[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 117 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  1st Session
                                 S. 117

 To prohibit discrimination against individuals with disabilities who 
     need long-term services and supports, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            January 15, 2019

  Mr. Schumer (for himself, Mr. Gardner, Ms. Baldwin, Mr. Bennet, Mr. 
  Blumenthal, Ms. Cantwell, Mr. Casey, Mr. Coons, Ms. Duckworth, Mrs. 
 Gillibrand, Ms. Harris, Ms. Hassan, Mr. Jones, Mr. Leahy, Mr. Markey, 
 Mrs. Murray, Mr. Van Hollen, Ms. Warren, Mr. Tester, Mr. Sanders, Mr. 
    Durbin, Mr. Booker, Mr. Merkley, and Ms. Smith) introduced the 
 following bill; which was read twice and referred to the Committee on 
                 Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
 To prohibit discrimination against individuals with disabilities who 
     need long-term services and supports, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Disability Integration Act of 
2019''.

SEC. 2. FINDINGS AND PURPOSES.

    (a) Findings.--Congress finds the following:
            (1) In enacting the Americans with Disabilities Act of 1990 
        (referred to in this Act as the ``ADA''), Congress--
                    (A) recognized that ``historically, society has 
                tended to isolate and segregate individuals with 
                disabilities, and, despite some improvements, such 
                forms of discrimination against individuals with 
                disabilities continue to be a serious and pervasive 
                social problem''; and
                    (B) intended that the ADA assure ``full 
                participation'' and ``independent living'' for 
                individuals with disabilities by addressing 
                ``discrimination against individuals with disabilities 
                [that] persists in critical areas'', including 
                institutionalization.
            (2) While Congress expected that the ADA's integration 
        mandate would be interpreted in a manner that ensures that 
        individuals who are eligible for institutional placement are 
        able to exercise a right to community-based long-term services 
        and supports, that expectation has not been fulfilled.
            (3) The holdings of the Supreme Court in Olmstead v. L.C., 
        527 U.S. 581 (1999), and companion cases, have clearly 
        articulated that individuals with disabilities have a civil 
        right under the ADA to participate in society as equal 
        citizens. However, many States still do not provide sufficient 
        community-based long-term services and supports to individuals 
        with disabilities to end segregation in institutions.
            (4) The right to live in the community is necessary for the 
        exercise of the civil rights that the ADA was intended to 
        secure for all individuals with disabilities. The lack of 
        adequate community-based services and supports has imperiled 
        the civil rights of all individuals with disabilities, and has 
        undermined the very promise of the ADA. It is, therefore, 
        necessary to recognize in statute a robust and fully 
        articulated right to community living.
            (5) States, with a few exceptions, continue to approach 
        decisions regarding long-term services and supports from social 
        welfare and budgetary perspectives, but for the promise of the 
        ADA to be fully realized, States must approach these decisions 
        from a civil rights perspective.
            (6) States have not consistently planned to ensure 
        sufficient services and supports for individuals with 
        disabilities, including those with the most significant 
        disabilities, to enable individuals with disabilities to live 
        in the most integrated setting. As a result, many individuals 
        with disabilities who reside in institutions are prevented from 
        residing in the community and individuals with disabilities who 
        are not in institutions find themselves at risk of 
        institutional placement.
            (7) The continuing existence of unfair and unnecessary 
        institutionalization denies individuals with disabilities the 
        opportunity to live and participate on an equal basis in the 
        community and costs the United States billions of dollars in 
        unnecessary spending related to perpetuating dependency and 
        unnecessary confinement.
    (b) Purposes.--The purposes of this Act are--
            (1) to clarify and strengthen the ADA's integration mandate 
        in a manner that accelerates State compliance;
            (2) to clarify that every individual who is eligible for 
        long-term services and supports has a federally protected right 
        to be meaningfully integrated into that individual's community 
        and receive community-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 
        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 institutions and into the most 
        integrated setting; and
            (5) to establish a requirement for clear and uniform annual 
        public reporting by States that includes reporting about--
                    (A) the number of individuals with disabilities who 
                are served in the community and the number who are 
                served in institutions; and
                    (B) the number of individuals with disabilities who 
                have transitioned from an institution to a community-
                based living situation, and the 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 ``Administrator'' means--
                    (A) the Administrator of the Administration for 
                Community Living; or
                    (B) another designee of the Secretary of Health and 
                Human Services.
