,,ii #aai? ,,congress #a/ ,session ,s4 #cbjf ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,novemb] #ai1 #bjbe,mr4 ,m>key 7= himself1 ,mr4 ,blum5?al1 ,mr4 ,m]kley1 ,mr4 ,s*iff1 ,mr4 ,wyd51 & ,mr4 ,padilla7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ,a ,,bill ,to improve access to evid5ce-bas$1 lifesav+ heal? c>e = transg5d] p1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be ref]r$ to z ! ,transg5d] ,heal? ,c>e ,access ,act4 #b4 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,receiv+ g5d]-affirm+ c>e increases self-e/eem & quality ( life & decreases depression1 self-h>m1 & suicidality 9 transg5d] p ( all ages4 7#b7 ,!re is a /rong m$ical cons5sus ab\t ! importance ( heal? c>e = transg5d] p1 includ+ transg5d] "y p4 ,! ,am]ican ,academy ( ,*ild & ,adolesc5t ,psy*iatry1 ,am]ican ,academy ( ,d]matology1 ,am]ican ,academy ( ,p$iatrics1 ,am]ican ,academy ( ,physician ,assi/ants1 ,am]ican ,m$ical ,association1 ,am]ican ,nurses ,association1 ,am]ican ,association ( ,cl9ical ,endocr9ology1 ,am]ican ,association ( ,g]iatric ,psy*iatry1 ,am]ican ,college ,heal? ,association1 ,am]ican ,college ( ,nurse-,midwives1 ,am]ican ,college ( ,ob/etricians & ,gynecologi/s1 ,am]ican ,college ( ,physicians1 ,am]ican ,c\nsel+ ,association1 ,am]ican ,he>t ,association1 ,am]ican ,m$ical ,/ud5t ,association1 ,am]ican ,psy*iatric ,association1 ,am]ican ,psy*ological ,association1 ,am]ican ,society = ,reproductive ,m$ic9e1 ,am]ican ,urological ,association1 ,endocr9e ,society1 ,f$]ation ( ,p$iatric ,organizations1 ,,glma3 ,heal? ,pr(essionals ,advanc+ ,,lgbtq ,equality1 ,! ,j\rnal ( ! ,am]ican ,m$ical ,association1 ,national ,association ( ,nurse ,practition]s 9 ,wom5's ,heal?1 ,national ,association ( ,social ,work]s1 ,p$iatric ,endocr9e ,society1 ,p$iatrics 7,j\rnal ( ! ,am]ican ,academy ( ,p$iatrics71 ,unit$ ,/ates ,pr(essional ,association = ,transg5d] ,heal? 7,,uspa?71 ,_w ,heal? ,organization 7,,:o71 ,_w ,m$ical ,association1 & ,_w ,pr(essional ,association = ,transg5d] ,heal?1 h all issu$ /atem5ts 9 support ( heal? c>e = transg5d] p4 7#c7 ,!re is a gap 9 education across heal? pr(essions ar\nd treat+ transg5d] pati5ts4 ,"o survey ( /ud5ts at #aj m$ical s*ools %[$ t approximately #hj p]c5t ( /ud5ts did n feel compet5t at treat+ transg5d] pati5ts4 7#d7 ,academic lit]ature %[s t ?is education gap is a significant b>ri] to appropriate heal? c>e4 7#e7 ,exp]ts 9 g5d]-affirm+ c>e & culturally compet5t c>e = transg5d] p are improv+ access to g5d]-affirm+ c>e ?r\gh pe]-to-pe] education4 #c4 ,def9itions ,9 ?is ,act3 7#a7 ,g5d]-affirm+ c>e ,! t]m g5d]-affirm+ c>e-- 7,a7 means heal? c>e design$ to treat g5d] dysphoria2 7,b7 includes all supplies1 c>e1 & s]vices ( a m$ical1 behavioral heal?1 m5tal heal?1 surgical1 psy*iatric1 !rapeutic1 diagno/ic1 prev5tative1 rehabilitative1 or supportive nature1 includ+ m$ication1 relat+ to ! treatm5t ( g5d] dysphoria2 & 7,c7 excludes conv]sion !rapy4 7#b7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 #d4 ,improv+ m$ical education curricula = g5d]-affirm+ c>e 7a7 ,improv+ ! provision ( g5d]-,affirm+ c>e 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all aw>d grants to eligible entities = ! developm5t1 evaluation1 & implem5tation ( model curricula1 demon/ration projects1 & tra9+ projects to improve ! provision ( g5d]-affirm+ c>e4 7#b7 ,eligible entities ,to be eligible to receive a grant "u p>agraph 7#a71 an entity %all be-- 7,a7 a heal? c>e pr(essions s*ool2 7,b7 a heal? c>e deliv]y site ) fell[s1 resid5ts1 or o!r heal? c>e pr(essional /ud5ts or tra9ees2 or 7,c7 a lic5s+ or accr$itation entity = heal? c>e pr(essions s*ools4 7b7 ,curricula 7#a7 ,topics ,! ,secret>y %all ensure t curricula develop$ pursuant to subsection 7a7 include in/ruction on "o or m ( ! foll[+ topics3 7,a7 ,g5d]-affirm+ c>e4 7,b7 ,cultural compet5cy 9 treat+ transg5d] pati5ts4 7#b7 ,p$agogical approa*es ,curricula develop$ pursuant to subsection 7a7 may employ-- 7,a7 didactic education2 7,b7 cl9ical education2 7,c7 simulat$ or /&>diz$ pati5t education2 7,d7 community-bas$ rese>*2 & 7,e7 community-bas$ le>n+4 7c7 ,dissem9ation ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,national ,libr>y ( ,m$ic9e & ! ,director ( ! ,national ,in/itutes ( ,heal?1 9 collaboration ) m$ical education accr$it+ organizations1 %all dissem9ate model curricula develop$ "u ?is section4 7d7 ,duration ( aw>d ,! p]iod ( a grant "u ?is section %all be #c ye>s1 subject to annual review & cont9uation by ! ,secret>y4 7e7 ,c>ryov] funds ,! ,secret>y %all make available funds to grantees "u ?is section on an annual basis1 b may au?orize a grantee to reta9 ! funds = obligation & exp5diture ?r\gh ! end ( ! #c-ye> grant p]iod ref]r$ to 9 subsection 7f74 7f7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #aj1jjj1jjj = ea* ( fiscal ye>s #bjbf ?r\gh #bjcj4 #e4 ,tra9+ demon/ration program = g5d]-affirm+ c>e 7a7 ,9 g5]al ,! ,secret>y %all e/abli% a demon/ration program to aw>d grants to eligible entities to support-- 7#a7 tra9+ = m$ical resid5ts & fell[s to practice g5d]-affirm+ c>e2 7#b7 tra9+ 7includ+ = individuals complet+ cl9ical tra9+ requirem5ts = lic5sure7 = nurse practition]s1 physician assi/ants1 heal? s]vice psy*ologi/s1 cl9ical psy*ologi/s1 c\nselors1 nurses1 & social work]s to practice g5d]-affirm+ c>e2 & 7#c7 e/abli%+1 ma9ta9+1 or improv+ academic programs t-- 7,a7 provide tra9+ = /ud5ts or faculty1 includ+ ?r\gh cl9ical exp]i5ces1 to improve _! ability to provide culturally compet5t g5d]-affirm+ c>e2 & 7,b7 conduct rese>* to develop evid5ce-bas$ practices reg>d+ g5d]-affirm+ c>e1 includ+ curriculum cont5t /&>ds = programs t provide tra9+ = /ud5ts or faculty z describ$ 9 subp>agraph 7,a74 7b7 ,eligible entities 7#a7 ,tra9+ = resid5ts & fell[s ,to be eligible to receive a grant "u subsection 7a77#a71 an entity %all be-- 7,a7 a consortium consi/+ (-- 7i7 at lea/ "o tea*+ heal? c5t]2 & 7ii7 ! sponsor+ in/itution 7or p>5t in/itution ( ! sponsor+ in/itution7 (-- 7,i7 a resid5cy program 9 prim>y c>e1 int]nal m$ic9e1 family m$ic9e1 p$iatric m$ic9e1 gynecology1 endocr9ology1 or surg]y t is accr$it$ by ! ,accr$itation ,c\ncil = ,graduate ,m$ical ,education2 or 7,,ii7 a fell[%ip program 9 a field id5tifi$ 9 subclause 7,i72 or 7,b7 an in/itution describ$ 9 subp>agraph 7,a77ii7 t provides opportunities = resid5ts or fell[s to tra9 9 community-bas$ sett+s t provide heal? c>e to transg5d] populations4 7#b7 ,tra9+ = o!r provid]s ,to be eligible to receive a grant "u subsection 7a77#b71 an entity %all be-- 7,a7 a tea*+ heal? c5t] 7z def9$ 9 section #gdi;,a7f77#c7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bicl-#a7;f77#c7772 7,b7 a ,f$]ally-qualifi$ heal? c5t] 7z def9$ 9 section #aije7l77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7772 7,c7 a community m5tal heal? c5t] 7z def9$ 9 section #ahfa7;ff77#c77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ff77#c77;,b7772 7,d7 a rural heal? cl9ic 7z def9$ 9 section #ahfa7;aa77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#b7772 7,e7 a heal? c5t] op]at$ by ! ,indian ,heal? ,s]vice1 an ,indian ,tribe1 a ,tribal organization1 or an ,urban ,indian organization 7z def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc772 or 7,f7 an entity ) a demon/rat$ record ( success 9 provid+ tra9+ = nurse practition]s1 physician assi/ants1 heal? s]vice psy*ologi/s1 c\nselors1 nurses1 or social work]s1 includ+ su* entities t s]ve p$iatric populations4 7#c7 ,academic units or programs ,to be eligible to receive a grant "u subsection 7a77#c71 an entity %all be-- 7,a7 a s*ool ( m$ic9e or o/eopa?ic m$ic9e2 7,b7 a s*ool ( nurs+2 7,c7 a physician assi/ant tra9+ program2 7,d7 a s*ool ( ph>macy2 7,e7 a s*ool ( social "w2 7,f7 an accr$it$ public or nonpr(it private hospital2 7,g7 an accr$it$ m$ical resid5cy program2 or 7,h7 a public or nonpr(it private entity t ! ,secret>y det]m9es is capable ( c>ry+ out su* a grant because ( prior exp]i5ce provid+ education on ! provision ( heal? c>e to transg5d] p4 7c7 ,use ( funds 7#a7 ,tra9+ grants ,a recipi5t ( a grant "u subsection 7a77#a7 or 7a77#b7-- 7,a7 %all use ! grant funds to plan1 develop1 & op]ate a tra9+ program = resid5ts & fell[s2 & 7,b7 may use ! grant funds to-- 7i7 support ! adm9i/ration ( a program describ$ 9 subp>agraph 7,a72 7ii7 support pr(essional developm5t = faculty ( a program describ$ 9 subp>agraph 7,a72 or 7iii7 e/abli%1 ma9ta91 or improve dep>tm5ts1 divisions1 or o!r units necess>y to implem5t a program describ$ 9 subp>agraph 7,a74 7#b7 ,grants to academic units or programs ,a recipi5t ( a grant "u subsection 7a77#c7 %all ent] into a p>tn]%ip ) education accr$it+ organizations or simil> organizations to c>ry out activities "u subsection 7a77#c74 7d7 ,priority ,9 mak+ aw>ds "u ?is section1 ! ,secret>y %all give priority to eligible entities t-- 7#a7 h a hi/ory ( provid+ heal? c>e to transg5d] p2 or 7#b7 s]ve areas :]e access to g5d]-affirm+ c>e is limit$4 7e7 ,m9imum p]iod ( grants ,! p]iod ( a grant "u ?is section %all be n less ?an #e ye>s4 7f7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #ae1jjj1jjj = ea* ( fiscal ye>s #bjbf ?r\gh #bjcj4 #f4 ,exp&+ capacity = g5d]-affirm+ c>e at community heal? c5t]s 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all aw>d grants or coop]ative agreem5ts to eligible entities to promote ! capacity ( community heal? c5t]s to provide g5d]-affirm+ c>e to transg5d] populations4 7b7 ,eligible entities ,to be eligible to receive a grant "u subsection 7a71 an entity %all be-- 7#a7 a tea*+ heal? c5t] 7z def9$ 9 section #gdi;,a7f77#c7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bicl-#a7;f77#c7772 7#b7 a ,f$]ally-qualifi$ heal? c5t] 7z def9$ 9 section #aije7l77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7772 7#c7 a community m5tal heal? c5t] 7z def9$ 9 section #ahfa7;ff77#c77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ff77#c77;,b7772 7#d7 a rural heal? cl9ic 7z def9$ 9 section #ahfa7;aa77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#b7772 7#e7 a heal? c5t] op]at$ by ! ,indian ,heal? ,s]vice1 an ,indian ,tribe1 a ,tribal organization1 or an ,urban ,indian organization 7z def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc772 or 7#f7 a ,/ate or local entity1 su* z a ,/ate (fice ( rural heal?4 7c7 ,use ( funds ,a grant "u subsection 7a7 %all be us$ to promote ! capacity ( community heal? c5t]s to provide g5d]-affirm+ c>e1 :i* may include-- 7#a7 education & tra9+1 includ+ pr(essional developm5t & tra9+ on nondiscrim9ation regulations1 = heal? c>e pr(essionals & o!r /aff ( heal? c>e provid]s2 7#b7 e/abli%+ or su/a9+ a community review bo>d2 7#c7 updat+ electronic heal? records2 & 7#d7 adm9i/rative1 op]ational1 or te*nical co/s relat$ to ! effective provision ( g5d]-affirm+ c>e4 7d7 ,m9imum p]iod ( grants ,! p]iod ( a grant "u ?is section %all be n less ?an #c ye>s4 7e7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #ae1jjj1jjj = ea* ( fiscal ye>s #bjbf ?r\gh #bjcj4 #g4 ,tra9+ rural provid]s 9 g5d]-affirm+ c>e 7a7 ,9 g5]al ,! ,secret>y %all aw>d grants or coop]ative agreem5ts to eligible entities to e/abli% collaborative networks to improve ! quality ( g5d]-affirm+ c>e4 7b7 ,eligible entities ,to be eligible = a grant "u subsection 7a71 an entity %all be-- 7#a7 a public or nonpr(it private heal? c>e provid]1 su* z a critical access hospital or heal? cl9ic2 7#b7 a ,f$]ally-qualifi$ heal? c5t] 7z def9$ 9 section #aije7l77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7772 7#c7 a heal? c>e pr(essions s*ool2 7#d7 a heal? c>e deliv]y site t has fell[s1 resid5ts1 or o!r heal? c>e pr(essional /ud5ts or tra9ees2 & 7#e7 a lic5s+ or accr$itation entity = heal? c>e pr(essions s*ools4 7c7 ,all[able activities ,9 e/abli%+ a collaborative network z describ$ 9 subsection 7a71 a grantee may1 ) respect to g5d]-affirm+ c>e1 use grant funds-- 7#a7 to assi/ rural heal? c>e provid]s 9 ! network to conduct or pursue additional tra9+2 7#b7 to p]=m provid]-to-provid] education & outrea* to rural heal? c>e provid]s2 & 7#c7 to p]=m pati5t education4 7d7 ,def9ition ,9 ?is section1 ! t]m rural heal? c>e provid] means a heal? c>e provid] s]v+ an area t is n designat$ by ! ,unit$ ,/ates ,c5sus ,bureau z an urbaniz$ area or urban clu/]4 7e7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #e1jjj1jjj = ea* ( fiscal ye>s #bjbf ?r\gh #bjcj4 #h4 ,report to ,congress 7a7 ,submission ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all submit to ,congress a report on ! programs & activities "u ?is ,act4 7b7 ,cont5t ,! report submitt$ "u subsection 7a7 %all include-- 7#a7 a description (-- 7,a7 progress made 9 implem5t+ programs & activities "u ?is ,act2 & 7,b7 ! ext5t to :i* su* programs & activities h improv$ heal? equity = transg5d] populations2 & 7#b7 recomm5dations = work=ce developm5t to improve access to1 & ! quality (1 g5d]-affirm+ c>e = transg5d] populations4