Text: H.R.3001 — 111th Congress (2009-2010)All Information (Except Text)

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Introduced in House (06/23/2009)


111th CONGRESS
1st Session
H. R. 3001


To address the health disparities experienced by lesbian, gay, bisexual, and transgender Americans, to eliminate the barriers they face in accessing quality health care, and to ensure that good health and well-being is accessible to all.


IN THE HOUSE OF REPRESENTATIVES

June 23, 2009

Ms. Baldwin (for herself, Mr. Waxman, Ms. Lee of California, Mr. Honda, and Ms. Velázquez) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Armed Services, the Judiciary, Ways and Means, Oversight and Government Reform, House Administration, Education and Labor, Veterans’ Affairs, Transportation and Infrastructure, Select Intelligence (Permanent Select), and Foreign Affairs, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned


A BILL

To address the health disparities experienced by lesbian, gay, bisexual, and transgender Americans, to eliminate the barriers they face in accessing quality health care, and to ensure that good health and well-being is accessible to all.

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

SECTION 1. Short title.

This Act may be cited as the “Ending LGBT Health Disparities Act”.

SEC. 2. Table of contents.

The table of contents of this Act is as follows:


Sec. 1. Short title.

Sec. 2. Table of contents.

Sec. 3. Definition.

Sec. 4. Effective date.

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

Sec. 102. Preexisting condition exclusion patient protection.

Sec. 103. Domestic Partnership Benefits and Obligations Act.

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.

Sec. 121. Health Promotion Grants.

Sec. 122. Mental Health Promotion Grants.

Sec. 123. Health Insurance Coverage Grants.

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.

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.

Sec. 401. Office of LGBT Health.

Sec. 402. Community health centers.

Sec. 501. Priority.

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

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

Sec. 603. Assistance to reduce teen pregnancy, HIV/AIDS, and other sexually transmitted diseases and to support healthy adolescent development.

Sec. 604. Mother's and father's insurance benefits under Social Security for same-sex surviving parents.

Sec. 605. Prohibition against discrimination on the basis of sexual orientation or gender identity under the health benefits program for Federal employees.

Sec. 606. Prohibition against discrimination on the basis of sex, gender identity, or sexual orientation under certain laws providing health care and other benefits for members of the Armed Forces and Veterans.

SEC. 3. Definition.

In this Act:

(1) Unless otherwise specified, the term “Secretary” means the Secretary of Health and Human Services.

(2) The terms “sexual or gender minority” and “sexual and gender minority” mean a lesbian, gay, bisexual, or transgender individual.

SEC. 4. Effective date.

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

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

(a) Application of accident and health plans to eligible beneficiaries.—

(1) EXCLUSION OF CONTRIBUTIONS.—Section 106 of the Internal Revenue Code of 1986 (relating to contributions by employer to accident and health plans) is amended by adding at the end the following new subsection:

“(f) Coverage provided for eligible beneficiaries of employees.—

“(1) IN GENERAL.—Subsection (a) shall apply with respect to an eligible beneficiary and any qualifying child who is a dependent of the eligible beneficiary.

“(2) QUALIFYING CHILD; DEPENDENT.—For purposes of this subsection—

“(A) QUALIFYING CHILD.—The term ‘qualifying child’ has the meaning given such term by section 152(c).

“(B) DEPENDENT.—The term ‘dependent’ has the meaning given such term by section 105(b).”.

(2) EXCLUSION OF AMOUNTS EXPENDED FOR MEDICAL CARE.—The first sentence of section 105(b) of such Code (relating to amounts expended for medical care) is amended by inserting before the period the following: “and eligible beneficiary and the qualifying children of the eligible beneficiary (within the meaning of section 106(f)) with respect to the taxpayer”.

(3) PAYROLL TAXES.—

(A) Section 3121(a)(2) of such Code is amended—

(i) by inserting “, or his eligible beneficiary or any qualifying children of the eligible beneficiary,” after “his dependents” both places it appears,

(ii) by inserting “, and eligible beneficiaries and qualifying children of eligible beneficiaries (within the meaning of section 106(f)),” after “their dependents” the first place it appears, and

(iii) by inserting “, eligible beneficiaries, and qualifying children of eligible beneficiaries” after “their dependents” the second place it appears.

(B) Section 3231(e)(1) of such Code is amended—

(i) by inserting “, or his eligible beneficiary or any qualifying children of his eligible beneficiary,” after “his dependents”,

(ii) by inserting “, and eligible beneficiaries and qualifying children of eligible beneficiaries (within the meaning of section 106(f)),” after “their dependents” the first place it appears, and

(iii) by inserting “, eligible beneficiaries, and qualifying children of eligible beneficiaries” after “their dependents” the second place it appears.

(C) Section 3306(b)(2) of such Code is amended—

(i) by inserting “, or his eligible beneficiary or any qualifying children of his eligible beneficiary,” after “his dependents” both places it appears,

(ii) by inserting “, and eligible beneficiaries and qualifying children of eligible beneficiaries (within the meaning of section 106(f)),” after “their dependents” the first place it appears, and

(iii) by inserting “, eligible beneficiaries, and qualifying children of eligible beneficiaries” after “their dependents” the second place it appears.

(D) Section 3401(a) of such Code is amended by striking “or” at the end of paragraph (21), by striking the period at the end of paragraph (22) and inserting “; or”, and by inserting after paragraph (22) the following new paragraph:

“(23) for any payment made to or for the benefit of an employee or his eligible beneficiary or any qualifying children of his eligible beneficiary (within the meaning of section 106(f)) if at the time of such payment it is reasonable to believe that the employee will be able to exclude such payment from income under section 106(f) or under section 105 by reference in section 105(b) to section 106(f);”.

(4) EFFECTIVE DATE.—The amendments made by this section shall apply to taxable years beginning after December 31, 2009.

(b) Expansion of dependency for purposes of deduction for health insurance costs of self-employed individuals.—

(1) IN GENERAL.—Subsection (l) of section 162 of the Internal Revenue Code of 1986 (relating to special rules for health insurance costs of self-employed individuals) is amended by adding at the end the following new paragraph:

“(6) DEPENDENTS.—For purposes of this subsection, the term ‘dependents’ shall include the following with respect to the taxpayer—

“(A) any individual who satisfies the requirements of sections 152(c)(3)(A) and 152(d)(2)(H) (determined without regard to subsections (d)(1)(B) and (d)(1)(D) thereof), and

“(B) one individual who does not satisfy the requirements of section 152(c)(3)(A), but who satisfies the requirements of section 152(d)(2)(H) (determined without regard to subsections (d)(1)(B) and (d)(1)(C) thereof).”.

(2) CONFORMING AMENDMENT.—Subparagraph (B) of section 162(l)(2) of such Code is amended by inserting “or dependent (as defined in paragraph (1))” after “spouse”.

(3) EFFECTIVE DATE.—The amendments made by this section shall apply to taxable years beginning after December 31, 2009.

(c) Extension to eligible beneficiaries of sick and accident benefits provided to members of a voluntary employees’ beneficiary association and their dependents.—

(1) IN GENERAL.—Section 501(c)(9) of the Internal Revenue Code of 1986 (relating to list of exempt organizations) is amended by adding at the end the following new sentence: “For purposes of providing for the payment of sick and accident benefits to members of such an association and their dependents, the term ‘dependents’ shall include any individual who is an eligible beneficiary, or qualified child of an eligible beneficiary, as determined under the terms of a medical benefit, health insurance, or other program under which members and their dependents are entitled to sick and accident benefits.”.

(2) EFFECTIVE DATE.—The amendment made by this section shall apply to taxable years beginning after December 31, 2009.

(d) Flexible spending arrangements and health reimbursement arrangements.—The Secretary of Treasury shall issue guidance of general applicability providing that medical expenses that otherwise qualify—

(1) for reimbursement from a flexible spending arrangement under regulations in effect on the date of the enactment of this Act may be reimbursed from an employee’s flexible spending arrangement, notwithstanding the fact that such expenses are attributable to an individual who is the employee’s eligible beneficiary under any accident or health plan of the employer, and

(2) for reimbursement from a health reimbursement arrangement under regulations in effect on the date of the enactment of this Act may be reimbursed from an employee’s health reimbursement arrangement, notwithstanding the fact that such expenses are attributable to an individual who is not a spouse or dependent within the meaning of section 152 but who is designated by the employee as eligible to have his or her expenses reimbursed under the health reimbursement arrangement.

SEC. 102. Preexisting condition exclusion patient protection.

(a) Amendments relating to preexisting condition exclusions under group health plans.—

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

(A) REDUCTION IN LOOK-BACK PERIOD.—Section 701(a)(1) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1181(a)(1)) is amended by striking “6-month period” and inserting “30-day period”.

(B) REDUCTION IN PERMITTED PREEXISTING CONDITION LIMITATION PERIOD.—Section 701(a)(2) of such Act (29 U.S.C. 1181(a)(2)) is amended by striking “12 months” and inserting “3 months”, and by striking “18 months” and inserting “9 months”.

(2) AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.—

(A) REDUCTION IN LOOK-BACK PERIOD.—Section 2701(a)(1) of the Public Health Service Act (42 U.S.C. 300gg(a)(1)) is amended by striking “6-month period” and inserting “30-day period”.

(B) REDUCTION IN PERMITTED PREEXISTING CONDITION LIMITATION PERIOD.—Section 2701(a)(2) of such Act (42 U.S.C. 300gg(a)(2)) is amended by striking “12 months” and inserting “3 months”, and by striking “18 months” and inserting “9 months”.

(3) AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986.—

(A) REDUCTION IN LOOK-BACK PERIOD.—Paragraph (1) of section 9801(a) of the Internal Revenue Code of 1986 (relating to limitation on preexisting condition exclusion period and crediting for periods of previous coverage) is amended by striking “6-month period” and inserting “30-day period”.

(B) REDUCTION IN PERMITTED PREEXISTING CONDITION LIMITATION PERIOD.—Paragraph (2) of section 9801(a) of such Code is amended by striking “12 months” and inserting “3 months”, and by striking “18 months” and inserting “9 months”.

(4) EFFECTIVE DATE.—

(A) IN GENERAL.—Except as provided in paragraph (2), the amendments made by this subsection shall apply with respect to group health plans for plan years beginning after the end of the 12th calendar month following the date of the enactment of this Act.