            (3) Community-based.--The term ``community-based'', when 
        used in reference to services or supports, means services or 
        supports that are provided to an individual with an LTSS 
        disability to enable that individual to live in the community 
        and lead an independent life, and that are delivered in 
        whichever setting the individual with an LTSS disability has 
        chosen out of the following settings with the following 
        qualities:
                    (A) In the case of a dwelling or a nonresidential 
                setting (such as a setting in which an 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 individual 
                        with an LTSS disability who receives services 
                        or supports at the setting--
                                    (I) full access to the greater 
                                community (including access to 
                                opportunities to seek employment and 
                                work in competitive integrated 
                                settings, engage in community life, 
                                control personal resources, and receive 
                                services in the community); and
                                    (II) access to the greater 
                                community to the same extent as access 
                                to the community is enjoyed by an 
                                individual who is not receiving long-
                                term services or supports;
                            (ii) that the individual has selected as a 
                        meaningful choice from among nonresidential 
                        setting options, including nondisability-
                        specific settings;
                            (iii) in which an individual has rights to 
                        privacy, dignity, and respect, and freedom from 
                        coercion and restraint;
                            (iv) that, as a matter of infrastructure, 
                        environment, amenities, location, services, and 
                        features, optimizes, but does not regiment, 
                        individual initiative, autonomy, and 
                        independence in making life choices, including 
                        choices about daily activities, 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 family 
                        member;
                            (ii) that is leased to the individual with 
                        an LTSS disability under an individual 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 residence--
                                    (I) in which no more than 4 
                                unrelated individuals with an LTSS 
                                disability 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 
                                responsibilities 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 
                                        individual'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 within the 
                                        residence;
                                            (cc) has the freedom to 
                                        furnish and decorate the 
                                        individual's sleeping or living 
                                        unit as permitted under the 
                                        lease or other agreement;
                                            (dd) has the freedom and 
                                        support to control the 
                                        individual's own schedules and 
                                        activities; 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 
                                disability 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).
            (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 section 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 
                        living;
                            (iii) health-related tasks; or
                            (iv) other functions, tasks, or activities 
                        related to an activity or task described in 
                        clause (i), (ii), or (iii); and
                    (B)(i) is currently in an institutional placement; 
                or
                    (ii) is at risk of institutionalization if the 
                individual does not receive community-based long-term 
                services and supports.
            (8) Instrumental activities of daily living.--
                    (A) In general.--The term ``instrumental activities 
                of daily living'' means one or more activities related 
                to living independently in the community, including 
                activities related to--
                            (i) nutrition, such as preparing meals or 
                        special diets, monitoring to prevent choking or 
                        aspiration, or assisting with special utensils;
                            (ii) household chores and environmental 
                        maintenance tasks;
                            (iii) communication and interpersonal 
                        skills, such as--
                                    (I) using the telephone or other 
                                communications devices;
                                    (II) forming and maintaining 
                                interpersonal relationships; or
                                    (III) securing opportunities to 
                                participate in group support or peer-
                                to-peer support arrangements;
                            (iv) travel and community participation, 
                        such as shopping, arranging appointments, or 
                        moving around the community;
                            (v) care of others, such as raising 
                        children, taking care of pets, or selecting 
                        caregivers; or
                            (vi) 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 immediate response.
                    (B) Assistance.--The term ``assistance'' used with 
                respect to instrumental activities of daily living, 
                includes support provided to an individual by another 
                person due to confusion, dementia, behavioral symptoms, 
                or cognitive, intellectual, mental, or emotional 
                disabilities, including support to--
                            (i) help the individual identify and set 
                        goals, overcome fears, and manage transitions;
                            (ii) help the individual with executive 
                        functioning, decisionmaking, and problem 
                        solving;
                            (iii) provide reassurance to the 
                        individual; and
                            (iv) help the individual with orientation, 
                        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 related 
                to an activity or task described in subparagraph (A), 
                (B), or (C).
