II 

118TH CONGRESS 

1ST SESSION S. 1193 

To prohibit discrimination against individuals with disabilities who need longterm services and supports, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 19, 2023 

Mr. BENNET (for himself, Mr. BOOKER, Mr. MARKEY, Mr. WHITEHOUSE, Mr. 

SCHUMER, Ms. STABENOW, Mr. REED, Mr. HEINRICH, Ms. WARREN, Ms. 

CORTEZ MASTO, Mr. HICKENLOOPER, Ms. KLOBUCHAR, Ms. BALDWIN, 

Mrs. GILLIBRAND, Mr. CARPER, Ms. HIRONO, and Mr. VAN HOLLEN) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To prohibit discrimination against individuals with disabilities who need long-term services and supports, and for 

other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Latonya Reeves Free5 dom Act of 2023’’. 

6 SEC. 2. PURPOSES. 

7 The purposes of this Act are— 


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1 (1) to clarify and strengthen the integration 

2 mandate of the Americans with Disabilities Act of 

3 1990, held by the Supreme Court in Olmstead v. 

4 L.C., 527 U.S. 581 (1999) in a manner that acceler5 ates and improves State compliance; 

6 (2) to affirm that every individual who is eligi7 ble for long-term services and supports has a feder8 ally protected right to be meaningfully integrated 

9 into that individual’s community and receive commu10 nity-based long-term services and supports; 

11 (3) to ensure that States provide long-term 

12 services and supports to individuals with disabilities 

13 in a manner that allows individuals with disabilities 

14 to live in the most integrated setting, including the 

15 individual’s own home, have maximum control over 

16 their services and supports, and ensure that long17 term services and supports are provided in a manner 

18 that allows individuals with disabilities to lead an 

19 independent life; 

20 (4) to establish a comprehensive State planning 

21 requirement that includes enforceable, measurable 

22 objectives that are designed to transition individuals 

23 with all types of disabilities at all ages out of institu24 tions and into the most integrated setting, if they 

25 choose that transition; and 


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1 (5) to identify and address disparities in the 

2 provision of community-based long-term services and 

3 supports. 

4 SEC. 3. DEFINITIONS AND RULE. 

5 (a) DEFINITIONS.—In this Act: 

6 (1) ACTIVITIES OF DAILY LIVING.—The term 

7 ‘‘activities of daily living’’ has the meaning given the 

8 term in section 441.505 of title 42, Code of Federal 

9 Regulations (or a successor regulation). 

10 (2) ADMINISTRATOR.—The term ‘‘Adminis11 trator’’ means— 

12 (A) the Administrator of the Administra13 tion for Community Living; or 

14 (B) another designee of the Secretary of 

15 Health and Human Services. 

16 (3) COMMUNITY-BASED; SERVICES OR SUP17 PORTS.—The term ‘‘community-based’’, when used 

18 in reference to services or supports, means services 

19 or supports that are provided to an individual with 

20 an LTSS disability to enable that individual to live 

21 in the community and lead an independent life, and 

22 that are delivered in whichever setting the individual 

23 with an LTSS disability has chosen out of the fol24 lowing settings with the following qualities: 


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1 (A) In the case of a dwelling or a nonresi2 dential setting (such as a setting in which an 

3 individual with an LTSS disability receives day 

4 services and supported employment), a dwelling 

5 or setting— 

6 (i) that, as a matter of infrastructure, 

7 environment, amenities, location, services, 

8 and features, is integrated into the greater 

9 community and supports, for each indi10 vidual with an LTSS disability who re11 ceives services or supports at the setting— 

12 (I) full access to the greater com13 munity (including access to opportuni14 ties to seek employment and work in 

15 competitive integrated settings, en16 gage in community life, control per17 sonal resources, and receive services 

18 in the community); and 

19 (II) access to the greater commu20 nity to the same extent as access to 

21 the community is enjoyed by an indi22 vidual who is not receiving long-term 

23 services or supports; 

24 (ii) that the individual has selected as 

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1 dential setting options, including nondis2 ability-specific settings; 

3 (iii) in which an individual has rights 

4 to privacy, dignity, and respect, and free5 dom from coercion and restraint; 

6 (iv) that, as a matter of infrastruc7 ture, environment, amenities, location, 

8 services, and features, optimizes, but does 

9 not regiment, individual initiative, auton10 omy, and independence in making life 

11 choices, including choices about daily ac12 tivities, physical environment, and persons 

13 with whom the individual interacts; and 

14 (v) that, as a matter of infrastructure, 

15 environment, amenities, location, services, 

16 and features, facilitates individual choice 

17 regarding the provision of services and 

18 supports, and who provides those services 

19 and supports. 

