I 

117TH CONGRESS 

2D SESSION H. R. 6860 

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

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 28, 2022 

Ms. CLARKE of New York (for herself, Mr. COHEN, Mr. YARMUTH, Ms. SCHAKOWSKY, Mr. DOGGETT, Mr. FITZPATRICK, Mr. TONKO, Mr. DANNY K. 

DAVIS of Illinois, Mr. LANGEVIN, Ms. NORTON, Mr. RASKIN, Mrs. 

BUSTOS, Mr. DAVID SCOTT of Georgia, Mr. DELGADO, Mr. GARCI ́A of 

Illinois, Mr. BOWMAN, Ms. WASSERMAN SCHULTZ, Mr. KILMER, Mr. 

MOULTON, Ms. HOULAHAN, Ms. BONAMICI, Mr. KEATING, Mr. 

MORELLE, Mr. SUOZZI, Mr. STANTON, Mr. THOMPSON of Mississippi, 

Ms. MCCOLLUM, Mr. SMITH of Washington, Mr. JOHNSON of Georgia, 

Ms. SEWELL, Mr. CICILLINE, Mr. CONNOLLY, Mr. CARSON, Ms. TLAIB, 

Mr. VARGAS, Mrs. MCBATH, Mr. DEUTCH, Mr. CORREA, Mr. PERLMUTTER, Ms. TITUS, Ms. ADAMS, Mr. LEVIN of Michigan, Mr. GRIJALVA, 

Mr. DESAULNIER, Ms. PRESSLEY, Mr. EVANS, and Mr. GARAMENDI) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on the Judiciary, 

for a period to be subsequently determined by the Speaker, in each case 

for consideration of such provisions as fall within the jurisdiction of the 

committee concerned 

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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Latonya Reeves Free3 dom Act of 2022’’. 

4 SEC. 2. PURPOSES. 

5 The purposes of this Act are— 

6 (1) to clarify and strengthen the integration 

7 mandate of the Americans with Disabilities Act of 

8 1990, held by the Supreme Court in Olmstead v. 

9 L.C., 527 U.S. 581 (1999) in a manner that acceler10 ates and improves State compliance; 

11 (2) 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 (3) 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 (4) to identify and address racial, ethnic, geo2 graphic, socioeconomic, sexual orientation, gender 

3 identity, and other disparities in the provision of 

4 community-based long-term services and supports. 

5 SEC. 3. DEFINITIONS AND RULE. 

6 (a) DEFINITIONS.—In this Act: 

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

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

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

10 Regulations (or a successor regulation). 

11 (2) ADMINISTRATOR.—The term ‘‘Adminis12 trator’’ means— 

13 (A) the Administrator of the Administra14 tion for Community Living; or 

15 (B) another designee of the Secretary of 

16 Health and Human Services. 

17 (3) COMMUNITY-BASED.—The term ‘‘commu18 nity-based’’, when used in reference to services or 

19 supports, means services or supports that are pro20 vided to an individual with an LTSS disability to en21 able that individual to live in the community and 

22 lead an independent life, and that are delivered in 

23 whichever setting the individual with an LTSS dis24 ability has chosen out of the following settings with 

25 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) DWELLING.—The term ‘‘dwelling’’ has the 

2 meaning given the term in section 802 of the Fair 

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

4 (5) HEALTH-RELATED TASKS.—The term 

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

6 tasks, typically regulated by States as medical or 

7 nursing tasks that an individual with a disability 

8 may require to live in the community, including— 

9 (A) administration of medication; 

10 (B) assistance with use, operation, and 

11 maintenance of a ventilator; and 

12 (C) maintenance and use of a gastrostomy 

13 tube, a catheter, or a stable ostomy. 

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

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

16 who is a person with a disability, as defined in sec17 tion 3 of the Americans with Disabilities Act of 

18 1990 (42 U.S.C. 12102). 

19 (7) INDIVIDUAL WITH AN LTSS DISABILITY.— 

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

21 means an individual with a disability who— 

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

23 lead an independent life requires assistance in 

24 accomplishing— 

25 (i) activities of daily living; 


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1 (ii) instrumental activities of daily liv2 ing; 

3 (iii) health-related tasks; or 

4 (iv) other functions, tasks, or activi5 ties related to an activity or task described 

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

7 (B)(i) is currently in an institutional place8 ment; or 

9 (ii) is at risk of institutionalization if the 

10 individual does not receive community-based 

11 long-term services and supports. 

