1.This Act may be cited as the
Ending LGBT Health Disparities
Act
.
2.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.
3.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.
4.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.
<enum>I</enum><header>Health Access and
Promotion</header>
<subtitle id="H9746EC978AE04EC8984A3C1C1D91AEF7"><enum>A</enum><header>Private health
insurance</header>
<section display-inline="no-display-inline" id="H59EC1EFF185D4A6AB6911788DB10DAA4" section-type="subsequent-section"><enum>101.</enum><header>Tax Equity for
Health Plan Beneficiaries Act</header>
<subsection display-inline="no-display-inline" id="H76821952E3564C13A2754C17E9CD88A8"><enum>(a)</enum><header>Application of
accident and health plans to eligible beneficiaries</header>
<paragraph display-inline="no-display-inline" id="HCC75E370ACD0489D00D400388F288EE"><enum>(1)</enum><header>Exclusion of
contributions</header><text>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:</text>
<quoted-block id="H5D90933543244608BDE31DA1F2EA00DF" style="OLC">
<subsection id="HA47F067536A346EF85E11CB31C21B5F7"><enum>(f)</enum><header>Coverage
provided for eligible beneficiaries of employees</header>
<paragraph id="H51B25A7E149F44F09DD66F83860061"><enum>(1)</enum><header>In
general</header><text>Subsection (a) shall apply with respect to an eligible
beneficiary and any qualifying child who is a dependent of the eligible
beneficiary.</text>
</paragraph><paragraph id="HD17C4D8895084E8285B6C6E150D14C5F"><enum>(2)</enum><header>Qualifying
child; dependent</header><text>For purposes of this subsection—</text>
<subparagraph id="H6EC3C11B170145DA00B22D647535834B"><enum>(A)</enum><header>Qualifying
child</header><text>The term <term>qualifying child</term> has the meaning
given such term by section 152(c).</text>
</subparagraph><subparagraph id="H2F035430C17A472EB08BB6FEFA84A98C"><enum>(B)</enum><header>Dependent</header><text display-inline="yes-display-inline">The term <term>dependent</term> has the
meaning given such term by section
105(b).</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H0BBB505EACB94F7C985268004BE839BC"><enum>(2)</enum><header>Exclusion of
amounts expended for medical care</header><text>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: <quote>and eligible beneficiary
and the qualifying children of the eligible beneficiary (within the meaning of
section 106(f)) with respect to the taxpayer</quote>.</text>
</paragraph><paragraph id="H28F8F4B376B64ACE92D5696741375243"><enum>(3)</enum><header>Payroll
taxes</header>
<subparagraph id="H4C94C75B078A434291F573C045ED560"><enum>(A)</enum><text>Section 3121(a)(2)
of such Code is amended—</text>
<clause id="H2D630AC581B546A9AC19C78B2F24477E"><enum>(i)</enum><text>by
inserting <quote>, or his eligible beneficiary or any qualifying children of
the eligible beneficiary,</quote> after <quote>his dependents</quote> both
places it appears,</text>
</clause><clause id="H52B38148C97147D39C583E8350DDA1FD"><enum>(ii)</enum><text display-inline="yes-display-inline">by inserting <quote>, and eligible
beneficiaries and qualifying children of eligible beneficiaries (within the
meaning of section 106(f)),</quote> after <quote>their dependents</quote> the
first place it appears, and</text>
</clause><clause id="H861819F6B51245F290066EBB05496E8E"><enum>(iii)</enum><text display-inline="yes-display-inline">by inserting <quote>, eligible
beneficiaries, and qualifying children of eligible beneficiaries</quote> after
<quote>their dependents</quote> the second place it appears.</text>
</clause></subparagraph><subparagraph id="HFFDAE8E6FD844148008B00A273BE8D3B"><enum>(B)</enum><text>Section 3231(e)(1)
of such Code is amended—</text>
<clause id="H315D2B89F2094FEC9672C69F3064D22"><enum>(i)</enum><text>by
inserting <quote>, or his eligible beneficiary or any qualifying children of
his eligible beneficiary,</quote> after <quote>his dependents</quote>,</text>
</clause><clause id="H3DE6A63A90BE42CC8500E555E7FA99DD"><enum>(ii)</enum><text display-inline="yes-display-inline">by inserting <quote>, and eligible
beneficiaries and qualifying children of eligible beneficiaries (within the
meaning of section 106(f)),</quote> after <quote>their dependents</quote> the
first place it appears, and</text>
</clause><clause id="HB9CE9E1B3D0949D49C8D3F360814CCE2"><enum>(iii)</enum><text display-inline="yes-display-inline">by inserting <quote>, eligible
beneficiaries, and qualifying children of eligible beneficiaries</quote> after
<quote>their dependents</quote> the second place it appears.</text>
</clause></subparagraph><subparagraph id="H308E3EF6B8D14512AD03757EDCFF097E"><enum>(C)</enum><text>Section 3306(b)(2)
of such Code is amended—</text>
<clause id="HFB79EFE2642245DEBDB9B2224C001FDA"><enum>(i)</enum><text>by
inserting <quote>, or his eligible beneficiary or any qualifying children of
his eligible beneficiary,</quote> after <quote>his dependents</quote> both
places it appears,</text>
</clause><clause id="H8A7F6F5F7D2C493B9096AAD0FE1804A3"><enum>(ii)</enum><text display-inline="yes-display-inline">by inserting <quote>, and eligible
beneficiaries and qualifying children of eligible beneficiaries (within the
meaning of section 106(f)),</quote> after <quote>their dependents</quote> the
first place it appears, and</text>
</clause><clause id="H1DCCBD94AEDE435E93431CDDB24BBA00"><enum>(iii)</enum><text display-inline="yes-display-inline">by inserting <quote>, eligible
beneficiaries, and qualifying children of eligible beneficiaries</quote> after
<quote>their dependents</quote> the second place it appears.</text>
</clause></subparagraph><subparagraph id="H7F9872E684D942E09F860266016BF348"><enum>(D)</enum><text>Section 3401(a) of
such Code is amended by striking <quote>or</quote> at the end of paragraph
(21), by striking the period at the end of paragraph (22) and inserting
<quote>; or</quote>, and by inserting after paragraph (22) the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HBA3037AF218D49DE8491621DE76BA3CD" style="OLC">
<paragraph id="H346035222ACC4960B900587EE0C08C7D"><enum>(23)</enum><text display-inline="yes-display-inline">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);</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="HF1A90C79C8C14DD7A68C148BE3E11750"><enum>(4)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to taxable
years beginning after December 31, 2009.</text>
</paragraph></subsection><subsection id="H669652E89A0E43698DC2AC68BFFF3019"><enum>(b)</enum><header>Expansion of
dependency for purposes of deduction for health insurance costs of
self-employed individuals</header>
<paragraph id="HB24D71F8CDB545A99B9E41E0A7539378"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">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:</text>
<quoted-block display-inline="no-display-inline" id="H2B3FD14B8CD042E5AD96E53449F028E" style="OLC">
<paragraph id="HD0CE505E6CAA483B001E558EA0A83FF5"><enum>(6)</enum><header>Dependents</header><text display-inline="yes-display-inline">For purposes of this subsection, the term
<term>dependents</term> shall include the following with respect to the
taxpayer—</text>
<subparagraph id="H6550302E041B4791B1D5B19A828AFE"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph id="H102A7B5474124258ABFB661426F87500"><enum>(B)</enum><text>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).</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HAC959120ACB5423EA857215E61152082"><enum>(2)</enum><header>Conforming
amendment</header><text display-inline="yes-display-inline">Subparagraph (B) of
section 162(l)(2) of such Code is amended by inserting <quote>or dependent (as
defined in paragraph (1))</quote> after <quote>spouse</quote>.</text>
</paragraph><paragraph id="H7850D0043AB94CCBBFFA5C832E21CB59"><enum>(3)</enum><header>Effective
date</header><text display-inline="yes-display-inline">The amendments made by
this section shall apply to taxable years beginning after December 31,
2009.</text>
</paragraph></subsection><subsection id="H967F5720F8724387B9ABA94BC177963C"><enum>(c)</enum><header>Extension to
eligible beneficiaries of sick and accident benefits provided to members of a
voluntary employees’ beneficiary association and their dependents</header>
<paragraph id="H6EA4018A40DF43889300AA13C7528200"><enum>(1)</enum><header>In
general</header><text>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: <quote>For purposes of providing for the payment of
sick and accident benefits to members of such an association and their
dependents, the term <term>dependents</term> 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.</quote>.</text>
</paragraph><paragraph id="H481E84A1B9B04D58AB73D11EB65F7D92"><enum>(2)</enum><header>Effective
date</header><text>The amendment made by this section shall apply to taxable
years beginning after December 31, 2009.</text>
</paragraph></subsection><subsection id="HE7CC24CC5CE441B79666EB73B7B4EAB1"><enum>(d)</enum><header>Flexible
spending arrangements and health reimbursement arrangements</header><text>The
Secretary of Treasury shall issue guidance of general applicability providing
that medical expenses that otherwise qualify—</text>
<paragraph id="H745938CD1F83451989CEEE44148D29E0"><enum>(1)</enum><text display-inline="yes-display-inline">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</text>
</paragraph><paragraph id="H9031D1A90F744563A5F0ACEEF0ACCC32"><enum>(2)</enum><text display-inline="yes-display-inline">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.</text>
</paragraph></subsection></section><section display-inline="no-display-inline" id="HBA1FFDA85E5C4D678C7F1FE89DA1285A" section-type="subsequent-section"><enum>102.</enum><header>Preexisting
condition exclusion patient protection</header>
<subsection display-inline="no-display-inline" id="HFFDC1E9E10A142C893572E4825E95D29"><enum>(a)</enum><header>Amendments
relating to preexisting condition exclusions under group health plans</header>
<paragraph id="HD54E4C99BDF1410FA18FFDD034153CFE"><enum>(1)</enum><header>Amendments to
the Employee Retirement Income Security Act of 1974</header>
<subparagraph id="H5DBD0BC751ED4F0F8D6B06BADECBA457"><enum>(A)</enum><header>Reduction in
look-back period</header><text>Section 701(a)(1) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1181(a)(1)) is amended by striking
<quote>6-month period</quote> and inserting <quote>30-day
period</quote>.</text>
</subparagraph><subparagraph id="HB86C27F5C2444C36A05BF760E8BBA108"><enum>(B)</enum><header>Reduction in
permitted preexisting condition limitation period</header><text>Section
701(a)(2) of such Act (29 U.S.C. 1181(a)(2)) is amended by striking <quote>12
months</quote> and inserting <quote>3 months</quote>, and by striking <quote>18
months</quote> and inserting <quote>9 months</quote>.</text>
</subparagraph></paragraph><paragraph id="H5D350C121ADF48CB90F1B5469EC0E61B"><enum>(2)</enum><header>Amendments to
the Public Health Service Act</header>
<subparagraph id="H863AE8207BB244D3A35EFF763E5DD818"><enum>(A)</enum><header>Reduction in
look-back period</header><text>Section 2701(a)(1) of the Public Health Service
Act (42 U.S.C. 300gg(a)(1)) is amended by striking <quote>6-month
period</quote> and inserting <quote>30-day period</quote>.</text>
</subparagraph><subparagraph id="HD6CD6C68EBDF469FBD6D5834BC9AE247"><enum>(B)</enum><header>Reduction in
permitted preexisting condition limitation period</header><text>Section
2701(a)(2) of such Act (42 U.S.C. 300gg(a)(2)) is amended by striking <quote>12
months</quote> and inserting <quote>3 months</quote>, and by striking <quote>18
months</quote> and inserting <quote>9 months</quote>.</text>
</subparagraph></paragraph><paragraph id="H573E5477862141A8A76B5E794786D08A"><enum>(3)</enum><header>Amendments to
the Internal Revenue Code of 1986</header>
<subparagraph id="H34C17DABD1B04766B2FF2AC07A3C1F67"><enum>(A)</enum><header>Reduction in
look-back period</header><text display-inline="yes-display-inline">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 <quote>6-month period</quote> and
inserting <quote>30-day period</quote>.</text>
</subparagraph><subparagraph id="HE577A32C52794A219B291B8E111BF8B4"><enum>(B)</enum><header>Reduction in
permitted preexisting condition limitation period</header><text>Paragraph (2)
of section 9801(a) of such Code is amended by striking <quote>12 months</quote>
and inserting <quote>3 months</quote>, and by striking <quote>18 months</quote>
and inserting <quote>9 months</quote>.</text>
</subparagraph></paragraph><paragraph id="H86CFA133E7D4438ABE82EE0C5C50CC11"><enum>(4)</enum><header>Effective
date</header>
<subparagraph id="HF1A27CFBD0F94FD5ACD1D75443FCE447"><enum>(A)</enum><header>In
general</header><text>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.</text>
</subparagraph><subparagraph id="HA1B3E06C7754449082B8EDEC6FABE4FF"><enum>(B)</enum><header>Special rule for
collective bargaining agreements</header><text>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—</text>
<clause id="H5F1CE1C991E84C528BC3455DA7E6032A"><enum>(i)</enum><text>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</text>
</clause><clause commented="no" id="H6CB9B2F203044E8992B42E7258025905"><enum>(ii)</enum><text>3 years after the
date of the enactment of this Act.</text>
</clause><continuation-text continuation-text-level="subparagraph">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.</continuation-text></subparagraph></paragraph></subsection><subsection id="H1E3B8EDAECC348898BB7763DDF4CB911"><enum>(b)</enum><header>Amendments
relating to preexisting condition exclusions in health insurance coverage in
the individual market</header>
<paragraph id="H0320B5CE9CA74CDE81DFF5D5B288E271"><enum>(1)</enum><header>Applicability of
group health insurance limitations on imposition of preexisting condition
exclusions</header>
<subparagraph id="HFD3863377FDE448EAFDA7BC7593BEEE2"><enum>(A)</enum><header>In
general</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H9756BCF8983D47DDA0CA8E414B584742" style="OLC">
<section id="HCAD827CE056F4096A6AAF4DD3F1DF4A7"><enum>2741A.</enum><header>Application
of group health insurance limitations on imposition of preexisting condition
exclusions</header>
<subsection id="HD47F5B1936604180B2C6B0695828BE55"><enum>(a)</enum><header>In
general</header><text>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.</text>
</subsection><subsection id="HC59AF4C00FA0480397B660BC0D389EFE"><enum>(b)</enum><header>Limitation</header><text>In
the case of an individual who—</text>
<paragraph id="HCA804FC0A6C945EAA0DA3BE6A2DFAE8B"><enum>(1)</enum><text>is enrolled in
individual health insurance coverage;</text>
</paragraph><paragraph id="HC24BB69311514C748FF360BCCCCDB3A1"><enum>(2)</enum><text>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</text>
</paragraph><paragraph id="H18E58C8B4E6941CCB74B835D50169CC2"><enum>(3)</enum><text>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,</text>
</paragraph><continuation-text continuation-text-level="subsection">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.</continuation-text></subsection></section><section id="HACAB76443E42463C83A384E77D4A2726"><enum>2741B.</enum><header>Eligibility
to enroll</header>
<subsection id="HED17BAE55CDC4B81BF66949B1A6ABF20"><enum>(a)</enum><header>In
general</header><text>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:</text>
<paragraph id="H4F6D7ADF53E043A79A2A2DF06517BD89"><enum>(1)</enum><text>Health
status.</text>
</paragraph><paragraph id="H90AA250CB8AE4AD697A85D0FC86FC3FB"><enum>(2)</enum><text>Medical condition
(including both physical and mental illnesses).</text>
</paragraph><paragraph id="HCCB5B989AB874805AD94BF3F8874E1EC"><enum>(3)</enum><text>Claims
experience.</text>
</paragraph><paragraph id="HF1DC205585174D469E3D87521DDF1683"><enum>(4)</enum><text>Receipt of health
