,,ii  #aac? ,,congress  #b;d ,session   
,s4 #beae  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #bd1 #bjad ,mr4  
,h>k9 introduc$ ! foll[+ bill2 :i* 0    
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to ensure t        
,m$icaid b5efici>ies h ! opportunity to 
receive c>e 9 a home & community-bas$   
sett+4  #a4 ,%ort title  ,?is ,act may  
be cit$ z ! ,community ,integration ,act
 ( #bjad4  #b4 ,f9d+s ,congress f9ds !  
foll[+3 7#a7 ,! ,supreme ,c\rt's #aiii  
decision 9 ,olm/ead v4 ,l4,c41 #ebg     
,u4,s4 #eha 7#aiii71 held t ! unnecess>y
 segregation ( individuals )            
disabilities is a violation ( !         
,am]icans ) ,disabilities ,act ( #aiij  
7#db ,u4,s4,c4 #abaja et seq474  7#b7   
,"u ,olm/ead1 individuals g5]ally h ! "r
 to receive _! supports & s]vices 9 home
 & community-bas$ sett+s1 r ?an 9       
in/itutional sett+s1 if !y s *oose4     
7#c7 ,olm/ead envision$ t ,/ates w\ld   
provide appropriate long-t]m s]vices &  
supports to individuals ) disabilities  

?r\gh home & community-bas$ s]vices &   
end =c$ segregation 9 nurs+ homes & o!r 
in/itutions4  7#d7 ,:ile !re has be5    
progress 9 rebalanc+ ,/ate sp5d+ on     
individuals ) disabilities 9 in/itutions
 z comp>$ to home & community-bas$      
sett+s1 m ?an #ge p]c5t ( ,/ates cont9ue
 to sp5d ! majority ( _! long-t]m c>e   
doll>s on nurs+ homes & o!r in/itutional
 sett+s1 & ! numb] ( individuals )      
disabilities "u age #fe 9 nurs+ homes   
increas$ betwe5 #bjjh & #bjab4  7#e7 ,z 
( ,june #bjac1 !re 7 m ?an #bjj1jjj     
individuals y\ng] ?an age #fe 9 nurs+   
homes--almo/ #af p]c5t ( ! total nurs+  
home population4  7#f7 ,?irty-eight     
/udies publi%$ f #bjje to #bjab conclud$
 t provid+ s]vices 9 home &             
community-bas$ sett+s is less co/ly ?an 
provid+ c>e 9 a nurs+ home or o!r       
in/itutional sett+4  7#g7 ,no cle> or   
c5traliz$ report+ sy/em exi/s to comp>e 
h[ effectively ,/ates are meet+ !       
,olm/ead m&ate4  #c4 ,ensur+ ,m$icaid   
b5efici>ies may elect to receive c>e 9 a

 home & community-bas$ sett+  7a7 ,9    
g5]al ,section #aijb7;a7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77 is am5d$-- 7#a7 9 p>agraph  
7#hj71 by /rik+ & at ! end2  7#b7 9     
p>agraph 7#ha71 by /rik+ ! p]iod &      
ins]t+ 2 &2 &  7#c7 by ins]t+ aft]      
p>agraph 7#ha7 ! foll[+ new p>agraph3   
7#hb7 9 ! case ( any individual )       
respect to :om !re has be5 a det]m9ation
 t ! individual requires ! level ( c>e  
provid$ 9 a nurs+ facility1 int]m$iate  
c>e facility = ! m5tally ret>d$1        
in/itution = m5tal disease1 or o!r      
simil>ly re/rictive or in/itutional     
sett+-- 7,a7 provide ! individual ) !   
*oice & opportunity to receive su* c>e 9
 a home & community-bas$ sett+1 includ+ 
rehabilitative s]vices1 assi/ance &     
support 9 accompli%+ activities ( daily 
liv+1 in/rum5tal activities ( daily     
liv+1 & heal?-relat$ tasks1 & assi/ance 
9 acquir+1 ma9ta9+1 or enhanc+ skills   
necess>y to accompli% su* activities1   
tasks1 or s]vices2  7,b7 ensure t ea*   