20 (B) In the case of a dwelling, a dwelling— 

21 (i) that is owned by an individual with 

22 an LTSS disability or the individual’s fam23 ily member; 

24 (ii) that is leased to the individual 

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1 vidual lease, that has lockable access and 

2 egress, and that includes living, sleeping, 

3 bathing, and cooking areas over which an 

4 individual with an LTSS disability or the 

5 individual’s family member has domain 

6 and control; or 

7 (iii) that is a group or shared resi8 dence— 

9 (I) in which no more than 4 un10 related individuals with an LTSS dis11 ability reside; 

12 (II) for which each individual 

13 with an LTSS disability living at the 

14 residence owns, rents, or occupies the 

15 residence under a legally enforceable 

16 agreement under which the individual 

17 has, at a minimum, the same respon18 sibilities and protections as tenants 

19 have under applicable landlord-tenant 

20 law; 

21 (III) in which each individual 

22 with an LTSS disability living at the 

23 residence— 

24 (aa) has privacy in the indi25 vidual’s sleeping unit, including a 


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1 lockable entrance door controlled 

2 by the individual; 

3 (bb) shares a sleeping unit 

4 only if such individual and the 

5 individual sharing the unit choose 

6 to do so, and if individuals in the 

7 residence so choose, they also 

8 have a choice of roommates with9 in the residence; 

10 (cc) has the freedom to fur11 nish and decorate the individual’s 

12 sleeping or living unit as per13 mitted under the lease or other 

14 agreement; 

15 (dd) has the freedom and 

16 support to control the individ17 ual’s own schedules and activi18 ties; and 

19 (ee) is able to have visitors 

20 of the individual’s choosing at 

21 any time; and 

22 (IV) that is physically accessible 

23 to the individual with an LTSS dis24 ability living at the residence. 


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1 (4) COMMUNITY-BASED; SETTING.—The term 

2 ‘‘community-based’’, when used in reference to a set3 ting, means a setting described in subparagraph (A) 

4 or (B) of paragraph (3). 

5 (5) DWELLING.—The term ‘‘dwelling’’ has the 

6 meaning given the term in section 802 of the Fair 

7 Housing Act (42 U.S.C. 3602). 

8 (6) HEALTH-RELATED TASKS.—The term 

9 ‘‘health-related tasks’’ means specific nonacute 

10 tasks, typically regulated by States as medical or 

11 nursing tasks that an individual with a disability 

12 may require to live in the community, including— 

13 (A) administration of medication; 

14 (B) assistance with use, operation, and 

15 maintenance of a ventilator; and 

16 (C) maintenance and use of a gastrostomy 

17 tube, a catheter, or a stable ostomy. 

18 (7) INDIVIDUAL WITH A DISABILITY.—The term 

19 ‘‘individual with a disability’’ means an individual 

20 who is a person with a disability, as defined in sec21 tion 3 of the Americans with Disabilities Act of 

22 1990 (42 U.S.C. 12102). 

23 (8) INDIVIDUAL WITH AN LTSS DISABILITY.— 

24 The term ‘‘individual with an LTSS disability’’ 

25 means an individual with a disability who— 


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1 (A) in order to live in the community and 

2 lead an independent life requires assistance in 

3 accomplishing— 

4 (i) activities of daily living; 

5 (ii) instrumental activities of daily liv6 ing; 

7 (iii) health-related tasks; or 

8 (iv) other functions, tasks, or activi9 ties related to an activity or task described 

10 in clause (i), (ii), or (iii); and 

11 (B)(i) is currently in an institutional place12 ment; or 

13 (ii) is at risk of institutionalization if the 

14 individual does not receive community-based 

15 long-term services and supports. 

16 (9) INSTITUTION; INSTITUTIONALIZATION.— 

17 (A) INSTITUTION.—The term ‘‘institution’’ 

18 means— 

19 (i) a skilled nursing facility (as de20 fined in section 1819(a) of the Social Secu21 rity Act (42 U.S.C. 1395i–3(a))); 

22 (ii) a nursing facility (as defined in 

23 section 1919(a) of such Act (42 U.S.C. 

24 1396r(a))); 


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1 (iii) a long-term care hospital (as de2 scribed in section 1886(d)(1)(B)(iv) of 

3 such Act (42 U.S.C. 

4 1395ww(d)(1)(B)(iv))); 

5 (iv) a facility described in section 

6 1905(d) of such Act (42 U.S.C. 1396d(d)); 

7 (v) an institution which is a psy8 chiatric hospital (as defined in section 

9 1861(f) of such Act (42 U.S.C. 1395x(f))) 

10 or that provides in-patient psychiatric serv11 ices in a residential setting specified by the 

12 Secretary; 

13 (vi) an institution described in section 

14 1905(i) of such Act (42 U.S.C. 1396d(i)); 

15 and 

16 (vii) any congregate setting that is not 

17 community-based or that has the effect of 

18 isolating individuals with disabilities from 

19 the community. 

20 (B) INSTITUTIONALIZATION.—The term 

21 ‘‘institutionalization’’, used with respect to an 

22 individual with an LTSS disability, refers to the 

23 individual living or receiving services or sup24 ports in a setting that is not community-based. 


