II 

117TH CONGRESS 

1ST SESSION S. 3417 

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

IN THE SENATE OF THE UNITED STATES 

DECEMBER 16, 2021 

Mr. BENNET (for himself, Mr. SANDERS, Ms. DUCKWORTH, Mr. TESTER, and 

Ms. SMITH) 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 2021’’. 

6 SEC. 2. PURPOSES. 

7 The purposes of this Act are— 

8 (1) to clarify and strengthen the integration 

9 mandate of the Americans with Disabilities Act of 


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1 1990, held by the Supreme Court in Olmstead v. 

2 L.C., 527 U.S. 581 (1999) in a manner that acceler3 ates and improves State compliance; 

4 (2) to ensure that States provide long-term 

5 services and supports to individuals with disabilities 

6 in a manner that allows individuals with disabilities 

7 to live in the most integrated setting, including the 

8 individual’s own home, have maximum control over 

9 their services and supports, and ensure that long10 term services and supports are provided in a manner 

11 that allows individuals with disabilities to lead an 

12 independent life; 

13 (3) to establish a comprehensive State planning 

14 requirement that includes enforceable, measurable 

15 objectives that are designed to transition individuals 

16 with all types of disabilities at all ages out of institu17 tions and into the most integrated setting, if they 

18 choose that transition; and 

19 (4) to identify and address racial, ethnic, geo20 graphic, socioeconomic, sexual orientation, gender 

21 identity, and other disparities in the provision of 

22 community-based long-term services and supports. 

23 SEC. 3. DEFINITIONS AND RULE. 

24 (a) DEFINITIONS.—In this Act: 


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

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

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

4 Regulations (or a successor regulation). 

5 (2) ADMINISTRATOR.—The term ‘‘Adminis6 trator’’ means— 

7 (A) the Administrator of the Administra8 tion for Community Living; or 

9 (B) another designee of the Secretary of 

10 Health and Human Services. 

11 (3) COMMUNITY-BASED.—The term ‘‘commu12 nity-based’’, when used in reference to services or 

13 supports, means services or supports that are pro14 vided to an individual with an LTSS disability to en15 able that individual to live in the community and 

16 lead an independent life, and that are delivered in 

17 whichever setting the individual with an LTSS dis18 ability has chosen out of the following settings with 

19 the following qualities: 

20 (A) In the case of a dwelling or a nonresi21 dential setting (such as a setting in which an 

22 individual with an LTSS disability receives day 

23 services and supported employment), a dwelling 

24 or setting— 


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

2 environment, amenities, location, services, 

3 and features, is integrated into the greater 

4 community and supports, for each indi5 vidual with an LTSS disability who re6 ceives services or supports at the setting— 

7 (I) full access to the greater com8 munity (including access to opportuni9 ties to seek employment and work in 

10 competitive integrated settings, en11 gage in community life, control per12 sonal resources, and receive services 

13 in the community); and 

14 (II) access to the greater commu15 nity to the same extent as access to 

16 the community is enjoyed by an indi17 vidual who is not receiving long-term 

18 services or supports; 

19 (ii) that the individual has selected as 

20 a meaningful choice from among nonresi21 dential setting options, including nondis22 ability-specific settings; 

23 (iii) in which an individual has rights 

24 to privacy, dignity, and respect, and free25 dom from coercion and restraint; 


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1 (iv) that, as a matter of infrastruc2 ture, environment, amenities, location, 

3 services, and features, optimizes, but does 

4 not regiment, individual initiative, auton5 omy, and independence in making life 

6 choices, including choices about daily ac7 tivities, physical environment, and persons 

8 with whom the individual interacts; and 

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

10 environment, amenities, location, services, 

11 and features, facilitates individual choice 

12 regarding the provision of services and 

13 supports, and who provides those services 

14 and supports. 

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

16 (i) that is owned by an individual with 

17 an LTSS disability or the individual’s fam18 ily member; 

19 (ii) that is leased to the individual 

20 with an LTSS disability under an indi21 vidual lease, that has lockable access and 

22 egress, and that includes living, sleeping, 

23 bathing, and cooking areas over which an 

24 individual with an LTSS disability or the 


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1 individual’s family member has domain 

2 and control; or 

3 (iii) that is a group or shared resi4 dence— 

5 (I) in which no more than 4 un6 related individuals with an LTSS dis7 ability reside; 

8 (II) for which each individual 

9 with an LTSS disability living at the 

10 residence owns, rents, or occupies the 

11 residence under a legally enforceable 

12 agreement under which the individual 

13 has, at a minimum, the same respon14 sibilities and protections as tenants 

15 have under applicable landlord-tenant 

16 law; 

