,i  #aacth ,,congress  #b;d ,session    
,h4 ,r4 #eedg  ,,in ,,the ,,house ,,of  
,,representatives  ,september #ah1 #bjad
 ,mr4 ,cartwright 7for himself and ,mr4 
,michaud7 introduced the following bill2
 which was referred to the ,committee on
 ,energy and ,commerce  ,a ,,bill  ,to  
ensure that ,medicaid beneficiaries have
 the opportunity to receive care in a   
home and community-based setting4  #a4  
,short title ,this ,act may be cited as 
the ,community ,integration ,act of     
#bjad4  #b4 ,findings ,congress finds   
the following3  7#a7 ,the ,supreme      
,court's #aiii decision in ,olmstead v4 
,l4,c41 #ebg ,u4,s4 #eha 7#aiii71 held  
that the unnecessary segregation of     
individuals with disabilities is a      
violation of the ,americans with        
,disabilities ,act of #aiij 7#db        
,u4,s4,c4 #abaja et seq474  7#b7 ,under 
,olmstead1 individuals generally have   
the right to receive their supports and 
services in home and community-based    
settings1 rather than in institutional  

settings1 if they so choose4  7#c7      
,olmstead envisioned that ,states would 
provide appropriate long-term services  
and supports to individuals with        
disabilities through home and           
community-based services and end forced 
segregation in nursing homes and other  
institutions4  7#d7 ,while there has    
been progress in rebalancing ,state     
spending on individuals with            
disabilities in institutions as compared
 to home and community-based settings1  
more than #ge percent of ,states        
continue to spend the majority of their 
long-term care dollars on nursing homes 
and other institutional settings1 and   
the number of individuals with          
disabilities under age #fe in nursing   
homes increased between #bjjh and #bjab4
  7#e7 ,as of ,june #bjac1 there were   
more than #bjj1jjj individuals younger  
than age #fe in nursing homes--almost   
#af percent of the total nursing home   
population4  7#f7 ,thirty-eight studies 
published from #bjje to #bjab concluded 

that providing services in home and     
community-based settings is less costly 
than providing care in a nursing home or
 other institutional setting4  7#g7 ,no 
clear or centralized reporting system   
exists to compare how effectively       
,states are meeting the ,olmstead       
mandate4  #c4 ,ensuring ,medicaid       
beneficiaries may elect to receive care 
in a home and community-based setting   
7a7 ,in general ,section #aijb7;a7 of   
the ,social ,security ,act 7#db         
,u4,s4,c4 #acif;a7a77 is amended--  7#a7
 in paragraph 7#hj71 by striking and at 
the end2  7#b7 in paragraph 7#ha71 by   
striking the period and inserting 2 and2
 and  7#c7 by inserting after paragraph 
7#ha7 the following new paragraph3      
7#hb7 in the case of any individual with
 respect to whom there has been a       
determination that the individual       
requires the level of care provided in a
 nursing facility1 intermediate care    
facility for the mentally retarded1     
institution for mental disease1 or other

 similarly restrictive or institutional 
setting--  7,a7 provide the individual  
with the choice and opportunity to      
receive such care in a home and         
community-based setting1 including      
rehabilitative services1 assistance and 
support in accomplishing activities of  
daily living1 instrumental activities of
 daily living1 and health-related tasks1
 and assistance in acquiring1           
maintaining1 or enhancing skills        
necessary to accomplish such activities1
 tasks1 or services2  7,b7 ensure that  
each such individual has an equal       
opportunity 7when compared to the       
receipt and availability of nursing     
facility services7 to receive care in a 
home and community-based setting1 if the
 individual so chooses1 by ensuring that
 the provision of such care in a home   
and community-based setting is widely   
available on a statewide basis for all  
such individuals within the ,state2 and 
7,c7 meet the requirements of section   
#aijd;,a 7relating to the provision of  

care in a home and community-based      
setting74  4  7b7 ,requirements for     
community care options ,title ,,xix of  
the ,social ,security ,act 7#db         
,u4,s4,c4 #acif et seq47 is amended by  
inserting after section #aijd the       
following new section3  #aijd;,a4       
,provisions related to home and         
community-based care  7a7 ,definitions  
,for purposes of this section1 section  
#aijb7;a77#hb71 and section             
#aije7;a77#d77;,a73  7#a7 ,activities of
 daily living ,the term activities of   
daily living includes1 but is not       
limited to1 tasks such as eating1       
toileting1 grooming1 dressing1 bathing1 
and transferring4  7#b7 ,health-related 
tasks ,the term health-related tasks    
means specific tasks related to the     
needs of an individual1 including1 but  
not limited to1 bowel or bladder care1  
wound care1 use and care of ventilators 
and feeding tubes1 and the              
administration of medications and       
injections1 which1 in the opinion of the

