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LEGISLATURE OF NEBRASKA
ONE HUNDRED NINTH LEGISLATURE
SECOND SESSION
LEGISLATIVE BILL 731
Introduced by Kauth, 31.
Read first time January 07, 2026
Committee: Judiciary
A BILL FOR AN ACT relating to public health and welfare; to amend section1
25-222, Reissue Revised Statutes of Nebraska, and section 71-7307,2
Revised Statutes Cumulative Supplement, 2024; to adopt the Gender3
Transition Malpractice Accountability Act; to require insurance4
coverage for certain treatments and procedures arising as a result5
of a gender-altering procedure as prescribed; to provide an6
exemption to the time limitation to commence certain actions7
relating to professional negligence; to change provisions relating8
to civil actions under the Let Them Grow Act; to provide an9
operative date; to provide severability; and to repeal the original10
sections. 11
Be it enacted by the people of the State of Nebraska,12
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Section 1. Sections 1 to 6 of this act shall be known and may be1
cited as the Gender Transition Malpractice Accountability Act.2
Sec. 2. The Legislature finds that: 3
(1) Individuals subjected to gender transition procedures,4
especially as minors, may not recognize the full extent of physical,5
psychological, or reproductive harm until well into adulthood;6
(2) Standard medical malpractice statutes of limitations often7
expire before such individuals can reasonably discover injury or8
causation; and 9
(3) Extending the statute of limitations and creating a private10
right of action for such individuals protects patients, promotes11
accountability, and upholds the integrity of medical practice.12
Sec. 3. For purposes of the Gender Transition Malpractice13
Accountability Act: 14
(1) Cross-sex hormones means testosterone or other androgens given15
to biological females in amounts that are larger or more potent than16
would normally occur naturally in healthy females and estrogen given to17
males in amounts that are larger or more potent than would normally occur18
naturally in healthy males; 19
(2) Female has the same meaning as in section 79-3803;20
(3) Gender means the psychological, behavioral, social, and cultural21
aspects of being male or female; 22
(4) Gender alteration means the process in which a person goes from23
identifying with and living as a gender that corresponds to his or her24
sex to identifying with and living as a gender different from his or her25
sex, such as a member of the opposite sex or as nonbinary, and may26
involve social, legal, or physical changes; 27
(5)(a) Gender-altering procedures includes any medical or surgical28
service, including without limitation physician's services, inpatient and29
outpatient hospital services, or prescribed drugs related to gender30
alteration, that seeks to: 31
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(i) Alter or remove physical or anatomical characteristics or1
features that are typical for the individual's sex; or2
(ii) Instill or create physiological or anatomical characteristics3
that resemble a sex different from the individual's sex, including4
without limitation medical services that provide puberty-blocking drugs,5
cross-sex hormones, or other mechanisms to promote the development of6
feminizing or masculinizing features in the opposite sex, or genital or7
nongenital gender-altering surgery performed for the purpose of assisting8
an individual with a gender alteration. 9
(b) Gender-altering procedures does not include:10
(i) Services to persons born with a medically verifiable disorder of11
sex development, including a person with external sex characteristics12
that are irresolvably ambiguous, such as those born with 46 XX13
chromosomes with virilization, 46 XY chromosomes with undervirilization,14
or both ovarian and testicular tissue; 15
(ii) Services provided when a physician has otherwise diagnosed a16
disorder of sexual development that the physician has determined, through17
genetic or biochemical testing, that the person does not have normal sex-18
chromosome structure, sex-steroid production, or sex-steroid hormone19
action; 20
(iii) The acute and chronic treatment of any infection, injury,21
disease, or disorder that has been caused by or exacerbated by the22
performance of a gender-altering procedure, whether or not the gender-23
altering procedure was performed in accordance with state and federal24
law; or 25
(iv) Any procedure undertaken because the individual suffers from a26
physical disorder, physical injury, or physical illness that would, as27
certified by the physician, place the individual in imminent danger of28
death or impairment of major bodily function unless surgery is performed;29
(6) Gender-altering surgery means any medical or surgical service30
that seeks to surgically alter or remove healthy physical or anatomical31
