I 
115TH CONGRESS 
1ST SESSION H. R. 2472 
To prohibit discrimination against individuals with disabilities who need long- 
term services and supports, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 16, 2017 
Mr. SENSENBRENNER (for himself, Mr. CONYERS, Ms. SLAUGHTER, Ms. NOR-
TON, Mr. TONKO, Ms. BLUNT ROCHESTER, Mr. RUPPERSBERGER, and 
Mr. TED LIEU of California) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce, and in addition to 
the Committee on the Judiciary, for a period to be subsequently deter-
mined 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 disabil-
ities who need long-term services and supports, and for 
other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Disability Integration 
Act of 2017’’. 
SEC. 2. FINDINGS AND PURPOSES. 
(a) FINDINGS.—Congress finds the following: 
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(1) In enacting the Americans with Disabilities 
Act of 1990 (referred to in this Act as the ‘‘ADA’’), 
Congress— 
(A) recognized that ‘‘historically, society 
has tended to isolate and segregate individuals 
with disabilities, and, despite some improve-
ments, such forms of discrimination against in-
dividuals with disabilities continue to be a seri-
ous and pervasive social problem’’; and 
(B) intended that the ADA assure ‘‘full 
participation’’ and ‘‘independent living’’ for in-
dividuals with disabilities by addressing ‘‘dis-
crimination against individuals with disabilities 
[that] persists in critical areas’’, including insti-
tutionalization. 
(2) While Congress expected that the ADA’s in-
tegration mandate would be interpreted in a manner 
that ensures that individuals who are eligible for in-
stitutional placement are able to exercise a right to 
community-based long-term services and supports, 
that expectation has not been fulfilled. 
(3) The holdings of the Supreme Court in 
Olmstead v. L.C., 527 U.S. 581 (1999), and com-
panion cases, have clearly articulated that individ-
uals with disabilities have a civil right under the 
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ADA to participate in society as equal citizens. How-
ever, many States still do not provide sufficient com-
munity-based long-term services and supports to in-
dividuals with disabilities to end segregation in insti-
tutions. 
(4) The right to live in the community is nec-
essary for the exercise of the civil rights that the 
ADA was intended to secure for all individuals with 
disabilities. The lack of adequate community-based 
services and supports has imperiled the civil rights 
of all individuals with disabilities, and has under-
mined the very promise of the ADA. It is, therefore, 
necessary to recognize in statute a robust and fully 
articulated right to community living. 
(5) States, with a few exceptions, continue to 
approach decisions regarding long-term services and 
supports from social welfare and budgetary perspec-
tives, but for the promise of the ADA to be fully re-
alized, States must approach these decisions from a 
civil rights perspective. 
(6) States have not consistently planned to en-
sure sufficient services and supports for individuals 
with disabilities, including those with the most sig-
nificant disabilities, to enable individuals with dis-
abilities to live in the most integrated setting. As a 
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result, many individuals with disabilities who reside 
in institutions are prevented from residing in the 
community and individuals with disabilities who are 
not in institutions find themselves at risk of institu-
tional placement. 
(7) The continuing existence of unfair and un-
necessary institutionalization denies individuals with 
disabilities the opportunity to live and participate on 
an equal basis in the community and costs the 
United States billions of dollars in unnecessary 
spending related to perpetuating dependency and 
unnecessary confinement. 
