II 118th CONGRESS 1st Session S. 2904 IN THE SENATE OF THE UNITED STATES September 21, 2023 Mr. Casey (for himself, Mr. Sanders , Mr. Fetterman , and Mr. Markey ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To support national training, technical assistance, and resource centers, to ensure that all individuals with significant expressive communication disabilities have access to the augmentative and alternative communication the individuals need to interact with others, in order to learn, work, socialize, and take advantage of all aspects of life in the United States.

1. Short title This Act may be cited as the Augmentative and Alternative Communication Centers of Excellence and National Technical Assistance Act or the AACCENT Act . 2. Findings Congress makes the following findings: (1) Communication is a basic human need and fundamental right, and is essential to self-determination, social inclusion, and emotional and physical well-being. In enacting a provision of the Americans with Disabilities Act of 1990 (referred to in this section as the ADA ), Congress recognized that physical or mental disabilities in no way diminish a person’s right to fully participate in all aspects of society, and that the discriminatory effects of communication barriers are a form of discrimination. (2) Three decades after the passage of the ADA, Americans with significant expressive communication disabilities still experience discrimination in the form of communication barriers, institutionalization, segregation, and relegation to lesser services, programs, activities, benefits, jobs, or other opportunities compared to Americans without significant expressive communication disabilities. (3) Data about augmentative and alternative communication is lacking, but it is estimated there are at least 4,000,000 people in the United States who cannot reliably meet their daily communication needs using natural speech. (4) The population of individuals with significant expressive communication difficulties is at substantial risk for limited education, unemployment, poor health outcomes, poverty, and low quality of life. (5) People can acquire a significant expressive communication disability and need augmentative and alternative communication as a result of many health and developmental conditions at all stages of life. (6) Research indicates that individuals who belong to racial or ethnic minority communities face a greater likelihood of being born with or acquiring expressive communication disabilities, as well as added difficulties in obtaining intervention services, including augmentative and alternative communication. (7) Individuals with significant expressive communication disabilities, schools, families, employers, direct support providers, health care providers, the justice system, and the general public need more information about how to effectively deploy, implement, and ensure continued access to robust communication tools, services, and other supports for individuals with significant expressive communication disabilities. (8) The lived experiences and writings of individuals with significant expressive communication disabilities demonstrate the positive impact augmentative and alternative communication has on their lives. These lived experiences and writings also illustrate the harm that results from denying augmentative and alternative communication to those who need it. (9) The leadership of individuals with significant expressive communication disabilities is critical in crafting and implementing effective policies and programs affecting their lives, including policies and programs regarding augmentative and alternative communication. (10) The freedoms of expression, and to be understood, are essential to both democracy and to individual well-being. Individuals with significant expressive communication disabilities must be afforded equal rights, opportunities, strategies, technologies, services, and other supports to effectively express themselves and participate in their communities and in democracy. 3. Purpose The purpose of this Act is to work toward eliminating the continued discrimination, isolation, marginalization, and denial of equal opportunity of individuals with significant expressive communication disabilities by providing for comprehensive national training, technical assistance, and resource centers to improve— (1) access to a full range of augmentative and alternative communication; (2) access to equal opportunity; (3) awareness and implementation of relevant laws, policies, and practices; (4) leadership and self-advocacy skills; (5) capacity, in the case of individuals with significant expressive communication disabilities, educators, professionals, and families; (6) national statistical data; and (7) societal awareness. 4. Definitions In this Act: (1) Advisory council The term advisory council means an 11-person advisory council that— (A) provides guidance, recommendations, and oversight to an eligible entity; (B) is comprised exclusively of individuals with significant expressive communication disabilities who collectively have diverse— (i) educational and professional backgrounds; (ii) racial, ethnic, gender, and linguistic identities; (iii) disabilities, including intellectual disabilities, ages, and geographic locations; (iv) levels of income; and (v) forms of augmentative and alternative communication relied upon; and (C) is subject to each of the following conditions: (i) The initial council members shall be identified in the grant application by the partners of the eligible entity. (ii) Each member of the advisory council shall be appointed for a period of 5 years. (iii) The Chair and Vice Chair of the council shall be selected by the council