care.</text>
</paragraph><paragraph id="H372CE47DF6E94EA6B36A62F615C032B0"><enum>(5)</enum><text>Medical
history.</text>
</paragraph><paragraph id="HE80E298BFD194CC986FFFE640871B011"><enum>(6)</enum><text>Genetic
information.</text>
</paragraph><paragraph id="H21590A459692444FAE53D4320D4D0427"><enum>(7)</enum><text>Evidence of
insurability (including conditions arising out of acts of domestic
violence).</text>
</paragraph><paragraph id="H72786E7D245845CFBA639B6A0F50E36F"><enum>(8)</enum><text>Disability.</text>
</paragraph></subsection><subsection id="HF23C2E38836C43309A7BBBF932C96ECE"><enum>(b)</enum><header>No application
to benefits or exclusions</header><text>To the extent consistent with section
2701, subsection (a) shall not be construed—</text>
<paragraph id="H68B4EA5A21F8444499694E1E748E5939"><enum>(1)</enum><text>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</text>
</paragraph><paragraph id="H361E5DB5A4F94979A45308CB94184013"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection id="HCCAF3F97DA3D44D3BD995DC86F70A5C6"><enum>(c)</enum><header>Rules for
eligibility</header><text>In subsection (a), the term <term>rules for
eligibility</term>, with respect to enrollment under the terms of a plan,
includes any rule defining any applicable waiting period for such
enrollment.</text>
</subsection><subsection id="HF83D39EBE3744ACA9CB1A0E4DB586983"><enum>(d)</enum><header>In premium
contributions</header>
<paragraph id="H0BBBD484E34144CE945EBF2446DC5525"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph id="H55787301712B429CA9C7AFAD7DB93A6D"><enum>(2)</enum><header>Construction</header><text>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.</text>
</paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="H10491A6870B34FE4997E870757BAE558"><enum>(B)</enum><header>Elimination of
COBRA requirement</header><text display-inline="yes-display-inline">Subsection
(b) of section 2741 of the Public Health Service Act (42 U.S.C. 300gg–41) is
amended—</text>
<clause id="H21F9D881A53B405BAC6CB9D76D0E0725"><enum>(i)</enum><text>by
adding <quote>and</quote> at the end of paragraph (2);</text>
</clause><clause id="HB82E3649572F4889A75F6AF0598F6FC6"><enum>(ii)</enum><text>by
striking the semicolon at the end of paragraph (3) and inserting a period;
and</text>
</clause><clause id="HA74FB4E686F84DAABE6FED338036FD1E"><enum>(iii)</enum><text>by
striking paragraphs (4) and (5).</text>
</clause></subparagraph></paragraph><paragraph id="HAD48154047B1410AA24EF2B8451CEC8F"><enum>(2)</enum><header>Effective
date</header><text>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.</text>
</paragraph></subsection></section><section id="HE885B7EBEF0D44DDA87FE6ADACE5D9C6" section-type="subsequent-section"><enum>103.</enum><header>Domestic Partnership
Benefits and Obligations Act</header>
<subsection id="HAEAFA7846DD044B2B44BCDCEA83EFCA1"><enum>(a)</enum><header>Benefits to
domestic partners of Federal employees</header>
<paragraph id="HF1E2BDD19AB6471DB7808477832483A5"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph id="H7EAA1A314C4A423A9476FCC396D3270B"><enum>(2)</enum><header>Certification of
eligibility</header><text>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—</text>
<subparagraph id="H9000946619DD405585322E6978DD5393"><enum>(A)</enum><text>are each other’s
sole domestic partner and intend to remain so indefinitely;</text>
</subparagraph><subparagraph id="H47C34EDC61DB4ACF968CBCED1B4B3AD7"><enum>(B)</enum><text>have a common
residence, and intend to continue the arrangement;</text>
</subparagraph><subparagraph id="H391B788D395A49CB97A1D49D32E97FAA"><enum>(C)</enum><text>are at least 18
years of age and mentally competent to consent to contract;</text>
</subparagraph><subparagraph id="H809A8DAE6D384B7E84F5DF7DE5B75184"><enum>(D)</enum><text>share
responsibility for a significant measure of each other’s common welfare and
financial obligations;</text>
</subparagraph><subparagraph id="H551A0A93456A4018B4DA0FB548851A38"><enum>(E)</enum><text>are not married to
or domestic partners with anyone else;</text>
</subparagraph><subparagraph id="HE3832EA282654E36B711D040E0730449"><enum>(F)</enum><text>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</text>
</subparagraph><subparagraph id="H7776F2B32DF84BCEA0485766394C0CB8"><enum>(G)</enum><text>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.</text>
</subparagraph></paragraph><paragraph id="HBE33E950A0C2456480D27A4A960AE827"><enum>(3)</enum><header>Dissolution of
partnership</header>
<subparagraph id="HF941B3A12AB84FA4B61B03166D692534"><enum>(A)</enum><header>In
general</header><text>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.</text>
</subparagraph><subparagraph id="H5F32E62735FB49938349984E6870DDDA"><enum>(B)</enum><header>Death of
employee</header><text>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.</text>
</subparagraph><subparagraph id="H6D3FF03D47CC4DF9ACA1479958269122"><enum>(C)</enum><header>Other
dissolution of partnership</header>
<clause id="H8AABB6664253457183BB86F980FDA534"><enum>(i)</enum><header>In
general</header><text>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.</text>
</clause><clause id="H8AE3BA949F354614864C26604F67ECA3"><enum>(ii)</enum><header>Exception</header><text>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.</text>
</clause></subparagraph></paragraph><paragraph id="H5E70EAC55A8C46E688B0E5B8A020F494"><enum>(4)</enum><header>Stepchildren</header><text>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.</text>
</paragraph><paragraph id="HD98477A0347D45D1A92E150DCA10E479"><enum>(5)</enum><header>Confidentiality</header><text>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).</text>
</paragraph><paragraph id="H7291F0D3333A43E09AFB67A35A60F492"><enum>(6)</enum><header>Regulations and
orders</header>
<subparagraph id="HF843D98535E94374A99A8F3CF6FA0D96"><enum>(A)</enum><header>Office of
personnel management</header><text>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).</text>
</subparagraph><subparagraph id="HE193665295684461A1CEC78B0F1795E8"><enum>(B)</enum><header>Other executive
branch regulations</header><text>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.</text>
</subparagraph><subparagraph id="H67693AD055144473B4D9BDB880E937B1"><enum>(C)</enum><header>Other
regulations and orders</header><text>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.</text>
</subparagraph><subparagraph id="HCA997AE7EFFE45ADAE0E3613729D1645"><enum>(D)</enum><header>Procedure</header><text>Regulations
and orders required under this paragraph shall be promulgated after notice to
interested persons and an opportunity for comment.</text>
</subparagraph></paragraph><paragraph id="HA97E082B940C462782BE79F00EC1C76E"><enum>(7)</enum><header>Definitions</header><text>In
this section:</text>
<subparagraph id="HDC9092B013764B1EB25100CEA1477FAD"><enum>(A)</enum><header>Benefits</header><text>The
term <term>benefits</term> means—</text>
<clause id="H3DAF2056EC534EFCB56717E31AB2EA1C"><enum>(i)</enum><text>health insurance
and enhanced dental and vision benefits, as provided under chapters 89, 89A,
and 89B of title 5, United States Code;</text>
</clause><clause id="H9719DF45474E4256A0D3F21B24E6DE99"><enum>(ii)</enum><text>retirement and
disability benefits and plans, as provided under—</text>
<subclause id="H829DA209ACCC43C3A29F4B89C8AB39BC"><enum>(I)</enum><text>chapters 83 and 84
of title 5, United States Code;</text>
</subclause><subclause id="H44151019700A4EF4A8D6E811C2901EE9"><enum>(II)</enum><text>chapter 8 of the
Foreign Service Act of 1980 (22 U.S.C. 4041 et seq.); and</text>
</subclause><subclause id="H60D71D6D0FFA4A34BECEB3E102888015"><enum>(III)</enum><text>the Central
Intelligence Agency Retirement Act of 1964 for Certain Employees (50 U.S.C.
chapter 38);</text>
</subclause></clause><clause id="H1F93AB4C57274A0FB783D4F22963B83E"><enum>(iii)</enum><text>family, medical,
and emergency leave, as provided under—</text>
<subclause id="H5219B0A397DA46608955DBC8B576E8B5"><enum>(I)</enum><text>subchapters III,
IV, and V of chapter 63 of title 5, United States Code;</text>
</subclause><subclause id="HCF0F9710C7B74F58BEE4AEA7A648DDDC"><enum>(II)</enum><text>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;</text>
</subclause><subclause id="H443BBB524DE84BF2A6C6FCB2742CF912"><enum>(III)</enum><text>section 202 of
the Congressional Accountability Act of 1995 (2 U.S.C. 1312); and</text>
</subclause><subclause id="HA2FA72F5DA034FE9A93024817EC5C7BB"><enum>(IV)</enum><text>section 412 of
title 3, United States Code;</text>
</subclause></clause><clause id="H1D4503044EBD41BDA843CBC935C0EB38"><enum>(iv)</enum><text>Federal group
life insurance, as provided under chapter 87 of title 5, United States
Code;</text>
</clause><clause id="HFC0A6D7C735F4BD0AB4E2019689F4D6D"><enum>(v)</enum><text>long-term care
insurance, as provided under chapter 90 of title 5, United States Code;</text>
</clause><clause id="HD8C6E89F3AF64BFCA704EF1FB5C9FB2D"><enum>(vi)</enum><text>compensation for
work injuries, as provided under chapter 81 of title 5, United States
Code;</text>
</clause><clause id="H2D5651C4EA804950BC4ADC50FBCE6ECC"><enum>(vii)</enum><text>benefits for
disability, death, or captivity, as provided under—</text>
<subclause id="H4CC5F327B6F2488E8FFCBC90F7676C48"><enum>(I)</enum><text>sections 5569 and
5570 of title 5, United States Code;</text>
</subclause><subclause id="H1065C904D97B46A18C2AA7500792076A"><enum>(II)</enum><text>section 413 of
the Foreign Service Act of 1980 (22 U.S.C. 3973);</text>
</subclause><subclause id="H2101D7C3C96741C4AA571E685BEA2E3D"><enum>(III)</enum><text>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</text>
</subclause></clause><clause id="H327EE372A2FA442387DB48E3E01EA024"><enum>(viii)</enum><text>travel,
transportation, and related payments and benefits, as provided under—</text>
<subclause id="HB57E215D4A2F4E4C85F9A52EC34B166A"><enum>(I)</enum><text>chapter 57 of
title 5, United States Code;</text>
</subclause><subclause id="HF57609C5716E48CEA3B409E6FDEDD34C"><enum>(II)</enum><text>chapter 9 of the
Foreign Service Act of 1980 (22 U.S.C. 4081 et seq.); and</text>
</subclause><subclause id="H8731E1794F154E84872AE43CD35E160A"><enum>(III)</enum><text>section 1599b of
title 10, United States Code; and</text>
</subclause></clause><clause id="HBEB77AF9546545899B6A96E6F34481AC"><enum>(ix)</enum><text>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.</text>
</clause></subparagraph><subparagraph id="HF2E60888E7704DFA93014E5E1817FC1B"><enum>(B)</enum><header>Domestic
partner</header><text>The term <term>domestic partner</term> means an adult
unmarried person living with another adult unmarried person of the same sex in
a committed, intimate relationship.</text>
</subparagraph><subparagraph id="H850786CDE783456E9561E567E010B339"><enum>(C)</enum><header>Employee</header><text>The
term <term>employee</term>—</text>
<clause id="H08F3FCB814614B689244B40C2D0FA762"><enum>(i)</enum><text>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</text>
</clause><clause id="H27A6F6AE9C85402C99C2F4605C76891D"><enum>(ii)</enum><text>shall not include
a member of the uniformed services.</text>
</clause></subparagraph><subparagraph id="H3042AFF8F2BC41108326DD7DD72AC24B"><enum>(D)</enum><header>Obligations</header><text>The
term <term>obligations</term> 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.</text>
</subparagraph><subparagraph id="HDAB8AE9788EF41D4B2EEA0552474CE47"><enum>(E)</enum><header>Uniformed
services</header><text>The term <term>uniformed services</term> has the meaning
given under section 2101(3) of title 5, United States Code.</text>
</subparagraph></paragraph></subsection><subsection id="HF3C7A9EBA204402BAD43F638BB3FE342"><enum>(b)</enum><header>Effective
date</header><text>This section and the amendments made by this section
shall—</text>
<paragraph id="H658AB3E43DBA4241A8F93CF689F2B1A5"><enum>(1)</enum><text display-inline="yes-display-inline">with respect to the provision of benefits
and obligations, take effect 6 months after the date of enactment of this Act;
and</text>
</paragraph><paragraph id="H4EB0E8353DAD44B88FD25011D7B7732D"><enum>(2)</enum><text display-inline="yes-display-inline">apply to any individual who is employed as
an employee on or after the date of enactment of this Act.</text>
</paragraph></subsection></section></subtitle><subtitle id="HFF31F15091834E40B7A949C298698499"><enum>B</enum><header>Public Health
Insurance</header>
<section id="HF404F47E504C4ED6A81F26B1FFD1E701" section-type="subsequent-section"><enum>111.</enum><header>Optional Medicaid
coverage of low-income HIV-infected individuals</header>
<subsection id="HD707CE18DFA647C8976E008704F82A2"><enum>(a)</enum><header>In
General</header><text>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—</text>
<paragraph id="HD1998E4A87E040AA9314B62BD5958000"><enum>(1)</enum><text>in subsection
(a)(10)(A)(ii)—</text>
<subparagraph id="H7D0FD300A94C44C6834BF73570D7B3F"><enum>(A)</enum><text>by striking
<quote>or</quote> at the end of subclause (XVIII);</text>
</subparagraph><subparagraph id="H4821C16A5F39449981C1E572BF2CB0CA"><enum>(B)</enum><text>by adding
<quote>or</quote> at the end of subclause (XIX); and</text>
</subparagraph><subparagraph id="HCA7EB2641508470F81A48655A0828BF7"><enum>(C)</enum><text>by adding at the
end the following:</text>
<quoted-block id="HA3A5726374994669B8815EA88E9CA7A3" style="OLC">
<paragraph id="H6E16BEB2215E4444BBD5118D7F9E4447"><enum>(XX)</enum><text>who are described
in subsection (gg) (relating to HIV-infected
individuals);</text>
</paragraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="HF1B840C3751545ABA6D22DC4239CF281"><enum>(2)</enum><text>by adding at the
end the following:</text>
<quoted-block id="H897CE6DCA3AE4F8EA5ABB710C8299406" style="OLC">
<subsection id="H31E845849B904435AD93751772B8EE77"><enum>(gg)</enum><text>HIV-infected
individuals described in this subsection are individuals not described in
subsection (a)(10)(A)(i)—</text>
<paragraph id="HC2BBC89C96BE4FBFB6007D5DF4CEAD8"><enum>(1)</enum><text>who are infected
with HIV;</text>
</paragraph><paragraph id="H487E0C9088DF4E6698D8EEBDF4FFC435"><enum>(2)</enum><text>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</text>
</paragraph><paragraph id="H593689E452814B879EE4E74175B9DE00"><enum>(3)</enum><text>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.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HC4D3FFF745E94FD591552700006DD56C"><enum>(b)</enum><header>Enhanced
Match</header><text>The first sentence of section 1905(b) of such Act (42
U.S.C. 1396d(b)) is amended by striking <quote>section
1902(a)(10)(A)(ii)(XVIII)</quote> and inserting <quote>subclause (XVIII) or
(XX) of section 1902(a)(10)(A)(ii)</quote>.</text>
</subsection><subsection id="H427B951ABAA140C58BF6822BFC2DF43B"><enum>(c)</enum><header>Conforming
Amendments</header><text display-inline="yes-display-inline">Section 1905(a) of
such Act (42 U.S.C. 1396d(a)) is amended, in the matter preceding paragraph
(1)—</text>
<paragraph id="H818D68179C084353B4563EEA69EC97B"><enum>(1)</enum><text>by
striking <quote>or</quote> at the end of clause (xii);</text>
</paragraph><paragraph id="H3200A3A249BC4F94B1D6553B176CCB19"><enum>(2)</enum><text>by adding
<quote>or</quote> at the end of clause (xiii); and</text>
</paragraph><paragraph id="H77A2A60364494499A728FDCEBC71378"><enum>(3)</enum><text>by
inserting after clause (xiii) the following:</text>
<quoted-block id="H846754B7446F49EBBFC95B7052893FE" style="OLC">
<clause id="H3C69841F8565403FAE55A9F331001BAA" indent="up2"><enum>(xiv)</enum><text>individuals described in section
1902(gg);</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HFD4093B4E5D9493FB9DB8174631EF75F"><enum>(d)</enum><header>Exemption From