su* individual has an equal opportunity 
7:5 comp>$ to ! receipt & availability (
 nurs+ facility s]vices7 to receive c>e 
9 a home & community-bas$ sett+1 if !   
individual s *ooses1 by ensur+ t !      
provision ( su* c>e 9 a home &          
community-bas$ sett+ is widely available
 on a /atewide basis = all su*          
individuals )9 ! ,/ate2 &  7,c7 meet !  
requirem5ts ( section #aijd;,a 7relat+  
to ! provision ( c>e 9 a home &         
community-bas$ sett+74  4  7b7          
,requirem5ts = community c>e options    
,title ,,xix ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #acif et seq47 is am5d$  
by ins]t+ aft] section #aijd ! foll[+   
new section3  #aijd;,a4 ,provisions     
relat$ to home & community-bas$ c>e  7a7
 ,def9itions ,= purposes ( ?is section1 
section #aijb7;a77#hb71 & section       
#aije7;a77#d77;,a73 7#a7 ,activities (  
daily liv+ ,! t]m activities ( daily    
liv+ includes1 b is n limit$ to1 tasks  
su* z eat+1 toilet+1 groom+1 dress+1    
ba?+1 & transf]r+4  7#b7 ,heal?-relat$  

tasks ,! t]m heal?-relat$ tasks means   
specific tasks relat$ to ! ne$s ( an    
individual1 includ+1 b n limit$ to1 b[el
 or bladd] c>e1 w\nd c>e1 use & c>e (   
v5tilators & fe$+ tubes1 & !            
adm9i/ration ( m$ications & injections1 
:i*1 9 ! op9ion ( ! individual's        
physician1 c be delegat$ to be p]=m$ by 
an att5dant4  7#c7 ,home &              
community-bas$ sett+ ,! t]m home &      
community-bas$ sett+ means1 ) respect to
 an individual :o requires a level ( c>e
 provid$ 9 a nurs+ facility1 int]m$iate 
c>e facility = ! m5tally ret>d$1        
in/itution = m5tal disease1 or o!r      
simil>ly re/rictive or in/itutional     
sett+1 a sett+ t-- 7,a7 includes a h\se1
 ap>tm5t1 t[nh\se1 condom9ium1 or simil>
 public or private h\s+ :]e ! individual
 resides t-- 7i7 is own$ or leas$ by !  
individual or a memb] ( ! individual's  
family2  7ii7 ensures ! individual's    
privacy1 dignity1 respect1 & fre$om f   
co]cion2 &  7iii7 maximizes !           
individual's autonomy & indep5d5ce2     

7,b7 is integrat$ 91 & provides access  
to1 ! g5]al community 9 :i* ! sett+ is  
locat$ s t ! individual has access to ! 
community & opportunities to seek       
employm5t & "w 9 competitive integrat$  
sett+s1 p>ticipate 9 community life1    
control & utilize p]sonal res\rces1     
b5efit f community s]vices1 & p>ticipate
 9 ! community 9 an ov]all mann] t is   
comp>able to t available to individuals 
:o are n individuals ) disabilities2 &  
7,c7 has ! s]vices & supports t !       
individual ne$s 9 ord] to live z        
indep5d5tly z possible4  7#d7           
,in/rum5tal activities ( daily liv+ ,!  
t]m in/rum5tal activities ( daily liv+  
means activities relat$ to liv+         
indep5d5tly 9 ! community & includes1 b 
is n limit$ to1 meal plann+ &           
prep>ation1 manag+ f9ances1 %opp+ =     
food1 clo?+1 & o!r items1 p]=m+ h\sehold
 *ores1 communicat+ by phone or o!r     
m$ia1 & travel+ ar\nd & p>ticipat+ 9 !  
community4  7#e7 ,public entity ,! t]m  
public entity means a public entity z   

def9$ 9 subp>agraphs 7,a7 & 7,b7 (      
section #bja7a7 ( ! ,am]icans )         
,disabilities ,act ( #aiij4  7b7        
,requirem5ts = provid+ s]vices 9 home & 
community-,bas$ sett+s ,) respect to !  
availability & provision ( s]vices "u ! 
,/ate plan "u ?is title1 or "u any waiv]
 ( ,/ate plan requirem5ts 7subject to   
section #c7;d7 ( ! ,community           
,integration ,act ( #bjad71 9 a home &  
community-bas$ sett+ to any individual  
:o requires a level ( c>e provid$ 9 a   
nurs+ facility1 int]m$iate c>e facility 
= ! m5tally ret>d$1 in/itution = m5tal  
disease1 or o!r simil>ly re/rictive or  
in/itutional sett+1 any public entity t 
receives paym5t "u ! ,/ate plan or waiv]
 = provid+ s]vices to su* an individual 
%all n-- 7#a7 impose or utilize         
policies1 practices1 or proc$ures1 su* z
 unnecess>y requirem5ts or arbitr>y     
s]vice or co/ caps1 t limit !           
availability ( s]vices 9 home &         
community-bas$ sett+s to an individual )
 a disability 7includ+ individuals ) !  

