I 

111TH CONGRESS 

1ST SESSION H. R. 3001 

To address the health disparities experienced by lesbian, gay, bisexual, and 

transgender Americans, to eliminate the barriers they face in accessing 

quality health care, and to ensure that good health and well-being is 

accessible to all. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 23, 2009 

Ms. BALDWIN (for herself, Mr. WAXMAN, Ms. LEE of California, Mr. HONDA, 

and Ms. VELA ́ZQUEZ) introduced the following bill; which was referred to 

the Committee on Energy and Commerce, and in addition to the Committees on Armed Services, the Judiciary, Ways and Means, Oversight and 

Government Reform, House Administration, Education and Labor, Veterans’ Affairs, Transportation and Infrastructure, Select Intelligence 

(Permanent Select), and Foreign Affairs, for a period to be subsequently 

determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To address the health disparities experienced by lesbian, 

gay, bisexual, and transgender Americans, to eliminate 

the barriers they face in accessing quality health care, 

and to ensure that good health and well-being is accessible to all. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Ending LGBT Health 

3 Disparities Act’’. 

4 SEC. 2. TABLE OF CONTENTS. 

5 The table of contents of this Act is as follows: 

Sec. 1. Short title. 

Sec. 2. Table of contents. 

Sec. 3. Definition. 

Sec. 4. Effective date. 

TITLE I—HEALTH ACCESS AND PROMOTION 

Subtitle A—Private Health Insurance 

Sec. 101. Tax Equity for Health Plan Beneficiaries Act. 

Sec. 102. Preexisting condition exclusion patient protection. 

Sec. 103. Domestic Partnership Benefits and Obligations Act. 

Subtitle B—Public Health Insurance 

Sec. 111. Optional Medicaid coverage of low-income HIV-infected individuals. 

Sec. 112. Expanded definition of spouse for purposes of the Medicare program. 

Sec. 113. Ending the Medicare Disability Waiting Period Act. 

Sec. 114. Including costs incurred by AIDS drug assistance programs in providing prescription drugs toward the annual out-of-pocket 

threshold under Medicare part D. 

Sec. 115. Nondiscrimination based on gender identity or sexual orientation 

under the Medicaid, Medicare, and CHIP programs. 

Subtitle C—Miscellaneous 

Sec. 121. Health Promotion Grants. 

Sec. 122. Mental Health Promotion Grants. 

Sec. 123. Health Insurance Coverage Grants. 

TITLE II—CULTURAL COMPETENCY AND WORKFORCE 

Sec. 201. Amendment to the Public Health Service Act. 

Sec. 202. Definitions. 

Sec. 203. Federal reimbursement for culturally competent services under the 

Medicare, Medicaid, and Children’s Health Insurance Programs. 

Sec. 204. Report on Federal efforts to provide culturally competent health care 

services to sexual and gender minorities. 

TITLE III—RESEARCH AND DATA COLLECTION 

Sec. 301. No compelled disclosure of data. 

Sec. 302. Federal collection of data on sexual and gender minorities. 

Sec. 303. Inclusion of sexual orientation and gender identity in federally funded 

health surveys. 

Sec. 304. Research on sexual and gender minority health. 


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TITLE IV—INFRASTRUCTURE AND CAPACITY BUILDING 

Sec. 401. Office of LGBT Health. 

Sec. 402. Community health centers. 

TITLE V—OLDER AMERICANS SUPPORT PROGRAM 

Sec. 501. Priority. 

TITLE VI—MISCELLANEOUS PROVISIONS 

Sec. 601. Nondiscrimination contingency for VAWA grant funds; Grant program for LGBT victims of violence. 

Sec. 602. National Baseline Study on Domestic Violence and Sexual Assault in 

the LGBT Community. 

Sec. 603. Assistance to reduce teen pregnancy, HIV/AIDS, and other sexually 

transmitted diseases and to support healthy adolescent development. 

Sec. 604. Mother’s and father’s insurance benefits under Social Security for 

same-sex surviving parents. 

Sec. 605. Prohibition against discrimination on the basis of sexual orientation 

or gender identity under the health benefits program for Federal employees. 

Sec. 606. Prohibition against discrimination on the basis of sex, gender identity, or sexual orientation under certain laws providing health 

care and other benefits for members of the Armed Forces and 

Veterans. 

1 SEC. 3. DEFINITION. 

2 In this Act: 

3 (1) Unless otherwise specified, the term ‘‘Sec4 retary’’ means the Secretary of Health and Human 

5 Services. 

6 (2) The terms ‘‘sexual or gender minority’’ and 

7 ‘‘sexual and gender minority’’ mean a lesbian, gay, 

8 bisexual, or transgender individual. 

9 SEC. 4. EFFECTIVE DATE. 

10 Unless otherwise specified, this Act and the amend11 ments made this Act shall take effect on the date that 

12 is 30 days after the date of the enactment of this Act. 


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1 TITLE I—HEALTH ACCESS AND 

2 PROMOTION 

3 Subtitle A—Private Health 

4 Insurance 

5 SEC. 101. TAX EQUITY FOR HEALTH PLAN BENEFICIARIES 

6 ACT. 

7 (a) APPLICATION OF ACCIDENT AND HEALTH PLANS

8 TO ELIGIBLE BENEFICIARIES.— 

9 (1) EXCLUSION OF CONTRIBUTIONS.—Section 

10 106 of the Internal Revenue Code of 1986 (relating 

11 to contributions by employer to accident and health 

12 plans) is amended by adding at the end the following 

13 new subsection: 

14 ‘‘(f) COVERAGE PROVIDED FOR ELIGIBLE BENE15 FICIARIES OF EMPLOYEES.— 

16 ‘‘(1) IN GENERAL.—Subsection (a) shall apply 

17 with respect to an eligible beneficiary and any quali18 fying child who is a dependent of the eligible bene19 ficiary. 

20 ‘‘(2) QUALIFYING CHILD; DEPENDENT.—For 

21 purposes of this subsection— 

22 ‘‘(A) QUALIFYING CHILD.—The term 

23 ‘qualifying child’ has the meaning given such 

24 term by section 152(c). 


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1 ‘‘(B) DEPENDENT.—The term ‘dependent’ 

2 has the meaning given such term by section 

3 105(b).’’. 

4 (2) EXCLUSION OF AMOUNTS EXPENDED FOR

5 MEDICAL CARE.—The first sentence of section 

6 105(b) of such Code (relating to amounts expended 

7 for medical care) is amended by inserting before the 

8 period the following: ‘‘and eligible beneficiary and 

9 the qualifying children of the eligible beneficiary 

10 (within the meaning of section 106(f)) with respect 

11 to the taxpayer’’. 

12 (3) PAYROLL TAXES.— 

13 (A) Section 3121(a)(2) of such Code is 

14 amended— 

15 (i) by inserting ‘‘, or his eligible bene16 ficiary or any qualifying children of the eli17 gible beneficiary,’’ after ‘‘his dependents’’ 

18 both places it appears, 

19 (ii) by inserting ‘‘, and eligible bene20 ficiaries and qualifying children of eligible 

21 beneficiaries (within the meaning of section 

22 106(f)),’’ after ‘‘their dependents’’ the first 

23 place it appears, and 

24 (iii) by inserting ‘‘, eligible bene25 ficiaries, and qualifying children of eligible 


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1 beneficiaries’’ after ‘‘their dependents’’ the 

2 second place it appears. 

3 (B) Section 3231(e)(1) of such Code is 

4 amended— 

5 (i) by inserting ‘‘, or his eligible bene6 ficiary or any qualifying children of his eli7 gible beneficiary,’’ after ‘‘his dependents’’, 

8 (ii) by inserting ‘‘, and eligible bene9 ficiaries and qualifying children of eligible 

10 beneficiaries (within the meaning of section 

11 106(f)),’’ after ‘‘their dependents’’ the first 

12 place it appears, and 

13 (iii) by inserting ‘‘, eligible bene14 ficiaries, and qualifying children of eligible 

15 beneficiaries’’ after ‘‘their dependents’’ the 

16 second place it appears. 

17 (C) Section 3306(b)(2) of such Code is 

18 amended— 

19 (i) by inserting ‘‘, or his eligible bene20 ficiary or any qualifying children of his eli21 gible beneficiary,’’ after ‘‘his dependents’’ 

22 both places it appears, 

23 (ii) by inserting ‘‘, and eligible bene24 ficiaries and qualifying children of eligible 

25 beneficiaries (within the meaning of section 


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1 106(f)),’’ after ‘‘their dependents’’ the first 

2 place it appears, and 

3 (iii) by inserting ‘‘, eligible bene4 ficiaries, and qualifying children of eligible 

5 beneficiaries’’ after ‘‘their dependents’’ the 

6 second place it appears. 

7 (D) Section 3401(a) of such Code is 

8 amended by striking ‘‘or’’ at the end of para9 graph (21), by striking the period at the end of 

10 paragraph (22) and inserting ‘‘; or’’, and by in11 serting after paragraph (22) the following new 

12 paragraph: 

13 ‘‘(23) for any payment made to or for the ben14 efit of an employee or his eligible beneficiary or any 

15 qualifying children of his eligible beneficiary (within 

16 the meaning of section 106(f)) if at the time of such 

17 payment it is reasonable to believe that the employee 

18 will be able to exclude such payment from income 

19 under section 106(f) or under section 105 by ref20 erence in section 105(b) to section 106(f);’’. 

21 (4) EFFECTIVE DATE.—The amendments made 

22 by this section shall apply to taxable years beginning 

23 after December 31, 2009. 


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1 (b) EXPANSION OF DEPENDENCY FOR PURPOSES OF

2 DEDUCTION FOR HEALTH INSURANCE COSTS OF SELF3 EMPLOYED INDIVIDUALS.— 

4 (1) IN GENERAL.—Subsection (l) of section 162 

5 of the Internal Revenue Code of 1986 (relating to 

6 special rules for health insurance costs of self-em7 ployed individuals) is amended by adding at the end 

8 the following new paragraph: 

9 ‘‘(6) DEPENDENTS.—For purposes of this sub10 section, the term ‘dependents’ shall include the fol11 lowing with respect to the taxpayer— 

12 ‘‘(A) any individual who satisfies the re13 quirements of sections 152(c)(3)(A) and 

14 152(d)(2)(H) (determined without regard to 

15 subsections (d)(1)(B) and (d)(1)(D) thereof), 

16 and 

17 ‘‘(B) one individual who does not satisfy 

18 the requirements of section 152(c)(3)(A), but 

19 who satisfies the requirements of section 

20 152(d)(2)(H) (determined without regard to 

21 subsections (d)(1)(B) and (d)(1)(C) thereof).’’. 

22 (2) CONFORMING AMENDMENT.—Subparagraph 

23 (B) of section 162(l)(2) of such Code is amended by 

24 inserting ‘‘or dependent (as defined in paragraph 

25 (1))’’ after ‘‘spouse’’. 


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1 (3) EFFECTIVE DATE.—The amendments made 

2 by this section shall apply to taxable years beginning 

3 after December 31, 2009. 

4 (c) EXTENSION TO ELIGIBLE BENEFICIARIES OF

5 SICK AND ACCIDENT BENEFITS PROVIDED TO MEMBERS

6 OF A VOLUNTARY EMPLOYEES’ BENEFICIARY ASSOCIA7 TION AND THEIR DEPENDENTS.— 

8 (1) IN GENERAL.—Section 501(c)(9) of the In9 ternal Revenue Code of 1986 (relating to list of ex10 empt organizations) is amended by adding at the 

11 end the following new sentence: ‘‘For purposes of 

12 providing for the payment of sick and accident bene13 fits to members of such an association and their de14 pendents, the term ‘dependents’ shall include any in15 dividual who is an eligible beneficiary, or qualified 

16 child of an eligible beneficiary, as determined under 

17 the terms of a medical benefit, health insurance, or 

18 other program under which members and their de19 pendents are entitled to sick and accident benefits.’’. 

20 (2) EFFECTIVE DATE.—The amendment made 

21 by this section shall apply to taxable years beginning 

22 after December 31, 2009. 

23 (d) FLEXIBLE SPENDING ARRANGEMENTS AND

24 HEALTH REIMBURSEMENT ARRANGEMENTS.—The Sec25 retary of Treasury shall issue guidance of general applicaVerDate Nov 24 2008 23:57 Jun 25, 2009 Jkt 079200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3001.IH H3001

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1 bility providing that medical expenses that otherwise qual2 ify— 

3 (1) for reimbursement from a flexible spending 

4 arrangement under regulations in effect on the date 

5 of the enactment of this Act may be reimbursed 

6 from an employee’s flexible spending arrangement, 

7 notwithstanding the fact that such expenses are at8 tributable to an individual who is the employee’s eli9 gible beneficiary under any accident or health plan 

10 of the employer, and 

11 (2) for reimbursement from a health reimburse12 ment arrangement under regulations in effect on the 

13 date of the enactment of this Act may be reimbursed 

14 from an employee’s health reimbursement arrange15 ment, notwithstanding the fact that such expenses 

16 are attributable to an individual who is not a spouse 

17 or dependent within the meaning of section 152 but 

18 who is designated by the employee as eligible to have 

19 his or her expenses reimbursed under the health re20 imbursement arrangement. 

21 SEC. 102. PREEXISTING CONDITION EXCLUSION PATIENT 

22 PROTECTION. 

23 (a) AMENDMENTS RELATING TO PREEXISTING CON24 DITION EXCLUSIONS UNDER GROUP HEALTH PLANS.— 


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1 (1) AMENDMENTS TO THE EMPLOYEE RETIRE2 MENT INCOME SECURITY ACT OF 1974.— 

3 (A) REDUCTION IN LOOK-BACK PERIOD.— 

4 Section 701(a)(1) of the Employee Retirement 

5 Income Security Act of 1974 (29 U.S.C. 

6 1181(a)(1)) is amended by striking ‘‘6-month 

7 period’’ and inserting ‘‘30-day period’’. 

8 (B) REDUCTION IN PERMITTED PRE9 EXISTING CONDITION LIMITATION PERIOD.— 

10 Section 701(a)(2) of such Act (29 U.S.C. 

11 1181(a)(2)) is amended by striking ‘‘12 

12 months’’ and inserting ‘‘3 months’’, and by 

13 striking ‘‘18 months’’ and inserting ‘‘9 

14 months’’. 

15 (2) AMENDMENTS TO THE PUBLIC HEALTH

16 SERVICE ACT.— 

17 (A) REDUCTION IN LOOK-BACK PERIOD.— 

18 Section 2701(a)(1) of the Public Health Service 

19 Act (42 U.S.C. 300gg(a)(1)) is amended by 

20 striking ‘‘6-month period’’ and inserting ‘‘30- 

21 day period’’. 