Funding Limitation for Territories</header><text>Section 1108(g) of the Social
Security Act (42 U.S.C. 1308(g)) is amended by adding at the end the
following:</text>
<quoted-block id="HB2B76DE42B2F4F70B192066638C92D17" style="OLC">
<paragraph id="H6B629FB05BDA44AC9CE00B4BFEF198E"><enum>(5)</enum><header>Disregarding
medical assistance for optional low-income HIV-infected
individuals</header><text>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).</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H5CD1FCC6086D498AA2F50A5EB7CCDDC"><enum>(e)</enum><header>Effective
Date</header><text>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.</text>
</subsection></section><section id="H67BF74F9ACBE49B1ABBEBC8C600BEDA"><enum>112.</enum><header>Expanded
definition of spouse for purposes of the Medicare program</header><text display-inline="no-display-inline">Section 1101(a) of the Social Security Act
(42 U.S.C. 1301a)) is amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H67A3135ACB124DA99D2ED89AA0EE4D18" style="OLC">
<paragraph id="HD108C8AEAE794B938DEC453543FD0F0E"><enum>(11)</enum><text display-inline="yes-display-inline">Notwithstanding section 7 of title 1,
United States Code, for purposes title XVIII of this Act—</text>
<subparagraph id="H2964903839FC4359AE006C2AAFD4F633"><enum>(A)</enum><text>the term
<term>spouse</term> 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</text>
</subparagraph><subparagraph id="H2FBB6EF82D664A9AB7AC15E9F575FDC8"><enum>(B)</enum><text display-inline="yes-display-inline">the term <term>married</term> 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.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section display-inline="no-display-inline" id="H79276C33323D43EE99ED769472765CE1" section-type="subsequent-section"><enum>113.</enum><header>Ending the Medicare
Disability Waiting Period Act</header>
<subsection id="H90ACD19186B64CA1961BBCC978B5354C"><enum>(a)</enum><header>Phase-Out of
waiting period for medicare disability benefits</header>
<paragraph id="H150890AE288240CCAFCCBA156B5CE114"><enum>(1)</enum><header>In
general</header><text>Section 226(b) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 426(b)) is
amended—</text>
<subparagraph id="H26AD90B83F644139B6D160C22032F9F5"><enum>(A)</enum><text>in paragraph
(2)(A), by striking <quote>, and has for 24 calendar months been entitled
to,</quote> and inserting <quote>, and for the waiting period (as defined in
subsection (k)) has been entitled to,</quote>;</text>
</subparagraph><subparagraph id="H4D20C68F98694A69A6D5590058ED05BB"><enum>(B)</enum><text>in paragraph
(2)(B), by striking <quote>, and has been for not less than 24 months,</quote>
and inserting <quote>, and has been for not less than the waiting
period,</quote>;</text>
</subparagraph><subparagraph id="HEA564B319C9E4C8981518D0000DAC840"><enum>(C)</enum><text>in paragraph
(2)(C)(ii), by striking <quote>, including the requirement that he has been
entitled to the specified benefits for 24 months,</quote> and inserting
<quote>, including the requirement that the individual has been entitled to the
specified benefits for the waiting period,</quote>; and</text>
</subparagraph><subparagraph id="H9E27C1BB0F084576A097FCAD7D3E8942"><enum>(D)</enum><text>in the flush
matter following paragraph (2)(C)(ii)(II)—</text>
<clause id="HE65E062B3CF34D908FC217483340C494"><enum>(i)</enum><text>in
the first sentence, by striking <quote>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</quote> and inserting <quote>for each month beginning after the waiting
period for which the individual satisfies paragraph (2) and</quote>;</text>
</clause><clause id="H664B25AC899345F695490916F902E870"><enum>(ii)</enum><text>in
the second sentence, by striking <quote>the <quote>twenty-fifth month of his
entitlement</quote> refers to the first month after the twenty-fourth month of
entitlement to specified benefits referred to in paragraph (2)(C) and</quote>;
and</text>
</clause><clause id="H4824CC066B374FFDB8E7D2D074B9F45E"><enum>(iii)</enum><text>in
the third sentence, by striking <quote>, but not in excess of 78 such
months</quote>.</text>
</clause></subparagraph></paragraph><paragraph id="H23C5494CBBB84C749DE91DC2894370ED"><enum>(2)</enum><header>Schedule for
phase-out of waiting period</header><text>Section 226 of the such Act (42
U.S.C. 426) is amended by adding at the end the following new
subsection:</text>
<quoted-block act-name="Social Security Act" id="H44AE6190A0154D309D28FAAB4DE769D">
<subsection id="HE04B3B61141C4EC7AFA76341A3BEA639"><enum>(k)</enum><text>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 <term>waiting
period</term> means—</text>
<paragraph id="H0C01BCC4BEA642B3BE000098AB9FC4B7"><enum>(1)</enum><text>for 2010, 18
months;</text>
</paragraph><paragraph id="H96AE5650115E4FBE8CABCAC6BA4D002E"><enum>(2)</enum><text>for 2011, 16
months;</text>
</paragraph><paragraph id="HF2C228526AE24420A1277C5682486876"><enum>(3)</enum><text>for 2012, 14
months;</text>
</paragraph><paragraph id="HDC7B6880413442E581222FB1F2F4DD9"><enum>(4)</enum><text>for 2013, 12
months;</text>
</paragraph><paragraph id="H451F7449631F4405A54F4200204F5C3E"><enum>(5)</enum><text>for 2014, 10
months;</text>
</paragraph><paragraph id="H42932936FAE842EC83CFD07C06477C6D"><enum>(6)</enum><text>for 2015, 8
months;</text>
</paragraph><paragraph id="H22526F0C22E74664B0CFC487EC005D7C"><enum>(7)</enum><text>for 2016, 6
months;</text>
</paragraph><paragraph id="HF108DE7F062A49E99B3501A760B75BC6"><enum>(8)</enum><text>for 2017, 4
months;</text>
</paragraph><paragraph id="H0E78E378360B4042AC5B98A787B21864"><enum>(9)</enum><text>for 2018, 2
months; and</text>
</paragraph><paragraph id="H7FA4B449ECC34E708D261F26A5DAD8C3"><enum>(10)</enum><text>for 2019 and each
subsequent year, 0
months.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HE5D93AF1DCF34929AED7BA6E5F3DE700"><enum>(3)</enum><header>Conforming
amendments</header>
<subparagraph id="H44F9ECEBBE064772929C15A4E7602769"><enum>(A)</enum><header>Sunset</header><text>Effective
January 1, 2019, subsection (f) of section 226 of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 426) is
repealed.</text>
</subparagraph><subparagraph id="H9C0A27E3FE3E4E5486FBDFCD5B3514DD"><enum>(B)</enum><header>Medicare
description</header><text>Section 1811(2) of such Act (42 U.S.C. 1395c(2)) is
amended by striking <quote>entitled for not less than 24 months</quote> and
inserting <quote>entitled for the waiting period (as defined in section
226(k))</quote>.</text>
</subparagraph><subparagraph id="H07A04BB60F064E6985A84ED00017B03"><enum>(C)</enum><header>Medicare part B
coverage</header><text>Section 1837(g)(1) of such Act (42 U.S.C. 1395p(g)(1))
is amended by striking <quote>of the later of (A) April 1973 or (B) the third
month before the 25th month of such entitlement</quote> and inserting <quote>of
the third month before the first month following the waiting period (as defined
in section 226(k)) applicable under section 226(b)</quote>.</text>
</subparagraph><subparagraph id="H73C85FA83DAB45319363FCA5032517F"><enum>(D)</enum><header>Railroad
retirement system</header><text>Section 7(d)(2)(ii) of the Railroad Retirement
Act of 1974 (45 U.S.C. 231f(d)(2)(ii)) is amended—</text>
<clause id="H08EA8E6D4D404FD2A877624C819B00CA"><enum>(i)</enum><text>by
striking <quote>, for not less than 24 months</quote> and inserting <quote>,
for the waiting period (as defined in section 226(k) of the Social Security
Act)</quote>; and</text>
</clause><clause id="H9FF6C18B1DAC4343BEB9E1AF404113F8"><enum>(ii)</enum><text>by
striking <quote>could have been entitled for 24 calendar months, and</quote>
and inserting <quote>could have been entitled for the waiting period (as
defined in section 226(k) of the Social Security Act), and</quote>.</text>
</clause></subparagraph></paragraph><paragraph commented="no" id="HCDA32408145643788CCAA4F4B07232D6"><enum>(4)</enum><header>Effective
date</header><text display-inline="yes-display-inline">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.</text>
</paragraph></subsection><subsection id="H5E708F8DEB074E90B319C59F741DA295"><enum>(b)</enum><header>Institute of
Medicine study and report on delay and prevention of disability
conditions</header>
<paragraph id="H7861EDB55D684935998F9F0040AF3F51"><enum>(1)</enum><header>Study</header><text>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.</text>
</paragraph><paragraph id="H02169FB74ADA4933AE85F612F3D311E4"><enum>(2)</enum><header>Report</header><text>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.</text>
</paragraph><paragraph id="H84C0F4B616DC4E8CAF6E758402DF379B"><enum>(3)</enum><header>Authorization of
appropriations</header><text>There is authorized to be appropriated to carry
out this subsection $750,000 for the period of fiscal years 2010 and
2011.</text>
</paragraph></subsection></section><section id="HFDB083162B5A4A52B5570B582CF57337"><enum>114.</enum><header>Including costs
incurred by AIDS drug assistance programs in providing prescription drugs
toward the annual out-of-pocket threshold under Medicare part D</header>
<subsection id="H646427711E184E7192AAAA3E45FFE80D"><enum>(a)</enum><header>In
General</header><text>Section 1860D–2(b)(4)(C) of the Social Security Act (42
U.S.C. 1395w–102(b)(4)(C)) is amended—</text>
<paragraph id="H8C78873535494B37B2ECFB769EE9E874"><enum>(1)</enum><text>in clause (i), by
striking <quote>and</quote> at the end;</text>
</paragraph><paragraph id="HB8845D37426B4D9586B0ED767DB2CB80"><enum>(2)</enum><text>in clause
(ii)—</text>
<subparagraph id="H80C2A0CC2D4C4445AC37B497492B6C3F"><enum>(A)</enum><text>by inserting
<quote>subject to clause (iii),</quote> after <quote>(ii)</quote>;</text>
</subparagraph><subparagraph id="H7C87E475BF8A4D8EB0514D7BEB2FAE95"><enum>(B)</enum><text>by striking
<quote>, under section 1860D–14, or under a State Pharmaceutical Assistance
Program</quote>; and</text>
</subparagraph><subparagraph id="H16D8227039234A61AFBC1CFF61907ED6"><enum>(C)</enum><text>by striking the
period at the end and inserting <quote>; and</quote>; and</text>
</subparagraph></paragraph><paragraph id="HB9506DF21395473C8ACAFAC192024865"><enum>(3)</enum><text>by inserting after
clause (ii) the following new clause:</text>
<quoted-block id="HB2553D465CDB4277B240554707068C2A" style="OLC">
<clause id="H59D45A2EF8254467BB337C028DC62656"><enum>(iii)</enum><text>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—</text>
<subclause id="HB8DD45D8F3A34BF59D74630564C83BBC"><enum>(I)</enum><text>under section
1860D–14;</text>
</subclause><subclause id="HE4FB88A3C8D34BA498E35CEBED4DE184"><enum>(II)</enum><text>under a State
Pharmaceutical Assistance Program; or</text>
</subclause><subclause id="H2703CA816BA142C693CFA4F5178B26C8"><enum>(III)</enum><text>under an AIDS
Drug Assistance Program under part B of title XXVI of the Public Health Service
Act.</text>
</subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H164770CB53BE4BAAB7B5C644C570DFC1"><enum>(b)</enum><header>Effective
Date</header><text>The amendments made by subsection (a) shall apply to costs
incurred on or after January 1, 2010.</text>
</subsection></section><section id="HFCAB3700EF904741B0AD0A23277C7BD7"><enum>115.</enum><header>Nondiscrimination
based on gender identity or sexual orientation under the Medicaid, Medicare,
and CHIP programs</header>
<subsection id="H43B36DBB15E74C0C82A7F8B956636417"><enum>(a)</enum><header>Medicaid</header>
<paragraph id="H4B190DBE89124B15A85FCB9E9C160E74"><enum>(1)</enum><text>Section 1902(a) of
the Social Security Act is amended by—</text>
<subparagraph id="HFBE4B69A3029458FA1B2E387229DF6C8"><enum>(A)</enum><text>striking the
<quote>and</quote> at the end of paragraph (72);</text>
</subparagraph><subparagraph id="H0357CE02D70149F69BE02FD31141CBFE"><enum>(B)</enum><text>striking the
period at the end of paragraph (73)(B) and inserting <quote>;
and</quote>;</text>
</subparagraph><subparagraph id="H277E96E7C8944F9CB7EDFB252A468F2F"><enum>(C)</enum><text>inserting after
paragraph (73) the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HC9D49E0A7157429DACD2C1827EC8DE07" style="OLC">
<paragraph id="H1F9DCA7EFE634D6B8A938B42A88BDFF9"><enum>(74)</enum><text display-inline="yes-display-inline">provide that the State shall not
discriminate against any person on the basis of sexual orientation or gender
identity.</text>
</paragraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="HDE482E2976184460AC587DB9D336A7A2"><enum>(D)</enum><text>adding at the end
the following undesignated paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H4C48C287DBDA4011AC8929DD8C06F32D" style="OLC">
<paragraph id="H5503214019E843D5A00B5426AE566634"><enum></enum><text display-inline="yes-display-inline">For the purposes of paragraph (74)
<quote>sexual orientation</quote> shall mean homosexuality, heterosexuality, or
bisexuality. <quote>Gender identity</quote> 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.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H232EB756BA1C4CFEA43001D1DB10FF87"><enum>(2)</enum><text display-inline="yes-display-inline">Section 1916 of the Social Security Act is
amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H2B86A96249974D19AEF919B1DA6CB30A" style="OLC">
<subsection id="H73FFF9C0EE364077BB34F6B7DA8B9608"><enum>(k)</enum><header>No
discrimination on premiums or cost sharing</header><text display-inline="yes-display-inline">The State shall provide that in the case of
all individuals described in section 1902(a) who are eligible under the
plan—</text>
<paragraph id="HF59C58EEB233473B8D36D97FEC3635C9"><enum>(1)</enum><text>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</text>
</paragraph><paragraph id="H79227C070A4642758EB3A00218CC449D"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H7BBB1F8C11EF4579A6AA758C7B53525C"><enum>(b)</enum><header>State children’s
health insurance program</header><text display-inline="yes-display-inline">Section 2102 of the Social Security Act is
amended by adding at the end the following subsection: “(d).”</text>
<quoted-block display-inline="no-display-inline" id="H86B6077BE6054B8C8CAE69BDDEEE873C" style="OLC">
<subsection id="H2CC58A829FE944C3850627DB25985832"><enum>(d)</enum><header>No
discrimination in State child health plans</header><text display-inline="yes-display-inline">A State child health plan may not
discriminate on the basis sexual orientation or gender identity as defined in
section
1902.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H413FCBD96103444BAB3542A91D9A3B9C"><enum>(c)</enum><header>Medicare</header><text display-inline="yes-display-inline">Title XVIII of the Social Security Act is
amended by—</text>
<paragraph id="HA48841FB217C4BBBB6713752A76386CB"><enum>(1)</enum><text>adding at the end
the following:</text>
<quoted-block display-inline="no-display-inline" id="HE5C840C94C134D50ACBC3BEE98D5DC25" style="OLC">
<section id="HCDD0B88F2B664DBD9BC703A8DB951B91"><enum>1899.</enum><header>Nondiscrimination
based on gender identity or sexual orientation</header>
<subsection id="HD4B235AC0DCE44AC8F4C47654BCAAD48"><enum>(a)</enum><header>Condition of
participation</header><text display-inline="yes-display-inline">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.</text>
</subsection><subsection id="H1FDB63C0FDA4431DA12C06C5376065B6"><enum>(b)</enum><header>Coverage
determinations</header><text display-inline="yes-display-inline">The Secretary
may not discriminate on the basis of the sex, gender identity, or sexual
orientation in fulfillment of his duties under this Act.</text>
</subsection><subsection id="H0DF20B5A99214FF286DF557CB826AE9F"><enum>(c)</enum><header>Regulations</header><text display-inline="yes-display-inline">The Secretary shall promulgate regulations
to implement this section.</text>
</subsection></section><after-quoted-block>.