(b) PURPOSES.—The purposes of this Act are— 
(1) to clarify and strengthen the ADA’s inte-
gration mandate in a manner that accelerates State 
compliance; 
(2) to clarify that every individual who is eligi-
ble for long-term services and supports has a feder-
ally protected right to be meaningfully integrated 
into that individual’s community and receive commu-
nity-based long-term services and supports; 
(3) to ensure that States provide long-term 
services and supports to individuals with disabilities 
in a manner that allows individuals with disabilities 
to live in the most integrated setting, including the 
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individual’s own home, have maximum control over 
their services and supports, and ensure that long- 
term services and supports are provided in a manner 
that allows individuals with disabilities to lead an 
independent life; 
(4) to establish a comprehensive State planning 
requirement that includes enforceable, measurable 
objectives that are designed to transition individuals 
with all types of disabilities at all ages out of institu-
tions and into the most integrated setting; and 
(5) to establish a requirement for clear and uni-
form annual public reporting by States that includes 
reporting about— 
(A) the number of individuals with disabil-
ities who are served in the community and the 
number who are served in institutions; and 
(B) the number of individuals with disabil-
ities who have transitioned from an institution 
to a community-based living situation, and the 
type of community-based living situation into 
which those individuals have transitioned. 
SEC. 3. DEFINITIONS AND RULE. 
(a) DEFINITIONS.—In this Act: 
(1) ACTIVITIES OF DAILY LIVING.—The term 
‘‘activities of daily living’’ has the meaning given the 
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term in section 441.505 of title 42, Code of Federal 
Regulations (or a successor regulation). 
(2) ADMINISTRATOR.—The term ‘‘Adminis-
trator’’ means— 
(A) the Administrator of the Administra-
tion for Community Living; or 
(B) another designee of the Secretary of 
Health and Human Services. 
(3) COMMUNITY-BASED.—The term ‘‘commu-
nity-based’’, when used in reference to services or 
supports, means services or supports that are pro-
vided to an individual with an LTSS disability to en-
able that individual to live in the community and 
lead an independent life, and that are delivered in 
whichever setting the individual with an LTSS dis-
ability has chosen out of the following settings with 
the following qualities: 
(A) In the case of a dwelling or a nonresi-
dential setting (such as a setting in which an 
individual with an LTSS disability receives day 
services and supported employment), a dwelling 
or setting— 
(i) that, as a matter of infrastructure, 
environment, amenities, location, services, 
and features, is integrated into the greater 
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community and supports, for each indi-
vidual with an LTSS disability who re-
ceives services or supports at the setting— 
(I) full access to the greater com-
munity (including access to opportuni-
ties to seek employment and work in 
competitive integrated settings, en-
gage in community life, control per-
sonal resources, and receive services 
in the community); and 
(II) access to the greater commu-
nity to the same extent as access to 
the community is enjoyed by an indi-
vidual who is not receiving long-term 
services or supports; 
(ii) that the individual has selected as 
a meaningful choice from among nonresi-
dential setting options, including nondis-
ability-specific settings; 
(iii) in which an individual has rights 
to privacy, dignity, and respect, and free-
dom from coercion and restraint; 
(iv) that, as a matter of infrastruc-
ture, environment, amenities, location, 
services, and features, optimizes, but does 
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not regiment, individual initiative, auton-
omy, and independence in making life 
choices, including choices about daily ac-
tivities, physical environment, and persons 
with whom the individual interacts; and 
(v) that, as a matter of infrastructure, 
environment, amenities, location, services, 
and features, facilitates individual choice 
regarding the provision of services and 
supports, and who provides those services 
and supports. 
(B) In the case of a dwelling, a dwelling— 
(i) that is owned by an individual with 
an LTSS disability or the individual’s fam-
ily member; 
(ii) that is leased to the individual 
with an LTSS disability under an indi-
vidual lease, that has lockable access and 
egress, and that includes living, sleeping, 
bathing, and cooking areas over which an 
individual with an LTSS disability or the 
individual’s family member has domain 
and control; or 
(iii) that is a group or shared resi-
dence— 
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(I) in which no more than 4 un-
related individuals with an LTSS dis-
ability reside; 
(II) for which each individual 
with an LTSS disability living at the 
residence owns, rents, or occupies the 
residence under a legally enforceable 
agreement under which the individual 
has, at a minimum, the same respon-
sibilities and protections as tenants 
have under applicable landlord-tenant 
law; 
(III) in which each individual 
with an LTSS disability living at the 
residence— 
(aa) has privacy in the indi-
vidual’s sleeping unit, including a 
lockable entrance door controlled 
by the individual; 
(bb) shares a sleeping unit 
only if such individual and the 
individual sharing the unit choose 
to do so, and if individuals in the 
residence so choose, they also 
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have a choice of roommates with-
in the residence; 
(cc) has the freedom to fur-
nish and decorate the individual’s 
sleeping or living unit as per-
mitted under the lease or other 
agreement; 
(dd) has the freedom and 
support to control the individ-
ual’s own schedules and activi-
ties; and 
(ee) is able to have visitors 
of the individual’s choosing at 
any time; and 
(IV) that is physically accessible 
to the individual with an LTSS dis-
ability living at the residence. 