17 (III) in which each individual 

18 with an LTSS disability living at the 

19 residence— 

20 (aa) has privacy in the indi21 vidual’s sleeping unit, including a 

22 lockable entrance door controlled 

23 by the individual; 

24 (bb) shares a sleeping unit 

25 only if such individual and the 


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1 individual sharing the unit choose 

2 to do so, and if individuals in the 

3 residence so choose, they also 

4 have a choice of roommates with5 in the residence; 

6 (cc) has the freedom to fur7 nish and decorate the individual’s 

8 sleeping or living unit as per9 mitted under the lease or other 

10 agreement; 

11 (dd) has the freedom and 

12 support to control the individ13 ual’s own schedules and activi14 ties; and 

15 (ee) is able to have visitors 

16 of the individual’s choosing at 

17 any time; and 

18 (IV) that is physically accessible 

19 to the individual with an LTSS dis20 ability living at the residence. 

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

22 meaning given the term in section 802 of the Fair 

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

24 (5) HEALTH-RELATED TASKS.—The term 

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


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1 tasks, typically regulated by States as medical or 

2 nursing tasks that an individual with a disability 

3 may require to live in the community, including— 

4 (A) administration of medication; 

5 (B) assistance with use, operation, and 

6 maintenance of a ventilator; and 

7 (C) maintenance and use of a gastrostomy 

8 tube, a catheter, or a stable ostomy. 

9 (6) INDIVIDUAL WITH A DISABILITY.—The term 

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

11 who is a person with a disability, as defined in sec12 tion 3 of the Americans with Disabilities Act of 

13 1990 (42 U.S.C. 12102). 

14 (7) INDIVIDUAL WITH AN LTSS DISABILITY.— 

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

16 means an individual with a disability who— 

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

18 lead an independent life requires assistance in 

19 accomplishing— 

20 (i) activities of daily living; 

21 (ii) instrumental activities of daily liv22 ing; 

23 (iii) health-related tasks; or 


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1 (iv) other functions, tasks, or activi2 ties related to an activity or task described 

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

4 (B)(i) is currently in an institutional place5 ment; or 

6 (ii) is at risk of institutionalization if the 

7 individual does not receive community-based 

8 long-term services and supports. 

9 (8) INSTITUTION.—The term ‘‘institution’’ 

10 means— 

11 (A) a skilled nursing facility (as defined in 

12 section 1819(a) of the Social Security Act (42 

13 U.S.C. 1395i–3(a))); 

14 (B) a nursing facility (as defined in section 

15 1919(a) of such Act (42 U.S.C. 1396r(a))); 

16 (C) a long-term care hospital (as described 

17 in section 1886(d)(1)(B)(iv) of such Act (42 

18 U.S.C. 1395ww(d)(1)(B)(iv))); 

19 (D) a facility described in section 1905(d) 

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

21 (E) an institution which is a psychiatric 

22 hospital (as defined in section 1861(f) of such 

23 Act (42 U.S.C. 1395x(f))) or that provides in24 patient psychiatric services in a residential set25 ting specified by the Secretary; 


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1 (F) an institution described in section 

2 1905(i) of such Act (42 U.S.C. 1396d(i)); and 

3 (G) any congregate health care services 

4 setting that is not community-based. 

5 (9) INSTRUMENTAL ACTIVITIES OF DAILY LIV6 ING.— 

7 (A) IN GENERAL.—The term ‘‘instru8 mental activities of daily living’’ means one or 

9 more activities related to living independently in 

10 the community, including activities related to— 

11 (i) nutrition, such as preparing meals 

12 or special diets, monitoring to prevent 

13 choking or aspiration, or assisting with 

14 special utensils; 

15 (ii) household chores and environ16 mental maintenance tasks; 

17 (iii) communication and interpersonal 

18 skills, such as— 

19 (I) using the telephone or other 

20 communications devices; 

21 (II) forming and maintaining 

22 interpersonal relationships; or 

23 (III) securing opportunities to 

24 participate in group support or peer25 to-peer support arrangements; 


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1 (iv) travel and community participa2 tion, such as shopping, arranging appoint3 ments, or moving around the community; 

4 (v) care of others, such as raising 

5 children, taking care of pets, or selecting 

6 caregivers; or 

7 (vi) management of personal property 

8 and personal safety, such as— 

9 (I) taking medication; 

10 (II) handling or managing 

11 money; or 

12 (III) responding to emergent sit13 uations or unscheduled needs requir14 ing an immediate response. 