members at the first meeting and thereafter as the council determines to be appropriate. (iv) The council shall fill any vacancy in accordance with section 7(b)(8)(C). (2) Augmentative and alternative communication The term augmentative and alternative communication means any tool, method, technology, strategy, service, training, coaching, and other support used to supplement or replace speech. (3) Competitive integrated employment The term competitive integrated employment has the meaning given the term in section 7 of the Rehabilitation Act of 1973 ( 29 U.S.C. 705 ). (4) Disability The term disability has the meaning given the term in section 3 of the Americans with Disabilities Act of 1990 ( 42 U.S.C. 12102 ). (5) Eligible entity The term eligible entity means a partnership of at least 2 organizations— (A) for which the controlling partner of the partnership is a nonprofit organization headquartered in the United States that vests power and authority in individuals with significant expressive communication disabilities in terms of management, staffing, decisionmaking, operation, and provision of services; (B) that includes at least one other organization headquartered in the United States that is either an institution of higher education or an association of professional service providers or educators in the field of significant expressive communication disabilities; (C) that has a cross-disability and cross-generational focus; (D) that is advised by an advisory council; (E) that has adopted a mission that values equal opportunity and the fundamental right of communication access, and operating principles that respect the rights of individuals with significant expressive communication disabilities to express themselves in the manner of their choosing; and (F) of which the organizational members, collectively— (i) have knowledge, experience, and capacity in conducting training, technical assistance, or knowledge dissemination related to the priority activities described in section 6; (ii) have experience working directly with individuals with significant expressive communication disabilities in association with— (I) early intervention programs, early childhood programs, elementary or secondary schools, or postsecondary education programs; or (II) 2 or more types of entities from among— (aa) centers for independent living authorized under part C of title VII of the Rehabilitation Act of 1973 ( 29 U.S.C. 796f et seq. ); (bb) home and community-based service providers; (cc) employers; (dd) health care providers; (ee) protection and advocacy organizations; (ff) aging networks; (gg) caregiver organizations; or (hh) State, Tribal, or local government agencies; and (iii) have experience developing and maintaining collaborative working relationships among disability-led advocacy organizations, institutions of higher education, professional associations, or caregiver organizations. (6) Evidence-based The term evidence-based , used with respect to assistance that is knowledge, a resource, training, or technical assistance, means assistance— (A) that demonstrates a rationale based on a high-quality research finding or positive evaluation that such assistance is likely to improve a communication outcome or other relevant outcome; and (B) for which ongoing efforts are made to examine the effects of the assistance. (7) Individual with significant expressive communication disabilities The term individual with significant expressive communication disabilities means an individual of any age— (A) who has 1 or more real or perceived significant expressive communication disabilities and may have other disabilities; and (B) whose disabilities result in the individual's need for, or benefit from, augmentative and alternative communication and other supports to enable the individual to communicate and to aid the individual in participating in 1 or more aspects of life. (8) Institution of higher education The term institution of higher education has the meaning given the term in section 101(a) of the Higher Education Act of 1965 ( 20 U.S.C. 1001(a) ). (9) National resource center The term national resource center means a National Resource Center on Augmentative and Alternative Communication referred to in section 5(a). (10) Secretary The term Secretary means the Secretary of Health and Human Services. (11) Significant expressive communication disability (A) In general The term significant expressive communication disability means any disability, whether congenital, developmental, or acquired at any point in life, that prevents or significantly limits an individual from understanding or being understood using spoken words, resulting in the individual’s need for or benefit from augmentative and alternative communication. (B) Application The term does not apply to an individual whose primary communication disability is visual or auditory in nature, but does apply to an individual with a disability described in subparagraph (A) who also has a visual or auditory communication disability and who may communicate using sign language. (12) State The term State means the 50 States, the District of Columbia, the Commonwealth of Puerto Rico, the United States Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands. 5. Grants (a) In general The Secretary shall award 3 grants through an open competition to eligible entities, with applications approved under section 7, to create, maintain, and administer a network of National Resource Centers on Augmentative and Alternative Communication. Each national resource center shall be a comprehensive training, technical assistance, and resource center created to work toward eliminating the continued discrimination against, isolation of, marginalization