,,ii #aaith ,,congress #ast ,session ,s4 #cbjf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,november #ai1 #bjbe,mr4 ,markey 7for himself1 ,mr4 ,blumenthal1 ,mr4 ,merkley1 ,mr4 ,schiff1 ,mr4 ,wyden1 and ,mr4 ,padilla7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to improve access to evidence-based1 lifesaving health care for transgender people1 and for other purposes4 #a4 ,short title ,this ,act may be referred to as the ,transgender ,health ,care ,access ,act4 #b4 ,findings ,congress finds the following3 7#a7 ,receiving gender-affirming care increases self-esteem and quality of life and decreases depression1 self-harm1 and suicidality in transgender people of all ages4 7#b7 ,there is a strong medical consensus about the importance of health care for transgender people1 including transgender young people4 ,the ,american ,academy of ,child and ,adolescent ,psychiatry1 ,american ,academy of ,dermatology1 ,american ,academy of ,pediatrics1 ,american ,academy of ,physician ,assistants1 ,american ,medical ,association1 ,american ,nurses ,association1 ,american ,association of ,clinical ,endocrinology1 ,american ,association of ,geriatric ,psychiatry1 ,american ,college ,health ,association1 ,american ,college of ,nurse-,midwives1 ,american ,college of ,obstetricians and ,gynecologists1 ,american ,college of ,physicians1 ,american ,counseling ,association1 ,american ,heart ,association1 ,american ,medical ,student ,association1 ,american ,psychiatric ,association1 ,american ,psychological ,association1 ,american ,society for ,reproductive ,medicine1 ,american ,urological ,association1 ,endocrine ,society1 ,federation of ,pediatric ,organizations1 ,,glma3 ,health ,professionals ,advancing ,,lgbtq ,equality1 ,the ,journal of the ,american ,medical ,association1 ,national ,association of ,nurse ,practitioners in ,women's ,health1 ,national ,association of ,social ,workers1 ,pediatric ,endocrine ,society1 ,pediatrics 7,journal of the ,american ,academy of ,pediatrics71 ,united ,states ,professional ,association for ,transgender ,health 7,,uspath71 ,world ,health ,organization 7,,who71 ,world ,medical ,association1 and ,world ,professional ,association for ,transgender ,health1 have all issued statements in support of health care for transgender people4 7#c7 ,there is a gap in education across health professions around treating transgender patients4 ,one survey of students at #aj medical schools showed that approximately #hj percent of students did not feel competent at treating transgender patients4 7#d7 ,academic literature shows that this education gap is a significant barrier to appropriate health care4 7#e7 ,experts in gender-affirming care and culturally competent care for transgender people are improving access to gender-affirming care through peer-to-peer education4 #c4 ,definitions ,in this ,act3 7#a7 ,gender-affirming care ,the term gender-affirming care-- 7,a7 means health care designed to treat gender dysphoria2 7,b7 includes all supplies1 care1 and services of a medical1 behavioral health1 mental health1 surgical1 psychiatric1 therapeutic1 diagnostic1 preventative1 rehabilitative1 or supportive nature1 including medication1 relating to the treatment of gender dysphoria2 and 7,c7 excludes conversion therapy4 7#b7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 #d4 ,improving medical education curricula for gender-affirming care 7a7 ,improving the provision of gender-,affirming care 7#a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall award grants to eligible entities for the development1 evaluation1 and implementation of model curricula1 demonstration projects1 and training projects to improve the provision of gender-affirming care4 7#b7 ,eligible entities ,to be eligible to receive a grant under paragraph 7#a71 an entity shall be-- 7,a7 a health care professions school2 7,b7 a health care delivery site with fellows1 residents1 or other health care professional students or trainees2 or 7,c7 a licensing or accreditation entity for health care professions schools4 7b7 ,curricula 7#a7 ,topics ,the ,secretary shall ensure that curricula developed pursuant to subsection 7a7 include instruction on one or more of the following topics3 7,a7 ,gender-affirming care4 7,b7 ,cultural competency in treating transgender patients4 7#b7 ,pedagogical approaches ,curricula developed pursuant to subsection 7a7 may employ-- 7,a7 didactic education2 7,b7 clinical education2 7,c7 simulated or standardized patient education2 7,d7 community-based research2 and 7,e7 community-based learning4 7c7 ,dissemination ,the ,secretary1 acting through the ,director of the ,national ,library of ,medicine and the ,director of the ,national ,institutes of ,health1 in collaboration