            (10) LTSS insurance provider.--The term ``LTSS insurance 
        provider'' means a public or private entity that--
                    (A) provides funds for long-term services and 
                supports; and
                    (B) is engaged in commerce or in an industry or 
                activity affecting commerce.
            (11) Public entity.--
                    (A) In general.--The term ``public entity'' means 
                an entity that--
                            (i) provides or funds institutional 
                        placements for individuals with LTSS 
                        disabilities; and
                            (ii) is--
                                    (I) a State or local government; or
                                    (II) any department, agency, entity 
                                administering a special purpose 
                                district, or other instrumentality, of 
                                a State or local government.
                    (B) Interstate commerce.--For purposes of 
                subparagraph (A), a public entity shall be considered 
                to be a person engaged in commerce or in an industry or 
                activity affecting commerce.
    (b) Rule of Construction.--Nothing in subsection (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 insurance provider shall 
deny an individual with an LTSS disability who is eligible for 
institutional placement, or otherwise 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;
            (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 community-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 disability, or any class of 
        individuals with LTSS disabilities, to live in the community 
        and lead an independent life, which may include a requirement 
        that an individual with an LTSS disability receive a service or 
        support (such as day services or employment services) in a 
        congregate or disability-specific setting;
            (5) the imposition or application of a waiting list or 
        other mechanism that delays or restricts access of an 
        individual with an LTSS disability to a community-based long-
        term service or support;
            (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 services 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 informal support, that 
        restricts, limits, or delays the ability of an individual with 
        an LTSS disability to secure a community-based long-term 
        service or support 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 institutionalization; and
                    (B) if selected by an individual with an LTSS 
                disability, the community-based long-term services and 
                supports described in subparagraph (A) are provided;
            (10) a failure to ensure that each institutionalized 
        individual with an LTSS disability is regularly notified of the 
        alternative of community-based long-term services and supports 
        and that those community-based long-term services and supports 
        are provided if the individual with an LTSS disability selects 
        such services and supports; and
            (11) a failure to make a reasonable modification 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 failure to ensure 
that there is sufficient availability of affordable, accessible, and 
integrated housing to allow an individual 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 receipt of 
LTSS is not tied to tenancy.
    (d) Construction.--Nothing in this section--
            (1) shall be construed--
                    (A) to prevent a public entity or LTSS insurance 
                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; or
                    (B) to limit the rights of an individual with a 
                disability under any provision of law other than this 
                section;
            (2) shall be construed to affect the scope of obligations 
        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 techniques 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.--
            (1) Department of justice.--The Attorney General shall--
                    (A) investigate and take enforcement action for 
                violations of this Act; and
                    (B) enforce section 6(c).
            (2) Department of health and human services.--The Secretary 
        of Health and Human Services, through the Administrator, 
        shall--
                    (A) conduct studies regarding the nature and extent 
                of institutionalization of individuals with LTSS 
                disabilities in representative communities, including 
                urban, suburban, and rural communities, throughout the 
                United States;
                    (B) publish and disseminate reports, 
                recommendations, and information derived from such 
                studies, including an annual report to Congress, 
                specifying--
                            (i) the nature and extent of progress in 
                        the United States in eliminating 
                        institutionalization for individuals with LTSS 
                        disabilities in violation of this Act and 
                        furthering the purposes of this Act;
                            (ii) obstacles that remain in the effort to 
                        achieve the provision of community-based long-
                        term services and supports for all individuals 
                        with LTSS disabilities; and
                            (iii) recommendations for further 
                        legislative or executive action;
                    (C) cooperate with, and provide grants for 
                technical assistance to, Federal, State, and local 
                public or private agencies and organizations that are 
                formulating or carrying out programs to prevent or 
                eliminate institutionalization of individuals with LTSS 
                disabilities or to promote the provision of community-
                based long-term services and supports;
                    (D) implement educational and conciliatory 
                activities to further the purposes of this Act; and
                    (E) 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 
alternatives 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 individuals with LTSS disabilities 
in accordance with this Act and shall cooperate with the Attorney 
General and the Administrator to further the purposes of this Act.

