plan, the Secretary shall make the increase de-
scribed in subparagraph (B). 
(B) INCREASE IN FMAP.—On making the 
determination described in subparagraph (A) 
for a public entity (including a State), the Sec-
retary of Health and Human Services shall, as 
described in subparagraph (C), increase by 5 
percentage points the FMAP for the State in 
which the public entity is located for amounts 
expended by the State for medical assistance 
consisting of home and community-based serv-
ices furnished under the State Medicaid plan 
under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) or a waiver of such plan— 
(i) that— 
(I) are identified by a public enti-
ty or LTSS insurance provider under 
subsection (b)(5)(A)(iii); 
(II) resulted from shifts in fund-
ing identified by a public entity under 
subsection (b)(10)(B); or 
(III) are environmental modifica-
tions to achieve the affordable, acces-
sible, integrated housing identified by 
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a public entity under subsection 
(b)(6)(E); and 
(ii) are described by the State in a re-
quest to the Secretary of Health and 
Human Services for the increase. 
(C) PERIOD OF INCREASE.—The Secretary 
of Health and Human Services shall increase 
the FMAP described in subparagraph (B)— 
(i) beginning with the first quarter 
that begins after the date of the deter-
mination; and 
(ii) ending with the quarter in which 
the next annual determination under sub-
paragraph (A) occurs. 
(D) DEFINITIONS.—In this paragraph: 
(i) 
FMAP.—The 
term 
‘‘FMAP’’ 
means the Federal medical assistance per-
centage for a State determined under sec-
tion 1905(b) of the Social Security Act (42 
U.S.C. 1396d(b)) without regard to any in-
creases in that percentage applicable under 
other subsections of that section or any 
other provision of law, including this sec-
tion. 
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(ii) HOME
AND
COMMUNITY-BASED 
SERVICES DEFINED.—The term ‘‘home and 
community-based services’’ means any of 
the following services provided under a 
State Medicaid plan under title XIX of the 
Social Security Act (42 U.S.C. 1396 et 
seq.) or a waiver of such plan: 
(I) Home and community-based 
services provided under subsection (c), 
(d), or (i) of section 1915 of the So-
cial Security Act (42 U.S.C. 1396n). 
(II) Home health care services. 
(III) Personal care services. 
(IV) Services described in section 
1905(a)(26) of the Social Security Act 
(42 U.S.C. 1396d(a)(26)) (relating to 
PACE program services). 
(V) Self-directed personal assist-
ance services provided in accordance 
with section 1915(j) of the Social Se-
curity Act (42 U.S.C. 1396n(j)). 
(VI) Community-based attendant 
services and supports provided in ac-
cordance with section 1915(k) of the 
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Social 
Security 
Act 
(42 
U.S.C. 
1396n(k)). 
(VII) 
Rehabilitative 
services, 
within 
the 
meaning 
of 
section 
1905(a)(13) of the Social Security Act 
(42 U.S.C. 1396d(a)(13)). 
(d) RULE
OF CONSTRUCTION.—Nothing in sub-
section (b)(10) or (c) or any other provision of this Act 
shall be construed to modify the requirements of any other 
Federal law, relating to integration of individuals with dis-
abilities 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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