of, and denial of effective communication for and equal opportunity of, individuals with significant expressive communication disabilities, through activities including the priority activities described in section 6. (b) Awards for multiple centers The Secretary shall award the grants for national resource centers in 3 geographically diverse locations, and shall designate one of the centers as the lead administrative center. (c) Lead Administrative Center The lead administrative center shall coordinate— (1) all activities of the centers; (2) specialization of priorities among the centers; (3) dissemination of information among the centers; (4) responses of the centers to the Secretary; and (5) ensuring that the full range of individuals with significant expressive communication disabilities is served by the centers. (d) Amount The Secretary shall, to the extent practicable, award the 3 grants in amounts that total not more than $9,000,000 per year of a period described in subsection (e). (e) Periods The Secretary shall award each grant for a period of 5 years, through an open competition held initially and at the end of each 5-year period. An eligible entity that receives a grant under this section may reapply for such a grant at the end of the grant period. 6. National resource center priority activities The priority activities of a national resource center shall be to— (1) increase access to and effective implementation of the full range of augmentative and alternative communication for all individuals with significant expressive communication disabilities in the United States, regardless of age, race, ethnicity, gender, gender identity, LGBTQ+ status, immigration status, educational achievement, socioeconomic condition, primary language, nature or severity of disability, location of residence, and age of onset of the significant expressive communication disability; (2) increase the capacity of individuals with significant expressive communication disabilities, educators, professional service providers, families, and direct support professionals to support individuals with significant expressive communication disabilities by creating and disseminating evidence-based knowledge, resources, training and technical assistance, and recommended practices in ensuring individuals with significant expressive communication disabilities have the tools and other supports necessary to exercise self-determination and effectively access and participate in all aspects of life, including education, employment, health care, and community living; (3) promote awareness and implementation of the laws, regulations, policies, practices, procedures, and systems that facilitate access to the full range of augmentative and alternative communication and promote equal access and opportunity for individuals with significant expressive communication disabilities; (4) support and enhance the skills and leadership of individuals with significant expressive communication disabilities and their families to advocate for the rights of the individuals to effective communication, education, self-determination, access to justice, and equal opportunity and participation in all aspects of life; (5) support the improved collection, availability, and dissemination of demographic and characteristic data, with a cross-disability and cross-generational focus, regarding individuals with significant expressive communication disabilities in the United States, the barriers the individuals experience to meaningful access to augmentative and alternative communication, and the unmet communication support and other needs of this population; and (6) increase societal awareness and knowledge about individuals with significant expressive communication disabilities and the importance of, need for, benefits of, and rights to meaningful access to effective communication tools and other supports in all aspects of community and life. 7. Applications (a) In general To be qualified to receive a grant under section 5, an eligible entity shall submit an application to the Secretary at such time and in such manner as the Secretary may require. (b) Contents Each such application from an eligible entity shall include, at a minimum, each of the following: (1) A description of the experience of each partner organization in the entity in providing training, information, advocacy, and support related to augmentative and alternative communication and individuals with significant expressive communication disabilities. (2) A description of each partner organization’s experience in providing training, information, advocacy, and support related to augmentative and alternative communication and to individuals with significant expressive communication disabilities, to— (A) early intervention specialists; (B) elementary education, secondary education, postsecondary education, and specialized instructional support personnel as defined in section 8101 of the Elementary and Secondary Education Act of 1965 ( 20 U.S.C. 7801 ); (C) caregiver groups; (D) providers of home and community-based services for adults; (E) health care providers and educators; (F) employers; (G) providers of services to older adults; (H) law enforcement agencies, courts, offices of district attorneys, and other public and private security agencies and businesses; (I) institutional long-term care services and support providers; (J) nursing home providers; and (K) other stakeholders. (3) A description of each partner organization’s experience working with State, local, or Tribal government agencies in providing training, information, and support related to augmentative and alternative communication for full expression and individuals with significant expressive communication