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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3001 Introduced in House (IH)]

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. Velazquez) 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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Ending LGBT Health Disparities 
Act''.

SEC. 2. TABLE OF CONTENTS.

    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.
             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.

SEC. 3. DEFINITION.

    In this Act:
            (1) Unless otherwise specified, the term ``Secretary'' 
        means the Secretary of Health and Human Services.
            (2) The terms ``sexual or gender minority'' and ``sexual 
        and gender minority'' mean a lesbian, gay, bisexual, or 
        transgender individual.

SEC. 4. EFFECTIVE DATE.

    Unless otherwise specified, this Act and the amendments made this 
Act shall take effect on the date that is 30 days after the date of the 
enactment of this Act.

                  TITLE I--HEALTH ACCESS AND PROMOTION

                  Subtitle A--Private Health Insurance

SEC. 101. TAX EQUITY FOR HEALTH PLAN BENEFICIARIES ACT.

    (a) Application of Accident and Health Plans to Eligible 
Beneficiaries.--
            (1) Exclusion of contributions.--Section 106 of the 
        Internal Revenue Code of 1986 (relating to contributions by 
        employer to accident and health plans) is amended by adding at 
        the end the following new subsection:
    ``(f) Coverage Provided for Eligible Beneficiaries of Employees.--
            ``(1) In general.--Subsection (a) shall apply with respect 
        to an eligible beneficiary and any qualifying child who is a 
        dependent of the eligible beneficiary.
            ``(2) Qualifying child; dependent.--For purposes of this 
        subsection--
                    ``(A) Qualifying child.--The term `qualifying 
                child' has the meaning given such term by section 
                152(c).
                    ``(B) Dependent.--The term `dependent' has the 
                meaning given such term by section 105(b).''.
            (2) Exclusion of amounts expended for medical care.--The 
        first sentence of section 105(b) of such Code (relating to 
        amounts expended for medical care) is amended by inserting 
        before the period the following: ``and eligible beneficiary and 
        the qualifying children of the eligible beneficiary (within the 
        meaning of section 106(f)) with respect to the taxpayer''.
            (3) Payroll taxes.--
                    (A) Section 3121(a)(2) of such Code is amended--
                            (i) by inserting ``, or his eligible 
                        beneficiary or any qualifying children of the 
                        eligible beneficiary,'' after ``his 
                        dependents'' both places it appears,
                            (ii) by inserting ``, and eligible 
                        beneficiaries and qualifying children of 
                        eligible beneficiaries (within the meaning of 
                        section 106(f)),'' after ``their dependents'' 
                        the first place it appears, and
                            (iii) by inserting ``, eligible 
                        beneficiaries, and qualifying children of 
                        eligible beneficiaries'' after ``their 
                        dependents'' the second place it appears.
                    (B) Section 3231(e)(1) of such Code is amended--
                            (i) by inserting ``, or his eligible 
                        beneficiary or any qualifying children of his 
                        eligible beneficiary,'' after ``his 
                        dependents'',
                            (ii) by inserting ``, and eligible 
                        beneficiaries and qualifying children of 
                        eligible beneficiaries (within the meaning of 
                        section 106(f)),'' after ``their dependents'' 
                        the first place it appears, and
                            (iii) by inserting ``, eligible 
                        beneficiaries, and qualifying children of 
                        eligible beneficiaries'' after ``their 
                        dependents'' the second place it appears.
                    (C) Section 3306(b)(2) of such Code is amended--
                            (i) by inserting ``, or his eligible 
                        beneficiary or any qualifying children of his 
                        eligible beneficiary,'' after ``his 
                        dependents'' both places it appears,
                            (ii) by inserting ``, and eligible 
                        beneficiaries and qualifying children of 
                        eligible beneficiaries (within the meaning of 
                        section 106(f)),'' after ``their dependents'' 
                        the first place it appears, and
                            (iii) by inserting ``, eligible 
                        beneficiaries, and qualifying children of 
                        eligible beneficiaries'' after ``their 
                        dependents'' the second place it appears.
                    (D) Section 3401(a) of such Code is amended by 
                striking ``or'' at the end of paragraph (21), by 
                striking the period at the end of paragraph (22) and 
                inserting ``; or'', and by inserting after paragraph 
                (22) the following new paragraph:
            ``(23) for any payment made to or for the benefit of an 
        employee or his eligible beneficiary or any qualifying children 
        of his eligible beneficiary (within the meaning of section 
        106(f)) if at the time of such payment it is reasonable to 
        believe that the employee will be able to exclude such payment 
        from income under section 106(f) or under section 105 by 
        reference in section 105(b) to section 106(f);''.
            (4) Effective date.--The amendments made by this section 
        shall apply to taxable years beginning after December 31, 2009.
    (b) Expansion of Dependency for Purposes of Deduction for Health 
Insurance Costs of Self-employed Individuals.--
            (1) In general.--Subsection (l) of section 162 of the 
        Internal Revenue Code of 1986 (relating to special rules for 
        health insurance costs of self-employed individuals) is amended 
        by adding at the end the following new paragraph:
            ``(6) Dependents.--For purposes of this subsection, the 
        term `dependents' shall include the following with respect to 
        the taxpayer--
                    ``(A) any individual who satisfies the requirements 
                of sections 152(c)(3)(A) and 152(d)(2)(H) (determined 
                without regard to subsections (d)(1)(B) and (d)(1)(D) 
                thereof), and
                    ``(B) one individual who does not satisfy the 
                requirements of section 152(c)(3)(A), but who satisfies 
                the requirements of section 152(d)(2)(H) (determined 
                without regard to subsections (d)(1)(B) and (d)(1)(C) 
                thereof).''.
            (2) Conforming amendment.--Subparagraph (B) of section 
        162(l)(2) of such Code is amended by inserting ``or dependent 
        (as defined in paragraph (1))'' after ``spouse''.
            (3) Effective date.--The amendments made by this section 
        shall apply to taxable years beginning after December 31, 2009.
    (c) Extension to Eligible Beneficiaries of Sick and Accident 
Benefits Provided to Members of a Voluntary Employees' Beneficiary 
Association and Their Dependents.--
            (1) In general.--Section 501(c)(9) of the Internal Revenue 
        Code of 1986 (relating to list of exempt organizations) is 
        amended by adding at the end the following new sentence: ``For 
        purposes of providing for the payment of sick and accident 
        benefits to members of such an association and their 
        dependents, the term `dependents' shall include any individual 
        who is an eligible beneficiary, or qualified child of an 
        eligible beneficiary, as determined under the terms of a 
        medical benefit, health insurance, or other program under which 
        members and their dependents are entitled to sick and accident 
        benefits.''.
            (2) Effective date.--The amendment made by this section 
        shall apply to taxable years beginning after December 31, 2009.
    (d) Flexible Spending Arrangements and Health Reimbursement 
Arrangements.--The Secretary of Treasury shall issue guidance of 
general applicability providing that medical expenses that otherwise 
qualify--
            (1) for reimbursement from a flexible spending arrangement 
        under regulations in effect on the date of the enactment of 
        this Act may be reimbursed from an employee's flexible spending 
        arrangement, notwithstanding the fact that such expenses are 
        attributable to an individual who is the employee's eligible 
        beneficiary under any accident or health plan of the employer, 
        and
            (2) for reimbursement from a health reimbursement 
        arrangement under regulations in effect on the date of the 
        enactment of this Act may be reimbursed from an employee's 
        health reimbursement arrangement, notwithstanding the fact that 
        such expenses are attributable to an individual who is not a 
        spouse or dependent within the meaning of section 152 but who 
        is designated by the employee as eligible to have his or her 
        expenses reimbursed under the health reimbursement arrangement.

SEC. 102. PREEXISTING CONDITION EXCLUSION PATIENT PROTECTION.

    (a) Amendments Relating to Preexisting Condition Exclusions Under 
Group Health Plans.--
            (1) Amendments to the employee retirement income security 
        act of 1974.--
                    (A) Reduction in look-back period.--Section 
                701(a)(1) of the Employee Retirement Income Security 
                Act of 1974 (29 U.S.C. 1181(a)(1)) is amended by 
                striking ``6-month period'' and inserting ``30-day 
                period''.
                    (B) Reduction in permitted preexisting condition 
                limitation period.--Section 701(a)(2) of such Act (29 
                U.S.C. 1181(a)(2)) is amended by striking ``12 months'' 
                and inserting ``3 months'', and by striking ``18 
                months'' and inserting ``9 months''.
            (2) Amendments to the public health service act.--
                    (A) Reduction in look-back period.--Section 
                2701(a)(1) of the Public Health Service Act (42 U.S.C. 
                300gg(a)(1)) is amended by striking ``6-month period'' 
                and inserting ``30-day period''.
                    (B) Reduction in permitted preexisting condition 
                limitation period.--Section 2701(a)(2) of such Act (42 
                U.S.C. 300gg(a)(2)) is amended by striking ``12 
                months'' and inserting ``3 months'', and by striking 
                ``18 months'' and inserting ``9 months''.
            (3) Amendments to the internal revenue code of 1986.--
                    (A) Reduction in look-back period.--Paragraph (1) 
                of section 9801(a) of the Internal Revenue Code of 1986 
                (relating to limitation on preexisting condition 
                exclusion period and crediting for periods of previous 
                coverage) is amended by striking ``6-month period'' and 
                inserting ``30-day period''.
                    (B) Reduction in permitted preexisting condition 
                limitation period.--Paragraph (2) of section 9801(a) of 
                such Code is amended by striking ``12 months'' and 
                inserting ``3 months'', and by striking ``18 months'' 
                and inserting ``9 months''.
            (4) Effective date.--
                    (A) In general.--Except as provided in paragraph 
                (2), the amendments made by this subsection shall apply 
                with respect to group health plans for plan years 
                beginning after the end of the 12th calendar month 
                following the date of the enactment of this Act.
                    (B) Special rule for collective bargaining 
                agreements.--In the case of a group health plan 
                maintained pursuant to one or more collective 
                bargaining agreements between employee representatives 
                and one or more employers ratified before the date of 
                the enactment of this Act, the amendments made by this 
                subsection shall not apply to plan years beginning 
                before the earlier of--
                            (i) the date on which the last of the 
                        collective bargaining agreements relating to 
                        the plan terminates (determined without regard 
                        to any extension thereof agreed to after the 
                        date of the enactment of this Act), or
                            (ii) 3 years after the date of the 
                        enactment of this Act.
                For purposes of clause (i), any plan amendment made 
                pursuant to a collective bargaining agreement relating 
                to the plan which amends the plan solely to conform to 
                any requirement added by the amendments made by this 
                subsection shall not be treated as a termination of 
                such collective bargaining agreement.
    (b) Amendments Relating to Preexisting Condition Exclusions in 
Health Insurance Coverage in the Individual Market.--
            (1) Applicability of group health insurance limitations on 
        imposition of preexisting condition exclusions.--
                    (A) In general.--Subpart 1 of part B of title XXVII 
                of the Public Health Service Act (42 U.S.C. 300gg-41 et 
                seq.) is amended by inserting after section 2741 the 
                following:

``SEC. 2741A. APPLICATION OF GROUP HEALTH INSURANCE LIMITATIONS ON 
              IMPOSITION OF PREEXISTING CONDITION EXCLUSIONS.

    ``(a) In General.--Subject to subsection (b), a health insurance 
issuer that provides individual health insurance coverage may not 
impose a preexisting condition exclusion (as defined in subsection 
(b)(1)(A) of section 2701) with respect to such coverage except to the 
extent that such exclusion could be imposed consistent with such 
section if such coverage were group health insurance coverage.
    ``(b) Limitation.--In the case of an individual who--
            ``(1) is enrolled in individual health insurance coverage;
            ``(2) during the period of such enrollment has a condition 
        for which no medical advice, diagnosis, care, or treatment had 
        been recommended or received as of the enrollment date; and
            ``(3) seeks to enroll under other individual health 
        insurance coverage which provides benefits different from those 
        provided under the coverage referred to in paragraph (1) with 
        respect to such condition,
the issuer of the individual health insurance coverage described in 
paragraph (2) may impose a preexisting condition exclusion with respect 
to such condition and any benefits in addition to those provided under 
the coverage referred to in paragraph (1), but such exclusion may not 
extend for a period of more than 3 months.