15 (B) ASSISTANCE.—The term ‘‘assistance’’ 

16 used with respect to instrumental activities of 

17 daily living, includes support provided to an in18 dividual by another person due to confusion, de19 mentia, behavioral symptoms, or cognitive, in20 tellectual, mental, or emotional disabilities, in21 cluding support to— 

22 (i) help the individual identify and set 

23 goals, overcome fears, and manage transi24 tions; 


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1 (ii) help the individual with executive 

2 functioning, decision making, and problem 

3 solving; 

4 (iii) provide reassurance to the indi5 vidual; and 

6 (iv) help the individual with orienta7 tion, memory, and other activities related 

8 to independent living. 

9 (10) LONG-TERM SERVICE OR SUPPORT.—The 

10 terms ‘‘long-term service or support’’ and ‘‘LTSS’’ 

11 mean the assistance provided to an individual with 

12 a disability in accomplishing, acquiring the means or 

13 ability to accomplish, maintaining, or enhancing— 

14 (A) activities of daily living; 

15 (B) instrumental activities of daily living; 

16 (C) health-related tasks; or 

17 (D) other functions, tasks, or activities re18 lated to an activity or task described in sub19 paragraph (A), (B), or (C). 

20 (11) LTSS INSURANCE PROVIDER.—The term 

21 ‘‘LTSS insurance provider’’ means a public or pri22 vate entity that— 

23 (A) provides funds for long-term services 

24 and supports; and 


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1 (B) is engaged in commerce or in an in2 dustry or activity affecting commerce. 

3 (12) PUBLIC ENTITY.— 

4 (A) IN GENERAL.—The term ‘‘public enti5 ty’’ means an entity that— 

6 (i) provides or funds institutional 

7 placements for individuals with LTSS dis8 abilities; and 

9 (ii) is— 

10 (I) a State or local government; 

11 or 

12 (II) any department, agency, en13 tity administering a special purpose 

14 district, or other instrumentality, of a 

15 State or local government. 

16 (B) INTERSTATE COMMERCE.—For pur17 poses of subparagraph (A), a public entity shall 

18 be considered to be a person engaged in com19 merce or in an industry or activity affecting 

20 commerce. 

21 (b) RULE OF CONSTRUCTION.—Nothing in sub22 section (a)(2) or any other provision of this section shall 

23 be construed to preclude an individual with a disability 

24 from receiving community-based services and supports in 

25 an integrated community setting such as a grocery store, 


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1 retail establishment, restaurant, bank, park, concert 

2 venue, theater, or workplace. 

3 SEC. 4. DISCRIMINATION. 

4 (a) IN GENERAL.—No public entity or LTSS insur5 ance provider shall deny an individual with an LTSS dis6 ability who is eligible for institutional placement, or other7 wise discriminate against that individual in the provision 

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

9 enable the individual to live in the community and lead 

10 an independent life. 

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

12 Act, discrimination by a public entity or LTSS insurance 

13 provider includes— 

14 (1) the imposition or application of eligibility 

15 criteria or another policy that prevents or tends to 

16 prevent an individual with an LTSS disability, or 

17 any class of individuals with LTSS disabilities, from 

18 receiving a community-based long-term service or 

19 support; 

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

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

22 prevent or tends to prevent an individual with an 

23 LTSS disability, or any class of individuals with 

24 LTSS disabilities, from receiving a community-based 

25 long-term service or support; 


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1 (3) a failure to provide a specific community2 based long-term service or support or a type of com3 munity-based long-term service or support needed 

4 for an individual with an LTSS disability, or any 

5 class of individuals with LTSS disabilities; 

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

7 rule, regulation, or restriction that interferes with 

8 the opportunity for an individual with an LTSS dis9 ability, or any class of individuals with LTSS dis10 abilities, to live in the community and lead an inde11 pendent life, which may include a requirement that 

12 an individual with an LTSS disability receive a serv13 ice or support (such as day services or employment 

14 services) in a congregate or disability-specific set15 ting; 

16 (5) the imposition or application of a waiting 

17 list or other mechanism that delays or restricts ac18 cess of an individual with an LTSS disability to a 

19 community-based long-term service or support; 

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

21 other payment structure that is necessary to ensure 

22 the availability of a workforce sufficient to support 

23 an individual with an LTSS disability in living in 

24 the community and leading an independent life; 


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1 (7) a failure to provide community-based serv2 ices and supports, on an intermittent, short-term, or 

3 emergent basis, that assist an individual with an 

4 LTSS disability to live in the community and lead 

5 an independent life; 

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

7 such as a requirement that an individual utilize in8 formal support, that restricts, limits, or delays the 

9 ability of an individual with an LTSS disability to 

10 secure a community-based long-term service or sup11 port to live in the community or lead an independent 

12 life; 

13 (9) a failure to implement a formal procedure 

14 and a mechanism to ensure that— 

15 (A) individuals with LTSS disabilities are 

16 offered the alternative of community-based 

17 long-term services and supports prior to institu18 tionalization; and 

19 (B) if selected by an individual with an 

20 LTSS disability, the community-based long21 term services and supports described in sub22 paragraph (A) are provided; 

23 (10) a failure to ensure that each institutional24 ized individual with an LTSS disability is regularly 

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1 term services and supports and that those commu2 nity-based long-term services and supports are pro3 vided if the individual with an LTSS disability se4 lects such services and supports; and 

5 (11) a failure to make a reasonable modifica6 tion in a policy, practice, or procedure, when such 

7 modification is necessary to allow an individual with 

8 an LTSS disability to receive a community-based 

9 long-term service or support. 