(4) DWELLING.—The term ‘‘dwelling’’ has the 
meaning given the term in section 802 of the Fair 
Housing Act (42 U.S.C. 3602). 
(5) 
HEALTH-RELATED
TASKS.—The 
term 
‘‘health-related tasks’’ means specific nonacute 
tasks, typically regulated by States as medical or 
nursing tasks that an individual with a disability 
may require to live in the community, including— 
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(A) administration of medication; 
(B) assistance with use, operation, and 
maintenance of a ventilator; and 
(C) maintenance and use of a gastrostomy 
tube, a catheter, or a stable ostomy. 
(6) INDIVIDUAL WITH A DISABILITY.—The term 
‘‘individual with a disability’’ means an individual 
who is a person with a disability, as defined in sec-
tion 3 of the Americans with Disabilities Act of 
1990 (42 U.S.C. 12102). 
(7) INDIVIDUAL WITH AN LTSS DISABILITY.— 
The term ‘‘individual with an LTSS disability’’ 
means an individual with a disability who— 
(A) in order to live in the community and 
lead an independent life requires assistance in 
accomplishing— 
(i) activities of daily living; 
(ii) instrumental activities of daily liv-
ing; 
(iii) health-related tasks; or 
(iv) other functions, tasks, or activi-
ties related to an activity or task described 
in clause (i), (ii), or (iii); and 
(B)(i) is currently in an institutional place-
ment; or 
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(ii) is at risk of institutionalization if the 
individual does not receive community-based 
long-term services and supports. 
(8) INSTRUMENTAL ACTIVITIES OF DAILY LIV-
ING.— 
(A) IN
GENERAL.—The term ‘‘instru-
mental activities of daily living’’ means one or 
more activities related to living independently in 
the community, including activities related to— 
(i) nutrition, such as preparing meals 
or special diets, monitoring to prevent 
choking or aspiration, or assisting with 
special utensils; 
(ii) household chores and environ-
mental maintenance tasks; 
(iii) communication and interpersonal 
skills, such as— 
(I) using the telephone or other 
communications devices; 
(II) forming and maintaining 
interpersonal relationships; or 
(III) securing opportunities to 
participate in group support or peer- 
to-peer support arrangements; 
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(iv) travel and community participa-
tion, such as shopping, arranging appoint-
ments, or moving around the community; 
(v) care of others, such as raising 
children, taking care of pets, or selecting 
caregivers; or 
(vi) management of personal property 
and personal safety, such as— 
(I) taking medication; 
(II) 
handling 
or 
managing 
money; or 
(III) responding to emergent sit-
uations or unscheduled needs requir-
ing an immediate response. 
(B) ASSISTANCE.—The term ‘‘assistance’’ 
used with respect to instrumental activities of 
daily living, includes support provided to an in-
dividual by another person due to confusion, de-
mentia, behavioral symptoms, or cognitive, in-
tellectual, mental, or emotional disabilities, in-
cluding support to— 
(i) help the individual identify and set 
goals, overcome fears, and manage transi-
tions; 
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(ii) help the individual with executive 
functioning, decisionmaking, and problem 
solving; 
(iii) provide reassurance to the indi-
vidual; and 
(iv) help the individual with orienta-
tion, memory, and other activities related 
to independent living. 