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

13 means— 

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

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

16 U.S.C. 1395i–3(a))); 

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

18 1919(a) of such Act (42 U.S.C. 1396r(a))); 

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

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

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

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

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

24 (E) an institution which is a psychiatric 

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


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1 Act (42 U.S.C. 1395x(f))) or that provides in2 patient psychiatric services in a residential set3 ting specified by the Secretary; 

4 (F) an institution described in section 

5 1905(i) of such Act (42 U.S.C. 1396d(i)); and 

6 (G) any congregate health care services 

7 setting that is not community-based. 

8 (9) INSTRUMENTAL ACTIVITIES OF DAILY LIV9 ING.— 

10 (A) IN GENERAL.—The term ‘‘instru11 mental activities of daily living’’ means one or 

12 more activities related to living independently in 

13 the community, including activities related to— 

14 (i) nutrition, such as preparing meals 

15 or special diets, monitoring to prevent 

16 choking or aspiration, or assisting with 

17 special utensils; 

18 (ii) household chores and environ19 mental maintenance tasks; 

20 (iii) communication and interpersonal 

21 skills, such as— 

22 (I) using the telephone or other 

23 communications devices; 

24 (II) forming and maintaining 

25 interpersonal relationships; or 


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1 (III) securing opportunities to 

2 participate in group support or peer3 to-peer support arrangements; 

4 (iv) travel and community participa5 tion, such as shopping, arranging appoint6 ments, or moving around the community; 

7 (v) care of others, such as raising 

8 children, taking care of pets, or selecting 

9 caregivers; or 

10 (vi) management of personal property 

11 and personal safety, such as— 

12 (I) taking medication; 

13 (II) handling or managing 

14 money; or 

15 (III) responding to emergent sit16 uations or unscheduled needs requir17 ing an immediate response. 

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

19 used with respect to instrumental activities of 

20 daily living, includes support provided to an in21 dividual by another person due to confusion, de22 mentia, behavioral symptoms, or cognitive, in23 tellectual, mental, or emotional disabilities, in24 cluding support to— 


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1 (i) help the individual identify and set 

2 goals, overcome fears, and manage transi3 tions; 

4 (ii) help the individual with executive 

5 functioning, decision making, and problem 

6 solving; 

7 (iii) provide reassurance to the indi8 vidual; and 

9 (iv) help the individual with orienta10 tion, memory, and other activities related 

11 to independent living. 

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

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

14 mean the assistance provided to an individual with 

15 a disability in accomplishing, acquiring the means or 

16 ability to accomplish, maintaining, or enhancing— 

17 (A) activities of daily living; 

18 (B) instrumental activities of daily living; 

19 (C) health-related tasks; or 

20 (D) other functions, tasks, or activities re21 lated to an activity or task described in sub22 paragraph (A), (B), or (C). 

23 (11) LTSS INSURANCE PROVIDER.—The term 

24 ‘‘LTSS insurance provider’’ means a public or pri25 vate entity that— 


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1 (A) provides funds for long-term services 

2 and supports; and 

3 (B) is engaged in commerce or in an in4 dustry or activity affecting commerce. 

5 (12) PUBLIC ENTITY.— 

6 (A) IN GENERAL.—The term ‘‘public enti7 ty’’ means an entity that— 

8 (i) provides or funds institutional 

9 placements for individuals with LTSS dis10 abilities; and 

11 (ii) is— 

12 (I) a State or local government; 

13 or 

14 (II) any department, agency, en15 tity administering a special purpose 

16 district, or other instrumentality, of a 

17 State or local government. 

18 (B) INTERSTATE COMMERCE.—For pur19 poses of subparagraph (A), a public entity shall 

20 be considered to be a person engaged in com21 merce or in an industry or activity affecting 

22 commerce. 