 individual's physician1 can be         
delegated to be performed by an         
attendant4  7#c7 ,home and              
community-based setting ,the term home  
and community-based setting means1 with 
respect to an individual who requires a 
level of care provided in a nursing     
facility1 intermediate care facility for
 the mentally retarded1 institution for 
mental disease1 or other similarly      
restrictive or institutional setting1 a 
setting that--  7,a7 includes a house1  
apartment1 townhouse1 condominium1 or   
similar public or private housing where 
the individual resides that--  7i7 is   
owned or leased by the individual or a  
member of the individual's family2  7ii7
 ensures the individual's privacy1      
dignity1 respect1 and freedom from      
coercion2 and  7iii7 maximizes the      
individual's autonomy and independence2 
7,b7 is integrated in1 and provides     
access to1 the general community in     
which the setting is located so that the
 individual has access to the community 

and opportunities to seek employment and
 work in competitive integrated         
settings1 participate in community life1
 control and utilize personal resources1
 benefit from community services1 and   
participate in the community in an      
overall manner that is comparable to    
that available to individuals who are   
not individuals with disabilities2 and  
7,c7 has the services and supports that 
the individual needs in order to live as
 independently as possible4  7#d7       
,instrumental activities of daily living
 ,the term instrumental activities of   
daily living means activities related to
 living independently in the community  
and includes1 but is not limited to1    
meal planning and preparation1 managing 
finances1 shopping for food1 clothing1  
and other items1 performing household   
chores1 communicating by phone or other 
media1 and traveling around and         
participating in the community4  7#e7   
,public entity ,the term public entity  
means a public entity as defined in     

subparagraphs 7,a7 and 7,b7 of section  
#bja7a7 of the ,americans with          
,disabilities ,act of #aiij4  7b7       
,requirements for providing services in 
home and community-,based settings ,with
 respect to the availability and        
provision of services under the ,state  
plan under this title1 or under any     
waiver of ,state plan requirements      
7subject to section #c7;d7 of the       
,community ,integration ,act of #bjad71 
in a home and community-based setting to
 any individual who requires a level of 
care provided in a nursing facility1    
intermediate care facility for the      
mentally retarded1 institution for      
mental disease1 or other similarly      
restrictive or institutional setting1   
any public entity that receives payment 
under the ,state plan or waiver for     
providing services to such an individual
 shall not--  7#a7 impose or utilize    
policies1 practices1 or procedures1 such
 as unnecessary requirements or         
arbitrary service or cost caps1 that    

limit the availability of services in   
home and community-based settings to an 
individual with a disability 7including 
individuals with the most significant   
disabilities7 who need such services2   
7#b7 impose or utilize policies1        
practices1 or procedures that limit the 
availability of services in a home and  
community-based setting 7including      
assistance and support in accomplishing 
activities of daily living1 instrumental
 activities of daily living1            
health-related tasks1 and rehabilitative
 services7 based on the specific        
disability of an otherwise eligible     
individual2  7#c7 impose or utilize     
policies1 practices1 or procedures that 
arbitrarily restrict an individual with 
a disability from full and meaningful   
participation in community life2  7#d7  
impose or utilize policies1 practices1  
or procedures that unnecessarily delay  
or restrict the provision of services in
 a home and community-based setting to  
any individual who requires such        

services2  7#e7 fail to establish and   
utilize adequate payment structures to  
maintain a sufficient workforce to      
provide services in home and            
community-based settings to any         
individual who requires such services2  
7#f7 fail to provide information1 on an 
ongoing basis1 to help any individual   
who receives care in a nursing facility1
 intermediate care facility for the     
mentally retarded1 institution for      
mental disease1 or other similarly      
restrictive or institutional setting1   
understand the individual's right to    
choose to receive such care in a home   
and community-based setting2 or  7#g7   
fail to provide information to help any 
individual that requires the level of   
care provided in a nursing facility1    
intermediate care facility for the      
mentally retarded1 institution for      
mental disease1 or other similarly      
restrictive or institutional setting1   
prior to the individual's placement in  
such a facility or institution1         

understand the individual's right to    
choose to receive such care in a home   
and community-based setting4  7c7 ,plan 
,to increase affordable and accessible  
housing ,not later than #ahj days after 
the enactment of this section1 each     
,state shall develop a statewide plan to
 increase the availability of affordable
 and accessible private and public      
housing stock for individuals with      
disabilities 7including accessible      
housing for individuals with physical   
disabilities and those using mobility   
devices74  7d7 ,availability of remedies
 and procedures  7#a7 ,in general ,the  
remedies and procedures set forth in    
sections #bjc and #eje of the ,americans
 with ,disabilities ,act of #aiij shall 
be available to any person aggrieved by 
the failure of--  7,a7 a ,state to      
comply with this section or section     
#aijb7;a77#hb72 or  7,b7 a public entity
 7including a ,state7 to comply with the
 requirements of subsection 7b74  7#b7  
,rule of construction ,nothing in       