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characteristics or features that are typical for the individual's sex in1
order to instill or create physiological or anatomical characteristics2
that resemble a sex different from the individual's sex, including3
without limitation, genital or nongenital gender-altering surgery4
performed for the purpose of assisting an individual with a gender5
alteration; 6
(7) Genital gender-altering surgery means a medical procedure7
performed for the purpose of assisting an individual with a gender8
alteration, including without limitation: 9
(a) Surgical procedures such as penectomy, orchiectomy,10
vaginoplasty, clitoroplasty, or vulvoplasty for male patients or11
hysterectomy or ovariectomy for female patients; 12
(b) Reconstruction of the fixed part of the urethra with or without13
a metoidioplasty; or 14
(c) Phalloplasty, vaginectomy, scrotoplasty, or implantation of15
erection or testicular prostheses for female patients;16
(8) Male has the same meaning as in section 79-3803;17
(9) Nongenital gender-altering surgery means medical procedures18
performed for the purpose of assisting an individual with a gender19
alteration, including without limitation: 20
(a) Surgical procedures for male patients, such as voice surgery or21
thyroid cartilage reduction; or 22
(b) Surgical procedures for female patients, such as subcutaneous23
mastectomy or voice surgery; 24
(10) Provider means any physician, mental health professional,25
clinic, hospital, or other entity involved in recommending, approving, or26
providing a gender-altering procedure; 27
(11) Puberty-blocking drugs means gonadotropin-releasing hormone28
analogues or other synthetic drugs used in biological males to stop29
luteinizing hormone secretion and therefore testosterone secretion, or30
synthetic drugs used in females which stop the production of estrogens31
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and progesterone, when used to delay or suppress pubertal development in1
children for the purpose of assisting an individual with a gender2
alteration; and 3
(12) Sex means an individual's sex, either male or female, without4
reference to the individual's psychological state, behavior, expression,5
or personal identity. 6
Sec. 4. (1) An action for injury or damages arising out of the7
recommendation, approval, or provision of a gender-altering procedure can8
only be brought against a provider within twelve years after the later of9
the date of such provider's recommendation, approval, or procedure.10
(2) Sovereign immunity is waived for any claim brought for injury or11
damages arising out of the recommendation, approval, or provision of a12
gender-altering procedure. 13
(3) A provider shall not seek a contractual waiver of the liability14
arising out of the performance of or failure to perform services while in15
the course of facilitating or perpetuating a gender-altering procedure.16
Any attempted waiver is contrary to the public policy of this state and17
is null and void. 18
Sec. 5. Any person entitled to bring an action under the Gender19
Transition Malpractice Accountability Act may recover actual damages and20
reasonable attorney's fees. Actual damages shall include, without21
limitation, damages for physical injury, pain and suffering, emotional22
distress, loss of fertility, diminished capacity for sexual relations,23
loss of income, and other economic and noneconomic losses.24
Sec. 6. (1) A provider who performs or prescribes any gender-25
altering procedure shall, prior to initiating the procedure, provide the26
patient, and the patient's parent or legal guardian if the patient is27
younger than nineteen years of age, with a written disclosure of:28
(a) All known physical and psychological risks associated with the29
gender-altering procedure; 30
(b) If applicable, the lack of conclusive long-term data on safety31
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and efficacy of the gender-altering procedure; and 1
(c) The potential for regret and need for future medical2
interventions. 3
(2) Such disclosure shall be signed by the provider, the patient,4
and, as appropriate, at least one parent or legal guardian. The provider5
shall maintain a copy of such disclosure in the medical record for such6
patient. 7
(3) Nothing in this section shall authorize a provider to perform or8
prescribe any gender-altering procedure on a patient who is younger than9
nineteen years of age in violation of any state law, the Let Them Grow10
Act, or any rules and regulations adopted and promulgated under the Let11
Them Grow Act. 12
Sec. 7. (1) For purposes of this section: 13
(a) Cross-sex hormones has the same meaning as in section 3 of this14
act; 15
(b) Female has the same meaning as in section 79-3803;16
(c) Gender has the same meaning as in section 3 of this act;17
(d) Gender alteration has the same meaning as in section 3 of this18