</after-quoted-block></quoted-block>
</paragraph></subsection></section></subtitle><subtitle id="H1FE2A82FF5D24BC6A2BF481D00B1C6D5"><enum>C</enum><header>Miscellaneous</header>
<section id="H71C3A88276AA4B95821E64A117316F3D"><enum>121.</enum><header>Health
Promotion Grants</header>
<subsection id="HBD3C9966EA364C89973DC85D20DC3BF8"><enum>(a)</enum><header>Demonstration
Projects</header><text>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.</text>
</subsection><subsection id="HE915CAD45608492781A3E5931DC02C8F"><enum>(b)</enum><header>Eligibility</header><text>In
this section:</text>
<paragraph id="H619A0086A55D42BDA2D998CDC54168FC"><enum>(1)</enum><header>Eligible
entity</header><text>The term <term>eligible entity</term> means a qualified
organization or a community-based consortium.</text>
</paragraph><paragraph id="HFCB3DC762604406100DC65ABC3DF12C2"><enum>(2)</enum><header>Qualified
organization</header><text>The term <term>qualified organization</term>
means—</text>
<subparagraph id="HB8BEAFC116CD48DDB3D47100AB56F48"><enum>(A)</enum><text>a hospital, health
plan, or clinic;</text>
</subparagraph><subparagraph id="H4FD237A545DF4F0FA2E022A1CC7B7B9B"><enum>(B)</enum><text>an academic
institution;</text>
</subparagraph><subparagraph id="H6B6A3B6A8EEF4E20B0E613471796708F"><enum>(C)</enum><text>a State health
agency;</text>
</subparagraph><subparagraph id="H0782B993532D468DAA1301007C7C0701"><enum>(D)</enum><text>an Indian Health
Service hospital or clinic, Indian tribal health facility, or urban Indian
facility;</text>
</subparagraph><subparagraph id="HA02CA9831206452993835F3E3ECFE7E2"><enum>(E)</enum><text display-inline="yes-display-inline">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);</text>
</subparagraph><subparagraph id="H2B9DFE9F9FBC479BAB7552BE1094098"><enum>(F)</enum><text>a primary care
practice-based research network;</text>
</subparagraph><subparagraph id="H509C6BED8D004C569682360BBA2026E1"><enum>(G)</enum><text>long-term care
facilities, including nursing homes and assisted living facilities; or</text>
</subparagraph><subparagraph id="HA2F437BCB15F4936B87DD83CBEDB000"><enum>(H)</enum><text>any other similar
entity determined to be appropriate by the Secretary.</text>
</subparagraph></paragraph><paragraph id="H374838A3AA954CDEBE80FB429C4CC775"><enum>(3)</enum><header>Community-based
consortium</header><text>The term <term>community-based consortium</term> means
a partnership that—</text>
<subparagraph id="HAEAE90DB6309435F90AA89B531088183"><enum>(A)</enum><text>includes—</text>
<clause id="HD2FDB8962A4F40C2926E1017A8667EB4"><enum>(i)</enum><text>individuals who
are representatives of organizations of sexual and gender minorities;</text>
</clause><clause id="H81A9E80168D5464D00B8A4360356FF00"><enum>(ii)</enum><text>community leaders
and leaders of community-based organizations;</text>
</clause><clause id="HCF0E2211A471412EA9B8555B55537E68"><enum>(iii)</enum><text>health care
providers, including providers who treat sexual and gender minorities;
and</text>
</clause><clause id="H1AA5CF8B1CC14C879418DFC004ED2F9"><enum>(iv)</enum><text>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</text>
</clause></subparagraph><subparagraph id="H0B337EC09702491B8E08F199D3B78EE9"><enum>(B)</enum><text>is located within
an area with a significant population of sexual and gender minorities.</text>
</subparagraph></paragraph></subsection><subsection id="H97BCD508B5D04F57B47927501139D29B"><enum>(c)</enum><header>Use of
Funds</header><text>An eligible entity shall use amounts received under this
section for demonstration projects to—</text>
<paragraph id="HFB45E7A9D88E427EA4533B29F4378EB7"><enum>(1)</enum><text display-inline="yes-display-inline">address health disparities affecting sexual
and gender minorities in the areas of—</text>
<subparagraph id="H579F2538890647E4BC0089056C514DD0"><enum>(A)</enum><text>primary care and
preventive health, including health education and promotion;</text>
</subparagraph><subparagraph id="H3F483703DEC1464A8954FDB3C279E697"><enum>(B)</enum><text>behavioral and
mental health and substance abuse;</text>
</subparagraph><subparagraph id="H82F3A77C0ABC434D97A5286E3C85CD6E"><enum>(C)</enum><text>health services
research;</text>
</subparagraph><subparagraph commented="no" id="HE39F0B188C6643F5AD64E9253CD585A0"><enum>(D)</enum><text>demographics and
data collection; and</text>
</subparagraph><subparagraph id="H2D4A9FCB000543598BD8F91EC55B954"><enum>(E)</enum><text>other areas
determined appropriate by the Secretary;</text>
</subparagraph></paragraph><paragraph id="H9B1559321DF3408BA07CBBCCE99E5FBB"><enum>(2)</enum><text>identify, educate,
and enroll into clinical trials and comparative effectiveness research eligible
patients from sexual or gender minority groups;</text>
</paragraph><paragraph id="H1992BF4AA4654F9DA2A5C222C5E13D82"><enum>(3)</enum><text>educate, guide,
and provide outreach in a community setting regarding health problems prevalent
among sexual or gender minority populations, including—</text>
<subparagraph id="H767562D6E4684242B025F2F92C5DA978"><enum>(A)</enum><text>HIV in high-risk
subpopulations, including—</text>
<clause id="H9885A5556DEA4A7DB2B28BF37BDD7940"><enum>(i)</enum><text>transgender
populations;</text>
</clause><clause id="HBE878AC8E466499CAB007F1210F6D3BA"><enum>(ii)</enum><text>sex
workers; and</text>
</clause><clause id="H30CE595ACF1C4C1286B343AFA3F0D6B3"><enum>(iii)</enum><text>people of
color;</text>
</clause></subparagraph><subparagraph id="HEC490CC39FCA48D597A8A0703F549DE1"><enum>(B)</enum><text>cancers;</text>
</subparagraph><subparagraph id="H621C662A5E9D4697BA36B48BCE1516BF"><enum>(C)</enum><text>school
violence;</text>
</subparagraph><subparagraph id="H295BD57C5FDF40BD9B74030078553C41"><enum>(D)</enum><text>emerging drugs;
and</text>
</subparagraph><subparagraph id="H2CF2BDE162C24F6CA63D00DA834B372E"><enum>(E)</enum><text>suicide
prevention;</text>
</subparagraph></paragraph><paragraph id="HBFE145200E4C455A8271360000455500"><enum>(4)</enum><text>educate, guide,
and provide experiential learning opportunities to sexual and gender minorities
targeting behavioral risk factors including—</text>
<subparagraph id="HFFBA5E505A37477EAB50ABE7F0116A"><enum>(A)</enum><text>poor
nutrition;</text>
</subparagraph><subparagraph id="H6A2EDE7DC1334BD897E267F0CADE32AC"><enum>(B)</enum><text>physical
inactivity;</text>
</subparagraph><subparagraph id="HA4ACD9A662DA44F1A7ED5EAC3892BF08"><enum>(C)</enum><text>being overweight
or obese;</text>
</subparagraph><subparagraph id="H2EA7BE1BA092472691684134EEBF9773"><enum>(D)</enum><text>tobacco
use;</text>
</subparagraph><subparagraph id="H673E69B82DAC406986FF7694EBCAEAF8"><enum>(E)</enum><text>alcohol and
substance use;</text>
</subparagraph><subparagraph id="H0B69F5F125384BF5B44894D3730243FE"><enum>(F)</enum><text>injury and
violence;</text>
</subparagraph><subparagraph id="H3B555EAE17BB41499B4529E69DF12285"><enum>(G)</enum><text>high-risk sexual
behavior; and</text>
</subparagraph><subparagraph id="H081F4B6FE898499D9416F67C506662BA"><enum>(H)</enum><text>mental health
problems;</text>
</subparagraph></paragraph><paragraph id="H34D97620EE9A49A089349488ECB8892"><enum>(5)</enum><text>educate and provide
guidance to sexual and gender minorities regarding effective strategies to
promote positive health behaviors within the community; or</text>
</paragraph><paragraph id="H999860C722774C1688E307DF271DBCE7"><enum>(6)</enum><text>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.</text>
</paragraph></subsection><subsection id="H1BD0EB212BFE41F2A5EC03A635B8E199"><enum>(d)</enum><header>Report to
Congress</header>
<paragraph id="HFCCCCF98C54C4E8488124CC693E64AE"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph id="H2CAD61BC3E8A4FD18BA24CFD6EFDB082"><enum>(2)</enum><header>Contents</header><text>The
report required under paragraph (1) shall include the following:</text>
<subparagraph id="HAD367455F9744A30A2CD57BB03C8BA47"><enum>(A)</enum><text>A description of
the programs for which grant funds were used.</text>
</subparagraph><subparagraph id="H6CE199A1C97B467E88B677CF653DF1DF"><enum>(B)</enum><text>The number of
individuals served under such programs.</text>
</subparagraph><subparagraph id="H36F8143DF93241909DD57C9294BBFFF5"><enum>(C)</enum><text>An evaluation
of—</text>
<clause id="HD73E1D73FB764E2BB7B9CA7EE5164327"><enum>(i)</enum><text>the
effectiveness of such programs;</text>
</clause><clause id="HBB336CA6077F43179855809666F7A8B2"><enum>(ii)</enum><text>the
cost of such programs; and</text>
</clause><clause id="H11B8C2ED15A745609FED111BC8DAFEEF"><enum>(iii)</enum><text>the impact of
such programs on the health outcomes of the community residents.</text>
</clause></subparagraph><subparagraph id="HAEE48A49AF5C4B858345AA26743DA24"><enum>(D)</enum><text>Recommendations for
improving the health and health care of sexual and gender minorities.</text>
</subparagraph><subparagraph id="H6CFCE2D957A64B3794696445EB9CD038"><enum>(E)</enum><text>A description of
how the Secretary will continue to work to improve the use of grant funds under
this section.</text>
</subparagraph></paragraph></subsection></section><section id="H8492217499344DD9BAD8DFFE97341E6"><enum>122.</enum><header>Mental Health
Promotion Grants</header>
<subsection id="H37D26DC1696C48B2BFF89B1D58D20029"><enum>(a)</enum><header>Demonstration
Projects</header><text>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.</text>
</subsection><subsection id="H5ED9A5469BA748808529B322948E7CD2"><enum>(b)</enum><header>Eligibility</header><text>In
this section:</text>
<paragraph id="H6039D56909DC483990E109F98816A18E"><enum>(1)</enum><header>Eligible
entity</header><text>The term <term>eligible entity</term> means a qualified
organization or a community-based consortium.</text>
</paragraph><paragraph id="H98127A0CC1454DDDA9EFCF38AA65227E"><enum>(2)</enum><header>Qualified
organization</header><text>The term <term>qualified organization</term>
means—</text>
<subparagraph id="H21B446CBE09D4C0192805888CDD100A2"><enum>(A)</enum><text>a hospital, health
plan, or clinic;</text>
</subparagraph><subparagraph id="HEA0DA4B8EC194694866F594F7096E827"><enum>(B)</enum><text>an academic
institution;</text>
</subparagraph><subparagraph id="HBEE626B779D24847B43E445CDA0026A6"><enum>(C)</enum><text>a State health
agency;</text>
</subparagraph><subparagraph id="HADE44496BD2D44449BF700174634008D"><enum>(D)</enum><text>an Indian Health
Service hospital or clinic, Indian tribal health facility, or urban Indian
facility;</text>
</subparagraph><subparagraph id="H48CF4B96C95E4C6CA176409C72D927A3"><enum>(E)</enum><text>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);</text>
</subparagraph><subparagraph id="H6AF08BD40C6A42C39496DDAB5E7553AE"><enum>(F)</enum><text>a certified mental
health treatment center;</text>
</subparagraph><subparagraph id="H841AB35E47F946F09330FD8EACC0EFB5"><enum>(G)</enum><text>a long-term care
facility, including a nursing home or assisted living facility; and</text>
</subparagraph><subparagraph id="HF73E97591661448C8FE4546C8D2C4E94"><enum>(H)</enum><text>any other similar
entity determined to be appropriate by the Secretary.</text>
</subparagraph></paragraph><paragraph id="H81A13DECC21B4D1DBFBECA335AD74E4"><enum>(3)</enum><header>Community-based
consortium</header><text>The term <term>community-based consortium</term> means
a partnership that—</text>
<subparagraph id="H96EDADA2BE444B3F9D5C4FE38F37B84C"><enum>(A)</enum><text>includes—</text>
<clause id="HDB5B45AF16644F1B90523462003E9BA6"><enum>(i)</enum><text>individuals who
are representatives of organizations of sexual or gender minorities;</text>
</clause><clause id="H2E906653AA2445CBB3E7DB932E86B0E3"><enum>(ii)</enum><text>community leaders
and leaders of community-based organizations;</text>
</clause><clause id="H1596F34A47F0494FAE5873EC0062CF7E"><enum>(iii)</enum><text>mental health
care providers, including providers who treat sexual or gender minorities;
and</text>
</clause><clause id="H9092CCC364D64830B45800BA71839037"><enum>(iv)</enum><text>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</text>
</clause></subparagraph><subparagraph id="H38B2F1D54BA14289B834BA956F39D3FC"><enum>(B)</enum><text>is located within
an area with a significant population of sexual or gender minorities.</text>
</subparagraph></paragraph></subsection><subsection id="HEFEF156FB4A149B196A8889C72FA00DB"><enum>(c)</enum><header>Use of
Funds</header><text>An eligible entity shall use amounts received under this
section for demonstration projects to—</text>
<paragraph id="HD0D3D0D95CDF4177BDE5C752A9DAF71F"><enum>(1)</enum><text>address health
disparities in the areas of behavioral and mental health and substance
abuse;</text>
</paragraph><paragraph id="H758D6216A9784B08006ED47B6B649233"><enum>(2)</enum><text>educate, guide,
and provide outreach in a community setting regarding mental health problems
prevalent among sexual or gender minority populations;</text>
</paragraph><paragraph id="H51D2C3088651472FBA69F2B141842D"><enum>(3)</enum><text>educate, guide, and
provide experiential learning opportunities that target behavioral risk factors
including—</text>
<subparagraph id="H8AA38DADB7CD4B84B87FE302D100565B"><enum>(A)</enum><text>alcohol and
substance use;</text>
</subparagraph><subparagraph id="H3D54F4F89BF3499184C51DE342A1737E"><enum>(B)</enum><text>high-risk sexual
behavior; and</text>
</subparagraph><subparagraph id="H12BB283E89064323A500751D7D1CFC70"><enum>(C)</enum><text>mental health
problems;</text>
</subparagraph></paragraph><paragraph id="HD7527125206640898C797EDB7629C774"><enum>(4)</enum><text>develop or adapt
curricula and interventions to address major mental health issues in the sexual
and gender minority community, including—</text>
<subparagraph id="HB8EE788FD9284C64BEEC7461F78EC62C"><enum>(A)</enum><text>school
violence;</text>
</subparagraph><subparagraph id="H2F210BDCB1FA46B59F84F8EE4E12B019"><enum>(B)</enum><text>emerging
drugs;</text>
</subparagraph><subparagraph id="H8FE8AD3B197F4C888F12B66B61701463"><enum>(C)</enum><text>suicide;
and</text>
</subparagraph><subparagraph id="H39FA282B29684218B2D2F5D214E740B3"><enum>(D)</enum><text display-inline="yes-display-inline">family acceptance of lesbian, gay,
bisexual, and transgender youth;</text>
</subparagraph></paragraph><paragraph id="HC4EFB5DE4B3F46B3966110DF73B0BB6B"><enum>(5)</enum><text>educate and
provide guidance regarding effective strategies to promote positive health
behaviors within the community, including the promotion of resiliency and
wellness strategies;</text>
</paragraph><paragraph id="H81EC331572ED4F0BBBFACC59B5BA8FB"><enum>(6)</enum><text>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</text>
</paragraph><paragraph id="H00E68512206C496BA2E11B8D014316C4"><enum>(7)</enum><text display-inline="yes-display-inline">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.</text>
</paragraph></subsection><subsection id="H70AA35F097B34ED292D244EC33A34920"><enum>(d)</enum><header>Report to
Congress</header>
<paragraph id="H413349BFCC634827B9F9B5E2F167A945"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph id="H0ACF369A364742F28D0079B557EC8900"><enum>(2)</enum><header>Contents</header><text>The
report required under paragraph (1) shall include the following:</text>
<subparagraph id="HB3CD25B837AB43949091D8BBA9CC0035"><enum>(A)</enum><text>A description of
the programs for which grant funds were used.</text>
</subparagraph><subparagraph id="H3AA309898D214EDD9F2300F82FD8E493"><enum>(B)</enum><text>The number of
individuals served under such programs.</text>
</subparagraph><subparagraph id="HF4AC1343CEAE4802BC0597B47766CC9B"><enum>(C)</enum><text>An evaluation
of—</text>
<clause id="H160D27CA6ED94776B300A333A07BCC7"><enum>(i)</enum><text>the
effectiveness of such programs;</text>
</clause><clause id="H2F1C6CE7E5AB4E1B8167EE968E1503A0"><enum>(ii)</enum><text>the
cost of such programs; and</text>
</clause><clause id="H73AE4895AA7441DDB34DB1568D2C7BA"><enum>(iii)</enum><text>the
impact of the programs on the health outcomes of the community
residents.</text>
</clause></subparagraph><subparagraph id="H3C1E511D671C4333B03C570987FBE2B3"><enum>(D)</enum><text>Recommendations
for improving the mental health and mental health care of sexual and gender
minorities.</text>