``SEC. 2741B. ELIGIBILITY TO ENROLL.

    ``(a) In General.--Subject to subsection (d), an individual health 
plan, and a health insurance issuer offering health insurance in the 
individual market, may not decline to offer coverage to, deny 
enrollment of, or establish rules for eligibility (including continued 
eligibility) to enroll under the terms of the plan, an individual based 
on any of the following health status-related factors in relation to 
the individual or a dependent of the individual:
            ``(1) Health status.
            ``(2) Medical condition (including both physical and mental 
        illnesses).
            ``(3) Claims experience.
            ``(4) Receipt of health care.
            ``(5) Medical history.
            ``(6) Genetic information.
            ``(7) Evidence of insurability (including conditions 
        arising out of acts of domestic violence).
            ``(8) Disability.
    ``(b) No Application to Benefits or Exclusions.--To the extent 
consistent with section 2701, subsection (a) shall not be construed--
            ``(1) to require an individual health plan, or a health 
        insurance issuer offering health insurance on the individual 
        market, to provide particular benefits other than those 
        provided under the terms of such plan or coverage; or
            ``(2) to prevent such a plan or coverage from establishing 
        limitations or restrictions on the amount, level, extent, or 
        nature of the benefits or coverage for similarly situated 
        individuals enrolled in the plan or coverage.
    ``(c) Rules for Eligibility.--In subsection (a), the term `rules 
for eligibility', with respect to enrollment under the terms of a plan, 
includes any rule defining any applicable waiting period for such 
enrollment.
    ``(d) In Premium Contributions.--
            ``(1) In general.--An individual health plan, and a health 
        insurance issuer offering health insurance on the individual 
        market, may not require any individual (as a condition of 
        enrollment or continued enrollment under the plan) to pay a 
        premium or contribution which is greater than such premium or 
        contribution for a similarly situated individual enrolled in 
        the plan on the basis of any health status-related factor in 
        relation to the individual or to an individual enrolled under 
        the plan as a dependent of the individual.
            ``(2) Construction.--Nothing in subsection (a) shall be 
        construed to prevent an individual health plan, and a health 
        insurance issuer offering health insurance on the individual 
        market from establishing premium discounts or rebates or 
        modifying otherwise applicable copayments or deductibles in 
        return for adherence to programs of health promotion and 
        disease prevention.''.
                    (B) Elimination of cobra requirement.--Subsection 
                (b) of section 2741 of the Public Health Service Act 
                (42 U.S.C. 300gg-41) is amended--
                            (i) by adding ``and'' at the end of 
                        paragraph (2);
                            (ii) by striking the semicolon at the end 
                        of paragraph (3) and inserting a period; and
                            (iii) by striking paragraphs (4) and (5).
            (2) Effective date.--The amendments made by this subsection 
        shall apply with respect to health insurance coverage offered, 
        sold, issued, renewed, in effect, or operated in the individual 
        market after the end of the 12th calendar month following the 
        date of the enactment of this Act.

SEC. 103. DOMESTIC PARTNERSHIP BENEFITS AND OBLIGATIONS ACT.

    (a) Benefits to Domestic Partners of Federal Employees.--
            (1) In general.--An employee who has a domestic partner and 
        the domestic partner of the employee shall be entitled to 
        benefits available to, and shall be subject to obligations 
        imposed upon, a married employee and the spouse of the 
        employee.
            (2) Certification of eligibility.--In order to obtain 
        benefits and assume obligations under this section, an employee 
        shall file an affidavit of eligibility for benefits and 
        obligations with the Office of Personnel Management identifying 
        the domestic partner of the employee and certifying that the 
        employee and the domestic partner of the employee--
                    (A) are each other's sole domestic partner and 
                intend to remain so indefinitely;
                    (B) have a common residence, and intend to continue 
                the arrangement;
                    (C) are at least 18 years of age and mentally 
                competent to consent to contract;
                    (D) share responsibility for a significant measure 
                of each other's common welfare and financial 
                obligations;
                    (E) are not married to or domestic partners with 
                anyone else;
                    (F) are same sex domestic partners, and not related 
                in a way that, if the 2 were of the opposite sex, would 
                prohibit legal marriage in the State in which they 
                reside; and
                    (G) understand that willful falsification of 
                information within the affidavit may lead to 
                disciplinary action and the recovery of the cost of 
                benefits received related to such falsification and may 
                constitute a criminal violation.
            (3) Dissolution of partnership.--
                    (A) In general.--An employee or domestic partner of 
                an employee who obtains benefits under this section 
                shall file a statement of dissolution of the domestic 
                partnership with the Office of Personnel Management not 
                later than 30 days after the death of the employee or 
                the domestic partner or the date of dissolution of the 
                domestic partnership.
                    (B) Death of employee.--In a case in which an 
                employee dies, the domestic partner of the employee at 
                the time of death shall receive under this section such 
                benefits as would be received by the widow or widower 
                of an employee.
                    (C) Other dissolution of partnership.--
                            (i) In general.--In a case in which a 
                        domestic partnership dissolves by a method 
                        other than death of the employee or domestic 
                        partner of the employee, any benefits received 
                        by the domestic partner as a result of this 
                        section shall terminate.
                            (ii) Exception.--In a case in which a 
                        domestic partnership dissolves by a method 
                        other than death of the employee or domestic 
                        partner of the employee, the former domestic 
                        partner of the employee shall be entitled to 
                        benefits available to, and shall be subject to 
                        obligations imposed upon, a former spouse.
            (4) Stepchildren.--For purposes of affording benefits under 
        this section, any natural or adopted child of a domestic 
        partner of an employee shall be deemed a stepchild of the 
        employee.
            (5) Confidentiality.--Any information submitted to the 
        Office of Personnel Management under paragraph (2) shall be 
        used solely for the purpose of certifying an individual's 
        eligibility for benefits under paragraph (1).
            (6) Regulations and orders.--
                    (A) Office of personnel management.--Not later than 
                6 months after the date of enactment of this Act, the 
                Office of Personnel Management shall promulgate 
                regulations to implement paragraphs (2) and (3).
                    (B) Other executive branch regulations.--Not later 
                than 6 months after the date of enactment of this Act, 
                the President or designees of the President shall 
                promulgate regulations to implement this section with 
                respect to benefits and obligations administered by 
                agencies or other entities of the executive branch.
                    (C) Other regulations and orders.--Not later than 6 
                months after the date of enactment of this Act, each 
                agency or other entity or official not within the 
                executive branch that administers a program providing 
                benefits or imposing obligations shall promulgate 
                regulations or orders to implement this section with 
                respect to the program.
                    (D) Procedure.--Regulations and orders required 
                under this paragraph shall be promulgated after notice 
                to interested persons and an opportunity for comment.
            (7) Definitions.--In this section:
                    (A) Benefits.--The term ``benefits'' means--
                            (i) health insurance and enhanced dental 
                        and vision benefits, as provided under chapters 
                        89, 89A, and 89B of title 5, United States 
                        Code;
                            (ii) retirement and disability benefits and 
                        plans, as provided under--
                                    (I) chapters 83 and 84 of title 5, 
                                United States Code;
                                    (II) chapter 8 of the Foreign 
                                Service Act of 1980 (22 U.S.C. 4041 et 
                                seq.); and
                                    (III) the Central Intelligence 
                                Agency Retirement Act of 1964 for 
                                Certain Employees (50 U.S.C. chapter 
                                38);
                            (iii) family, medical, and emergency leave, 
                        as provided under--
                                    (I) subchapters III, IV, and V of 
                                chapter 63 of title 5, United States 
                                Code;
                                    (II) the Family and Medical Leave 
                                Act of 1993 (29 U.S.C. 2601 et seq.), 
                                insofar as that Act applies to the 
                                Government Accountability Office and 
                                the Library of Congress;
                                    (III) section 202 of the 
                                Congressional Accountability Act of 
                                1995 (2 U.S.C. 1312); and
                                    (IV) section 412 of title 3, United 
                                States Code;
                            (iv) Federal group life insurance, as 
                        provided under chapter 87 of title 5, United 
                        States Code;
                            (v) long-term care insurance, as provided 
                        under chapter 90 of title 5, United States 
                        Code;
                            (vi) compensation for work injuries, as 
                        provided under chapter 81 of title 5, United 
                        States Code;
                            (vii) benefits for disability, death, or 
                        captivity, as provided under--
                                    (I) sections 5569 and 5570 of title 
                                5, United States Code;
                                    (II) section 413 of the Foreign 
                                Service Act of 1980 (22 U.S.C. 3973);
                                    (III) part L of title I of the 
                                Omnibus Crime Control and Safe Streets 
                                Act of 1968 (42 U.S.C. 3796 et seq.), 
                                insofar as that part applies to any 
                                employee; and
                            (viii) travel, transportation, and related 
                        payments and benefits, as provided under--
                                    (I) chapter 57 of title 5, United 
                                States Code;
                                    (II) chapter 9 of the Foreign 
                                Service Act of 1980 (22 U.S.C. 4081 et 
                                seq.); and
                                    (III) section 1599b of title 10, 
                                United States Code; and
                            (ix) any other benefit similar to a benefit 
                        described under clauses (i) through (viii) 
                        provided by or on behalf of the United States 
                        to any employee.
                    (B) Domestic partner.--The term ``domestic 
                partner'' means an adult unmarried person living with 
                another adult unmarried person of the same sex in a 
                committed, intimate relationship.
                    (C) Employee.--The term ``employee''--
                            (i) means an officer or employee of the 
                        United States or of any department, agency, or 
                        other entity of the United States, including 
                        the President, the Vice President, a Member of 
                        Congress, or a Federal judge; and
                            (ii) shall not include a member of the 
                        uniformed services.
                    (D) Obligations.--The term ``obligations'' means 
                any duties or responsibilities with respect to Federal 
                employment that would be incurred by a married employee 
                or by the spouse of an employee.
                    (E) Uniformed services.--The term ``uniformed 
                services'' has the meaning given under section 2101(3) 
                of title 5, United States Code.
    (b) Effective Date.--This section and the amendments made by this 
section shall--
            (1) with respect to the provision of benefits and 
        obligations, take effect 6 months after the date of enactment 
        of this Act; and
            (2) apply to any individual who is employed as an employee 
        on or after the date of enactment of this Act.

                  Subtitle B--Public Health Insurance

SEC. 111. OPTIONAL MEDICAID COVERAGE OF LOW-INCOME HIV-INFECTED 
              INDIVIDUALS.

