S.; defining the
  228         terms “sex” and “sex-reassignment procedures”;
  229         creating s. 456.52, F.S.; prohibiting sex-reassignment
  230         procedures for patients younger than 18 years of age;
  231         requiring that such procedures for patients older than
  232         18 years of age be performed only with voluntary and
  233         informed consent of the patient; providing criteria
  234         for what constitutes voluntary and informed consent;
  235         providing that only a physician may perform such
  236         procedures; defining the term “physician”; providing
  237         applicability; providing for disciplinary action;
  238         providing criminal penalties; requiring the Department
  239         of Health to adopt certain emergency rules; providing
  240         that such emergency rules remain in effect until they
  241         are replaced by nonemergency rules; amending s.
  242         456.074, F.S.; requiring the department to immediately
  243         suspend the license of a health care practitioner who
  244         is arrested for committing or attempting, soliciting,
  245         or conspiring to commit specified violations related
  246         to sex-reassignment procedures for a patient younger
  247         than