I 
118TH CONGRESS 
1ST SESSION H. R. 2708 
To prohibit discrimination against individuals with disabilities who need long- 
term services and supports, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 19, 2023 
Mr. COHEN (for himself, Mr. AUCHINCLOSS, Mrs. BEATTY, Mr. BERA, Mr. 
BISHOP of Georgia, Ms. BLUNT ROCHESTER, Ms. BONAMICI, Mr. BOW-
MAN, Mr. BOYLE of Pennsylvania, Mr. BUCK, Mr. CARBAJAL, Ms. CHU, 
Ms. CLARKE of New York, Mr. CONNOLLY, Ms. CRAIG, Mr. DOGGETT, 
Mr. EVANS, Mr. GOMEZ, Mr. GREEN of Texas, Mr. GRIJALVA, Mr. 
HUFFMAN, Ms. JACOBS, Mr. KEATING, Mr. KILDEE, Mr. KILMER, Ms. 
KUSTER, Mr. LIEU, Mr. LYNCH, Mrs. MCBATH, Ms. MENG, Mr. MFUME, 
Ms. MOORE of Wisconsin, Mr. MOULTON, Mr. NEGUSE, Mr. PASCRELL, 
Mr. PETERS, Ms. PINGREE, Mr. POCAN, Ms. PORTER, Mr. QUIGLEY, Mr. 
RUPPERSBERGER, Mr. RYAN, Ms. SCANLON, Ms. SCHAKOWSKY, Mr. 
SCHIFF, Mr. SMITH of Washington, Ms. STEVENS, Ms. STRICKLAND, Mr. 
THOMPSON
of 
Mississippi, 
Ms. 
TLAIB, 
Ms. 
UNDERWOOD, 
Ms. 
VELA´ZQUEZ, Ms. WASSERMAN SCHULTZ, Mrs. WATSON COLEMAN, Ms. 
WILD, Ms. WILLIAMS of Georgia, Mr. PANETTA, Ms. MATSUI, and Mr. 
FITZPATRICK) 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 disabil-
ities who need long-term services and supports, and for 
other purposes. 
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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 ‘‘Latonya Reeves Free-
dom Act of 2023’’. 
SEC. 2. PURPOSES. 
The purposes of this Act are— 
(1) to clarify and strengthen the integration 
mandate of the Americans with Disabilities Act of 
1990, held by the Supreme Court in Olmstead v. 
L.C., 527 U.S. 581 (1999) in a manner that acceler-
ates and improves State compliance; 
(2) to affirm 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 
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 
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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, if they 
choose that transition; and 
(5) to identify and address disparities in the 
provision of community-based long-term services and 
supports. 
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 
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; SERVICES
OR
SUP-
PORTS.—The term ‘‘community-based’’, when used 
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(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 
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 
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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— 
(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-
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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 
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-
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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) COMMUNITY-BASED; SETTING.—The term 
‘‘community-based’’, when used in reference to a set-
ting, means a setting described in subparagraph (A) 
or (B) of paragraph (3). 
(5) DWELLING.—The term ‘‘dwelling’’ has the 
meaning given the term in section 802 of the Fair 
Housing Act (42 U.S.C. 3602). 
(6) 
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— 
(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. 
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(7) 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). 
(8) 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 
(ii) is at risk of institutionalization if the 
individual does not receive community-based 
long-term services and supports. 
(9) INSTITUTION; INSTITUTIONALIZATION.— 
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(A) INSTITUTION.—The term ‘‘institution’’ 
means— 
(i) a skilled nursing facility (as de-
fined in section 1819(a) of the Social Secu-
rity Act (42 U.S.C. 1395i–3(a))); 
(ii) a nursing facility (as defined in 
section 1919(a) of such Act (42 U.S.C. 
1396r(a))); 
(iii) a long-term care hospital (as de-
scribed in section 1886(d)(1)(B)(iv) of 
such 
Act 
(42 
U.S.C. 
1395ww(d)(1)(B)(iv))); 
(iv) a facility described in section 
1905(d) of such Act (42 U.S.C. 1396d(d)); 
(v) an institution which is a psy-
chiatric hospital (as defined in section 
1861(f) of such Act (42 U.S.C. 1395x(f))) 
or that provides in-patient psychiatric serv-
ices in a residential setting specified by the 
Secretary; 
(vi) an institution described in section 
1905(i) of such Act (42 U.S.C. 1396d(i)); 
and 
(vii) any congregate setting that is not 
community-based or that has the effect of 
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isolating individuals with disabilities from 
the community. 