    (a) In General.--Section 1902 of the Social Security Act (42 U.S.C. 
1396a), as amended by section 5006(b)(1) of division B of Public Law 
11-5, is amended--
            (1) in subsection (a)(10)(A)(ii)--
                    (A) by striking ``or'' at the end of subclause 
                (XVIII);
                    (B) by adding ``or'' at the end of subclause (XIX); 
                and
                    (C) by adding at the end the following:
            ``(XX) who are described in subsection (gg) (relating to 
        HIV-infected individuals);''; and
            (2) by adding at the end the following:
    ``(gg) HIV-infected individuals described in this subsection are 
individuals not described in subsection (a)(10)(A)(i)--
            ``(1) who are infected with HIV;
            ``(2) whose income (as determined under the State plan 
        under this title with respect to disabled individuals) does not 
        exceed the maximum amount of income a disabled individual 
        described in subsection (a)(10)(A)(i) may have to obtain 
        medical assistance under the plan; and
            ``(3) whose resources (as determined under the State plan 
        under this title with respect to disabled individuals) do not 
        exceed the maximum amount of resources a disabled individual 
        described in subsection (a)(10)(A)(i) may have to obtain 
        medical assistance under the plan.''.
    (b) Enhanced Match.--The first sentence of section 1905(b) of such 
Act (42 U.S.C. 1396d(b)) is amended by striking ``section 
1902(a)(10)(A)(ii)(XVIII)'' and inserting ``subclause (XVIII) or (XX) 
of section 1902(a)(10)(A)(ii)''.
    (c) Conforming Amendments.--Section 1905(a) of such Act (42 U.S.C. 
1396d(a)) is amended, in the matter preceding paragraph (1)--
            (1) by striking ``or'' at the end of clause (xii);
            (2) by adding ``or'' at the end of clause (xiii); and
            (3) by inserting after clause (xiii) the following:
            ``(xiv) individuals described in section 1902(gg);''.
    (d) Exemption From Funding Limitation for Territories.--Section 
1108(g) of the Social Security Act (42 U.S.C. 1308(g)) is amended by 
adding at the end the following:
            ``(5) Disregarding medical assistance for optional low-
        income hiv-infected individuals.--The limitations under 
        subsection (f) and this subsection shall not apply to amounts 
        expended for medical assistance for individuals described in 
        section 1902(gg) who are only eligible for such assistance on 
        the basis of section 1902(a)(10)(A)(ii)(XX).''.
    (e) Effective Date.--The amendments made by this section shall 
apply to calendar quarters beginning on or after the date of the 
enactment of this Act, without regard to whether or not final 
regulations to carry out such amendments have been promulgated by such 
date.

SEC. 112. EXPANDED DEFINITION OF SPOUSE FOR PURPOSES OF THE MEDICARE 
              PROGRAM.

    Section 1101(a) of the Social Security Act (42 U.S.C. 1301a)) is 
amended by adding at the end the following:
            ``(11) Notwithstanding section 7 of title 1, United States 
        Code, for purposes title XVIII of this Act--
                    ``(A) the term `spouse' means an individual in a 
                relationship that any State recognizes as a marriage or 
                similar union under the laws of a State providing for 
                such marriage or similar union; and
                    ``(B) the term `married' means in a relationship 
                that any State recognizes as a marriage or similar 
                union under the laws of a State providing for such 
                marriage or similar union.''.

SEC. 113. ENDING THE MEDICARE DISABILITY WAITING PERIOD ACT.

    (a) Phase-Out of Waiting Period for Medicare Disability Benefits.--
            (1) In general.--Section 226(b) of the Social Security Act 
        (42 U.S.C. 426(b)) is amended--
                    (A) in paragraph (2)(A), by striking ``, and has 
                for 24 calendar months been entitled to,'' and 
                inserting ``, and for the waiting period (as defined in 
                subsection (k)) has been entitled to,'';
                    (B) in paragraph (2)(B), by striking ``, and has 
                been for not less than 24 months,'' and inserting ``, 
                and has been for not less than the waiting period,'';
                    (C) in paragraph (2)(C)(ii), by striking ``, 
                including the requirement that he has been entitled to 
                the specified benefits for 24 months,'' and inserting 
                ``, including the requirement that the individual has 
                been entitled to the specified benefits for the waiting 
                period,''; and
                    (D) in the flush matter following paragraph 
                (2)(C)(ii)(II)--
                            (i) in the first sentence, by striking 
                        ``for each month beginning with the later of 
                        (I) July 1973 or (II) the twenty-fifth month of 
                        his entitlement or status as a qualified 
                        railroad retirement beneficiary described in 
                        paragraph (2), and'' and inserting ``for each 
                        month beginning after the waiting period for 
                        which the individual satisfies paragraph (2) 
                        and'';
                            (ii) in the second sentence, by striking 
                        ``the `twenty-fifth month of his entitlement' 
                        refers to the first month after the twenty-
                        fourth month of entitlement to specified 
                        benefits referred to in paragraph (2)(C) and''; 
                        and
                            (iii) in the third sentence, by striking 
                        ``, but not in excess of 78 such months''.
            (2) Schedule for phase-out of waiting period.--Section 226 
        of the such Act (42 U.S.C. 426) is amended by adding at the end 
        the following new subsection:
    ``(k) For purposes of subsection (b) (and for purposes of section 
1837(g)(1) of this Act and section 7(d)(2)(ii) of the Railroad 
Retirement Act of 1974), the term `waiting period' means--
            ``(1) for 2010, 18 months;
            ``(2) for 2011, 16 months;
            ``(3) for 2012, 14 months;
            ``(4) for 2013, 12 months;
            ``(5) for 2014, 10 months;
            ``(6) for 2015, 8 months;
            ``(7) for 2016, 6 months;
            ``(8) for 2017, 4 months;
            ``(9) for 2018, 2 months; and
            ``(10) for 2019 and each subsequent year, 0 months.''.
            (3) Conforming amendments.--
                    (A) Sunset.--Effective January 1, 2019, subsection 
                (f) of section 226 of the Social Security Act (42 
                U.S.C. 426) is repealed.
                    (B) Medicare description.--Section 1811(2) of such 
                Act (42 U.S.C. 1395c(2)) is amended by striking 
                ``entitled for not less than 24 months'' and inserting 
                ``entitled for the waiting period (as defined in 
                section 226(k))''.
                    (C) Medicare part b coverage.--Section 1837(g)(1) 
                of such Act (42 U.S.C. 1395p(g)(1)) is amended by 
                striking ``of the later of (A) April 1973 or (B) the 
                third month before the 25th month of such entitlement'' 
                and inserting ``of the third month before the first 
                month following the waiting period (as defined in 
                section 226(k)) applicable under section 226(b)''.
                    (D) Railroad retirement system.--Section 
                7(d)(2)(ii) of the Railroad Retirement Act of 1974 (45 
                U.S.C. 231f(d)(2)(ii)) is amended--
                            (i) by striking ``, for not less than 24 
                        months'' and inserting ``, for the waiting 
                        period (as defined in section 226(k) of the 
                        Social Security Act)''; and
                            (ii) by striking ``could have been entitled 
                        for 24 calendar months, and'' and inserting 
                        ``could have been entitled for the waiting 
                        period (as defined in section 226(k) of the 
                        Social Security Act), and''.
            (4) Effective date.--Except as provided in paragraph 
        (3)(A), the amendments made by this subsection shall apply with 
        respect to items and services furnished under title XVIII of 
        the Social Security Act on or after the first day of first 
        month beginning more than 90 days after the date of the 
        enactment of this Act.
    (b) Institute of Medicine Study and Report on Delay and Prevention 
of Disability Conditions.--
            (1) Study.--The Secretary shall request that the Institute 
        of Medicine of the National Academy of Sciences conduct a study 
        on the range of disability conditions that can be delayed or 
        prevented if individuals receive access to health care services 
        and coverage before the condition reaches a level that results 
        in a disability.
            (2) Report.--Not later than the date that is 2 years after 
        the date of enactment of this Act, the Secretary shall submit 
        to the Congress a report containing the results of the 
        Institute of Medicine study authorized under this subsection.
            (3) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $750,000 for 
        the period of fiscal years 2010 and 2011.

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.

    (a) In General.--Section 1860D-2(b)(4)(C) of the Social Security 
Act (42 U.S.C. 1395w-102(b)(4)(C)) is amended--
            (1) in clause (i), by striking ``and'' at the end;
            (2) in clause (ii)--
                    (A) by inserting ``subject to clause (iii),'' after 
                ``(ii)'';
                    (B) by striking ``, under section 1860D-14, or 
                under a State Pharmaceutical Assistance Program''; and
                    (C) by striking the period at the end and inserting 
                ``; and''; and
            (3) by inserting after clause (ii) the following new 
        clause:
                            ``(iii) such costs shall be treated as 
                        incurred and shall not be considered to be 
                        reimbursed under clause (ii) if such costs are 
                        borne or paid--
                                    ``(I) under section 1860D-14;
                                    ``(II) under a State Pharmaceutical 
                                Assistance Program; or
                                    ``(III) under an AIDS Drug 
                                Assistance Program under part B of 
                                title XXVI of the Public Health Service 
                                Act.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to costs incurred on or after January 1, 2010.

SEC. 115. NONDISCRIMINATION BASED ON GENDER IDENTITY OR SEXUAL 
              ORIENTATION UNDER THE MEDICAID, MEDICARE, AND CHIP 
              PROGRAMS.

    (a) Medicaid.--
            (1) Section 1902(a) of the Social Security Act is amended 
        by--
                    (A) striking the ``and'' at the end of paragraph 
                (72);
                    (B) striking the period at the end of paragraph 
                (73)(B) and inserting ``; and'';
                    (C) inserting after paragraph (73) the following 
                new paragraph:
            ``(74) provide that the State shall not discriminate 
        against any person on the basis of sexual orientation or gender 
        identity.''; and
                    (D) adding at the end the following undesignated 
                paragraph:
            ``For the purposes of paragraph (74) `sexual orientation' 
        shall mean homosexuality, heterosexuality, or bisexuality. 
        `Gender identity' shall mean the gender-related identity, 
        appearance, or mannerisms, or other gender-related 
        characteristics of an individual, with or without regard to the 
        individual's designated sex at birth.''.
            (2) Section 1916 of the Social Security Act is amended by 
        adding at the end the following new subsection:
    ``(k) No Discrimination on Premiums or Cost Sharing.--The State 
shall provide that in the case of all individuals described in section 
1902(a) who are eligible under the plan--
            ``(1) there may be imposed no enrollment fee, premium, 
        similar charge on the basis of sexual orientation or gender 
        identity as defined in such section; and
            ``(2) there may be imposed no deduction, cost sharing, or 
        similar charge on the basis of sexual orientation or gender 
        identity as defined in such section.''.
    (b) State Children's Health Insurance Program.--Section 2102 of the 
Social Security Act is amended by adding at the end the following 
subsection: ``(d).''
    ``(d) No Discrimination in State Child Health Plans.--A State child 
health plan may not discriminate on the basis sexual orientation or 
gender identity as defined in section 1902.''.
    (c) Medicare.--Title XVIII of the Social Security Act is amended 
by--
            (1) adding at the end the following:

``SEC. 1899. NONDISCRIMINATION BASED ON GENDER IDENTITY OR SEXUAL 
              ORIENTATION.

    ``(a) Condition of Participation.--As a condition of participation 
as a provider of services or supplier under section 1866(a)(1) or 
1842(h), respectively, the provider or supplier may not discriminate on 
the basis of sex, gender identity, or sexual orientation of a 
beneficiary in the provision of items or services for which payment may 
be made under this title.
    ``(b) Coverage Determinations.--The Secretary may not discriminate 
on the basis of the sex, gender identity, or sexual orientation in 
fulfillment of his duties under this Act.
    ``(c) Regulations.--The Secretary shall promulgate regulations to 
implement this section.''.

                       Subtitle C--Miscellaneous

SEC. 121. HEALTH PROMOTION GRANTS.