22 (B) REDUCTION IN PERMITTED PRE23 EXISTING CONDITION LIMITATION PERIOD.— 

24 Section 2701(a)(2) of such Act (42 U.S.C. 

25 300gg(a)(2)) is amended by striking ‘‘12 


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1 months’’ and inserting ‘‘3 months’’, and by 

2 striking ‘‘18 months’’ and inserting ‘‘9 

3 months’’. 

4 (3) AMENDMENTS TO THE INTERNAL REVENUE

5 CODE OF 1986.— 

6 (A) REDUCTION IN LOOK-BACK PERIOD.— 

7 Paragraph (1) of section 9801(a) of the Inter8 nal Revenue Code of 1986 (relating to limita9 tion on preexisting condition exclusion period 

10 and crediting for periods of previous coverage) 

11 is amended by striking ‘‘6-month period’’ and 

12 inserting ‘‘30-day period’’. 

13 (B) REDUCTION IN PERMITTED PRE14 EXISTING CONDITION LIMITATION PERIOD.— 

15 Paragraph (2) of section 9801(a) of such Code 

16 is amended by striking ‘‘12 months’’ and insert17 ing ‘‘3 months’’, and by striking ‘‘18 months’’ 

18 and inserting ‘‘9 months’’. 

19 (4) EFFECTIVE DATE.— 

20 (A) IN GENERAL.—Except as provided in 

21 paragraph (2), the amendments made by this 

22 subsection shall apply with respect to group 

23 health plans for plan years beginning after the 

24 end of the 12th calendar month following the 

25 date of the enactment of this Act. 


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1 (B) SPECIAL RULE FOR COLLECTIVE BAR2 GAINING AGREEMENTS.—In the case of a group 

3 health plan maintained pursuant to one or more 

4 collective bargaining agreements between em5 ployee representatives and one or more employ6 ers ratified before the date of the enactment of 

7 this Act, the amendments made by this sub8 section shall not apply to plan years beginning 

9 before the earlier of— 

10 (i) the date on which the last of the 

11 collective bargaining agreements relating to 

12 the plan terminates (determined without 

13 regard to any extension thereof agreed to 

14 after the date of the enactment of this 

15 Act), or 

16 (ii) 3 years after the date of the en17 actment of this Act. 

18 For purposes of clause (i), any plan amendment 

19 made pursuant to a collective bargaining agree20 ment relating to the plan which amends the 

21 plan solely to conform to any requirement 

22 added by the amendments made by this sub23 section shall not be treated as a termination of 

24 such collective bargaining agreement. 


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1 (b) AMENDMENTS RELATING TO PREEXISTING CON2 DITION EXCLUSIONS IN HEALTH INSURANCE COVERAGE

3 IN THE INDIVIDUAL MARKET.— 

4 (1) APPLICABILITY OF GROUP HEALTH INSUR5 ANCE LIMITATIONS ON IMPOSITION OF PREEXISTING

6 CONDITION EXCLUSIONS.— 

7 (A) IN GENERAL.—Subpart 1 of part B of 

8 title XXVII of the Public Health Service Act 

9 (42 U.S.C. 300gg–41 et seq.) is amended by in10 serting after section 2741 the following: 

11 ‘‘SEC. 2741A. APPLICATION OF GROUP HEALTH INSURANCE 

12 LIMITATIONS ON IMPOSITION OF PRE13 EXISTING CONDITION EXCLUSIONS. 

14 ‘‘(a) IN GENERAL.—Subject to subsection (b), a 

15 health insurance issuer that provides individual health in16 surance coverage may not impose a preexisting condition 

17 exclusion (as defined in subsection (b)(1)(A) of section 

18 2701) with respect to such coverage except to the extent 

19 that such exclusion could be imposed consistent with such 

20 section if such coverage were group health insurance cov21 erage. 

22 ‘‘(b) LIMITATION.—In the case of an individual 

23 who— 

24 ‘‘(1) is enrolled in individual health insurance 

25 coverage; 


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1 ‘‘(2) during the period of such enrollment has 

2 a condition for which no medical advice, diagnosis, 

3 care, or treatment had been recommended or re4 ceived as of the enrollment date; and 

5 ‘‘(3) seeks to enroll under other individual 

6 health insurance coverage which provides benefits 

7 different from those provided under the coverage re8 ferred to in paragraph (1) with respect to such con9 dition, 

10 the issuer of the individual health insurance coverage de11 scribed in paragraph (2) may impose a preexisting condi12 tion exclusion with respect to such condition and any bene13 fits in addition to those provided under the coverage re14 ferred to in paragraph (1), but such exclusion may not 

15 extend for a period of more than 3 months. 

16 ‘‘SEC. 2741B. ELIGIBILITY TO ENROLL. 

17 ‘‘(a) IN GENERAL.—Subject to subsection (d), an in18 dividual health plan, and a health insurance issuer offer19 ing health insurance in the individual market, may not de20 cline to offer coverage to, deny enrollment of, or establish 

21 rules for eligibility (including continued eligibility) to en22 roll under the terms of the plan, an individual based on 

23 any of the following health status-related factors in rela24 tion to the individual or a dependent of the individual: 

25 ‘‘(1) Health status. 


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1 ‘‘(2) Medical condition (including both physical 

2 and mental illnesses). 

3 ‘‘(3) Claims experience. 

4 ‘‘(4) Receipt of health care. 

5 ‘‘(5) Medical history. 

6 ‘‘(6) Genetic information. 

7 ‘‘(7) Evidence of insurability (including condi8 tions arising out of acts of domestic violence). 

9 ‘‘(8) Disability. 

10 ‘‘(b) NO APPLICATION TO BENEFITS OR EXCLU11 SIONS.—To the extent consistent with section 2701, sub12 section (a) shall not be construed— 

13 ‘‘(1) to require an individual health plan, or a 

14 health insurance issuer offering health insurance on 

15 the individual market, to provide particular benefits 

16 other than those provided under the terms of such 

17 plan or coverage; or 

18 ‘‘(2) to prevent such a plan or coverage from 

19 establishing limitations or restrictions on the 

20 amount, level, extent, or nature of the benefits or 

21 coverage for similarly situated individuals enrolled in 

22 the plan or coverage. 

23 ‘‘(c) RULES FOR ELIGIBILITY.—In subsection (a), 

24 the term ‘rules for eligibility’, with respect to enrollment 


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1 under the terms of a plan, includes any rule defining any 

2 applicable waiting period for such enrollment. 

3 ‘‘(d) IN PREMIUM CONTRIBUTIONS.— 

4 ‘‘(1) IN GENERAL.—An individual health plan, 

5 and a health insurance issuer offering health insur6 ance on the individual market, may not require any 

7 individual (as a condition of enrollment or continued 

8 enrollment under the plan) to pay a premium or 

9 contribution which is greater than such premium or 

10 contribution for a similarly situated individual en11 rolled in the plan on the basis of any health status12 related factor in relation to the individual or to an 

13 individual enrolled under the plan as a dependent of 

14 the individual. 

15 ‘‘(2) CONSTRUCTION.—Nothing in subsection 

16 (a) shall be construed to prevent an individual 

17 health plan, and a health insurance issuer offering 

18 health insurance on the individual market from es19 tablishing premium discounts or rebates or modi20 fying otherwise applicable copayments or deductibles 

21 in return for adherence to programs of health pro22 motion and disease prevention.’’. 

23 (B) ELIMINATION OF COBRA REQUIRE24 MENT.—Subsection (b) of section 2741 of the 


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1 Public Health Service Act (42 U.S.C. 300gg– 

2 41) is amended— 

3 (i) by adding ‘‘and’’ at the end of 

4 paragraph (2); 

5 (ii) by striking the semicolon at the 

6 end of paragraph (3) and inserting a pe7 riod; and 

8 (iii) by striking paragraphs (4) and 

9 (5). 

10 (2) EFFECTIVE DATE.—The amendments made 

11 by this subsection shall apply with respect to health 

12 insurance coverage offered, sold, issued, renewed, in 

13 effect, or operated in the individual market after the 

14 end of the 12th calendar month following the date 

15 of the enactment of this Act. 

16 SEC. 103. DOMESTIC PARTNERSHIP BENEFITS AND OBLIGA17 TIONS ACT. 

18 (a) BENEFITS TO DOMESTIC PARTNERS OF FED19 ERAL EMPLOYEES.— 

20 (1) IN GENERAL.—An employee who has a do21 mestic partner and the domestic partner of the em22 ployee shall be entitled to benefits available to, and 

23 shall be subject to obligations imposed upon, a mar24 ried employee and the spouse of the employee. 


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1 (2) CERTIFICATION OF ELIGIBILITY.—In order 

2 to obtain benefits and assume obligations under this 

3 section, an employee shall file an affidavit of eligi4 bility for benefits and obligations with the Office of 

5 Personnel Management identifying the domestic 

6 partner of the employee and certifying that the em7 ployee and the domestic partner of the employee— 

8 (A) are each other’s sole domestic partner 

9 and intend to remain so indefinitely; 

10 (B) have a common residence, and intend 

11 to continue the arrangement; 

12 (C) are at least 18 years of age and men13 tally competent to consent to contract; 

14 (D) share responsibility for a significant 

15 measure of each other’s common welfare and fi16 nancial obligations; 

17 (E) are not married to or domestic part18 ners with anyone else; 

19 (F) are same sex domestic partners, and 

20 not related in a way that, if the 2 were of the 

21 opposite sex, would prohibit legal marriage in 

22 the State in which they reside; and 

23 (G) understand that willful falsification of 

24 information within the affidavit may lead to dis25 ciplinary action and the recovery of the cost of 


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1 benefits received related to such falsification 

2 and may constitute a criminal violation. 

3 (3) DISSOLUTION OF PARTNERSHIP.— 

4 (A) IN GENERAL.—An employee or domes5 tic partner of an employee who obtains benefits 

6 under this section shall file a statement of dis7 solution of the domestic partnership with the 

8 Office of Personnel Management not later than 

9 30 days after the death of the employee or the 

10 domestic partner or the date of dissolution of 

11 the domestic partnership. 

12 (B) DEATH OF EMPLOYEE.—In a case in 

13 which an employee dies, the domestic partner of 

14 the employee at the time of death shall receive 

15 under this section such benefits as would be re16 ceived by the widow or widower of an employee. 

17 (C) OTHER DISSOLUTION OF PARTNER18 SHIP.— 

19 (i) IN GENERAL.—In a case in which 

20 a domestic partnership dissolves by a 

21 method other than death of the employee 

22 or domestic partner of the employee, any 

23 benefits received by the domestic partner 

24 as a result of this section shall terminate. 


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1 (ii) EXCEPTION.—In a case in which 

2 a domestic partnership dissolves by a 

3 method other than death of the employee 

4 or domestic partner of the employee, the 

5 former domestic partner of the employee 

6 shall be entitled to benefits available to, 

7 and shall be subject to obligations imposed 

8 upon, a former spouse. 

9 (4) STEPCHILDREN.—For purposes of affording 

10 benefits under this section, any natural or adopted 

11 child of a domestic partner of an employee shall be 

12 deemed a stepchild of the employee. 

13 (5) CONFIDENTIALITY.—Any information sub14 mitted to the Office of Personnel Management under 

15 paragraph (2) shall be used solely for the purpose of 

16 certifying an individual’s eligibility for benefits 

17 under paragraph (1). 

18 (6) REGULATIONS AND ORDERS.— 

19 (A) OFFICE OF PERSONNEL MANAGE20 MENT.—Not later than 6 months after the date 

21 of enactment of this Act, the Office of Per22 sonnel Management shall promulgate regula23 tions to implement paragraphs (2) and (3). 

24 (B) OTHER EXECUTIVE BRANCH REGULA25 TIONS.—Not later than 6 months after the date 


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1 of enactment of this Act, the President or des2 ignees of the President shall promulgate regula3 tions to implement this section with respect to 

4 benefits and obligations administered by agen5 cies or other entities of the executive branch. 

6 (C) OTHER REGULATIONS AND ORDERS.— 

7 Not later than 6 months after the date of en8 actment of this Act, each agency or other entity 

9 or official not within the executive branch that 

10 administers a program providing benefits or im11 posing obligations shall promulgate regulations 

12 or orders to implement this section with respect 

13 to the program. 

14 (D) PROCEDURE.—Regulations and orders 

15 required under this paragraph shall be promul16 gated after notice to interested persons and an 

17 opportunity for comment. 

18 (7) DEFINITIONS.—In this section: 

19 (A) BENEFITS.—The term ‘‘benefits’’ 

20 means— 

21 (i) health insurance and enhanced 

22 dental and vision benefits, as provided 

23 under chapters 89, 89A, and 89B of title 

24 5, United States Code; 


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1 (ii) retirement and disability benefits 

2 and plans, as provided under— 

3 (I) chapters 83 and 84 of title 5, 

4 United States Code; 

5 (II) chapter 8 of the Foreign 

6 Service Act of 1980 (22 U.S.C. 4041 

7 et seq.); and 

8 (III) the Central Intelligence 

9 Agency Retirement Act of 1964 for 

10 Certain Employees (50 U.S.C. chapter 

11 38); 

12 (iii) family, medical, and emergency 

13 leave, as provided under— 

14 (I) subchapters III, IV, and V of 

15 chapter 63 of title 5, United States 

16 Code; 

17 (II) the Family and Medical 

18 Leave Act of 1993 (29 U.S.C. 2601 et 

19 seq.), insofar as that Act applies to 

20 the Government Accountability Office 

21 and the Library of Congress; 

22 (III) section 202 of the Congres23 sional Accountability Act of 1995 (2 

24 U.S.C. 1312); and 


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1 (IV) section 412 of title 3, 

2 United States Code; 

3 (iv) Federal group life insurance, as 

4 provided under chapter 87 of title 5, 

5 United States Code; 

6 (v) long-term care insurance, as pro7 vided under chapter 90 of title 5, United 

8 States Code; 

9 (vi) compensation for work injuries, as 

10 provided under chapter 81 of title 5, 

11 United States Code; 

12 (vii) benefits for disability, death, or 

13 captivity, as provided under— 

14 (I) sections 5569 and 5570 of 

15 title 5, United States Code; 

16 (II) section 413 of the Foreign 

17 Service Act of 1980 (22 U.S.C. 3973); 

18 (III) part L of title I of the Om19 nibus Crime Control and Safe Streets 

20 Act of 1968 (42 U.S.C. 3796 et seq.), 

21 insofar as that part applies to any 

22 employee; and 

23 (viii) travel, transportation, and re24 lated payments and benefits, as provided 

25 under— 


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1 (I) chapter 57 of title 5, United 

2 States Code; 

3 (II) chapter 9 of the Foreign 

4 Service Act of 1980 (22 U.S.C. 4081 

5 et seq.); and 

6 (III) section 1599b of title 10, 

7 United States Code; and 

8 (ix) any other benefit similar to a ben9 efit described under clauses (i) through 

10 (viii) provided by or on behalf of the 

11 United States to any employee. 

12 (B) DOMESTIC PARTNER.—The term ‘‘do13 mestic partner’’ means an adult unmarried per14 son living with another adult unmarried person 

15 of the same sex in a committed, intimate rela16 tionship. 