(B) SPECIAL RULE FOR COLLECTIVE BARGAINING AGREEMENTS.—In the case of a group health plan maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers ratified before the date of the enactment of this Act, the amendments made by this subsection shall not apply to plan years beginning before the earlier of—

(i) the date on which the last of the collective bargaining agreements relating to the plan terminates (determined without regard to any extension thereof agreed to after the date of the enactment of this Act), or

(ii) 3 years after the date of the enactment of this Act.

For purposes of clause (i), any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement added by the amendments made by this subsection shall not be treated as a termination of such collective bargaining agreement.

(b) Amendments relating to preexisting condition exclusions in health insurance coverage in the individual market.—

(1) APPLICABILITY OF GROUP HEALTH INSURANCE LIMITATIONS ON IMPOSITION OF PREEXISTING CONDITION EXCLUSIONS.—

(A) IN GENERAL.—Subpart 1 of part B of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–41 et seq.) is amended by inserting after section 2741 the following:

“SEC. 2741A. Application of group health insurance limitations on imposition of preexisting condition exclusions.

“(a) In general.—Subject to subsection (b), a health insurance issuer that provides individual health insurance coverage may not impose a preexisting condition exclusion (as defined in subsection (b)(1)(A) of section 2701) with respect to such coverage except to the extent that such exclusion could be imposed consistent with such section if such coverage were group health insurance coverage.

“(b) Limitation.—In the case of an individual who—

“(1) is enrolled in individual health insurance coverage;

“(2) during the period of such enrollment has a condition for which no medical advice, diagnosis, care, or treatment had been recommended or received as of the enrollment date; and

“(3) seeks to enroll under other individual health insurance coverage which provides benefits different from those provided under the coverage referred to in paragraph (1) with respect to such condition,

the issuer of the individual health insurance coverage described in paragraph (2) may impose a preexisting condition exclusion with respect to such condition and any benefits in addition to those provided under the coverage referred to in paragraph (1), but such exclusion may not extend for a period of more than 3 months.

“SEC. 2741B. Eligibility to enroll.

“(a) In general.—Subject to subsection (d), an individual health plan, and a health insurance issuer offering health insurance in the individual market, may not decline to offer coverage to, deny enrollment of, or establish rules for eligibility (including continued eligibility) to enroll under the terms of the plan, an individual based on any of the following health status-related factors in relation to the individual or a dependent of the individual:

“(1) Health status.

“(2) Medical condition (including both physical and mental illnesses).

“(3) Claims experience.

“(4) Receipt of health care.

“(5) Medical history.

“(6) Genetic information.

“(7) Evidence of insurability (including conditions arising out of acts of domestic violence).

“(8) Disability.

“(b) No application to benefits or exclusions.—To the extent consistent with section 2701, subsection (a) shall not be construed—

“(1) to require an individual health plan, or a health insurance issuer offering health insurance on the individual market, to provide particular benefits other than those provided under the terms of such plan or coverage; or

“(2) to prevent such a plan or coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the plan or coverage.

“(c) Rules for eligibility.—In subsection (a), the term ‘rules for eligibility’, with respect to enrollment under the terms of a plan, includes any rule defining any applicable waiting period for such enrollment.

“(d) In premium contributions.—

“(1) IN GENERAL.—An individual health plan, and a health insurance issuer offering health insurance on the individual market, may not require any individual (as a condition of enrollment or continued enrollment under the plan) to pay a premium or contribution which is greater than such premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health status-related factor in relation to the individual or to an individual enrolled under the plan as a dependent of the individual.

“(2) CONSTRUCTION.—Nothing in subsection (a) shall be construed to prevent an individual health plan, and a health insurance issuer offering health insurance on the individual market from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.”.

(B) ELIMINATION OF COBRA REQUIREMENT.—Subsection (b) of section 2741 of the Public Health Service Act (42 U.S.C. 300gg–41) is amended—

(i) by adding “and” at the end of paragraph (2);

(ii) by striking the semicolon at the end of paragraph (3) and inserting a period; and

(iii) by striking paragraphs (4) and (5).

(2) EFFECTIVE DATE.—The amendments made by this subsection shall apply with respect to health insurance coverage offered, sold, issued, renewed, in effect, or operated in the individual market after the end of the 12th calendar month following the date of the enactment of this Act.

SEC. 103. Domestic Partnership Benefits and Obligations Act.

(a) Benefits to domestic partners of Federal employees.—

(1) IN GENERAL.—An employee who has a domestic partner and the domestic partner of the employee shall be entitled to benefits available to, and shall be subject to obligations imposed upon, a married employee and the spouse of the employee.

(2) CERTIFICATION OF ELIGIBILITY.—In order to obtain benefits and assume obligations under this section, an employee shall file an affidavit of eligibility for benefits and obligations with the Office of Personnel Management identifying the domestic partner of the employee and certifying that the employee and the domestic partner of the employee—

(A) are each other’s sole domestic partner and intend to remain so indefinitely;

(B) have a common residence, and intend to continue the arrangement;

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

(D) share responsibility for a significant measure of each other’s common welfare and financial obligations;

(E) are not married to or domestic partners with anyone else;

(F) are same sex domestic partners, and not related in a way that, if the 2 were of the opposite sex, would prohibit legal marriage in the State in which they reside; and

(G) understand that willful falsification of information within the affidavit may lead to disciplinary action and the recovery of the cost of benefits received related to such falsification and may constitute a criminal violation.

(3) DISSOLUTION OF PARTNERSHIP.—

(A) IN GENERAL.—An employee or domestic partner of an employee who obtains benefits under this section shall file a statement of dissolution of the domestic partnership with the Office of Personnel Management not later than 30 days after the death of the employee or the domestic partner or the date of dissolution of the domestic partnership.

(B) DEATH OF EMPLOYEE.—In a case in which an employee dies, the domestic partner of the employee at the time of death shall receive under this section such benefits as would be received by the widow or widower of an employee.

(C) OTHER DISSOLUTION OF PARTNERSHIP.—

(i) IN GENERAL.—In a case in which a domestic partnership dissolves by a method other than death of the employee or domestic partner of the employee, any benefits received by the domestic partner as a result of this section shall terminate.

(ii) EXCEPTION.—In a case in which a domestic partnership dissolves by a method other than death of the employee or domestic partner of the employee, the former domestic partner of the employee shall be entitled to benefits available to, and shall be subject to obligations imposed upon, a former spouse.

(4) STEPCHILDREN.—For purposes of affording benefits under this section, any natural or adopted child of a domestic partner of an employee shall be deemed a stepchild of the employee.

(5) CONFIDENTIALITY.—Any information submitted to the Office of Personnel Management under paragraph (2) shall be used solely for the purpose of certifying an individual’s eligibility for benefits under paragraph (1).

(6) REGULATIONS AND ORDERS.—

(A) OFFICE OF PERSONNEL MANAGEMENT.—Not later than 6 months after the date of enactment of this Act, the Office of Personnel Management shall promulgate regulations to implement paragraphs (2) and (3).

(B) OTHER EXECUTIVE BRANCH REGULATIONS.—Not later than 6 months after the date of enactment of this Act, the President or designees of the President shall promulgate regulations to implement this section with respect to benefits and obligations administered by agencies or other entities of the executive branch.

(C) OTHER REGULATIONS AND ORDERS.—Not later than 6 months after the date of enactment of this Act, each agency or other entity or official not within the executive branch that administers a program providing benefits or imposing obligations shall promulgate regulations or orders to implement this section with respect to the program.

(D) PROCEDURE.—Regulations and orders required under this paragraph shall be promulgated after notice to interested persons and an opportunity for comment.

(7) DEFINITIONS.—In this section:

(A) BENEFITS.—The term “benefits” means—

(i) health insurance and enhanced dental and vision benefits, as provided under chapters 89, 89A, and 89B of title 5, United States Code;

(ii) retirement and disability benefits and plans, as provided under—

(I) chapters 83 and 84 of title 5, United States Code;

(II) chapter 8 of the Foreign Service Act of 1980 (22 U.S.C. 4041 et seq.); and

(III) the Central Intelligence Agency Retirement Act of 1964 for Certain Employees (50 U.S.C. chapter 38);

(iii) family, medical, and emergency leave, as provided under—

(I) subchapters III, IV, and V of chapter 63 of title 5, United States Code;

(II) the Family and Medical Leave Act of 1993 (29 U.S.C. 2601 et seq.), insofar as that Act applies to the Government Accountability Office and the Library of Congress;

(III) section 202 of the Congressional Accountability Act of 1995 (2 U.S.C. 1312); and

(IV) section 412 of title 3, United States Code;

(iv) Federal group life insurance, as provided under chapter 87 of title 5, United States Code;

(v) long-term care insurance, as provided under chapter 90 of title 5, United States Code;

(vi) compensation for work injuries, as provided under chapter 81 of title 5, United States Code;

(vii) benefits for disability, death, or captivity, as provided under—

(I) sections 5569 and 5570 of title 5, United States Code;

(II) section 413 of the Foreign Service Act of 1980 (22 U.S.C. 3973);

(III) part L of title I of the Omnibus Crime Control and Safe Streets Act of 1968 (42 U.S.C. 3796 et seq.), insofar as that part applies to any employee; and

(viii) travel, transportation, and related payments and benefits, as provided under—

(I) chapter 57 of title 5, United States Code;

(II) chapter 9 of the Foreign Service Act of 1980 (22 U.S.C. 4081 et seq.); and

(III) section 1599b of title 10, United States Code; and

(ix) any other benefit similar to a benefit described under clauses (i) through (viii) provided by or on behalf of the United States to any employee.

(B) DOMESTIC PARTNER.—The term “domestic partner” means an adult unmarried person living with another adult unmarried person of the same sex in a committed, intimate relationship.

(C) EMPLOYEE.—The term “employee”—

(i) means an officer or employee of the United States or of any department, agency, or other entity of the United States, including the President, the Vice President, a Member of Congress, or a Federal judge; and

(ii) shall not include a member of the uniformed services.

(D) OBLIGATIONS.—The term “obligations” means any duties or responsibilities with respect to Federal employment that would be incurred by a married employee or by the spouse of an employee.

(E) UNIFORMED SERVICES.—The term “uniformed services” has the meaning given under section 2101(3) of title 5, United States Code.