23 (b) RULE OF CONSTRUCTION.—Nothing in sub24 section (a)(2) or any other provision of this section shall 

25 be construed to preclude an individual with a disability 


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1 from receiving community-based services and supports in 

2 an integrated community setting such as a grocery store, 

3 retail establishment, restaurant, bank, park, concert 

4 venue, theater, or workplace. 

5 SEC. 4. DISCRIMINATION. 

6 (a) IN GENERAL.—No public entity or LTSS insur7 ance provider shall deny an individual with an LTSS dis8 ability who is eligible for institutional placement, or other9 wise discriminate against that individual in the provision 

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

11 enable the individual to live in the community and lead 

12 an independent life. 

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

14 Act, discrimination by a public entity or LTSS insurance 

15 provider includes— 

16 (1) the imposition or application of eligibility 

17 criteria or another policy that prevents or tends to 

18 prevent an individual with an LTSS disability, or 

19 any class of individuals with LTSS disabilities, from 

20 receiving a community-based long-term service or 

21 support; 

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

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

24 prevent or tends to prevent an individual with an 

25 LTSS disability, or any class of individuals with 


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1 LTSS disabilities, from receiving a community-based 

2 long-term service or support; 

3 (3) a failure to provide a specific community4 based long-term service or support or a type of com5 munity-based long-term service or support needed 

6 for an individual with an LTSS disability, or any 

7 class of individuals with LTSS disabilities; 

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

9 rule, regulation, or restriction that interferes with 

10 the opportunity for an individual with an LTSS dis11 ability, or any class of individuals with LTSS dis12 abilities, to live in the community and lead an inde13 pendent life, which may include a requirement that 

14 an individual with an LTSS disability receive a serv15 ice or support (such as day services or employment 

16 services) in a congregate or disability-specific set17 ting; 

18 (5) the imposition or application of a waiting 

19 list or other mechanism that delays or restricts ac20 cess of an individual with an LTSS disability to a 

21 community-based long-term service or support; 

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

23 other payment structure that is necessary to ensure 

24 the availability of a workforce sufficient to support 


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1 an individual with an LTSS disability in living in 

2 the community and leading an independent life; 

3 (7) a failure to provide community-based serv4 ices and supports, on an intermittent, short-term, or 

5 emergent basis, that assist an individual with an 

6 LTSS disability to live in the community and lead 

7 an independent life; 

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

9 such as a requirement that an individual utilize in10 formal support, that restricts, limits, or delays the 

11 ability of an individual with an LTSS disability to 

12 secure a community-based long-term service or sup13 port to live in the community or lead an independent 

14 life; 

15 (9) a failure to implement a formal procedure 

16 and a mechanism to ensure that— 

17 (A) individuals with LTSS disabilities are 

18 offered the alternative of community-based 

19 long-term services and supports prior to institu20 tionalization; and 

21 (B) if selected by an individual with an 

22 LTSS disability, the community-based long23 term services and supports described in sub24 paragraph (A) are provided; 


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1 (10) a failure to ensure that each institutional2 ized individual with an LTSS disability is regularly 

3 notified of the alternative of community-based long4 term services and supports and that those commu5 nity-based long-term services and supports are pro6 vided if the individual with an LTSS disability se7 lects such services and supports; and 

8 (11) a failure to make a reasonable modifica9 tion in a policy, practice, or procedure, when such 

10 modification is necessary to allow an individual with 

11 an LTSS disability to receive a community-based 

12 long-term service or support. 

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

14 Act, discrimination by a public entity also includes a fail15 ure to ensure that there is sufficient availability of afford16 able, accessible, and integrated housing to allow an indi17 vidual with an LTSS disability to choose to live in the 

18 community and lead an independent life, including the 

19 availability of an option to live in housing where the re20 ceipt of LTSS is not tied to tenancy. 

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

22 (1) shall be construed— 

23 (A) to prevent a public entity or LTSS in24 surance provider from providing community25 based long-term services and supports at a level 


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1 that is greater than the level that is required by 

2 this section; or 

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

4 a disability under any provision of law other 

5 than this section; 

6 (2) shall be construed to affect the scope of ob7 ligations imposed by any other provision of law; or 

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

9 or LTSS insurance provider from using managed 

10 care techniques, as long as the use of such tech11 niques does not have the effect of discriminating 

12 against an individual in the provision of community13 based long-term services and supports, as prohibited 

14 by this Act. 

