I 
114TH CONGRESS 
2D SESSION 
H. R. 5689 
To prohibit discrimination against individuals with disabilities who need long- 
term services and supports, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 8, 2016 
Mr. GIBSON introduced the following bill; which was referred to the Committee 
on Energy and Commerce, and in addition to the Committee on the Judi-
ciary, 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 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 2016’’. 
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 from eviction 
as tenants have under applicable land-
lord-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; 
(C) maintenance of a catheter; and 
(D) maintenance of 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 mental or 
emotional disabilities, including support to— 
(i) help the individual identify and set 
goals, overcome fears, and manage transi-
tions; 
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