(b) Effective date.—This section and the amendments made by this section shall—

(1) with respect to the provision of benefits and obligations, take effect 6 months after the date of enactment of this Act; and

(2) apply to any individual who is employed as an employee on or after the date of enactment of this Act.

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

(a) In General.—Section 1902 of the Social Security Act (42 U.S.C. 1396a), as amended by section 5006(b)(1) of division B of Public Law 11–5, is amended—

(1) in subsection (a)(10)(A)(ii)—

(A) by striking “or” at the end of subclause (XVIII);

(B) by adding “or” at the end of subclause (XIX); and

(C) by adding at the end the following:

“(XX) who are described in subsection (gg) (relating to HIV-infected individuals);”; and

(2) by adding at the end the following:

“(gg) HIV-infected individuals described in this subsection are individuals not described in subsection (a)(10)(A)(i)—

“(1) who are infected with HIV;

“(2) whose income (as determined under the State plan under this title with respect to disabled individuals) does not exceed the maximum amount of income a disabled individual described in subsection (a)(10)(A)(i) may have to obtain medical assistance under the plan; and

“(3) whose resources (as determined under the State plan under this title with respect to disabled individuals) do not exceed the maximum amount of resources a disabled individual described in subsection (a)(10)(A)(i) may have to obtain medical assistance under the plan.”.

(b) Enhanced Match.—The first sentence of section 1905(b) of such Act (42 U.S.C. 1396d(b)) is amended by striking “section 1902(a)(10)(A)(ii)(XVIII)” and inserting “subclause (XVIII) or (XX) of section 1902(a)(10)(A)(ii)”.

(c) Conforming Amendments.—Section 1905(a) of such Act (42 U.S.C. 1396d(a)) is amended, in the matter preceding paragraph (1)—

(1) by striking “or” at the end of clause (xii);

(2) by adding “or” at the end of clause (xiii); and

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

“(xiv) individuals described in section 1902(gg);”.

(d) Exemption From Funding Limitation for Territories.—Section 1108(g) of the Social Security Act (42 U.S.C. 1308(g)) is amended by adding at the end the following:

“(5) DISREGARDING MEDICAL ASSISTANCE FOR OPTIONAL LOW-INCOME HIV-INFECTED INDIVIDUALS.—The limitations under subsection (f) and this subsection shall not apply to amounts expended for medical assistance for individuals described in section 1902(gg) who are only eligible for such assistance on the basis of section 1902(a)(10)(A)(ii)(XX).”.

(e) Effective Date.—The amendments made by this section shall apply to calendar quarters beginning on or after the date of the enactment of this Act, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date.

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

Section 1101(a) of the Social Security Act (42 U.S.C. 1301a)) is amended by adding at the end the following:

“(11) Notwithstanding section 7 of title 1, United States Code, for purposes title XVIII of this Act—

“(A) the term ‘spouse’ means an individual in a relationship that any State recognizes as a marriage or similar union under the laws of a State providing for such marriage or similar union; and

“(B) the term ‘married’ means in a relationship that any State recognizes as a marriage or similar union under the laws of a State providing for such marriage or similar union.”.

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

(a) Phase-Out of waiting period for medicare disability benefits.—

(1) IN GENERAL.—Section 226(b) of the Social Security Act (42 U.S.C. 426(b)) is amended—

(A) in paragraph (2)(A), by striking “, and has for 24 calendar months been entitled to,” and inserting “, and for the waiting period (as defined in subsection (k)) has been entitled to,”;

(B) in paragraph (2)(B), by striking “, and has been for not less than 24 months,” and inserting “, and has been for not less than the waiting period,”;

(C) in paragraph (2)(C)(ii), by striking “, including the requirement that he has been entitled to the specified benefits for 24 months,” and inserting “, including the requirement that the individual has been entitled to the specified benefits for the waiting period,”; and

(D) in the flush matter following paragraph (2)(C)(ii)(II)—

(i) in the first sentence, by striking “for each month beginning with the later of (I) July 1973 or (II) the twenty-fifth month of his entitlement or status as a qualified railroad retirement beneficiary described in paragraph (2), and” and inserting “for each month beginning after the waiting period for which the individual satisfies paragraph (2) and”;

(ii) in the second sentence, by striking “the ‘twenty-fifth month of his entitlement’ refers to the first month after the twenty-fourth month of entitlement to specified benefits referred to in paragraph (2)(C) and”; and

(iii) in the third sentence, by striking “, but not in excess of 78 such months”.

(2) SCHEDULE FOR PHASE-OUT OF WAITING PERIOD.—Section 226 of the such Act (42 U.S.C. 426) is amended by adding at the end the following new subsection:

“(k) For purposes of subsection (b) (and for purposes of section 1837(g)(1) of this Act and section 7(d)(2)(ii) of the Railroad Retirement Act of 1974), the term ‘waiting period’ means—

“(1) for 2010, 18 months;

“(2) for 2011, 16 months;

“(3) for 2012, 14 months;

“(4) for 2013, 12 months;

“(5) for 2014, 10 months;

“(6) for 2015, 8 months;

“(7) for 2016, 6 months;

“(8) for 2017, 4 months;

“(9) for 2018, 2 months; and

“(10) for 2019 and each subsequent year, 0 months.”.

(3) CONFORMING AMENDMENTS.—

(A) SUNSET.—Effective January 1, 2019, subsection (f) of section 226 of the Social Security Act (42 U.S.C. 426) is repealed.

(B) MEDICARE DESCRIPTION.—Section 1811(2) of such Act (42 U.S.C. 1395c(2)) is amended by striking “entitled for not less than 24 months” and inserting “entitled for the waiting period (as defined in section 226(k))”.

(C) MEDICARE PART B COVERAGE.—Section 1837(g)(1) of such Act (42 U.S.C. 1395p(g)(1)) is amended by striking “of the later of (A) April 1973 or (B) the third month before the 25th month of such entitlement” and inserting “of the third month before the first month following the waiting period (as defined in section 226(k)) applicable under section 226(b)”.

(D) RAILROAD RETIREMENT SYSTEM.—Section 7(d)(2)(ii) of the Railroad Retirement Act of 1974 (45 U.S.C. 231f(d)(2)(ii)) is amended—

(i) by striking “, for not less than 24 months” and inserting “, for the waiting period (as defined in section 226(k) of the Social Security Act)”; and

(ii) by striking “could have been entitled for 24 calendar months, and” and inserting “could have been entitled for the waiting period (as defined in section 226(k) of the Social Security Act), and”.

(4) EFFECTIVE DATE.—Except as provided in paragraph (3)(A), the amendments made by this subsection shall apply with respect to items and services furnished under title XVIII of the Social Security Act on or after the first day of first month beginning more than 90 days after the date of the enactment of this Act.

(b) Institute of Medicine study and report on delay and prevention of disability conditions.—

(1) STUDY.—The Secretary shall request that the Institute of Medicine of the National Academy of Sciences conduct a study on the range of disability conditions that can be delayed or prevented if individuals receive access to health care services and coverage before the condition reaches a level that results in a disability.

(2) REPORT.—Not later than the date that is 2 years after the date of enactment of this Act, the Secretary shall submit to the Congress a report containing the results of the Institute of Medicine study authorized under this subsection.

(3) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to be appropriated to carry out this subsection $750,000 for the period of fiscal years 2010 and 2011.

SEC. 114. Including costs incurred by AIDS drug assistance programs in providing prescription drugs toward the annual out-of-pocket threshold under Medicare part D.

(a) In General.—Section 1860D–2(b)(4)(C) of the Social Security Act (42 U.S.C. 1395w–102(b)(4)(C)) is amended—

(1) in clause (i), by striking “and” at the end;

(2) in clause (ii)—

(A) by inserting “subject to clause (iii),” after “(ii)”;

(B) by striking “, under section 1860D–14, or under a State Pharmaceutical Assistance Program”; and

(C) by striking the period at the end and inserting “; and”; and

(3) by inserting after clause (ii) the following new clause:

“(iii) such costs shall be treated as incurred and shall not be considered to be reimbursed under clause (ii) if such costs are borne or paid—

“(I) under section 1860D–14;

“(II) under a State Pharmaceutical Assistance Program; or

“(III) under an AIDS Drug Assistance Program under part B of title XXVI of the Public Health Service Act.”.

(b) Effective Date.—The amendments made by subsection (a) shall apply to costs incurred on or after January 1, 2010.

SEC. 115. Nondiscrimination based on gender identity or sexual orientation under the Medicaid, Medicare, and CHIP programs.

(a) Medicaid.—

(1) Section 1902(a) of the Social Security Act is amended by—

(A) striking the “and” at the end of paragraph (72);

(B) striking the period at the end of paragraph (73)(B) and inserting “; and”;

(C) inserting after paragraph (73) the following new paragraph:

“(74) provide that the State shall not discriminate against any person on the basis of sexual orientation or gender identity.”; and

(D) adding at the end the following undesignated paragraph:

“ For the purposes of paragraph (74) ‘sexual orientation’ shall mean homosexuality, heterosexuality, or bisexuality. ‘Gender identity’ shall mean the gender-related identity, appearance, or mannerisms, or other gender-related characteristics of an individual, with or without regard to the individual’s designated sex at birth.”.

(2) Section 1916 of the Social Security Act is amended by adding at the end the following new subsection:

“(k) No discrimination on premiums or cost sharing.—The State shall provide that in the case of all individuals described in section 1902(a) who are eligible under the plan—

“(1) there may be imposed no enrollment fee, premium, similar charge on the basis of sexual orientation or gender identity as defined in such section; and

“(2) there may be imposed no deduction, cost sharing, or similar charge on the basis of sexual orientation or gender identity as defined in such section.”.

(b) State children’s health insurance program.—Section 2102 of the Social Security Act is amended by adding at the end the following subsection: “(d).”

“(d) No discrimination in State child health plans.—A State child health plan may not discriminate on the basis sexual orientation or gender identity as defined in section 1902.”.

(c) Medicare.—Title XVIII of the Social Security Act is amended by—

(1) adding at the end the following:

“SEC. 1899. Nondiscrimination based on gender identity or sexual orientation.

“(a) Condition of participation.—As a condition of participation as a provider of services or supplier under section 1866(a)(1) or 1842(h), respectively, the provider or supplier may not discriminate on the basis of sex, gender identity, or sexual orientation of a beneficiary in the provision of items or services for which payment may be made under this title.