15 SEC. 5. ADMINISTRATION. 

16 (a) AUTHORITY AND RESPONSIBILITY.— 

17 (1) DEPARTMENT OF JUSTICE.—The Attorney 

18 General shall investigate and take enforcement ac19 tion for violations of this Act. 

20 (2) DEPARTMENT OF HEALTH AND HUMAN

21 SERVICES.—The Secretary of Health and Human 

22 Services, through the Administrator, shall— 

23 (A) review, and approve or disapprove, 

24 transition plans submitted by public entities, 

25 under section 6(b)(10); 


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

2 ethnic, geographic, socioeconomic, sexual ori3 entation, gender identity, and other disparities 

4 in the availability and provision of community5 based long-term services and supports, which 

6 task force shall be responsible for— 

7 (i) overseeing studies regarding the 

8 nature and extent of racial, ethnic, geo9 graphic, socioeconomic, sexual orientation, 

10 gender identity, and other disparities in 

11 the availability and provision of commu12 nity-based long-term services and supports 

13 and the impact that those disparities have 

14 on the institutionalization of individuals 

15 with LTSS disabilities; and 

16 (ii) submitting to Congress not later 

17 than 2 years after the date of enactment 

18 of this Act a report on the nature and ex19 tent of racial, ethnic, geographic, socio20 economic, sexual orientation, gender iden21 tity, and other disparities in the avail22 ability and provision of community-based 

23 long-term services and supports, including 

24 recommendations for addressing those dis25 parities; 


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1 (C) establish a task force to identify obsta2 cles that prevent individuals with LTSS disabil3 ities from being able to choose community4 based alternatives to institutionalization, and to 

5 recommend legislative or executive action to ad6 dress the obstacles; and 

7 (D) refer information on violations of this 

8 Act to the Attorney General for investigation 

9 and enforcement action under this Act. 

10 (b) COOPERATION OF EXECUTIVE DEPARTMENTS

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

12 each Federal agency covered by Executive Order 13217 

13 (66 Fed. Reg. 33155; relating to community-based alter14 natives for individuals with disabilities), shall carry out 

15 programs and activities relating to the institutionalization 

16 of individuals with LTSS disabilities and the provision of 

17 community-based long-term services and supports for indi18 viduals with LTSS disabilities in accordance with this Act 

19 and shall cooperate with the Attorney General and the Ad20 ministrator to further the purposes of this Act. 

21 SEC. 6. REGULATIONS. 

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

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

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

25 5, United States Code, final regulations to carry out this 


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1 Act, which shall include the regulations described in sub2 section (b). 

3 (b) REQUIRED CONTENTS OF REGULATIONS.— 

4 (1) PROTECTED INDIVIDUALS.—The regula5 tions shall require each public entity and LTSS in6 surance provider to offer, and, if accepted, provide 

7 community-based long-term services and supports as 

8 required under this Act to any individual with an 

9 LTSS disability who would otherwise qualify for in10 stitutional placement provided or funded by the pub11 lic entity or LTSS insurance provider. 

12 (2) SERVICES TO BE PROVIDED.—The regula13 tions issued under this section shall require each 

14 public entity and LTSS insurance provider to pro15 vide the Attorney General and the Administrator 

16 (for purposes of enabling the Attorney General to 

17 consult with the Administrator) with an assurance 

18 that the public entity or LTSS insurance provider— 

19 (A) ensures that individuals with LTSS 

20 disabilities receive assistance through hands-on 

21 assistance, training, cueing, and safety moni22 toring, including access to backup systems, 

23 with— 

24 (i) activities of daily living; 


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1 (ii) instrumental activities of daily liv2 ing; 

3 (iii) health-related tasks; or 

4 (iv) other functions, tasks, or activi5 ties related to an activity or task described 

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

7 (B) coordinates, conducts, performs, pro8 vides, or funds discharge planning from acute, 

9 rehabilitation, and long-term facilities to pro10 mote individuals with LTSS disabilities living in 

11 the most integrated setting chosen by the indi12 viduals; 