(9) LONG-TERM
SERVICE
OR
SUPPORT.—The 
terms ‘‘long-term service or support’’ and ‘‘LTSS’’ 
mean the assistance provided to an individual with 
a disability in accomplishing, acquiring the means or 
ability to accomplish, maintaining, or enhancing— 
(A) activities of daily living; 
(B) instrumental activities of daily living; 
(C) health-related tasks; or 
(D) other functions, tasks, or activities re-
lated to an activity or task described in sub-
paragraph (A), (B), or (C). 
(10) LTSS INSURANCE PROVIDER.—The term 
‘‘LTSS insurance provider’’ means a public or pri-
vate entity that— 
(A) provides funds for long-term services 
and supports; and 
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(B) is engaged in commerce or in an in-
dustry or activity affecting commerce. 
(11) PUBLIC ENTITY.— 
(A) IN GENERAL.—The term ‘‘public enti-
ty’’ means an entity that— 
(i) provides or funds institutional 
placements for individuals with LTSS dis-
abilities; and 
(ii) is— 
(I) a State or local government; 
or 
(II) any department, agency, en-
tity administering a special purpose 
district, or other instrumentality, of a 
State or local government. 
(B) INTERSTATE
COMMERCE.—For pur-
poses of subparagraph (A), a public entity shall 
be considered to be a person engaged in com-
merce or in an industry or activity affecting 
commerce. 
(b) RULE
OF CONSTRUCTION.—Nothing in sub-
section (a)(2) or any other provision of this section shall 
be construed to preclude an individual with a disability 
from receiving community-based services and supports in 
an integrated community setting such as a grocery store, 
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retail establishment, restaurant, bank, park, concert 
venue, theater, or workplace. 
SEC. 4. DISCRIMINATION. 
(a) IN GENERAL.—No public entity or LTSS insur-
ance provider shall deny an individual with an LTSS dis-
ability who is eligible for institutional placement, or other-
wise discriminate against that individual in the provision 
of, community-based long-term services and supports that 
enable the individual to live in the community and lead 
an independent life. 
(b) SPECIFIC PROHIBITIONS.—For purposes of this 
Act, discrimination by a public entity or LTSS insurance 
provider includes— 
(1) the imposition or application of eligibility 
criteria or another policy that prevents or tends to 
prevent an individual with an LTSS disability, or 
any class of individuals with LTSS disabilities, from 
receiving a community-based long-term service or 
support; 
(2) the imposition or application of a policy or 
other mechanism, such as a service or cost cap, that 
prevent or tends to prevent an individual with an 
LTSS disability, or any class of individuals with 
LTSS disabilities, from receiving a community-based 
long-term service or support; 
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(3) a failure to provide a specific community- 
based long-term service or support or a type of com-
munity-based long-term service or support needed 
for an individual with an LTSS disability, or any 
class of individuals with LTSS disabilities; 
(4) the imposition or application of a policy, 
rule, regulation, or restriction that interferes with 
the opportunity for an individual with an LTSS dis-
ability, or any class of individuals with LTSS dis-
abilities, to live in the community and lead an inde-
pendent life, which may include a requirement that 
an individual with an LTSS disability receive a serv-
ice or support (such as day services or employment 
services) in a congregate or disability-specific set-
ting; 
(5) the imposition or application of a waiting 
list or other mechanism that delays or restricts ac-
cess of an individual with an LTSS disability to a 
community-based long-term service or support; 
(6) a failure to establish an adequate rate or 
other payment structure that is necessary to ensure 
the availability of a workforce sufficient to support 
an individual with an LTSS disability in living in 
the community and leading an independent life; 
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(7) a failure to provide community-based serv-
ices and supports, on an intermittent, short-term, or 
emergent basis, that assist an individual with an 
LTSS disability to live in the community and lead 
an independent life; 
(8) the imposition or application of a policy, 
such as a requirement that an individual utilize in-
formal support, that restricts, limits, or delays the 
ability of an individual with an LTSS disability to 
secure a community-based long-term service or sup-
port to live in the community or lead an independent 
life; 
(9) a failure to implement a formal procedure 
and a mechanism to ensure that— 
(A) individuals with LTSS disabilities are 
offered the alternative of community-based 
long-term services and supports prior to institu-
tionalization; and 
(B) if selected by an individual with an 
LTSS disability, the community-based long- 
term services and supports described in sub-
paragraph (A) are provided; 
(10) a failure to ensure that each institutional-
ized individual with an LTSS disability is regularly 
notified of the alternative of community-based long- 
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term services and supports and that those commu-
nity-based long-term services and supports are pro-
vided if the individual with an LTSS disability se-
lects such services and supports; and 
(11) a failure to make a reasonable modifica-
tion in a policy, practice, or procedure, when such 
modification is necessary to allow an individual with 
an LTSS disability to receive a community-based 
long-term service or support. 