17 (C) EMPLOYEE.—The term ‘‘employee’’— 

18 (i) means an officer or employee of 

19 the United States or of any department, 

20 agency, or other entity of the United 

21 States, including the President, the Vice 

22 President, a Member of Congress, or a 

23 Federal judge; and 

24 (ii) shall not include a member of the 

25 uniformed services. 


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1 (D) OBLIGATIONS.—The term ‘‘obliga2 tions’’ means any duties or responsibilities with 

3 respect to Federal employment that would be 

4 incurred by a married employee or by the 

5 spouse of an employee. 

6 (E) UNIFORMED SERVICES.—The term 

7 ‘‘uniformed services’’ has the meaning given 

8 under section 2101(3) of title 5, United States 

9 Code. 

10 (b) EFFECTIVE DATE.—This section and the amend11 ments made by this section shall— 

12 (1) with respect to the provision of benefits and 

13 obligations, take effect 6 months after the date of 

14 enactment of this Act; and 

15 (2) apply to any individual who is employed as 

16 an employee on or after the date of enactment of 

17 this Act. 

18 Subtitle B—Public Health 

19 Insurance 

20 SEC. 111. OPTIONAL MEDICAID COVERAGE OF LOW-INCOME 

21 HIV-INFECTED INDIVIDUALS. 

22 (a) IN GENERAL.—Section 1902 of the Social Secu23 rity Act (42 U.S.C. 1396a), as amended by section 

24 5006(b)(1) of division B of Public Law 11–5, is amend25 ed— 


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1 (1) in subsection (a)(10)(A)(ii)— 

2 (A) by striking ‘‘or’’ at the end of sub3 clause (XVIII); 

4 (B) by adding ‘‘or’’ at the end of subclause 

5 (XIX); and 

6 (C) by adding at the end the following: 

7 ‘‘(XX) who are described in subsection (gg) (re8 lating to HIV-infected individuals);’’; and 

9 (2) by adding at the end the following: 

10 ‘‘(gg) HIV-infected individuals described in this sub11 section are individuals not described in subsection 

12 (a)(10)(A)(i)— 

13 ‘‘(1) who are infected with HIV; 

14 ‘‘(2) whose income (as determined under the 

15 State plan under this title with respect to disabled 

16 individuals) does not exceed the maximum amount 

17 of income a disabled individual described in sub18 section (a)(10)(A)(i) may have to obtain medical as19 sistance under the plan; and 

20 ‘‘(3) whose resources (as determined under the 

21 State plan under this title with respect to disabled 

22 individuals) do not exceed the maximum amount of 

23 resources a disabled individual described in sub24 section (a)(10)(A)(i) may have to obtain medical as25 sistance under the plan.’’. 


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1 (b) ENHANCED MATCH.—The first sentence of sec2 tion 1905(b) of such Act (42 U.S.C. 1396d(b)) is amended 

3 by striking ‘‘section 1902(a)(10)(A)(ii)(XVIII)’’ and in4 serting ‘‘subclause (XVIII) or (XX) of section 

5 1902(a)(10)(A)(ii)’’. 

6 (c) CONFORMING AMENDMENTS.—Section 1905(a) of 

7 such Act (42 U.S.C. 1396d(a)) is amended, in the matter 

8 preceding paragraph (1)— 

9 (1) by striking ‘‘or’’ at the end of clause (xii); 

10 (2) by adding ‘‘or’’ at the end of clause (xiii); 

11 and 

12 (3) by inserting after clause (xiii) the following: 

13 ‘‘(xiv) individuals described in section 

14 1902(gg);’’. 

15 (d) EXEMPTION FROM FUNDING LIMITATION FOR

16 TERRITORIES.—Section 1108(g) of the Social Security 

17 Act (42 U.S.C. 1308(g)) is amended by adding at the end 

18 the following: 

19 ‘‘(5) DISREGARDING MEDICAL ASSISTANCE FOR

20 OPTIONAL LOW-INCOME HIV-INFECTED INDIVID21 UALS.—The limitations under subsection (f) and this 

22 subsection shall not apply to amounts expended for 

23 medical assistance for individuals described in sec24 tion 1902(gg) who are only eligible for such assistVerDate Nov 24 2008 23:57 Jun 25, 2009 Jkt 079200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\H3001.IH H3001

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1 ance on the basis of section 

2 1902(a)(10)(A)(ii)(XX).’’. 

3 (e) EFFECTIVE DATE.—The amendments made by 

4 this section shall apply to calendar quarters beginning on 

5 or after the date of the enactment of this Act, without 

6 regard to whether or not final regulations to carry out 

7 such amendments have been promulgated by such date. 

8 SEC. 112. EXPANDED DEFINITION OF SPOUSE FOR PUR9 POSES OF THE MEDICARE PROGRAM. 

10 Section 1101(a) of the Social Security Act (42 U.S.C. 

11 1301a)) is amended by adding at the end the following: 

12 ‘‘(11) Notwithstanding section 7 of title 1, 

13 United States Code, for purposes title XVIII of this 

14 Act— 

15 ‘‘(A) the term ‘spouse’ means an individual 

16 in a relationship that any State recognizes as a 

17 marriage or similar union under the laws of a 

18 State providing for such marriage or similar 

19 union; and 

20 ‘‘(B) the term ‘married’ means in a rela21 tionship that any State recognizes as a mar22 riage or similar union under the laws of a State 

23 providing for such marriage or similar union.’’. 


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1 SEC. 113. ENDING THE MEDICARE DISABILITY WAITING PE2 RIOD ACT. 

3 (a) PHASE-OUT OF WAITING PERIOD FOR MEDICARE

4 DISABILITY BENEFITS.— 

5 (1) IN GENERAL.—Section 226(b) of the Social 

6 Security Act (42 U.S.C. 426(b)) is amended— 

7 (A) in paragraph (2)(A), by striking ‘‘, and 

8 has for 24 calendar months been entitled to,’’ 

9 and inserting ‘‘, and for the waiting period (as 

10 defined in subsection (k)) has been entitled 

11 to,’’; 

12 (B) in paragraph (2)(B), by striking ‘‘, 

13 and has been for not less than 24 months,’’ and 

14 inserting ‘‘, and has been for not less than the 

15 waiting period,’’; 

16 (C) in paragraph (2)(C)(ii), by striking ‘‘, 

17 including the requirement that he has been en18 titled to the specified benefits for 24 months,’’ 

19 and inserting ‘‘, including the requirement that 

20 the individual has been entitled to the specified 

21 benefits for the waiting period,’’; and 

22 (D) in the flush matter following para23 graph (2)(C)(ii)(II)— 

24 (i) in the first sentence, by striking 

25 ‘‘for each month beginning with the later 

26 of (I) July 1973 or (II) the twenty-fifth 


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1 month of his entitlement or status as a 

2 qualified railroad retirement beneficiary 

3 described in paragraph (2), and’’ and in4 serting ‘‘for each month beginning after 

5 the waiting period for which the individual 

6 satisfies paragraph (2) and’’; 

7 (ii) in the second sentence, by striking 

8 ‘‘the ‘twenty-fifth month of his entitlement’ 

9 refers to the first month after the twenty10 fourth month of entitlement to specified 

11 benefits referred to in paragraph (2)(C) 

12 and’’; and 

13 (iii) in the third sentence, by striking 

14 ‘‘, but not in excess of 78 such months’’. 

15 (2) SCHEDULE FOR PHASE-OUT OF WAITING

16 PERIOD.—Section 226 of the such Act (42 U.S.C. 

17 426) is amended by adding at the end the following 

18 new subsection: 

19 ‘‘(k) For purposes of subsection (b) (and for purposes 

20 of section 1837(g)(1) of this Act and section 7(d)(2)(ii) 

21 of the Railroad Retirement Act of 1974), the term ‘waiting 

22 period’ means— 

23 ‘‘(1) for 2010, 18 months; 

24 ‘‘(2) for 2011, 16 months; 

25 ‘‘(3) for 2012, 14 months; 


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1 ‘‘(4) for 2013, 12 months; 

2 ‘‘(5) for 2014, 10 months; 

3 ‘‘(6) for 2015, 8 months; 

4 ‘‘(7) for 2016, 6 months; 

5 ‘‘(8) for 2017, 4 months; 

6 ‘‘(9) for 2018, 2 months; and 

7 ‘‘(10) for 2019 and each subsequent year, 0 

8 months.’’. 

9 (3) CONFORMING AMENDMENTS.— 

10 (A) SUNSET.—Effective January 1, 2019, 

11 subsection (f) of section 226 of the Social Secu12 rity Act (42 U.S.C. 426) is repealed. 

13 (B) MEDICARE DESCRIPTION.—Section 

14 1811(2) of such Act (42 U.S.C. 1395c(2)) is 

15 amended by striking ‘‘entitled for not less than 

16 24 months’’ and inserting ‘‘entitled for the 

17 waiting period (as defined in section 226(k))’’. 

18 (C) MEDICARE PART B COVERAGE.—Sec19 tion 1837(g)(1) of such Act (42 U.S.C. 

20 1395p(g)(1)) is amended by striking ‘‘of the 

21 later of (A) April 1973 or (B) the third month 

22 before the 25th month of such entitlement’’ and 

23 inserting ‘‘of the third month before the first 

24 month following the waiting period (as defined 


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1 in section 226(k)) applicable under section 

2 226(b)’’. 

3 (D) RAILROAD RETIREMENT SYSTEM.— 

4 Section 7(d)(2)(ii) of the Railroad Retirement 

5 Act of 1974 (45 U.S.C. 231f(d)(2)(ii)) is 

6 amended— 

7 (i) by striking ‘‘, for not less than 24 

8 months’’ and inserting ‘‘, for the waiting 

9 period (as defined in section 226(k) of the 

10 Social Security Act)’’; and 

11 (ii) by striking ‘‘could have been enti12 tled for 24 calendar months, and’’ and in13 serting ‘‘could have been entitled for the 

14 waiting period (as defined in section 

15 226(k) of the Social Security Act), and’’. 

16 (4) EFFECTIVE DATE.—Except as provided in 

17 paragraph (3)(A), the amendments made by this 

18 subsection shall apply with respect to items and 

19 services furnished under title XVIII of the Social Se20 curity Act on or after the first day of first month 

21 beginning more than 90 days after the date of the 

22 enactment of this Act. 

23 (b) INSTITUTE OF MEDICINE STUDY AND REPORT

24 ON DELAY AND PREVENTION OF DISABILITY CONDI25 TIONS.— 


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1 (1) STUDY.—The Secretary shall request that 

2 the Institute of Medicine of the National Academy 

3 of Sciences conduct a study on the range of dis4 ability conditions that can be delayed or prevented 

5 if individuals receive access to health care services 

6 and coverage before the condition reaches a level 

7 that results in a disability. 

8 (2) REPORT.—Not later than the date that is 

9 2 years after the date of enactment of this Act, the 

10 Secretary shall submit to the Congress a report con11 taining the results of the Institute of Medicine study 

12 authorized under this subsection. 

13 (3) AUTHORIZATION OF APPROPRIATIONS.— 

14 There is authorized to be appropriated to carry out 

15 this subsection $750,000 for the period of fiscal 

16 years 2010 and 2011. 

17 SEC. 114. INCLUDING COSTS INCURRED BY AIDS DRUG AS18 SISTANCE PROGRAMS IN PROVIDING PRE19 SCRIPTION DRUGS TOWARD THE ANNUAL 

20 OUT-OF-POCKET THRESHOLD UNDER MEDI21 CARE PART D. 

22 (a) IN GENERAL.—Section 1860D–2(b)(4)(C) of the 

23 Social Security Act (42 U.S.C. 1395w–102(b)(4)(C)) is 

24 amended— 

25 (1) in clause (i), by striking ‘‘and’’ at the end; 


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1 (2) in clause (ii)— 

2 (A) by inserting ‘‘subject to clause (iii),’’ 

3 after ‘‘(ii)’’; 

4 (B) by striking ‘‘, under section 1860D– 

5 14, or under a State Pharmaceutical Assistance 

6 Program’’; and 

7 (C) by striking the period at the end and 

8 inserting ‘‘; and’’; and 

9 (3) by inserting after clause (ii) the following 

10 new clause: 

11 ‘‘(iii) such costs shall be treated as in12 curred and shall not be considered to be 

13 reimbursed under clause (ii) if such costs 

14 are borne or paid— 

15 ‘‘(I) under section 1860D–14; 

16 ‘‘(II) under a State Pharma17 ceutical Assistance Program; or 

18 ‘‘(III) under an AIDS Drug As19 sistance Program under part B of 

20 title XXVI of the Public Health Serv21 ice Act.’’. 

22 (b) EFFECTIVE DATE.—The amendments made by 

23 subsection (a) shall apply to costs incurred on or after 

24 January 1, 2010. 


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1 SEC. 115. NONDISCRIMINATION BASED ON GENDER IDEN2 TITY OR SEXUAL ORIENTATION UNDER THE 

3 MEDICAID, MEDICARE, AND CHIP PROGRAMS. 

4 (a) MEDICAID.— 

5 (1) Section 1902(a) of the Social Security Act 

6 is amended by— 

7 (A) striking the ‘‘and’’ at the end of para8 graph (72); 

9 (B) striking the period at the end of para10 graph (73)(B) and inserting ‘‘; and’’; 

11 (C) inserting after paragraph (73) the fol12 lowing new paragraph: 

13 ‘‘(74) provide that the State shall not discrimi14 nate against any person on the basis of sexual ori15 entation or gender identity.’’; and 

16 (D) adding at the end the following undes17 ignated paragraph: 

18 ‘‘For the purposes of paragraph (74) ‘sexual 

19 orientation’ shall mean homosexuality, hetero20 sexuality, or bisexuality. ‘Gender identity’ shall mean 

21 the gender-related identity, appearance, or manner22 isms, or other gender-related characteristics of an 

23 individual, with or without regard to the individual’s 

24 designated sex at birth.’’. 


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1 (2) Section 1916 of the Social Security Act is 

2 amended by adding at the end the following new 

3 subsection: 

4 ‘‘(k) NO DISCRIMINATION ON PREMIUMS OR COST

5 SHARING.—The State shall provide that in the case of all 

6 individuals described in section 1902(a) who are eligible 

7 under the plan— 

8 ‘‘(1) there may be imposed no enrollment fee, 

9 premium, similar charge on the basis of sexual ori10 entation or gender identity as defined in such sec11 tion; and 

12 ‘‘(2) there may be imposed no deduction, cost 

13 sharing, or similar charge on the basis of sexual ori14 entation or gender identity as defined in such sec15 tion.’’. 