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

14 funds policies and programs to promote self-di15 rection and the provision of consumer-directed 

16 services and supports for all populations of indi17 viduals with LTSS disabilities served; 

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

19 or funds policies and programs to support infor20 mal caregivers who provide services for individ21 uals with LTSS disabilities; and 

22 (E) ensures that individuals with all types 

23 of LTSS disabilities are able to live in the com24 munity and lead an independent life, including 

25 ensuring that the individuals have maximum 


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1 control over the services and supports that the 

2 individuals receive, choose the setting in which 

3 the individuals receive those services and sup4 ports, and exercise control and direction over 

5 their own lives. 

6 (3) PUBLIC PARTICIPATION.— 

7 (A) PUBLIC ENTITY.—The regulations 

8 issued under this section shall require each pub9 lic entity to carry out a public participation 

10 process in preparing the public entity’s self11 evaluation under paragraph (5) and transition 

12 plan under paragraph (10). 

13 (B) LTSS INSURANCE PROVIDER.—The 

14 regulations issued under this section shall re15 quire each LTSS insurance provider to carry 

16 out a public participation process that involves 

17 holding a public hearing, providing an oppor18 tunity for public comment, and consulting with 

19 individuals with LTSS disabilities, in preparing 

20 the LTSS insurance provider’s self-evaluation 

21 under paragraph (5). 

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

23 participation process under subparagraph (A) 

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1 quirements of subparagraphs (A) and (C) of 

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

3 (42 U.S.C. 1315(d)(2)), except that— 

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

5 level’’ shall be disregarded; and 

6 (ii) the reference to an application 

7 shall be considered to be a reference to the 

8 self-evaluation or plan involved. 

9 (4) ADDITIONAL SERVICES AND SUPPORTS.— 

10 The regulations issued under this section shall es11 tablish circumstances under which a public entity 

12 shall provide community-based long-term services 

13 and supports under this section beyond the level of 

14 community-based long-term services and supports 

15 which would otherwise be required under this sub16 section. 

17 (5) SELF-EVALUATION.— 

18 (A) IN GENERAL.—The regulations issued 

19 under this section shall require each public enti20 ty and each LTSS insurance provider, not later 

21 than 30 months after the date of enactment of 

22 this Act, to evaluate current services, policies, 

23 and practices, and the effects thereof, that do 

24 not or may not meet the requirements of this 

25 Act and, to the extent modification of any such 


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1 services, policies, and practices is required to 

2 meet the requirements of this Act, make the 

3 necessary modifications. The self-evaluation 

4 shall include— 

5 (i) collection of baseline information, 

6 including the numbers of individuals with 

7 LTSS disabilities in various institutional 

8 and community-based settings served by 

9 the public entity or LTSS insurance pro10 vider, including demographic data that— 

11 (I) specifies whether the individ12 uals are women, veterans, or minori13 ties; and 

14 (II) is disaggregated by race in a 

15 manner that captures all the racial 

16 groups specified in the American 

17 Community Survey conducted by the 

18 Bureau of the Census; 

19 (ii) a review of community capacity, in 

20 communities served by the entity or pro21 vider, in providing community-based long22 term services and supports; 

23 (iii) identification of improvements 

24 needed to ensure that all community-based 

25 long-term services and supports provided 


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1 by the public entity or LTSS insurance 

2 provider to individuals with LTSS disabil3 ities are comprehensive, are accessible, are 

4 not duplicative of existing (as of the date 

5 of the identification) services and supports, 

6 meet the needs of persons who are likely to 

7 require assistance in order to live, or lead 

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

9 culturally competent, high-quality services 

10 and supports, which may include identi11 fying system improvements that create an 

12 option to self-direct receipt of such services 

13 and supports for all populations of such in14 dividuals served; and 

15 (iv) a review of funding sources for 

16 community-based long-term services and 

17 supports and an analysis of how those 

18 funding sources could be organized into a 

19 fair, coherent system that affords individ20 uals reasonable and timely access to cul21 turally competent, community-based long22 term services and supports. 

