Definitions

Subsection (a) of section 111 of the Child Abuse Prevention and Treatment Act (42 U.S.C. 5106g) is amended to read as follows: (a) Definitions For purposes of this title: (1) (A) The term adverse State action means any covered action taken by a covered entity, if any of the following was a motivating factor, without regard to how the covered entity characterizes the reason for the covered action: (i) Affirmation of, or intent to affirm, the child's sex by the parent, legal guardian, or caregiver. (ii) The child’s request to be treated in a manner inconsistent with the child's sex or the child's request for, or attempt to obtain, sex-rejecting interventions. (iii) The child’s expression of psychological distress, including suicidal ideation or threat of self-harm, related to affirmation of the child's sex by the parent, legal guardian, or caregiver. (iv) That the child ran away, threatens to run away, or intends to run away from or requests no contact with a parent, legal guardian, or caregiver because of a circumstance described in clause (i), (ii), or (iii). (B) For purposes of subparagraph (A), a covered action includes any of the following: (i) The removal or threat of removal of a child from the home, or the removal or threat of removal of a parent, legal guardian, or caregiver from the home, including removal of the child or such parent, legal guardian, or caregiver pursuant to any safety plan or other protective-services action by a covered entity. (ii) Any assessment, investigation, or inquiry conducted for the purpose of determining the existence of child abuse, neglect, or parental unfitness or incapacity. (iii) Any dependency, child welfare, or juvenile court proceeding, including any investigation, removal proceeding, proceeding to limit or condition the exercise of parental rights, proceeding relating to visitation, proceeding to terminate parental rights, or other related child welfare or court proceeding. (iv) Denying, impeding, interfering with or unreasonably delaying— (I) the parent’s, legal guardian’s, or caregiver’s visitation, communication, or meeting with the child; (II) the parent's, legal guardian's, or caregiver’s scheduled meeting, case conference, or other planned communication with an employee or agent of a covered entity regarding the child; or (III) the return of the child to the parent, legal guardian, or caregiver. (v) The making of any finding or substantiation of child abuse, neglect, or parental unfitness or incapacity. (vi) Any case plan, safety plan, service plan, or reunification plan recommendation or requirement imposed by a covered entity as a condition of visitation, communication, or meeting with a child, reunification, return of a child, or continued family preservation. (vii) The involuntary termination of parental rights to a child or to a sibling of a child. (viii) Placement on a State child abuse registry or index. (ix) The delay or denial of foster-care placement or adoption. (2) The terms affirm, affirmed, and affirmation, with respect to the sex of a child, mean referring to or raising the child, or intending to refer to or raise the child, as his or her sex, including refusing to consent to sex-rejecting interventions for the child. (3) The term Alaska Native has the meaning given the term Native in section 3 of the Alaska Native Claims Settlement Act (43 U.S.C. 1602). (4) The term caregiver means any person who provides ongoing care, supervision, and decision-making for a child on a regular basis, including a licensed foster parent, kinship caregiver, pre-adoptive foster parent, or person acting in loco parentis, but does not include any person who is a parent or legal guardian. (5) The term covered entity means— (A) an entity that has received funds under this title, directly or as a recipient of a subgrant, including— (i) any State, and any agency of a State that administers child protective services, child welfare services, or related functions; (ii) any Indian Tribe or Tribal organization; or (iii) any public or private agency or organization that contracts with any entity listed in clause (i) or (ii); or (B) any individual who is a contractor, employee, or agent of any of the entities described in subparagraph (A). (6) The term disorder of sex development means a congenital condition involving atypical complement or structure or development of sex chromosomes, gonads, internal genital ducts, or external genitalia, including disorders of sex hormone synthesis or action, but does not include psychological or behavioral conditions, nor typical male or female sex development with distress regarding sexed anatomy. (7) The term infant or toddler with a disability has the meaning given the term in section 632 of the Individuals with Disabilities Education Act (20 U.S.C. 1432). (8) The term Native Hawaiian has the meaning given the term in section 6207 of the Elementary and Secondary Education Act of 1965. (9) The term sex means an individual’s immutable biological sex, either— (A) male, whereby the individual naturally has, had, will have, or would have, but for a disorder of sex development or an intentional or unintentional disruption, the reproductive system that produces, transports, and utilizes the small gamete (sperm) for fertilization; or (B) female, whereby the individual naturally has, had, will have, or would have, but for a disorder of sex development or an intentional or unintentional disruption, the reproductive system that produces, transports, and utilizes the large gamete (ova) for fertilization. (10) The term sex-rejecting intervention — (A) means a psychological, medical, or surgical intervention that is intended to promote, endorse, or enable a child’s rejection of the child’s sex, to promote, endorse, or enable a child to adopt an appearance that does not correspond to the child's sex, or to intentionally change the body of a child, including the child's external appearance or biological functions, to no longer correspond to the child's sex, including— (i) intentionally delaying, halting, or disrupting the natural development of the child’s body, including the onset or progression of puberty, so that the child's body does not develop or halts developing to correspond to the child’s sex, which may include the use of puberty blocking drugs, such as gonadotropin releasing hormone agonists or antagonists; (ii) prescribing, administering, or dispensing to the child androgen blockers or sex hormones such as estrogen, progesterone, or testosterone; (iii) prescribing or performing any surgical procedure that attempts to transform the physical appearance, or that attempts to alter or remove the tissues, cavities, bone, cartilage, or organs, of a child; (iv) providing compression materials or garments that are designed to constrict female breasts, or that flatten or tuck a male’s genitals, prosthetic breasts, genitals, or hips, or any other materials that enable the child to conceal his or her sex or to simulate the physical characteristics of the opposite sex; or (v) permitting or assigning a child who is 4 years of age or older to— (I) use sleeping quarters, bathrooms, locker rooms, changing rooms, or other areas in which a child may be in a state of undress, with individuals of the opposite sex; or (II) participate in sex-separated activities designated for individuals of the opposite sex; and (B) does not include the treatment of a disorder of sex development or the treatment of any infection, injury, disease, or disorder that has been caused or exacerbated by the performance of an intervention described in any of clauses (i) through (iv) of subparagraph (A). (11) The term sexual abuse includes— (A) the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct; or (B) the rape, and in cases of caretaker or inter-familial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children. (12) The term withholding of medically indicated treatment means the failure to respond to the infant's life-threatening conditions by providing treatment (including appropriate nutrition, hydration, and medication) which, in the treating physician's or physicians' reasonable medical judgment, will be most likely to be effective in ameliorating or correcting all such conditions, except that the term does not include the failure to provide treatment (other than appropriate nutrition, hydration, or medication) to an infant when, in the treating physician's or physicians' reasonable medical judgment— (A) the infant is chronically and irreversibly comatose; (B) the provision of such treatment would— (i) merely prolong dying; (ii) not be effective in ameliorating or correcting all of the infant's life-threatening conditions; or (iii) otherwise be futile in terms of the survival of the infant; or (C) the provision of such treatment would be virtually futile in terms of the survival of the infant and the treatment itself under such circumstances would be inhumane..