(6) Thirty-eight studies published from 2005 to 
2012 concluded that providing services in home and 
community-based settings is less costly than pro-
viding care in a nursing home or other institutional 
setting. 
(7) No clear or centralized reporting system ex-
ists to compare how effectively States are meeting 
the Olmstead mandate. 
SEC. 3. ENSURING MEDICAID BENEFICIARIES MAY ELECT 
TO RECEIVE CARE IN A HOME AND COMMU-
NITY-BASED SETTING. 
(a) IN GENERAL.—Section 1902(a) of the Social Se-
curity Act (42 U.S.C. 1396a(a)) is amended— 
(1) in paragraph (85), by striking ‘‘and’’ at the 
end; 
(2) in paragraph (86), by striking the period 
and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (86) the fol-
lowing new paragraph: 
‘‘(87) in the case of any individual with respect 
to whom there has been a determination that the in-
dividual requires the level of care provided in a nurs-
ing facility, an intermediate care facility for the 
mentally retarded, an institution for mental diseases, 
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pbinns on DSKJLVW7X2PROD with BILLS
or any other similarly restrictive or institutional set-
ting— 
‘‘(A) provide the individual with the choice 
and opportunity to receive such care in a home 
and community-based setting, including reha-
bilitative services, assistance and support in ac-
complishing activities of daily living, instru-
mental activities of daily living, and health-re-
lated tasks, and assistance in acquiring, main-
taining, or enhancing skills necessary to accom-
plish such activities, tasks, or services; 
‘‘(B) ensure that each such individual has 
an equal opportunity (when compared to the re-
ceipt and availability of nursing facility serv-
ices) to receive care in a home and community- 
based setting, if the individual so chooses, by 
ensuring that the provision of such care in a 
home and community-based setting is widely 
available on a statewide basis for all such indi-
viduals within the State; and 
‘‘(C) meet the requirements of section 
1904A (relating to the provision of care in a 
home and community-based setting).’’. 
(b) REQUIREMENTS
FOR COMMUNITY CARE OP-
TIONS.—Title XIX of the Social Security Act is amended 
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by inserting after section 1904 (42 U.S.C. 1396c) the fol-
lowing new section: 
‘‘PROVISIONS RELATED TO HOME AND COMMUNITY- 
BASED CARE 
‘‘SEC. 1904A. (a) DEFINITIONS.—For purposes of 
this 
section, 
section 
1902(a)(87), 
and 
section 
1905(a)(4)(A): 
‘‘(1) ACTIVITIES OF DAILY LIVING.—The term 
‘activities of daily living’ includes, but is not limited 
to, tasks such as eating, toileting, grooming, dress-
ing, bathing, and transferring. 
‘‘(2) HEALTH-RELATED
TASKS.—The term 
‘health-related tasks’ means specific tasks related to 
the needs of an individual, including, but not limited 
to, bowel or bladder care, wound care, use and care 
of ventilators and feeding tubes, and the administra-
tion of medications and injections, which, in the 
opinion of the individual’s physician, can be dele-
gated to be performed by an attendant. 
‘‘(3) HOME
AND
COMMUNITY-BASED
SET-
TING.—The term ‘home and community-based set-
ting’ means, with respect to an individual who re-
quires a level of care provided in a nursing facility, 
an intermediate care facility for the mentally re-
tarded, an institution for mental diseases, or any 
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other similarly restrictive or institutional setting, a 
setting that— 
‘‘(A) includes a house, an apartment, a 
townhouse, a condominium, or any similar pub-
lic or private housing where the individual re-
sides that— 
‘‘(i) is owned or leased by the indi-
vidual or a member of the individual’s fam-
ily; 
‘‘(ii) ensures the individual’s privacy, 
dignity, respect, and freedom from coer-
cion; and 
‘‘(iii) maximizes the individual’s au-
tonomy and independence; 
‘‘(B) is integrated in, and provides access 
to, the general community in which the setting 
is located so that the individual has access to 
the community and opportunities to seek em-
ployment and work in competitive integrated 
settings, participate in community life, control 
and utilize personal resources, benefit from 
community services, and participate in the com-
munity in an overall manner that is comparable 
to that available to individuals who are not indi-
viduals with disabilities; and 
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‘‘(C) has the services and supports that the 
individual needs in order to live as independ-
ently as possible. 
‘‘(4) INSTRUMENTAL ACTIVITIES OF DAILY LIV-
ING.—The term ‘instrumental activities of daily liv-
ing’ means activities related to living independently 
in the community and includes, but is not limited to, 
meal planning and preparation, managing finances, 
shopping for food, clothing, and other items, per-
forming household chores, communicating by phone 
or other media, and traveling around and partici-
pating in the community. 
‘‘(5) PUBLIC ENTITY.—The term ‘public entity’ 
means a public entity as defined in subparagraphs 
(A) and (B) of section 201(1) of the Americans with 
Disabilities Act of 1990. 
‘‘(b) REQUIREMENTS FOR PROVIDING SERVICES IN 
HOME AND COMMUNITY-BASED SETTINGS.—With respect 
to the availability and provision of services under the State 
plan under this title, or under any waiver of State plan 
requirements (subject to section 3(d) of the Community 
Integration Act of 2020), in a home and community-based 
setting to any individual who requires a level of care pro-
vided in a nursing facility, an intermediate care facility 
for the mentally retarded, an institution for mental dis-
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