paragraph 7#a7 shall be construed to    
limit any remedy or right of action that
 otherwise is available to an aggrieved 
person under this title4  7e7           
,enforcement by the ,secretary  7#a7 ,in
 general ,the ,secretary may reduce the 
,federal matching assistance percentage 
applicable to the ,state 7as determined 
under section #aije7;b77 if the         
,secretary determines that the ,state   
has violated the requirements of        
subsection 7b74  7#b7 ,rule of          
construction ,nothing in paragraph 7#a7 
shall be construed to limit any remedy  
or right of action that is otherwise    
available to the ,secretary4  7f7       
,reporting requirements ,with respect to
 fiscal year #bjaf1 and for each fiscal 
year thereafter1 each ,state shall      
submit to the ,administrator of the     
,administration for ,community ,living  
of the ,department of ,health and ,human
 ,services1 not later than ,april #a of 
the succeeding fiscal year1 a report1 in
 such form and manner as the ,secretary 

shall require1 that includes--  7#a7 the
 total number of individuals enrolled in
 the ,state plan or under a waiver of   
the plan during such fiscal year that   
required the level of care provided in a
 nursing facility1 intermediate care    
facility for the mentally retarded1     
institution for mental disease1 or other
 similarly restrictive or institutional 
setting1 disaggregated by the type of   
facility or setting2  7#b7 with respect 
to the total number described in        
paragraph 7#a71 the total number of     
individuals described in that paragraph 
who received care in a nursing facility1
 intermediate care facility for the     
mentally retarded1 institution for      
mental disease1 or other similarly      
restrictive or institutional setting1   
disaggregated by the type of facility or
 setting2 and  7#c7 with respect to the 
total number described in paragraph     
7#b71 the total number of individuals   
described in that paragraph who were    
transitioned from a nursing facility1   

intermediate care facility for the      
mentally retarded1 institution for      
mental disease1 or other similarly      
restrictive or institutional setting to 
a home and community-based setting1     
disaggregated by the type of home and   
community-based setting4  4  7c7        
,inclusion as a mandatory service       
,section #aije7;a77#d77;,a7 of the      
,social ,security ,act 7#db ,u4,s4,c4   
#acif;d7a77#d77;,a77 is amended by      
striking other than and inserting       
including similar services such as      
rehabilitative services and assistance  
and support in accomplishing activities 
of daily living1 instrumental activities
 of daily living1 and health-related    
tasks1 that are provided1 at the        
individual's option1 in a home and      
community-based setting 7as defined in  
section #aijd;,a7a77#c771 but not       
including4  7d7 ,application to waivers 
,notwithstanding section #aijd;,a of the
 ,social ,security ,act 7as added by    
subsection 7b771 such section1 and      

sections #aijb7;a77#hb71 and            
#aije7;a77#d77;,a7 of the ,social       
,security ,act 7#db ,u4,s4,c4 #acif et  
seq471 as amended by subsections 7a7 and
 7c71 respectively1 shall not apply to  
any individuals who are eligible for    
medical assistance for home and         
community-based services under a waiver 
under section #aaae or #aiae of the     
,social ,security ,act 7#db ,u4,s4,c4   
#acae1 #acifn7 and who are receiving    
such services1 to the extent such       
sections 7as so added or amended7 are   
inconsistent with any such waiver4  7e7 
,effective date  7#a7 ,in general       
,except as provided in paragraph 7#b71  
the amendments made by this section     
shall take effect on ,october #a1 #bjad4
  7#b7 ,delay permitted if ,state       
legislation required ,in the case of a  
,state plan under section #aijb of the  
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7 which the ,secretary of ,health
 and ,human ,services determines        
requires ,state legislation 7other than 

legislation appropriating funds7 in     
order for the plan to meet the          
additional requirements imposed by the  
amendments made by this section1 the    
,state plan shall not be regarded as    
failing to comply with the requirements 
of such section #aijb solely on the     
basis of the failure of the plan to meet
 such additional requirements before the
 #ast day of the #ast calendar quarter  
beginning after the close of the #ast   
regular session of the ,state           
legislature that begins after the date  
of enactment of this ,act4 ,for purposes
 of the previous sentence1 in the case  
of a ,state that has a #b-year          
legislative session1 each year of such  
session shall be deemed to be a separate
 regular session of the ,state          
legislature4