Eighteen of 21 participating Massachusetts health care facilities earned perfect scores in a survey gauging how well their policies protect health care access for people who are lesbian, gay, bisexual, or transgender. One notable outlier in the voluntary survey administered by the advocacy group Human Rights Campaign was Massachusetts General Hospital, which did not meet five of seven criteria.

The hospital does not specifically cite sexual orientation or gender identity in its patient non-discrimination and visitation policies, which accounted for four of the bad grades. It does provide such specifics in a patient admissions guide.

Explicitly citing protections against discrimination based on gender or sexual orientation is a “public commitment” to preserving equality in access to care, said Paul Guequierre, spokesman for the Human Rights Campaign.

Jeff Davis, senior vice president of human resources at Mass. General, said the hospital designed its policy to be more inclusive and has a long-standing commitment to the LGBT community. “We’ll change our language to do well on the survey, but it won’t change our policy,” Davis said, indicating that the hospital’s policies already protect patient rights.

The hospital also does not have a training program for managers focusing on caring for LGBT patients.

For the first time this year, the survey asked health care organizations to show whether certain staff had received training in the past year on topics such as health disparities, why people in the LGBT population may avoid doctors, how to improve interactions between clinicians and patients, and legal and financial challenges for LGBT patients. (See this Globe story by Neena Satija about how gender identity and sexual orientation can shape a person’s health care needs.)

Tufts Medical Center and Dana-Farber Cancer Institute also reported that they did not have the training, according to the report.

The training requirement was added to the survey this year to emphasize that putting policies on paper is not enough, said Guequierre, whose group offers a training program.

Davis said he planned to look into how other Partners hospitals in the survey, including Brigham and Women’s, had handled their training.

“I think it’s probably a good idea,” he said.

Davis said the Mass. General gay, lesbian, bisexual, and transgender employee association completed the survey on the hospital’s behalf.

See the full report on the Healthcare Equality Index website. To see local results, select Massachusetts from the drop-down menu.