16 (b) STATE CHILDREN’S HEALTH INSURANCE PRO17 GRAM.—Section 2102 of the Social Security Act is amend18 ed by adding at the end the following subsection: ‘‘(d).’’ 

19 ‘‘(d) NO DISCRIMINATION IN STATE CHILD HEALTH

20 PLANS.—A State child health plan may not discriminate 

21 on the basis sexual orientation or gender identity as de22 fined in section 1902.’’. 

23 (c) MEDICARE.—Title XVIII of the Social Security 

24 Act is amended by— 

25 (1) adding at the end the following: 


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1 ‘‘SEC. 1899. NONDISCRIMINATION BASED ON GENDER IDEN2 TITY OR SEXUAL ORIENTATION. 

3 ‘‘(a) CONDITION OF PARTICIPATION.—As a condition 

4 of participation as a provider of services or supplier under 

5 section 1866(a)(1) or 1842(h), respectively, the provider 

6 or supplier may not discriminate on the basis of sex, gen7 der identity, or sexual orientation of a beneficiary in the 

8 provision of items or services for which payment may be 

9 made under this title. 

10 ‘‘(b) COVERAGE DETERMINATIONS.—The Secretary 

11 may not discriminate on the basis of the sex, gender iden12 tity, or sexual orientation in fulfillment of his duties under 

13 this Act. 

14 ‘‘(c) REGULATIONS.—The Secretary shall promulgate 

15 regulations to implement this section.’’. 

16 Subtitle C—Miscellaneous 

17 SEC. 121. HEALTH PROMOTION GRANTS. 

18 (a) DEMONSTRATION PROJECTS.—The Secretary, in 

19 collaboration with the Deputy Assistant Secretary for 

20 LGBT Health, shall award multiyear contracts or com21 petitive grants to eligible entities to support demonstration 

22 projects designed to improve the health and health care 

23 of sexual or gender minorities through improved access to 

24 health care, patient navigators, primary prevention activi25 ties, health promotion and disease prevention activities, 

26 and health literacy education and services. 


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1 (b) ELIGIBILITY.—In this section: 

2 (1) ELIGIBLE ENTITY.—The term ‘‘eligible enti3 ty’’ means a qualified organization or a community4 based consortium. 

5 (2) QUALIFIED ORGANIZATION.—The term 

6 ‘‘qualified organization’’ means— 

7 (A) a hospital, health plan, or clinic; 

8 (B) an academic institution; 

9 (C) a State health agency; 

10 (D) an Indian Health Service hospital or 

11 clinic, Indian tribal health facility, or urban In12 dian facility; 

13 (E) a nonprofit organization, including a 

14 faith-based organization or consortium, to the 

15 extent that a contract or grant awarded to such 

16 an entity is consistent with the requirements of 

17 section 1955 of the Public Health Service Act 

18 (42 U.S.C. 300x–65); 

19 (F) a primary care practice-based research 

20 network; 

21 (G) long-term care facilities, including 

22 nursing homes and assisted living facilities; or 

23 (H) any other similar entity determined to 

24 be appropriate by the Secretary. 


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1 (3) COMMUNITY-BASED CONSORTIUM.—The 

2 term ‘‘community-based consortium’’ means a part3 nership that— 

4 (A) includes— 

5 (i) individuals who are representatives 

6 of organizations of sexual and gender mi7 norities; 

8 (ii) community leaders and leaders of 

9 community-based organizations; 

10 (iii) health care providers, including 

11 providers who treat sexual and gender mi12 norities; and 

13 (iv) experts in the area of social and 

14 behavioral science, who have knowledge, 

15 training, or practical experience in health 

16 policy, advocacy, cultural competency, or 

17 other relevant areas as determined by the 

18 Secretary; and 

19 (B) is located within an area with a signifi20 cant population of sexual and gender minorities. 

21 (c) USE OF FUNDS.—An eligible entity shall use 

22 amounts received under this section for demonstration 

23 projects to— 

24 (1) address health disparities affecting sexual 

25 and gender minorities in the areas of— 


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1 (A) primary care and preventive health, in2 cluding health education and promotion; 

3 (B) behavioral and mental health and sub4 stance abuse; 

5 (C) health services research; 

6 (D) demographics and data collection; and 

7 (E) other areas determined appropriate by 

8 the Secretary; 

9 (2) identify, educate, and enroll into clinical 

10 trials and comparative effectiveness research eligible 

11 patients from sexual or gender minority groups; 

12 (3) educate, guide, and provide outreach in a 

13 community setting regarding health problems preva14 lent among sexual or gender minority populations, 

15 including— 

16 (A) HIV in high-risk subpopulations, in17 cluding— 

18 (i) transgender populations; 

19 (ii) sex workers; and 

20 (iii) people of color; 

21 (B) cancers; 

22 (C) school violence; 

23 (D) emerging drugs; and 

24 (E) suicide prevention; 


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1 (4) educate, guide, and provide experiential 

2 learning opportunities to sexual and gender minori3 ties targeting behavioral risk factors including— 

4 (A) poor nutrition; 

5 (B) physical inactivity; 

6 (C) being overweight or obese; 

7 (D) tobacco use; 

8 (E) alcohol and substance use; 

9 (F) injury and violence; 

10 (G) high-risk sexual behavior; and 

11 (H) mental health problems; 

12 (5) educate and provide guidance to sexual and 

13 gender minorities regarding effective strategies to 

14 promote positive health behaviors within the commu15 nity; or 

16 (6) educate and refer sexual and gender minori17 ties to appropriate health care agencies and commu18 nity-based programs and organizations in order to 

19 increase access to high-quality health care services, 

20 including preventive health services. 

21 (d) REPORT TO CONGRESS.— 

22 (1) IN GENERAL.—Not later than 4 years after 

23 the date on which the Secretary first awards grants 

24 under subsection (a), the Secretary shall submit to 

25 the Congress a report regarding such grants. 


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1 (2) CONTENTS.—The report required under 

2 paragraph (1) shall include the following: 

3 (A) A description of the programs for 

4 which grant funds were used. 

5 (B) The number of individuals served 

6 under such programs. 

7 (C) An evaluation of— 

8 (i) the effectiveness of such programs; 

9 (ii) the cost of such programs; and 

10 (iii) the impact of such programs on 

11 the health outcomes of the community resi12 dents. 

13 (D) Recommendations for improving the 

14 health and health care of sexual and gender mi15 norities. 

16 (E) A description of how the Secretary will 

17 continue to work to improve the use of grant 

18 funds under this section. 

19 SEC. 122. MENTAL HEALTH PROMOTION GRANTS. 

20 (a) DEMONSTRATION PROJECTS.—The Secretary, in 

21 collaboration with the Deputy Assistant Secretary for 

22 LGBT Health and the Administrator of the Substance 

23 Abuse and Mental Health Services Administration, shall 

24 award multiyear contracts or competitive grants to eligible 

25 entities to support demonstration projects designed to imVerDate Nov 24 2008 23:57 Jun 25, 2009 Jkt 079200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\H3001.IH H3001

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1 prove the mental health of sexual and gender minorities 

2 through improved access to health care, primary preven3 tion activities, health promotion and prevention activities, 

4 and education and services. 

5 (b) ELIGIBILITY.—In this section: 

6 (1) ELIGIBLE ENTITY.—The term ‘‘eligible enti7 ty’’ means a qualified organization or a community8 based consortium. 

9 (2) QUALIFIED ORGANIZATION.—The term 

10 ‘‘qualified organization’’ means— 

11 (A) a hospital, health plan, or clinic; 

12 (B) an academic institution; 

13 (C) a State health agency; 

14 (D) an Indian Health Service hospital or 

15 clinic, Indian tribal health facility, or urban In16 dian facility; 

17 (E) a nonprofit organization, including a 

18 faith-based organization or consortium, to the 

19 extent that a contract or grant awarded to such 

20 an entity is consistent with the requirements of 

21 section 1955 of the Public Health Service Act 

22 (42 U.S.C. 300x–65); 

23 (F) a certified mental health treatment 

24 center; 


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1 (G) a long-term care facility, including a 

2 nursing home or assisted living facility; and 

3 (H) any other similar entity determined to 

4 be appropriate by the Secretary. 

5 (3) COMMUNITY-BASED CONSORTIUM.—The 

6 term ‘‘community-based consortium’’ means a part7 nership that— 

8 (A) includes— 

9 (i) individuals who are representatives 

10 of organizations of sexual or gender mi11 norities; 

12 (ii) community leaders and leaders of 

13 community-based organizations; 

14 (iii) mental health care providers, in15 cluding providers who treat sexual or gen16 der minorities; and 

17 (iv) experts in the area of social and 

18 behavioral science, who have knowledge, 

19 training, or practical experience in health 

20 policy, advocacy, cultural competency, or 

21 other relevant areas as determined by the 

22 Secretary; and 

23 (B) is located within an area with a signifi24 cant population of sexual or gender minorities. 


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1 (c) USE OF FUNDS.—An eligible entity shall use 

2 amounts received under this section for demonstration 

3 projects to— 

4 (1) address health disparities in the areas of be5 havioral and mental health and substance abuse; 

6 (2) educate, guide, and provide outreach in a 

7 community setting regarding mental health problems 

8 prevalent among sexual or gender minority popu9 lations; 

10 (3) educate, guide, and provide experiential 

11 learning opportunities that target behavioral risk 

12 factors including— 

13 (A) alcohol and substance use; 

14 (B) high-risk sexual behavior; and 

15 (C) mental health problems; 

16 (4) develop or adapt curricula and interventions 

17 to address major mental health issues in the sexual 

18 and gender minority community, including— 

19 (A) school violence; 

20 (B) emerging drugs; 

21 (C) suicide; and 

22 (D) family acceptance of lesbian, gay, bi23 sexual, and transgender youth; 

24 (5) educate and provide guidance regarding ef25 fective strategies to promote positive health behavVerDate Nov 24 2008 23:57 Jun 25, 2009 Jkt 079200 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 E:\BILLS\H3001.IH H3001

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1 iors within the community, including the promotion 

2 of resiliency and wellness strategies; 

3 (6) educate and refer sexual and gender minori4 ties to appropriate agencies and community-based 

5 programs and organizations in order to increase ac6 cess to high-quality mental health services, including 

7 preventive mental health services; or 

8 (7) provide mental health counseling and edu9 cation for families to promote acceptance of lesbian, 

10 gay, bisexual, and transgender youth, which may in11 clude the creation and distribution of support-fo12 cused resource guides. 

13 (d) REPORT TO CONGRESS.— 

14 (1) IN GENERAL.—Not later than 4 years after 

15 the date on which the Secretary first awards grants 

16 under subsection (a), the Secretary shall submit to 

17 the Congress a report regarding such grants. 

18 (2) CONTENTS.—The report required under 

19 paragraph (1) shall include the following: 

20 (A) A description of the programs for 

21 which grant funds were used. 

22 (B) The number of individuals served 

23 under such programs. 

24 (C) An evaluation of— 

25 (i) the effectiveness of such programs; 


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1 (ii) the cost of such programs; and 

2 (iii) the impact of the programs on 

3 the health outcomes of the community resi4 dents. 

5 (D) Recommendations for improving the 

6 mental health and mental health care of sexual 

7 and gender minorities. 

8 SEC. 123. HEALTH INSURANCE COVERAGE GRANTS. 

9 (a) IN GENERAL.—The Secretary, in collaboration 

10 with the Deputy Assistant Secretary for LGBT Health, 

11 the Director of the Centers for Disease Control and Pre12 vention and other Federal officials determined appropriate 

13 by the Secretary, may award grants to State or local gov14 ernments, Indian tribes (including Alaska Native villages), 

15 tribal organizations, and urban Indian organizations to 

16 support projects designed to improve the health and health 

17 care of sexual and gender minorities through improved ac18 cess to health care through expanded health insurance. 

19 (b) APPLICATION.—An eligible entity seeking a grant 

20 under this section shall submit an application to the Sec21 retary at such time, in such manner, and containing such 

22 information as the Secretary may require, including assur23 ances that the eligible entity will— 

24 (1) target individuals who are members of sex25 ual or gender minority groups that experience health 


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1 disparities through specific outreach activities fund2 ed through the grant; 

3 (2) collaborate with appropriate community or4 ganizations and include meaningful community par5 ticipation in planning, implementation, and evalua6 tion of activities; 

7 (3) demonstrate capacity to enroll individuals 

8 currently without health coverage into public or pri9 vate health insurance plans that meet their treat10 ment and care needs; 

11 (4) set appropriate and measurable goals for 

12 health insurance enrollment of sexual and gender 

13 minorities; 

14 (5) provide ongoing outreach and education to 

15 the populations targeted under paragraph (1); 

16 (6) demonstrate coordination between public 

17 and private entities for purposes of assisting public 

18 entities in leveraging private funds to improve the 

19 health and health care of sexual and gender minori20 ties; 

21 (7) assist individuals and groups in accessing 

22 public and private programs that will help eliminate 

23 disparities in health and health care for sexual and 

24 gender minorities; 


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1 (8) develop a plan for long-term sustainability 

2 for the activities funded through the grant; and 

3 (9) evaluate the effectiveness of activities under 

4 this section, within an appropriate time frame, which 

5 shall include a focus on quality and outcomes per6 formance measures to ensure that the activities are 

7 meeting the intended goals, and that the entity is 

8 able to disseminate findings from such evaluations. 

9 (c) PRIORITIES.— 

10 (1) IN GENERAL.—In awarding contracts and 

11 grants under this section, the Secretary shall give 

12 priority to applicants that meet the criteria under 

13 paragraph (2) and are— 

14 (A) safety net hospitals, defined as hos15 pitals with a low-income utilization rate greater 

16 than 25 percent (as defined in section 

17 1923(b)(3) of the Social Security Act (42 

18 U.S.C. 1396r–4(b)(3))); 

19 (B) a federally qualified health center as 

20 defined in section 1905(l)(2)(B) of the Social 

21 Security Act with the ability to establish and 

22 lead a collaborative partnership; 

23 (C) a community-based consortium; 

24 (D) safety net health plans that work in 

25 coordination with local health centers; 


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1 (E) an Indian tribe, tribal organization, or 

2 urban Indian organization; or 

3 (F) other health systems. 

