At this level, healthcare facilities are typically early in their inclusion journey and have demonstrated that they have key foundational policies in place for LGBTQ+ inclusion. These policies focus on Patient Non-Discrimination, Equal Visitation and Employee Non-Discrimination--where each must be codified and communicated publicly. Healthcare facilities must also provide some training in LGBTQ+ culturally competent care*. To achieve this tier of recognition, a healthcare facility must receive full credit for all the questions in Criteria 1 - Non-Discrimination and Staff Training.

*Training options (that include CME/CEU credits) are available to facilities that complete the survey.

At this level, in addition to meeting the Foundational Tier of Recognition, Top Performer healthcare facilities have demonstrated that they have adopted a minimum number of LGBTQ+ inclusive policies and practices in Criteria 2: Patient Services and Support, Criteria 3: Employee Benefits and Policies and Criteria 4: Patient and Community Engagement. To achieve this tier of recognition, a healthcare facility must receive full credit in Criteria 1, at least partial credit in Criteria 2 (both scoring sections), 3 and 4, and obtain an overall score between 80-95.

At this level, Leader healthcare facilities demonstrate true leadership in adopting LGBTQ+ policies and practices. To achieve this tier of recognition, a healthcare facility must receive full credit in Criteria 1, 2, 3 and 4 and meet the criteria for the provision of transgender-inclusive health insurance. These facilities receive a top score of 100.

Up to 10 points

1. LGBTQ+ inclusive Patient Non-Discrimination Policy or Patient Bill of Rights
   1. Internal Non-Discrimination and/or Patient Bill of Rights Policy must include the terms “sexual orientation” and “gender identity and expression” (or “gender identity”)
2. Patient non-discrimination is communicated to patients and staff
   1. Policy is shared in two ways with the public, typically online and in-print
   2. Policy is shared with staff in at least one way

View Patient Non-Discrimination Resources for Healthcare Facilities

Up to 10 points

1. Equal Visitation Policy
   1. Policy must allow the patient’s visitor of their choice
2. Equal Visitation Policy is communicated to patients and staff
   1. Policy is shared in two ways with the public, typically online and in-print
   2. Policy is shared with staff in at least one way

View Equal Visitation Resources for Healthcare Facilities

Up to 10 points

1. LGBTQ+ inclusive Employment Non-Discrimination Policy
   1. Internal Employment Non-Discrimination Policy must include the terms “sexual orientation” and “gender identity or expression” (or “gender identity”)
2. Employment Non-Discrimination Policy is shared with the public
   1. Policy is shared with the public in at least one way

View Employment Non-Discrimination Resources for Healthcare Facilities

Up to 5 points

REVISED - Staff Training Requirement

Staff Training- Executive Briefing: For new facilities or those that have not previously met the training requirement, key senior executives must complete the LGBTQ+ Patient-Centered Care: An Executive Briefing training provided by the HEI 

Staff Training - Ongoing: Returning facilities that have previously met the Executive Briefing requirement must provide staff with training and development opportunities specific to health equity, culturally competent patient care, and employee inclusion and belonging that incorporate LGBTQ+ topics.

Additional Training in LGBTQ+ Patient-Centered Care – NEW

The facility must demonstrate that staff have completed a minimum number of hours of training on LGBTQ+ health equity and/or culturally competent patient care. The minimum number of training hours equals 5% of the number of FTEs at the healthcare facility.

Scoring Section One: There are 18 scored questions in these three subsections. In order to receive the full 20 points for these subsections, a facility must have at least 7 or more of these best practices in place from any of these subsections. Facilities with 3 to 6 of these best practices in place will receive a partial score of 10 for these subsections.

Scored best practices include:

Have a plan for reducing health disparities and increasing health equity among all patients, including considerations for patients of diverse backgrounds, such as race, ethnicity, language, sexual orientation, and gender identity

Have an internal planning or advisory committee focused on reducing health disparities and increasing health equity among all patients, including considerations for patients of diverse backgrounds, such as race, ethnicity, language, sexual orientation, and gender identity

Have a mechanism for potential patients to identify providers or facilities that are knowledgeable about and welcoming to LGBTQ+ patients

Provide HIV specific services

Provide services to meet the needs of LGBTQ+ patients

Have an LGBTQ+ specific clinic 

Have a program office, patient navigator/advocate or community health worker that is focused on LGBTQ+ patient care

Provide educational health information resources or links to outside health education resources related to LGBTQ+ patient care

Create and distribute health education brochures or other print materials about specific health topics and how they impact LGBTQ+ people

New hire training clearly states that the patient non-discrimination policy includes sexual orientation and gender identity and reviews the equal visitation policy and provides definitions or scenarios illustrating how these policies are to be implemented

View LGBTQ Patient Services Resources for Healthcare Facilities

The Gender Affirming Services and Support section utilizes best practices from The Joint Commission and other sources to enhance care for gender diverse patients, who often encounter discomfort and bias when receiving care.

