MO SB861

Removes the August 28, 2027 sunset date from Missouri's existing SAFE Act, making permanent the prohibition on health care providers prescribing or administering cross-sex hormones or puberty-blocking drugs to minors for gender transition purposes

Excludes gender transition surgeries, cross-sex hormones, and puberty-blocking drugs from the legal definition of "reproductive health care" for both minors and adults under Missouri law

Maintains existing provisions prohibiting gender transition surgeries on individuals under 18, with violations resulting in mandatory license revocation for health care providers

Preserves the private cause of action allowing individuals to sue providers, with a 15-year statute of limitations from age 21, minimum $500,000 damages, treble damages, and a rebuttable presumption of harm if infertility occurs

Continues exemptions for individuals with medically-verifiable disorders of sex development, those who began treatment before August 28, 2023, and emergency medical situations