(c) ADDITIONAL PROHIBITION.—For purposes of this 
Act, discrimination by a public entity also includes a fail-
ure to ensure that there is sufficient availability of afford-
able, accessible, and integrated housing to allow an indi-
vidual with an LTSS disability to choose to live in the 
community and lead an independent life, including the 
availability of an option to live in housing where the re-
ceipt of LTSS is not tied to tenancy. 
(d) CONSTRUCTION.—Nothing in this section— 
(1) shall be construed— 
(A) to prevent a public entity or LTSS in-
surance provider from providing community- 
based long-term services and supports at a level 
that is greater than the level that is required by 
this section; or 
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(B) to limit the rights of an individual with 
a disability under any provision of law other 
than this section; or 
(2) shall be construed to prohibit a public entity 
or LTSS insurance provider from using managed 
care techniques, as long as the use of such tech-
niques does not have the effect of discriminating 
against an individual in the provision of community- 
based long-term services and supports, as prohibited 
by this Act. 
SEC. 5. ADMINISTRATION. 
(a) AUTHORITY AND RESPONSIBILITY.— 
(1) DEPARTMENT OF JUSTICE.—The Attorney 
General shall— 
(A) investigate and take enforcement ac-
tion for violations of this Act; and 
(B) enforce section 6(c). 
(2) DEPARTMENT
OF
HEALTH
AND
HUMAN 
SERVICES.—The Secretary of Health and Human 
Services, through the Administrator, shall— 
(A) conduct studies regarding the nature 
and extent of institutionalization of individuals 
with LTSS disabilities in representative com-
munities, including urban, suburban, and rural 
communities, throughout the United States; 
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(B) publish and disseminate reports, rec-
ommendations, and information derived from 
such studies, including an annual report to 
Congress, specifying— 
(i) the nature and extent of progress 
in the United States in eliminating institu-
tionalization for individuals with LTSS 
disabilities in violation of this Act and fur-
thering the purposes of this Act; 
(ii) obstacles that remain in the effort 
to achieve the provision of community- 
based long-term services and supports for 
all individuals with LTSS disabilities; and 
(iii) recommendations for further leg-
islative or executive action; 
(C) cooperate with, and provide technical 
assistance to, Federal, State, and local public or 
private agencies and organizations that are for-
mulating or carrying out programs to prevent 
or eliminate institutionalization of individuals 
with LTSS disabilities or to promote the provi-
sion of community-based long-term services and 
supports; 
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(D) implement educational and conciliatory 
activities to further the purposes of this Act; 
and 
(E) refer information on violations of this 
Act to the Attorney General for investigation 
and enforcement action under this Act. 
(b) COOPERATION
OF EXECUTIVE DEPARTMENTS 
AND AGENCIES.—Each Federal agency and, in particular, 
each Federal agency covered by Executive Order 13217 
(66 Fed. Reg. 33155; relating to community-based alter-
natives for individuals with disabilities), shall carry out 
programs and activities relating to the institutionalization 
of individuals with LTSS disabilities and the provision of 
community-based long-term services and supports for indi-
viduals with LTSS disabilities in accordance with this Act 
and shall cooperate with the Attorney General and the Ad-
ministrator to further the purposes of this Act. 