“(b) Coverage determinations.—The Secretary may not discriminate on the basis of the sex, gender identity, or sexual orientation in fulfillment of his duties under this Act.

“(c) Regulations.—The Secretary shall promulgate regulations to implement this section.”.

SEC. 121. Health Promotion Grants.

(a) Demonstration Projects.—The Secretary, in collaboration with the Deputy Assistant Secretary for LGBT Health, shall award multiyear contracts or competitive grants to eligible entities to support demonstration projects designed to improve the health and health care of sexual or gender minorities through improved access to health care, patient navigators, primary prevention activities, health promotion and disease prevention activities, and health literacy education and services.

(b) Eligibility.—In this section:

(1) ELIGIBLE ENTITY.—The term “eligible entity” means a qualified organization or a community-based consortium.

(2) QUALIFIED ORGANIZATION.—The term “qualified organization” means—

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

(B) an academic institution;

(C) a State health agency;

(D) an Indian Health Service hospital or clinic, Indian tribal health facility, or urban Indian facility;

(E) a nonprofit organization, including a faith-based organization or consortium, to the extent that a contract or grant awarded to such an entity is consistent with the requirements of section 1955 of the Public Health Service Act (42 U.S.C. 300x–65);

(F) a primary care practice-based research network;

(G) long-term care facilities, including nursing homes and assisted living facilities; or

(H) any other similar entity determined to be appropriate by the Secretary.

(3) COMMUNITY-BASED CONSORTIUM.—The term “community-based consortium” means a partnership that—

(A) includes—

(i) individuals who are representatives of organizations of sexual and gender minorities;

(ii) community leaders and leaders of community-based organizations;

(iii) health care providers, including providers who treat sexual and gender minorities; and

(iv) experts in the area of social and behavioral science, who have knowledge, training, or practical experience in health policy, advocacy, cultural competency, or other relevant areas as determined by the Secretary; and

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

(c) Use of Funds.—An eligible entity shall use amounts received under this section for demonstration projects to—

(1) address health disparities affecting sexual and gender minorities in the areas of—

(A) primary care and preventive health, including health education and promotion;

(B) behavioral and mental health and substance abuse;

(C) health services research;

(D) demographics and data collection; and

(E) other areas determined appropriate by the Secretary;

(2) identify, educate, and enroll into clinical trials and comparative effectiveness research eligible patients from sexual or gender minority groups;

(3) educate, guide, and provide outreach in a community setting regarding health problems prevalent among sexual or gender minority populations, including—

(A) HIV in high-risk subpopulations, including—

(i) transgender populations;

(ii) sex workers; and

(iii) people of color;

(B) cancers;

(C) school violence;

(D) emerging drugs; and

(E) suicide prevention;

(4) educate, guide, and provide experiential learning opportunities to sexual and gender minorities targeting behavioral risk factors including—

(A) poor nutrition;

(B) physical inactivity;

(C) being overweight or obese;

(D) tobacco use;

(E) alcohol and substance use;

(F) injury and violence;

(G) high-risk sexual behavior; and

(H) mental health problems;

(5) educate and provide guidance to sexual and gender minorities regarding effective strategies to promote positive health behaviors within the community; or

(6) educate and refer sexual and gender minorities to appropriate health care agencies and community-based programs and organizations in order to increase access to high-quality health care services, including preventive health services.

(d) Report to Congress.—

(1) IN GENERAL.—Not later than 4 years after the date on which the Secretary first awards grants under subsection (a), the Secretary shall submit to the Congress a report regarding such grants.

(2) CONTENTS.—The report required under paragraph (1) shall include the following:

(A) A description of the programs for which grant funds were used.

(B) The number of individuals served under such programs.

(C) An evaluation of—

(i) the effectiveness of such programs;

(ii) the cost of such programs; and

(iii) the impact of such programs on the health outcomes of the community residents.

(D) Recommendations for improving the health and health care of sexual and gender minorities.

(E) A description of how the Secretary will continue to work to improve the use of grant funds under this section.

SEC. 122. Mental Health Promotion Grants.

(a) Demonstration Projects.—The Secretary, in collaboration with the Deputy Assistant Secretary for LGBT Health and the Administrator of the Substance Abuse and Mental Health Services Administration, shall award multiyear contracts or competitive grants to eligible entities to support demonstration projects designed to improve the mental health of sexual and gender minorities through improved access to health care, primary prevention activities, health promotion and prevention activities, and education and services.

(b) Eligibility.—In this section:

(1) ELIGIBLE ENTITY.—The term “eligible entity” means a qualified organization or a community-based consortium.

(2) QUALIFIED ORGANIZATION.—The term “qualified organization” means—

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

(B) an academic institution;

(C) a State health agency;

(D) an Indian Health Service hospital or clinic, Indian tribal health facility, or urban Indian facility;

(E) a nonprofit organization, including a faith-based organization or consortium, to the extent that a contract or grant awarded to such an entity is consistent with the requirements of section 1955 of the Public Health Service Act (42 U.S.C. 300x–65);

(F) a certified mental health treatment center;

(G) a long-term care facility, including a nursing home or assisted living facility; and

(H) any other similar entity determined to be appropriate by the Secretary.

(3) COMMUNITY-BASED CONSORTIUM.—The term “community-based consortium” means a partnership that—

(A) includes—

(i) individuals who are representatives of organizations of sexual or gender minorities;

(ii) community leaders and leaders of community-based organizations;

(iii) mental health care providers, including providers who treat sexual or gender minorities; and

(iv) experts in the area of social and behavioral science, who have knowledge, training, or practical experience in health policy, advocacy, cultural competency, or other relevant areas as determined by the Secretary; and

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

(c) Use of Funds.—An eligible entity shall use amounts received under this section for demonstration projects to—

(1) address health disparities in the areas of behavioral and mental health and substance abuse;

(2) educate, guide, and provide outreach in a community setting regarding mental health problems prevalent among sexual or gender minority populations;

(3) educate, guide, and provide experiential learning opportunities that target behavioral risk factors including—

(A) alcohol and substance use;

(B) high-risk sexual behavior; and

(C) mental health problems;

(4) develop or adapt curricula and interventions to address major mental health issues in the sexual and gender minority community, including—

(A) school violence;

(B) emerging drugs;

(C) suicide; and

(D) family acceptance of lesbian, gay, bisexual, and transgender youth;

(5) educate and provide guidance regarding effective strategies to promote positive health behaviors within the community, including the promotion of resiliency and wellness strategies;

(6) educate and refer sexual and gender minorities to appropriate agencies and community-based programs and organizations in order to increase access to high-quality mental health services, including preventive mental health services; or

(7) provide mental health counseling and education for families to promote acceptance of lesbian, gay, bisexual, and transgender youth, which may include the creation and distribution of support-focused resource guides.

(d) Report to Congress.—

(1) IN GENERAL.—Not later than 4 years after the date on which the Secretary first awards grants under subsection (a), the Secretary shall submit to the Congress a report regarding such grants.

(2) CONTENTS.—The report required under paragraph (1) shall include the following:

(A) A description of the programs for which grant funds were used.

(B) The number of individuals served under such programs.

(C) An evaluation of—

(i) the effectiveness of such programs;

(ii) the cost of such programs; and

(iii) the impact of the programs on the health outcomes of the community residents.

(D) Recommendations for improving the mental health and mental health care of sexual and gender minorities.

SEC. 123. Health Insurance Coverage Grants.

(a) In general.—The Secretary, in collaboration with the Deputy Assistant Secretary for LGBT Health, the Director of the Centers for Disease Control and Prevention and other Federal officials determined appropriate by the Secretary, may award grants to State or local governments, Indian tribes (including Alaska Native villages), tribal organizations, and urban Indian organizations to support projects designed to improve the health and health care of sexual and gender minorities through improved access to health care through expanded health insurance.

(b) Application.—An eligible entity seeking a grant under this section shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require, including assurances that the eligible entity will—

(1) target individuals who are members of sexual or gender minority groups that experience health disparities through specific outreach activities funded through the grant;

(2) collaborate with appropriate community organizations and include meaningful community participation in planning, implementation, and evaluation of activities;

(3) demonstrate capacity to enroll individuals currently without health coverage into public or private health insurance plans that meet their treatment and care needs;

(4) set appropriate and measurable goals for health insurance enrollment of sexual and gender minorities;

(5) provide ongoing outreach and education to the populations targeted under paragraph (1);

(6) demonstrate coordination between public and private entities for purposes of assisting public entities in leveraging private funds to improve the health and health care of sexual and gender minorities;

(7) assist individuals and groups in accessing public and private programs that will help eliminate disparities in health and health care for sexual and gender minorities;

(8) develop a plan for long-term sustainability for the activities funded through the grant; and

(9) evaluate the effectiveness of activities under this section, within an appropriate time frame, which shall include a focus on quality and outcomes performance measures to ensure that the activities are meeting the intended goals, and that the entity is able to disseminate findings from such evaluations.

(c) Priorities.—

(1) IN GENERAL.—In awarding contracts and grants under this section, the Secretary shall give priority to applicants that meet the criteria under paragraph (2) and are—

(A) safety net hospitals, defined as hospitals with a low-income utilization rate greater than 25 percent (as defined in section 1923(b)(3) of the Social Security Act (42 U.S.C. 1396r–4(b)(3)));

(B) a federally qualified health center as defined in section 1905(l)(2)(B) of the Social Security Act with the ability to establish and lead a collaborative partnership;

(C) a community-based consortium;

(D) safety net health plans that work in coordination with local health centers;

(E) an Indian tribe, tribal organization, or urban Indian organization; or

(F) other health systems.

(2) ADDITIONAL CRITERIA.—For purposes of paragraph (1), the criteria under this paragraph is that the applicant—

(A) by legal mandate or explicitly adopted mission, provide patients with access to services regardless of their ability to pay;

(B) provide care or treatment for a substantial number of patients who are uninsured, are receiving assistance under a State program under title XIX of the Social Security Act, or are members of vulnerable populations, as determined by the Secretary;

(C) serve a disproportionate percentage of patients who are sexual or gender minorities; and

(D) provide an assurance that amounts received under the grant or contract will be used to support quality improvement activities for patients from sexual and gender minority groups.