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1 (10) INSTRUMENTAL ACTIVITIES OF DAILY LIV2 ING.—The term ‘‘instrumental activities of daily liv3 ing’’ means one or more activities related to living 

4 independently in the community, including activities 

5 related to— 

6 (A) nutrition, such as preparing meals or 

7 special diets, monitoring to prevent choking or 

8 aspiration, or assisting with special utensils; 

9 (B) household chores and environmental 

10 maintenance tasks; 

11 (C) communication and interpersonal 

12 skills, such as— 

13 (i) using the telephone or other com14 munications devices; 

15 (ii) forming and maintaining inter16 personal relationships; or 

17 (iii) securing opportunities to partici18 pate in group support or peer-to-peer sup19 port arrangements; 

20 (D) travel and community participation, 

21 such as shopping, arranging appointments, or 

22 moving around the community; 

23 (E) care of others, such as raising chil24 dren, taking care of pets, or selecting care25 givers; or 


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1 (F) management of personal property and 

2 personal safety, such as— 

3 (i) taking medication; 

4 (ii) handling or managing money; or 

5 (iii) responding to emergent situations 

6 or unscheduled needs requiring an imme7 diate response. 

8 (11) LONG-TERM SERVICE OR SUPPORT.— 

9 (A) IN GENERAL.—The terms ‘‘long-term 

10 service or support’’ and ‘‘LTSS’’ mean the as11 sistance provided to an individual with a dis12 ability in accomplishing, acquiring the means or 

13 ability to accomplish, maintaining, or enhanc14 ing— 

15 (i) activities of daily living; 

16 (ii) instrumental activities of daily liv17 ing; 

18 (iii) health-related tasks; or 

19 (iv) other functions, tasks, or activi20 ties related to an activity or task described 

21 in clause (i), (ii), or (iii). 

22 (B) ASSISTANCE.—In subparagraph (A), 

23 the term ‘‘assistance’’ includes support provided 

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1 nitive, intellectual, mental, or emotional disabil2 ities, including support to— 

3 (i) help the individual identify and set 

4 goals, communicate needs, overcome fears, 

5 and manage transitions; 

6 (ii) help the individual with executive 

7 functioning, decision making, self-expres8 sion, and problemsolving; 

9 (iii) provide reassurance to the indi10 vidual; and 

11 (iv) help the individual with orienta12 tion, memory, and other activities related 

13 to independent living. 

14 (12) LTSS INSURANCE PROVIDER.—The term 

15 ‘‘LTSS insurance provider’’ means a public or pri16 vate entity that— 

17 (A) provides funds for long-term services 

18 and supports; and 

19 (B) is engaged in commerce or in an in20 dustry or activity affecting commerce. 

21 (13) PUBLIC ENTITY.— 

22 (A) IN GENERAL.—The term ‘‘public enti23 ty’’ means an entity that— 


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1 (i) provides or funds institutional 

2 placements for individuals with LTSS dis3 abilities; and 

4 (ii) is— 

5 (I) a State or local government; 

6 or 

7 (II) any department, agency, en8 tity administering a special purpose 

9 district, or other instrumentality, of a 

10 State or local government. 

11 (B) INTERSTATE COMMERCE.—For pur12 poses of subparagraph (A), a public entity shall 

13 be considered to be a person engaged in com14 merce or in an industry or activity affecting 

15 commerce. 

16 (b) RULE OF CONSTRUCTION.—Nothing in sub17 section (a) or any other provision of this section shall be 

18 construed to preclude an individual with a disability from 

19 receiving community-based services and supports in an in20 tegrated community setting such as a grocery store, retail 

21 establishment, restaurant, bank, park, concert venue, the22 ater, or workplace. 

23 SEC. 4. DISCRIMINATION. 

24 (a) IN GENERAL.—No public entity or LTSS insur25 ance provider shall deny an individual with an LTSS disVerDate Sep 11 2014 22:42 Apr 21, 2023 Jkt 039200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S1193.IS S1193

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1 ability who is eligible for institutional placement, or other2 wise discriminate against that individual in the provision 

3 of, community-based long-term services and supports that 

4 enable the individual to live in the community and lead 

5 an independent life. 

6 (b) SPECIFIC PROHIBITIONS.—For purposes of this 

7 Act, discrimination by a public entity or LTSS insurance 

8 provider includes— 

9 (1) the imposition or application of eligibility 

10 criteria or another policy that prevents or tends to 

11 prevent an individual with an LTSS disability, or 

12 any class of individuals with LTSS disabilities, from 

13 receiving a community-based long-term service or 

14 support; 

15 (2) the imposition or application of a policy or 

16 other mechanism, such as a service or cost cap, that 

17 prevent or tends to prevent an individual with an 

18 LTSS disability, or any class of individuals with 

19 LTSS disabilities, from receiving a community-based 

20 long-term service or support; 

21 (3) a failure to provide a specific community22 based long-term service or support or a type of com23 munity-based long-term service or support needed 

24 for an individual with an LTSS disability, or any 

25 class of individuals with LTSS disabilities; 


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1 (4) the imposition or application of a policy, 

2 rule, regulation, or restriction that interferes with 

3 the opportunity for an individual with an LTSS dis4 ability, or any class of individuals with LTSS dis5 abilities, to live in the community and lead an inde6 pendent life, which may include a requirement that 

7 an individual with an LTSS disability receive a serv8 ice or support (such as day services or employment 

9 services) in a congregate or disability-specific set10 ting; 

11 (5) the imposition or application of a waiting 

12 list or other mechanism that delays or restricts ac13 cess of an individual with an LTSS disability to a 

14 community-based long-term service or support; 

15 (6) a failure to establish an adequate rate or 

16 other payment structure that is necessary to ensure 

17 the availability of a workforce sufficient to support 

18 an individual with an LTSS disability in living in 

19 the community and leading an independent life; 

