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 evalua-
tion 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, includ-
ing 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 qual-
ity of health care and the health status of sexual 
and gender minority individuals and populations; 
VerDate Nov 24 2008 
23:57 Jun 25, 2009
Jkt 079200
PO 00000
Frm 00060
Fmt 6652
Sfmt 6201
E:\BILLS\H3001.IH
H3001
bajohnson on PROD1PC77 with BILLS
‘‘(3) health care providers’ and health adminis-
trators’ 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 im-
proving the quality of care; 
‘‘(5) the cost-effectiveness of providing com-
petency access services; and 
‘‘(6) optimal approaches for delivering com-
petency 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 defini-
tions 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. 
VerDate Nov 24 2008 
23:57 Jun 25, 2009
Jkt 079200
PO 00000
Frm 00061
Fmt 6652
Sfmt 6201
E:\BILLS\H3001.IH
H3001
bajohnson on PROD1PC77 with BILLS
SEC. 203. FEDERAL REIMBURSEMENT FOR CULTURALLY 
COMPETENT SERVICES UNDER THE MEDI-
CARE, 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 reim-
bursement 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 organiza-
tions; 
(C) hospitals; and 
(D) community-based clinics. 
(3) DURATION.—The demonstration shall be 
conducted for a period not longer than 2 years. 
VerDate Nov 24 2008 
23:57 Jun 25, 2009
Jkt 079200
PO 00000
Frm 00062
Fmt 6652
Sfmt 6201
E:\BILLS\H3001.IH
H3001
bajohnson on PROD1PC77 with BILLS
(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 addi-
tional 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 enti-
ties 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 
VerDate Nov 24 2008 
23:57 Jun 25, 2009
Jkt 079200
PO 00000
Frm 00063
Fmt 6652
Sfmt 6201
E:\BILLS\H3001.IH
H3001
bajohnson on PROD1PC77 with BILLS
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 sec-
tion 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 pursu-
ant 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 Se-
curity Act (42 U.S.C. 1397ee(c)(2)(A)) is amended by in-
serting 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’’. 
VerDate Nov 24 2008 
23:57 Jun 25, 2009
Jkt 079200
PO 00000
Frm 00064
Fmt 6652
Sfmt 6201
E:\BILLS\H3001.IH
H3001
bajohnson on PROD1PC77 with BILLS