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

11 Act, discrimination by a public entity also includes a fail12 ure to ensure that there is sufficient availability of afford13 able, accessible, and integrated housing to allow an indi14 vidual with an LTSS disability to choose to live in the 

15 community and lead an independent life, including the 

16 availability of an option to live in housing where the re17 ceipt of LTSS is not tied to tenancy. 

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

19 (1) shall be construed— 

20 (A) to prevent a public entity or LTSS in21 surance provider from providing community22 based long-term services and supports at a level 

23 that is greater than the level that is required by 

24 this section; or 


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

2 a disability under any provision of law other 

3 than this section; 

4 (2) shall be construed to affect the scope of ob5 ligations imposed by any other provision of law; or 

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

7 or LTSS insurance provider from using managed 

8 care techniques, as long as the use of such tech9 niques does not have the effect of discriminating 

10 against an individual in the provision of community11 based long-term services and supports, as prohibited 

12 by this Act. 

13 SEC. 5. ADMINISTRATION. 

14 (a) AUTHORITY AND RESPONSIBILITY.— 

15 (1) DEPARTMENT OF JUSTICE.—The Attorney 

16 General shall investigate and take enforcement ac17 tion for violations of this Act. 

18 (2) DEPARTMENT OF HEALTH AND HUMAN

19 SERVICES.—The Secretary of Health and Human 

20 Services, through the Administrator, shall— 

21 (A) review, and approve or disapprove, 

22 transition plans submitted by public entities, 

23 under section 6(b)(10); 

24 (B) establish a task force to assess racial, 

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1 entation, gender identity, and other disparities 

2 in the availability and provision of community3 based long-term services and supports, which 

4 task force shall be responsible for— 

5 (i) overseeing studies regarding the 

6 nature and extent of racial, ethnic, geo7 graphic, socioeconomic, sexual orientation, 

8 gender identity, and other disparities in 

9 the availability and provision of commu10 nity-based long-term services and supports 

11 and the impact that those disparities have 

12 on the institutionalization of individuals 

13 with LTSS disabilities; 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 racial, ethnic, geographic, socio18 economic, sexual orientation, gender iden19 tity, and other disparities in the avail20 ability and provision of community-based 

21 long-term services and supports, including 

22 recommendations for addressing those dis23 parities; 

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1 ities from being able to choose community2 based alternatives to institutionalization, and to 

3 recommend legislative or executive action to ad4 dress the obstacles; and 

5 (D) refer information on violations of this 

6 Act to the Attorney General for investigation 

7 and enforcement action under this Act. 

8 (b) COOPERATION OF EXECUTIVE DEPARTMENTS

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

10 each Federal agency covered by Executive Order 13217 

11 (66 Fed. Reg. 33155; relating to community-based alter12 natives for individuals with disabilities), shall carry out 

13 programs and activities relating to the institutionalization 

14 of individuals with LTSS disabilities and the provision of 

15 community-based long-term services and supports for indi16 viduals with LTSS disabilities in accordance with this Act 

17 and shall cooperate with the Attorney General and the Ad18 ministrator to further the purposes of this Act. 

19 SEC. 6. REGULATIONS. 

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

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

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

23 5, United States Code, final regulations to carry out this 

24 Act, which shall include the regulations described in sub25 section (b). 


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1 (b) REQUIRED CONTENTS OF REGULATIONS.— 

2 (1) PROTECTED INDIVIDUALS.—The regula3 tions shall require each public entity and LTSS in4 surance provider to offer, and, if accepted, provide 

5 community-based long-term services and supports as 

6 required under this Act to any individual with an 

7 LTSS disability who would otherwise qualify for in8 stitutional placement provided or funded by the pub9 lic entity or LTSS insurance provider. 

