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 
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 
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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 
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; 
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(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 
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, 
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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-
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; 
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(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-
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). 
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(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— 
(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 
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tellectual, mental, or emotional disabilities, in-
cluding support to— 
(i) help the individual identify and set 
goals, overcome fears, and manage transi-
tions; 
(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). 
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(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 
(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. 
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(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, 
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; 
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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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