(d) Use of Funds.—An eligible entity shall use such amounts received under this section for demonstration projects to—

(1) address health disparities in the areas of health insurance coverage; and

(2) evaluate methods for strengthening the health coverage and continuity of coverage of sexual and gender minority populations, including—

(A) targeting enrollment of uninsured sexual and gender minority populations into title XIX of the Social Security Act; and

(B) assessing eligibility for domestic partner benefits.

(e) Evaluation and report by grantee.—

(1) EVALUATION.—Any entity that receives a grant under this section shall conduct an evaluation of the activities conducted under such grant and the impact of such activities on decreasing health disparities for sexual and gender minorities.

(2) REPORT.—Not later than 3 years after the date an entity receives a contract or grant under this section and annually thereafter, the entity shall provide to the Secretary a report containing the results of the evaluation conducted under paragraph (1).

(f) Report and public access to information by Secretary.—

(1) REPORT TO CONGRESS.—Beginning on or before the 60th day following the date that the first report is submitted under subsection (e), the Secretary shall submit a report to the Congress complying the results of evaluations under such subsection and describing the overall impact of the grant program under this section.

(2) PUBLIC ACCESS.—The Secretary shall, as appropriate, provide the public with access to the report under paragraph (1) and the information contained in the reports under subsection (e)(2).

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

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

“TITLE XXXICULTURALLY COMPETENT HEALTH CARE

“SEC. 3100. Definitions.

“In this title:

“(1) CULTURALLY COMPETENT.—The term ‘culturally competent care’, with respect to health care or services for sexual and gender minorities, means health care or services that, at a minimum, do not include nonclinical or medically unsound judgments based on sex, sexual orientation, or gender identity and expression that affect the amount and kind of treatment received or that act as a barrier to an individual receiving timely and high-quality care.

“(2) SEXUAL OR GENDER MINORITY.—The terms ‘sexual or gender minority’ and ‘sexual and gender minority’ mean a lesbian, gay, bisexual, or transgender individual.

“(3) STATE.—The term ‘State’ means each of the several states, the District of Columbia, the Commonwealth of Puerto Rico, the Indian tribes, the Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands.

“SEC. 3101. National standards for culturally competent services in health care.

“Recipients of Federal financial assistance from the Secretary shall, to the extent reasonable and practicable—

“(1) implement strategies to recruit, retain, and promote individuals at all levels of the organization to maintain a diverse staff and leadership that can provide culturally competent health care to sexual or gender minority patients;

“(2) ensure that staff at all levels and across all disciplines of the organization receive ongoing education and training in culturally competent service delivery for sexual or gender minority patients;

“(3) develop and implement clear goals, policies, operational plans, and management accountability and oversight mechanisms to provide culturally competent services for sexual and gender minority patients;

“(4) conduct initial and ongoing organizational assessments of culturally competent services-related activities for sexual and gender minority patients and integrate valid competence-related measures into the internal audits, performance improvement programs, patient satisfaction assessments, and outcomes-based evaluations of the organization;

“(5) ensure that, consistent with the privacy protections provided for under the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996, data on the individual patient’s sexual orientation and gender identity are collected in health records, integrated into the organization’s management information systems, and periodically updated;

“(6) maintain a current demographic, cultural, and epidemiological profile of the community as well as a needs assessment to accurately plan for and implement services that respond to the cultural characteristics of the service area of the organization;

“(7) develop participatory, collaborative partnerships with communities and utilize a variety of formal and informal mechanisms to facilitate community and patient involvement in designing and implementing culturally competent services-related activities for sexual and gender minority patients;

“(8) ensure that conflict and grievance resolution processes are culturally sensitive and capable of identifying, preventing, and resolving cross-cultural conflicts or complaints by sexual and gender minority patients;

“(9) regularly make available to the public information about their progress and successful innovations in implementing the standards under this section and provide public notice in their communities about the availability of this information; and

“(10) if requested, regularly make available to the head of each Federal entity from which Federal funds are received, information about their progress and successful innovations in implementing the standards under this section as required by the head of such entity.

“SEC. 3102. Center for cultural competence in health care.

“(a) Establishment.—The Secretary, acting through the Deputy Assistant Secretary for LGBT Health, shall establish and support a center to be known as the ‘Center for Cultural Competence in Health Care’ (referred to in this section as the ‘Center’).

“(b) Provision of information.—The Center shall provide information relating to culturally competent health care for sexual and gender minority populations residing in the United States to all health care providers and health care organizations at no cost. Such information shall include—

“(1) tenets of culturally competent care;

“(2) cultural competence self-assessment tools;

“(3) cultural competence training tools;

“(4) strategic plans to increase cultural competence in different types of health care organizations, including regional collaborations among health care organizations; and

“(5) resources for cultural competence information for educators, practitioners, and researchers.

“(c) Director.—The Center shall be headed by a Director who shall be appointed by, and who shall report to, the Deputy Assistant Secretary for LGBT Health.

“(d) Authorization of Appropriations.—There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2010 through 2014.

“SEC. 3103. Innovations in cultural competence grants.

“(a) In General.—The Secretary, acting through the Administrator of the Centers for Medicare & Medicaid Services, the Administrator of the Health Resources and Services Administration, the Secretary of Education, and the Deputy Assistant Secretary for LGBT Health, shall award grants to eligible entities to enable such entities to design, implement, and evaluate innovative, cost-effective programs to improve cultural competence in health.

“(b) Eligibility.—To be eligible to receive a grant under subsection (a), an entity shall—

“(1) be a city, county, Indian tribe, State, territory, community-based or other nonprofit organization, health center or community clinic, hospital, university, college, or other entity designated by the Secretary; and

“(2) prepare and submit to the Secretary an application, at such time, in such manner, and accompanied by such additional information as the Secretary may require.

“(c) Use of Funds.—An entity shall use funds received under a grant under this section to—

“(1) develop formal training programs for individuals interested in becoming dedicated culturally competent health care providers for sexual and gender minorities;

“(2) develop formal training programs for individuals interested in becoming dedicated culturally competent health care providers for sexual and gender minority youth and their families;

“(3) develop training programs for individuals interested in becoming dedicated culturally competent health care providers for aging sexual and gender minorities; and

“(4) develop other culturally competent services as determined appropriate by the Secretary.

“(d) Priority.—In awarding grants under this section, the Secretary shall give priority to entities that have developed partnerships with organizations or agencies with experience in culturally competent services.

“(e) Evaluation.—An entity that receives a grant under this section shall submit to the Secretary an evaluation that describes the activities carried out with funds received under the grant, and how such activities improved access to health care services and the quality of health care for individuals. Such evaluation shall be collected and disseminated through the Center for Cultural Competence in Health Care established under section 3102.

“(f) Authorization of Appropriations.—There is authorized to be appropriated to carry out this section $5,000,000 for each of fiscal years 2010 through 2014.

“SEC. 3104. Research on cultural competence.

“(a) In General.—The Director of the Agency for Healthcare Research and Quality, in collaboration with the Deputy Assistant Secretary for LGBT Health, shall expand research concerning—

“(1) the barriers to health care services, including mental and behavioral services and services at skilled nursing facilities, that are faced by sexual and gender minority individuals;

“(2) the impact of cultural barriers on the quality of health care and the health status of sexual and gender minority individuals and populations;

“(3) health care providers’ and health administrators’ attitudes, knowledge, and awareness of the barriers described in paragraphs (1) and (2);

“(4) the means by which competency access services are provided to sexual and gender minority individuals and how such services are effective in improving the quality of care;

“(5) the cost-effectiveness of providing competency access services; and

“(6) optimal approaches for delivering competency access services.

“(b) Authorization of Appropriations.—There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2010 through 2014.”.

SEC. 202. Definitions.

In this title:

(1) INCORPORATED DEFINITIONS.—The definitions contained in section 3100 of the Public Health Service Act, as added by section 201, shall apply.

(2) SECRETARY.—The term “Secretary” means the Secretary of Health and Human Services.

SEC. 203. Federal reimbursement for culturally competent services under the Medicare, Medicaid, and Children’s Health Insurance Programs.

(a) Demonstration Project Promoting Access for Medicare Beneficiaries in sexual and gender minority populations.—

(1) IN GENERAL.—The Secretary shall conduct a demonstration project (in this subsection referred to as the “project”) to provide reimbursement for access services to certain Medicare beneficiaries in sexual and gender minority groups in urban and rural areas and document the impact of such reimbursement on Medicare program costs and health outcomes.

(2) SCOPE.—The Secretary shall carry out the project in not less than 30 States or territories through contracts with—

(A) MA plans (under part C of title XVIII of the Social Security Act);

(B) community-based nonprofit organizations;

(C) hospitals; and

(D) community-based clinics.

(3) DURATION.—The demonstration shall be conducted for a period not longer than 2 years.

(4) REPORT.—Upon completion of the project, the Secretary shall submit a report to the Congress on the project which shall include recommendations regarding—

(A) the extension of such project for additional time periods; and

(B) the expansion of such project to the entire Medicare program.

(5) EVALUATION.—The Director of the Agency for Healthcare Research and Quality, in consultation with the Office of Minority Health and the National Center on Minority Health and Health Disparities, shall award grants to public and private nonprofit entities that demonstrate experience and capability with respect to cultural competence, including entities directed by and serving representatives of sexual and gender minority groups, to conduct evaluations of the project under paragraph (1). Such evaluations shall focus on the impact of the project on access to services, utilization rates, efficiency in the provision of services, cost-effectiveness, patient satisfaction, and select health outcomes.

(b) Medicaid and CHIP.—Section 1903(a)(3) of the Social Security Act (42 U.S.C. 1396b(a)(3)), as amended by section 4201(a) of division B of the American Recovery and Reinvestment Act of 2009 (Public Law 111–5), is amended—

(1) in subparagraph (E), by striking “and” at the end;

(2) in subparagraph (F), by striking “plus” at the end and inserting “and”; and

(3) by adding at the end the following:

“(G) 100 percent of so much of the sums expended with respect to costs incurred during such quarter as are attributable to the provision of access services (as defined in section 203(d) of the Ending LGBT Health Disparities Act) to sexual and gender minorities (as defined in section 3 of the Ending LGBT Health Disparities Act) who apply for or receive medical assistance under the State plan under this title (including any provisions of the plan implemented pursuant to any waiver authority of the Secretary) or child health assistance under a State child health plan under title XXI; plus”.