10 (2) SERVICES TO BE PROVIDED.—The regula11 tions issued under this section shall require each 

12 public entity and LTSS insurance provider to pro13 vide the Attorney General and the Administrator 

14 (for purposes of enabling the Attorney General to 

15 consult with the Administrator) with an assurance 

16 that the public entity or LTSS insurance provider— 

17 (A) ensures that individuals with LTSS 

18 disabilities receive assistance through hands-on 

19 assistance, training, cueing, and safety moni20 toring, including access to backup systems, 

21 with— 

22 (i) activities of daily living; 

23 (ii) instrumental activities of daily liv24 ing; 

25 (iii) health-related tasks; or 


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1 (iv) other functions, tasks, or activi2 ties related to an activity or task described 

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

4 (B) coordinates, conducts, performs, pro5 vides, or funds discharge planning from acute, 

6 rehabilitation, and long-term facilities to pro7 mote individuals with LTSS disabilities living in 

8 the most integrated setting chosen by the indi9 viduals; 

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

11 funds policies and programs to promote self-di12 rection and the provision of consumer-directed 

13 services and supports for all populations of indi14 viduals with LTSS disabilities served; 

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

16 or funds policies and programs to support infor17 mal caregivers who provide services for individ18 uals with LTSS disabilities; and 

19 (E) ensures that individuals with all types 

20 of LTSS disabilities are able to live in the com21 munity and lead an independent life, including 

22 ensuring that the individuals have maximum 

23 control over the services and supports that the 

24 individuals receive, choose the setting in which 

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1 ports, and exercise control and direction over 

2 their own lives. 

3 (3) PUBLIC PARTICIPATION.— 

4 (A) PUBLIC ENTITY.—The regulations 

5 issued under this section shall require each pub6 lic entity to carry out a public participation 

7 process in preparing the public entity’s self8 evaluation under paragraph (5) and transition 

9 plan under paragraph (10). 

10 (B) LTSS INSURANCE PROVIDER.—The 

11 regulations issued under this section shall re12 quire each LTSS insurance provider to carry 

13 out a public participation process that involves 

14 holding a public hearing, providing an oppor15 tunity for public comment, and consulting with 

16 individuals with LTSS disabilities, in preparing 

17 the LTSS insurance provider’s self-evaluation 

18 under paragraph (5). 

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

20 participation process under subparagraph (A) 

21 or (B), a public entity or LTSS insurance pro22 vider shall ensure that the process meets the re23 quirements of subparagraphs (A) and (C) of 

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

25 (42 U.S.C. 1315(d)(2)), except that— 


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

2 level’’ shall be disregarded; and 

3 (ii) the reference to an application 

4 shall be considered to be a reference to the 

5 self-evaluation or plan involved. 

6 (4) ADDITIONAL SERVICES AND SUPPORTS.— 

7 The regulations issued under this section shall es8 tablish circumstances under which a public entity 

9 shall provide community-based long-term services 

10 and supports under this section beyond the level of 

11 community-based long-term services and supports 

12 which would otherwise be required under this sub13 section. 

14 (5) SELF-EVALUATION.— 

15 (A) IN GENERAL.—The regulations issued 

16 under this section shall require each public enti17 ty and each LTSS insurance provider, not later 

18 than 30 months after the date of enactment of 

19 this Act, to evaluate current services, policies, 

20 and practices, and the effects thereof, that do 

21 not or may not meet the requirements of this 

22 Act and, to the extent modification of any such 

23 services, policies, and practices is required to 

24 meet the requirements of this Act, make the 


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1 necessary modifications. The self-evaluation 

2 shall include— 

3 (i) collection of baseline information, 

4 including the numbers of individuals with 

5 LTSS disabilities in various institutional 

6 and community-based settings served by 

7 the public entity or LTSS insurance pro8 vider, including demographic data that— 

9 (I) specifies whether the individ10 uals are women, veterans, or minori11 ties; and 

12 (II) is disaggregated by race in a 

13 manner that captures all the racial 

14 groups specified in the American 

15 Community Survey conducted by the 

16 Bureau of the Census; 

17 (ii) a review of community capacity, in 

18 communities served by the entity or pro19 vider, in providing community-based long20 term services and supports; 

21 (iii) identification of improvements 

22 needed to ensure that all community-based 

23 long-term services and supports provided 

24 by the public entity or LTSS insurance 

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1 ities are comprehensive, are accessible, are 

2 not duplicative of existing (as of the date 

3 of the identification) services and supports, 

4 meet the needs of persons who are likely to 

5 require assistance in order to live, or lead 

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

7 culturally competent, high-quality services 

8 and supports, which may include identi9 fying system improvements that create an 

10 option to self-direct receipt of such services 

11 and supports for all populations of such in12 dividuals served; and 

13 (iv) a review of funding sources for 

14 community-based long-term services and 

15 supports and an analysis of how those 

16 funding sources could be organized into a 

17 fair, coherent system that affords individ18 uals reasonable and timely access to cul19 turally competent, community-based long20 term services and supports. 

