; and (C) is able to translate effectively, accurately, and impartially to and from such languages and English, using any necessary specialized vocabulary, terminology, and phraseology. (21) Racial and ethnic minority group The term racial and ethnic minority group means American Indians and Alaska Natives, African Americans (including Caribbean Blacks, Africans, and other Blacks), Asian Americans, Hispanics (including Latinos), and Native Hawaiians and other Pacific Islanders. (22) Sexual and gender minority group The term sexual and gender minority group encompasses lesbian, gay, bisexual, and transgender populations, as well as those whose sexual orientation, gender identity and expression, or reproductive development varies from traditional, societal, cultural, or physiological norms. (23) Onsite interpretation The term onsite interpretation means a method of interpreting or interpretation for which the interpreter is in the physical presence of the provider of health care or health-care-related services and the recipient of such services who is limited in English proficiency or has a communication impairment such as hearing, vision, or learning. (24) Secretary The term Secretary means the Secretary of Health and Human Services. (25) Sight translation The term sight translation means the transmission of a written message in one language into a spoken or signed message in another language, or an alternative format in English or another language. (26) State The term State means each of the several States, the District of Columbia, the Commonwealth of Puerto Rico, the Indian Tribes, the United States Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands. (27) Telephonic interpretation The term telephonic interpretation (also known as over the phone interpretation or OPI) means a method of interpretation for which the interpreter is not in the physical presence of the provider of health care or related services and the limited-English-proficient recipient of such services but