4 (2) ADDITIONAL CRITERIA.—For purposes of 

5 paragraph (1), the criteria under this paragraph is 

6 that the applicant— 

7 (A) by legal mandate or explicitly adopted 

8 mission, provide patients with access to services 

9 regardless of their ability to pay; 

10 (B) provide care or treatment for a sub11 stantial number of patients who are uninsured, 

12 are receiving assistance under a State program 

13 under title XIX of the Social Security Act, or 

14 are members of vulnerable populations, as de15 termined by the Secretary; 

16 (C) serve a disproportionate percentage of 

17 patients who are sexual or gender minorities; 

18 and 

19 (D) provide an assurance that amounts re20 ceived under the grant or contract will be used 

21 to support quality improvement activities for 

22 patients from sexual and gender minority 

23 groups. 


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1 (d) USE OF FUNDS.—An eligible entity shall use such 

2 amounts received under this section for demonstration 

3 projects to— 

4 (1) address health disparities in the areas of 

5 health insurance coverage; and 

6 (2) evaluate methods for strengthening the 

7 health coverage and continuity of coverage of sexual 

8 and gender minority populations, including— 

9 (A) targeting enrollment of uninsured sex10 ual and gender minority populations into title 

11 XIX of the Social Security Act; and 

12 (B) assessing eligibility for domestic part13 ner benefits. 

14 (e) EVALUATION AND REPORT BY GRANTEE.— 

15 (1) EVALUATION.—Any entity that receives a 

16 grant under this section shall conduct an evaluation 

17 of the activities conducted under such grant and the 

18 impact of such activities on decreasing health dis19 parities for sexual and gender minorities. 

20 (2) REPORT.—Not later than 3 years after the 

21 date an entity receives a contract or grant under 

22 this section and annually thereafter, the entity shall 

23 provide to the Secretary a report containing the re24 sults of the evaluation conducted under paragraph 

25 (1). 


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1 (f) REPORT AND PUBLIC ACCESS TO INFORMATION

2 BY SECRETARY.— 

3 (1) REPORT TO CONGRESS.—Beginning on or 

4 before the 60th day following the date that the first 

5 report is submitted under subsection (e), the Sec6 retary shall submit a report to the Congress com7 plying the results of evaluations under such sub8 section and describing the overall impact of the 

9 grant program under this section. 

10 (2) PUBLIC ACCESS.—The Secretary shall, as 

11 appropriate, provide the public with access to the re12 port under paragraph (1) and the information con13 tained in the reports under subsection (e)(2). 

14 TITLE II—CULTURAL 

15 COMPETENCY AND WORKFORCE 

16 SEC. 201. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

17 ACT. 

18 The Public Health Service Act (42 U.S.C. 201 et 

19 seq.) is amended by adding at the end the following: 

20 ‘‘TITLE XXXI—CULTURALLY 

21 COMPETENT HEALTH CARE 

22 ‘‘SEC. 3100. DEFINITIONS. 

23 ‘‘In this title: 

24 ‘‘(1) CULTURALLY COMPETENT.—The term 

25 ‘culturally competent care’, with respect to health 


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1 care or services for sexual and gender minorities, 

2 means health care or services that, at a minimum, 

3 do not include nonclinical or medically unsound 

4 judgments based on sex, sexual orientation, or gen5 der identity and expression that affect the amount 

6 and kind of treatment received or that act as a bar7 rier to an individual receiving timely and high-qual8 ity care. 

9 ‘‘(2) SEXUAL OR GENDER MINORITY.—The 

10 terms ‘sexual or gender minority’ and ‘sexual and 

11 gender minority’ mean a lesbian, gay, bisexual, or 

12 transgender individual. 

13 ‘‘(3) STATE.—The term ‘State’ means each of 

14 the several states, the District of Columbia, the 

15 Commonwealth of Puerto Rico, the Indian tribes, 

16 the Virgin Islands, Guam, American Samoa, and the 

17 Commonwealth of the Northern Mariana Islands. 

18 ‘‘SEC. 3101. NATIONAL STANDARDS FOR CULTURALLY COM19 PETENT SERVICES IN HEALTH CARE. 

20 ‘‘Recipients of Federal financial assistance from the 

21 Secretary shall, to the extent reasonable and practicable— 

22 ‘‘(1) implement strategies to recruit, retain, and 

23 promote individuals at all levels of the organization 

24 to maintain a diverse staff and leadership that can 


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1 provide culturally competent health care to sexual or 

2 gender minority patients; 

3 ‘‘(2) ensure that staff at all levels and across all 

4 disciplines of the organization receive ongoing edu5 cation and training in culturally competent service 

6 delivery for sexual or gender minority patients; 

7 ‘‘(3) develop and implement clear goals, poli8 cies, operational plans, and management account9 ability and oversight mechanisms to provide cul10 turally competent services for sexual and gender mi11 nority patients; 

12 ‘‘(4) conduct initial and ongoing organizational 

13 assessments of culturally competent services-related 

14 activities for sexual and gender minority patients 

15 and integrate valid competence-related measures into 

16 the internal audits, performance improvement pro17 grams, patient satisfaction assessments, and out18 comes-based evaluations of the organization; 

19 ‘‘(5) ensure that, consistent with the privacy 

20 protections provided for under the regulations pro21 mulgated under section 264(c) of the Health Insur22 ance Portability and Accountability Act of 1996, 

23 data on the individual patient’s sexual orientation 

24 and gender identity are collected in health records, 


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1 integrated into the organization’s management infor2 mation systems, and periodically updated; 

3 ‘‘(6) maintain a current demographic, cultural, 

4 and epidemiological profile of the community as well 

5 as a needs assessment to accurately plan for and im6 plement services that respond to the cultural charac7 teristics of the service area of the organization; 

8 ‘‘(7) develop participatory, collaborative part9 nerships with communities and utilize a variety of 

10 formal and informal mechanisms to facilitate com11 munity and patient involvement in designing and im12 plementing culturally competent services-related ac13 tivities for sexual and gender minority patients; 

14 ‘‘(8) ensure that conflict and grievance resolu15 tion processes are culturally sensitive and capable of 

16 identifying, preventing, and resolving cross-cultural 

17 conflicts or complaints by sexual and gender minor18 ity patients; 

19 ‘‘(9) regularly make available to the public in20 formation about their progress and successful inno21 vations in implementing the standards under this 

22 section and provide public notice in their commu23 nities about the availability of this information; and 

24 ‘‘(10) if requested, regularly make available to 

25 the head of each Federal entity from which Federal 


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1 funds are received, information about their progress 

2 and successful innovations in implementing the 

3 standards under this section as required by the head 

4 of such entity. 

5 ‘‘SEC. 3102. CENTER FOR CULTURAL COMPETENCE IN 

6 HEALTH CARE. 

7 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

8 through the Deputy Assistant Secretary for LGBT 

9 Health, shall establish and support a center to be known 

10 as the ‘Center for Cultural Competence in Health Care’ 

11 (referred to in this section as the ‘Center’). 

12 ‘‘(b) PROVISION OF INFORMATION.—The Center 

13 shall provide information relating to culturally competent 

14 health care for sexual and gender minority populations re15 siding in the United States to all health care providers 

16 and health care organizations at no cost. Such information 

17 shall include— 

18 ‘‘(1) tenets of culturally competent care; 

19 ‘‘(2) cultural competence self-assessment tools; 

20 ‘‘(3) cultural competence training tools; 

21 ‘‘(4) strategic plans to increase cultural com22 petence in different types of health care organiza23 tions, including regional collaborations among health 

24 care organizations; and 


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1 ‘‘(5) resources for cultural competence informa2 tion for educators, practitioners, and researchers. 

3 ‘‘(c) DIRECTOR.—The Center shall be headed by a 

4 Director who shall be appointed by, and who shall report 

5 to, the Deputy Assistant Secretary for LGBT Health. 

6 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

7 are authorized to be appropriated to carry out this section 

8 such sums as may be necessary for each of fiscal years 

9 2010 through 2014. 

10 ‘‘SEC. 3103. INNOVATIONS IN CULTURAL COMPETENCE 

11 GRANTS. 

12 ‘‘(a) IN GENERAL.—The Secretary, acting through 

13 the Administrator of the Centers for Medicare & Medicaid 

14 Services, the Administrator of the Health Resources and 

15 Services Administration, the Secretary of Education, and 

16 the Deputy Assistant Secretary for LGBT Health, shall 

17 award grants to eligible entities to enable such entities to 

18 design, implement, and evaluate innovative, cost-effective 

19 programs to improve cultural competence in health. 

20 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

21 under subsection (a), an entity shall— 

22 ‘‘(1) be a city, county, Indian tribe, State, terri23 tory, community-based or other nonprofit organiza24 tion, health center or community clinic, hospital, 


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1 university, college, or other entity designated by the 

2 Secretary; and 

3 ‘‘(2) prepare and submit to the Secretary an 

4 application, at such time, in such manner, and ac5 companied by such additional information as the 

6 Secretary may require. 

7 ‘‘(c) USE OF FUNDS.—An entity shall use funds re8 ceived under a grant under this section to— 

9 ‘‘(1) develop formal training programs for indi10 viduals interested in becoming dedicated culturally 

11 competent health care providers for sexual and gen12 der minorities; 

13 ‘‘(2) develop formal training programs for indi14 viduals interested in becoming dedicated culturally 

15 competent health care providers for sexual and gen16 der minority youth and their families; 

17 ‘‘(3) develop training programs for individuals 

18 interested in becoming dedicated culturally com19 petent health care providers for aging sexual and 

20 gender minorities; and 

21 ‘‘(4) develop other culturally competent services 

22 as determined appropriate by the Secretary. 

23 ‘‘(d) PRIORITY.—In awarding grants under this sec24 tion, the Secretary shall give priority to entities that have 


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1 developed partnerships with organizations or agencies with 

2 experience in culturally competent services. 

3 ‘‘(e) EVALUATION.—An entity that receives a grant 

4 under this section shall submit to the Secretary an evalua5 tion that describes the activities carried out with funds 

6 received under the grant, and how such activities improved 

7 access to health care services and the quality of health 

8 care for individuals. Such evaluation shall be collected and 

9 disseminated through the Center for Cultural Competence 

10 in Health Care established under section 3102. 

11 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

12 is authorized to be appropriated to carry out this section 

13 $5,000,000 for each of fiscal years 2010 through 2014. 

14 ‘‘SEC. 3104. RESEARCH ON CULTURAL COMPETENCE. 

15 ‘‘(a) IN GENERAL.—The Director of the Agency for 

16 Healthcare Research and Quality, in collaboration with 

17 the Deputy Assistant Secretary for LGBT Health, shall 

18 expand research concerning— 

19 ‘‘(1) the barriers to health care services, includ20 ing mental and behavioral services and services at 

21 skilled nursing facilities, that are faced by sexual 

22 and gender minority individuals; 

23 ‘‘(2) the impact of cultural barriers on the qual24 ity of health care and the health status of sexual 

25 and gender minority individuals and populations; 


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1 ‘‘(3) health care providers’ and health adminis2 trators’ attitudes, knowledge, and awareness of the 

3 barriers described in paragraphs (1) and (2); 

4 ‘‘(4) the means by which competency access 

5 services are provided to sexual and gender minority 

6 individuals and how such services are effective in im7 proving the quality of care; 

8 ‘‘(5) the cost-effectiveness of providing com9 petency access services; and 

10 ‘‘(6) optimal approaches for delivering com11 petency access services. 

12 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 

13 are authorized to be appropriated to carry out this section 

14 such sums as may be necessary for each of fiscal years 

15 2010 through 2014.’’. 

16 SEC. 202. DEFINITIONS. 

17 In this title: 

18 (1) INCORPORATED DEFINITIONS.—The defini19 tions contained in section 3100 of the Public Health 

20 Service Act, as added by section 201, shall apply. 

21 (2) SECRETARY.—The term ‘‘Secretary’’ means 

22 the Secretary of Health and Human Services. 


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1 SEC. 203. FEDERAL REIMBURSEMENT FOR CULTURALLY 

2 COMPETENT SERVICES UNDER THE MEDI3 CARE, MEDICAID, AND CHILDREN’S HEALTH 

4 INSURANCE PROGRAMS. 

5 (a) DEMONSTRATION PROJECT PROMOTING ACCESS

6 FOR MEDICARE BENEFICIARIES IN SEXUAL AND GENDER

7 MINORITY POPULATIONS.— 

8 (1) IN GENERAL.—The Secretary shall conduct 

9 a demonstration project (in this subsection referred 

10 to as the ‘‘project’’) to provide reimbursement for 

11 access services to certain Medicare beneficiaries in 

12 sexual and gender minority groups in urban and 

13 rural areas and document the impact of such reim14 bursement on Medicare program costs and health 

15 outcomes. 

16 (2) SCOPE.—The Secretary shall carry out the 

17 project in not less than 30 States or territories 

18 through contracts with— 

19 (A) MA plans (under part C of title XVIII 

20 of the Social Security Act); 

21 (B) community-based nonprofit organiza22 tions; 

23 (C) hospitals; and 

24 (D) community-based clinics. 

25 (3) DURATION.—The demonstration shall be 

26 conducted for a period not longer than 2 years. 


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1 (4) REPORT.—Upon completion of the project, 

2 the Secretary shall submit a report to the Congress 

3 on the project which shall include recommendations 

4 regarding— 

5 (A) the extension of such project for addi6 tional time periods; and 

7 (B) the expansion of such project to the 

8 entire Medicare program. 

9 (5) EVALUATION.—The Director of the Agency 

10 for Healthcare Research and Quality, in consultation 

11 with the Office of Minority Health and the National 

12 Center on Minority Health and Health Disparities, 

13 shall award grants to public and private nonprofit 

14 entities that demonstrate experience and capability 

15 with respect to cultural competence, including enti16 ties directed by and serving representatives of sexual 

17 and gender minority groups, to conduct evaluations 

18 of the project under paragraph (1). Such evaluations 

19 shall focus on the impact of the project on access to 

20 services, utilization rates, efficiency in the provision 

21 of services, cost-effectiveness, patient satisfaction, 

22 and select health outcomes. 

23 (b) MEDICAID AND CHIP.—Section 1903(a)(3) of 

24 the Social Security Act (42 U.S.C. 1396b(a)(3)), as 

25 amended by section 4201(a) of division B of the American 


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1 Recovery and Reinvestment Act of 2009 (Public Law 111– 

2 5), is amended— 

3 (1) in subparagraph (E), by striking ‘‘and’’ at 

4 the end; 

5 (2) in subparagraph (F), by striking ‘‘plus’’ at 

6 the end and inserting ‘‘and’’; and 

7 (3) by adding at the end the following: 

8 ‘‘(G) 100 percent of so much of the sums 

9 expended with respect to costs incurred during 

10 such quarter as are attributable to the provision 

11 of access services (as defined in section 203(d) 

12 of the Ending LGBT Health Disparities Act) to 

13 sexual and gender minorities (as defined in sec14 tion 3 of the Ending LGBT Health Disparities 

15 Act) who apply for or receive medical assistance 

16 under the State plan under this title (including 

17 any provisions of the plan implemented pursu18 ant to any waiver authority of the Secretary) or 

19 child health assistance under a State child 

20 health plan under title XXI; plus’’. 