21 (B) PUBLIC ENTITY.—A public entity, in22 cluding an LTSS insurance provider that is a 

23 public entity, shall— 

24 (i) include in the self-evaluation de25 scribed in subparagraph (A)— 


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1 (I) an assessment of the avail2 ability of accessible, affordable trans3 portation across the State involved 

4 and whether transportation barriers 

5 prevent individuals from receiving 

6 long-term services and supports in the 

7 most integrated setting; and 

8 (II) an assessment of the avail9 ability of integrated employment op10 portunities in the jurisdiction served 

11 by the public entity for individuals 

12 with LTSS disabilities; 

13 (ii) provide the self-evaluation de14 scribed in subparagraph (A) to the Attor15 ney General; and 

16 (iii) make the self-evaluation described 

17 in subparagraph (A) available on the pub18 lic internet website of the public entity. 

19 (C) LTSS INSURANCE PROVIDER.—An 

20 LTSS insurance provider shall keep the self21 evaluation described in subparagraph (A) on 

22 file, and may be required to produce such self23 evaluation in the event of a review, investiga24 tion, or action described in section 8. 


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1 (6) ADDITIONAL REQUIREMENT FOR PUBLIC

2 ENTITIES.—The regulations issued under this sec3 tion shall require a public entity, in conjunction with 

4 the housing agencies serving the jurisdiction served 

5 by the public entity, to review and improve commu6 nity capacity, in all communities throughout the en7 tirety of that jurisdiction, in providing affordable, 

8 accessible, and integrated housing, including an eval9 uation of available units, unmet need, and other 

10 identifiable barriers to the provision of that housing. 

11 In carrying out that improvement, the public entity, 

12 in conjunction with such housing agencies, shall— 

13 (A) ensure, and assure the Attorney Gen14 eral and the Administrator that there is, suffi15 cient availability of affordable, accessible, and 

16 integrated housing in a setting that is not a dis17 ability-specific residential setting or a setting 

18 where services are tied to tenancy, in order to 

19 provide individuals with LTSS disabilities a 

20 meaningful choice in their housing; 

21 (B) in order to address the need for af22 fordable, accessible, and integrated housing— 

23 (i) in the case of such a housing agen24 cy, establish relationships with State and 

25 local housing authorities; and 


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1 (ii) in the case of the public entity, es2 tablish relationships with State and local 

3 housing agencies, including housing au4 thorities; 

5 (C) establish, where needed, necessary 

6 preferences and set-asides in housing programs 

7 for individuals with LTSS disabilities who are 

8 transitioning from or avoiding institutional 

9 placement; 

10 (D) establish a process to fund necessary 

11 home modifications so that individuals with 

12 LTSS disabilities can live independently; and 

13 (E) ensure, and assure the Attorney Gen14 eral and the Administrator, that funds and pro15 grams implemented or overseen by the public 

16 entity or in the public entity’s jurisdiction are 

17 targeted toward affordable, accessible, inte18 grated housing for individuals with an LTSS 

19 disability who have the lowest income levels in 

20 the jurisdiction as a priority over any other de21 velopment until capacity barriers for such hous22 ing are removed or unmet needs for such hous23 ing have been met. 

24 (7) DESIGNATION OF RESPONSIBLE EM25 PLOYEE.—The regulations issued under this section 


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1 shall require each public entity and LTSS insurance 

2 provider to designate at least one employee to co3 ordinate the entity’s or provider’s efforts to comply 

4 with and carry out the entity or provider’s respon5 sibilities under this Act, including the investigation 

6 of any complaint communicated to the entity or pro7 vider that alleges a violation of this Act. Each public 

8 entity and LTSS insurance provider shall make 

9 available to all interested individuals the name, of10 fice address, and telephone number of the employee 

11 designated pursuant to this paragraph. 

12 (8) GRIEVANCE PROCEDURES.—The regulations 

13 issued under this section shall require public entities 

14 and LTSS insurance providers to adopt and publish 

15 grievance procedures providing for prompt and equi16 table resolution of complaints alleging a violation of 

17 this Act. 

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

19 regulations issued under this section shall require 

20 each public entity submitting a self-evaluation under 

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

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

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

24 instrumentality of the public entity with regards to 


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

2 such plan or self-evaluation. 