Scored best practices include:

Have a written policy (or policies) that specifically outline at least three different processes aimed at eliminating bias and insensitivity, and ensuring appropriate, welcoming interactions with gender diverse patients

Offer gender-transition related medical and mental health care

Have a multidisciplinary gender affirming clinic for adults and/or youth

Have a program office or patient advocacy position to provide patient advocacy services to gender diverse patients

Offer all gender restrooms in public areas for patients and visitors and/or has clearly posted signage indicating a policy that allows individuals to use the restroom that aligns with their gender identity 

View Gender Affirming Services Resources for Healthcare Facilities

The Medical Decision Making section emphasizes that patients have the right to appoint anyone they choose, including a same-sex partner, to make medical decisions for them if they become incapacitated. Unfortunately, healthcare organizations have occasionally failed to respect the medical decision-making rights of LGBTQ+ patients. According to 2011 regulations from the Centers for Medicare & Medicaid Services (CMS), it should be more straightforward for family members, including same-sex partners, to make informed care decisions for incapacitated loved ones.

Scored best practices include:

Explicitly informs patients of their right to designate any person of their choice, including an unmarried partner, as medical decision-maker 

Provides staff training related to medical decision-making for all patients that includes LGBTQ+ specific information and/or scenarios

Have a policy, or official practices related to the treatment of intersex children that delays medically unnecessary procedures until the patient is old enough to make an informed decision 
 

View Medical Decision Making Resources for Healthcare Facilities

Patient Self-Identification is crucial for healthcare facilities to allow patients the option to identify as LGBTQ+ in their health records if they choose. Incorporating LGBTQ+ self-identification options into an electronic health record system is a significant step a facility can take to help address and reduce LGBTQ+ health disparities.

Scoring Section Two: There are 10 scored questions in this subsection. In order to receive the full 10 points in this subsection, a facility must have at least 5 or more of these best practices in place. Facilities with 2 to 4 of these best practices in place will receive a partial score of 5 for this subsection.

Scored best practices include:
 

Electronic health record (EHR) system offers explicit options to capture patient’s current gender identity 

A two-question process is used to collect gender identity information (i.e. first asking current gender identity and subsequently asking sex assigned at birth) 

EHR system offers an explicit way to capture a patient’s anatomical inventory

EHR system offers explicit options for capturing a patient’s sexual orientation

EHR system captures the patient’s name in use if it differs from their legal name AND prominently displays this name in the banner, flag, or a pop-up easily accessible for front line staff and providers

EHR system captures the patient’s pronouns in use AND prominently displays these pronouns in the banner, flag, or a pop-up easily accessible for front line staff and providers

EHR offers clear options for recording diverse families, including families with same sex parents

EHR system offers explicit options for recording relationship status with an un-married partner

Provides staff training specifically about collecting and recording gender identity data in the facility’s EHR system 

Provides staff training on the confidentiality of all protected patient health information, including information related to sexual orientation or gender identity, in accordance with HIPAA regulations.

View Patient Self-Identification Resources for Healthcare Facilities

There are 19 scored questions in this section, In order to receive full 15 points in this subsection, a facility must have at least 7 or more of these best practices in place. Facilities with 3 to 6 of these best practices in place will receive a partial score of 10 points.

Scored best practices include:

Equal Benefits

Provides healthcare benefits to domestic partners of employees

REVISED -- Offers financial assistance benefits for family formation, such as adoption, foster care, and/or surrogacy assistance programs that are inclusive of LGBTQ+ employees

REVISED -- Health insurance (or add-on service) covers clinically based family formation, such as fertility treatments, including assisted reproductive technologies, and egg and sperm freezing, that are inclusive of LGBTQ+ employees

NEW -- Provides at least one health plan to all employees that covers HIV screening and both oral and injectable Preexposure Prophylaxis (PrEP) for the prevention of HIV at no or low cost.

Provides FMLA-equivalent benefits that allow employees to take family and medical leave to care for domestic partners and the children of a domestic partner, regardless of biological or adoptive status

Have a LGBTQ+ inclusive paid, long-term family leave policy that allows paid time off to care for domestic partners as well as the children of a domestic partner, regardless of biological or adoptive status and parental leave policies that do not exclude non-birth parents and do not discriminate in access to benefits based on sex, sexual orientation, gender identity and marital status

Provides bereavement leave benefit that includes the event of the death of a domestic partner or the partner’s immediate family

Provide at least one health plan to all employees that affirmatively and explicitly covers medically necessary health services for transgender people, including gender transition-related treatment.

NEW – Provide coverage for 3 or more additional services related to gender affirming care beyond baseline requirements for coverage.