SEC. 6. REGULATIONS. 
(a) ISSUANCE OF REGULATIONS.—Not later than 24 
months after the date of enactment of this Act, the Attor-
ney General and the Secretary of Health and Human 
Services shall issue, in accordance with section 553 of title 
5, United States Code, final regulations to carry out this 
Act, which shall include the regulations described in sub-
section (b). 
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(b) REQUIRED CONTENTS OF REGULATIONS.— 
(1) ELIGIBLE RECIPIENTS OF SERVICE.—The 
regulations shall require each public entity and 
LTSS insurance provider to offer, and, if accepted, 
provide community-based long-term services and 
supports as required under this Act to any indi-
vidual with an LTSS disability who would otherwise 
qualify for institutional placement provided or fund-
ed by the public entity or LTSS insurance provider. 
(2) SERVICES TO BE PROVIDED.—The regula-
tions issued under this section shall require each 
public entity and LTSS insurance provider to pro-
vide the Attorney General and the Administrator 
with an assurance that the public entity or LTSS in-
surance provider— 
(A) ensures that individuals with LTSS 
disabilities receive assistance through hands-on 
assistance, training, cueing, and safety moni-
toring, including access to backup systems, 
with— 
(i) activities of daily living; 
(ii) instrumental activities of daily liv-
ing; 
(iii) health-related tasks; or 
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(iv) other functions, tasks, or activi-
ties related to an activity or task described 
in clause (i), (ii), or (iii); 
(B) coordinates, conducts, performs, pro-
vides, or funds discharge planning from acute, 
rehabilitation, and long-term facilities to pro-
mote individuals with LTSS disabilities living in 
the most integrated setting chosen by the indi-
viduals; 
(C) issues, conducts, performs, provides, or 
funds policies and programs to promote self-di-
rection and the provision of consumer-directed 
services and supports for all populations of indi-
viduals with LTSS disabilities served; 
(D) issues, conducts, performs, provides, 
or funds policies and programs to support infor-
mal caregivers who provide services for individ-
uals with LTSS disabilities; and 
(E) ensures that individuals with all types 
of LTSS disabilities are able to live in the com-
munity and lead an independent life, including 
ensuring that the individuals have maximum 
control over the services and supports that the 
individuals receive, choose the setting in which 
the individuals receive those services and sup-
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ports, and exercise control and direction over 
their own lives. 
(3) PUBLIC PARTICIPATION.— 
(A) PUBLIC
ENTITY.—The regulations 
issued under this section shall require each pub-
lic entity to carry out an extensive public par-
ticipation process in preparing the public enti-
ty’s self-evaluation under paragraph (5) and 
transition plan under paragraph (10). 
(B) LTSS INSURANCE
PROVIDER.—The 
regulations issued under this section shall re-
quire each LTSS insurance provider to carry 
out a public participation process that involves 
holding a public hearing, providing an oppor-
tunity for public comment, and consulting with 
individuals with LTSS disabilities, in preparing 
the LTSS insurance provider’s self-evaluation 
under paragraph (5). 
(C) PROCESS.—In carrying out a public 
participation process under subparagraph (A) 
or (B), a public entity or LTSS insurance pro-
vider shall ensure that the process meets the re-
quirements of subparagraphs (A) and (C) of 
section 1115(d)(2) of the Social Security Act 
(42 U.S.C. 1315(d)(2)), except that— 
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(i) the reference to ‘‘at the State 
level’’ shall be disregarded; and 
(ii) the reference to an application 
shall be considered to be a reference to the 
self-evaluation or plan involved. 
(4) ADDITIONAL SERVICES AND SUPPORTS.— 
The regulations issued under this section shall es-
tablish circumstances under which a public entity 
shall provide community-based long-term services 
and supports under this section beyond the level of 
community-based long-term services and supports 
which would otherwise be required under this sub-
section. 