3 (10) TRANSITION PLANS.—The regulations 

4 issued under this section shall require each public 

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

6 enactment of this Act, to submit to the Adminis7 trator and, on approval by the Administrator, begin 

8 implementing a transition plan for carrying out this 

9 Act that establishes the achievement of the require10 ments of this Act, as soon as practicable, but in no 

11 event later than 12 years after the date of enact12 ment of this Act. The transition plan shall— 

13 (A) establish measurable objectives to ad14 dress the barriers to community living identified 

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

16 (B) establish specific annual targets for 

17 the transition of individuals with LTSS disabil18 ities, and shifts in funding, from institutional 

19 settings to integrated community-based services 

20 and supports, and related programs; 

21 (C) describe specific efforts to support in22 dividuals with LTSS disabilities to avoid un23 wanted institutionalization through the provi24 sion of LTSS; 


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1 (D) describe the manner in which the pub2 lic entity has obtained or plans to obtain nec3 essary funding and resources needed for imple4 mentation of the plan (regardless of whether 

5 the entity began carrying out the objectives of 

6 this Act prior to the date of enactment of this 

7 Act); and 

8 (E) describe the steps taken to ensure that 

9 the transition plan addresses the needs of com10 munities of color and lesbian, gay, bisexual, and 

11 transgender, and other underrepresented indi12 viduals. 

13 (11) ANNUAL REPORTING.— 

14 (A) IN GENERAL.—The regulations issued 

15 under this section shall establish annual report16 ing requirements for each public entity covered 

17 by this section. 

18 (B) PROGRESS ON OBJECTIVES, TARGETS, 

19 AND EFFORTS.—The regulations issued under 

20 this section shall require each public entity that 

21 has submitted a transition plan, to make pub22 licly available on the entity’s website an annual 

23 report on the progress the public entity has 

24 made during the previous year in meeting the 


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1 measurable objectives, specific annual targets, 

2 and specific efforts described in paragraph (10). 

3 (c) REVIEW OF TRANSITION PLANS.— 

4 (1) GENERAL RULE.—The Administrator shall 

5 review a transition plan submitted in accordance 

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

7 receiving the plan, for the purpose of determining 

8 whether such plan meets the requirements of this 

9 Act, including the regulations issued under this sec10 tion. 

11 (2) DISAPPROVAL.—If the Administrator deter12 mines that a transition plan reviewed under this 

13 subsection fails to meet the requirements of this Act, 

14 the Administrator shall disapprove the transition 

15 plan and notify the public entity that submitted the 

16 transition plan of, and the reasons for, such dis17 approval. 

18 (3) MODIFICATION OF DISAPPROVED PLAN.— 

19 Not later than 90 days after the date of disapproval 

20 of a transition plan under this subsection, the public 

21 entity that submitted the transition plan shall mod22 ify the transition plan to meet the requirements of 

23 this section and shall submit the modified plan to 

24 the Administrator. Not later than 90 days after re25 ceiving the modified plan, the Administrator shall 


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1 review the plan and, on approval by the Adminis2 trator, the public entity shall begin implementing the 

3 plan. 

4 (d) RULE OF CONSTRUCTION.—Nothing in sub5 section (b)(10) or (c) or any other provision of this Act 

6 shall be construed to limit the rights, protections, or re7 quirements of any other Federal law, relating to integra8 tion of individuals with disabilities into the community and 

9 enabling those individuals to live in the most integrated 

10 setting. 

11 SEC. 7. EXEMPTIONS FOR RELIGIOUS ORGANIZATIONS. 

12 This Act shall not prohibit a religious organization, 

13 association, or society from giving preference in providing 

14 community-based long-term services and supports to indi15 viduals of a particular religion connected with the beliefs 

16 of such organization, association, or society. 

17 SEC. 8. ENFORCEMENT. 

18 (a) CIVIL ACTION.— 

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

20 relief, including an application for a permanent or 

21 temporary injunction, restraining order, or other 

22 order, may be instituted by an individual described 

23 in paragraph (2) in an appropriate Federal district 

24 court. 

25 (2) AGGRIEVED INDIVIDUAL.— 


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1 (A) IN GENERAL.—The remedies and pro2 cedures set forth in this section are the rem3 edies and procedures this Act provides to any 

4 individual who is being subjected to a violation 

5 of this Act, or who has reasonable grounds for 

6 believing that such individual is about to be 

7 subjected to such a violation. 

8 (B) STANDING.—An individual with a dis9 ability shall have standing to institute a civil ac10 tion under this subsection if the individual 

11 makes a prima facie showing that the indi12 vidual— 

13 (i) is an individual with an LTSS dis14 ability; and 

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

16 be subjected to, such a violation (including 

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

18 (3) APPOINTMENT OF ATTORNEY; NO FEES, 

19 COSTS, OR SECURITY.—Upon application by the 

20 complainant described in paragraph (2) and in such 

21 circumstances as the court may determine to be just, 

22 the court may appoint an attorney for the complain23 ant and may authorize the commencement of such 

24 civil action without the payment of fees, costs, or se25 curity. 