23 (B) PUBLIC ENTITY.—A public entity, in24 cluding an LTSS insurance provider that is a 

25 public entity, shall— 


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1 (i) include in the self-evaluation de2 scribed in subparagraph (A)— 

3 (I) an assessment of the avail4 ability of accessible, affordable trans5 portation across the State involved 

6 and whether transportation barriers 

7 prevent individuals from receiving 

8 long-term services and supports in the 

9 most integrated setting; and 

10 (II) an assessment of the avail11 ability of integrated employment op12 portunities in the jurisdiction served 

13 by the public entity for individuals 

14 with LTSS disabilities; 

15 (ii) provide the self-evaluation de16 scribed in subparagraph (A) to the Attor17 ney General; and 

18 (iii) make the self-evaluation described 

19 in subparagraph (A) available on the pub20 lic internet website of the public entity. 

21 (C) LTSS INSURANCE PROVIDER.—An 

22 LTSS insurance provider shall keep the self23 evaluation described in subparagraph (A) on 

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1 evaluation in the event of a review, investiga2 tion, or action described in section 8. 

3 (6) ADDITIONAL REQUIREMENT FOR PUBLIC

4 ENTITIES.—The regulations issued under this sec5 tion shall require a public entity, in conjunction with 

6 the housing agencies serving the jurisdiction served 

7 by the public entity, to review and improve commu8 nity capacity, in all communities throughout the en9 tirety of that jurisdiction, in providing affordable, 

10 accessible, and integrated housing, including an eval11 uation of available units, unmet need, and other 

12 identifiable barriers to the provision of that housing. 

13 In carrying out that improvement, the public entity, 

14 in conjunction with such housing agencies, shall— 

15 (A) ensure, and assure the Attorney Gen16 eral and the Administrator that there is, suffi17 cient availability of affordable, accessible, and 

18 integrated housing in a setting that is not a dis19 ability-specific residential setting or a setting 

20 where services are tied to tenancy, in order to 

21 provide individuals with LTSS disabilities a 

22 meaningful choice in their housing; 

23 (B) in order to address the need for af24 fordable, accessible, and integrated housing— 


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1 (i) in the case of such a housing agen2 cy, establish relationships with State and 

3 local housing authorities; and 

4 (ii) in the case of the public entity, es5 tablish relationships with State and local 

6 housing agencies, including housing au7 thorities; 

8 (C) establish, where needed, necessary 

9 preferences and set-asides in housing programs 

10 for individuals with LTSS disabilities who are 

11 transitioning from or avoiding institutional 

12 placement; 

13 (D) establish a process to fund necessary 

14 home modifications so that individuals with 

15 LTSS disabilities can live independently; and 

16 (E) ensure, and assure the Attorney Gen17 eral and the Administrator, that funds and pro18 grams implemented or overseen by the public 

19 entity or in the public entity’s jurisdiction are 

20 targeted toward affordable, accessible, inte21 grated housing for individuals with an LTSS 

22 disability who have the lowest income levels in 

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1 ing are removed or unmet needs for such hous2 ing have been met. 

3 (7) DESIGNATION OF RESPONSIBLE EM4 PLOYEE.—The regulations issued under this section 

5 shall require each public entity and LTSS insurance 

6 provider to designate at least one employee to co7 ordinate the entity’s or provider’s efforts to comply 

8 with and carry out the entity or provider’s respon9 sibilities under this Act, including the investigation 

10 of any complaint communicated to the entity or pro11 vider that alleges a violation of this Act. Each public 

12 entity and LTSS insurance provider shall make 

13 available to all interested individuals the name, of14 fice address, and telephone number of the employee 

15 designated pursuant to this paragraph. 

16 (8) GRIEVANCE PROCEDURES.—The regulations 

17 issued under this section shall require public entities 

18 and LTSS insurance providers to adopt and publish 

19 grievance procedures providing for prompt and equi20 table resolution of complaints alleging a violation of 

21 this Act. 

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

23 regulations issued under this section shall require 

24 each public entity submitting a self-evaluation under 

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


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

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

3 instrumentality of the public entity with regards to 

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

5 such plan or self-evaluation. 