(c) SCHIP.—Section 2105(c)(2)(A) of the Social Security Act (42 U.S.C. 1397ee(c)(2)(A)) is amended by inserting before the period at the end the following: “except that expenditures described in, and reimbursable under, section 1903(a)(3)(G) shall not count towards this total”.

(d) Definition of access services.—For purposes of this section, the term “access services” means—

(1) outreach (including care coordination, nursing outreach, and reminder phone calls) designed to—

(A) inform individuals of the benefits to which they are entitled; and

(B) encourage individuals to use such benefits; and

(2) services (including transportation) that assist the individual in accessing such benefits.

(e) Effective Date.—The amendments made by this section is effective for payment for items and services furnished on or after October 1, 2010.

SEC. 204. Report on Federal efforts to provide culturally competent health care services to sexual and gender minorities.

Not later than 1 year after the date of enactment of this Act and annually thereafter, the Secretary shall enter into a contract with the Institute of Medicine for the preparation and publication of a report that describes Federal efforts to ensure that all individuals have meaningful access to culturally competent health care services. Such report shall include—

(1) a description and evaluation of the activities carried out under this Act;

(2) a description of best practices, model programs, guidelines, and other effective strategies for providing access to culturally competent health care services for sexual and gender minority populations; and

(3) an assessment of the implementation of the Department of Health and Human Services National Standards on Culturally Appropriate Services (CLAS) in Health Care, in particular the implementation of CLAS mandates by recipients of Federal funds.

SEC. 301. No compelled disclosure of data.

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

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

(a) Requirements.—

(1) IN GENERAL.—Each health-related program operated by or that receives funding or reimbursement, in whole or in part, either directly or indirectly from the Department of Health and Human Services shall—

(A) require the collection, by the agency or program involved, of sexual and gender minority data for each applicant for and recipient of health-related assistance under such program;

(B) systematically analyze such data using the smallest appropriate units of analysis feasible to detect sexual and gender minority disparities in health and health care and when appropriate, analyze such data for each identified sexual identity separately, and report the results of such analysis to the Secretary, the Director of the Office for Civil Rights, the Committee on Health, Education, Labor, and Pensions and the Committee on Finance of the Senate, and the Committee on Energy and Commerce and the Committee on Ways and Means of the House of Representatives;

(C) provide such data to the Secretary on at least an annual basis; and

(D) ensure that the provision of assistance to an applicant or recipient of assistance is not denied or otherwise adversely affected because of the failure of the applicant or recipient to provide sexual and gender minority data.

(2) BUREAU OF PRISONS.—The Attorney General of the United States, acting through the Director of the Bureau of Prisons, shall collect and share with the Secretary sexual and minority data for each individual who is incarcerated and receives health assistance in an institution under the jurisdiction of the Bureau of Prisons.

(3) RULES OF CONSTRUCTION.—Nothing in this subsection shall be construed to—

(A) permit the use of information collected under this subsection in a manner that would adversely affect any individual providing any such information; and

(B) require health care providers to collect data.

(b) Protection of Data.—Through the promulgation of regulations or otherwise, the Secretary shall ensure that all data collected pursuant to subsection (a)(1) or received pursuant to subsection (a)(2), and the Attorney General of the United States shall ensure that all data collected pursuant to subsection (a)(2), is protected—

(1) under the same privacy protections as the Secretary applies to other health data under the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (Public Law 104–191; 110 Stat. 2033) relating to the privacy of individually identifiable health information and other protections; and

(2) from all inappropriate internal use by any entity that collects, stores, or receives the data, including use of such data in determinations of eligibility (or continued eligibility) in health plans, and from other inappropriate uses, as defined by the Secretary.

(c) National Plan of the Data Council.—The Secretary shall develop and implement a national plan to ensure the collection of data in a culturally appropriate and competent manner, and to improve the collection, analysis, and reporting of sexual and gender minority data at the Federal, State, territorial, tribal, and local levels, including data to be collected under subsection (a). The Data Council of the Department of Health and Human Services, in consultation with the National Committee on Vital Health Statistics, the National Center for Health Statistics, the Office of Minority Health, and other appropriate public and private entities, shall make recommendations to the Secretary concerning the development, implementation, and revision of the national plan. Such plan shall include recommendations on how to—

(1) implement subsection (a) while minimizing the cost and administrative burdens of data collection and reporting;

(2) expand awareness among Federal agencies, States, territories, Indian tribes, health providers, health plans, health insurance issuers, and the general public that data collection, analysis, and reporting of sexual and gender minority data is necessary to assure equity and nondiscrimination in the quality of health care services;

(3) ensure that future patient record systems have data code sets for sexual and gender minority identifiers and that such identifiers can be retrieved from clinical records, including records transmitted electronically;

(4) provide researchers with greater access to sexual and gender minority data, subject to privacy and confidentiality regulations; and

(5) safeguard and prevent the misuse of data collected under subsection (a).

(d) Compliance With Standards.—Data collected under subsection (a) shall be obtained, maintained, and presented (including for reporting purposes) in accordance with the 1997 Office of Management and Budget Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity (at a minimum).

(e) Sexual and Gender Minority Data Collection Standards.—Not later than 1 year after the date of enactment of this Act, the Deputy Assistant Secretary for LGBT Health, in consultation with the Office for Civil Rights of the Department of Health and Human Services and relevant data collection agencies, shall develop and disseminate Standards for the Classification of Federal Data on Sexual and Gender Minorities.

(f) Technical Assistance for the Collection and Reporting of Data.—

(1) IN GENERAL.—The Secretary may, either directly or through grant or contract, provide technical assistance to enable a health care program or an entity operating under such program to comply with the requirements of this section.

(2) TYPES OF ASSISTANCE.—Assistance provided under this subsection may include assistance to—

(A) enhance or upgrade computer technology that will facilitate sexual and gender minority data collection and analysis;

(B) develop mechanisms for submitting collected data subject to existing privacy and confidentiality regulations; and

(C) develop educational programs to inform health insurance issuers, health plans, health providers, health-related agencies, and the general public that data collection and reporting by sexual and gender minority are legal and essential for eliminating health and health care disparities.

(g) Analysis of sexual and gender minority health data.—The Secretary, acting through the Director of the Agency for Healthcare Research and Quality and in coordination with the Administrator of the Centers for Medicare & Medicaid Services, shall provide technical assistance to agencies of the Department of Health and Human Services in meeting Federal standards for sexual and gender minority data collection and analysis of sexual and gender minority disparities in health and health care in public programs by—

(1) identifying appropriate quality assurance mechanisms to monitor for health disparities;

(2) specifying the clinical, diagnostic, or therapeutic measures which should be monitored;

(3) developing new quality measures relating to sexual and gender minority disparities in health and health care;

(4) identifying the level at which data analysis should be conducted; and

(5) sharing data with external organizations for research and quality improvement purposes.

(h) Report.—Not later than 2 years after the date of enactment of this Act, and biennially thereafter, the Secretary shall submit to the appropriate committees of Congress a report on the effectiveness of data collection, analysis, and reporting on sexual and minorities under the programs and activities of the Department of Health and Human Services and under other Federal data collection systems with which the Department interacts to collect relevant data on sexual and gender minorities. The report shall evaluate the progress made in the Department with respect to the national plan under subsection (c) or subsequent revisions thereto.

(i) Definition.—In this section, the term “health-related program” means a program—

(1) under the Social Security Act (42 U.S.C. 301 et seq.) that pays for health care and services; and

(2) under this Act that provides Federal financial assistance for health care, biomedical research, health services research, or programs designed to improve the public’s health.

(j) Authorization of Appropriations.—There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2010 through 2015.

SEC. 303. Inclusion of sexual orientation and gender identity in federally funded health surveys.

The Secretary shall ensure that, not later than 3 years after the date of enactment of this Act, any ongoing or new federally conducted or supported health programs (including surveys) achieve the—

(1) collection and reporting of data by sexual and gender identity, using tested methods for doing this with the greatest possible accuracy; and

(2) development of a standard question to be included on such surveys which includes information as to the individual’s sexual orientation and gender identity.

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

(a) In general.—The Secretary, acting through the Deputy Assistant Secretary for LGBT Health, the Director of the Agency for Health Quality and Research, and the Director of the National Institutes of Health, shall develop plans to expand existing research into health disparities to include those experienced by sexual and gender minority populations. In developing such plans, the Secretary shall—

(1) determine which areas of research focus would have the greatest impact on health care improvement and elimination of disparities, taking into consideration the overall health status of various populations, disproportionate burden of diseases or health conditions, and types of interventions for which data on effectiveness is limited;

(2) establish measurable goals and objectives which will allow assessment of progress; and

(3) solicit public review and comment from experts in health disparities experienced by sexual and gender minorities.

(b) Establishment of grants.—The Secretary, acting through the directors of the Agency for Healthcare Research and Quality and the National Institutes of Health, and in collaboration with the Deputy Assistant Secretary for LGBT Health, may award grants or contracts to eligible entities to execute research plans to assess the health of sexual and gender minorities.

(c) Application; eligible entities.—

(1) APPLICATION.—To receive a grant or contract under this section, an eligible entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.

(2) ELIGIBLE ENTITIES.—To be eligible to receive a grant or contract under this section, an entity shall be a health center, hospital, health system, community clinic, university, community-based organization, or other health entity determined appropriate by the Secretary, that—

(A) serves a disproportionate percentage of patients from sexual or gender minority groups; and

(B) include a focus on community-based participation in research and demonstrations, as well as research analysis, interpretation, solutions and partnerships for patients from sexual or gender minority groups.

(3) PREFERENCE.—Consortia of 3 or more eligible entities, particularly those entities that partner with health plans, shall be given a preference for grant or contract funding under this section.

(d) Research.—The research funded under this section, with respect to sexual and gender minority groups, shall—

(1) prioritize the translation of existing research into practical interventions for improving health and health care and reducing disparities; and

(2) include a focus on community-based participatory research solutions and partnerships as appropriate.

(e) Dissemination of research findings.—To ensure that findings from the research funded under this section are disseminated and applied promptly, the Director shall—

(1) develop outreach and training programs for health care providers with respect to the practical and effective interventions that result from research programs carried out with grants or contracts awarded under this section; and

(2) provide technical assistance for the implementation of evidence-based practices that will improve health and health care and reduce disparities.