20 (7) a failure to provide community-based serv21 ices and supports, on an intermittent, short-term, or 

22 emergent basis, that assist an individual with an 

23 LTSS disability to live in the community and lead 

24 an independent life; 


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1 (8) the imposition or application of a policy, 

2 such as a requirement that an individual utilize in3 formal support, that restricts, limits, or delays the 

4 ability of an individual with an LTSS disability to 

5 secure a community-based long-term service or sup6 port to live in the community or lead an independent 

7 life; 

8 (9) a failure to implement a formal procedure 

9 and a mechanism to ensure that— 

10 (A) individuals with LTSS disabilities are 

11 offered the alternative of community-based 

12 long-term services and supports prior to institu13 tionalization; and 

14 (B) if selected by an individual with an 

15 LTSS disability, the community-based long16 term services and supports described in sub17 paragraph (A) are provided; 

18 (10) a failure to ensure that each institutional19 ized individual with an LTSS disability is regularly 

20 notified of the alternative of community-based long21 term services and supports and that those commu22 nity-based long-term services and supports are pro23 vided if the individual with an LTSS disability se24 lects such services and supports; and 


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1 (11) a failure to make a reasonable modifica2 tion in a policy, practice, or procedure, when such 

3 modification is necessary to allow an individual with 

4 an LTSS disability to receive a community-based 

5 long-term service or support. 

6 (c) ADDITIONAL PROHIBITION.—For purposes of this 

7 Act, discrimination by a public entity also includes a fail8 ure to ensure that there is sufficient availability of afford9 able, accessible, and integrated housing to allow an indi10 vidual with an LTSS disability to choose to live in the 

11 community and lead an independent life, including the 

12 availability of an option to live in housing where the re13 ceipt of LTSS is not tied to tenancy. 

14 (d) CONSTRUCTION.—Nothing in this section— 

15 (1) shall be construed— 

16 (A) to prevent a public entity or LTSS in17 surance provider from providing community18 based long-term services and supports at a level 

19 that is greater than the level that is required by 

20 this section; 

21 (B) to limit the rights of an individual with 

22 a disability under any provision of law other 

23 than this section; or 

24 (C) to require that an individual with an 

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1 ports in a more integrated setting if the indi2 vidual chooses a less integrated setting; 

3 (2) shall be construed to affect the scope of ob4 ligations imposed by any other provision of law; or 

5 (3) shall be construed to prohibit a public entity 

6 or LTSS insurance provider from using managed 

7 care techniques, as long as the use of such tech8 niques does not have the effect of discriminating 

9 against an individual in the provision of community10 based long-term services and supports, as prohibited 

11 by this Act. 

12 SEC. 5. ADMINISTRATION. 

13 (a) AUTHORITY AND RESPONSIBILITY.— 

14 (1) DEPARTMENT OF JUSTICE.—The Attorney 

15 General shall investigate and take enforcement ac16 tion for violations of this Act. 

17 (2) DEPARTMENT OF HEALTH AND HUMAN

18 SERVICES.—The Secretary of Health and Human 

19 Services, through the Administrator, shall— 

20 (A) review, and approve or disapprove, 

21 transition plans submitted by public entities, 

22 under section 6(b)(10); 

23 (B) establish a task force to identify socio24 demographic, geographic, and other factors that 

25 are barriers that prevent individuals with LTSS 


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1 disabilities from receiving community-based 

2 long-term services and supports or from being 

3 able to choose alternatives in the community to 

4 institutionalization and identify other dispari5 ties in the availability and provision of commu6 nity-based long-term services and supports, 

7 which task force shall be responsible for— 

8 (i) overseeing studies regarding the 

9 nature and extent of those barriers and 

10 disparities and the impact that those bar11 riers and disparities have on the institu12 tionalization of individuals with LTSS dis13 abilities; and 

14 (ii) submitting to Congress not later 

15 than 2 years after the date of enactment 

16 of this Act a report on the nature and ex17 tent of those barriers and disparities, in18 cluding a description of legislative or exec19 utive action to address the barriers and 

20 disparities; and 

21 (C) refer information on violations of this 

22 Act to the Attorney General for investigation 

23 and enforcement action under this Act. 

24 (b) COOPERATION OF EXECUTIVE DEPARTMENTS

25 AND AGENCIES.—Each Federal agency and, in particular, 


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1 each Federal agency covered by Executive Order 13217 

2 (66 Fed. Reg. 33155; relating to community-based alter3 natives for individuals with disabilities), shall carry out 

4 programs and activities relating to the institutionalization 

5 of individuals with LTSS disabilities and the provision of 

6 community-based long-term services and supports for indi7 viduals with LTSS disabilities in accordance with this Act 

8 and shall cooperate with the Attorney General and the Ad9 ministrator to further the purposes of this Act. 