mo/ significant disabilities7 :o ne$ su*
 s]vices2  7#b7 impose or utilize       
policies1 practices1 or proc$ures t     
limit ! availability ( s]vices 9 a home 
& community-bas$ sett+ 7includ+         
assi/ance & support 9 accompli%+        
activities ( daily liv+1 in/rum5tal     
activities ( daily liv+1 heal?-relat$   
tasks1 & rehabilitative s]vices7 bas$ on
 ! specific disability ( an o!rwise     
eligible individual2  7#c7 impose or    
utilize policies1 practices1 or         
proc$ures t arbitr>ily re/rict an       
individual ) a disability f full &      
mean+ful p>ticipation 9 community life2 
7#d7 impose or utilize policies1        
practices1 or proc$ures t unnecess>ily  
delay or re/rict ! provision ( s]vices 9
 a home & community-bas$ sett+ to any   
individual :o requires su* s]vices2     
7#e7 fail to e/abli% & utilize adequate 
paym5t /ructures to ma9ta9 a suffici5t  
work=ce to provide s]vices 9 home &     
community-bas$ sett+s to any individual 
:o requires su* s]vices2  7#f7 fail to  

provide in=mation1 on an ongo+ basis1 to
 help any individual :o receives c>e 9 a
 nurs+ facility1 int]m$iate c>e facility
 = ! m5tally ret>d$1 in/itution = m5tal 
disease1 or o!r simil>ly re/rictive or  
in/itutional sett+1 und]/& !            
individual's "r to *oose to receive su* 
c>e 9 a home & community-bas$ sett+2 or 
7#g7 fail to provide in=mation to help  
any individual t requires ! level ( c>e 
provid$ 9 a nurs+ facility1 int]m$iate  
c>e facility = ! m5tally ret>d$1        
in/itution = m5tal disease1 or o!r      
simil>ly re/rictive or in/itutional     
sett+1 prior to ! individual's placem5t 
9 su* a facility or in/itution1 und]/& !
 individual's "r to *oose to receive su*
 c>e 9 a home & community-bas$ sett+4   
7c7 ,plan ,to increase af=dable &       
accessible h\s+ ,n lat] ?an #ahj days   
aft] ! enactm5t ( ?is section1 ea* ,/ate
 %all develop a /atewide plan to        
increase ! availability ( af=dable &    
accessible private & public h\s+ /ock = 
individuals ) disabilities 7includ+     

accessible h\s+ = individuals ) physical
 disabilities & ^? us+ mobility         
devices74  7d7 ,availability ( rem$ies &
 proc$ures  7#a7 ,9 g5]al ,! rem$ies &  
proc$ures set =? 9 sections #bjc & #eje 
( ! ,am]icans ) ,disabilities ,act (    
#aiij %all be available to any p]son    
aggriev$ by ! failure (-- 7,a7 a ,/ate  
to comply ) ?is section or section      
#aijb7;a77#hb72 or  7,b7 a public entity
 7includ+ a ,/ate7 to comply ) !        
requirem5ts ( subsection 7b74  7#b7     
,rule ( con/ruction ,no?+ 9 p>agraph    
7#a7 %all be con/ru$ to limit any rem$y 
or "r ( action t o!rwise is available to
 an aggriev$ p]son "u ?is title4  7e7   
,en=cem5t by ! ,secret>y  7#a7 ,9 g5]al 
,! ,secret>y may r$uce ! ,f$]al mat*+   
assi/ance p]c5tage applicable to ! ,/ate
 7z det]m9$ "u section #aije7;b77 if !  
,secret>y det]m9es t ! ,/ate has violat$
 ! requirem5ts ( subsection 7b74  7#b7  
,rule ( con/ruction ,no?+ 9 p>agraph    
7#a7 %all be con/ru$ to limit any rem$y 
or "r ( action t is o!rwise available to

