month of his entitlement or status as a 
qualified railroad retirement beneficiary 
described in paragraph (2), and’’ and in-
serting ‘‘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; 
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‘‘(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 Secu-
rity Act (42 U.S.C. 426) is repealed.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.—Sec-
tion 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 
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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 enti-
tled for 24 calendar months, and’’ and in-
serting ‘‘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 Se-
curity 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 CONDI-
TIONS.— 
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(1) STUDY.—The Secretary shall request that 
the Institute of Medicine of the National Academy 
of Sciences conduct a study on the range of dis-
ability 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 con-
taining 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 AS-
SISTANCE PROGRAMS IN PROVIDING PRE-
SCRIPTION DRUGS TOWARD THE ANNUAL 
OUT-OF-POCKET THRESHOLD UNDER MEDI-
CARE 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; 
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(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 in-
curred 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 Pharma-
ceutical Assistance Program; or 
‘‘(III) under an AIDS Drug As-
sistance Program under part B of 
title XXVI of the Public Health Serv-
ice Act.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to costs incurred on or after 
January 1, 2010. 
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SEC. 115. NONDISCRIMINATION BASED ON GENDER IDEN-
TITY 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 para-
graph (72); 
(B) striking the period at the end of para-
graph (73)(B) and inserting ‘‘; and’’; 
(C) inserting after paragraph (73) the fol-
lowing new paragraph: 
‘‘(74) provide that the State shall not discrimi-
nate against any person on the basis of sexual ori-
entation or gender identity.’’; and 
(D) adding at the end the following undes-
ignated paragraph: 
‘‘For the purposes of paragraph (74) ‘sexual 
orientation’ 
shall 
mean 
homosexuality, 
hetero-
sexuality, or bisexuality. ‘Gender identity’ shall mean 
the gender-related identity, appearance, or manner-
isms, or other gender-related characteristics of an 
individual, with or without regard to the individual’s 
designated sex at birth.’’. 
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(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 ori-
entation or gender identity as defined in such sec-
tion; and 
‘‘(2) there may be imposed no deduction, cost 
sharing, or similar charge on the basis of sexual ori-
entation or gender identity as defined in such sec-
tion.’’. 
(b) STATE CHILDREN’S HEALTH INSURANCE PRO-
GRAM.—Section 2102 of the Social Security Act is amend-
ed 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 de-
fined in section 1902.’’. 
(c) MEDICARE.—Title XVIII of the Social Security 
Act is amended by— 
(1) adding at the end the following: 
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‘‘SEC. 1899. NONDISCRIMINATION BASED ON GENDER IDEN-
TITY 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, gen-
der 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 iden-
tity, 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 com-
petitive 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 activi-
ties, health promotion and disease prevention activities, 
and health literacy education and services. 
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(b) ELIGIBILITY.—In this section: 
(1) ELIGIBLE ENTITY.—The term ‘‘eligible enti-
ty’’ 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 In-
dian 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. 
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(3) 
COMMUNITY-BASED
CONSORTIUM.—The 
term ‘‘community-based consortium’’ means a part-
nership that— 
(A) includes— 
(i) individuals who are representatives 
of organizations of sexual and gender mi-
norities; 
(ii) community leaders and leaders of 
community-based organizations; 
(iii) health care providers, including 
providers who treat sexual and gender mi-
norities; 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 signifi-
cant 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— 
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(A) primary care and preventive health, in-
cluding health education and promotion; 
(B) behavioral and mental health and sub-
stance 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 preva-
lent among sexual or gender minority populations, 
including— 
(A) HIV in high-risk subpopulations, in-
cluding— 
(i) transgender populations; 
(ii) sex workers; and 
(iii) people of color; 
(B) cancers; 
(C) school violence; 
(D) emerging drugs; and 
(E) suicide prevention; 
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(4) educate, guide, and provide experiential 
learning opportunities to sexual and gender minori-
ties 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 commu-
nity; or 
(6) educate and refer sexual and gender minori-
ties to appropriate health care agencies and commu-
nity-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. 
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(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 resi-
dents. 
(D) Recommendations for improving the 
health and health care of sexual and gender mi-
norities. 
(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 im-
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prove the mental health of sexual and gender minorities 
through improved access to health care, primary preven-
tion activities, health promotion and prevention activities, 
and education and services. 
(b) ELIGIBILITY.—In this section: 
(1) ELIGIBLE ENTITY.—The term ‘‘eligible enti-
ty’’ 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 In-
dian 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; 
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(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 part-
nership that— 
(A) includes— 
(i) individuals who are representatives 
of organizations of sexual or gender mi-
norities; 
(ii) community leaders and leaders of 
community-based organizations; 
(iii) mental health care providers, in-
cluding providers who treat sexual or gen-
der 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 signifi-
cant population of sexual or gender minorities. 