    (a) Demonstration Projects.--The Secretary, in collaboration with 
the Deputy Assistant Secretary for LGBT Health, shall award multiyear 
contracts or competitive grants to eligible entities to support 
demonstration projects designed to improve the health and health care 
of sexual or gender minorities through improved access to health care, 
patient navigators, primary prevention activities, health promotion and 
disease prevention activities, and health literacy education and 
services.
    (b) Eligibility.--In this section:
            (1) Eligible entity.--The term ``eligible entity'' means a 
        qualified organization or a community-based consortium.
            (2) Qualified organization.--The term ``qualified 
        organization'' means--
                    (A) a hospital, health plan, or clinic;
                    (B) an academic institution;
                    (C) a State health agency;
                    (D) an Indian Health Service hospital or clinic, 
                Indian tribal health facility, or urban Indian 
                facility;
                    (E) a nonprofit organization, including a faith-
                based organization or consortium, to the extent that a 
                contract or grant awarded to such an entity is 
                consistent with the requirements of section 1955 of the 
                Public Health Service Act (42 U.S.C. 300x-65);
                    (F) a primary care practice-based research network;
                    (G) long-term care facilities, including nursing 
                homes and assisted living facilities; or
                    (H) any other similar entity determined to be 
                appropriate by the Secretary.
            (3) Community-based consortium.--The term ``community-based 
        consortium'' means a partnership that--
                    (A) includes--
                            (i) individuals who are representatives of 
                        organizations of sexual and gender minorities;
                            (ii) community leaders and leaders of 
                        community-based organizations;
                            (iii) health care providers, including 
                        providers who treat sexual and gender 
                        minorities; and
                            (iv) experts in the area of social and 
                        behavioral science, who have knowledge, 
                        training, or practical experience in health 
                        policy, advocacy, cultural competency, or other 
                        relevant areas as determined by the Secretary; 
                        and
                    (B) is located within an area with a significant 
                population of sexual and gender minorities.
    (c) Use of Funds.--An eligible entity shall use amounts received 
under this section for demonstration projects to--
            (1) address health disparities affecting sexual and gender 
        minorities in the areas of--
                    (A) primary care and preventive health, including 
                health education and promotion;
                    (B) behavioral and mental health and substance 
                abuse;
                    (C) health services research;
                    (D) demographics and data collection; and
                    (E) other areas determined appropriate by the 
                Secretary;
            (2) identify, educate, and enroll into clinical trials and 
        comparative effectiveness research eligible patients from 
        sexual or gender minority groups;
            (3) educate, guide, and provide outreach in a community 
        setting regarding health problems prevalent among sexual or 
        gender minority populations, including--
                    (A) HIV in high-risk subpopulations, including--
                            (i) transgender populations;
                            (ii) sex workers; and
                            (iii) people of color;
                    (B) cancers;
                    (C) school violence;
                    (D) emerging drugs; and
                    (E) suicide prevention;
            (4) educate, guide, and provide experiential learning 
        opportunities to sexual and gender minorities targeting 
        behavioral risk factors including--
                    (A) poor nutrition;
                    (B) physical inactivity;
                    (C) being overweight or obese;
                    (D) tobacco use;
                    (E) alcohol and substance use;
                    (F) injury and violence;
                    (G) high-risk sexual behavior; and
                    (H) mental health problems;
            (5) educate and provide guidance to sexual and gender 
        minorities regarding effective strategies to promote positive 
        health behaviors within the community; or
            (6) educate and refer sexual and gender minorities to 
        appropriate health care agencies and community-based programs 
        and organizations in order to increase access to high-quality 
        health care services, including preventive health services.
    (d) Report to Congress.--
            (1) In general.--Not later than 4 years after the date on 
        which the Secretary first awards grants under subsection (a), 
        the Secretary shall submit to the Congress a report regarding 
        such grants.
            (2) Contents.--The report required under paragraph (1) 
        shall include the following:
                    (A) A description of the programs for which grant 
                funds were used.
                    (B) The number of individuals served under such 
                programs.
                    (C) An evaluation of--
                            (i) the effectiveness of such programs;
                            (ii) the cost of such programs; and
                            (iii) the impact of such programs on the 
                        health outcomes of the community residents.
                    (D) Recommendations for improving the health and 
                health care of sexual and gender minorities.
                    (E) A description of how the Secretary will 
                continue to work to improve the use of grant funds 
                under this section.

SEC. 122. MENTAL HEALTH PROMOTION GRANTS.

    (a) Demonstration Projects.--The Secretary, in collaboration with 
the Deputy Assistant Secretary for LGBT Health and the Administrator of 
the Substance Abuse and Mental Health Services Administration, shall 
award multiyear contracts or competitive grants to eligible entities to 
support demonstration projects designed to improve the mental health of 
sexual and gender minorities through improved access to health care, 
primary prevention activities, health promotion and prevention 
activities, and education and services.
    (b) Eligibility.--In this section:
            (1) Eligible entity.--The term ``eligible entity'' means a 
        qualified organization or a community-based consortium.
            (2) Qualified organization.--The term ``qualified 
        organization'' means--
                    (A) a hospital, health plan, or clinic;
                    (B) an academic institution;
                    (C) a State health agency;
                    (D) an Indian Health Service hospital or clinic, 
                Indian tribal health facility, or urban Indian 
                facility;
                    (E) a nonprofit organization, including a faith-
                based organization or consortium, to the extent that a 
                contract or grant awarded to such an entity is 
                consistent with the requirements of section 1955 of the 
                Public Health Service Act (42 U.S.C. 300x-65);
                    (F) a certified mental health treatment center;
                    (G) a long-term care facility, including a nursing 
                home or assisted living facility; and
                    (H) any other similar entity determined to be 
                appropriate by the Secretary.
            (3) Community-based consortium.--The term ``community-based 
        consortium'' means a partnership that--
                    (A) includes--
                            (i) individuals who are representatives of 
                        organizations of sexual or gender minorities;
                            (ii) community leaders and leaders of 
                        community-based organizations;
                            (iii) mental health care providers, 
                        including providers who treat sexual or gender 
                        minorities; and
                            (iv) experts in the area of social and 
                        behavioral science, who have knowledge, 
                        training, or practical experience in health 
                        policy, advocacy, cultural competency, or other 
                        relevant areas as determined by the Secretary; 
                        and
                    (B) is located within an area with a significant 
                population of sexual or gender minorities.
    (c) Use of Funds.--An eligible entity shall use amounts received 
under this section for demonstration projects to--
            (1) address health disparities in the areas of behavioral 
        and mental health and substance abuse;
            (2) educate, guide, and provide outreach in a community 
        setting regarding mental health problems prevalent among sexual 
        or gender minority populations;
            (3) educate, guide, and provide experiential learning 
        opportunities that target behavioral risk factors including--
                    (A) alcohol and substance use;
                    (B) high-risk sexual behavior; and
                    (C) mental health problems;
            (4) develop or adapt curricula and interventions to address 
        major mental health issues in the sexual and gender minority 
        community, including--
                    (A) school violence;
                    (B) emerging drugs;
                    (C) suicide; and
                    (D) family acceptance of lesbian, gay, bisexual, 
                and transgender youth;
            (5) educate and provide guidance regarding effective 
        strategies to promote positive health behaviors within the 
        community, including the promotion of resiliency and wellness 
        strategies;
            (6) educate and refer sexual and gender minorities to 
        appropriate agencies and community-based programs and 
        organizations in order to increase access to high-quality 
        mental health services, including preventive mental health 
        services; or
            (7) provide mental health counseling and education for 
        families to promote acceptance of lesbian, gay, bisexual, and 
        transgender youth, which may include the creation and 
        distribution of support-focused resource guides.
    (d) Report to Congress.--
            (1) In general.--Not later than 4 years after the date on 
        which the Secretary first awards grants under subsection (a), 
        the Secretary shall submit to the Congress a report regarding 
        such grants.
            (2) Contents.--The report required under paragraph (1) 
        shall include the following:
                    (A) A description of the programs for which grant 
                funds were used.
                    (B) The number of individuals served under such 
                programs.
                    (C) An evaluation of--
                            (i) the effectiveness of such programs;
                            (ii) the cost of such programs; and
                            (iii) the impact of the programs on the 
                        health outcomes of the community residents.
                    (D) Recommendations for improving the mental health 
                and mental health care of sexual and gender minorities.

SEC. 123. HEALTH INSURANCE COVERAGE GRANTS.

    (a) In General.--The Secretary, in collaboration with the Deputy 
Assistant Secretary for LGBT Health, the Director of the Centers for 
Disease Control and Prevention and other Federal officials determined 
appropriate by the Secretary, may award grants to State or local 
governments, Indian tribes (including Alaska Native villages), tribal 
organizations, and urban Indian organizations to support projects 
designed to improve the health and health care of sexual and gender 
minorities through improved access to health care through expanded 
health insurance.
    (b) Application.--An eligible entity seeking a grant under this 
section shall submit an application to the Secretary at such time, in 
such manner, and containing such information as the Secretary may 
require, including assurances that the eligible entity will--
            (1) target individuals who are members of sexual or gender 
        minority groups that experience health disparities through 
        specific outreach activities funded through the grant;
            (2) collaborate with appropriate community organizations 
        and include meaningful community participation in planning, 
        implementation, and evaluation of activities;
            (3) demonstrate capacity to enroll individuals currently 
        without health coverage into public or private health insurance 
        plans that meet their treatment and care needs;
            (4) set appropriate and measurable goals for health 
        insurance enrollment of sexual and gender minorities;
            (5) provide ongoing outreach and education to the 
        populations targeted under paragraph (1);
            (6) demonstrate coordination between public and private 
        entities for purposes of assisting public entities in 
        leveraging private funds to improve the health and health care 
        of sexual and gender minorities;
            (7) assist individuals and groups in accessing public and 
        private programs that will help eliminate disparities in health 
        and health care for sexual and gender minorities;
            (8) develop a plan for long-term sustainability for the 
        activities funded through the grant; and
            (9) evaluate the effectiveness of activities under this 
        section, within an appropriate time frame, which shall include 
        a focus on quality and outcomes performance measures to ensure 
        that the activities are meeting the intended goals, and that 
        the entity is able to disseminate findings from such 
        evaluations.
    (c) Priorities.--
            (1) In general.--In awarding contracts and grants under 
        this section, the Secretary shall give priority to applicants 
        that meet the criteria under paragraph (2) and are--
                    (A) safety net hospitals, defined as hospitals with 
                a low-income utilization rate greater than 25 percent 
                (as defined in section 1923(b)(3) of the Social 
                Security Act (42 U.S.C. 1396r-4(b)(3)));
                    (B) a federally qualified health center as defined 
                in section 1905(l)(2)(B) of the Social Security Act 
                with the ability to establish and lead a collaborative 
                partnership;
                    (C) a community-based consortium;
                    (D) safety net health plans that work in 
                coordination with local health centers;
                    (E) an Indian tribe, tribal organization, or urban 
                Indian organization; or
                    (F) other health systems.
            (2) Additional criteria.--For purposes of paragraph (1), 
        the criteria under this paragraph is that the applicant--
                    (A) by legal mandate or explicitly adopted mission, 
                provide patients with access to services regardless of 
                their ability to pay;
                    (B) provide care or treatment for a substantial 
                number of patients who are uninsured, are receiving 
                assistance under a State program under title XIX of the 
                Social Security Act, or are members of vulnerable 
                populations, as determined by the Secretary;
                    (C) serve a disproportionate percentage of patients 
                who are sexual or gender minorities; and
                    (D) provide an assurance that amounts received 
                under the grant or contract will be used to support 
                quality improvement activities for patients from sexual 
                and gender minority groups.
    (d) Use of Funds.--An eligible entity shall use such amounts 
received under this section for demonstration projects to--
            (1) address health disparities in the areas of health 
        insurance coverage; and
            (2) evaluate methods for strengthening the health coverage 
        and continuity of coverage of sexual and gender minority 
        populations, including--
                    (A) targeting enrollment of uninsured sexual and 
                gender minority populations into title XIX of the 
                Social Security Act; and
                    (B) assessing eligibility for domestic partner 
                benefits.
    (e) Evaluation and Report by Grantee.--
            (1) Evaluation.--Any entity that receives a grant under 
        this section shall conduct an evaluation of the activities 
        conducted under such grant and the impact of such activities on 
        decreasing health disparities for sexual and gender minorities.
            (2) Report.--Not later than 3 years after the date an 
        entity receives a contract or grant under this section and 
        annually thereafter, the entity shall provide to the Secretary 
        a report containing the results of the evaluation conducted 
        under paragraph (1).
    (f) Report and Public Access to Information by Secretary.--
            (1) Report to congress.--Beginning on or before the 60th 
        day following the date that the first report is submitted under 
        subsection (e), the Secretary shall submit a report to the 
        Congress complying the results of evaluations under such 
        subsection and describing the overall impact of the grant 
        program under this section.
            (2) Public access.--The Secretary shall, as appropriate, 
        provide the public with access to the report under paragraph 
        (1) and the information contained in the reports under 
        subsection (e)(2).