(f) Report.—

(1) IN GENERAL.—Not later than September 30, 2010, the Deputy Assistant Secretary for LGBT Health shall submit to the Secretary and the relevant committees of Congress a report that describes the extent to which the activities and research funded under this section have been successful in reducing and eliminating disparities in health and health care in targeted populations.

(2) AVAILABILITY.—The Secretary shall ensure that the report under paragraph (1) is made available on the Internet websites of the Office of Minority Health, the Agency for Healthcare Research and Quality, and other agencies as appropriate.

SEC. 401. Office of LGBT Health.

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

“SEC. 1707A. Office of LGBT Health.

“(a) Establishment.—There is established within the Office of Minority Health an Office of Lesbian, Gay, Bisexual, and Transgender Health (in this section referred to as the ‘Office’), which Office shall be headed by a Deputy Assistant Secretary for LGBT Health, appointed by the Secretary.

“(b) Duties.—The Deputy Assistant Secretary for LGBT Health shall—

“(1) establish, implement, monitor, and evaluate short-range and long-range goals and objectives for all activities within the Public Health Service that relate to disease prevention, health promotion, service delivery, and research concerning sexual and gender minorities;

“(2) coordinate with the efforts of the offices and agencies of the Department of Health and Human Services to address health disparities experienced by sexual and gender minorities; and

“(3) coordinate with existing Federal research initiatives, including comparative effectiveness research, to establish guidelines for the physical and mental health care of sexual and gender minorities.

“(c) Definition.—In this section, the term ‘sexual and gender minorities’ means lesbian, gay, bisexual, and transgender individuals.”.

SEC. 402. Community health centers.

Section 330 of the Public Health Services Act (42 U.S.C. 254b) is amended—

(1) in subsection (a)(2), by striking “or (i)” and inserting “(i), or (r)”;

(2) in the matter following clause (iii) in subsection (k)(3)(H), by striking “or (p)” and inserting “(p), or (r)”;

(3) by redesignating subsection (r) as subsection (s); and

(4) by inserting after subsection (q) the following:

“(r) Lesbian, gay, bisexual, and transgender population.—

“(1) IN GENERAL.—The Secretary may award grants for the planning and delivery of services, including innovative programs that provide outreach and comprehensive, culturally competent primary health services, to a medically underserved population comprised of lesbian, gay, bisexual, and transgender individuals of all ages.

“(2) ELIGIBILITY.—In order to be eligible for the grant under paragraph (1), an applicant shall demonstrate to the Secretary that the applicant—

“(A) provides comprehensive, high-quality care for the lesbian, gay, bisexual, and transgender population;

“(B) has specialized knowledge of the unique needs of this population; and

“(C) has culturally competent staff.”.

SEC. 501. Priority.

Section 373(c)(2) of the Older Americans Act of 1965 (42 U.S.C. 3030s–1(c)(2)) is amended—

(1) in subparagraph (A) by striking “and” at the end,

(2) in subparagraph (B) by striking the period at the end and inserting “; and”, and

(3) by adding at the end the following:

    “(C) individuals providing care to minority individuals, including sexual and gender minorities.”.

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

(a) Nondiscrimination contingency for VAWA grant funds.—Section 40002(b) of the Violence Against Women Act of 1994 (42 U.S.C. 13925(b)) is amended by adding at the end the following new paragraph:

“(12) NONDISCRIMINATION CONTINGENCY.—An entity shall not be eligible to receive any Federal funds, including through a grant or contract, under this title unless the entity provides assurances to the satisfaction of the Attorney General through an application or agreement for such funds, or both, that the entity does not discriminate on the basis of sexual orientation or gender identity.”.

(b) Grant program for LGBT victims of violence.—

(1) GRANTS AUTHORIZED.—The Attorney General may award grants to eligible entities described in paragraph (4)—

(A) to provide services for LGBT victims of violence, as defined in paragraph (3);

(B) to provide training, consultation, and information on domestic violence, dating violence, stalking, and sexual assault against individuals who are lesbian, gay, bisexual, or transgender, and to enhance direct services to such individuals;

(C) for training programs to assist law enforcement officers, prosecutors, governmental agencies, victim assistants, and relevant officers of Federal, State, tribal, territorial, and local courts in recognizing, addressing, investigating, and prosecuting instances of adult or minor domestic violence, dating violence, sexual assault, stalking, elder abuse, and violence against lesbian, gay, bisexual, and transgender individuals; and

(D) for multidisciplinary collaborative community responses to such victims.

(2) USE OF FUNDS.—Grants awarded under this subsection may be used—

(A) to implement or expand programs or services to respond to the needs of LGBT victims of violence;

(B) to provide personnel, training, technical assistance, advocacy, intervention, risk reduction, and prevention of domestic violence, dating violence, stalking, and sexual assault against lesbian, gay, bisexual, and transgender individuals;

(C) to conduct outreach activities to ensure that LGBT victims of violence receive appropriate assistance;

(D) to conduct cross-training for victim service organizations, governmental agencies, and nonprofit, nongovernmental organizations serving individuals with disabilities; about risk reduction, intervention, prevention, and the nature and dynamic of domestic violence, dating violence, stalking, and sexual assault for lesbian, gay, bisexual, and transgender individuals;

(E) to provide technical assistance to assist with modifications to existing policies, protocols, and procedures to ensure equal access to the services, programs, and activities of victim service organizations for LGBT victims of violence;

(F) to provide advocacy and intervention services for LGBT victims of violence; and

(G) to develop model programs providing advocacy and intervention services within organizations serving LGBT victims of violence.

(3) LGBT VICTIMS OF VIOLENCE DEFINED.—For purposes of this subsection, the term “LGBT victim of violence” means a lesbian, gay, bisexual, or transgender individual who is a victim of domestic violence, dating violence, sexual assault, other criminal assault, stalking, bias-motivated crime, or elder abuse.

(4) ELIGIBLE ENTITIES.—

(A) IN GENERAL.—An entity shall be eligible to receive a grant under this subsection if the entity is—

(i) a State;

(ii) a unit of local government;

(iii) a nonprofit, nongovernmental organization such as a victim services organization, an organization serving individuals with disabilities or a community-based organization; or

(iv) a religious organization.

(B) NONDISCRIMINATION.—An entity shall not be eligible to receive a grant under this subsection unless the entity provides assurances to the satisfaction of the Attorney General through an application under paragraph (4) or agreement for such grant, or both, that the entity does not discriminate on the basis of sexual orientation or gender identity.

(5) APPLICATION.—To be eligible for a grant under this subsection an entity shall submit to the Attorney General an application at such time, in such manner, and containing such information as the Attorney General may require.

(6) REPORTING.—Not later than 1 year after the last day of the first fiscal year commencing on or after the date of the enactment of this Act, and not later than 180 days after the last day of each fiscal year thereafter, the Attorney General shall submit to Congress a report evaluating the effectiveness of programs administered and operated through grants awarded under this subsection.

(7) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to be appropriated $5,000,000 for each of the fiscal years 2010 through 2014 to carry out this subsection.

SEC. 602. National Baseline Study on Domestic Violence and Sexual Assault in the LGBT Community.

(a) Study.—The Attorney General of the United States, in consultation with the Deputy Assistant Secretary for LGBT Health, shall provide for a national baseline study to examine the scope of the problem of domestic violence and sexual assaults against lesbian, gay, bisexual, and transgender victims and the effectiveness of institutional and legal policies in addressing such crimes and protecting such victims.

(b) Report.—Not less than 1 year after the date of the enactment of this Act, the Attorney General shall prepare and transmit to the Committees on the Judiciary of the Senate and the House of Representatives a report based on the study required by subsection (a) including an analysis of—

(1) the number of reported allegations and estimated number of unreported allegations of domestic violence and sexual assault involving sexual and gender minorities, and to whom the allegations are reported (including sexual assault victim service entities, and local criminal authorities);

(2) Federal and State laws or regulations pertaining specifically to sexual assaults involving sexual and gender minorities; and

(3) any recommendations the Attorney General may have for reforms to address domestic violence and sexual assaults involving sexual and gender minorities and protect victims more effectively, and any other matters that the Attorney General deems relevant to the subject of the study and report required by this section.

(c) Authorization of appropriations.—There is authorized to be appropriated to carry out this section $500,000 for fiscal year 2010.

SEC. 603. Assistance to reduce teen pregnancy, HIV/AIDS, and other sexually transmitted diseases and to support healthy adolescent development.

(a) In General.—The Secretary may award a grant to each eligible State to conduct programs of sex education described in subsection (b), including education on both abstinence and contraception for the prevention of teenage pregnancy and sexually transmitted diseases, including HIV/AIDS.

(b) Requirements for Sex Education Programs.—A program of sex education described in this subsection is a program that—

(1) is age appropriate and medically accurate;

(2) stresses the value of abstinence while not ignoring those young people who have been or are sexually active;

(3) provides information about the health benefits and side effects of contraceptive and barrier methods used—

(A) as a means to prevent pregnancy; and

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

(4) encourages family communication between parent and child about sexuality;

(5) cultivates a respectful dialogue about sexuality, including sexual orientation and gender identity, and embraces the principles of nondiscrimination based on sexual orientation and gender identity;

(6) counters the perpetuation of narrow gender roles, including the sexualization of female children, adolescents, and adults;

(7) teaches young people the skills to make responsible decisions about sexuality, including how to avoid unwanted verbal, physical, and sexual advances and how to avoid making verbal, physical, and sexual advances that are not wanted by the other party;

(8) develops healthy relationships, including the prevention of dating and sexual violence;

(9) teaches young people how alcohol and drug use can affect responsible decisionmaking; and

(10) does not teach or promote religion.

(c) Additional Activities.—In carrying out a program of sex education, a State may expend grant funds awarded under subsection (a) to carry out educational and motivational activities that help young people—

(1) gain knowledge about the physical, emotional, biological, and hormonal changes of adolescence and subsequent stages of human maturation;

(2) develop the knowledge and skills necessary to ensure and protect their sexual and reproductive health from unintended pregnancy and sexually transmitted disease, including HIV/AIDS, throughout their lifespan;

(3) gain knowledge about the specific involvement and responsibility of each individual in sexual decisionmaking;

(4) develop healthy attitudes and values about adolescent growth and development, body image, gender roles, racial and ethnic diversity, sexual orientation and gender identity, and other subjects;

(5) develop and practice healthy life skills including goal-setting, decisionmaking, negotiation, communication, and stress management; and

(6) promote self-esteem and positive interpersonal skills focusing on relationship dynamics, including friendships, dating, romantic involvement, marriage, and family interactions.