act; 19
(e) Gender-altering procedure has the same meaning as in section 320
of this act; 21
(f) Gender-altering surgery has the same meaning as in section 3 of22
this act; 23
(g) Genital gender-altering surgery has the same meaning as in24
section 3 of this act; 25
(h) Health insurance policy means (i) any individual or group26
sickness and accident insurance policy or subscriber contract delivered,27
issued for delivery, or renewed in this state and any hospital, medical,28
or surgical expense-incurred policy, except for policies that provide29
coverage for a specific disease or other limited-benefit coverage, and30
(ii) any self-funded employee benefit plan to the extent not preempted by31
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federal law; 1
(i) Male has the same meaning as in section 79-3803;2
(j) Nongenital gender-altering surgery has the same meaning as in3
section 3 of this act; 4
(k) Puberty-blocking drugs has the same meaning as in section 3 of5
this act; and 6
(l) Sex means an individual's sex, either male or female without7
reference to the individual's psychological state, behavior, expression,8
or personal identity. 9
(2) This section applies beginning January 1, 2027.10
(3) Notwithstanding section 44-3,131, any health insurance policy11
which provides coverage or has ever provided coverage for a covered12
individual's gender-altering procedure shall: 13
(a) Provide coverage, including for any applicable diagnostic or14
billing code, for: 15
(i) All possible adverse consequences related to the covered16
individual's gender-altering procedure, including any short-term or long-17
term side effects of the procedure; 18
(ii) Any baseline and follow-up testing or screening necessary to19
monitor the mental and physical health of the covered individual on at20
least an annual basis without regard to the sex or gender identity21
designation in the covered individual's medical record; and22
(iii) Any procedure, treatment, or therapy necessary to manage,23
reverse, reconstruct from, or recover from the covered individual's24
gender-altering procedure; and 25
(b) Provide the coverage described in this subsection to any covered26
individual who has undergone a gender-altering procedure regardless of27
whether the covered individual was enrolled in the plan or policy at the28
time of the procedure. 29
Sec. 8. Section 25-222, Reissue Revised Statutes of Nebraska, is30
amended to read: 31
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25-222 Any action to recover damages based on alleged professional1
negligence or upon alleged breach of warranty in rendering or failure to2
render professional services shall be commenced within two years next3
after the alleged act or omission in rendering or failure to render4
professional services providing the basis for such action; Provided, if5
the cause of action is not discovered and could not be reasonably6
discovered within such two-year period, then the action may be commenced7
within one year from the date of such discovery or from the date of8
discovery of facts which would reasonably lead to such discovery,9
whichever is earlier; and provided further, that in no event may any10
action be commenced to recover damages for professional negligence or11
breach of warranty in rendering or failure to render professional12
services more than ten years after the date of rendering or failure to13
render such professional service which provides the basis for the cause14
of action. 15
This section does not apply to claims brought pursuant to the Gender16
Transition Malpractice Accountability Act. 17
Sec. 9. Section 71-7307, Revised Statutes Cumulative Supplement,18
2024, is amended to read: 19
71-7307 An individual that received a gender-altering procedure in20
violation of section 71-7304 after October 1, 2023, and while such21
individual was younger than nineteen years of age, or the parent or22
guardian of such an individual, may bring a civil action for appropriate23
relief against the health care practitioner who performed the gender-24
altering procedure. Appropriate relief in an action under this section25
includes actual damages and reasonable attorney's fees. An action under26
this section shall be brought within the time an action must be brought27
pursuant to section 4 of this act two years after discovery of damages.28
Sec. 10. This act becomes operative on January 1, 2027.29
Sec. 11. If any section in this act or any part of any section is30
declared invalid or unconstitutional, the declaration shall not affect31
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the validity or constitutionality of the remaining portions.1
Sec. 12. Original section 25-222, Reissue Revised Statutes of2
Nebraska, and section 71-7307, Revised Statutes Cumulative Supplement,3
2024, are repealed. 4
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