</subparagraph></paragraph></subsection></section><section id="H951298F96B174E0FB1B99D7659788E89"><enum>123.</enum><header>Health
Insurance Coverage Grants</header>
<subsection id="HC77D70FEFF0E4A47B23B86C4D6AF756D"><enum>(a)</enum><header>In
general</header><text>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.</text>
</subsection><subsection id="H58ED59B29C9D476D86437FB859043512"><enum>(b)</enum><header>Application</header><text>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—</text>
<paragraph id="H2570ED4E3D2044BF94F6CE8C6F551B3F"><enum>(1)</enum><text>target individuals
who are members of sexual or gender minority groups that experience health
disparities through specific outreach activities funded through the
grant;</text>
</paragraph><paragraph id="H65779E3959FB4B5981700645B8BE5FA"><enum>(2)</enum><text>collaborate with
appropriate community organizations and include meaningful community
participation in planning, implementation, and evaluation of activities;</text>
</paragraph><paragraph id="HEAA8BC37184846D4983CCA2823DB3B32"><enum>(3)</enum><text display-inline="yes-display-inline">demonstrate capacity to enroll individuals
currently without health coverage into public or private health insurance plans
that meet their treatment and care needs;</text>
</paragraph><paragraph id="HD9CA92A21771405D9530D1B2A3E3AE6E"><enum>(4)</enum><text display-inline="yes-display-inline">set appropriate and measurable goals for
health insurance enrollment of sexual and gender minorities;</text>
</paragraph><paragraph id="HDBD8762028254CF8BF447B3C419CAA22"><enum>(5)</enum><text>provide ongoing
outreach and education to the populations targeted under paragraph (1);</text>
</paragraph><paragraph commented="no" id="H6DCF90A4184B47AF85EE9CBA2006E921"><enum>(6)</enum><text>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;</text>
</paragraph><paragraph id="H97300C051FF74962A127550089616B52"><enum>(7)</enum><text>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;</text>
</paragraph><paragraph id="H23615917016D4495BABF007DB289AAFE"><enum>(8)</enum><text>develop a plan for
long-term sustainability for the activities funded through the grant;
and</text>
</paragraph><paragraph id="H85ADA96C4DB14704B037DEC21D6EC253"><enum>(9)</enum><text>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.</text>
</paragraph></subsection><subsection id="H6700B9ED20AF4276B91958FBB6C1EF3E"><enum>(c)</enum><header>Priorities</header>
<paragraph id="HEF50B43B97D24120AC61A55D35F3235E"><enum>(1)</enum><header>In
general</header><text>In awarding contracts and grants under this section, the
Secretary shall give priority to applicants that meet the criteria under
paragraph (2) and are—</text>
<subparagraph id="HD64E76D1ECDB4663AAEC9644B3BB715"><enum>(A)</enum><text>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)));</text>
</subparagraph><subparagraph id="H03452383BF0C43B99B8FB5426D355551"><enum>(B)</enum><text>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;</text>
</subparagraph><subparagraph id="HA9EA38027A094B98BAD553A7CE1E05C6"><enum>(C)</enum><text>a community-based
consortium;</text>
</subparagraph><subparagraph id="H55220B1864F54EAAABB23CBF4430EFA3"><enum>(D)</enum><text>safety net health
plans that work in coordination with local health centers;</text>
</subparagraph><subparagraph id="H9386FED0335241BAAED6E3E0677FE3CA"><enum>(E)</enum><text>an Indian tribe,
tribal organization, or urban Indian organization; or</text>
</subparagraph><subparagraph id="HA3665FBE3CD540F7A5A7993E41E261D3"><enum>(F)</enum><text>other health
systems.</text>
</subparagraph></paragraph><paragraph id="HB0816DE1047747128F4BE18A87B14A5E"><enum>(2)</enum><header>Additional
criteria</header><text display-inline="yes-display-inline">For purposes of
paragraph (1), the criteria under this paragraph is that the applicant—</text>
<subparagraph id="H838AF2A928F54988B7307C8E1D5A9271"><enum>(A)</enum><text>by legal mandate
or explicitly adopted mission, provide patients with access to services
regardless of their ability to pay;</text>
</subparagraph><subparagraph id="H9ECE12E0A6CE46FB97B776D48D31CB00"><enum>(B)</enum><text>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;</text>
</subparagraph><subparagraph id="HD37EB4149A2845EFB5B6B02800752ECA"><enum>(C)</enum><text>serve a
disproportionate percentage of patients who are sexual or gender minorities;
and</text>
</subparagraph><subparagraph id="H29BA882D953541E18526A8A7771E3BDD"><enum>(D)</enum><text>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.</text>
</subparagraph></paragraph></subsection><subsection id="H14A597A883524223B2DD0031F9058424"><enum>(d)</enum><header>Use of
Funds</header><text>An eligible entity shall use such amounts received under
this section for demonstration projects to—</text>
<paragraph id="H770AE2AC618343E196C4D1EA704DC72"><enum>(1)</enum><text>address health
disparities in the areas of health insurance coverage; and</text>
</paragraph><paragraph id="H6121E3917A4843228210891DE7A52CF"><enum>(2)</enum><text>evaluate methods
for strengthening the health coverage and continuity of coverage of sexual and
gender minority populations, including—</text>
<subparagraph id="HDF2DE5760C104E749D53E441265D5242"><enum>(A)</enum><text>targeting
enrollment of uninsured sexual and gender minority populations into title XIX
of the Social Security Act; and</text>
</subparagraph><subparagraph id="H9B2ED779E56F474CB6C477F6A68C6E2F"><enum>(B)</enum><text>assessing
eligibility for domestic partner benefits.</text>
</subparagraph></paragraph></subsection><subsection id="HDCB4E853BDAF43ED869848C21027AD7D"><enum>(e)</enum><header>Evaluation and
report by grantee</header>
<paragraph id="H02B123A53EC4410C805AB46FF13C7F3D"><enum>(1)</enum><header>Evaluation</header><text>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.</text>
</paragraph><paragraph id="HC971DC40A40D46DEA6CD48570D433F16"><enum>(2)</enum><header>Report</header><text>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).</text>
</paragraph></subsection><subsection id="HDB764E8D89CC47AEABC5F5F5FB94A6E"><enum>(f)</enum><header>Report and public
access to information by Secretary</header>
<paragraph id="H3445B6F5B0FE4D50B953C54C5399C22F"><enum>(1)</enum><header>Report to
Congress</header><text display-inline="yes-display-inline">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.</text>
</paragraph><paragraph id="H6EF50C0149FA47A0B775E24A755790C1"><enum>(2)</enum><header>Public
Access</header><text>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).</text>
</paragraph></subsection></section></subtitle><enum>II</enum><header>Cultural
Competency and Workforce</header>
<section id="HEEC78015F59340FFBC35E732E5DAC7F8"><enum>201.</enum><header>Amendment to
the Public Health Service Act</header><text display-inline="no-display-inline">The Public Health Service Act (42 U.S.C. 201
et seq.) is amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H816FCFB8A84E4A14908BA8A34A5F0FDE" style="OLC">
<title id="H13EFCFAC2981438E9E7A3FD4AB0FC6FB"><enum>XXXI</enum><header>CULTURALLY
COMPETENT HEALTH CARE</header>
<section id="H1C13C1758F92429D9FB20BCC92915367"><enum>3100.</enum><header>Definitions</header><text display-inline="no-display-inline">In this title:</text>
<paragraph commented="no" id="HA8E413A123B44B88B85AC138E015B282"><enum>(1)</enum><header>Culturally
competent</header><text>The term <term>culturally competent care</term>, 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.</text>
</paragraph><paragraph id="H01C8ADB87A6645948A96B96F3CB4CA38"><enum>(2)</enum><header>Sexual or gender
minority</header><text>The terms <term>sexual or gender minority</term> and
<term>sexual and gender minority</term> mean a lesbian, gay, bisexual, or
transgender individual.</text>
</paragraph><paragraph id="HD908460DB8E141F3926FBA33EB092D02"><enum>(3)</enum><header>State</header><text>The
term <term>State</term> 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.</text>
</paragraph></section><section id="H3B5A264A9EFF487CAF36482EB4455B47"><enum>3101.</enum><header>National
standards for culturally competent services in health care</header><text display-inline="no-display-inline">Recipients of Federal financial assistance
from the Secretary shall, to the extent reasonable and practicable—</text>
<paragraph id="H37B16624F94F43A5AED232E0E2A94BC1"><enum>(1)</enum><text display-inline="yes-display-inline">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;</text>
</paragraph><paragraph id="H80D1BF4514FD45B288D79BE7313CF07D"><enum>(2)</enum><text display-inline="yes-display-inline">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;</text>
</paragraph><paragraph id="H6A5EB92EF98A4815917A7C28DB9E3374"><enum>(3)</enum><text display-inline="yes-display-inline">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;</text>
</paragraph><paragraph id="HEBC8B54062DB47698E6CDBE9CEB609A9"><enum>(4)</enum><text display-inline="yes-display-inline">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;</text>
</paragraph><paragraph id="H01C9A5AB6389471FA802E64CEED11AE5"><enum>(5)</enum><text>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;</text>
</paragraph><paragraph id="HAB2BA65F4F5A4244B38ED0A43230F2DC"><enum>(6)</enum><text>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;</text>
</paragraph><paragraph id="H8A76FF8C701D46D1A250DF719D4981B4"><enum>(7)</enum><text display-inline="yes-display-inline">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;</text>
</paragraph><paragraph id="HA3E167A185524694865156061C4D79CF"><enum>(8)</enum><text display-inline="yes-display-inline">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;</text>
</paragraph><paragraph id="H900FF6CF441940CF910F4FCEE95674DE"><enum>(9)</enum><text>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</text>
</paragraph><paragraph id="H5A33E287C9F845BF8145FF6B85CAAED1"><enum>(10)</enum><text>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.</text>
</paragraph></section><section id="H1FB145C766E34987A4B60CC8EA069E05"><enum>3102.</enum><header>Center for
cultural competence in health care</header>
<subsection id="H7931DC4A0D60463EBB09F304AB8967A8"><enum>(a)</enum><header>Establishment</header><text>The
Secretary, acting through the Deputy Assistant Secretary for LGBT Health, shall
establish and support a center to be known as the <quote>Center for Cultural
Competence in Health Care</quote> (referred to in this section as the
<quote>Center</quote>).</text>
</subsection><subsection commented="no" id="HC36C57A029B242DCB47968D93DF45A5F"><enum>(b)</enum><header>Provision of
information</header><text display-inline="yes-display-inline">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—</text>
<paragraph commented="no" id="HDB77304494264CD180766418639CF064"><enum>(1)</enum><text>tenets of
culturally competent care;</text>
</paragraph><paragraph commented="no" id="HD10C09080497446F9009A66CA2A5758D"><enum>(2)</enum><text>cultural
competence self-assessment tools;</text>
</paragraph><paragraph commented="no" id="H9253311D05CE4839A49B96B2DC012E96"><enum>(3)</enum><text>cultural
competence training tools;</text>
</paragraph><paragraph commented="no" id="H21A3EDE586D54A2B8F87048E187F0EE1"><enum>(4)</enum><text>strategic plans to
increase cultural competence in different types of health care organizations,
including regional collaborations among health care organizations; and</text>
</paragraph><paragraph commented="no" id="H6732419C674A449F9F0286D006438491"><enum>(5)</enum><text>resources for
cultural competence information for educators, practitioners, and
researchers.</text>
</paragraph></subsection><subsection id="H495F175D87A949A498BB779487C97B1A"><enum>(c)</enum><header>Director</header><text display-inline="yes-display-inline">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.</text>
</subsection><subsection id="HD7041F82174149E98DAB45714863A191"><enum>(d)</enum><header>Authorization of
Appropriations</header><text>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.</text>
</subsection></section><section id="HF5EC9C26ECDD49D5A7BBA2F60949E643"><enum>3103.</enum><header>Innovations in
cultural competence grants</header>
<subsection id="HEC40DD51CEBB48FC88CBBC106F537FB4"><enum>(a)</enum><header>In
General</header><text display-inline="yes-display-inline">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.</text>
</subsection><subsection id="HF7DFD5A83C304ECDB9E6F0DBF1F493AB"><enum>(b)</enum><header>Eligibility</header><text>To
be eligible to receive a grant under subsection (a), an entity shall—</text>
<paragraph id="H2D63E5E12BE24341B70E631CAEB85FB7"><enum>(1)</enum><text>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</text>
</paragraph><paragraph id="H96BD8BA47EF84908822AA5495FBD4B73"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection id="H3D046AD9878240F58F82C1A7B668A7D7"><enum>(c)</enum><header>Use of
Funds</header><text>An entity shall use funds received under a grant under this
section to—</text>
<paragraph id="H41407F8A4F594E0F8E6A0982000D630A"><enum>(1)</enum><text display-inline="yes-display-inline">develop formal training programs for
individuals interested in becoming dedicated culturally competent health care
providers for sexual and gender minorities;</text>
</paragraph><paragraph id="H4905F42CBC4E4DF0AFB892B28EE56C33"><enum>(2)</enum><text>develop formal
training programs for individuals interested in becoming dedicated culturally
competent health care providers for sexual and gender minority youth and their
families;</text>
</paragraph><paragraph id="H861D80FCAAC64A9FB7D94D9B54E4A50B"><enum>(3)</enum><text display-inline="yes-display-inline">develop training programs for individuals
interested in becoming dedicated culturally competent health care providers for
aging sexual and gender minorities; and</text>
</paragraph><paragraph id="H118D99A83C40422CA0E76B1D3B9113BC"><enum>(4)</enum><text>develop other
culturally competent services as determined appropriate by the
Secretary.</text>
</paragraph></subsection><subsection id="HC1C305EC569444A887613EB7945CB573"><enum>(d)</enum><header>Priority</header><text>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.</text>
</subsection><subsection id="H1A4598BD6782462D86DB1BD6161D7600"><enum>(e)</enum><header>Evaluation</header><text>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.</text>
</subsection><subsection id="H046969B237E44038BFD5236B2791CD9D"><enum>(f)</enum><header>Authorization of
Appropriations</header><text>There is authorized to be appropriated to carry
out this section $5,000,000 for each of fiscal years 2010 through 2014.</text>
</subsection></section><section id="H2B667AB914574B518276581F37308014"><enum>3104.</enum><header>Research on
cultural competence</header>
<subsection id="H40C91B856D1947A0AAFCC5214C179FC4"><enum>(a)</enum><header>In
General</header><text display-inline="yes-display-inline">The Director of the
Agency for Healthcare Research and Quality, in collaboration with the Deputy
Assistant Secretary for LGBT Health, shall expand research concerning—</text>
<paragraph id="H8E2870369D6146C8B1C1F3454C15DD5E"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph id="H1D1CF13C42364E22ABE5B8F37099A4A3"><enum>(2)</enum><text>the impact of
cultural barriers on the quality of health care and the health status of sexual
and gender minority individuals and populations;</text>
</paragraph><paragraph id="H7B573224CD964331A1027164D2EFDF51"><enum>(3)</enum><text>health care
providers’ and health administrators’ attitudes, knowledge, and awareness of
the barriers described in paragraphs (1) and (2);</text>
</paragraph><paragraph id="H963EF263B71D4AE69ED4985D57190FDB"><enum>(4)</enum><text>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;</text>
</paragraph><paragraph id="H1B2CDD556B844084B9D8520884AD6F1C"><enum>(5)</enum><text>the
cost-effectiveness of providing competency access services; and</text>
</paragraph><paragraph id="HFC9FCDC48892467F899389FB11BE8B24"><enum>(6)</enum><text display-inline="yes-display-inline">optimal approaches for delivering
competency access services.</text>
</paragraph></subsection><subsection id="HC3C4D2366490412187088395C3851A12"><enum>(b)</enum><header>Authorization of
Appropriations</header><text display-inline="yes-display-inline">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.</text>
</subsection></section>.