21 (c) SCHIP.—Section 2105(c)(2)(A) of the Social Se22 curity Act (42 U.S.C. 1397ee(c)(2)(A)) is amended by in23 serting before the period at the end the following: ‘‘except 

24 that expenditures described in, and reimbursable under, 

25 section 1903(a)(3)(G) shall not count towards this total’’. 


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1 (d) DEFINITION OF ACCESS SERVICES.—For pur2 poses of this section, the term ‘‘access services’’ means— 

3 (1) outreach (including care coordination, nurs4 ing outreach, and reminder phone calls) designed 

5 to— 

6 (A) inform individuals of the benefits to 

7 which they are entitled; and 

8 (B) encourage individuals to use such ben9 efits; and 

10 (2) services (including transportation) that as11 sist the individual in accessing such benefits. 

12 (e) EFFECTIVE DATE.—The amendments made by 

13 this section is effective for payment for items and services 

14 furnished on or after October 1, 2010. 

15 SEC. 204. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL16 TURALLY COMPETENT HEALTH CARE SERV17 ICES TO SEXUAL AND GENDER MINORITIES. 

18 Not later than 1 year after the date of enactment 

19 of this Act and annually thereafter, the Secretary shall 

20 enter into a contract with the Institute of Medicine for 

21 the preparation and publication of a report that describes 

22 Federal efforts to ensure that all individuals have mean23 ingful access to culturally competent health care services. 

24 Such report shall include— 


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1 (1) a description and evaluation of the activities 

2 carried out under this Act; 

3 (2) a description of best practices, model pro4 grams, guidelines, and other effective strategies for 

5 providing access to culturally competent health care 

6 services for sexual and gender minority populations; 

7 and 

8 (3) an assessment of the implementation of the 

9 Department of Health and Human Services National 

10 Standards on Culturally Appropriate Services 

11 (CLAS) in Health Care, in particular the implemen12 tation of CLAS mandates by recipients of Federal 

13 funds. 

14 TITLE III—RESEARCH AND DATA 

15 COLLECTION 

16 SEC. 301. NO COMPELLED DISCLOSURE OF DATA. 

17 This title does not authorize any Federal official or 

18 other entity to compel the disclosure of sexual or gender 

19 minority data. The disclosure of any such data pursuant 

20 to this title shall be strictly voluntary. 

21 SEC. 302. FEDERAL COLLECTION OF DATA ON SEXUAL AND 

22 GENDER MINORITIES. 

23 (a) REQUIREMENTS.— 

24 (1) IN GENERAL.—Each health-related program 

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1 ment, in whole or in part, either directly or indi2 rectly from the Department of Health and Human 

3 Services shall— 

4 (A) require the collection, by the agency or 

5 program involved, of sexual and gender minor6 ity data for each applicant for and recipient of 

7 health-related assistance under such program; 

8 (B) systematically analyze such data using 

9 the smallest appropriate units of analysis fea10 sible to detect sexual and gender minority dis11 parities in health and health care and when ap12 propriate, analyze such data for each identified 

13 sexual identity separately, and report the re14 sults of such analysis to the Secretary, the Di15 rector of the Office for Civil Rights, the Com16 mittee on Health, Education, Labor, and Pen17 sions and the Committee on Finance of the 

18 Senate, and the Committee on Energy and 

19 Commerce and the Committee on Ways and 

20 Means of the House of Representatives; 

21 (C) provide such data to the Secretary on 

22 at least an annual basis; and 

23 (D) ensure that the provision of assistance 

24 to an applicant or recipient of assistance is not 

25 denied or otherwise adversely affected because 


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1 of the failure of the applicant or recipient to 

2 provide sexual and gender minority data. 

3 (2) BUREAU OF PRISONS.—The Attorney Gen4 eral of the United States, acting through the Direc5 tor of the Bureau of Prisons, shall collect and share 

6 with the Secretary sexual and minority data for each 

7 individual who is incarcerated and receives health 

8 assistance in an institution under the jurisdiction of 

9 the Bureau of Prisons. 

10 (3) RULES OF CONSTRUCTION.—Nothing in 

11 this subsection shall be construed to— 

12 (A) permit the use of information collected 

13 under this subsection in a manner that would 

14 adversely affect any individual providing any 

15 such information; and 

16 (B) require health care providers to collect 

17 data. 

18 (b) PROTECTION OF DATA.—Through the promulga19 tion of regulations or otherwise, the Secretary shall ensure 

20 that all data collected pursuant to subsection (a)(1) or re21 ceived pursuant to subsection (a)(2), and the Attorney 

22 General of the United States shall ensure that all data 

23 collected pursuant to subsection (a)(2), is protected— 

24 (1) under the same privacy protections as the 

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1 ulations promulgated under section 264(c) of the 

2 Health Insurance Portability and Accountability Act 

3 of 1996 (Public Law 104–191; 110 Stat. 2033) re4 lating to the privacy of individually identifiable 

5 health information and other protections; and 

6 (2) from all inappropriate internal use by any 

7 entity that collects, stores, or receives the data, in8 cluding use of such data in determinations of eligi9 bility (or continued eligibility) in health plans, and 

10 from other inappropriate uses, as defined by the 

11 Secretary. 

12 (c) NATIONAL PLAN OF THE DATA COUNCIL.—The 

13 Secretary shall develop and implement a national plan to 

14 ensure the collection of data in a culturally appropriate 

15 and competent manner, and to improve the collection, 

16 analysis, and reporting of sexual and gender minority data 

17 at the Federal, State, territorial, tribal, and local levels, 

18 including data to be collected under subsection (a). The 

19 Data Council of the Department of Health and Human 

20 Services, in consultation with the National Committee on 

21 Vital Health Statistics, the National Center for Health 

22 Statistics, the Office of Minority Health, and other appro23 priate public and private entities, shall make recommenda24 tions to the Secretary concerning the development, impleVerDate Nov 24 2008 23:57 Jun 25, 2009 Jkt 079200 PO 00000 Frm 00069 Fmt 6652 Sfmt 6201 E:\BILLS\H3001.IH H3001

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1 mentation, and revision of the national plan. Such plan 

2 shall include recommendations on how to— 

3 (1) implement subsection (a) while minimizing 

4 the cost and administrative burdens of data collec5 tion and reporting; 

6 (2) expand awareness among Federal agencies, 

7 States, territories, Indian tribes, health providers, 

8 health plans, health insurance issuers, and the gen9 eral public that data collection, analysis, and report10 ing of sexual and gender minority data is necessary 

11 to assure equity and nondiscrimination in the quality 

12 of health care services; 

13 (3) ensure that future patient record systems 

14 have data code sets for sexual and gender minority 

15 identifiers and that such identifiers can be retrieved 

16 from clinical records, including records transmitted 

17 electronically; 

18 (4) provide researchers with greater access to 

19 sexual and gender minority data, subject to privacy 

20 and confidentiality regulations; and 

21 (5) safeguard and prevent the misuse of data 

22 collected under subsection (a). 

23 (d) COMPLIANCE WITH STANDARDS.—Data collected 

24 under subsection (a) shall be obtained, maintained, and 

25 presented (including for reporting purposes) in accordance 


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1 with the 1997 Office of Management and Budget Stand2 ards for Maintaining, Collecting, and Presenting Federal 

3 Data on Race and Ethnicity (at a minimum). 

4 (e) SEXUAL AND GENDER MINORITY DATA COLLEC5 TION STANDARDS.—Not later than 1 year after the date 

6 of enactment of this Act, the Deputy Assistant Secretary 

7 for LGBT Health, in consultation with the Office for Civil 

8 Rights of the Department of Health and Human Services 

9 and relevant data collection agencies, shall develop and 

10 disseminate Standards for the Classification of Federal 

11 Data on Sexual and Gender Minorities. 

12 (f) TECHNICAL ASSISTANCE FOR THE COLLECTION

13 AND REPORTING OF DATA.— 

14 (1) IN GENERAL.—The Secretary may, either 

15 directly or through grant or contract, provide tech16 nical assistance to enable a health care program or 

17 an entity operating under such program to comply 

18 with the requirements of this section. 

19 (2) TYPES OF ASSISTANCE.—Assistance pro20 vided under this subsection may include assistance 

21 to— 

22 (A) enhance or upgrade computer tech23 nology that will facilitate sexual and gender mi24 nority data collection and analysis; 


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1 (B) develop mechanisms for submitting 

2 collected data subject to existing privacy and 

3 confidentiality regulations; and 

4 (C) develop educational programs to in5 form health insurance issuers, health plans, 

6 health providers, health-related agencies, and 

7 the general public that data collection and re8 porting by sexual and gender minority are legal 

9 and essential for eliminating health and health 

10 care disparities. 

11 (g) ANALYSIS OF SEXUAL AND GENDER MINORITY

12 HEALTH DATA.—The Secretary, acting through the Di13 rector of the Agency for Healthcare Research and Quality 

14 and in coordination with the Administrator of the Centers 

15 for Medicare & Medicaid Services, shall provide technical 

16 assistance to agencies of the Department of Health and 

17 Human Services in meeting Federal standards for sexual 

18 and gender minority data collection and analysis of sexual 

19 and gender minority disparities in health and health care 

20 in public programs by— 

21 (1) identifying appropriate quality assurance 

22 mechanisms to monitor for health disparities; 

23 (2) specifying the clinical, diagnostic, or thera24 peutic measures which should be monitored; 


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1 (3) developing new quality measures relating to 

2 sexual and gender minority disparities in health and 

3 health care; 

4 (4) identifying the level at which data analysis 

5 should be conducted; and 

6 (5) sharing data with external organizations for 

7 research and quality improvement purposes. 

8 (h) REPORT.—Not later than 2 years after the date 

9 of enactment of this Act, and biennially thereafter, the 

10 Secretary shall submit to the appropriate committees of 

11 Congress a report on the effectiveness of data collection, 

12 analysis, and reporting on sexual and minorities under the 

13 programs and activities of the Department of Health and 

14 Human Services and under other Federal data collection 

15 systems with which the Department interacts to collect 

16 relevant data on sexual and gender minorities. The report 

17 shall evaluate the progress made in the Department with 

18 respect to the national plan under subsection (c) or subse19 quent revisions thereto. 

20 (i) DEFINITION.—In this section, the term ‘‘health21 related program’’ means a program— 

22 (1) under the Social Security Act (42 U.S.C. 

23 301 et seq.) that pays for health care and services; 

24 and 


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1 (2) under this Act that provides Federal finan2 cial assistance for health care, biomedical research, 

3 health services research, or programs designed to 

4 improve the public’s health. 

5 (j) AUTHORIZATION OF APPROPRIATIONS.—There 

6 are authorized to be appropriated to carry out this section 

7 such sums as may be necessary for each of fiscal years 

8 2010 through 2015. 

9 SEC. 303. INCLUSION OF SEXUAL ORIENTATION AND GEN10 DER IDENTITY IN FEDERALLY FUNDED 

11 HEALTH SURVEYS. 

12 The Secretary shall ensure that, not later than 3 

13 years after the date of enactment of this Act, any ongoing 

14 or new federally conducted or supported health programs 

15 (including surveys) achieve the— 

16 (1) collection and reporting of data by sexual 

17 and gender identity, using tested methods for doing 

18 this with the greatest possible accuracy; and 

19 (2) development of a standard question to be 

20 included on such surveys which includes information 

21 as to the individual’s sexual orientation and gender 

22 identity. 


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1 SEC. 304. RESEARCH ON SEXUAL AND GENDER MINORITY 

2 HEALTH. 

3 (a) IN GENERAL.—The Secretary, acting through the 

4 Deputy Assistant Secretary for LGBT Health, the Direc5 tor of the Agency for Health Quality and Research, and 

6 the Director of the National Institutes of Health, shall de7 velop plans to expand existing research into health dispari8 ties to include those experienced by sexual and gender mi9 nority populations. In developing such plans, the Secretary 

10 shall— 

11 (1) determine which areas of research focus 

12 would have the greatest impact on health care im13 provement and elimination of disparities, taking into 

14 consideration the overall health status of various 

15 populations, disproportionate burden of diseases or 

16 health conditions, and types of interventions for 

17 which data on effectiveness is limited; 

18 (2) establish measurable goals and objectives 

19 which will allow assessment of progress; and 

20 (3) solicit public review and comment from ex21 perts in health disparities experienced by sexual and 

22 gender minorities. 

23 (b) ESTABLISHMENT OF GRANTS.—The Secretary, 

24 acting through the directors of the Agency for Healthcare 

25 Research and Quality and the National Institutes of 

26 Health, and in collaboration with the Deputy Assistant 


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1 Secretary for LGBT Health, may award grants or con2 tracts to eligible entities to execute research plans to as3 sess the health of sexual and gender minorities. 

4 (c) APPLICATION; ELIGIBLE ENTITIES.— 

5 (1) APPLICATION.—To receive a grant or con6 tract under this section, an eligible entity shall sub7 mit to the Secretary an application at such time, in 

8 such manner, and containing such information as 

9 the Secretary may require. 

10 (2) ELIGIBLE ENTITIES.—To be eligible to re11 ceive a grant or contract under this section, an enti12 ty shall be a health center, hospital, health system, 

13 community clinic, university, community-based orga14 nization, or other health entity determined appro15 priate by the Secretary, that— 

16 (A) serves a disproportionate percentage of 

17 patients from sexual or gender minority groups; 

18 and 

19 (B) include a focus on community-based 

20 participation in research and demonstrations, 

21 as well as research analysis, interpretation, so22 lutions and partnerships for patients from sex23 ual or gender minority groups. 

24 (3) PREFERENCE.—Consortia of 3 or more eli25 gible entities, particularly those entities that partner 


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1 with health plans, shall be given a preference for 

2 grant or contract funding under this section. 

3 (d) RESEARCH.—The research funded under this sec4 tion, with respect to sexual and gender minority groups, 

5 shall— 

6 (1) prioritize the translation of existing re7 search into practical interventions for improving 

8 health and health care and reducing disparities; and 

9 (2) include a focus on community-based 

10 participatory research solutions and partnerships as 

11 appropriate. 

12 (e) DISSEMINATION OF RESEARCH FINDINGS.—To 

13 ensure that findings from the research funded under this 

14 section are disseminated and applied promptly, the Direc15 tor shall— 

16 (1) develop outreach and training programs for 

17 health care providers with respect to the practical 

18 and effective interventions that result from research 

19 programs carried out with grants or contracts 

20 awarded under this section; and 

21 (2) provide technical assistance for the imple22 mentation of evidence-based practices that will im23 prove health and health care and reduce disparities. 