disabilities. (4) A description of each partner organization’s prior partnerships with disability-led organizations focused on augmentative and alternative communication and individuals with significant expressive communication disabilities. (5) Evidence of how the applicant satisfies the requirements of section 4(5). (6) A description of the applicant’s plan to ensure that the applicant will provide training, technical assistance, and information to target audiences, especially those audiences in need of knowledge and access to augmentative and alternative communication. (7) A description of the applicant’s plan to implement the priority activities in section 6, including how the organizational members of the eligible entity will partner, collaborate, and operationalize the activities. (8) Advisory council information, including— (A) a description of the advisory council, including a list of the inaugural members of the advisory council; (B) an assurance that the Chair and Vice Chair of the advisory council will be selected by the advisory council members at the first meeting of the advisory council and thereafter as the council determines to be appropriate; and (C) an assurance that, in filling a vacancy on the advisory council, the advisory council will— (i) solicit nominations from the population of augmentative and alternative communication users; (ii) if there is not more than 1 nominee for the vacancy, confirm the nominee as a new member; and (iii) if there is more than 1 nominee for the vacancy, vote to determine the nominee to fill the vacancy and subsequently confirm the nominee. (9) A description of how other individuals with significant expressive communication disabilities will be involved in the governance and operations of the national resource center involved, especially through employment of individuals with significant expressive communication disabilities. (10) A description of how the applicant will design and make training, technical assistance, and information available in accessible formats, including plain language. (11) Assurances that the applicant, acting through the national resource center, will work with the stakeholders identified in section 9(d). (12) Assurances that the applicant, acting through the national resource center, will provide the Secretary with requested data and information for purposes of evaluating the grant activities. 8. Award priority In awarding grants for activities described in this Act, the Secretary shall give priority to an eligible entity with at least 1 partner organization that— (1) demonstrates a minimum of 3 years of experience providing training and technical assistance and disseminating information related to augmentative and alternative communication and individuals with significant expressive communication disabilities, and being otherwise engaged in the priority activities described in section 6; (2) demonstrates that individuals with significant expressive communication disabilities and those who use augmentative and alternative communication are purposefully involved in the governance and operation of the organization, especially through their employment in service, delivery, and leadership positions; (3) demonstrates the ability to collaborate with disability self-advocacy, education, direct service, health care, employment, aging, caregiver, and housing organizations, whether the organizations are public agencies or private entities; and (4) demonstrates expertise in promoting accessibility and the use of universal design (the latter as defined in section 103 of the Higher Education Act of 1965 ( 20 U.S.C. 1003 )) in providing training and technical assistance, and information dissemination. 9. Use of funds (a) In general An eligible entity that receives a grant under section 5 shall use the grant funds to manage and carry out each of the priority activities described in section 6, activities described in this section, and any additional activities approved by the Secretary. (b) Coordination with Federal programs The work of a national resource center shall link to current and future policy and activities undertaken throughout the Federal Government in relation to self-advocacy, supported decisionmaking, person-centered planning, community living, and competitive integrated employment for individuals with disabilities and particularly for individuals with the most significant expressive communication disabilities, for the purpose of increasing— (1) success and self-determination in life; (2) the provision of inclusive early intervention services, elementary education, secondary education, and postsecondary education programs; (3) competitive integrated employment; (4) health, wellness, and personal safety; (5) economic security; (6) civic engagement; (7) community integration; and (8) improvement in other aspects of life. (c) Information dissemination Notwithstanding the priority activities described in section 6, a national resource center shall ensure information and other resources about augmentative and alternative communication and individuals with significant expressive communication disabilities are made available as appropriate to— (1) individuals with significant expressive communication disabilities and their families; (2) institutions of higher education; (3) State, Tribal, and local educational agencies; (4) law enforcement agencies, courts, offices of district attorneys, and other public and private security agencies and businesses; (5) national, State, regional, Tribal, and local employers, to enable businesses to hire into competitive integrated employment more individuals who use augmentative and alternative communication; (6) national, State, Tribal, and local government