202.In this title:
(1)The definitions contained in section 3100 of the
Public Health Service Act, as added by section 201, shall apply.
(2)The
term Secretary means the Secretary of Health and Human
Services.
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)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)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)The
demonstration shall be conducted for a period not longer than 2 years.
(4)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)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)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)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 servicesFor 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)The amendments made by this section is effective for payment
for items and services furnished on or after October 1, 2010.
204.Report on
Federal efforts to provide culturally competent health care services to sexual
and gender minoritiesNot
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.
<enum>III</enum><header>Research and
Data Collection</header>
<section id="H6E8FA3BD34F147E89090AD6650CF4E5C"><enum>301.</enum><header>No compelled
disclosure of data</header><text display-inline="no-display-inline">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.</text>
</section><section id="H7C8191E0743F49B08ECF54DFE144D64C"><enum>302.</enum><header>Federal
collection of data on sexual and gender minorities</header>
<subsection id="H6CFDB785FB8A402EB213994D280DC8EB"><enum>(a)</enum><header>Requirements</header>
<paragraph id="H718191669C1C4138A79F94FAAF60888E"><enum>(1)</enum><header>In
general</header><text>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—</text>
<subparagraph id="HCBF1BFAA94F14FEC82493161CB5D8952"><enum>(A)</enum><text>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;</text>
</subparagraph><subparagraph id="HA74B9177E45542B893EF6E815170516E"><enum>(B)</enum><text display-inline="yes-display-inline">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;</text>
</subparagraph><subparagraph id="H372110CE639C49F7B255E13B30923608"><enum>(C)</enum><text>provide such data
to the Secretary on at least an annual basis; and</text>
</subparagraph><subparagraph id="H90E9BEFEEEC04E4F98044FD465E152A4"><enum>(D)</enum><text>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.</text>
</subparagraph></paragraph><paragraph commented="no" id="HC2DFCC67774F4D359AF7763A2F7E6E98"><enum>(2)</enum><header>Bureau of
Prisons</header><text>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.</text>
</paragraph><paragraph id="H702DDF48B4D74870BBA52D94F3ACBA7B"><enum>(3)</enum><header>Rules of
construction</header><text>Nothing in this subsection shall be construed
to—</text>
<subparagraph id="H90BB7E3F14714FB4A90BDDC7F28D5758"><enum>(A)</enum><text>permit the use of
information collected under this subsection in a manner that would adversely
affect any individual providing any such information; and</text>
</subparagraph><subparagraph id="H51D581AF99DF496285856E1C6B5266CD"><enum>(B)</enum><text>require health
care providers to collect data.</text>
</subparagraph></paragraph></subsection><subsection id="H3C8DE13A26A24CE189D24A31FC4C33A2"><enum>(b)</enum><header>Protection of
Data</header><text display-inline="yes-display-inline">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—</text>
<paragraph id="H9ABB20E6C8E04F3FAAE22B095A47A8FB"><enum>(1)</enum><text>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</text>
</paragraph><paragraph id="HA50F5A8F4FFE416BBB9788719D04B9E3"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection id="HCBF9DBB29F9C47CCBBAE6972D0CB8472"><enum>(c)</enum><header>National Plan of
the Data Council</header><text>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—</text>
<paragraph id="HBD59A67AFFD34FEEBEC21A2D12C4447D"><enum>(1)</enum><text>implement
subsection (a) while minimizing the cost and administrative burdens of data
collection and reporting;</text>
</paragraph><paragraph id="H119E270C96E34A8C8DD0C5BE4F0CD98C"><enum>(2)</enum><text>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;</text>
</paragraph><paragraph id="H43FF8259AB0C410EB7E02982D7E8CDAF"><enum>(3)</enum><text>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;</text>
</paragraph><paragraph id="H30986DCBB19946BC82944D854E833C15"><enum>(4)</enum><text>provide
researchers with greater access to sexual and gender minority data, subject to
privacy and confidentiality regulations; and</text>
</paragraph><paragraph id="H660128D2F21E4E14B272D0CBC84C49B0"><enum>(5)</enum><text>safeguard and
prevent the misuse of data collected under subsection (a).</text>
</paragraph></subsection><subsection id="H10DAD77E97064618BE79D752E6AD9EE4"><enum>(d)</enum><header>Compliance With
Standards</header><text>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).</text>
</subsection><subsection id="H3C7272BF37474DCE9E285A7B103C0DBB"><enum>(e)</enum><header>Sexual and
Gender Minority Data Collection Standards</header><text>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.</text>
</subsection><subsection id="HEB2421C880ED4BE2B49FB1FB1F900AE8"><enum>(f)</enum><header>Technical
Assistance for the Collection and Reporting of Data</header>
<paragraph id="H95C02BB5169140D489459C8B4392D417"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph id="HAAE32DE1FF3746C992B2CB36190F81B2"><enum>(2)</enum><header>Types of
assistance</header><text>Assistance provided under this subsection may include
assistance to—</text>
<subparagraph id="HDFE019CCFC844F9A81297BBF206D9444"><enum>(A)</enum><text>enhance or upgrade
computer technology that will facilitate sexual and gender minority data
collection and analysis;</text>
</subparagraph><subparagraph id="H9A467B676056416E9C8F555560F03432"><enum>(B)</enum><text>develop mechanisms
for submitting collected data subject to existing privacy and confidentiality
regulations; and</text>
</subparagraph><subparagraph id="H5AB971424244480182EE033107F9AFC7"><enum>(C)</enum><text>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.</text>
</subparagraph></paragraph></subsection><subsection id="H73ED536523794342A2E8C9B9C24E1CA7"><enum>(g)</enum><header>Analysis of
sexual and gender minority health data</header><text>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—</text>
<paragraph id="H1AE364F1CEBF43D594809CB172A2DD7B"><enum>(1)</enum><text>identifying
appropriate quality assurance mechanisms to monitor for health
disparities;</text>
</paragraph><paragraph id="H09DAF3CECA024E6B9F043BA88A8621F6"><enum>(2)</enum><text>specifying the
clinical, diagnostic, or therapeutic measures which should be monitored;</text>
</paragraph><paragraph id="H3FE732ECF8F54B4483B79CDA3D8DB9D4"><enum>(3)</enum><text>developing new
quality measures relating to sexual and gender minority disparities in health
and health care;</text>
</paragraph><paragraph id="H709BCC908E674432960BE0E1C086B826"><enum>(4)</enum><text>identifying the
level at which data analysis should be conducted; and</text>
</paragraph><paragraph id="H7DD36263CAF14E10A5B3DBD4A023CB02"><enum>(5)</enum><text>sharing data with
external organizations for research and quality improvement purposes.</text>
</paragraph></subsection><subsection id="H9F68D39AE2944F95B54B080FE8FF774A"><enum>(h)</enum><header>Report</header><text>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.</text>
</subsection><subsection id="H91D34D8DDA9E43B5B371796CB37FD965"><enum>(i)</enum><header>Definition</header><text>In
this section, the term <term>health-related program</term> means a
program—</text>
<paragraph id="H8E0205EBAAF84AB782B73695BE20733D"><enum>(1)</enum><text>under the Social
Security Act (42 U.S.C. 301 et seq.) that pays for health care and services;
and</text>
</paragraph><paragraph id="H136608F9E087422B906B0848409E93EC"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><subsection id="H0E40FE1F39D143D79FFFEE746D913D72"><enum>(j)</enum><header>Authorization of
Appropriations</header><text>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.</text>
</subsection></section><section id="H8CAAF356EBDC4582B954C1F02021FCBB"><enum>303.</enum><header>Inclusion of
sexual orientation and gender identity in federally funded health
surveys</header><text display-inline="no-display-inline">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—</text>
<paragraph id="HD65C202E7F9442569E3E9CC11A197177"><enum>(1)</enum><text>collection and
reporting of data by sexual and gender identity, using tested methods for doing
this with the greatest possible accuracy; and</text>
</paragraph><paragraph id="H1AF30B0060964100AC4BCD44911DA0D8"><enum>(2)</enum><text>development of a
standard question to be included on such surveys which includes information as
to the individual’s sexual orientation and gender identity.</text>
</paragraph></section><section id="HD12DE9A2AE234807B29A2E3D24893FBF"><enum>304.</enum><header>Research on
sexual and gender minority health</header>
<subsection id="HC906A26FA4154178B07AB5F3A473CC28"><enum>(a)</enum><header>In
general</header><text>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—</text>
<paragraph id="HD61B117DE8B640DEAAFF7A2BF9CDA457"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph id="HE29C19004C3B433EA7497E0B787A6461"><enum>(2)</enum><text>establish
measurable goals and objectives which will allow assessment of progress;
and</text>
</paragraph><paragraph id="H1A03EB30E85A4E8DB48A102DE0573EE4"><enum>(3)</enum><text>solicit public
review and comment from experts in health disparities experienced by sexual and
gender minorities.</text>
</paragraph></subsection><subsection id="H4412AC01206848CC8C3CB43B911C1858"><enum>(b)</enum><header>Establishment of
grants</header><text>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.</text>
</subsection><subsection id="HD84AF40CD70D4EF39268A1EE9BEA66F2"><enum>(c)</enum><header>Application;
eligible entities</header>
<paragraph id="H48984D1E1EF54B2787703F3273403203"><enum>(1)</enum><header>Application</header><text>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.</text>
</paragraph><paragraph id="H97B98BD872724CF6B035F0B502ED655C"><enum>(2)</enum><header>Eligible
entities</header><text>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—</text>
<subparagraph id="HBD3CB1E14FAD44398A8177D34563A959"><enum>(A)</enum><text>serves a
disproportionate percentage of patients from sexual or gender minority groups;
and</text>
</subparagraph><subparagraph id="H5B98552D47A444DFA2A469D7D1609A33"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph id="H71247039D849451BA8C6EFAC93574036"><enum>(3)</enum><header>Preference</header><text>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.</text>
</paragraph></subsection><subsection id="H4BD011DC91A64DB58D6FA4E2B2DB76E4"><enum>(d)</enum><header>Research</header><text>The
research funded under this section, with respect to sexual and gender minority
groups, shall—</text>
<paragraph id="HD8EFB69D9177411EBEA399A452A1248C"><enum>(1)</enum><text>prioritize the
translation of existing research into practical interventions for improving
health and health care and reducing disparities; and</text>
</paragraph><paragraph id="H8C133ED0811440828218E03B955DFC92"><enum>(2)</enum><text>include a focus on
community-based participatory research solutions and partnerships as
appropriate.</text>
</paragraph></subsection><subsection id="H561192A17C684F25911485CFB758DB13"><enum>(e)</enum><header>Dissemination of
research findings</header><text>To ensure that findings from the research
funded under this section are disseminated and applied promptly, the Director
shall—</text>
<paragraph id="HACE316A1C9C94B07A652C0ADBE74D956"><enum>(1)</enum><text>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</text>
</paragraph><paragraph id="HEEB53172DBAF4FBD9129B663814D9357"><enum>(2)</enum><text>provide technical
assistance for the implementation of evidence-based practices that will improve
health and health care and reduce disparities.</text>
</paragraph></subsection><subsection id="H968A2FD8037E4952B4E0C6828292297F"><enum>(f)</enum><header>Report</header>
<paragraph id="H6A6286B54C2C4FD088376319A82CBFAE"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">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.</text>
</paragraph><paragraph id="H17E092C989BB41F599F6925BABCC21EF"><enum>(2)</enum><header>Availability</header><text>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.</text>
</paragraph></subsection></section><enum>IV</enum><header>Infrastructure
and Capacity Building</header>
<section id="H9B9EE2FAD7BA4F28BEC4AAB557A3ECF6"><enum>401.</enum><header>Office of LGBT
Health</header><text display-inline="no-display-inline">Title XVII of the
Public Health Service Act (42 U.S.C. 300u et seq.) is amended by inserting
after section 1707 the following:</text>
<quoted-block display-inline="no-display-inline" id="HB0257AC2B3D04A89A1DE02AEE0ABFA2B" style="OLC">
<section id="HC22F6E19130F4DA28CB04CDF59C9EA00"><enum>1707A.</enum><header>Office of
LGBT Health</header>
<subsection id="H73BBC93EAC844BF393A4DAC0D43921DC"><enum>(a)</enum><header>Establishment</header><text display-inline="yes-display-inline">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 <quote>Office</quote>), which Office shall be
headed by a Deputy Assistant Secretary for LGBT Health, appointed by the
Secretary.</text>
</subsection><subsection id="H27B9DD2AF09043CB914850FAB1222884"><enum>(b)</enum><header>Duties</header><text>The
Deputy Assistant Secretary for LGBT Health shall—</text>
<paragraph id="H88FF814916B948D690084980364262A8"><enum>(1)</enum><text>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;</text>
</paragraph><paragraph id="HD4BB19A5D4944722B1618F8599740054"><enum>(2)</enum><text>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</text>
</paragraph><paragraph id="HF036ECA36CF3478597E424F55D2D11DB"><enum>(3)</enum><text>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.</text>
</paragraph></subsection><subsection id="H4EF8D7DEF6D44174A66D76D34F3B8988"><enum>(c)</enum><header>Definition</header><text display-inline="yes-display-inline">In this section, the term <term>sexual and
gender minorities</term> means lesbian, gay, bisexual, and transgender
individuals.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="H5F14EE1A1C064A5888C8B7E279CC46B5"><enum>402.</enum><header>Community
health centers</header><text display-inline="no-display-inline">Section 330 of
the Public Health Services Act (42 U.S.C. 254b) is amended—</text>
<paragraph id="H535447A06FEC429A9BBFCD614E5B7679"><enum>(1)</enum><text>in subsection
(a)(2), by striking <quote>or (i)</quote> and inserting <quote>(i), or
(r)</quote>;</text>
</paragraph><paragraph id="H4776451061CA478BA0A7AB7D00B518C6"><enum>(2)</enum><text>in the matter
following clause (iii) in subsection (k)(3)(H), by striking <quote>or
(p)</quote> and inserting <quote>(p), or (r)</quote>;</text>
</paragraph><paragraph id="HF3460BAC1E98433A005B1C00FCBFF268"><enum>(3)</enum><text>by redesignating
subsection (r) as subsection (s); and</text>
</paragraph><paragraph id="H93AD324DEC37456BA19C67D9334DA694"><enum>(4)</enum><text>by inserting after
subsection (q) the following:</text>
<quoted-block display-inline="no-display-inline" id="HA99DB2424CDF4F7F8B82AC9FA27FAFBB" style="OLC">
<subsection commented="no" id="HC6B2472A7DCA4675B71089858D2798DB"><enum>(r)</enum><header>Lesbian, gay,
bisexual, and transgender population</header>
<paragraph commented="no" id="H3340CE5ECB514E55AE863BD5A611075B"><enum>(1)</enum><header>In