(B) INSTITUTIONALIZATION.—The term 
‘‘institutionalization’’, used with respect to an 
individual with an LTSS disability, refers to the 
individual living or receiving services or sup-
ports in a setting that is not community-based. 
(10) INSTRUMENTAL ACTIVITIES OF DAILY LIV-
ING.—The term ‘‘instrumental activities of daily liv-
ing’’ means one or more activities related to living 
independently in the community, including activities 
related to— 
(A) nutrition, such as preparing meals or 
special diets, monitoring to prevent choking or 
aspiration, or assisting with special utensils; 
(B) household chores and environmental 
maintenance tasks; 
(C) 
communication 
and 
interpersonal 
skills, such as— 
(i) using the telephone or other com-
munications devices; 
(ii) forming and maintaining inter-
personal relationships; or 
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(iii) securing opportunities to partici-
pate in group support or peer-to-peer sup-
port arrangements; 
(D) travel and community participation, 
such as shopping, arranging appointments, or 
moving around the community; 
(E) care of others, such as raising chil-
dren, taking care of pets, or selecting care-
givers; or 
(F) management of personal property and 
personal safety, such as— 
(i) taking medication; 
(ii) handling or managing money; or 
(iii) responding to emergent situations 
or unscheduled needs requiring an imme-
diate response. 
(11) LONG-TERM SERVICE OR SUPPORT.— 
(A) IN GENERAL.—The terms ‘‘long-term 
service or support’’ and ‘‘LTSS’’ mean the as-
sistance provided to an individual with a dis-
ability in accomplishing, acquiring the means or 
ability to accomplish, maintaining, or enhanc-
ing— 
(i) activities of daily living; 
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(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). 
(B) ASSISTANCE.—In subparagraph (A), 
the term ‘‘assistance’’ includes support provided 
to an individual by another person due to con-
fusion, dementia, behavioral symptoms, or cog-
nitive, intellectual, mental, or emotional disabil-
ities, including support to— 
(i) help the individual identify and set 
goals, communicate needs, overcome fears, 
and manage transitions; 
(ii) help the individual with executive 
functioning, decision making, self-expres-
sion, and problemsolving; 
(iii) provide reassurance to the indi-
vidual; and 
(iv) help the individual with orienta-
tion, memory, and other activities related 
to independent living. 
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(12) 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 
(B) is engaged in commerce or in an in-
dustry or activity affecting commerce. 
(13) 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. 
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(b) RULE
OF CONSTRUCTION.—Nothing in sub-
section (a) 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 in-
tegrated community setting such as a grocery store, retail 
establishment, restaurant, bank, park, concert venue, the-
ater, 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; 
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(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; 
(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; 
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(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; 
(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- 
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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- 
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— 
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(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; 
(B) to limit the rights of an individual with 
a disability under any provision of law other 
than this section; or 
(C) to require that an individual with an 
LTSS disability live or receive services or sup-
ports in a more integrated setting if the indi-
vidual chooses a less integrated setting; 
(2) shall be construed to affect the scope of ob-
ligations imposed by any other provision of law; or 
(3) 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.— 
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(1) DEPARTMENT OF JUSTICE.—The Attorney 
General shall investigate and take enforcement ac-
tion for violations of this Act. 
(2) DEPARTMENT
OF
HEALTH
AND
HUMAN 
SERVICES.—The Secretary of Health and Human 
Services, through the Administrator, shall— 
(A) review, and approve or disapprove, 
transition plans submitted by public entities, 
under section 6(b)(10); 
(B) establish a task force to identify socio- 
demographic, geographic, and other factors that 
are barriers that prevent individuals with LTSS 
disabilities from receiving community-based 
long-term services and supports or from being 
able to choose alternatives in the community to 
institutionalization and identify other dispari-
ties in the availability and provision of commu-
nity-based long-term services and supports, 
which task force shall be responsible for— 
(i) overseeing studies regarding the 
nature and extent of those barriers and 
disparities and the impact that those bar-
riers and disparities have on the institu-
tionalization of individuals with LTSS dis-
abilities; and 
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(ii) submitting to Congress not later 
than 2 years after the date of enactment 
of this Act a report on the nature and ex-
tent of those barriers and disparities, in-
cluding a description of legislative or exec-
utive action to address the barriers and 
disparities; and 
(C) 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 2 
years after the date of enactment of this Act, the Attorney 
General shall issue, in accordance with section 553 of title 
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5, United States Code, final regulations to carry out this 
Act, which shall include the regulations described in sub-
section (b). 