 ! ,secret>y4  7f7 ,report+ requirem5ts 
,) respect to fiscal ye> #bjaf1 & = ea* 
fiscal ye> !reaft]1 ea* ,/ate %all      
submit to ! ,adm9i/rator ( !            
,adm9i/ration = ,community ,liv+ ( !    
,dep>tm5t ( ,heal? & ,human ,s]vices1 n 
lat] ?an ,april #a ( ! succe$+ fiscal   
ye>1 a report1 9 su* =m & mann] z !     
,secret>y %all require1 t includes--    
7#a7 ! total numb] ( individuals enroll$
 9 ! ,/ate plan or "u a waiv] ( ! plan  
dur+ su* fiscal ye> t requir$ ! level ( 
c>e provid$ 9 a nurs+ facility1         
int]m$iate c>e facility = ! m5tally     
ret>d$1 in/itution = m5tal disease1 or  
o!r simil>ly re/rictive or in/itutional 
sett+1 disaggregat$ by ! type ( facility
 or sett+2  7#b7 ) respect to ! total   
numb] describ$ 9 p>agraph 7#a71 ! total 
numb] ( individuals describ$ 9 t        
p>agraph :o receiv$ c>e 9 a nurs+       
facility1 int]m$iate c>e facility = !   
m5tally ret>d$1 in/itution = m5tal      
disease1 or o!r simil>ly re/rictive or  
in/itutional sett+1 disaggregat$ by !   

type ( facility or sett+2 &  7#c7 )     
respect to ! total numb] describ$ 9     
p>agraph 7#b71 ! total numb] (          
individuals describ$ 9 t p>agraph :o 7  
transition$ f a nurs+ facility1         
int]m$iate c>e facility = ! m5tally     
ret>d$1 in/itution = m5tal disease1 or  
o!r simil>ly re/rictive or in/itutional 
sett+ to a home & community-bas$ sett+1 
disaggregat$ by ! type ( home &         
community-bas$ sett+4  4  7c7 ,inclusion
 z a m&atory s]vice ,section            
#aije7;a77#d77;,a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acif;d7a77#d77;,a77 is am5d$ by /rik+  
o!r ?an & ins]t+ includ+ simil> s]vices 
su* z rehabilitative s]vices & assi/ance
 & support 9 accompli%+ activities (    
daily liv+1 in/rum5tal activities (     
daily liv+1 & heal?-relat$ tasks1 t are 
provid$1 at ! individual's option1 9 a  
home & community-bas$ sett+ 7z def9$ 9  
section #aijd;,a7a77#c771 b n includ+4  
7d7 ,application to waiv]s ,not)/&+     
section #aijd;,a ( ! ,social ,security  

,act 7z add$ by subsection 7b771 su*    
section1 & sections #aijb7;a77#hb71 &   
#aije7;a77#d77;,a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acif et seq471 z  
am5d$ by subsections 7a7 & 7c71         
respectively1 %all n apply to any       
individuals :o are eligible = m$ical    
assi/ance = home & community-bas$       
s]vices "u a waiv] "u section #aaae or  
#aiae ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acae1 #acifn7 & :o are       
receiv+ su* s]vices1 to ! ext5t su*     
sections 7z s add$ or am5d$7 are        
inconsi/5t ) any su* waiv]4  7e7        
,effective date  7#a7 ,9 g5]al ,except z
 provid$ 9 p>agraph 7#b71 ! am5dm5ts    
made by ?is section %all take effect on 
,octob] #a1 #bjad4  7#b7 ,delay p]mitt$ 
if ,/ate legislation requir$ ,9 ! case (
 a ,/ate plan "u section #aijb ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7 :i* ! ,secret>y ( ,heal? &     
,human ,s]vices det]m9es requires ,/ate 
legislation 7o!r ?an legislation        
appropriat+ funds7 9 ord] = ! plan to   

meet ! additional requirem5ts impos$ by 
! am5dm5ts made by ?is section1 ! ,/ate 
plan %all n be reg>d$ z fail+ to comply 
) ! requirem5ts ( su* section #aijb     
solely on ! basis ( ! failure ( ! plan  
to meet su* additional requirem5ts be=e 
! #a/ day ( ! #a/ cal5d> qu>t] beg9n+   
aft] ! close ( ! #a/ regul> session ( ! 
,/ate legislature t beg9s aft] ! date ( 
enactm5t ( ?is ,act4 ,= purposes ( !    
previ\s s5t5ce1 9 ! case ( a ,/ate t has
 a #b-ye> legislative session1 ea* ye> (
 su* session %all be deem$ to be a      
sep>ate regul> session ( ! ,/ate        
legislature4