general</header><text>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.</text>
</paragraph><paragraph commented="no" id="H20AE41FAA90C4616B6D7569556DE869C"><enum>(2)</enum><header>Eligibility</header><text>In
order to be eligible for the grant under paragraph (1), an applicant shall
demonstrate to the Secretary that the applicant—</text>
<subparagraph commented="no" id="HDAD47AFB2DE44457925738C543D7720"><enum>(A)</enum><text>provides
comprehensive, high-quality care for the lesbian, gay, bisexual, and
transgender population;</text>
</subparagraph><subparagraph commented="no" id="HAC7BFA7F4DB74D02B8F1816244E039A2"><enum>(B)</enum><text>has specialized
knowledge of the unique needs of this population; and</text>
</subparagraph><subparagraph commented="no" id="H0A934D5BB62C497BA017B1A01536CC01"><enum>(C)</enum><text>has culturally
competent
staff.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><enum>V</enum><header>Older
Americans Support Program</header>
<section id="H7826964CA5BB4510BAD135C188CB4643"><enum>501.</enum><header>Priority</header><text display-inline="no-display-inline">Section 373(c)(2) of the Older Americans Act
of 1965 (42 U.S.C. 3030s–1(c)(2)) is amended—</text>
<paragraph id="HA15E3196DA374C45B050BA4276A39E0D"><enum>(1)</enum><text>in subparagraph
(A) by striking <quote>and</quote> at the end,</text>
</paragraph><paragraph id="H703DD79FDF4C4D9898D888C84F7157D5"><enum>(2)</enum><text display-inline="yes-display-inline">in subparagraph (B) by striking the period
at the end and inserting <quote>; and</quote>, and</text>
</paragraph><paragraph id="H261CCC9EEAA14ADBB35992EA5DC2C689"><enum>(3)</enum><text>by adding at the
end the following:</text>
<quoted-block display-inline="no-display-inline" id="H61D5CE7156434134ABBEA62564BF5A41" style="OLC">
<subparagraph id="H871C832B0316403288FD2952D48C4135"><enum>(C)</enum><text display-inline="yes-display-inline">individuals providing care to minority
individuals, including sexual and gender
minorities.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><enum>VI</enum><header>Miscellaneous
Provisions</header>
<section id="H1AA3204CF45A498ABA08BB671F2F1576"><enum>601.</enum><header>Nondiscrimination
contingency for VAWA grant funds; Grant program for LGBT victims of
violence</header>
<subsection id="HA6691FA012284171AF5B215CC8BF4D4D"><enum>(a)</enum><header>Nondiscrimination
contingency for VAWA grant funds</header><text display-inline="yes-display-inline">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:</text>
<quoted-block display-inline="no-display-inline" id="H943E04E2B54749DE9D73E9B5C438CCDB" style="OLC">
<paragraph id="HFF068D5205A64063BD4BE55E0ADD1802"><enum>(12)</enum><header>Nondiscrimination
contingency</header><text display-inline="yes-display-inline">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.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H4EB53C50022C4B21B92D4D858C8A5D6C"><enum>(b)</enum><header>Grant program
for LGBT victims of violence</header>
<paragraph id="H33E5CAB6DEF24268A260AD954DC9E68A"><enum>(1)</enum><header>Grants
Authorized</header><text>The Attorney General may award grants to eligible
entities described in paragraph (4)—</text>
<subparagraph id="H675A441FD44F48659397D64482623785"><enum>(A)</enum><text display-inline="yes-display-inline">to provide services for LGBT victims of
violence, as defined in paragraph (3);</text>
</subparagraph><subparagraph id="H4F3D134DA92742C4AFC7ED861BF9E0F0"><enum>(B)</enum><text display-inline="yes-display-inline">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;</text>
</subparagraph><subparagraph id="H3422D7C253E04457825168F6A44D2E4E"><enum>(C)</enum><text display-inline="yes-display-inline">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</text>
</subparagraph><subparagraph id="H819A3EB096C54DD3BBD29F5ABC5372D0"><enum>(D)</enum><text>for
multidisciplinary collaborative community responses to such victims.</text>
</subparagraph></paragraph><paragraph id="HBE78E403B04546AD8FDF8F5F10204B81"><enum>(2)</enum><header>Use of
Funds</header><text>Grants awarded under this subsection may be used—</text>
<subparagraph id="H5873FBEA8A674D96A94D98DD75CD3D8B"><enum>(A)</enum><text display-inline="yes-display-inline">to implement or expand programs or services
to respond to the needs of LGBT victims of violence;</text>
</subparagraph><subparagraph id="H63531A1A8D4744E18478CFAE92C1D91A"><enum>(B)</enum><text display-inline="yes-display-inline">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;</text>
</subparagraph><subparagraph id="HB395E810DE364653BD5146A29940BF46"><enum>(C)</enum><text>to conduct
outreach activities to ensure that LGBT victims of violence receive appropriate
assistance;</text>
</subparagraph><subparagraph id="HDA305086A10C4816AA6A25B969915272"><enum>(D)</enum><text display-inline="yes-display-inline">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;</text>
</subparagraph><subparagraph id="H62BC9882498248338283C77D2B2826D4"><enum>(E)</enum><text display-inline="yes-display-inline">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;</text>
</subparagraph><subparagraph id="HF25BDE9203D84868A9B972CDB73B40F3"><enum>(F)</enum><text display-inline="yes-display-inline">to provide advocacy and intervention
services for LGBT victims of violence; and</text>
</subparagraph><subparagraph id="H52232050A0FF4E2EA64A7EC89B9AF596"><enum>(G)</enum><text display-inline="yes-display-inline">to develop model programs providing
advocacy and intervention services within organizations serving LGBT victims of
violence.</text>
</subparagraph></paragraph><paragraph id="H4C6F3EE95053404086DC7372BD3D60DE"><enum>(3)</enum><header>LGBT victims of
violence defined</header><text display-inline="yes-display-inline">For purposes
of this subsection, the term <term>LGBT victim of violence</term> 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.</text>
</paragraph><paragraph id="HAFEC668536544DFBBA8D73AA563AD65C"><enum>(4)</enum><header>Eligible
Entities</header>
<subparagraph id="H5427F6C8614A4707BAA5B3FF423F205B"><enum>(A)</enum><header>In
general</header><text>An entity shall be eligible to receive a grant under this
subsection if the entity is—</text>
<clause id="H2ED5B30DB6774CC482DECBC6173881F1"><enum>(i)</enum><text>a
State;</text>
</clause><clause id="H424C1FAE8D6B4166809ED0B123B2326C"><enum>(ii)</enum><text>a
unit of local government;</text>
</clause><clause id="H3EA8091573F94A73B3134AAAF33406B1"><enum>(iii)</enum><text>a
nonprofit, nongovernmental organization such as a victim services organization,
an organization serving individuals with disabilities or a community-based
organization; or</text>
</clause><clause id="HD353BB609526471DBF91BECFA8B39247"><enum>(iv)</enum><text>a
religious organization.</text>
</clause></subparagraph><subparagraph commented="no" id="H4FA4EA7CC44E44518691CDDF35EF4D76"><enum>(B)</enum><header>Nondiscrimination</header><text display-inline="yes-display-inline">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.</text>
</subparagraph></paragraph><paragraph id="HC04401FFE61D446884ECFE981AA71021"><enum>(5)</enum><header>Application</header><text>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.</text>
</paragraph><paragraph id="HD1E4D0B3CFBB4D58B5B85FB247DC7DEB"><enum>(6)</enum><header>Reporting</header><text>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.</text>
</paragraph><paragraph id="H450F79F924854B1BBB70B3A5CAB856F8"><enum>(7)</enum><header>Authorization of
Appropriations</header><text>There are authorized to be appropriated $5,000,000
for each of the fiscal years 2010 through 2014 to carry out this
subsection.</text>
</paragraph></subsection></section><section id="HE822ADA3C01F4629A46F1CA4577240D0"><enum>602.</enum><header>National
Baseline Study on Domestic Violence and Sexual Assault in the LGBT
Community</header>
<subsection id="HA9CC8383C5854158B0318DAE191C965A"><enum>(a)</enum><header>Study</header><text display-inline="yes-display-inline">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.</text>
</subsection><subsection id="H42BD49417E2A43B9B4AF967C41238D94"><enum>(b)</enum><header>Report</header><text>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—</text>
<paragraph id="HE5C1B602024243D9819003FB0CC5802C"><enum>(1)</enum><text>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);</text>
</paragraph><paragraph id="H0D41C0464BE2437F8BA551F4D7B0EC22"><enum>(2)</enum><text>Federal and State
laws or regulations pertaining specifically to sexual assaults involving sexual
and gender minorities; and</text>
</paragraph><paragraph id="H40C6FD44C6A6438B876CE36311DC1420"><enum>(3)</enum><text>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.</text>
</paragraph></subsection><subsection id="HE5EED2276C944B94B9915F68E97A77EC"><enum>(c)</enum><header>Authorization of
appropriations</header><text>There is authorized to be appropriated to carry
out this section $500,000 for fiscal year 2010.</text>
</subsection></section><section id="HD55F8AFE2F2F41958B20B73F852F049C"><enum>603.</enum><header>Assistance to
reduce teen pregnancy, HIV/AIDS, and other sexually transmitted diseases and to
support healthy adolescent development</header>
<subsection id="HE453F6021C7C44F48B4DC8197F266ADC"><enum>(a)</enum><header>In
General</header><text>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.</text>
</subsection><subsection id="H4D041F4E84D847C2B31BF1D5F917DA36"><enum>(b)</enum><header>Requirements for
Sex Education Programs</header><text>A program of sex education described in
this subsection is a program that—</text>
<paragraph id="HC26B932E0B9C4C4494371A59B5469B9A"><enum>(1)</enum><text>is age appropriate
and medically accurate;</text>
</paragraph><paragraph id="H803630FDE1E44D338C202356632E4EE0"><enum>(2)</enum><text>stresses the value
of abstinence while not ignoring those young people who have been or are
sexually active;</text>
</paragraph><paragraph id="H26706BE848704E2FA96F1FB8BF59875E"><enum>(3)</enum><text>provides
information about the health benefits and side effects of contraceptive and
barrier methods used—</text>
<subparagraph id="H76515D0BD6A64B9D870D34571670B50C"><enum>(A)</enum><text>as a means to
prevent pregnancy; and</text>
</subparagraph><subparagraph id="H4F6E08E79B5C492299BFAD8B0BF46480"><enum>(B)</enum><text>to reduce the risk
of contracting sexually transmitted disease, including HIV/AIDS;</text>
</subparagraph></paragraph><paragraph id="H6247CCCCB2D04AD98475B1025DE52A5B"><enum>(4)</enum><text>encourages family
communication between parent and child about sexuality;</text>
</paragraph><paragraph id="H53889B0242C642A79FF3B87D9D253D9F"><enum>(5)</enum><text>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;</text>
</paragraph><paragraph id="H50E87B5A8A3C45CDA988C156D9852E51"><enum>(6)</enum><text>counters the
perpetuation of narrow gender roles, including the sexualization of female
children, adolescents, and adults;</text>
</paragraph><paragraph id="H5DCF1132766E4B0586E8A9C410EAA5B3"><enum>(7)</enum><text>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;</text>
</paragraph><paragraph id="H300FCF15BA824168AAA06CB309A24757"><enum>(8)</enum><text>develops healthy
relationships, including the prevention of dating and sexual violence;</text>
</paragraph><paragraph id="HEBDFC273DCE84E30A3A1B98D348D3F2D"><enum>(9)</enum><text>teaches young
people how alcohol and drug use can affect responsible decisionmaking;
and</text>
</paragraph><paragraph id="HC23DF177AD384DA8863A07D1A1B1E67C"><enum>(10)</enum><text>does not teach or
promote religion.</text>
</paragraph></subsection><subsection id="H3FE1FE85CC5D4967B56C4AADE024AD4D"><enum>(c)</enum><header>Additional
Activities</header><text>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—</text>
<paragraph id="HE60147743CA549359249E28C30ACD5F2"><enum>(1)</enum><text>gain knowledge
about the physical, emotional, biological, and hormonal changes of adolescence
and subsequent stages of human maturation;</text>
</paragraph><paragraph id="HF47644A11F724280AE3C7D55FCF4A7B6"><enum>(2)</enum><text>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;</text>
</paragraph><paragraph id="H8D9E2FB4F48A48FE8E76A6D22156D36F"><enum>(3)</enum><text>gain knowledge
about the specific involvement and responsibility of each individual in sexual
decisionmaking;</text>
</paragraph><paragraph id="H32540E24B8A7451FAF7585C70C5F72EC"><enum>(4)</enum><text>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;</text>
</paragraph><paragraph id="HF18CE063A0854375BED881E1F0F33268"><enum>(5)</enum><text>develop and
practice healthy life skills including goal-setting, decisionmaking,
negotiation, communication, and stress management; and</text>
</paragraph><paragraph id="HAB2C2BEC3F9D44FFA3391BEBBF856D07"><enum>(6)</enum><text>promote
self-esteem and positive interpersonal skills focusing on relationship
dynamics, including friendships, dating, romantic involvement, marriage, and
family interactions.</text>
</paragraph></subsection><subsection commented="no" id="H1DA3B4550E534081A6EA795197DEC0C6"><enum>(d)</enum><header>Matching
funds</header><text display-inline="yes-display-inline">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.</text>
</subsection><subsection id="HC30F6012D5F2467AAFD2EDA36DE92BF9"><enum>(e)</enum><header>Evaluation of
programs</header>
<paragraph id="HA2289BAEAE35419F879EA15A7871F5F4"><enum>(1)</enum><header>In
General</header><text>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).</text>
</paragraph><paragraph id="H58916DB14C7E467FB8ED3D6060D06820"><enum>(2)</enum><header>National
Evaluation</header>
<subparagraph id="H6DB0F5082A314E31B4D784E335646217"><enum>(A)</enum><header>Method</header><text>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—</text>
<clause id="H5B97330BBF5A40BC8016007A41F6EE39"><enum>(i)</enum><text>the
effectiveness of such programs in helping to delay the initiation of sexual
intercourse and other high-risk behaviors;</text>
</clause><clause id="H196FA9536F3A496A8E0C10C9817EDB14"><enum>(ii)</enum><text>the
effectiveness of such programs in preventing adolescent pregnancy;</text>
</clause><clause id="H82D81F30251741D5950EF7729932519D"><enum>(iii)</enum><text>the
effectiveness of such programs in preventing sexually transmitted disease,
including HIV/AIDS;</text>
</clause><clause id="HA9F2A1A38C904B98A07AA033DC8B87E1"><enum>(iv)</enum><text>the
effectiveness of such programs in increasing contraceptive knowledge and
contraceptive behaviors when sexual intercourse occurs; and</text>
</clause><clause id="H4D69418C4D8A49F090C0D6DCCF767E2B"><enum>(v)</enum><text>a
list of best practices based upon essential programmatic components of
evaluated programs that have led to success described in clauses (i) through
(iv).</text>
</clause></subparagraph><subparagraph id="H254C19653C274DDB85637BE76CC89375"><enum>(B)</enum><header>Grant
condition</header><text>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).</text>
</subparagraph><subparagraph id="HE67B31C00C2E4D5EB62FA596262BECC4"><enum>(C)</enum><header>Report</header><text>The
Secretary shall submit to the Congress—</text>
<clause id="H89064E9E849640C1A5E5635C30867D5A"><enum>(i)</enum><text>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</text>
</clause><clause id="H4D13C0C54EB04BA9A3FFE366FA225281"><enum>(ii)</enum><text>not
later than March 31, 2015, a final report providing the results of such
national evaluation.</text>