              TITLE II--CULTURAL COMPETENCY AND WORKFORCE

SEC. 201. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
adding at the end the following:

             ``TITLE XXXI--CULTURALLY COMPETENT HEALTH CARE

``SEC. 3100. DEFINITIONS.

    ``In this title:
            ``(1) Culturally competent.--The term `culturally competent 
        care', with respect to health care or services for sexual and 
        gender minorities, means health care or services that, at a 
        minimum, do not include nonclinical or medically unsound 
        judgments based on sex, sexual orientation, or gender identity 
        and expression that affect the amount and kind of treatment 
        received or that act as a barrier to an individual receiving 
        timely and high-quality care.
            ``(2) Sexual or gender minority.--The terms `sexual or 
        gender minority' and `sexual and gender minority' mean a 
        lesbian, gay, bisexual, or transgender individual.
            ``(3) State.--The term `State' means each of the several 
        states, the District of Columbia, the Commonwealth of Puerto 
        Rico, the Indian tribes, the Virgin Islands, Guam, American 
        Samoa, and the Commonwealth of the Northern Mariana Islands.

``SEC. 3101. NATIONAL STANDARDS FOR CULTURALLY COMPETENT SERVICES IN 
              HEALTH CARE.

    ``Recipients of Federal financial assistance from the Secretary 
shall, to the extent reasonable and practicable--
            ``(1) implement strategies to recruit, retain, and promote 
        individuals at all levels of the organization to maintain a 
        diverse staff and leadership that can provide culturally 
        competent health care to sexual or gender minority patients;
            ``(2) ensure that staff at all levels and across all 
        disciplines of the organization receive ongoing education and 
        training in culturally competent service delivery for sexual or 
        gender minority patients;
            ``(3) develop and implement clear goals, policies, 
        operational plans, and management accountability and oversight 
        mechanisms to provide culturally competent services for sexual 
        and gender minority patients;
            ``(4) conduct initial and ongoing organizational 
        assessments of culturally competent services-related activities 
        for sexual and gender minority patients and integrate valid 
        competence-related measures into the internal audits, 
        performance improvement programs, patient satisfaction 
        assessments, and outcomes-based evaluations of the 
        organization;
            ``(5) ensure that, consistent with the privacy protections 
        provided for under the regulations promulgated under section 
        264(c) of the Health Insurance Portability and Accountability 
        Act of 1996, data on the individual patient's sexual 
        orientation and gender identity are collected in health 
        records, integrated into the organization's management 
        information systems, and periodically updated;
            ``(6) maintain a current demographic, cultural, and 
        epidemiological profile of the community as well as a needs 
        assessment to accurately plan for and implement services that 
        respond to the cultural characteristics of the service area of 
        the organization;
            ``(7) develop participatory, collaborative partnerships 
        with communities and utilize a variety of formal and informal 
        mechanisms to facilitate community and patient involvement in 
        designing and implementing culturally competent services-
        related activities for sexual and gender minority patients;
            ``(8) ensure that conflict and grievance resolution 
        processes are culturally sensitive and capable of identifying, 
        preventing, and resolving cross-cultural conflicts or 
        complaints by sexual and gender minority patients;
            ``(9) regularly make available to the public information 
        about their progress and successful innovations in implementing 
        the standards under this section and provide public notice in 
        their communities about the availability of this information; 
        and
            ``(10) if requested, regularly make available to the head 
        of each Federal entity from which Federal funds are received, 
        information about their progress and successful innovations in 
        implementing the standards under this section as required by 
        the head of such entity.

``SEC. 3102. CENTER FOR CULTURAL COMPETENCE IN HEALTH CARE.

    ``(a) Establishment.--The Secretary, acting through the Deputy 
Assistant Secretary for LGBT Health, shall establish and support a 
center to be known as the `Center for Cultural Competence in Health 
Care' (referred to in this section as the `Center').
    ``(b) Provision of Information.--The Center shall provide 
information relating to culturally competent health care for sexual and 
gender minority populations residing in the United States to all health 
care providers and health care organizations at no cost. Such 
information shall include--
            ``(1) tenets of culturally competent care;
            ``(2) cultural competence self-assessment tools;
            ``(3) cultural competence training tools;
            ``(4) strategic plans to increase cultural competence in 
        different types of health care organizations, including 
        regional collaborations among health care organizations; and
            ``(5) resources for cultural competence information for 
        educators, practitioners, and researchers.
    ``(c) Director.--The Center shall be headed by a Director who shall 
be appointed by, and who shall report to, the Deputy Assistant 
Secretary for LGBT Health.
    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2010 through 2014.

``SEC. 3103. INNOVATIONS IN CULTURAL COMPETENCE GRANTS.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Centers for Medicare & Medicaid Services, the Administrator of 
the Health Resources and Services Administration, the Secretary of 
Education, and the Deputy Assistant Secretary for LGBT Health, shall 
award grants to eligible entities to enable such entities to design, 
implement, and evaluate innovative, cost-effective programs to improve 
cultural competence in health.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            ``(1) be a city, county, Indian tribe, State, territory, 
        community-based or other nonprofit organization, health center 
        or community clinic, hospital, university, college, or other 
        entity designated by the Secretary; and
            ``(2) prepare and submit to the Secretary an application, 
        at such time, in such manner, and accompanied by such 
        additional information as the Secretary may require.
    ``(c) Use of Funds.--An entity shall use funds received under a 
grant under this section to--
            ``(1) develop formal training programs for individuals 
        interested in becoming dedicated culturally competent health 
        care providers for sexual and gender minorities;
            ``(2) develop formal training programs for individuals 
        interested in becoming dedicated culturally competent health 
        care providers for sexual and gender minority youth and their 
        families;
            ``(3) develop training programs for individuals interested 
        in becoming dedicated culturally competent health care 
        providers for aging sexual and gender minorities; and
            ``(4) develop other culturally competent services as 
        determined appropriate by the Secretary.
    ``(d) Priority.--In awarding grants under this section, the 
Secretary shall give priority to entities that have developed 
partnerships with organizations or agencies with experience in 
culturally competent services.
    ``(e) Evaluation.--An entity that receives a grant under this 
section shall submit to the Secretary an evaluation that describes the 
activities carried out with funds received under the grant, and how 
such activities improved access to health care services and the quality 
of health care for individuals. Such evaluation shall be collected and 
disseminated through the Center for Cultural Competence in Health Care 
established under section 3102.
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $5,000,000 for each of fiscal 
years 2010 through 2014.

``SEC. 3104. RESEARCH ON CULTURAL COMPETENCE.

    ``(a) In General.--The Director of the Agency for Healthcare 
Research and Quality, in collaboration with the Deputy Assistant 
Secretary for LGBT Health, shall expand research concerning--
            ``(1) the barriers to health care services, including 
        mental and behavioral services and services at skilled nursing 
        facilities, that are faced by sexual and gender minority 
        individuals;
            ``(2) the impact of cultural barriers on the quality of 
        health care and the health status of sexual and gender minority 
        individuals and populations;
            ``(3) health care providers' and health administrators' 
        attitudes, knowledge, and awareness of the barriers described 
        in paragraphs (1) and (2);
            ``(4) the means by which competency access services are 
        provided to sexual and gender minority individuals and how such 
        services are effective in improving the quality of care;
            ``(5) the cost-effectiveness of providing competency access 
        services; and
            ``(6) optimal approaches for delivering competency access 
        services.
    ``(b) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2010 through 2014.''.

SEC. 202. DEFINITIONS.

    In this title:
            (1) Incorporated definitions.--The definitions contained in 
        section 3100 of the Public Health Service Act, as added by 
        section 201, shall apply.
            (2) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

SEC. 203. FEDERAL REIMBURSEMENT FOR CULTURALLY COMPETENT SERVICES UNDER 
              THE MEDICARE, MEDICAID, AND CHILDREN'S HEALTH INSURANCE 
              PROGRAMS.

    (a) Demonstration Project Promoting Access for Medicare 
Beneficiaries in Sexual and Gender Minority Populations.--
            (1) In general.--The Secretary shall conduct a 
        demonstration project (in this subsection referred to as the 
        ``project'') to provide reimbursement for access services to 
        certain Medicare beneficiaries in sexual and gender minority 
        groups in urban and rural areas and document the impact of such 
        reimbursement on Medicare program costs and health outcomes.
            (2) Scope.--The Secretary shall carry out the project in 
        not less than 30 States or territories through contracts with--
                    (A) MA plans (under part C of title XVIII of the 
                Social Security Act);
                    (B) community-based nonprofit organizations;
                    (C) hospitals; and
                    (D) community-based clinics.
            (3) Duration.--The demonstration shall be conducted for a 
        period not longer than 2 years.
            (4) Report.--Upon completion of the project, the Secretary 
        shall submit a report to the Congress on the project which 
        shall include recommendations regarding--
                    (A) the extension of such project for additional 
                time periods; and
                    (B) the expansion of such project to the entire 
                Medicare program.
            (5) Evaluation.--The Director of the Agency for Healthcare 
        Research and Quality, in consultation with the Office of 
        Minority Health and the National Center on Minority Health and 
        Health Disparities, shall award grants to public and private 
        nonprofit entities that demonstrate experience and capability 
        with respect to cultural competence, including entities 
        directed by and serving representatives of sexual and gender 
        minority groups, to conduct evaluations of the project under 
        paragraph (1). Such evaluations shall focus on the impact of 
        the project on access to services, utilization rates, 
        efficiency in the provision of services, cost-effectiveness, 
        patient satisfaction, and select health outcomes.
    (b) Medicaid and CHIP.--Section 1903(a)(3) of the Social Security 
Act (42 U.S.C. 1396b(a)(3)), as amended by section 4201(a) of division 
B of the American Recovery and Reinvestment Act of 2009 (Public Law 
111-5), is amended--
            (1) in subparagraph (E), by striking ``and'' at the end;
            (2) in subparagraph (F), by striking ``plus'' at the end 
        and inserting ``and''; and
            (3) by adding at the end the following:
                    ``(G) 100 percent of so much of the sums expended 
                with respect to costs incurred during such quarter as 
                are attributable to the provision of access services 
                (as defined in section 203(d) of the Ending LGBT Health 
                Disparities Act) to sexual and gender minorities (as 
                defined in section 3 of the Ending LGBT Health 
                Disparities Act) who apply for or receive medical 
                assistance under the State plan under this title 
                (including any provisions of the plan implemented 
                pursuant to any waiver authority of the Secretary) or 
                child health assistance under a State child health plan 
                under title XXI; plus''.
    (c) SCHIP.--Section 2105(c)(2)(A) of the Social Security Act (42 
U.S.C. 1397ee(c)(2)(A)) is amended by inserting before the period at 
the end the following: ``except that expenditures described in, and 
reimbursable under, section 1903(a)(3)(G) shall not count towards this 
total''.
    (d) Definition of Access Services.--For purposes of this section, 
the term ``access services'' means--
            (1) outreach (including care coordination, nursing 
        outreach, and reminder phone calls) designed to--
                    (A) inform individuals of the benefits to which 
                they are entitled; and
                    (B) encourage individuals to use such benefits; and
            (2) services (including transportation) that assist the 
        individual in accessing such benefits.
    (e) Effective Date.--The amendments made by this section is 
effective for payment for items and services furnished on or after 
October 1, 2010.

SEC. 204. REPORT ON FEDERAL EFFORTS TO PROVIDE CULTURALLY COMPETENT 
              HEALTH CARE SERVICES TO SEXUAL AND GENDER MINORITIES.