(b) REQUIRED CONTENTS OF REGULATIONS.— 
(1) PROTECTED
INDIVIDUALS.—The regula-
tions shall require each public entity and LTSS in-
surance provider to offer, and, if accepted, provide 
community-based long-term services and supports as 
required under this Act to any individual with an 
LTSS disability who would otherwise qualify for in-
stitutional placement provided or funded by the pub-
lic 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 
(for purposes of enabling the Attorney General to 
consult with the Administrator) with an assurance 
that the public entity or LTSS insurance 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; 
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(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); 
(B) coordinates, conducts, performs, pro-
vides, or funds discharge planning from acute 
and rehabilitation facilities, and other institu-
tions, to promote individuals with LTSS disabil-
ities living in the most integrated setting chosen 
by the individuals; 
(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 
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control over the services and supports that the 
individuals receive, choose the setting in which 
the individuals receive those services and sup-
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 a public participation 
process in preparing the public entity’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-
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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— 
(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 
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services, policies, and practices is required to 
meet the requirements of this Act, make the 
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, including demographic data that— 
(I) specifies whether the individ-
uals are women, veterans, or members 
of a racial and ethnic minority group, 
as defined in section 1707 of the Pub-
lic Health Service Act (42 U.S.C. 
300u–6); and 
(II) is disaggregated by race in a 
manner that captures all the racial 
groups specified in the American 
Community Survey conducted by the 
Bureau of the Census; 
(ii) a review of community capacity, in 
communities served by the entity or pro-
vider, in providing community-based long- 
term services and supports; 
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(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 
culturally competent, high-quality services 
and supports, which may include identi-
fying system improvements that create an 
option to self-direct receipt of such services 
and supports for all populations of such in-
dividuals 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 cul-
turally competent, community-based long- 
term services and supports. 
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(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 
(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; 
(ii) provide the self-evaluation de-
scribed in subparagraph (A) to the Attor-
ney General; and 
(iii) make the self-evaluation described 
in subparagraph (A) available on the pub-
lic internet website of the public entity. 
(C) LTSS 
INSURANCE
PROVIDER.—An 
LTSS insurance provider shall keep the self- 
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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. 
In carrying out that improvement, the public entity, 
in conjunction with such housing agencies, shall— 
(A) ensure, and assure the Attorney Gen-
eral and the Administrator 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; 
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(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; 
(D) establish a process to fund necessary 
home modifications so that individuals with 
LTSS disabilities can live independently; and 
(E) ensure, and assure the Attorney Gen-
eral and the Administrator, that funds and pro-
grams implemented or overseen by the public 
entity or in the public entity’s jurisdiction are 
targeted toward affordable, accessible, inte-
grated housing for individuals with an LTSS 
disability who have the lowest income levels in 
the jurisdiction as a priority over any other de-
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velopment until capacity barriers for such hous-
ing are removed or unmet needs for such hous-
ing have been met. 
(7) 
DESIGNATION
OF
RESPONSIBLE
EM-
PLOYEE.—The regulations issued under this section 
shall require each public entity and LTSS insurance 
provider to designate at least one employee to co-
ordinate the entity’s or provider’s efforts to comply 
with and carry out the entity or provider’s respon-
sibilities under this Act, including the investigation 
of any complaint communicated to the entity or pro-
vider that alleges a violation of this Act. Each public 
entity and LTSS insurance provider shall make 
available to all interested individuals the name, of-
fice address, and telephone number of the employee 
designated pursuant to this paragraph. 
(8) GRIEVANCE PROCEDURES.—The regulations 
issued under this section shall require public entities 
and LTSS insurance providers to adopt and publish 
grievance procedures providing for prompt and equi-
table resolution of complaints alleging a violation of 
this Act. 
(9) PROVISION OF SERVICE BY OTHERS.—The 
regulations issued under this section shall require 
each public entity submitting a self-evaluation under 
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paragraph (5) to identify, as part of the transition 
plan described in paragraph (10), any other entity 
that is, or acts as, an agent, subcontractor, or other 
instrumentality of the public entity with regards to 
a service, support, policy, or practice described in 
such plan or self-evaluation. 