24 (f) REPORT.— 


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1 (1) IN GENERAL.—Not later than September 

2 30, 2010, the Deputy Assistant Secretary for LGBT 

3 Health shall submit to the Secretary and the rel4 evant committees of Congress a report that describes 

5 the extent to which the activities and research fund6 ed under this section have been successful in reduc7 ing and eliminating disparities in health and health 

8 care in targeted populations. 

9 (2) AVAILABILITY.—The Secretary shall ensure 

10 that the report under paragraph (1) is made avail11 able on the Internet websites of the Office of Minor12 ity Health, the Agency for Healthcare Research and 

13 Quality, and other agencies as appropriate. 

14 TITLE IV—INFRASTRUCTURE 

15 AND CAPACITY BUILDING 

16 SEC. 401. OFFICE OF LGBT HEALTH. 

17 Title XVII of the Public Health Service Act (42 

18 U.S.C. 300u et seq.) is amended by inserting after section 

19 1707 the following: 

20 ‘‘SEC. 1707A. OFFICE OF LGBT HEALTH. 

21 ‘‘(a) ESTABLISHMENT.—There is established within 

22 the Office of Minority Health an Office of Lesbian, Gay, 

23 Bisexual, and Transgender Health (in this section referred 

24 to as the ‘Office’), which Office shall be headed by a DepVerDate Nov 24 2008 23:57 Jun 25, 2009 Jkt 079200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6201 E:\BILLS\H3001.IH H3001

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1 uty Assistant Secretary for LGBT Health, appointed by 

2 the Secretary. 

3 ‘‘(b) DUTIES.—The Deputy Assistant Secretary for 

4 LGBT Health shall— 

5 ‘‘(1) establish, implement, monitor, and evalu6 ate short-range and long-range goals and objectives 

7 for all activities within the Public Health Service 

8 that relate to disease prevention, health promotion, 

9 service delivery, and research concerning sexual and 

10 gender minorities; 

11 ‘‘(2) coordinate with the efforts of the offices 

12 and agencies of the Department of Health and 

13 Human Services to address health disparities experi14 enced by sexual and gender minorities; and 

15 ‘‘(3) coordinate with existing Federal research 

16 initiatives, including comparative effectiveness re17 search, to establish guidelines for the physical and 

18 mental health care of sexual and gender minorities. 

19 ‘‘(c) DEFINITION.—In this section, the term ‘sexual 

20 and gender minorities’ means lesbian, gay, bisexual, and 

21 transgender individuals.’’. 

22 SEC. 402. COMMUNITY HEALTH CENTERS. 

23 Section 330 of the Public Health Services Act (42 

24 U.S.C. 254b) is amended— 


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1 (1) in subsection (a)(2), by striking ‘‘or (i)’’ 

2 and inserting ‘‘(i), or (r)’’; 

3 (2) in the matter following clause (iii) in sub4 section (k)(3)(H), by striking ‘‘or (p)’’ and inserting 

5 ‘‘(p), or (r)’’; 

6 (3) by redesignating subsection (r) as sub7 section (s); and 

8 (4) by inserting after subsection (q) the fol9 lowing: 

10 ‘‘(r) LESBIAN, GAY, BISEXUAL, AND TRANSGENDER

11 POPULATION.— 

12 ‘‘(1) IN GENERAL.—The Secretary may award 

13 grants for the planning and delivery of services, in14 cluding innovative programs that provide outreach 

15 and comprehensive, culturally competent primary 

16 health services, to a medically underserved popu17 lation comprised of lesbian, gay, bisexual, and 

18 transgender individuals of all ages. 

19 ‘‘(2) ELIGIBILITY.—In order to be eligible for 

20 the grant under paragraph (1), an applicant shall 

21 demonstrate to the Secretary that the applicant— 

22 ‘‘(A) provides comprehensive, high-quality 

23 care for the lesbian, gay, bisexual, and 

24 transgender population; 


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1 ‘‘(B) has specialized knowledge of the 

2 unique needs of this population; and 

3 ‘‘(C) has culturally competent staff.’’. 

4 TITLE V—OLDER AMERICANS 

5 SUPPORT PROGRAM 

6 SEC. 501. PRIORITY. 

7 Section 373(c)(2) of the Older Americans Act of 

8 1965 (42 U.S.C. 3030s–1(c)(2)) is amended— 

9 (1) in subparagraph (A) by striking ‘‘and’’ at 

10 the end, 

11 (2) in subparagraph (B) by striking the period 

12 at the end and inserting ‘‘; and’’, and 

13 (3) by adding at the end the following: 

14 ‘‘(C) individuals providing care to minority 

15 individuals, including sexual and gender minori16 ties.’’. 

17 TITLE VI—MISCELLANEOUS 

18 PROVISIONS 

19 SEC. 601. NONDISCRIMINATION CONTINGENCY FOR VAWA 

20 GRANT FUNDS; GRANT PROGRAM FOR LGBT 

21 VICTIMS OF VIOLENCE. 

22 (a) NONDISCRIMINATION CONTINGENCY FOR VAWA 

23 GRANT FUNDS.—Section 40002(b) of the Violence 

24 Against Women Act of 1994 (42 U.S.C. 13925(b)) is 


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1 amended by adding at the end the following new para2 graph: 

3 ‘‘(12) NONDISCRIMINATION CONTINGENCY.—An 

4 entity shall not be eligible to receive any Federal 

5 funds, including through a grant or contract, under 

6 this title unless the entity provides assurances to the 

7 satisfaction of the Attorney General through an ap8 plication or agreement for such funds, or both, that 

9 the entity does not discriminate on the basis of sex10 ual orientation or gender identity.’’. 

11 (b) GRANT PROGRAM FOR LGBT VICTIMS OF VIO12 LENCE.— 

13 (1) GRANTS AUTHORIZED.—The Attorney Gen14 eral may award grants to eligible entities described 

15 in paragraph (4)— 

16 (A) to provide services for LGBT victims 

17 of violence, as defined in paragraph (3); 

18 (B) to provide training, consultation, and 

19 information on domestic violence, dating vio20 lence, stalking, and sexual assault against indi21 viduals who are lesbian, gay, bisexual, or 

22 transgender, and to enhance direct services to 

23 such individuals; 

24 (C) for training programs to assist law en25 forcement officers, prosecutors, governmental 


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1 agencies, victim assistants, and relevant officers 

2 of Federal, State, tribal, territorial, and local 

3 courts in recognizing, addressing, investigating, 

4 and prosecuting instances of adult or minor do5 mestic violence, dating violence, sexual assault, 

6 stalking, elder abuse, and violence against les7 bian, gay, bisexual, and transgender individuals; 

8 and 

9 (D) for multidisciplinary collaborative com10 munity responses to such victims. 

11 (2) USE OF FUNDS.—Grants awarded under 

12 this subsection may be used— 

13 (A) to implement or expand programs or 

14 services to respond to the needs of LGBT vic15 tims of violence; 

16 (B) to provide personnel, training, tech17 nical assistance, advocacy, intervention, risk re18 duction, and prevention of domestic violence, 

19 dating violence, stalking, and sexual assault 

20 against lesbian, gay, bisexual, and transgender 

21 individuals; 

22 (C) to conduct outreach activities to ensure 

23 that LGBT victims of violence receive appro24 priate assistance; 


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1 (D) to conduct cross-training for victim 

2 service organizations, governmental agencies, 

3 and nonprofit, nongovernmental organizations 

4 serving individuals with disabilities; about risk 

5 reduction, intervention, prevention, and the na6 ture and dynamic of domestic violence, dating 

7 violence, stalking, and sexual assault for les8 bian, gay, bisexual, and transgender individuals; 

9 (E) to provide technical assistance to assist 

10 with modifications to existing policies, protocols, 

11 and procedures to ensure equal access to the 

12 services, programs, and activities of victim serv13 ice organizations for LGBT victims of violence; 

14 (F) to provide advocacy and intervention 

15 services for LGBT victims of violence; and 

16 (G) to develop model programs providing 

17 advocacy and intervention services within orga18 nizations serving LGBT victims of violence. 

19 (3) LGBT VICTIMS OF VIOLENCE DEFINED.— 

20 For purposes of this subsection, the term ‘‘LGBT 

21 victim of violence’’ means a lesbian, gay, bisexual, or 

22 transgender individual who is a victim of domestic 

23 violence, dating violence, sexual assault, other crimi24 nal assault, stalking, bias-motivated crime, or elder 

25 abuse. 


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1 (4) ELIGIBLE ENTITIES.— 

2 (A) IN GENERAL.—An entity shall be eligi3 ble to receive a grant under this subsection if 

4 the entity is— 

5 (i) a State; 

6 (ii) a unit of local government; 

7 (iii) a nonprofit, nongovernmental or8 ganization such as a victim services organi9 zation, an organization serving individuals 

10 with disabilities or a community-based or11 ganization; or 

12 (iv) a religious organization. 

13 (B) NONDISCRIMINATION.—An entity shall 

14 not be eligible to receive a grant under this sub15 section unless the entity provides assurances to 

16 the satisfaction of the Attorney General 

17 through an application under paragraph (4) or 

18 agreement for such grant, or both, that the en19 tity does not discriminate on the basis of sexual 

20 orientation or gender identity. 

21 (5) APPLICATION.—To be eligible for a grant 

22 under this subsection an entity shall submit to the 

23 Attorney General an application at such time, in 

24 such manner, and containing such information as 

25 the Attorney General may require. 


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1 (6) REPORTING.—Not later than 1 year after 

2 the last day of the first fiscal year commencing on 

3 or after the date of the enactment of this Act, and 

4 not later than 180 days after the last day of each 

5 fiscal year thereafter, the Attorney General shall 

6 submit to Congress a report evaluating the effective7 ness of programs administered and operated through 

8 grants awarded under this subsection. 

9 (7) AUTHORIZATION OF APPROPRIATIONS.— 

10 There are authorized to be appropriated $5,000,000 

11 for each of the fiscal years 2010 through 2014 to 

12 carry out this subsection. 

13 SEC. 602. NATIONAL BASELINE STUDY ON DOMESTIC VIO14 LENCE AND SEXUAL ASSAULT IN THE LGBT 

15 COMMUNITY. 

16 (a) STUDY.—The Attorney General of the United 

17 States, in consultation with the Deputy Assistant Sec18 retary for LGBT Health, shall provide for a national base19 line study to examine the scope of the problem of domestic 

20 violence and sexual assaults against lesbian, gay, bisexual, 

21 and transgender victims and the effectiveness of institu22 tional and legal policies in addressing such crimes and pro23 tecting such victims. 

24 (b) REPORT.—Not less than 1 year after the date of 

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1 pare and transmit to the Committees on the Judiciary of 

2 the Senate and the House of Representatives a report 

3 based on the study required by subsection (a) including 

4 an analysis of— 

5 (1) the number of reported allegations and esti6 mated number of unreported allegations of domestic 

7 violence and sexual assault involving sexual and gen8 der minorities, and to whom the allegations are re9 ported (including sexual assault victim service enti10 ties, and local criminal authorities); 

11 (2) Federal and State laws or regulations per12 taining specifically to sexual assaults involving sex13 ual and gender minorities; and 

14 (3) any recommendations the Attorney General 

15 may have for reforms to address domestic violence 

16 and sexual assaults involving sexual and gender mi17 norities and protect victims more effectively, and any 

18 other matters that the Attorney General deems rel19 evant to the subject of the study and report required 

20 by this section. 

21 (c) AUTHORIZATION OF APPROPRIATIONS.—There is 

22 authorized to be appropriated to carry out this section 

23 $500,000 for fiscal year 2010. 


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1 SEC. 603. ASSISTANCE TO REDUCE TEEN PREGNANCY, HIV/ 

2 AIDS, AND OTHER SEXUALLY TRANSMITTED 

3 DISEASES AND TO SUPPORT HEALTHY ADO4 LESCENT DEVELOPMENT. 

5 (a) IN GENERAL.—The Secretary may award a grant 

6 to each eligible State to conduct programs of sex education 

7 described in subsection (b), including education on both 

8 abstinence and contraception for the prevention of teenage 

9 pregnancy and sexually transmitted diseases, including 

10 HIV/AIDS. 

11 (b) REQUIREMENTS FOR SEX EDUCATION PRO12 GRAMS.—A program of sex education described in this 

13 subsection is a program that— 

14 (1) is age appropriate and medically accurate; 

15 (2) stresses the value of abstinence while not ig16 noring those young people who have been or are sex17 ually active; 

18 (3) provides information about the health bene19 fits and side effects of contraceptive and barrier 

20 methods used— 

21 (A) as a means to prevent pregnancy; and 

22 (B) to reduce the risk of contracting sexu23 ally transmitted disease, including HIV/AIDS; 

24 (4) encourages family communication between 

25 parent and child about sexuality; 


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1 (5) cultivates a respectful dialogue about sexu2 ality, including sexual orientation and gender iden3 tity, and embraces the principles of nondiscrimina4 tion based on sexual orientation and gender identity; 

5 (6) counters the perpetuation of narrow gender 

6 roles, including the sexualization of female children, 

7 adolescents, and adults; 

8 (7) teaches young people the skills to make re9 sponsible decisions about sexuality, including how to 

10 avoid unwanted verbal, physical, and sexual ad11 vances and how to avoid making verbal, physical, 

12 and sexual advances that are not wanted by the 

13 other party; 

14 (8) develops healthy relationships, including the 

15 prevention of dating and sexual violence; 

16 (9) teaches young people how alcohol and drug 

17 use can affect responsible decisionmaking; and 

18 (10) does not teach or promote religion. 

19 (c) ADDITIONAL ACTIVITIES.—In carrying out a pro20 gram of sex education, a State may expend grant funds 

21 awarded under subsection (a) to carry out educational and 

22 motivational activities that help young people— 

23 (1) gain knowledge about the physical, emo24 tional, biological, and hormonal changes of adoles25 cence and subsequent stages of human maturation; 


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1 (2) develop the knowledge and skills necessary 

2 to ensure and protect their sexual and reproductive 

3 health from unintended pregnancy and sexually 

4 transmitted disease, including HIV/AIDS, through5 out their lifespan; 

6 (3) gain knowledge about the specific involve7 ment and responsibility of each individual in sexual 

8 decisionmaking; 

9 (4) develop healthy attitudes and values about 

10 adolescent growth and development, body image, 

11 gender roles, racial and ethnic diversity, sexual ori12 entation and gender identity, and other subjects; 

13 (5) develop and practice healthy life skills in14 cluding goal-setting, decisionmaking, negotiation, 

15 communication, and stress management; and 

16 (6) promote self-esteem and positive inter17 personal skills focusing on relationship dynamics, in18 cluding friendships, dating, romantic involvement, 

19 marriage, and family interactions. 