</clause></subparagraph></paragraph><paragraph id="H027B197641614DA18D71AF9D9E11069A"><enum>(3)</enum><header>Individual State
Evaluations</header><text display-inline="yes-display-inline">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:</text>
<subparagraph id="HF46B98A19CC443F0AF8024CCC751858F"><enum>(A)</enum><text>The evaluation
will be conducted by an external, independent entity.</text>
</subparagraph><subparagraph id="HF660C8049D3C4B3089C550569B097CF7"><enum>(B)</enum><text>The purposes of
the evaluation will be the determination of—</text>
<clause id="H2BCFF4B0CC7C4DBF9AFD72A80584DB3C"><enum>(i)</enum><text>the
effectiveness of such programs in helping to delay the initiation of sexual
intercourse and other high-risk behaviors;</text>
</clause><clause id="HC93C469100914EDD9FE5EC27F680F298"><enum>(ii)</enum><text>the
effectiveness of such programs in preventing adolescent pregnancy;</text>
</clause><clause id="H2A149F9EAD4B4A00B4B92E6B6A8A1DC2"><enum>(iii)</enum><text>the
effectiveness of such programs in preventing sexually transmitted disease,
including HIV/AIDS; and</text>
</clause><clause id="HB4C2EAFCBD52451DBC3A0402FBA0619B"><enum>(iv)</enum><text display-inline="yes-display-inline">the effectiveness of such programs in
increasing contraceptive and barrier method knowledge and contraceptive
behaviors when sexual intercourse occurs.</text>
</clause></subparagraph></paragraph></subsection><subsection id="H13867E956A6F480EA78F30CBC68B1156"><enum>(f)</enum><header>Limitations on
use of funds</header>
<paragraph id="HEE5EFF24F23D49689ACAE3CDEDC8DBD3"><enum>(1)</enum><header>Limitations on
Secretary</header><text>Of the amounts appropriated for a fiscal year for
purposes of this section, the Secretary may not use more than—</text>
<subparagraph id="H10DB36DA077F44C2B2E9CB9E554E73E4"><enum>(A)</enum><text>7 percent of such
amounts for administrative expenses related to carrying out this section for
that fiscal year; and</text>
</subparagraph><subparagraph id="HB4F8F2EABE2049EBAE53E963FF33911D"><enum>(B)</enum><text>10 percent of such
amounts for the national evaluation under subsection (e)(2).</text>
</subparagraph></paragraph><paragraph id="HB8A72FA1B7FD466DACD970E1130744D9"><enum>(2)</enum><header>Limitations to
states</header><text>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).</text>
</paragraph></subsection><subsection id="HC4EDAB17F6F543C29A546CC7C3E1B8F1"><enum>(g)</enum><header>Nondiscrimination
required</header><text>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.).</text>
</subsection><subsection id="H1922558222DC4C5695CEE3F51332198D"><enum>(h)</enum><header>Definitions</header><text>For
purposes of this section:</text>
<paragraph id="HE0785993781B4A45B5C49F2BC194F431"><enum>(1)</enum><text>The term <term>age
appropriate</term> 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.</text>
</paragraph><paragraph id="H54A3D0B5937F4D78834916E6AAFCFB37"><enum>(2)</enum><text>The term
<term>eligible State</term> 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.</text>
</paragraph><paragraph id="H8F734E0F3E4E446F8E3F6A86FD80F021"><enum>(3)</enum><text>The term
<term>HIV/AIDS</term> means the human immunodeficiency virus, and includes
acquired immune deficiency syndrome.</text>
</paragraph><paragraph id="H7D9A1C0C2CFB498899FDF52357007CE6"><enum>(4)</enum><text display-inline="yes-display-inline">The term <term>medically accurate</term>,
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.</text>
</paragraph><paragraph id="H65D0E4BB0C9B464B979B10928BF8E0A1"><enum>(5)</enum><text>The term
<term>State</term> 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.</text>
</paragraph></subsection><subsection id="H9138ADB3E0AC45EC9F42E864BA9F9E10"><enum>(i)</enum><header>Authorization of
appropriations</header><text>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.</text>
</subsection></section><section display-inline="no-display-inline" id="HF4A46A281CBA427AA621DC7A036C896B" section-type="subsequent-section"><enum>604.</enum><header>Mother's and
father's insurance benefits under Social Security for same-sex surviving
parents</header>
<subsection id="HC6ED6BE4AA5646EFB355FA0ADEB08765"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 202(g)(1) of
the Social Security Act (42 U.S.C. 402(g)(1)) is amended—</text>
<paragraph id="H0184F21B3E7648A181A5229CF1F1D904"><enum>(1)</enum><text display-inline="yes-display-inline">by striking <quote>and every surviving
divorced parent (as defined in section 216(d))</quote> and inserting <quote>,
every surviving divorced parent (as defined in section 216(d)), and every
surviving same-sex parent (as defined in section 216(m))</quote>; and</text>
</paragraph><paragraph id="HD810E3DD17DE44F88B4FCE739B59B567"><enum>(2)</enum><text display-inline="yes-display-inline">in the matter before subparagraph (A), by
striking <quote>or surviving divorced parent</quote> and inserting <quote>,
surviving divorced parent, or surviving same-sex parent</quote>.</text>
</paragraph></subsection><subsection id="H41788851FDE74AB297907829E2D8848F"><enum>(b)</enum><header>Conforming
amendments</header>
<paragraph id="H028A1479EB5C4534BA88CF48698DE1CC"><enum>(1)</enum><text>Section 202(g)(1)
of such Act is amended—</text>
<subparagraph id="HA57454751CAD46E29C6771485A92E146"><enum>(A)</enum><text>in subparagraph
(F), by inserting <quote>or surviving same-sex parent</quote> after
<quote>surviving divorced parent</quote>; and</text>
</subparagraph><subparagraph id="H13729AC65CA24F0F98530A8327B3B178"><enum>(B)</enum><text>in the matter
following subparagraph (F)—</text>
<clause id="HCE27F4654BA14CE6BA9C8AA8386C58A7"><enum>(i)</enum><text>by
striking <quote>or surviving divorced parent</quote> and inserting <quote>,
such surviving divorced parent, or such surviving same-sex
parent</quote>;</text>
</clause><clause id="H1C4193F6726C40F69DFE3B4B16D6CF10"><enum>(ii)</enum><text>by
inserting <quote>or a surviving same-sex parent</quote> after <quote>in the
case of a surviving divorced parent</quote>; and</text>
</clause><clause id="HE20F4D1EDF894286B2F0175D0E295852"><enum>(iii)</enum><text>by
inserting <quote>or such surviving same-sex parent</quote> after <quote>adopted
child of such surviving divorced parent</quote>.</text>
</clause></subparagraph></paragraph><paragraph id="H3043BF2B5EB44833B636B4DCBFC353F0"><enum>(2)</enum><text>Section 202(g)(3)
of such Act is amended by striking <quote>or surviving divorced parent</quote>
each place it appears and inserting <quote>, surviving divorced parent, or
surviving same-sex parent</quote>.</text>
</paragraph></subsection><subsection id="H551D8E7121A14D58B3A8A547B1EFB0CC"><enum>(c)</enum><header>Surviving
same-sex parent</header><text>Section 216 of the Social Security Act (42 U.S.C.
416) is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HE08D907A06F0418CAFB66AC20FA1EA7B" other-style="archaic" style="other">
<subsection id="HBDF637CC213C47A69A1209E0A12A8547"><enum>(m)</enum><header>Surviving same-sex parent</header><paragraph commented="no" display-inline="yes-display-inline" id="H2D0464DAED3B4E5BBE9D49DE25F7FE83"><enum>(1)</enum><text>The term <term>surviving
same-sex parent</term> means, with respect to a deceased individual, an
individual who is of the same sex as such deceased individual but only
if—</text>
<subparagraph id="H45A62703ECD940589EE395B1FE2184E4" indent="up1"><enum>(A)</enum><text display-inline="yes-display-inline">he
or she is the mother or father of the individual’s child;</text>
</subparagraph><subparagraph id="HEE241942E0784A9BBE1E2C4E7A747C10" indent="up1"><enum>(B)</enum><text>such individual legally adopted the
deceased individual's son or daughter before such son or daughter attained the
age of 18;</text>
</subparagraph><subparagraph id="HD93A89699EEC40E9BC2C59AC83BB17CA" indent="up1"><enum>(C)</enum><text>the deceased individual legally
adopted the son or daughter of such individual before such son or daughter
attained the age of 18; or</text>
</subparagraph><subparagraph id="H9920C28888BF4560B702063F5C090D74" indent="up1"><enum>(D)</enum><text>such individual and the deceased
individual both legally adopted a child under the age of 18.</text>
</subparagraph></paragraph><paragraph id="HA40097C2F99C4AD69411FB4E35E140CF" indent="up1"><enum>(2)</enum><text>Determinations under this subsection
and section 202(g) shall be made without regard to section 7 of title 1, United
States
Code.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H636E08FB707F4C37B7ECB7CC1D163D6D"><enum>(d)</enum><header>Special marriage
rule for surviving same-sex parents</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="HFDCA7E53EF394C91A1555B37D09CAC56" style="OLC">
<paragraph id="H99CF9702898A4BD1A1DFFC76D280B3D0" indent="up1"><enum>(4)</enum><text>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.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H0E27AC486C974201AB775FA0DC7C360D"><enum>(e)</enum><header>Effective
date</header><text>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.</text>
</subsection></section><section id="H2E9DBB95076347D199D7EF8A74A981C3"><enum>605.</enum><header>Prohibition
against discrimination on the basis of sexual orientation or gender identity
under the health benefits program for Federal employees</header>
<subsection id="H0D82810ED91446A8AEB03C0659C5149A"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 8902(f) of
title 5, United States Code, is amended by inserting <quote>sexual orientation,
gender identity,</quote> after <quote>sex,</quote>.</text>
</subsection><subsection id="H6C7FF4682C6C44E383367D47B643E82A"><enum>(b)</enum><header>Regulations</header><text>Section
8913 of such title is amended—</text>
<paragraph id="HCA345B5D6EE34AB895E70A39464C3389"><enum>(1)</enum><text>by redesignating
subsection (d) as subsection (e); and</text>
</paragraph><paragraph id="HB1B111AC583244EAB8095B61709D17EC"><enum>(2)</enum><text>by inserting after
subsection (c) the following:</text>
<quoted-block display-inline="no-display-inline" id="H0AF308BDF4D0405B84BE779E1BB04F23" style="USC">
<subsection id="HCE7F11543FEA4EF3819CCFBFB79C3DCC"><enum>(d)</enum><text display-inline="yes-display-inline">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.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection></section><section id="H61FA382C269C4EABAB45377AE0EA40A1"><enum>606.</enum><header>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</header>
<subsection id="H51646F02C4504C41AB0EA7F87AE5291B"><enum>(a)</enum><header>Prohibition
against discrimination in administration of medical and dental care for certain
members of the Armed Forces</header>
<paragraph id="HA0275AD8353A412D94097775B315DC05"><enum>(1)</enum><header>In
general</header><text>Chapter 55 of title 10, United States Code, is amended by
inserting after section 1074l the following new section:</text>
<quoted-block display-inline="no-display-inline" id="H77F9C548DD3D45F8B89A83044C88D8DF" style="USC">
<section id="HE0C8ABABB98A4BA4A1BB181930798920"><enum>1074m.</enum><header>Prohibition
against discrimination on the basis of sex, gender identity, or sexual
orientation</header>
<subsection id="HE8F627FAB22B433A85325A297954538F"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">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.</text>
</subsection><subsection id="H5FDD761352AA47C798531DAE97CAE8FB"><enum>(b)</enum><header>Regulations</header><text display-inline="yes-display-inline">The Secretary of Defense, in consultation
with the other administering Secretaries, shall prescribe regulations to carry
out this
section.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HB6D0F68D2C20458BB831E28B0A1AEA71"><enum>(2)</enum><header>Clerical
amendment</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H82ADC873E42842AFBC0042EC6E7D55A7" style="USC">
<toc regeneration="no-regeneration">
<toc-entry level="section">1074m. Prohibition against discrimination
on the basis of sex, gender identity, or sexual
orientation.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H11DF0E0EF6394F958D3446DF243E314C"><enum>(b)</enum><header>Prohibition
against discrimination in personal service contracts related to medical care
for members of the Armed Forces</header><text>Paragraph (1) of section 1091(c)
of title 10, United States Code, is amended—</text>
<paragraph id="H8B739785952A48AD8296A494956FEBB6"><enum>(1)</enum><text>in subparagraph
(A), by striking <quote>and</quote>;</text>
</paragraph><paragraph id="H21C0BFFA50034B95AC60D603D2CDEF9D"><enum>(2)</enum><text>in subparagraph
(B), by striking the period at the end and inserting <quote>; and</quote>;
and</text>
</paragraph><paragraph id="H96732B7D357A4F42860F5E10C596E49E"><enum>(3)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H1E9A3901AF3B4E1D8DE2DB0BFED26602" style="USC">
<subparagraph id="idDB4784766D9146A5AE6CF0E8110A2378" indent="up1"><enum>(C)</enum><text display-inline="yes-display-inline">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.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HE9003ADEE63A4CC6900C77C1CCC48333"><enum>(c)</enum><header>Prohibition
against discrimination in administration of veterans’ benefits</header>
<paragraph id="HC15520E4213E476A9F59AEC6A7BEB198"><enum>(1)</enum><header>In
general</header><text>Subchapter II of chapter 5 of title 38, United States
Code, is amended by adding at the end the following new section:</text>
<quoted-block display-inline="no-display-inline" id="HD775C2E6ED5A4B19BA6763B6CB3FD47D" style="USC">
<section id="HFFE5DE46A53843B2B7FFA5D3B489A43B"><enum>533.</enum><header>Prohibition
against discrimination on the basis of sex, gender identity, or sexual
orientation</header><text display-inline="no-display-inline">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.</text>
</section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H0C51AD054C9247E7B4623F78F6EE5639"><enum>(2)</enum><header>Clerical
amendment</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="HEE0284E644D94DD99119B8619EA6B788" style="USC">
<toc regeneration="no-regeneration">
<toc-entry level="section">533. Prohibition against discrimination on
the basis of sex, gender identity, or sexual
orientation.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H94B64BBE7FAD4D24B0A2678F01AB00F0"><enum>(d)</enum><header>Prohibition
against discrimination in payment of veterans’ benefits</header>
<paragraph id="H584B9C92A6B4441889EFD510A4AA23BC"><enum>(1)</enum><header>In
general</header><text>Chapter 53 of title 38, United States Code, is amended by
adding at the end the following new section:</text>
<quoted-block display-inline="no-display-inline" id="H49F697FF534049F4B986A85F96EE99BF" style="USC">
<section id="HEDCA638546C3406684F98058689CAD7F"><enum>5320.</enum><header>Prohibition
against discrimination on the basis of sex, gender, identity, or sexual
orientation in the provision and administration of benefits</header><text display-inline="no-display-inline">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.</text>
</section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HA3F79A6641304452951BF11912942201"><enum>(2)</enum><header>Clerical
amendment</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="HF6CBD573840B4DAE94BFB7704566C202" style="USC">
<toc regeneration="no-regeneration">
<toc-entry level="section">5320. Prohibition against discrimination
on the basis of sex, gender, identity, or sexual orientation in the provision
and administration of
benefits.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection></section>