(10) TRANSITION
PLANS.—The regulations 
issued under this section shall require each public 
entity, not later than 42 months after the date of 
enactment of this Act, to submit to the Adminis-
trator and, on approval by the Administrator, begin 
implementing a transition plan for carrying out this 
Act that establishes the achievement of the require-
ments of this Act, as soon as practicable, but in no 
event later than 12 years after the date of enact-
ment of this Act. The transition plan shall— 
(A) establish measurable objectives to ad-
dress the barriers to community living identified 
in the self-evaluation under paragraph (5); 
(B) establish specific annual targets for 
the transition of individuals with LTSS disabil-
ities, and shifts in funding, from institutional 
settings to integrated community-based services 
and supports, and related programs; 
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(C) describe specific efforts to support in-
dividuals with LTSS disabilities to avoid un-
wanted institutionalization through the provi-
sion of LTSS; 
(D) describe the manner in which the pub-
lic entity has obtained or plans to obtain nec-
essary funding and resources needed for imple-
mentation of the plan (regardless of whether 
the entity began carrying out the objectives of 
this Act prior to the date of enactment of this 
Act); and 
(E) describe the steps taken to ensure that 
the transition plan addresses the needs of indi-
viduals from all socio-demographic and geo-
graphic backgrounds. 
(11) ANNUAL REPORTING.— 
(A) IN GENERAL.—The regulations issued 
under this section shall establish annual report-
ing requirements for each public entity covered 
by this section. 
(B) PROGRESS ON OBJECTIVES, TARGETS, 
AND EFFORTS.—The regulations issued under 
this section shall require each public entity that 
has submitted a transition plan, to make pub-
licly available on the entity’s website an annual 
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report on the progress the public entity has 
made during the previous year in meeting the 
measurable objectives, specific annual targets, 
and specific efforts described in paragraph (10). 
(c) REVIEW OF TRANSITION PLANS.— 
(1) GENERAL RULE.—The Administrator shall 
review a transition plan submitted in accordance 
with subsection (b)(10), not later than 90 days after 
receiving the plan, for the purpose of determining 
whether such plan meets the requirements of this 
Act, including the regulations issued under this sec-
tion. 
(2) DISAPPROVAL.—If the Administrator deter-
mines that a transition plan reviewed under this 
subsection fails to meet the requirements of this Act, 
the Administrator shall disapprove the transition 
plan and notify the public entity that submitted the 
transition plan of, and the reasons for, such dis-
approval. 
(3) MODIFICATION OF DISAPPROVED PLAN.— 
Not later than 90 days after the date of disapproval 
of a transition plan under this subsection, the public 
entity that submitted the transition plan shall mod-
ify the transition plan to meet the requirements of 
this section and shall submit the modified plan to 
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the Administrator. Not later than 90 days after re-
ceiving the modified plan, the Administrator shall 
review the plan and, on approval by the Adminis-
trator, the public entity shall begin implementing the 
plan. 
(d) RULE
OF CONSTRUCTION.—Nothing in sub-
section (b)(10) or (c) or any other provision of this Act 
shall be construed to limit the rights, protections, or re-
quirements of any other Federal law, relating to integra-
tion of individuals with disabilities into the community and 
enabling those individuals to live in the most integrated 
setting. 
SEC. 7. EXEMPTIONS FOR RELIGIOUS ORGANIZATIONS. 
This Act shall not prohibit a religious organization, 
association, or society from giving preference in providing 
community-based long-term services and supports to indi-
viduals of a particular religion connected with the beliefs 
of such organization, association, or society. 
SEC. 8. ENFORCEMENT. 
(a) CIVIL ACTION.— 
(1) IN GENERAL.—A civil action for preventive 
relief, including an application for a permanent or 
temporary injunction, restraining order, or other 
order, may be instituted by an individual described 
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in paragraph (2) in an appropriate Federal district 
court. 
(2) AGGRIEVED INDIVIDUAL.— 
(A) IN GENERAL.—The remedies and pro-
cedures set forth in this section are the rem-
edies and procedures this Act provides to any 
individual who is being subjected to a violation 
of this Act, or who has reasonable grounds for 
believing that such individual is about to be 
subjected to such a violation. 
(B) STANDING.—An individual with a dis-
ability shall have standing to institute a civil ac-
tion under this subsection if the individual 
makes a prima facie showing that the indi-
vidual— 
(i) is an individual with an LTSS dis-
ability; and 
(ii) is being subjected to, or about to 
be subjected to, such a violation (including 
a violation of section 4(b)(11)). 
(3) APPOINTMENT
OF
ATTORNEY; NO
FEES, 
COSTS, OR
SECURITY.—Upon application by the 
complainant described in paragraph (2) and in such 
circumstances as the court may determine to be just, 
the court may appoint an attorney for the complain-
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ant and may authorize the commencement of such 
civil action without the payment of fees, costs, or se-
curity. 