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1 (4) FUTILE GESTURE NOT REQUIRED.—Noth2 ing in this section shall require an individual with an 

3 LTSS disability to engage in a futile gesture if such 

4 person has actual notice that a public entity or 

5 LTSS insurance provider does not intend to comply 

6 with the provisions of this Act. 

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

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

9 is about to occur, the court may award to the complain10 ant— 

11 (1) actual and punitive damages; 

12 (2) immediate injunctive relief to prevent insti13 tutionalization; 

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

15 any permanent or temporary injunction (including 

16 an order to immediately provide or maintain commu17 nity-based long-term services or supports for an in18 dividual to prevent institutionalization or further in19 stitutionalization), temporary restraining order, or 

20 other order (including an order enjoining the defend21 ant from engaging in a practice that violates this 

22 Act or ordering such affirmative action as may be 

23 appropriate); and 

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

25 require the modification of a policy, practice, or proVerDate Sep 11 2014 16:29 Dec 21, 2021 Jkt 029200 PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 E:\BILLS\S3417.IS S3417

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1 cedure, or the provision of an alternative method of 

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

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

4 STATES FOR COSTS.—In any action commenced pursuant 

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

6 bringing a claim or counterclaim under this Act, other 

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

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

9 to the same extent as a private person. 

10 (d) ENFORCEMENT BY ATTORNEY GENERAL.— 

11 (1) DENIAL OF RIGHTS.— 

12 (A) DUTY TO INVESTIGATE.—The Attor13 ney General shall investigate alleged violations 

14 of this Act, and shall undertake periodic reviews 

15 of the compliance of public entities and LTSS 

16 insurance providers under this Act. 

17 (B) POTENTIAL VIOLATION.—The Attor18 ney General may commence a civil action in any 

19 appropriate Federal district court if the Attor20 ney General has reasonable cause to believe 

21 that— 

22 (i) any public entity or LTSS insur23 ance provider, including a group of public 

24 entities or LTSS insurance providers, is 


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1 engaged in a pattern or practice of viola2 tions of this Act; or 

3 (ii) any individual, including a group, 

4 has been subjected to a violation of this 

5 Act and the violation raises an issue of 

6 general public importance. 

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

8 under paragraph (1)(B), the court— 

9 (A) may grant any equitable relief that 

10 such court considers to be appropriate, includ11 ing, to the extent required by this Act— 

12 (i) granting temporary, preliminary, 

13 or permanent relief; and 

14 (ii) requiring the modification of a 

15 policy, practice, or procedure, or the provi16 sion of an alternative method of providing 

17 LTSS; 

18 (B) may award such other relief as the 

19 court considers to be appropriate, including 

20 damages to individuals described in subsection 

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

22 and 

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

24 assess a civil penalty against the public entity 

25 or LTSS insurance provider in an amount— 


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

2 violation; and 

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

4 subsequent violation. 

5 (3) SINGLE VIOLATION.—For purposes of para6 graph (2)(C), in determining whether a first or sub7 sequent violation has occurred, a determination in a 

8 single action, by judgment or settlement, that the 

9 public entity or LTSS insurance provider has en10 gaged in more than one violation of this Act shall be 

11 counted as a single violation. 

12 SEC. 9. TECHNICAL ASSISTANCE. 

13 (a) IN GENERAL.—The Administrator shall provide 

14 technical assistance to public entities for purposes of cre15 ating and implementing transition plans in accordance 

16 with section 6(b)(10). 

17 (b) APPROPRIATIONS.—In addition to amounts other18 wise available, there is appropriated to the Administrator 

19 for fiscal year 2022, out of any money in the Treasury 

20 not otherwise appropriated, $10,000,000, to remain avail21 able until expended, to carry out this section. 

22 SEC. 10. CONSTRUCTION. 

23 For purposes of construing this Act— 

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

25 manner that takes into account its similarities with 


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1 section 302(b)(2)(A)(ii) of the Americans with Dis2 abilities Act of 1990 (42 U.S.C. 12182(b)(2)(A)(ii)); 

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

4 be construed in a manner that takes into account its 

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

6 of Federal Regulations (as in effect on the day be7 fore the date of enactment of this Act); 

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

9 that takes into account its similarities with section 

10 807(a) of the Civil Rights Act of 1968 (42 U.S.C. 

11 3607(a)); 

12 (4) section 8(a)(2) shall be construed in a man13 ner that takes into account its similarities with sec14 tion 308(a)(1) of the Americans with Disabilities 

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

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

17 manner that takes into account its similarities with 

18 section 308(b)(1)(B) of the Americans with Disabil19 ities Act of 1990 (42 U.S.C. 12188(b)(1)(B)). 

Æ 


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