SEC. 6. REGULATIONS.

    (a) Issuance of Regulations.--Not later than 24 months after the 
date of enactment of this Act, the Attorney General and the Secretary 
of Health and Human Services shall issue, in accordance with section 
553 of title 5, United States Code, final regulations to carry out this 
Act, which shall include the regulations described in subsection (b).
    (b) Required Contents of Regulations.--
            (1) Eligible recipients of service.--The regulations shall 
        require each public entity and LTSS insurance 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 institutional placement provided or funded by the public 
        entity or LTSS insurance provider.
            (2) Services to be provided.--The regulations issued under 
        this section shall require each public entity and LTSS 
        insurance provider to provide the Attorney General and 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 monitoring, including 
                access to backup systems, with--
                            (i) activities of daily living;
                            (ii) instrumental activities of daily 
                        living;
                            (iii) health-related tasks; or
                            (iv) other functions, tasks, or activities 
                        related to an activity or task described in 
                        clause (i), (ii), or (iii);
                    (B) coordinates, conducts, performs, provides, or 
                funds discharge planning from acute, rehabilitation, 
                and long-term facilities to promote individuals with 
                LTSS disabilities living in the most integrated setting 
                chosen by the individuals;
                    (C) issues, conducts, performs, provides, or funds 
                policies and programs to promote self-direction and the 
                provision of consumer-directed services and supports 
                for all populations of individuals with LTSS 
                disabilities served;
                    (D) issues, conducts, performs, provides, or funds 
                policies and programs to support informal caregivers 
                who provide services for individuals with LTSS 
                disabilities; and
                    (E) ensures that individuals with all types of LTSS 
                disabilities are able to live in the community and lead 
                an independent life, including ensuring that the 
                individuals have maximum control over the services and 
                supports that the individuals receive, choose the 
                setting in which the individuals receive those services 
                and supports, and exercise control and direction over 
                their own lives.
            (3) Public participation.--
                    (A) Public entity.--The regulations issued under 
                this section shall require each public entity to carry 
                out an extensive 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 require each LTSS 
                insurance provider to carry out a public participation 
                process that involves holding a public hearing, 
                providing an opportunity 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 provider shall ensure 
                that the process meets the requirements 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 establish 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 subsection.
            (5) Self-evaluation.--
                    (A) In general.--The regulations issued under this 
                section shall require each public entity 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 
                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 provider;
                            (ii) a review of community capacity, in 
                        communities served by the entity or provider, 
                        in providing community-based long-term services 
                        and supports;
                            (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 disabilities 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 high-quality 
                        services and supports, which may include 
                        identifying system improvements that create an 
                        option to self-direct receipt of such services 
                        and supports for all populations of such 
                        individuals 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 individuals reasonable and timely 
                        access to community-based long-term services 
                        and supports.
                    (B) Public entity.--A public entity, including an 
                LTSS insurance provider that is a public entity, 
                shall--
                            (i) include in the self-evaluation 
                        described in subparagraph (A)--
                                    (I) an assessment of the 
                                availability of accessible, affordable 
                                transportation 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 
                                availability of integrated employment 
                                opportunities in the jurisdiction 
                                served by the public entity for 
                                individuals with LTSS disabilities; and
                            (ii) provide the self-evaluation described 
                        in subparagraph (A) to the Attorney General and 
                        the Administrator.
                    (C) LTSS insurance provider.--An LTSS insurance 
                provider shall keep the self-evaluation described in 
                subparagraph (A) on file, and may be required to 
                produce such self-evaluation in the event of a review, 
                investigation, or action described in section 8.