10 SEC. 6. REGULATIONS. 

11 (a) ISSUANCE OF REGULATIONS.—Not later than 2 

12 years after the date of enactment of this Act, the Attorney 

13 General shall issue, in accordance with section 553 of title 

14 5, United States Code, final regulations to carry out this 

15 Act, which shall include the regulations described in sub16 section (b). 

17 (b) REQUIRED CONTENTS OF REGULATIONS.— 

18 (1) PROTECTED INDIVIDUALS.—The regula19 tions shall require each public entity and LTSS in20 surance provider to offer, and, if accepted, provide 

21 community-based long-term services and supports as 

22 required under this Act to any individual with an 

23 LTSS disability who would otherwise qualify for in24 stitutional placement provided or funded by the pub25 lic entity or LTSS insurance provider. 


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1 (2) SERVICES TO BE PROVIDED.—The regula2 tions issued under this section shall require each 

3 public entity and LTSS insurance provider to pro4 vide the Attorney General and the Administrator 

5 (for purposes of enabling the Attorney General to 

6 consult with the Administrator) with an assurance 

7 that the public entity or LTSS insurance provider— 

8 (A) ensures that individuals with LTSS 

9 disabilities receive assistance through hands-on 

10 assistance, training, cueing, and safety moni11 toring, including access to backup systems, 

12 with— 

13 (i) activities of daily living; 

14 (ii) instrumental activities of daily liv15 ing; 

16 (iii) health-related tasks; or 

17 (iv) other functions, tasks, or activi18 ties related to an activity or task described 

19 in clause (i), (ii), or (iii); 

20 (B) coordinates, conducts, performs, pro21 vides, or funds discharge planning from acute 

22 and rehabilitation facilities, and other institu23 tions, to promote individuals with LTSS disabil24 ities living in the most integrated setting chosen 

25 by the individuals; 


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1 (C) issues, conducts, performs, provides, or 

2 funds policies and programs to promote self-di3 rection and the provision of consumer-directed 

4 services and supports for all populations of indi5 viduals with LTSS disabilities served; 

6 (D) issues, conducts, performs, provides, 

7 or funds policies and programs to support infor8 mal caregivers who provide services for individ9 uals with LTSS disabilities; and 

10 (E) ensures that individuals with all types 

11 of LTSS disabilities are able to live in the com12 munity and lead an independent life, including 

13 ensuring that the individuals have maximum 

14 control over the services and supports that the 

15 individuals receive, choose the setting in which 

16 the individuals receive those services and sup17 ports, and exercise control and direction over 

18 their own lives. 

19 (3) PUBLIC PARTICIPATION.— 

20 (A) PUBLIC ENTITY.—The regulations 

21 issued under this section shall require each pub22 lic entity to carry out a public participation 

23 process in preparing the public entity’s self24 evaluation under paragraph (5) and transition 

25 plan under paragraph (10). 


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1 (B) LTSS INSURANCE PROVIDER.—The 

2 regulations issued under this section shall re3 quire each LTSS insurance provider to carry 

4 out a public participation process that involves 

5 holding a public hearing, providing an oppor6 tunity for public comment, and consulting with 

7 individuals with LTSS disabilities, in preparing 

8 the LTSS insurance provider’s self-evaluation 

9 under paragraph (5). 

10 (C) PROCESS.—In carrying out a public 

11 participation process under subparagraph (A) 

12 or (B), a public entity or LTSS insurance pro13 vider shall ensure that the process meets the re14 quirements of subparagraphs (A) and (C) of 

15 section 1115(d)(2) of the Social Security Act 

16 (42 U.S.C. 1315(d)(2)), except that— 

17 (i) the reference to ‘‘at the State 

18 level’’ shall be disregarded; and 

19 (ii) the reference to an application 

20 shall be considered to be a reference to the 

21 self-evaluation or plan involved. 

22 (4) ADDITIONAL SERVICES AND SUPPORTS.— 

23 The regulations issued under this section shall es24 tablish circumstances under which a public entity 

25 shall provide community-based long-term services 


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1 and supports under this section beyond the level of 

2 community-based long-term services and supports 

3 which would otherwise be required under this sub4 section. 

5 (5) SELF-EVALUATION.— 

6 (A) IN GENERAL.—The regulations issued 

7 under this section shall require each public enti8 ty and each LTSS insurance provider, not later 

9 than 30 months after the date of enactment of 

10 this Act, to evaluate current services, policies, 

11 and practices, and the effects thereof, that do 

12 not or may not meet the requirements of this 

13 Act and, to the extent modification of any such 

14 services, policies, and practices is required to 

15 meet the requirements of this Act, make the 

16 necessary modifications. The self-evaluation 

17 shall include— 

18 (i) collection of baseline information, 

19 including the numbers of individuals with 

20 LTSS disabilities in various institutional 

21 and community-based settings served by 

22 the public entity or LTSS insurance pro23 vider, including demographic data that— 

24 (I) specifies whether the individ25 uals are women, veterans, or members 


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1 of a racial and ethnic minority group, 

2 as defined in section 1707 of the Pub3 lic Health Service Act (42 U.S.C. 