agencies that provide services and other supports to individuals with significant expressive communication disabilities, including agencies responsible for emergency preparedness, employment support, and vocational rehabilitation, agencies responsible for State programs under the Assistive Technology Act of 1988 ( 29 U.S.C. 3001 et seq. ), agencies responsible for State alternative financing programs, State agencies responsible for the Medicaid program under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ), and the agencies overseeing the provision of home and community-based services; (7) national and local disability and aging advocacy organizations, including disability self-advocacy organizations; (8) family support organizations, including the parent training and information centers supported under section 671 of the Individuals with Disabilities Education Act ( 20 U.S.C. 1471 ); (9) centers for independent living and Statewide Independent Living Councils authorized by title VII of the Rehabilitation Act of 1973 ( 29 U.S.C. 796 et seq. ); (10) network partners, including the State Councils on Developmental Disabilities described in section 125 of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 ( 42 U.S.C. 15025 ), the protection and advocacy systems described in section 143 of that Act ( 42 U.S.C. 15043 ), and University Centers for Excellence in Developmental Disabilities Education, Research, and Services supported under subtitle D of title I of that Act ( 42 U.S.C. 15061 et seq. ), participating in activities under that Act ( 42 U.S.C. 15001 et seq. ); (11) State agencies and area agencies on aging, entities carrying out long-term care ombudsman programs, and other entities funded under the Older Americans Act of 1965 ( 42 U.S.C. 3001 et seq. ); (12) health care providers and educators, health care advocacy organizations, nursing home providers, and institutional long-term care facilities; (13) professional organizations and organizations that certify preservice training programs; and (14) other groups and entities as identified by the eligible entity and the advisory council of the eligible entity. (d) Stakeholder collaboration A national resource center shall collaborate with— (1) organizations of individuals with significant expressive communication disabilities; (2) disability organizations; (3) entities carrying out State assistive technology programs and State alternative financing programs; (4) State, Tribal, and local educational agencies; (5) the councils, systems, and university centers described in subsection (c)(10); (6) entities carrying out national, State, Tribal and Native Hawaiian, and local programs authorized by the Older Americans Act of 1965; (7) the federally funded Rehabilitation Engineering Research Center on Augmentative and Alternative Communication; (8) State agencies responsible for vocational rehabilitation programs, as defined in section 3 of the Workforce Innovation and Opportunity Act ( 29 U.S.C. 3102 ); (9) professional associations whose members come in contact with and support individuals who may use augmentative and alternative communication; (10) local boards, as defined in section 3 of the Workforce Innovation and Opportunity Act ( 29 U.S.C. 3102 ); and (11) other State, regional, Tribal, and local entities with the ability to provide support for individuals who need and use augmentative and alternative communication. (e) Limitation A national resource center that receives grant funds under section 5 for a fiscal year shall use not more than 15 percent of the funds for the administrative costs of carrying out activities under this Act. 10. Annual report (a) Preparation The lead administrative center referred to in section 5(b), in coordination with the other national resource centers that receive grant funds under section 5, shall annually prepare a report containing, consistent with criteria established by the Secretary, information on— (1) activities conducted by each national resource center funded under section 5 to achieve the purpose of this Act; (2) collaboration by each such national resource center with other entities to achieve the purposes of this Act; (3) barriers to and strategies for equitable access to augmentative and alternative communication and other supports for individuals who belong to racial, ethnic, and linguistic minority communities and face a greater likelihood of being born with or acquiring significant expressive communication disabilities as well as added difficulties in obtaining effective augmentative and alternative communication; (4) identified gaps in available demographic and characteristic data on individuals with significant expressive communication disabilities in the United States; and (5) the unmet needs of individuals with significant expressive communication disabilities, from diverse backgrounds, in the United States and policy recommendations to address such unmet needs. (b) Submission The lead administrative center shall submit the report to— (1) the Secretary; (2) the Secretary of Education; (3) the relevant subcommittees of the Committee on Health, Education, Labor, and Pensions of the Senate, the Special Committee on Aging of the Senate, and the Committee on Education and the Workforce of the House of Representatives; and (4) the Subcommittee on Labor, Health and Human Services, Education, and Related Agencies of the Committee on Appropriations of the Senate, and the Subcommittee on Labor, Health and Human Services, Education, and Related Agencies of the Committee on Appropriations of the House of Representatives. 11. Authorization of appropriations There is authorized to be appropriated to carry out this Act $9,000,000 for each of fiscal years 2024 through 2028.