20 (d) MATCHING FUNDS.—The Secretary may not 

21 make payments to a State under this section in an amount 

22 exceeding Federal medical assistance percentage for such 

23 State (as such term is defined in section 1905(b) of the 

24 Social Security Act (42 U.S.C. 1396d(b))) of the costs of 

25 the programs conducted by the State under this section. 


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1 (e) EVALUATION OF PROGRAMS.— 

2 (1) IN GENERAL.—For the purpose of evalu3 ating the effectiveness of programs of sex education 

4 carried out with a grant under this section, evalua5 tions shall be carried out in accordance with para6 graphs (2) and (3). 

7 (2) NATIONAL EVALUATION.— 

8 (A) METHOD.—The Secretary shall pro9 vide for a national evaluation of a representa10 tive sample of programs of sex education car11 ried out with grants under this section to deter12 mine— 

13 (i) the effectiveness of such programs 

14 in helping to delay the initiation of sexual 

15 intercourse and other high-risk behaviors; 

16 (ii) the effectiveness of such programs 

17 in preventing adolescent pregnancy; 

18 (iii) the effectiveness of such pro19 grams in preventing sexually transmitted 

20 disease, including HIV/AIDS; 

21 (iv) the effectiveness of such programs 

22 in increasing contraceptive knowledge and 

23 contraceptive behaviors when sexual inter24 course occurs; and 


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1 (v) a list of best practices based upon 

2 essential programmatic components of 

3 evaluated programs that have led to suc4 cess described in clauses (i) through (iv). 

5 (B) GRANT CONDITION.—A condition for 

6 the receipt of a grant to a State under this sec7 tion is that the State cooperate with the evalua8 tion under subparagraph (A). 

9 (C) REPORT.—The Secretary shall submit 

10 to the Congress— 

11 (i) not later than the end of each fis12 cal year during the 5-year period beginning 

13 with fiscal year 2010, an interim report on 

14 the national evaluation under subpara15 graph (A); and 

16 (ii) not later than March 31, 2015, a 

17 final report providing the results of such 

18 national evaluation. 

19 (3) INDIVIDUAL STATE EVALUATIONS.—A con20 dition for the receipt of a grant under this section 

21 is that the State evaluate of the programs of sex 

22 education funded through such grant in accordance 

23 with the following requirements: 

24 (A) The evaluation will be conducted by an 

25 external, independent entity. 


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1 (B) The purposes of the evaluation will be 

2 the determination of— 

3 (i) the effectiveness of such programs 

4 in helping to delay the initiation of sexual 

5 intercourse and other high-risk behaviors; 

6 (ii) the effectiveness of such programs 

7 in preventing adolescent pregnancy; 

8 (iii) the effectiveness of such pro9 grams in preventing sexually transmitted 

10 disease, including HIV/AIDS; and 

11 (iv) the effectiveness of such programs 

12 in increasing contraceptive and barrier 

13 method knowledge and contraceptive be14 haviors when sexual intercourse occurs. 

15 (f) LIMITATIONS ON USE OF FUNDS.— 

16 (1) LIMITATIONS ON SECRETARY.—Of the 

17 amounts appropriated for a fiscal year for purposes 

18 of this section, the Secretary may not use more 

19 than— 

20 (A) 7 percent of such amounts for admin21 istrative expenses related to carrying out this 

22 section for that fiscal year; and 

23 (B) 10 percent of such amounts for the 

24 national evaluation under subsection (e)(2). 


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1 (2) LIMITATIONS TO STATES.—Of amounts pro2 vided to an eligible State under this subsection, the 

3 State may not use more than 10 percent of the 

4 grant to conduct any evaluation under subsection 

5 (e)(3). 

6 (g) NONDISCRIMINATION REQUIRED.—Programs 

7 funded under this section shall not discriminate on the 

8 basis of sex, race, ethnicity, national origin, disability, reli9 gion, sexual orientation, or gender identity. Nothing in 

10 this section shall be construed to invalidate or limit rights, 

11 remedies, procedures, or legal standards available to vic12 tims of discrimination under any other Federal law or any 

13 law of a State or a political subdivision of a State, includ14 ing title VI of the Civil Rights Act of 1964 (42 U.S.C. 

15 2000d et seq.), title IX of the Education Amendments of 

16 1972 (20 U.S.C. 1681 et seq.), section 504 of the Reha17 bilitation Act of 1973 (29 U.S.C. 794), and the Americans 

18 with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.). 

19 (h) DEFINITIONS.—For purposes of this section: 

20 (1) The term ‘‘age appropriate’’ means, with re21 spect to topics, messages, and teaching methods, 

22 those suitable to particular ages or age groups of 

23 children, adolescents, and adults, based on devel24 oping cognitive, emotional, and behavioral capacity 

25 typical for the age or age group. 


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1 (2) The term ‘‘eligible State’’ means a State 

2 that submits to the Secretary an application for a 

3 grant under this section that is in such form, is 

4 made in such manner, and contains such agree5 ments, assurances, and information as the Secretary 

6 determines to be necessary to carry out this section. 

7 (3) The term ‘‘HIV/AIDS’’ means the human 

8 immunodeficiency virus, and includes acquired im9 mune deficiency syndrome. 

10 (4) The term ‘‘medically accurate’’, with respect 

11 to information, means information that is supported 

12 by research, recognized as accurate and objective by 

13 leading medical, psychological, psychiatric, and pub14 lic health organizations and agencies, and, published 

15 in journals that are peer reviewed. 

16 (5) The term ‘‘State’’ means the 50 States, the 

17 District of Columbia, the Commonwealth of Puerto 

18 Rico, the Commonwealth of the Northern Mariana 

19 Islands, American Samoa, Guam, the Virgin Islands, 

20 and any other territory or possession of the United 

21 States. 

22 (i) AUTHORIZATION OF APPROPRIATIONS.—For the 

23 purpose of carrying out this section, there is authorized 

24 to be appropriated $50,000,000 for each of the fiscal years 

25 2010 through 2014. 


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1 SEC. 604. MOTHER’S AND FATHER’S INSURANCE BENEFITS 

2 UNDER SOCIAL SECURITY FOR SAME-SEX 

3 SURVIVING PARENTS. 

4 (a) IN GENERAL.—Section 202(g)(1) of the Social 

5 Security Act (42 U.S.C. 402(g)(1)) is amended— 

6 (1) by striking ‘‘and every surviving divorced 

7 parent (as defined in section 216(d))’’ and inserting 

8 ‘‘, every surviving divorced parent (as defined in sec9 tion 216(d)), and every surviving same-sex parent 

10 (as defined in section 216(m))’’; and 

11 (2) in the matter before subparagraph (A), by 

12 striking ‘‘or surviving divorced parent’’ and inserting 

13 ‘‘, surviving divorced parent, or surviving same-sex 

14 parent’’. 

15 (b) CONFORMING AMENDMENTS.— 

16 (1) Section 202(g)(1) of such Act is amended— 

17 (A) in subparagraph (F), by inserting ‘‘or 

18 surviving same-sex parent’’ after ‘‘surviving di19 vorced parent’’; and 

20 (B) in the matter following subparagraph 

21 (F)— 

22 (i) by striking ‘‘or surviving divorced 

23 parent’’ and inserting ‘‘, such surviving di24 vorced parent, or such surviving same-sex 

25 parent’’; 


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1 (ii) by inserting ‘‘or a surviving same2 sex parent’’ after ‘‘in the case of a sur3 viving divorced parent’’; and 

4 (iii) by inserting ‘‘or such surviving 

5 same-sex parent’’ after ‘‘adopted child of 

6 such surviving divorced parent’’. 

7 (2) Section 202(g)(3) of such Act is amended 

8 by striking ‘‘or surviving divorced parent’’ each place 

9 it appears and inserting ‘‘, surviving divorced par10 ent, or surviving same-sex parent’’. 

11 (c) SURVIVING SAME-SEX PARENT.—Section 216 of 

12 the Social Security Act (42 U.S.C. 416) is amended by 

13 adding at the end the following new subsection: 

14 ‘‘Surviving Same-sex Parent 

15 ‘‘(m)(1) The term ‘surviving same-sex parent’ means, 

16 with respect to a deceased individual, an individual who 

17 is of the same sex as such deceased individual but only 

18 if— 

19 ‘‘(A) he or she is the mother or father of the 

20 individual’s child; 

21 ‘‘(B) such individual legally adopted the de22 ceased individual’s son or daughter before such son 

23 or daughter attained the age of 18; 


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1 ‘‘(C) the deceased individual legally adopted the 

2 son or daughter of such individual before such son 

3 or daughter attained the age of 18; or 

4 ‘‘(D) such individual and the deceased indi5 vidual both legally adopted a child under the age of 

6 18. 

7 ‘‘(2) Determinations under this subsection and sec8 tion 202(g) shall be made without regard to section 7 of 

9 title 1, United States Code.’’. 

10 (d) SPECIAL MARRIAGE RULE FOR SURVIVING SAME11 SEX PARENTS.—Section 202(g) of the Social Security Act 

12 (42 U.S.C. 402(g)) is amended by adding at the end the 

13 following new paragraph: 

14 ‘‘(4) For purposes of this subsection, a surviving 

15 same-sex parent shall be considered to be married if such 

16 parent enters into a marriage or similar union under the 

17 laws of a State providing for such marriage or similar 

18 union.’’. 

19 (e) EFFECTIVE DATE.—The amendments made by 

20 this section shall apply with respect to benefits for months 

21 beginning one month after the date of the enactment of 

22 this Act, based on applications filed on or after such date. 


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1 SEC. 605. PROHIBITION AGAINST DISCRIMINATION ON THE 

2 BASIS OF SEXUAL ORIENTATION OR GENDER 

3 IDENTITY UNDER THE HEALTH BENEFITS 

4 PROGRAM FOR FEDERAL EMPLOYEES. 

5 (a) IN GENERAL.—Section 8902(f) of title 5, United 

6 States Code, is amended by inserting ‘‘sexual orientation, 

7 gender identity,’’ after ‘‘sex,’’. 

8 (b) REGULATIONS.—Section 8913 of such title is 

9 amended— 

10 (1) by redesignating subsection (d) as sub11 section (e); and 

12 (2) by inserting after subsection (c) the fol13 lowing: 

14 ‘‘(d) The regulations of the Office shall ensure that 

15 qualified carriers do not discriminate on the basis of sex, 

16 sexual orientation, gender identity, or any other basis 

17 which is prohibited by law.’’. 

18 SEC. 606. PROHIBITION AGAINST DISCRIMINATION ON THE 

19 BASIS OF SEX, GENDER IDENTITY, OR SEXUAL 

20 ORIENTATION UNDER CERTAIN LAWS PRO21 VIDING HEALTH CARE AND OTHER BENEFITS 

22 FOR MEMBERS OF THE ARMED FORCES AND 

23 VETERANS. 

24 (a) PROHIBITION AGAINST DISCRIMINATION IN AD25 MINISTRATION OF MEDICAL AND DENTAL CARE FOR CER26 TAIN MEMBERS OF THE ARMED FORCES.— 


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1 (1) IN GENERAL.—Chapter 55 of title 10, 

2 United States Code, is amended by inserting after 

3 section 1074l the following new section: 

4 ‘‘§ 1074m. Prohibition against discrimination on the 

5 basis of sex, gender identity, or sexual 

6 orientation 

7 ‘‘(a) IN GENERAL.—The Secretary of Defense may 

8 not discriminate against a former member of the uni9 formed services entitled to medical care under section 

10 1074 or 1074a of this title on the basis of sex, gender 

11 identity, or sexual orientation. 

12 ‘‘(b) REGULATIONS.—The Secretary of Defense, in 

13 consultation with the other administering Secretaries, 

14 shall prescribe regulations to carry out this section.’’. 

15 (2) CLERICAL AMENDMENT.—The table of sec16 tions at the beginning of such chapter is amended 

17 by inserting after the item relating to section 1074l 

18 the following new item: 

‘‘1074m. Prohibition against discrimination on the basis of sex, gender identity, 

or sexual orientation.’’. 

19 (b) PROHIBITION AGAINST DISCRIMINATION IN PER20 SONAL SERVICE CONTRACTS RELATED TO MEDICAL CARE

21 FOR MEMBERS OF THE ARMED FORCES.—Paragraph (1) 

22 of section 1091(c) of title 10, United States Code, is 

23 amended— 

24 (1) in subparagraph (A), by striking ‘‘and’’; 


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1 (2) in subparagraph (B), by striking the period 

2 at the end and inserting ‘‘; and’’; and 

3 (3) by adding at the end the following new sub4 paragraph: 

5 ‘‘(C) that an individual who enters into a per6 sonal services contract under subsection (a) shall not 

7 discriminate on the basis of sex, gender identity, or 

8 sexual orientation.’’. 

9 (c) PROHIBITION AGAINST DISCRIMINATION IN AD10 MINISTRATION OF VETERANS’ BENEFITS.— 

11 (1) IN GENERAL.—Subchapter II of chapter 5 

12 of title 38, United States Code, is amended by add13 ing at the end the following new section: 

14 ‘‘§ 533. Prohibition against discrimination on the 

15 basis of sex, gender identity, or sexual 

16 orientation 

17 ‘‘In carrying out this title, the Secretary of Veterans 

18 Affairs may not discriminate on the basis of sex, gender 

19 identity, or sexual orientation and shall ensure that no 

20 person is discriminated against on such basis in connec21 tion with the administration of this title or the payment 

22 of any benefit or claim or provision of any service under 

23 this title.’’. 

24 (2) CLERICAL AMENDMENT.—The table of sec25 tions at the beginning of such chapter is amended 


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1 by inserting after the item relating to section 532 

2 the following new item: 

‘‘533. Prohibition against discrimination on the basis of sex, gender identity, or 

sexual orientation.’’. 

3 (d) PROHIBITION AGAINST DISCRIMINATION IN PAY4 MENT OF VETERANS’ BENEFITS.— 

5 (1) IN GENERAL.—Chapter 53 of title 38, 

6 United States Code, is amended by adding at the 

7 end the following new section: 

8 ‘‘§ 5320. Prohibition against discrimination on the 

9 basis of sex, gender, identity, or sexual 

10 orientation in the provision and adminis11 tration of benefits 

12 ‘‘The Secretary of Veterans Affairs shall ensure that 

13 no person is discriminated against on the basis of sex, gen14 der identity, or sexual orientation in the entitlement to, 

15 administration of, or payment of benefits under this 

16 title.’’. 

17 (2) CLERICAL AMENDMENT.—The table of sec18 tions at the beginning of such chapter is amended 

19 by inserting after the item relating to section 5319 

20 the following new item: 

‘‘5320. Prohibition against discrimination on the basis of sex, gender, identity, 

or sexual orientation in the provision and administration of 

benefits.’’. 

Æ 


bajohnson on PROD1PC77 with BILLS