4 300u–6); and 

5 (II) is disaggregated by race in a 

6 manner that captures all the racial 

7 groups specified in the American 

8 Community Survey conducted by the 

9 Bureau of the Census; 

10 (ii) a review of community capacity, in 

11 communities served by the entity or pro12 vider, in providing community-based long13 term services and supports; 

14 (iii) identification of improvements 

15 needed to ensure that all community-based 

16 long-term services and supports provided 

17 by the public entity or LTSS insurance 

18 provider to individuals with LTSS disabil19 ities are comprehensive, are accessible, are 

20 not duplicative of existing (as of the date 

21 of the identification) services and supports, 

22 meet the needs of persons who are likely to 

23 require assistance in order to live, or lead 

24 a life, as described in section 4(a), and are 

25 culturally competent, high-quality services 


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1 and supports, which may include identi2 fying system improvements that create an 

3 option to self-direct receipt of such services 

4 and supports for all populations of such in5 dividuals served; and 

6 (iv) a review of funding sources for 

7 community-based long-term services and 

8 supports and an analysis of how those 

9 funding sources could be organized into a 

10 fair, coherent system that affords individ11 uals reasonable and timely access to cul12 turally competent, community-based long13 term services and supports. 

14 (B) PUBLIC ENTITY.—A public entity, in15 cluding an LTSS insurance provider that is a 

16 public entity, shall— 

17 (i) include in the self-evaluation de18 scribed in subparagraph (A)— 

19 (I) an assessment of the avail20 ability of accessible, affordable trans21 portation across the State involved 

22 and whether transportation barriers 

23 prevent individuals from receiving 

24 long-term services and supports in the 

25 most integrated setting; and 


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1 (II) an assessment of the avail2 ability of integrated employment op3 portunities in the jurisdiction served 

4 by the public entity for individuals 

5 with LTSS disabilities; 

6 (ii) provide the self-evaluation de7 scribed in subparagraph (A) to the Attor8 ney General; and 

9 (iii) make the self-evaluation described 

10 in subparagraph (A) available on the pub11 lic internet website of the public entity. 

12 (C) LTSS INSURANCE PROVIDER.—An 

13 LTSS insurance provider shall keep the self14 evaluation described in subparagraph (A) on 

15 file, and may be required to produce such self16 evaluation in the event of a review, investiga17 tion, or action described in section 8. 

18 (6) ADDITIONAL REQUIREMENT FOR PUBLIC

19 ENTITIES.—The regulations issued under this sec20 tion shall require a public entity, in conjunction with 

21 the housing agencies serving the jurisdiction served 

22 by the public entity, to review and improve commu23 nity capacity, in all communities throughout the en24 tirety of that jurisdiction, in providing affordable, 

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1 uation of available units, unmet need, and other 

2 identifiable barriers to the provision of that housing. 

3 In carrying out that improvement, the public entity, 

4 in conjunction with such housing agencies, shall— 

5 (A) ensure, and assure the Attorney Gen6 eral and the Administrator that there is, suffi7 cient availability of affordable, accessible, and 

8 integrated housing in a setting that is not a dis9 ability-specific residential setting or a setting 

10 where services are tied to tenancy, in order to 

11 provide individuals with LTSS disabilities a 

12 meaningful choice in their housing; 

13 (B) in order to address the need for af14 fordable, accessible, and integrated housing— 

15 (i) in the case of such a housing agen16 cy, establish relationships with State and 

17 local housing authorities; and 

18 (ii) in the case of the public entity, es19 tablish relationships with State and local 

20 housing agencies, including housing au21 thorities; 

22 (C) establish, where needed, necessary 

23 preferences and set-asides in housing programs 

24 for individuals with LTSS disabilities who are 


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1 transitioning from or avoiding institutional 

2 placement; 

3 (D) establish a process to fund necessary 

4 home modifications so that individuals with 

5 LTSS disabilities can live independently; and 

6 (E) ensure, and assure the Attorney Gen7 eral and the Administrator, that funds and pro8 grams implemented or overseen by the public 

9 entity or in the public entity’s jurisdiction are 

10 targeted toward affordable, accessible, inte11 grated housing for individuals with an LTSS 

12 disability who have the lowest income levels in 

13 the jurisdiction as a priority over any other de14 velopment until capacity barriers for such hous15 ing are removed or unmet needs for such hous16 ing have been met. 

17 (7) DESIGNATION OF RESPONSIBLE EM18 PLOYEE.—The regulations issued under this section 

19 shall require each public entity and LTSS insurance 

20 provider to designate at least one employee to co21 ordinate the entity’s or provider’s efforts to comply 

22 with and carry out the entity or provider’s respon23 sibilities under this Act, including the investigation 

24 of any complaint communicated to the entity or pro25 vider that alleges a violation of this Act. Each public 


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1 entity and LTSS insurance provider shall make 

2 available to all interested individuals the name, of3 fice address, and telephone number of the employee 

4 designated pursuant to this paragraph. 

5 (8) GRIEVANCE PROCEDURES.—The regulations 

6 issued under this section shall require public entities 

7 and LTSS insurance providers to adopt and publish 

8 grievance procedures providing for prompt and equi9 table resolution of complaints alleging a violation of 

10 this Act. 

11 (9) PROVISION OF SERVICE BY OTHERS.—The 

12 regulations issued under this section shall require 

13 each public entity submitting a self-evaluation under 

14 paragraph (5) to identify, as part of the transition 

15 plan described in paragraph (10), any other entity 

16 that is, or acts as, an agent, subcontractor, or other 

17 instrumentality of the public entity with regards to 

18 a service, support, policy, or practice described in 

19 such plan or self-evaluation. 