    Not later than 1 year after the date of enactment of this Act and 
annually thereafter, the Secretary shall enter into a contract with the 
Institute of Medicine for the preparation and publication of a report 
that describes Federal efforts to ensure that all individuals have 
meaningful access to culturally competent health care services. Such 
report shall include--
            (1) a description and evaluation of the activities carried 
        out under this Act;
            (2) a description of best practices, model programs, 
        guidelines, and other effective strategies for providing access 
        to culturally competent health care services for sexual and 
        gender minority populations; and
            (3) an assessment of the implementation of the Department 
        of Health and Human Services National Standards on Culturally 
        Appropriate Services (CLAS) in Health Care, in particular the 
        implementation of CLAS mandates by recipients of Federal funds.

                TITLE III--RESEARCH AND DATA COLLECTION

SEC. 301. NO COMPELLED DISCLOSURE OF DATA.

    This title does not authorize any Federal official or other entity 
to compel the disclosure of sexual or gender minority data. The 
disclosure of any such data pursuant to this title shall be strictly 
voluntary.

SEC. 302. FEDERAL COLLECTION OF DATA ON SEXUAL AND GENDER MINORITIES.

    (a) Requirements.--
            (1) In general.--Each health-related program operated by or 
        that receives funding or reimbursement, in whole or in part, 
        either directly or indirectly from the Department of Health and 
        Human Services shall--
                    (A) require the collection, by the agency or 
                program involved, of sexual and gender minority data 
                for each applicant for and recipient of health-related 
                assistance under such program;
                    (B) systematically analyze such data using the 
                smallest appropriate units of analysis feasible to 
                detect sexual and gender minority disparities in health 
                and health care and when appropriate, analyze such data 
                for each identified sexual identity separately, and 
                report the results of such analysis to the Secretary, 
                the Director of the Office for Civil Rights, the 
                Committee on Health, Education, Labor, and Pensions and 
                the Committee on Finance of the Senate, and the 
                Committee on Energy and Commerce and the Committee on 
                Ways and Means of the House of Representatives;
                    (C) provide such data to the Secretary on at least 
                an annual basis; and
                    (D) ensure that the provision of assistance to an 
                applicant or recipient of assistance is not denied or 
                otherwise adversely affected because of the failure of 
                the applicant or recipient to provide sexual and gender 
                minority data.
            (2) Bureau of prisons.--The Attorney General of the United 
        States, acting through the Director of the Bureau of Prisons, 
        shall collect and share with the Secretary sexual and minority 
        data for each individual who is incarcerated and receives 
        health assistance in an institution under the jurisdiction of 
        the Bureau of Prisons.
            (3) Rules of construction.--Nothing in this subsection 
        shall be construed to--
                    (A) permit the use of information collected under 
                this subsection in a manner that would adversely affect 
                any individual providing any such information; and
                    (B) require health care providers to collect data.
    (b) Protection of Data.--Through the promulgation of regulations or 
otherwise, the Secretary shall ensure that all data collected pursuant 
to subsection (a)(1) or received pursuant to subsection (a)(2), and the 
Attorney General of the United States shall ensure that all data 
collected pursuant to subsection (a)(2), is protected--
            (1) under the same privacy protections as the Secretary 
        applies to other health data under the regulations promulgated 
        under section 264(c) of the Health Insurance Portability and 
        Accountability Act of 1996 (Public Law 104-191; 110 Stat. 2033) 
        relating to the privacy of individually identifiable health 
        information and other protections; and
            (2) from all inappropriate internal use by any entity that 
        collects, stores, or receives the data, including use of such 
        data in determinations of eligibility (or continued 
        eligibility) in health plans, and from other inappropriate 
        uses, as defined by the Secretary.
    (c) National Plan of the Data Council.--The Secretary shall develop 
and implement a national plan to ensure the collection of data in a 
culturally appropriate and competent manner, and to improve the 
collection, analysis, and reporting of sexual and gender minority data 
at the Federal, State, territorial, tribal, and local levels, including 
data to be collected under subsection (a). The Data Council of the 
Department of Health and Human Services, in consultation with the 
National Committee on Vital Health Statistics, the National Center for 
Health Statistics, the Office of Minority Health, and other appropriate 
public and private entities, shall make recommendations to the 
Secretary concerning the development, implementation, and revision of 
the national plan. Such plan shall include recommendations on how to--
            (1) implement subsection (a) while minimizing the cost and 
        administrative burdens of data collection and reporting;
            (2) expand awareness among Federal agencies, States, 
        territories, Indian tribes, health providers, health plans, 
        health insurance issuers, and the general public that data 
        collection, analysis, and reporting of sexual and gender 
        minority data is necessary to assure equity and 
        nondiscrimination in the quality of health care services;
            (3) ensure that future patient record systems have data 
        code sets for sexual and gender minority identifiers and that 
        such identifiers can be retrieved from clinical records, 
        including records transmitted electronically;
            (4) provide researchers with greater access to sexual and 
        gender minority data, subject to privacy and confidentiality 
        regulations; and
            (5) safeguard and prevent the misuse of data collected 
        under subsection (a).
    (d) Compliance With Standards.--Data collected under subsection (a) 
shall be obtained, maintained, and presented (including for reporting 
purposes) in accordance with the 1997 Office of Management and Budget 
Standards for Maintaining, Collecting, and Presenting Federal Data on 
Race and Ethnicity (at a minimum).
    (e) Sexual and Gender Minority Data Collection Standards.--Not 
later than 1 year after the date of enactment of this Act, the Deputy 
Assistant Secretary for LGBT Health, in consultation with the Office 
for Civil Rights of the Department of Health and Human Services and 
relevant data collection agencies, shall develop and disseminate 
Standards for the Classification of Federal Data on Sexual and Gender 
Minorities.
    (f) Technical Assistance for the Collection and Reporting of 
Data.--
            (1) In general.--The Secretary may, either directly or 
        through grant or contract, provide technical assistance to 
        enable a health care program or an entity operating under such 
        program to comply with the requirements of this section.
            (2) Types of assistance.--Assistance provided under this 
        subsection may include assistance to--
                    (A) enhance or upgrade computer technology that 
                will facilitate sexual and gender minority data 
                collection and analysis;
                    (B) develop mechanisms for submitting collected 
                data subject to existing privacy and confidentiality 
                regulations; and
                    (C) develop educational programs to inform health 
                insurance issuers, health plans, health providers, 
                health-related agencies, and the general public that 
                data collection and reporting by sexual and gender 
                minority are legal and essential for eliminating health 
                and health care disparities.
    (g) Analysis of Sexual and Gender Minority Health Data.--The 
Secretary, acting through the Director of the Agency for Healthcare 
Research and Quality and in coordination with the Administrator of the 
Centers for Medicare & Medicaid Services, shall provide technical 
assistance to agencies of the Department of Health and Human Services 
in meeting Federal standards for sexual and gender minority data 
collection and analysis of sexual and gender minority disparities in 
health and health care in public programs by--
            (1) identifying appropriate quality assurance mechanisms to 
        monitor for health disparities;
            (2) specifying the clinical, diagnostic, or therapeutic 
        measures which should be monitored;
            (3) developing new quality measures relating to sexual and 
        gender minority disparities in health and health care;
            (4) identifying the level at which data analysis should be 
        conducted; and
            (5) sharing data with external organizations for research 
        and quality improvement purposes.
    (h) Report.--Not later than 2 years after the date of enactment of 
this Act, and biennially thereafter, the Secretary shall submit to the 
appropriate committees of Congress a report on the effectiveness of 
data collection, analysis, and reporting on sexual and minorities under 
the programs and activities of the Department of Health and Human 
Services and under other Federal data collection systems with which the 
Department interacts to collect relevant data on sexual and gender 
minorities. The report shall evaluate the progress made in the 
Department with respect to the national plan under subsection (c) or 
subsequent revisions thereto.
    (i) Definition.--In this section, the term ``health-related 
program'' means a program--
            (1) under the Social Security Act (42 U.S.C. 301 et seq.) 
        that pays for health care and services; and
            (2) under this Act that provides Federal financial 
        assistance for health care, biomedical research, health 
        services research, or programs designed to improve the public's 
        health.
    (j) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2010 through 2015.

SEC. 303. INCLUSION OF SEXUAL ORIENTATION AND GENDER IDENTITY IN 
              FEDERALLY FUNDED HEALTH SURVEYS.

    The Secretary shall ensure that, not later than 3 years after the 
date of enactment of this Act, any ongoing or new federally conducted 
or supported health programs (including surveys) achieve the--
            (1) collection and reporting of data by sexual and gender 
        identity, using tested methods for doing this with the greatest 
        possible accuracy; and
            (2) development of a standard question to be included on 
        such surveys which includes information as to the individual's 
        sexual orientation and gender identity.

SEC. 304. RESEARCH ON SEXUAL AND GENDER MINORITY HEALTH.

    (a) In General.--The Secretary, acting through the Deputy Assistant 
Secretary for LGBT Health, the Director of the Agency for Health 
Quality and Research, and the Director of the National Institutes of 
Health, shall develop plans to expand existing research into health 
disparities to include those experienced by sexual and gender minority 
populations. In developing such plans, the Secretary shall--
            (1) determine which areas of research focus would have the 
        greatest impact on health care improvement and elimination of 
        disparities, taking into consideration the overall health 
        status of various populations, disproportionate burden of 
        diseases or health conditions, and types of interventions for 
        which data on effectiveness is limited;
            (2) establish measurable goals and objectives which will 
        allow assessment of progress; and
            (3) solicit public review and comment from experts in 
        health disparities experienced by sexual and gender minorities.
    (b) Establishment of Grants.--The Secretary, acting through the 
directors of the Agency for Healthcare Research and Quality and the 
National Institutes of Health, and in collaboration with the Deputy 
Assistant Secretary for LGBT Health, may award grants or contracts to 
eligible entities to execute research plans to assess the health of 
sexual and gender minorities.
    (c) Application; Eligible Entities.--
            (1) Application.--To receive a grant or contract under this 
        section, an eligible entity shall submit to the Secretary an 
        application at such time, in such manner, and containing such 
        information as the Secretary may require.
            (2) Eligible entities.--To be eligible to receive a grant 
        or contract under this section, an entity shall be a health 
        center, hospital, health system, community clinic, university, 
        community-based organization, or other health entity determined 
        appropriate by the Secretary, that--
                    (A) serves a disproportionate percentage of 
                patients from sexual or gender minority groups; and
                    (B) include a focus on community-based 
                participation in research and demonstrations, as well 
                as research analysis, interpretation, solutions and 
                partnerships for patients from sexual or gender 
                minority groups.
            (3) Preference.--Consortia of 3 or more eligible entities, 
        particularly those entities that partner with health plans, 
        shall be given a preference for grant or contract funding under 
        this section.
    (d) Research.--The research funded under this section, with respect 
to sexual and gender minority groups, shall--
            (1) prioritize the translation of existing research into 
        practical interventions for improving health and health care 
        and reducing disparities; and
            (2) include a focus on community-based participatory 
        research solutions and partnerships as appropriate.
    (e) Dissemination of Research Findings.--To ensure that findings 
from the research funded under this section are disseminated and 
applied promptly, the Director shall--
            (1) develop outreach and training programs for health care 
        providers with respect to the practical and effective 
        interventions that result from research programs carried out 
        with grants or contracts awarded under this section; and
            (2) provide technical assistance for the implementation of 
        evidence-based practices that will improve health and health 
        care and reduce disparities.
    (f) Report.--
            (1) In general.--Not later than September 30, 2010, the 
        Deputy Assistant Secretary for LGBT Health shall submit to the 
        Secretary and the relevant committees of Congress a report that 
        describes the extent to which the activities and research 
        funded under this section have been successful in reducing and 
        eliminating disparities in health and health care in targeted 
        populations.
            (2) Availability.--The Secretary shall ensure that the 
        report under paragraph (1) is made available on the Internet 
        websites of the Office of Minority Health, the Agency for 
        Healthcare Research and Quality, and other agencies as 
        appropriate.

             TITLE IV--INFRASTRUCTURE AND CAPACITY BUILDING

SEC. 401. OFFICE OF LGBT HEALTH.