6 (10) TRANSITION PLANS.—The regulations 

7 issued under this section shall require each public 

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

9 enactment of this Act, to submit to the Adminis10 trator and, on approval by the Administrator, begin 

11 implementing a transition plan for carrying out this 

12 Act that establishes the achievement of the require13 ments of this Act, as soon as practicable, but in no 

14 event later than 12 years after the date of enact15 ment of this Act. The transition plan shall— 

16 (A) establish measurable objectives to ad17 dress the barriers to community living identified 

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

19 (B) establish specific annual targets for 

20 the transition of individuals with LTSS disabil21 ities, and shifts in funding, from institutional 

22 settings to integrated community-based services 

23 and supports, and related programs; 

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1 wanted institutionalization through the provi2 sion of LTSS; 

3 (D) describe the manner in which the pub4 lic entity has obtained or plans to obtain nec5 essary funding and resources needed for imple6 mentation of the plan (regardless of whether 

7 the entity began carrying out the objectives of 

8 this Act prior to the date of enactment of this 

9 Act); and 

10 (E) describe the steps taken to ensure that 

11 the transition plan addresses the needs of com12 munities of color and lesbian, gay, bisexual, and 

13 transgender, and other underrepresented indi14 viduals. 

15 (11) ANNUAL REPORTING.— 

16 (A) IN GENERAL.—The regulations issued 

17 under this section shall establish annual report18 ing requirements for each public entity covered 

19 by this section. 

20 (B) PROGRESS ON OBJECTIVES, TARGETS, 

21 AND EFFORTS.—The regulations issued under 

22 this section shall require each public entity that 

23 has submitted a transition plan, to make pub24 licly available on the entity’s website an annual 

25 report on the progress the public entity has 


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1 made during the previous year in meeting the 

2 measurable objectives, specific annual targets, 

3 and specific efforts described in paragraph (10). 

4 (c) REVIEW OF TRANSITION PLANS.— 

5 (1) GENERAL RULE.—The Administrator shall 

6 review a transition plan submitted in accordance 

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

8 receiving the plan, for the purpose of determining 

9 whether such plan meets the requirements of this 

10 Act, including the regulations issued under this sec11 tion. 

12 (2) DISAPPROVAL.—If the Administrator deter13 mines that a transition plan reviewed under this 

14 subsection fails to meet the requirements of this Act, 

15 the Administrator shall disapprove the transition 

16 plan and notify the public entity that submitted the 

17 transition plan of, and the reasons for, such dis18 approval. 

19 (3) MODIFICATION OF DISAPPROVED PLAN.— 

20 Not later than 90 days after the date of disapproval 

21 of a transition plan under this subsection, the public 

22 entity that submitted the transition plan shall mod23 ify the transition plan to meet the requirements of 

24 this section and shall submit the modified plan to 

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1 ceiving the modified plan, the Administrator shall 

2 review the plan and, on approval by the Adminis3 trator, the public entity shall begin implementing the 

4 plan. 

5 (d) RULE OF CONSTRUCTION.—Nothing in sub6 section (b)(10) or (c) or any other provision of this Act 

7 shall be construed to limit the rights, protections, or re8 quirements of any other Federal law, relating to integra9 tion of individuals with disabilities into the community and 

10 enabling those individuals to live in the most integrated 

11 setting. 

12 SEC. 7. EXEMPTIONS FOR RELIGIOUS ORGANIZATIONS. 

13 This Act shall not prohibit a religious organization, 

14 association, or society from giving preference in providing 

15 community-based long-term services and supports to indi16 viduals of a particular religion connected with the beliefs 

17 of such organization, association, or society. 

18 SEC. 8. ENFORCEMENT. 

19 (a) CIVIL ACTION.— 

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

21 relief, including an application for a permanent or 

22 temporary injunction, restraining order, or other 

23 order, may be instituted by an individual described 

24 in paragraph (2) in an appropriate Federal district 

25 court. 


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1 (2) AGGRIEVED INDIVIDUAL.— 

2 (A) IN GENERAL.—The remedies and pro3 cedures set forth in this section are the rem4 edies and procedures this Act provides to any 

5 individual who is being subjected to a violation 

6 of this Act, or who has reasonable grounds for 

7 believing that such individual is about to be 

8 subjected to such a violation. 

