House committee substitute to the 2nd edition replaces the entirety of the 2nd edition with the following.

Enacts new Article 1N, entitled Gender Procedures on Minors, to GS Chapter 90.  Bars a public healthcare facility, or a health care provider employed by  or under contract with a public healthcare facility, from performing a surgical gender transition on a minor or from dispensing or providing puberty-blocking drugs or cross-sex hormones to a minor (new GS 90-21.151(a)).

Sets forth 13 defined terms, including the following:

• Biological sex is the biological indication of male and female in the context of reproductive potential or capacity, such as sex chromosomes, naturally occurring sex hormones, gonads, and nonambiguous internal and external  genitalia present at birth, without regard to an individual's psychological, chosen, or subjective experience of gender.
• Cross-sex hormones are supraphysiologic doses of testosterone or other androgens to members of the female biological sex or supraphysiologic doses of estrogen or synthetic compounds with estrogenic activity to members of the male biological sex.
• Gender is the psychological, behavioral, social, and cultural aspects of being male or female.
• Gender reassignment surgery is any medical or surgical service that seeks to surgically alter or remove healthy physical or anatomical characteristics or features that are typical for the individual's biological sex, in order to instill or create physiological or anatomical characteristics that resemble a sex different from the individual's biological sex, including a genital or non-genital gender reassignment surgery as defined in this section.
• Gender transition is the process in which a person goes from identifying with and living as a gender that corresponds to his or her biological sex to identifying with and living as a gender different from his or her biological sex, and may involve social, legal, or physical changes.
• Genital gender reassignment surgery is a gender reassignment surgery performed for the purpose of assisting an individual with a gender transition, including, without limitation, any of the following: (1) surgical procedures such as penectomy, orchiectomy, vaginoplasty, clitoroplasty, or vulvoplasty for biologically male patients or hysterectomy or ovariectomy for biologically female patients; (2) reconstruction of the fixed part of the urethra with or without a metoidioplasty; or (3) phalloplasty, vaginectomy, scrotoplasty, or implantation of erection or testicular prostheses for biologically female patients.
• Minor is an individual who is younger than 18 years of age.
• Non-genital gender reassignment surgery is a gender reassignment surgery performed for the purpose of assisting an individual with a gender transition, including, without limitation, any of the following: (1) surgical procedures for biologically male patients, such as augmentation mammoplasty, facial feminization surgery, liposuction, lipofilling, voice surgery, thyroid cartilage reduction, gluteal augmentation, hair reconstruction, or various aesthetic procedures or (2) surgical procedures for biologically female patients, such as  subcutaneous mastectomy, voice surgery, liposuction, lipofilling, pectoral implants, or various aesthetic procedures.
• Puberty-blocking drugs are gonadotropin-releasing hormone analogues or other synthetic drugs used in biological males to stop luteinizing hormone secretion and therefore testosterone secretion, or synthetic drugs used in biological females which stop the production of estrogens and progesterone, when used to delay or suppress pubertal development in children for the purpose of assisting an individual with a gender transition.
• Public healthcare facility is any of the following: (1) The University of North Carolina Health Care System; (2) any healthcare institution, agency, or entity which has an affiliation agreement with the University of North Carolina, a constituent institution of the University of North Carolina, or the University of North Carolina Health Care System; (3) any facility operated by the Division of State Operated Healthcare Facilities, Department of Health and Human Services; (4) any local health department; or (5) any healthcare facility created or operated under Article 2 of GS Chapter 131E.
• Surgical gender transition procedure is any surgical service, including, without limitation, genital gender reassignment surgery and non-genital  reassignment surgery, physician's services, and inpatient and outpatient hospital services related to gender transition, that seeks to do any of the  following for the purpose of effecting a gender transition: (1) alter or remove physical or anatomical characteristics or features typical for the individual's biological sex or (2) instill or create physiological or anatomical characteristics that resemble a sex different from the individual's biological sex.

Exempts the following procedures on minors from the bar set forth above: (1) services to persons born with a medically verifiable disorder of sex development, including a person with external biological sex characteristics that are unresolvedly ambiguous, such as those born with 46 XX  chromosomes with virilization, 46 XY chromosomes with under-virilization, or having both ovarian and testicular tissue; (2) services provided when a physician has otherwise diagnosed a disorder of sexual development that the physician has determined through genetic or biochemical testing that the person does not have normal sex chromosome structure, sex steroid hormone production, or sex steroid hormone action; (3) the treatment of any infection, injury, disease, or disorder that has been caused by or exacerbated by the performance of gender transition procedures, whether or not the gender transition procedure was performed in accordance with State and federal law; (4) breast reduction procedures for a female patient causing a physical disorder; (5) any procedure undertaken because the individual suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the individual in imminent danger of death or impairment of major bodily function unless surgery is performed; and (6) any procedure, including those listed in GS 90-21.150(6) (definition of genital gender reassignment surgery) and (10) (definition of non-genital gender reassignment surgery), that a treating physician certifies is medically necessary to treat a physiological condition.

Specifies that nothing in new Article 1N should be construed to require a healthcare provider to perform a surgical gender transition procedure or to provide or dispense puberty-blocking drugs.

Enacts new GS 143C-6-5.6, which prohibits State funds from being used, directly or indirectly, for the performance of or in furtherance of surgical gender transition procedures, to provide puberty-blocking drugs or cross-sex hormones to a minor, or to support the administration of any governmental health plan or government-offered insurance policy offering surgical gender transition procedures, puberty-blocking drugs, or cross-sex hormones to a minor. Exempts the State Health Plan for Teachers and State Employees (Health Plan). and specifies that this exemption expires 30 days after the memorandum and order date June 10, 2022, or the permanent injunction ordered therein in Kadel v. Folwell is vacated, overturned, or no longer in force. Directs the Health Plan to notify the Revisor of Statutes if the order or injunction is vacated, overturned, or no longer in force. 

Effective October 1, 2023.

Makes conforming changes to the act's titles.