(4) FUTILE GESTURE NOT REQUIRED.—Noth-
ing in this section shall require an individual with an 
LTSS disability to engage in a futile gesture if such 
person has actual notice that a public entity or 
LTSS insurance provider does not intend to comply 
with the provisions of this Act. 
(b) DAMAGES
AND INJUNCTIVE RELIEF.—If the 
court finds that a violation of this Act has occurred or 
is about to occur, the court may award to the complain-
ant— 
(1) actual and punitive damages; 
(2) immediate injunctive relief to prevent insti-
tutionalization; 
(3) as the court determines to be appropriate, 
any permanent or temporary injunction (including 
an order to immediately provide or maintain commu-
nity-based long-term services or supports for an in-
dividual to prevent institutionalization or further in-
stitutionalization), temporary restraining order, or 
other order (including an order enjoining the defend-
ant from engaging in a practice that violates this 
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Act or ordering such affirmative action as may be 
appropriate); and 
(4) in an appropriate case, injunctive relief to 
require the modification of a policy, practice, or pro-
cedure, or the provision of an alternative method of 
providing LTSS, to the extent required by this Act. 
(c) ATTORNEY’S
FEES; LIABILITY
OF
UNITED 
STATES FOR COSTS.—In any action commenced pursuant 
to this Act, the court, in its discretion, may allow the party 
bringing a claim or counterclaim under this Act, other 
than the United States, a reasonable attorney’s fee as part 
of the costs, and the United States shall be liable for costs 
to the same extent as a private person. 
(d) ENFORCEMENT BY ATTORNEY GENERAL.— 
(1) DENIAL OF RIGHTS.— 
(A) DUTY TO INVESTIGATE.—The Attor-
ney General shall investigate alleged violations 
of this Act, and shall undertake periodic reviews 
of the compliance of public entities and LTSS 
insurance providers under this Act. 
(B) POTENTIAL
VIOLATION.—The Attor-
ney General may commence a civil action in any 
appropriate Federal district court if the Attor-
ney General has reasonable cause to believe 
that— 
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(i) any public entity or LTSS insur-
ance provider, including a group of public 
entities or LTSS insurance providers, is 
engaged in a pattern or practice of viola-
tions of this Act; or 
(ii) any individual, including a group, 
has been subjected to a violation of this 
Act and the violation raises an issue of 
general public importance. 
(2) AUTHORITY OF COURT.—In a civil action 
under paragraph (1)(B), the court— 
(A) may grant any equitable relief that 
such court considers to be appropriate, includ-
ing, to the extent required by this Act— 
(i) granting temporary, preliminary, 
or permanent relief; and 
(ii) requiring the modification of a 
policy, practice, or procedure, or the provi-
sion of an alternative method of providing 
LTSS; 
(B) may award such other relief as the 
court considers to be appropriate, including 
damages to individuals described in subsection 
(a)(2), when requested by the Attorney General; 
and 
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(C) may, to vindicate the public interest, 
assess a civil penalty against the public entity 
or LTSS insurance provider in an amount— 
(i) not exceeding $100,000 for a first 
violation; and 
(ii) not exceeding $200,000 for any 
subsequent violation. 
(3) SINGLE VIOLATION.—For purposes of para-
graph (2)(C), in determining whether a first or sub-
sequent violation has occurred, a determination in a 
single action, by judgment or settlement, that the 
public entity or LTSS insurance provider has en-
gaged in more than one violation of this Act shall be 
counted as a single violation. 
SEC. 9. CONSTRUCTION. 
For purposes of construing this Act— 
(1) section 4(b)(11) shall be construed in a 
manner that takes into account its similarities with 
section 302(b)(2)(A)(ii) of the Americans with Dis-
abilities Act of 1990 (42 U.S.C. 12182(b)(2)(A)(ii)); 
(2) the first sentence of section 6(b)(5)(A) shall 
be construed in a manner that takes into account its 
similarities with section 35.105(a) of title 28, Code 
of Federal Regulations (as in effect on the day be-
fore the date of enactment of this Act); 
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(3) section 7 shall be construed in a manner 
that takes into account its similarities with section 
807(a) of the Civil Rights Act of 1968 (42 U.S.C. 
3607(a)); 
(4) section 8(a)(2) shall be construed in a man-
ner that takes into account its similarities with sec-
tion 308(a)(1) of the Americans with Disabilities 
Act of 1990 (42 U.S.C. 12188(a)(1)); and 
(5) section 8(d)(1)(B) shall be construed in a 
manner that takes into account its similarities with 
section 308(b)(1)(B) of the Americans with Disabil-
ities Act of 1990 (42 U.S.C. 12188(b)(1)(B)). 
Æ 
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