            (6) Additional requirement for public entities.--The 
        regulations issued under this section shall require a public 
        entity, in conjunction with the housing agencies serving the 
        jurisdiction served by the public entity, to review and improve 
        community capacity, in all communities throughout the entirety 
        of that jurisdiction, in providing affordable, accessible, and 
        integrated housing, including an evaluation 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 Administrator and the 
                Attorney General that there is, sufficient availability 
                of affordable, accessible, and integrated housing in a 
                setting that is not a disability-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;
                    (B) in order to address the need for affordable, 
                accessible, and integrated housing--
                            (i) in the case of such a housing agency, 
                        establish relationships with State and local 
                        housing authorities; and
                            (ii) in the case of the public entity, 
                        establish relationships with State and local 
                        housing agencies, including housing 
                        authorities;
                    (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 Administrator and the 
                Attorney General, that funds and programs implemented 
                or overseen by the public entity or in the public 
                entity's jurisdiction are targeted toward affordable, 
                accessible, integrated housing for individuals with an 
                LTSS disability who have the lowest income levels in 
                the jurisdiction as a priority over any other 
                development until capacity barriers for such housing 
                are removed or unmet needs for such housing have been 
                met.
            (7) Designation of responsible employee.--The regulations 
        issued under this section shall require each public entity and 
        LTSS insurance provider to designate at least one employee to 
        coordinate the entity's or provider's efforts to comply with 
        and carry out the entity or provider's responsibilities under 
        this Act, including the investigation of any complaint 
        communicated to the entity or provider that alleges a violation 
        of this Act. Each public entity and LTSS insurance provider 
        shall make available to all interested individuals the name, 
        office 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 equitable 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 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 Administrator, and begin implementing, a transition plan 
        for carrying out this Act that establishes the achievement of 
        the requirements of this Act, as soon as practicable, but in no 
        event later than 12 years after the date of enactment of this 
        Act. The transition plan shall--
                    (A) establish measurable objectives to address 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 disabilities, and 
                shifts in funding, from institutional settings to 
                integrated community-based services and supports, and 
                related programs;
                    (C) describe specific efforts to support 
                individuals with LTSS disabilities to avoid unwanted 
                institutionalization through the provision of LTSS; and
                    (D) describe the manner in which the public entity 
                has obtained or plans to obtain necessary funding and 
                resources needed for implementation 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).
            (11) Annual reporting.--
                    (A) In general.--The regulations issued under this 
                section shall establish annual reporting 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 submit to the Administrator an annual 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).
            (12) Other provisions.--The regulations issued under this 
        section shall include such other provisions and requirements as 
        the Attorney General and the Secretary of Health and Human 
        Services determine are necessary to carry out the objectives of 
        this Act.
    (c) Review of Transition Plans.--
            (1) General rule.--The Administrator shall review a 
        transition plan submitted in accordance with subsection (b)(10) 
        for the purpose of determining whether such plan meets the 
        requirements of this Act, including the regulations issued 
        under this section.
            (2) Disapproval.--If the Administrator determines 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 disapproval.
            (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 modify the transition plan to meet the 
        requirements of this section and shall submit to the 
        Administrator, and commence implementation of, such modified 
        transition plan.
            (4) Incentives.--
                    (A) Determination.--For 10 years after the issuance 
                of the regulations described in subsection (a), the 
                Secretary of Health and Human Services shall annually 
                determine whether each State, or each other public 
                entity in the State, is complying with the transition 
                plan or modified transition plan the State or other 
                public entity submitted, and obtained approval for, 
                under this section. Notwithstanding any other provision 
                of law, if the Secretary of Health and Human Services 
                determines under this subparagraph that the State or 
                other public entity is complying with the corresponding 
                transition plan, the Secretary shall make the increase 
                described in subparagraph (B).
                    (B) Increase in fmap.--On making the determination 
                described in subparagraph (A) for a public entity 
                (including a State), the Secretary of Health and Human 
                Services shall, as described in subparagraph (C), 
                increase by 5 percentage points the FMAP (but shall in 
                no event increase the FMAP above 100 percent) 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 services 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 
                                entity or LTSS insurance provider under 
                                subsection (b)(5)(A)(iii);
                                    (II) resulted from shifts in 
                                funding identified by a public entity 
                                under subsection (b)(10)(B); or
                                    (III) are environmental 
                                modifications to achieve the 
                                affordable, accessible, integrated 
                                housing identified by a public entity 
                                under subsection (b)(6)(E); and
                            (ii) are described by the State in a 
                        request 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 determination; and
                            (ii) ending with the quarter in which the 
                        next annual determination under subparagraph 
                        (A) occurs.