9 (B) STANDING.—An individual with a dis10 ability shall have standing to institute a civil ac11 tion under this subsection if the individual 

12 makes a prima facie showing that the indi13 vidual— 

14 (i) is an individual with an LTSS dis15 ability; and 

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

17 be subjected to, such a violation (including 

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

19 (3) APPOINTMENT OF ATTORNEY; NO FEES, 

20 COSTS, OR SECURITY.—Upon application by the 

21 complainant described in paragraph (2) and in such 

22 circumstances as the court may determine to be just, 

23 the court may appoint an attorney for the complain24 ant and may authorize the commencement of such 


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1 civil action without the payment of fees, costs, or se2 curity. 

3 (4) FUTILE GESTURE NOT REQUIRED.—Noth4 ing in this section shall require an individual with an 

5 LTSS disability to engage in a futile gesture if such 

6 person has actual notice that a public entity or 

7 LTSS insurance provider does not intend to comply 

8 with the provisions of this Act. 

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

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

11 is about to occur, the court may award to the complain12 ant— 

13 (1) actual and punitive damages; 

14 (2) immediate injunctive relief to prevent insti15 tutionalization; 

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

17 any permanent or temporary injunction (including 

18 an order to immediately provide or maintain commu19 nity-based long-term services or supports for an in20 dividual to prevent institutionalization or further in21 stitutionalization), temporary restraining order, or 

22 other order (including an order enjoining the defend23 ant from engaging in a practice that violates this 

24 Act or ordering such affirmative action as may be 

25 appropriate); and 


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

2 require the modification of a policy, practice, or pro3 cedure, or the provision of an alternative method of 

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

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

6 STATES FOR COSTS.—In any action commenced pursuant 

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

8 bringing a claim or counterclaim under this Act, other 

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

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

11 to the same extent as a private person. 

12 (d) ENFORCEMENT BY ATTORNEY GENERAL.— 

13 (1) DENIAL OF RIGHTS.— 

14 (A) DUTY TO INVESTIGATE.—The Attor15 ney General shall investigate alleged violations 

16 of this Act, and shall undertake periodic reviews 

17 of the compliance of public entities and LTSS 

18 insurance providers under this Act. 

19 (B) POTENTIAL VIOLATION.—The Attor20 ney General may commence a civil action in any 

21 appropriate Federal district court if the Attor22 ney General has reasonable cause to believe 

23 that— 

24 (i) any public entity or LTSS insur25 ance provider, including a group of public 


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1 entities or LTSS insurance providers, is 

2 engaged in a pattern or practice of viola3 tions of this Act; or 

4 (ii) any individual, including a group, 

5 has been subjected to a violation of this 

6 Act and the violation raises an issue of 

7 general public importance. 

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

9 under paragraph (1)(B), the court— 

10 (A) may grant any equitable relief that 

11 such court considers to be appropriate, includ12 ing, to the extent required by this Act— 

13 (i) granting temporary, preliminary, 

14 or permanent relief; and 

15 (ii) requiring the modification of a 

16 policy, practice, or procedure, or the provi17 sion of an alternative method of providing 

18 LTSS; 

19 (B) may award such other relief as the 

20 court considers to be appropriate, including 

21 damages to individuals described in subsection 

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

23 and 


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

2 assess a civil penalty against the public entity 

3 or LTSS insurance provider in an amount— 

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

5 violation; and 

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

7 subsequent violation. 

8 (3) SINGLE VIOLATION.—For purposes of para9 graph (2)(C), in determining whether a first or sub10 sequent violation has occurred, a determination in a 

11 single action, by judgment or settlement, that the 

12 public entity or LTSS insurance provider has en13 gaged in more than one violation of this Act shall be 

14 counted as a single violation. 

15 SEC. 9. TECHNICAL ASSISTANCE. 

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

17 technical assistance to public entities for purposes of cre18 ating and implementing transition plans in accordance 

19 with section 6(b)(10). 

20 (b) APPROPRIATIONS.—In addition to amounts other21 wise available, there is appropriated to the Administrator 

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

23 not otherwise appropriated, $10,000,000, to remain avail24 able until expended, to carry out this section. 


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1 SEC. 10. 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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