    Title XVII of the Public Health Service Act (42 U.S.C. 300u et 
seq.) is amended by inserting after section 1707 the following:

``SEC. 1707A. OFFICE OF LGBT HEALTH.

    ``(a) Establishment.--There is established within the Office of 
Minority Health an Office of Lesbian, Gay, Bisexual, and Transgender 
Health (in this section referred to as the `Office'), which Office 
shall be headed by a Deputy Assistant Secretary for LGBT Health, 
appointed by the Secretary.
    ``(b) Duties.--The Deputy Assistant Secretary for LGBT Health 
shall--
            ``(1) establish, implement, monitor, and evaluate short-
        range and long-range goals and objectives for all activities 
        within the Public Health Service that relate to disease 
        prevention, health promotion, service delivery, and research 
        concerning sexual and gender minorities;
            ``(2) coordinate with the efforts of the offices and 
        agencies of the Department of Health and Human Services to 
        address health disparities experienced by sexual and gender 
        minorities; and
            ``(3) coordinate with existing Federal research 
        initiatives, including comparative effectiveness research, to 
        establish guidelines for the physical and mental health care of 
        sexual and gender minorities.
    ``(c) Definition.--In this section, the term `sexual and gender 
minorities' means lesbian, gay, bisexual, and transgender 
individuals.''.

SEC. 402. COMMUNITY HEALTH CENTERS.

    Section 330 of the Public Health Services Act (42 U.S.C. 254b) is 
amended--
            (1) in subsection (a)(2), by striking ``or (i)'' and 
        inserting ``(i), or (r)'';
            (2) in the matter following clause (iii) in subsection 
        (k)(3)(H), by striking ``or (p)'' and inserting ``(p), or 
        (r)'';
            (3) by redesignating subsection (r) as subsection (s); and
            (4) by inserting after subsection (q) the following:
    ``(r) Lesbian, Gay, Bisexual, and Transgender Population.--
            ``(1) In general.--The Secretary may award grants for the 
        planning and delivery of services, including innovative 
        programs that provide outreach and comprehensive, culturally 
        competent primary health services, to a medically underserved 
        population comprised of lesbian, gay, bisexual, and transgender 
        individuals of all ages.
            ``(2) Eligibility.--In order to be eligible for the grant 
        under paragraph (1), an applicant shall demonstrate to the 
        Secretary that the applicant--
                    ``(A) provides comprehensive, high-quality care for 
                the lesbian, gay, bisexual, and transgender population;
                    ``(B) has specialized knowledge of the unique needs 
                of this population; and
                    ``(C) has culturally competent staff.''.

                TITLE V--OLDER AMERICANS SUPPORT PROGRAM

SEC. 501. PRIORITY.

    Section 373(c)(2) of the Older Americans Act of 1965 (42 U.S.C. 
3030s-1(c)(2)) is amended--
            (1) in subparagraph (A) by striking ``and'' at the end,
            (2) in subparagraph (B) by striking the period at the end 
        and inserting ``; and'', and
            (3) by adding at the end the following:
                    ``(C) individuals providing care to minority 
                individuals, including sexual and gender minorities.''.

                   TITLE VI--MISCELLANEOUS PROVISIONS

SEC. 601. NONDISCRIMINATION CONTINGENCY FOR VAWA GRANT FUNDS; GRANT 
              PROGRAM FOR LGBT VICTIMS OF VIOLENCE.

    (a) Nondiscrimination Contingency for VAWA Grant Funds.--Section 
40002(b) of the Violence Against Women Act of 1994 (42 U.S.C. 13925(b)) 
is amended by adding at the end the following new paragraph:
            ``(12) Nondiscrimination contingency.--An entity shall not 
        be eligible to receive any Federal funds, including through a 
        grant or contract, under this title unless the entity provides 
        assurances to the satisfaction of the Attorney General through 
        an application or agreement for such funds, or both, that the 
        entity does not discriminate on the basis of sexual orientation 
        or gender identity.''.
    (b) Grant Program for LGBT Victims of Violence.--
            (1) Grants authorized.--The Attorney General may award 
        grants to eligible entities described in paragraph (4)--
                    (A) to provide services for LGBT victims of 
                violence, as defined in paragraph (3);
                    (B) to provide training, consultation, and 
                information on domestic violence, dating violence, 
                stalking, and sexual assault against individuals who 
                are lesbian, gay, bisexual, or transgender, and to 
                enhance direct services to such individuals;
                    (C) for training programs to assist law enforcement 
                officers, prosecutors, governmental agencies, victim 
                assistants, and relevant officers of Federal, State, 
                tribal, territorial, and local courts in recognizing, 
                addressing, investigating, and prosecuting instances of 
                adult or minor domestic violence, dating violence, 
                sexual assault, stalking, elder abuse, and violence 
                against lesbian, gay, bisexual, and transgender 
                individuals; and
                    (D) for multidisciplinary collaborative community 
                responses to such victims.
            (2) Use of funds.--Grants awarded under this subsection may 
        be used--
                    (A) to implement or expand programs or services to 
                respond to the needs of LGBT victims of violence;
                    (B) to provide personnel, training, technical 
                assistance, advocacy, intervention, risk reduction, and 
                prevention of domestic violence, dating violence, 
                stalking, and sexual assault against lesbian, gay, 
                bisexual, and transgender individuals;
                    (C) to conduct outreach activities to ensure that 
                LGBT victims of violence receive appropriate 
                assistance;
                    (D) to conduct cross-training for victim service 
                organizations, governmental agencies, and nonprofit, 
                nongovernmental organizations serving individuals with 
                disabilities; about risk reduction, intervention, 
                prevention, and the nature and dynamic of domestic 
                violence, dating violence, stalking, and sexual assault 
                for lesbian, gay, bisexual, and transgender 
                individuals;
                    (E) to provide technical assistance to assist with 
                modifications to existing policies, protocols, and 
                procedures to ensure equal access to the services, 
                programs, and activities of victim service 
                organizations for LGBT victims of violence;
                    (F) to provide advocacy and intervention services 
                for LGBT victims of violence; and
                    (G) to develop model programs providing advocacy 
                and intervention services within organizations serving 
                LGBT victims of violence.
            (3) LGBT victims of violence defined.--For purposes of this 
        subsection, the term ``LGBT victim of violence'' means a 
        lesbian, gay, bisexual, or transgender individual who is a 
        victim of domestic violence, dating violence, sexual assault, 
        other criminal assault, stalking, bias-motivated crime, or 
        elder abuse.
            (4) Eligible entities.--
                    (A) In general.--An entity shall be eligible to 
                receive a grant under this subsection if the entity 
                is--
                            (i) a State;
                            (ii) a unit of local government;
                            (iii) a nonprofit, nongovernmental 
                        organization such as a victim services 
                        organization, an organization serving 
                        individuals with disabilities or a community-
                        based organization; or
                            (iv) a religious organization.
                    (B) Nondiscrimination.--An entity shall not be 
                eligible to receive a grant under this subsection 
                unless the entity provides assurances to the 
                satisfaction of the Attorney General through an 
                application under paragraph (4) or agreement for such 
                grant, or both, that the entity does not discriminate 
                on the basis of sexual orientation or gender identity.
            (5) Application.--To be eligible for a grant under this 
        subsection an entity shall submit to the Attorney General an 
        application at such time, in such manner, and containing such 
        information as the Attorney General may require.
            (6) Reporting.--Not later than 1 year after the last day of 
        the first fiscal year commencing on or after the date of the 
        enactment of this Act, and not later than 180 days after the 
        last day of each fiscal year thereafter, the Attorney General 
        shall submit to Congress a report evaluating the effectiveness 
        of programs administered and operated through grants awarded 
        under this subsection.
            (7) Authorization of appropriations.--There are authorized 
        to be appropriated $5,000,000 for each of the fiscal years 2010 
        through 2014 to carry out this subsection.

SEC. 602. NATIONAL BASELINE STUDY ON DOMESTIC VIOLENCE AND SEXUAL 
              ASSAULT IN THE LGBT COMMUNITY.

    (a) Study.--The Attorney General of the United States, in 
consultation with the Deputy Assistant Secretary for LGBT Health, shall 
provide for a national baseline study to examine the scope of the 
problem of domestic violence and sexual assaults against lesbian, gay, 
bisexual, and transgender victims and the effectiveness of 
institutional and legal policies in addressing such crimes and 
protecting such victims.
    (b) Report.--Not less than 1 year after the date of the enactment 
of this Act, the Attorney General shall prepare and transmit to the 
Committees on the Judiciary of the Senate and the House of 
Representatives a report based on the study required by subsection (a) 
including an analysis of--
            (1) the number of reported allegations and estimated number 
        of unreported allegations of domestic violence and sexual 
        assault involving sexual and gender minorities, and to whom the 
        allegations are reported (including sexual assault victim 
        service entities, and local criminal authorities);
            (2) Federal and State laws or regulations pertaining 
        specifically to sexual assaults involving sexual and gender 
        minorities; and
            (3) any recommendations the Attorney General may have for 
        reforms to address domestic violence and sexual assaults 
        involving sexual and gender minorities and protect victims more 
        effectively, and any other matters that the Attorney General 
        deems relevant to the subject of the study and report required 
        by this section.
    (c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $500,000 for fiscal year 2010.

SEC. 603. ASSISTANCE TO REDUCE TEEN PREGNANCY, HIV/AIDS, AND OTHER 
              SEXUALLY TRANSMITTED DISEASES AND TO SUPPORT HEALTHY 
              ADOLESCENT DEVELOPMENT.