with medical education accrediting organizations1 shall disseminate model curricula developed under this section4 7d7 ,duration of award ,the period of a grant under this section shall be #c years1 subject to annual review and continuation by the ,secretary4 7e7 ,carryover funds ,the ,secretary shall make available funds to grantees under this section on an annual basis1 but may authorize a grantee to retain the funds for obligation and expenditure through the end of the #c-year grant period referred to in subsection 7f74 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #aj1jjj1jjj for each of fiscal years #bjbf through #bjcj4 #e4 ,training demonstration program for gender-affirming care 7a7 ,in general ,the ,secretary shall establish a demonstration program to award grants to eligible entities to support-- 7#a7 training for medical residents and fellows to practice gender-affirming care2 7#b7 training 7including for individuals completing clinical training requirements for licensure7 for nurse practitioners1 physician assistants1 health service psychologists1 clinical psychologists1 counselors1 nurses1 and social workers to practice gender-affirming care2 and 7#c7 establishing1 maintaining1 or improving academic programs that-- 7,a7 provide training for students or faculty1 including through clinical experiences1 to improve their ability to provide culturally competent gender-affirming care2 and 7,b7 conduct research to develop evidence-based practices regarding gender-affirming care1 including curriculum content standards for programs that provide training for students or faculty as described in subparagraph 7,a74 7b7 ,eligible entities 7#a7 ,training for residents and fellows ,to be eligible to receive a grant under subsection 7a77#a71 an entity shall be-- 7,a7 a consortium consisting of-- 7i7 at least one teaching health center2 and 7ii7 the sponsoring institution 7or parent institution of the sponsoring institution7 of-- 7,i7 a residency program in primary care1 internal medicine1 family medicine1 pediatric medicine1 gynecology1 endocrinology1 or surgery that is accredited by the ,accreditation ,council for ,graduate ,medical ,education2 or 7,,ii7 a fellowship program in a field identified in subclause 7,i72 or 7,b7 an institution described in subparagraph 7,a77ii7 that provides opportunities for residents or fellows to train in community-based settings that provide health care to transgender populations4 7#b7 ,training for other providers ,to be eligible to receive a grant under subsection 7a77#b71 an entity shall be-- 7,a7 a teaching health center 7as defined in section #gdi;,a7f77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bicl-#a7;f77#c7772 7,b7 a ,federally-qualified health center 7as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7772 7,c7 a community mental health center 7as defined in section #ahfa7;ff77#c77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ff77#c77;,b7772 7,d7 a rural health clinic 7as defined in section #ahfa7;aa77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#b7772 7,e7 a health center operated by the ,indian ,health ,service1 an ,indian ,tribe1 a ,tribal organization1 or an ,urban ,indian organization 7as defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc772 or 7,f7 an entity with a demonstrated record of success in providing training for nurse practitioners1 physician assistants1 health service psychologists1 counselors1 nurses1 or social workers1 including such entities that serve pediatric populations4 7#c7 ,academic units or programs ,to be eligible to receive a grant under subsection 7a77#c71 an entity shall be-- 7,a7 a school of medicine or osteopathic medicine2 7,b7 a school of nursing2 7,c7 a physician assistant training program2 7,d7 a school of pharmacy2 7,e7 a school of social work2 7,f7 an accredited public or nonprofit private hospital2 7,g7 an accredited medical residency program2 or 7,h7 a public or nonprofit private entity that the ,secretary determines is capable of carrying out such a grant because of prior experience providing education on the provision of health care to transgender people4 7c7 ,use of funds 7#a7 ,training grants ,a recipient of a grant under subsection 7a77#a7 or 7a77#b7-- 7,a7 shall use the grant funds to plan1 develop1 and operate a training program for residents and fellows2 and 7,b7 may use the grant funds to-- 7i7 support the administration of a program described in subparagraph 7,a72 7ii7 support professional development for faculty of a program described in subparagraph 7,a72 or 7iii7 establish1 maintain1 or improve departments1 divisions1 or other units necessary to implement a program described in subparagraph 7,a74 7#b7 ,grants to academic units or programs ,a recipient of a grant under subsection 7a77#c7 shall enter into a partnership with education accrediting organizations or similar organizations to carry out activities under subsection 7a77#c74 7d7 ,priority ,in making awards under this section1 the ,secretary shall give priority to eligible entities that-- 7#a7 have a history of providing health care to transgender people2 or 7#b7 serve areas where access to gender-affirming care is limited4 7e7 ,minimum period of grants ,the period of a grant under this section shall be not less than #e years4 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #ae1jjj1jjj for each of fiscal years #bjbf through #bjcj4 #f4 ,expanding capacity for gender-affirming care at community health centers 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall award grants or cooperative agreements to eligible entities to promote the capacity of community health centers to provide gender-affirming care to transgender populations4 7b7 ,eligible entities ,to be eligible to receive a grant under subsection 7a71 an entity shall be-- 7#a7 a teaching health center 7as defined in section #gdi;,a7f77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bicl-#a7;f77#c7772 7#b7 a ,federally-qualified health center 7as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7772 7#c7 a community mental health center 7as defined in section #ahfa7;ff77#c77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ff77#c77;,b7772 7#d7 a rural health clinic 7as defined in section #ahfa7;aa77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#b7772 7#e7 a health center operated by the ,indian ,health ,service1 an ,indian ,tribe1 a ,tribal organization1 or an ,urban ,indian organization 7as defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc772 or 7#f7 a ,state or local entity1 such as a ,state office of rural health4 7c7 ,use of funds ,a grant under subsection 7a7 shall be used to promote the capacity of community health centers to provide gender-affirming care1 which may include-- 7#a7 education and training1 including professional development and training on nondiscrimination regulations1 for health care professionals and other staff of health care providers2 7#b7 establishing or sustaining a community review board2 7#c7 updating electronic health records2 and 7#d7 administrative1 operational1 or technical costs related to the effective provision of gender-affirming care4 7d7 ,minimum period of grants ,the period of a grant under this section shall be not less than #c years4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #ae1jjj1jjj for each of fiscal years #bjbf through #bjcj4 #g4 ,training rural providers in gender-affirming care 7a7 ,in general ,the ,secretary shall award grants or cooperative agreements to eligible entities to establish collaborative networks to improve the quality of gender-affirming care4 7b7 ,eligible entities ,to be eligible for a grant under subsection 7a71 an entity shall be-- 7#a7 a public or nonprofit private health care provider1 such as a critical access hospital or health clinic2 7#b7 a ,federally-qualified health center 7as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7772 7#c7 a health care professions school2 7#d7 a health care delivery site that has fellows1 residents1 or other health care professional students or trainees2 and 7#e7 a licensing or accreditation entity for health care professions schools4 7c7 ,allowable activities ,in establishing a collaborative network as described in subsection 7a71 a grantee may1 with respect to gender-affirming care1 use grant funds-- 7#a7 to assist rural health care providers in the network to conduct or pursue additional training2 7#b7 to perform provider-to-provider education and outreach to rural health care providers2 and 7#c7 to perform patient education4 7d7 ,definition ,in this section1 the term rural health care provider means a health care provider serving an area that is not designated by the ,united ,states ,census ,bureau as an urbanized area or urban cluster4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #e1jjj1jjj for each of fiscal years #bjbf through #bjcj4 #h4 ,report to ,congress 7a7 ,submission ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall submit to ,congress a report on the programs and activities under this ,act4 7b7 ,content ,the report submitted under subsection 7a7 shall include-- 7#a7 a description of-- 7,a7 progress made in implementing programs and activities under this ,act2 and 7,b7 the extent to which such programs and activities have improved health equity for transgender populations2 and 7#b7 recommendations for workforce development to improve access to1 and the quality of1 gender-affirming care for transgender populations4