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(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 be-
havioral 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 popu-
lations; 
(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, bi-
sexual, and transgender youth; 
(5) educate and provide guidance regarding ef-
fective strategies to promote positive health behav-
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iors within the community, including the promotion 
of resiliency and wellness strategies; 
(6) educate and refer sexual and gender minori-
ties to appropriate agencies and community-based 
programs and organizations in order to increase ac-
cess to high-quality mental health services, including 
preventive mental health services; or 
(7) provide mental health counseling and edu-
cation for families to promote acceptance of lesbian, 
gay, bisexual, and transgender youth, which may in-
clude the creation and distribution of support-fo-
cused 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; 
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(ii) the cost of such programs; and 
(iii) the impact of the programs on 
the health outcomes of the community resi-
dents. 
(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 Pre-
vention and other Federal officials determined appropriate 
by the Secretary, may award grants to State or local gov-
ernments, 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 ac-
cess to health care through expanded health insurance. 
(b) APPLICATION.—An eligible entity seeking a grant 
under this section shall submit an application to the Sec-
retary at such time, in such manner, and containing such 
information as the Secretary may require, including assur-
ances that the eligible entity will— 
(1) target individuals who are members of sex-
ual or gender minority groups that experience health 
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disparities through specific outreach activities fund-
ed through the grant; 
(2) collaborate with appropriate community or-
ganizations and include meaningful community par-
ticipation in planning, implementation, and evalua-
tion of activities; 
(3) demonstrate capacity to enroll individuals 
currently without health coverage into public or pri-
vate health insurance plans that meet their treat-
ment 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 minori-
ties; 
(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; 
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(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 per-
formance 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 hos-
pitals 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; 
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(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 sub-
stantial 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 de-
termined by the Secretary; 
(C) serve a disproportionate percentage of 
patients who are sexual or gender minorities; 
and 
(D) provide an assurance that amounts re-
ceived under the grant or contract will be used 
to support quality improvement activities for 
patients from sexual and gender minority 
groups. 
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(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 sex-
ual and gender minority populations into title 
XIX of the Social Security Act; and 
(B) assessing eligibility for domestic part-
ner 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 dis-
parities 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 re-
sults of the evaluation conducted under paragraph 
(1). 
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(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 Sec-
retary shall submit a report to the Congress com-
plying the results of evaluations under such sub-
section 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 re-
port under paragraph (1) and the information con-
tained 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 
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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 gen-
der identity and expression that affect the amount 
and kind of treatment received or that act as a bar-
rier to an individual receiving timely and high-qual-
ity 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 COM-
PETENT 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 
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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 edu-
cation and training in culturally competent service 
delivery for sexual or gender minority patients; 
‘‘(3) develop and implement clear goals, poli-
cies, operational plans, and management account-
ability and oversight mechanisms to provide cul-
turally competent services for sexual and gender mi-
nority 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 pro-
grams, patient satisfaction assessments, and out-
comes-based evaluations of the organization; 
‘‘(5) ensure that, consistent with the privacy 
protections provided for under the regulations pro-
mulgated under section 264(c) of the Health Insur-
ance Portability and Accountability Act of 1996, 
data on the individual patient’s sexual orientation 
and gender identity are collected in health records, 
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integrated into the organization’s management infor-
mation 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 im-
plement services that respond to the cultural charac-
teristics of the service area of the organization; 
‘‘(7) develop participatory, collaborative part-
nerships with communities and utilize a variety of 
formal and informal mechanisms to facilitate com-
munity and patient involvement in designing and im-
plementing culturally competent services-related ac-
tivities for sexual and gender minority patients; 
‘‘(8) ensure that conflict and grievance resolu-
tion processes are culturally sensitive and capable of 
identifying, preventing, and resolving cross-cultural 
conflicts or complaints by sexual and gender minor-
ity patients; 
‘‘(9) regularly make available to the public in-
formation about their progress and successful inno-
vations in implementing the standards under this 
section and provide public notice in their commu-
nities about the availability of this information; and 
‘‘(10) if requested, regularly make available to 
the head of each Federal entity from which Federal 
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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 re-
siding 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 com-
petence in different types of health care organiza-
tions, including regional collaborations among health 
care organizations; and 
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‘‘(5) resources for cultural competence informa-
tion 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, terri-
tory, community-based or other nonprofit organiza-
tion, health center or community clinic, hospital, 
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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 ac-
companied by such additional information as the 
Secretary may require. 
‘‘(c) USE OF FUNDS.—An entity shall use funds re-
ceived under a grant under this section to— 
‘‘(1) develop formal training programs for indi-
viduals interested in becoming dedicated culturally 
competent health care providers for sexual and gen-
der minorities; 
‘‘(2) develop formal training programs for indi-
viduals interested in becoming dedicated culturally 
competent health care providers for sexual and gen-
der minority youth and their families; 
‘‘(3) develop training programs for individuals 
interested in becoming dedicated culturally com-
petent 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 sec-
tion, the Secretary shall give priority to entities that have 
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