    (a) In General.--The Secretary may award a grant to each eligible 
State to conduct programs of sex education described in subsection (b), 
including education on both abstinence and contraception for the 
prevention of teenage pregnancy and sexually transmitted diseases, 
including HIV/AIDS.
    (b) Requirements for Sex Education Programs.--A program of sex 
education described in this subsection is a program that--
            (1) is age appropriate and medically accurate;
            (2) stresses the value of abstinence while not ignoring 
        those young people who have been or are sexually active;
            (3) provides information about the health benefits and side 
        effects of contraceptive and barrier methods used--
                    (A) as a means to prevent pregnancy; and
                    (B) to reduce the risk of contracting sexually 
                transmitted disease, including HIV/AIDS;
            (4) encourages family communication between parent and 
        child about sexuality;
            (5) cultivates a respectful dialogue about sexuality, 
        including sexual orientation and gender identity, and embraces 
        the principles of nondiscrimination based on sexual orientation 
        and gender identity;
            (6) counters the perpetuation of narrow gender roles, 
        including the sexualization of female children, adolescents, 
        and adults;
            (7) teaches young people the skills to make responsible 
        decisions about sexuality, including how to avoid unwanted 
        verbal, physical, and sexual advances and how to avoid making 
        verbal, physical, and sexual advances that are not wanted by 
        the other party;
            (8) develops healthy relationships, including the 
        prevention of dating and sexual violence;
            (9) teaches young people how alcohol and drug use can 
        affect responsible decisionmaking; and
            (10) does not teach or promote religion.
    (c) Additional Activities.--In carrying out a program of sex 
education, a State may expend grant funds awarded under subsection (a) 
to carry out educational and motivational activities that help young 
people--
            (1) gain knowledge about the physical, emotional, 
        biological, and hormonal changes of adolescence and subsequent 
        stages of human maturation;
            (2) develop the knowledge and skills necessary to ensure 
        and protect their sexual and reproductive health from 
        unintended pregnancy and sexually transmitted disease, 
        including HIV/AIDS, throughout their lifespan;
            (3) gain knowledge about the specific involvement and 
        responsibility of each individual in sexual decisionmaking;
            (4) develop healthy attitudes and values about adolescent 
        growth and development, body image, gender roles, racial and 
        ethnic diversity, sexual orientation and gender identity, and 
        other subjects;
            (5) develop and practice healthy life skills including 
        goal-setting, decisionmaking, negotiation, communication, and 
        stress management; and
            (6) promote self-esteem and positive interpersonal skills 
        focusing on relationship dynamics, including friendships, 
        dating, romantic involvement, marriage, and family 
        interactions.
    (d) Matching Funds.--The Secretary may not make payments to a State 
under this section in an amount exceeding Federal medical assistance 
percentage for such State (as such term is defined in section 1905(b) 
of the Social Security Act (42 U.S.C. 1396d(b))) of the costs of the 
programs conducted by the State under this section.
    (e) Evaluation of Programs.--
            (1) In general.--For the purpose of evaluating the 
        effectiveness of programs of sex education carried out with a 
        grant under this section, evaluations shall be carried out in 
        accordance with paragraphs (2) and (3).
            (2) National evaluation.--
                    (A) Method.--The Secretary shall provide for a 
                national evaluation of a representative sample of 
                programs of sex education carried out with grants under 
                this section to determine--
                            (i) the effectiveness of such programs in 
                        helping to delay the initiation of sexual 
                        intercourse and other high-risk behaviors;
                            (ii) the effectiveness of such programs in 
                        preventing adolescent pregnancy;
                            (iii) the effectiveness of such programs in 
                        preventing sexually transmitted disease, 
                        including HIV/AIDS;
                            (iv) the effectiveness of such programs in 
                        increasing contraceptive knowledge and 
                        contraceptive behaviors when sexual intercourse 
                        occurs; and
                            (v) a list of best practices based upon 
                        essential programmatic components of evaluated 
                        programs that have led to success described in 
                        clauses (i) through (iv).
                    (B) Grant condition.--A condition for the receipt 
                of a grant to a State under this section is that the 
                State cooperate with the evaluation under subparagraph 
                (A).
                    (C) Report.--The Secretary shall submit to the 
                Congress--
                            (i) not later than the end of each fiscal 
                        year during the 5-year period beginning with 
                        fiscal year 2010, an interim report on the 
                        national evaluation under subparagraph (A); and
                            (ii) not later than March 31, 2015, a final 
                        report providing the results of such national 
                        evaluation.
            (3) Individual state evaluations.--A condition for the 
        receipt of a grant under this section is that the State 
        evaluate of the programs of sex education funded through such 
        grant in accordance with the following requirements:
                    (A) The evaluation will be conducted by an 
                external, independent entity.
                    (B) The purposes of the evaluation will be the 
                determination of--
                            (i) the effectiveness of such programs in 
                        helping to delay the initiation of sexual 
                        intercourse and other high-risk behaviors;
                            (ii) the effectiveness of such programs in 
                        preventing adolescent pregnancy;
                            (iii) the effectiveness of such programs in 
                        preventing sexually transmitted disease, 
                        including HIV/AIDS; and
                            (iv) the effectiveness of such programs in 
                        increasing contraceptive and barrier method 
                        knowledge and contraceptive behaviors when 
                        sexual intercourse occurs.
    (f) Limitations on Use of Funds.--
            (1) Limitations on secretary.--Of the amounts appropriated 
        for a fiscal year for purposes of this section, the Secretary 
        may not use more than--
                    (A) 7 percent of such amounts for administrative 
                expenses related to carrying out this section for that 
                fiscal year; and
                    (B) 10 percent of such amounts for the national 
                evaluation under subsection (e)(2).
            (2) Limitations to states.--Of amounts provided to an 
        eligible State under this subsection, the State may not use 
        more than 10 percent of the grant to conduct any evaluation 
        under subsection (e)(3).
    (g) Nondiscrimination Required.--Programs funded under this section 
shall not discriminate on the basis of sex, race, ethnicity, national 
origin, disability, religion, sexual orientation, or gender identity. 
Nothing in this section shall be construed to invalidate or limit 
rights, remedies, procedures, or legal standards available to victims 
of discrimination under any other Federal law or any law of a State or 
a political subdivision of a State, including title VI of the Civil 
Rights Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the Education 
Amendments of 1972 (20 U.S.C. 1681 et seq.), section 504 of the 
Rehabilitation Act of 1973 (29 U.S.C. 794), and the Americans with 
Disabilities Act of 1990 (42 U.S.C. 12101 et seq.).
    (h) Definitions.--For purposes of this section:
            (1) The term ``age appropriate'' means, with respect to 
        topics, messages, and teaching methods, those suitable to 
        particular ages or age groups of children, adolescents, and 
        adults, based on developing cognitive, emotional, and 
        behavioral capacity typical for the age or age group.
            (2) The term ``eligible State'' means a State that submits 
        to the Secretary an application for a grant under this section 
        that is in such form, is made in such manner, and contains such 
        agreements, assurances, and information as the Secretary 
        determines to be necessary to carry out this section.
            (3) The term ``HIV/AIDS'' means the human immunodeficiency 
        virus, and includes acquired immune deficiency syndrome.
            (4) The term ``medically accurate'', with respect to 
        information, means information that is supported by research, 
        recognized as accurate and objective by leading medical, 
        psychological, psychiatric, and public health organizations and 
        agencies, and, published in journals that are peer reviewed.
            (5) The term ``State'' means the 50 States, the District of 
        Columbia, the Commonwealth of Puerto Rico, the Commonwealth of 
        the Northern Mariana Islands, American Samoa, Guam, the Virgin 
        Islands, and any other territory or possession of the United 
        States.
    (i) Authorization of Appropriations.--For the purpose of carrying 
out this section, there is authorized to be appropriated $50,000,000 
for each of the fiscal years 2010 through 2014.

SEC. 604. MOTHER'S AND FATHER'S INSURANCE BENEFITS UNDER SOCIAL 
              SECURITY FOR SAME-SEX SURVIVING PARENTS.

    (a) In General.--Section 202(g)(1) of the Social Security Act (42 
U.S.C. 402(g)(1)) is amended--
            (1) by striking ``and every surviving divorced parent (as 
        defined in section 216(d))'' and inserting ``, every surviving 
        divorced parent (as defined in section 216(d)), and every 
        surviving same-sex parent (as defined in section 216(m))''; and
            (2) in the matter before subparagraph (A), by striking ``or 
        surviving divorced parent'' and inserting ``, surviving 
        divorced parent, or surviving same-sex parent''.
    (b) Conforming Amendments.--
            (1) Section 202(g)(1) of such Act is amended--
                    (A) in subparagraph (F), by inserting ``or 
                surviving same-sex parent'' after ``surviving divorced 
                parent''; and
                    (B) in the matter following subparagraph (F)--
                            (i) by striking ``or surviving divorced 
                        parent'' and inserting ``, such surviving 
                        divorced parent, or such surviving same-sex 
                        parent'';
                            (ii) by inserting ``or a surviving same-sex 
                        parent'' after ``in the case of a surviving 
                        divorced parent''; and
                            (iii) by inserting ``or such surviving 
                        same-sex parent'' after ``adopted child of such 
                        surviving divorced parent''.
            (2) Section 202(g)(3) of such Act is amended by striking 
        ``or surviving divorced parent'' each place it appears and 
        inserting ``, surviving divorced parent, or surviving same-sex 
        parent''.
    (c) Surviving Same-sex Parent.--Section 216 of the Social Security 
Act (42 U.S.C. 416) is amended by adding at the end the following new 
subsection:

                      ``Surviving Same-sex Parent

    ``(m)(1) The term `surviving same-sex parent' means, with respect 
to a deceased individual, an individual who is of the same sex as such 
deceased individual but only if--
            ``(A) he or she is the mother or father of the individual's 
        child;
            ``(B) such individual legally adopted the deceased 
        individual's son or daughter before such son or daughter 
        attained the age of 18;
            ``(C) the deceased individual legally adopted the son or 
        daughter of such individual before such son or daughter 
        attained the age of 18; or
            ``(D) such individual and the deceased individual both 
        legally adopted a child under the age of 18.
    ``(2) Determinations under this subsection and section 202(g) shall 
be made without regard to section 7 of title 1, United States Code.''.
    (d) Special Marriage Rule for Surviving Same-sex Parents.--Section 
202(g) of the Social Security Act (42 U.S.C. 402(g)) is amended by 
adding at the end the following new paragraph:
    ``(4) For purposes of this subsection, a surviving same-sex parent 
shall be considered to be married if such parent enters into a marriage 
or similar union under the laws of a State providing for such marriage 
or similar union.''.
    (e) Effective Date.--The amendments made by this section shall 
apply with respect to benefits for months beginning one month after the 
date of the enactment of this Act, based on applications filed on or 
after such date.

SEC. 605. PROHIBITION AGAINST DISCRIMINATION ON THE BASIS OF SEXUAL 
              ORIENTATION OR GENDER IDENTITY UNDER THE HEALTH BENEFITS 
              PROGRAM FOR FEDERAL EMPLOYEES.

    (a) In General.--Section 8902(f) of title 5, United States Code, is 
amended by inserting ``sexual orientation, gender identity,'' after 
``sex,''.
    (b) Regulations.--Section 8913 of such title is amended--
            (1) by redesignating subsection (d) as subsection (e); and
            (2) by inserting after subsection (c) the following:
    ``(d) The regulations of the Office shall ensure that qualified 
carriers do not discriminate on the basis of sex, sexual orientation, 
gender identity, or any other basis which is prohibited by law.''.

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.

    (a) Prohibition Against Discrimination in Administration of Medical 
and Dental Care for Certain Members of the Armed Forces.--
            (1) In general.--Chapter 55 of title 10, United States 
        Code, is amended by inserting after section 1074l the following 
        new section:
``Sec. 1074m. Prohibition against discrimination on the basis of sex, 
              gender identity, or sexual orientation
    ``(a) In General.--The Secretary of Defense may not discriminate 
against a former member of the uniformed services entitled to medical 
care under section 1074 or 1074a of this title on the basis of sex, 
gender identity, or sexual orientation.
    ``(b) Regulations.--The Secretary of Defense, in consultation with 
the other administering Secretaries, shall prescribe regulations to 
carry out this section.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of such chapter is amended by inserting after the 
        item relating to section 1074l the following new item:

``1074m. Prohibition against discrimination on the basis of sex, gender 
                            identity, or sexual orientation.''.
    (b) Prohibition Against Discrimination in Personal Service 
Contracts Related to Medical Care for Members of the Armed Forces.--
Paragraph (1) of section 1091(c) of title 10, United States Code, is 
amended--
            (1) in subparagraph (A), by striking ``and'';
            (2) in subparagraph (B), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
            ``(C) that an individual who enters into a personal 
        services contract under subsection (a) shall not discriminate 
        on the basis of sex, gender identity, or sexual orientation.''.
    (c) Prohibition Against Discrimination in Administration of 
Veterans' Benefits.--
            (1) In general.--Subchapter II of chapter 5 of title 38, 
        United States Code, is amended by adding at the end the 
        following new section:
``Sec. 533. Prohibition against discrimination on the basis of sex, 
              gender identity, or sexual orientation
    ``In carrying out this title, the Secretary of Veterans Affairs may 
not discriminate on the basis of sex, gender identity, or sexual 
orientation and shall ensure that no person is discriminated against on 
such basis in connection with the administration of this title or the 
payment of any benefit or claim or provision of any service under this 
title.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of such chapter is amended by inserting after the 
        item relating to section 532 the following new item:

``533. Prohibition against discrimination on the basis of sex, gender 
                            identity, or sexual orientation.''.
    (d) Prohibition Against Discrimination in Payment of Veterans' 
Benefits.--
            (1) In general.--Chapter 53 of title 38, United States 
        Code, is amended by adding at the end the following new 
        section:
``Sec. 5320. Prohibition against discrimination on the basis of sex, 
              gender, identity, or sexual orientation in the provision 
              and administration of benefits
    ``The Secretary of Veterans Affairs shall ensure that no person is 
discriminated against on the basis of sex, gender identity, or sexual 
orientation in the entitlement to, administration of, or payment of 
benefits under this title.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of such chapter is amended by inserting after the 
        item relating to section 5319 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.''.
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