Provides employees with an LGBTQ+ inclusive benefits guide upon hire and annually during open enrollment OR organization provides access to a benefits concierge service with an LGBTQ+ specialty

Additional Support for LGBTQ+ Employees

Have written gender transition guidelines documenting supportive policies and practices on issues pertinent to a workplace gender transition, with a minimum of supportive restroom, dress code, and documentation guidance

Have an officially recognized LGBTQ+ employee resource group that is open to all employees

Have an office, council, or working group focused on creating an inclusive workplace for all employees, including LGBTQ+ employees 

Conducts anonymous employee engagement or climate surveys that allow employees the choice to voluntarily disclose demographic information, including sexual orientation and gender identity

The anonymous employee engagement or climate surveys include specific question(s) related to the workplace climate for LGBTQ+ employees 

Confidential human resources information system (HRIS) captures voluntarily disclosed demographic information, including sexual orientation and gender identity.

Commemorates an LGBTQ+ Awareness Day for employees at the facility

Engage in outreach and recruitment efforts that seek to build an inclusive workforce, including LGBTQ+ employees

Have openly LGBTQ+ people serving in high-level visible leadership positions

View Employee Benefits & Policies Resources for Healthcare Facilities
 

The question in this subsection is scored independently (5 points) and must be met in order to attain Leader status.

Equal health coverage for gender diverse individuals for medically necessary care. Baseline coverage MUST include the following items:

• Mental health benefits

• Pharmaceutical coverage (hormone replacement therapies, puberty blockers for youth)

• Coverage for medical visits or laboratory services

• Coverage for reconstructive surgical procedures related to gender affirming surgery (including reconstructive chest, breast, and genital procedures and related medically necessary procedures such as hair removal prior to genital procedures and revisions)

• Short-term medical leave

• Covered gender affirming treatments and procedures must be clearly listed in the contract documentation and the scope of each benefit must be described clearly in the employee benefits materials so that employees and their eligible dependents can easily understand what is covered

• The plan must eliminate other barriers to coverage.

Scored best practices include:

LGBTQ+ Community Engagement and Marketing

REVISED - Supports/sponsors one or more external community events or initiatives in your service area that include a focus on LGBTQ+ populations.

NEW – Hosts/organizes one or more events or initiatives to engage or support LGBTQ+ individuals in your patient population or community.

Engage in marketing or advertising directed toward the LGBTQ+ community

Social media content includes topics or messages relevant to LGBTQ+ audiences at least four different times per year, with at least one post on a topic pertinent to transgender people.

Have a LGBTQ+ specific logo that is used externally online, in marketing materials, or in other community engagement efforts

Have a supplier diversity program with a demonstrated effort to include certified LGBTQ+ suppliers (must be evident in public-facing materials)

Publicly supported LGBTQ+ equality under the law through local, state, or federal legislation or initiatives

Understanding the Needs of LGBTQ+ Patients and Community 
 

Patient satisfaction surveys allow patients to voluntarily disclose demographic information, including sexual orientation and gender identity. 

Patient satisfaction survey includes questions related to treatment as an LGBTQ+ patient

Work with LGBTQ+ organizations or community members to assess LGBTQ+ needs or address LGBTQ+ related concerns

Include external LGBTQ+ representation on a governing or community advisory board

Support or conduct research on health-related topics that reflect the needs of diverse patient populations, including LGBTQ+ individuals.

Analyze patient satisfaction and/or EHR data to identify healthcare needs and opportunities for improving services for diverse patient populations, including those relevant to LGBTQ+ individuals.

View Patient & Community Engagement Resources for Healthcare Facilities

This section focuses on known activities that undermine LGBTQ+ equality or patient care.

Healthcare organizations can have points deducted from their score if they have policies in place that may lead to discriminatory treatment or a large-scale official or public anti-LGBTQ+ blemish on their recent records.

Both a major deduction of 25 points and a minor deduction of 5 points exist.

Major Deduction

The deduction of 25 points is for major offenses to the LGBTQ+ that come to the attention of the HRC Foundation. These offenses could include revoking LGBTQ+ inclusive policies and practices or having policies in place and/or engaging in proven practices that are contrary to the organization's written LGBTQ+ patient or employment policies, among other infractions. This deduction is rarely applied and will only be applied after prior notification and discussion with the facility.

Minor Deduction

The deduction of 5 points is specific to healthcare facilities that either follow a religious directive or have a policy in place that prevents them from providing specific medically necessary treatments. For example, under such policies procedures such as hysterectomy or mastectomy, would be denied to some patients based on a diagnosis of gender dysphoria, however the same treatment would be provided to other patients based on other diagnoses. This may result in discriminatory treatment that is in conflict with their non-discrimination policy—for this we would implement the minor deduction (which offsets the points received for the Patient Non-Discrimination Policy).

Facilities with this type of directive or policy in place will only receive the minor deduction if they take certain actions to mitigate the potential for discriminatory situations to occur. If the facility does not mitigate the potential for discriminatory situations, the facility may receive the major deduction.

Please see our website for more information about this criterion.