(d) Matching funds.—The Secretary may not make payments to a State under this section in an amount exceeding Federal medical assistance percentage for such State (as such term is defined in section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b))) of the costs of the programs conducted by the State under this section.

(e) Evaluation of programs.—

(1) IN GENERAL.—For the purpose of evaluating the effectiveness of programs of sex education carried out with a grant under this section, evaluations shall be carried out in accordance with paragraphs (2) and (3).

(2) NATIONAL EVALUATION.—

(A) METHOD.—The Secretary shall provide for a national evaluation of a representative sample of programs of sex education carried out with grants under this section to determine—

(i) the effectiveness of such programs in helping to delay the initiation of sexual intercourse and other high-risk behaviors;

(ii) the effectiveness of such programs in preventing adolescent pregnancy;

(iii) the effectiveness of such programs in preventing sexually transmitted disease, including HIV/AIDS;

(iv) the effectiveness of such programs in increasing contraceptive knowledge and contraceptive behaviors when sexual intercourse occurs; and

(v) a list of best practices based upon essential programmatic components of evaluated programs that have led to success described in clauses (i) through (iv).

(B) GRANT CONDITION.—A condition for the receipt of a grant to a State under this section is that the State cooperate with the evaluation under subparagraph (A).

(C) REPORT.—The Secretary shall submit to the Congress—

(i) not later than the end of each fiscal year during the 5-year period beginning with fiscal year 2010, an interim report on the national evaluation under subparagraph (A); and

(ii) not later than March 31, 2015, a final report providing the results of such national evaluation.

(3) INDIVIDUAL STATE EVALUATIONS.—A condition for the receipt of a grant under this section is that the State evaluate of the programs of sex education funded through such grant in accordance with the following requirements:

(A) The evaluation will be conducted by an external, independent entity.

(B) The purposes of the evaluation will be the determination of—

(i) the effectiveness of such programs in helping to delay the initiation of sexual intercourse and other high-risk behaviors;

(ii) the effectiveness of such programs in preventing adolescent pregnancy;

(iii) the effectiveness of such programs in preventing sexually transmitted disease, including HIV/AIDS; and

(iv) the effectiveness of such programs in increasing contraceptive and barrier method knowledge and contraceptive behaviors when sexual intercourse occurs.

(f) Limitations on use of funds.—

(1) LIMITATIONS ON SECRETARY.—Of the amounts appropriated for a fiscal year for purposes of this section, the Secretary may not use more than—

(A) 7 percent of such amounts for administrative expenses related to carrying out this section for that fiscal year; and

(B) 10 percent of such amounts for the national evaluation under subsection (e)(2).

(2) LIMITATIONS TO STATES.—Of amounts provided to an eligible State under this subsection, the State may not use more than 10 percent of the grant to conduct any evaluation under subsection (e)(3).

(g) Nondiscrimination required.—Programs funded under this section shall not discriminate on the basis of sex, race, ethnicity, national origin, disability, religion, sexual orientation, or gender identity. Nothing in this section shall be construed to invalidate or limit rights, remedies, procedures, or legal standards available to victims of discrimination under any other Federal law or any law of a State or a political subdivision of a State, including title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.), section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), and the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.).

(h) Definitions.—For purposes of this section:

(1) The term “age appropriate” means, with respect to topics, messages, and teaching methods, those suitable to particular ages or age groups of children, adolescents, and adults, based on developing cognitive, emotional, and behavioral capacity typical for the age or age group.

(2) The term “eligible State” means a State that submits to the Secretary an application for a grant under this section that is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this section.

(3) The term “HIV/AIDS” means the human immunodeficiency virus, and includes acquired immune deficiency syndrome.

(4) The term “medically accurate”, with respect to information, means information that is supported by research, recognized as accurate and objective by leading medical, psychological, psychiatric, and public health organizations and agencies, and, published in journals that are peer reviewed.

(5) The term “State” means the 50 States, the District of Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana Islands, American Samoa, Guam, the Virgin Islands, and any other territory or possession of the United States.

(i) Authorization of appropriations.—For the purpose of carrying out this section, there is authorized to be appropriated $50,000,000 for each of the fiscal years 2010 through 2014.

SEC. 604. Mother's and father's insurance benefits under Social Security for same-sex surviving parents.

(a) In general.—Section 202(g)(1) of the Social Security Act (42 U.S.C. 402(g)(1)) is amended—

(1) by striking “and every surviving divorced parent (as defined in section 216(d))” and inserting “, every surviving divorced parent (as defined in section 216(d)), and every surviving same-sex parent (as defined in section 216(m))”; and

(2) in the matter before subparagraph (A), by striking “or surviving divorced parent” and inserting “, surviving divorced parent, or surviving same-sex parent”.

(b) Conforming amendments.—

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

(A) in subparagraph (F), by inserting “or surviving same-sex parent” after “surviving divorced parent”; and

(B) in the matter following subparagraph (F)—

(i) by striking “or surviving divorced parent” and inserting “, such surviving divorced parent, or such surviving same-sex parent”;

(ii) by inserting “or a surviving same-sex parent” after “in the case of a surviving divorced parent”; and

(iii) by inserting “or such surviving same-sex parent” after “adopted child of such surviving divorced parent”.

(2) Section 202(g)(3) of such Act is amended by striking “or surviving divorced parent” each place it appears and inserting “, surviving divorced parent, or surviving same-sex parent”.

(c) Surviving same-sex parent.—Section 216 of the Social Security Act (42 U.S.C. 416) is amended by adding at the end the following new subsection:

“Surviving Same-sex Parent

“(m) (1) The term ‘surviving same-sex parent’ means, with respect to a deceased individual, an individual who is of the same sex as such deceased individual but only if—

“(A) he or she is the mother or father of the individual’s child;

“(B) such individual legally adopted the deceased individual's son or daughter before such son or daughter attained the age of 18;

“(C) the deceased individual legally adopted the son or daughter of such individual before such son or daughter attained the age of 18; or

“(D) such individual and the deceased individual both legally adopted a child under the age of 18.

“(2) Determinations under this subsection and section 202(g) shall be made without regard to section 7 of title 1, United States Code.”.

(d) Special marriage rule for surviving same-sex parents.—Section 202(g) of the Social Security Act (42 U.S.C. 402(g)) is amended by adding at the end the following new paragraph:

“(4) For purposes of this subsection, a surviving same-sex parent shall be considered to be married if such parent enters into a marriage or similar union under the laws of a State providing for such marriage or similar union.”.

(e) Effective date.—The amendments made by this section shall apply with respect to benefits for months beginning one month after the date of the enactment of this Act, based on applications filed on or after such date.

SEC. 605. Prohibition against discrimination on the basis of sexual orientation or gender identity under the health benefits program for Federal employees.

(a) In general.—Section 8902(f) of title 5, United States Code, is amended by inserting “sexual orientation, gender identity,” after “sex,”.

(b) Regulations.—Section 8913 of such title is amended—

(1) by redesignating subsection (d) as subsection (e); and

(2) by inserting after subsection (c) the following:

“(d) The regulations of the Office shall ensure that qualified carriers do not discriminate on the basis of sex, sexual orientation, gender identity, or any other basis which is prohibited by law.”.

SEC. 606. Prohibition against discrimination on the basis of sex, gender identity, or sexual orientation under certain laws providing health care and other benefits for members of the Armed Forces and Veterans.

(a) Prohibition against discrimination in administration of medical and dental care for certain members of the Armed Forces.—

(1) IN GENERAL.—Chapter 55 of title 10, United States Code, is amended by inserting after section 1074l the following new section:

§ 1074m. Prohibition against discrimination on the basis of sex, gender identity, or sexual orientation

“(a) In general.—The Secretary of Defense may not discriminate against a former member of the uniformed services entitled to medical care under section 1074 or 1074a of this title on the basis of sex, gender identity, or sexual orientation.

“(b) Regulations.—The Secretary of Defense, in consultation with the other administering Secretaries, shall prescribe regulations to carry out this section.”.

(2) CLERICAL AMENDMENT.—The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1074l the following new item:


“1074m. Prohibition against discrimination on the basis of sex, gender identity, or sexual orientation.”.

(b) Prohibition against discrimination in personal service contracts related to medical care for members of the Armed Forces.—Paragraph (1) of section 1091(c) of title 10, United States Code, is amended—

(1) in subparagraph (A), by striking “and”;

(2) in subparagraph (B), by striking the period at the end and inserting “; and”; and

(3) by adding at the end the following new subparagraph:

“(C) that an individual who enters into a personal services contract under subsection (a) shall not discriminate on the basis of sex, gender identity, or sexual orientation.”.

(c) Prohibition against discrimination in administration of veterans’ benefits.—

(1) IN GENERAL.—Subchapter II of chapter 5 of title 38, United States Code, is amended by adding at the end the following new section:

§ 533. Prohibition against discrimination on the basis of sex, gender identity, or sexual orientation

“In carrying out this title, the Secretary of Veterans Affairs may not discriminate on the basis of sex, gender identity, or sexual orientation and shall ensure that no person is discriminated against on such basis in connection with the administration of this title or the payment of any benefit or claim or provision of any service under this title.”.

(2) CLERICAL AMENDMENT.—The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 532 the following new item:


“533. Prohibition against discrimination on the basis of sex, gender identity, or sexual orientation.”.

(d) Prohibition against discrimination in payment of veterans’ benefits.—

(1) IN GENERAL.—Chapter 53 of title 38, United States Code, is amended by adding at the end the following new section:

§ 5320. Prohibition against discrimination on the basis of sex, gender, identity, or sexual orientation in the provision and administration of benefits

“The Secretary of Veterans Affairs shall ensure that no person is discriminated against on the basis of sex, gender identity, or sexual orientation in the entitlement to, administration of, or payment of benefits under this title.”.

(2) CLERICAL AMENDMENT.—The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 5319 the following new item:


“5320. Prohibition against discrimination on the basis of sex, gender, identity, or sexual orientation in the provision and administration of benefits.”.