20 (10) TRANSITION PLANS.—The regulations 

21 issued under this section shall require each public 

22 entity, not later than 42 months after the date of 

23 enactment of this Act, to submit to the Adminis24 trator and, on approval by the Administrator, begin 

25 implementing a transition plan for carrying out this 


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1 Act that establishes the achievement of the require2 ments of this Act, as soon as practicable, but in no 

3 event later than 12 years after the date of enact4 ment of this Act. The transition plan shall— 

5 (A) establish measurable objectives to ad6 dress the barriers to community living identified 

7 in the self-evaluation under paragraph (5); 

8 (B) establish specific annual targets for 

9 the transition of individuals with LTSS disabil10 ities, and shifts in funding, from institutional 

11 settings to integrated community-based services 

12 and supports, and related programs; 

13 (C) describe specific efforts to support in14 dividuals with LTSS disabilities to avoid un15 wanted institutionalization through the provi16 sion of LTSS; 

17 (D) describe the manner in which the pub18 lic entity has obtained or plans to obtain nec19 essary funding and resources needed for imple20 mentation of the plan (regardless of whether 

21 the entity began carrying out the objectives of 

22 this Act prior to the date of enactment of this 

23 Act); and 

24 (E) describe the steps taken to ensure that 

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1 viduals from all socio-demographic and geo2 graphic backgrounds. 

3 (11) ANNUAL REPORTING.— 

4 (A) IN GENERAL.—The regulations issued 

5 under this section shall establish annual report6 ing requirements for each public entity covered 

7 by this section. 

8 (B) PROGRESS ON OBJECTIVES, TARGETS, 

9 AND EFFORTS.—The regulations issued under 

10 this section shall require each public entity that 

11 has submitted a transition plan, to make pub12 licly available on the entity’s website an annual 

13 report on the progress the public entity has 

14 made during the previous year in meeting the 

15 measurable objectives, specific annual targets, 

16 and specific efforts described in paragraph (10). 

17 (c) REVIEW OF TRANSITION PLANS.— 

18 (1) GENERAL RULE.—The Administrator shall 

19 review a transition plan submitted in accordance 

20 with subsection (b)(10), not later than 90 days after 

21 receiving the plan, for the purpose of determining 

22 whether such plan meets the requirements of this 

23 Act, including the regulations issued under this sec24 tion. 


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1 (2) DISAPPROVAL.—If the Administrator deter2 mines that a transition plan reviewed under this 

3 subsection fails to meet the requirements of this Act, 

4 the Administrator shall disapprove the transition 

5 plan and notify the public entity that submitted the 

6 transition plan of, and the reasons for, such dis7 approval. 

8 (3) MODIFICATION OF DISAPPROVED PLAN.— 

9 Not later than 90 days after the date of disapproval 

10 of a transition plan under this subsection, the public 

11 entity that submitted the transition plan shall mod12 ify the transition plan to meet the requirements of 

13 this section and shall submit the modified plan to 

14 the Administrator. Not later than 90 days after re15 ceiving the modified plan, the Administrator shall 

16 review the plan and, on approval by the Adminis17 trator, the public entity shall begin implementing the 

18 plan. 

19 (d) RULE OF CONSTRUCTION.—Nothing in sub20 section (b)(10) or (c) or any other provision of this Act 

21 shall be construed to limit the rights, protections, or re22 quirements of any other Federal law, relating to integra23 tion of individuals with disabilities into the community and 

24 enabling those individuals to live in the most integrated 

25 setting. 


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1 SEC. 7. EXEMPTIONS FOR RELIGIOUS ORGANIZATIONS. 

2 This Act shall not prohibit a religious organization, 

3 association, or society from giving preference in providing 

4 community-based long-term services and supports to indi5 viduals of a particular religion connected with the beliefs 

6 of such organization, association, or society. 

7 SEC. 8. ENFORCEMENT. 

8 (a) CIVIL ACTION.— 

9 (1) IN GENERAL.—A civil action for preventive 

10 relief, including an application for a permanent or 

11 temporary injunction, restraining order, or other 

12 order, may be instituted by an individual described 

13 in paragraph (2) in an appropriate Federal district 

14 court. 

15 (2) AGGRIEVED INDIVIDUAL.— 

16 (A) IN GENERAL.—The remedies and pro17 cedures set forth in this section are the rem18 edies and procedures this Act provides to any 

19 individual who is being subjected to a violation 

20 of this Act, or who has reasonable grounds for 

21 believing that such individual is about to be 

22 subjected to such a violation. 

23 (B) STANDING.—An individual with a dis24 ability shall have standing to institute a civil ac25 tion under this subsection if the individual 


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1 makes a prima facie showing that the indi2 vidual— 

3 (i) is an individual with an LTSS dis4 ability; and 

5 (ii) is being subjected to, or about to 

6 be subjected to, such a violation (including 

7 a violation of section 4(b)(11)). 

8 (3) APPOINTMENT OF ATTORNEY; NO FEES, 

9 COSTS, OR SECURITY.—Upon application by the 

10 complainant described in paragraph (2) and in such 

11 circumstances as the court may determine to be just, 

12 the court may appoint an attorney for the complain13 ant and may authorize the commencement of such 

14 civil action without the payment of fees, costs, or se15 curity. 