                    (D) Additional condition for payment.--
                            (i) State report.--As a condition for the 
                        receipt of a payment based on an increase 
                        described in subparagraph (B) with respect to 
                        amounts to be expended by the State for medical 
                        assistance consisting of home and community-
                        based services described in subparagraph (B), 
                        the State shall report to the Secretary, for 
                        the reporting year, the amount of funds 
                        expended by the State for home and community-
                        based services (as defined in subparagraph 
                        (E)(ii)) in that year. The State shall make the 
                        report in a format developed or approved by the 
                        Secretary.
                            (ii) Reduction in payment if failure to 
                        maintain effort.--If the amount reported under 
                        clause (i) by a State with respect to a 
                        reporting year is less than the amount reported 
                        under clause (i) with respect to the previous 
                        fiscal year or fiscal year 2019, whichever was 
                        the greater reported amount, the Secretary 
                        shall provide for a reduction in the payment to 
                        the State based on the increase.
                    (E) Definitions.--In this paragraph:
                            (i) FMAP.--The term ``FMAP'' means the 
                        Federal medical assistance percentage for a 
                        State determined under section 1905(b) of the 
                        Social Security Act (42 U.S.C. 1396d(b)) 
                        without regard to any increases in that 
                        percentage applicable under other subsections 
                        of that section or any other provision of law, 
                        including this section.
                            (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 
                                Social 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 
                                assistance services provided in 
                                accordance with section 1915(j) of the 
                                Social Security Act (42 U.S.C. 
                                1396n(j)).
                                    (VI) Community-based attendant 
                                services and supports provided in 
                                accordance with section 1915(k) of the 
                                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)).
                            (iii) Reporting year.--The term ``reporting 
                        year'' means the most recent fiscal year 
                        preceding the date of a report under 
                        subparagraph (D)(i).
    (d) Rule of Construction.--Nothing in subsection (b)(10) or (c) or 
any other provision of this Act shall be construed to limit the rights, 
protections, or requirements of any other Federal law, relating to 
integration 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 individuals 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 in paragraph (2) in an 
        appropriate Federal district court.
            (2) Aggrieved individual.--
                    (A) In general.--The remedies and procedures set 
                forth in this section are the remedies 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 disability 
                shall have standing to institute a civil action under 
                this subsection if the individual makes a prima facie 
                showing that the individual--
                            (i) is an individual with an LTSS 
                        disability; 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 complainant and 
        may authorize the commencement of such civil action without the 
        payment of fees, costs, or security.
            (4) Futile gesture not required.--Nothing 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 complainant--
            (1) actual and punitive damages;
            (2) immediate injunctive relief to prevent 
        institutionalization;
            (3) as the court determines to be appropriate, any 
        permanent or temporary injunction (including an order to 
        immediately provide or maintain community-based long-term 
        services or supports for an individual to prevent 
        institutionalization or further institutionalization), 
        temporary restraining order, or other order (including an order 
        enjoining the defendant from engaging in a practice that 
        violates this 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 procedure, 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 Attorney 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 Attorney General may 
                commence a civil action in any appropriate Federal 
                district court if the Attorney General has reasonable 
                cause to believe that--
                            (i) any public entity or LTSS insurance 
                        provider, including a group of public entities 
                        or LTSS insurance providers, is engaged in a 
                        pattern or practice of violations 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, including, 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 
                        provision 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
                    (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 paragraph (2)(C), in 
        determining whether a first or subsequent violation has 
        occurred, a determination in a single action, by judgment or 
        settlement, that the public entity or LTSS insurance provider 
        has engaged 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 Disabilities 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 before the date of enactment of this 
        Act);
            (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 manner that 
        takes into account its similarities with section 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 Disabilities Act of 1990 (42 U.S.C. 
        12188(b)(1)(B)).
                                 <all>