(5) SELF-EVALUATION.— 
(A) IN GENERAL.—The regulations issued 
under this section shall require each public enti-
ty and each LTSS insurance provider, not later 
than 30 months after the date of enactment of 
this Act, to evaluate current services, policies, 
and practices, and the effects thereof, that do 
not or may not meet the requirements of this 
Act and, to the extent modification of any such 
services, policies, and practices is required to 
meet the requirements of this Act, make the 
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necessary modifications. The self-evaluation 
shall include— 
(i) collection of baseline information, 
including the numbers of individuals with 
LTSS disabilities in various institutional 
and community-based settings served by 
the public entity or LTSS insurance pro-
vider; 
(ii) a review of community capacity, in 
communities served by the entity or pro-
vider, in providing community-based long- 
term services and supports; 
(iii) identification of improvements 
needed to ensure that all community-based 
long-term services and supports provided 
by the public entity or LTSS insurance 
provider to individuals with LTSS disabil-
ities are comprehensive, are accessible, are 
not duplicative of existing (as of the date 
of the identification) services and supports, 
meet the needs of persons who are likely to 
require assistance in order to live, or lead 
a life, as described in section 4(a), and are 
high-quality services and supports, which 
may include identifying system improve-
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ments that create an option to self-direct 
receipt of such services and supports for 
all populations of such individuals served; 
and 
(iv) a review of funding sources for 
community-based long-term services and 
supports and an analysis of how those 
funding sources could be organized into a 
fair, coherent system that affords individ-
uals reasonable and timely access to com-
munity-based long-term services and sup-
ports. 
(B) PUBLIC ENTITY.—A public entity, in-
cluding an LTSS insurance provider that is a 
public entity, shall— 
(i) include in the self-evaluation de-
scribed in subparagraph (A)— 
(I) an assessment of the avail-
ability of accessible, affordable trans-
portation across the State involved 
and whether transportation barriers 
prevent individuals from receiving 
long-term services and supports in the 
most integrated setting; and 
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(II) an assessment of the avail-
ability of integrated employment op-
portunities in the jurisdiction served 
by the public entity for individuals 
with LTSS disabilities; and 
(ii) provide the self-evaluation de-
scribed in subparagraph (A) to the Attor-
ney General and the Administrator. 
(C) LTSS 
INSURANCE
PROVIDER.—An 
LTSS insurance provider shall keep the self- 
evaluation described in subparagraph (A) on 
file, and may be required to produce such self- 
evaluation in the event of a review, investiga-
tion, or action described in section 8. 
(6) ADDITIONAL
REQUIREMENT
FOR
PUBLIC 
ENTITIES.—The regulations issued under this sec-
tion shall require a public entity, in conjunction with 
the housing agencies serving the jurisdiction served 
by the public entity, to review and improve commu-
nity capacity, in all communities throughout the en-
tirety of that jurisdiction, in providing affordable, 
accessible, and integrated housing, including an eval-
uation of available units, unmet need, and other 
identifiable barriers to the provision of that housing. 
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In carrying out that improvement, the public entity, 
in conjunction with such housing agencies, shall— 
(A) ensure, and assure the Administrator 
and the Attorney General that there is, suffi-
cient availability of affordable, accessible, and 
integrated housing in a setting that is not a dis-
ability-specific residential setting or a setting 
where services are tied to tenancy, in order to 
provide individuals with LTSS disabilities a 
meaningful choice in their housing; 
(B) in order to address the need for af-
fordable, accessible, and integrated housing— 
(i) in the case of such a housing agen-
cy, establish relationships with State and 
local housing authorities; and 
(ii) in the case of the public entity, es-
tablish relationships with State and local 
housing agencies, including housing au-
thorities; 
(C) establish, where needed, necessary 
preferences and set-asides in housing programs 
for individuals with LTSS disabilities who are 
transitioning from or avoiding institutional 
placement; 
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