16 (4) FUTILE GESTURE NOT REQUIRED.—Noth17 ing in this section shall require an individual with an 

18 LTSS disability to engage in a futile gesture if such 

19 person has actual notice that a public entity or 

20 LTSS insurance provider does not intend to comply 

21 with the provisions of this Act. 

22 (b) DAMAGES AND INJUNCTIVE RELIEF.—If the 

23 court finds that a violation of this Act has occurred or 

24 is about to occur, the court may award to the complain25 ant— 


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1 (1) actual and punitive damages; 

2 (2) immediate injunctive relief to prevent insti3 tutionalization; 

4 (3) as the court determines to be appropriate, 

5 any permanent or temporary injunction (including 

6 an order to immediately provide or maintain commu7 nity-based long-term services or supports for an in8 dividual to prevent institutionalization or further in9 stitutionalization), temporary restraining order, or 

10 other order (including an order enjoining the defend11 ant from engaging in a practice that violates this 

12 Act or ordering such affirmative action as may be 

13 appropriate); and 

14 (4) in an appropriate case, injunctive relief to 

15 require the modification of a policy, practice, or pro16 cedure, or the provision of an alternative method of 

17 providing LTSS, to the extent required by this Act. 

18 (c) ATTORNEY’S FEES; LIABILITY OF UNITED

19 STATES FOR COSTS.—In any action commenced pursuant 

20 to this Act, the court, in its discretion, may allow the party 

21 bringing a claim or counterclaim under this Act, other 

22 than the United States, a reasonable attorney’s fee as part 

23 of the costs, and the United States shall be liable for costs 

24 to the same extent as a private person. 

25 (d) ENFORCEMENT BY ATTORNEY GENERAL.— 


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1 (1) DENIAL OF RIGHTS.— 

2 (A) DUTY TO INVESTIGATE.—The Attor3 ney General shall investigate alleged violations 

4 of this Act, and shall undertake periodic reviews 

5 of the compliance of public entities and LTSS 

6 insurance providers under this Act. 

7 (B) POTENTIAL VIOLATION.—The Attor8 ney General may commence a civil action in any 

9 appropriate Federal district court if the Attor10 ney General has reasonable cause to believe 

11 that— 

12 (i) any public entity or LTSS insur13 ance provider, including a group of public 

14 entities or LTSS insurance providers, is 

15 engaged in a pattern or practice of viola16 tions of this Act; or 

17 (ii) any individual, including a group, 

18 has been subjected to a violation of this 

19 Act and the violation raises an issue of 

20 general public importance. 

21 (2) AUTHORITY OF COURT.—In a civil action 

22 under paragraph (1)(B), the court— 

23 (A) may grant any equitable relief that 

24 such court considers to be appropriate, includ25 ing, to the extent required by this Act— 


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•S 1193 IS

1 (i) granting temporary, preliminary, 

2 or permanent relief; and 

3 (ii) requiring the modification of a 

4 policy, practice, or procedure, or the provi5 sion of an alternative method of providing 

6 LTSS; 

7 (B) may award such other relief as the 

8 court considers to be appropriate, including 

9 damages to individuals described in subsection 

10 (a)(2), when requested by the Attorney General; 

11 and 

12 (C) may, to vindicate the public interest, 

13 assess a civil penalty against the public entity 

14 or LTSS insurance provider in an amount— 

15 (i) not exceeding $100,000 for a first 

16 violation; and 

17 (ii) not exceeding $200,000 for any 

18 subsequent violation. 

19 (3) SINGLE VIOLATION.—For purposes of para20 graph (2)(C), in determining whether a first or sub21 sequent violation has occurred, a determination in a 

22 single action, by judgment or settlement, that the 

23 public entity or LTSS insurance provider has en24 gaged in more than one violation of this Act shall be 

25 counted as a single violation. 


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1 SEC. 9. CONSTRUCTION. 

2 For purposes of construing this Act— 

3 (1) section 4(b)(11) shall be construed in a 

4 manner that takes into account its similarities with 

5 section 302(b)(2)(A)(ii) of the Americans with Dis6 abilities Act of 1990 (42 U.S.C. 12182(b)(2)(A)(ii)); 

7 (2) the first sentence of section 6(b)(5)(A) shall 

8 be construed in a manner that takes into account its 

9 similarities with section 35.105(a) of title 28, Code 

10 of Federal Regulations (as in effect on the day be11 fore the date of enactment of this Act); 

12 (3) section 7 shall be construed in a manner 

13 that takes into account its similarities with section 

14 807(a) of the Civil Rights Act of 1968 (42 U.S.C. 

15 3607(a)); 

16 (4) section 8(a)(2) shall be construed in a man17 ner that takes into account its similarities with sec18 tion 308(a)(1) of the Americans with Disabilities 

19 Act of 1990 (42 U.S.C. 12188(a)(1)); and 

20 (5) section 8(d)(1)(B) shall be construed in a 

21 manner that takes into account its similarities with 

22 section 308(b)(1)(B) of the Americans with Disabil23 ities Act of 1990 (42 U.S.C. 12188(b)(1)(B)). 

Æ 


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