,i #aafth ,,congress #ast ,session ,h4 ,r4 #eee ,,in ,,the ,,house ,,of ,,representatives ,january #ae1 #bjai,mr4 ,sensenbrenner 7for himself1 ,mr4 ,doggett1 ,ms4 ,norton1 ,mr4 ,welch1 ,mr4 ,fitzpatrick1 ,mr4 ,connolly1 ,ms4 ,titus1 ,mr4 ,serrano1 ,mr4 ,morelle1 ,mr4 ,espaillat1 ,ms4 ,dean1 ,mr4 ,suozzi1 ,mr4 ,carbajal1 ,mr4 ,brendan ,f4 ,boyle of ,pennsylvania1 ,mr4 ,mc,govern1 ,mr4 ,katko1 ,mr4 ,perlmutter1 ,mr4 ,delgado1 ,mr4 ,higgins of ,new ,york1 ,ms4 ,matsui1 ,ms4 ,wasserman ,schultz1 ,ms4 ,ocasio-,cortez1 ,ms4 ,de,lauro1 ,ms4 ,de,gette1 ,mr4 ,raskin1 ,ms4 ,barragn1 ,mr4 ,cummings1 ,mr4 ,langevin1 ,ms4 ,schakowsky1 ,miss ,rice of ,new ,york1 ,mr4 ,ruppersberger1 ,ms4 ,stefanik1 ,ms4 ,bonamici1 ,mr4 ,crow1 ,mr4 ,engel1 ,mr4 ,tipton1 ,mr4 ,peterson1 ,mr4 ,castro of ,texas1 ,mrs4 ,lawrence1 ,mr4 ,neguse1 and ,mr4 ,brindisi7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on the ,judiciary1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to prohibit discrimination against individuals with disabilities who need long-term services and supports1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,disability ,integration ,act of #bjai4 #b4 ,findings and purposes 7a7 ,findings ,congress finds the following3 7#a7 ,in enacting the ,americans with ,disabilities ,act of #aiij 7referred to in this ,act as the ,,ada71 ,congress-- 7,a7 recognized that historically1 society has tended to isolate and segregate individuals with disabilities1 and1 despite some improvements1 such forms of discrimination against individuals with disabilities continue to be a serious and pervasive social problem2 and 7,b7 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 areas1 including institutionalization4 7#b7 ,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 supports1 that expectation has not been fulfilled4 7#c7 ,the holdings of the ,supreme ,court in ,olmstead v4 ,l4,c41 #ebg ,u4,s4 #eha 7#aiii71 and companion cases1 have clearly articulated that individuals with disabilities have a civil right under the ,,ada to participate in society as equal citizens4 ,however1 many ,states still do not provide sufficient community-based long-term services and supports to individuals with disabilities to end segregation in institutions4 7#d7 ,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 disabilities4 ,the lack of adequate community-based services and supports has imperiled the civil rights of all individuals with disabilities1 and has undermined the very promise of the ,,ada4 ,it is1 therefore1 necessary to recognize in statute a robust and fully articulated right to community living4 7#e7 ,states1 with a few exceptions1 continue to approach decisions regarding long-term services and supports from social welfare and budgetary perspectives1 but for the promise of the ,,ada to be fully realized1 ,states must approach these decisions from a civil rights perspective4 7#f7 ,states have not consistently planned to ensure sufficient services and supports for individuals with disabilities1 including those with the most significant disabilities1 to enable individuals with disabilities to live in the most integrated setting4 ,as a result1 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 placement4 7#g7 ,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 confinement4 7b7 ,purposes ,the purposes of this ,act are-- 7#a7 to clarify and strengthen the ,,ada's integration mandate in a manner that accelerates ,state compliance2 7#b7 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 supports2 7#c7 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 setting1 including the individual's own home1 have maximum control over their services and supports1 and ensure that long-term services and supports are provided in a manner that allows individuals with disabilities to lead an independent life2 7#d7 to establish a comprehensive ,state planning requirement that includes enforceable1 measurable objectives that are designed to transition individuals with all types of disabilities at all ages out of institutions and into the most integrated setting2 and 7#e7 to establish a requirement for clear and uniform annual public reporting by ,states that includes reporting about-- 7,a7 the number of individuals with disabilities who are served in the community and the number who are served in institutions2 and 7,b7 the number of individuals with disabilities who have transitioned from an institution to a community-based living situation1 and the type of community-based living situation into which those individuals have transitioned4 #c4 ,definitions and rule 7a7 ,definitions ,in this ,act3 7#a7 ,activities of daily living ,the term activities of daily living has the meaning given the term in section #dda4eje of title #db1 ,code of ,federal ,regulations 7or a successor regulation74 7#b7 ,administrator ,the term ,administrator means-- 7,a7 the ,administrator of the ,administration for ,community ,living2 or 7,b7 another designee of the ,secretary of ,health and ,human ,services4 7#c7 ,community-based ,the term community-based1 when used in reference to services or supports1 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 life1 and that are delivered in whichever setting the individual with an ,,ltss disability has chosen out of the following settings with the following qualities3 7,a7 ,in the case of a dwelling or a nonresidential setting 7such as a setting in which an individual with an ,,ltss disability receives day services and supported employment71 a dwelling or setting-- 7i7 that1 as a matter of infrastructure1 environment1 amenities1 location1 services1 and features1 is integrated into the greater community and supports1 for each individual with an ,,ltss disability who receives services or supports at the setting-- 7,i7 full access to the greater community 7including access to opportunities to seek employment and work in competitive integrated settings1 engage in community life1 control personal resources1 and receive services in the community72 and 7,,ii7 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 supports2 7ii7 that the individual has selected as a meaningful choice from among nonresidential setting options1 including nondisability-specific settings2 7iii7 in which an individual has rights to privacy1 dignity1 and respect1 and freedom from coercion and restraint2 7iv7 that1 as a matter of infrastructure1 environment1 amenities1 location1 services1 and features1 optimizes1 but does not regiment1 individual initiative1 autonomy1 and independence in making life choices1 including choices about daily activities1 physical environment1 and persons with whom the individual interacts2 and 7v7 that1 as a matter of infrastructure1 environment1 amenities1 location1 services1 and features1 facilitates individual choice regarding the provision of services and supports1 and who provides those services and supports4 7,b7 ,in the case of a dwelling1 a dwelling-- 7i7 that is owned by an individual with an ,,ltss disability or the individual's family member2 7ii7 that is leased to the individual with an ,,ltss disability under an individual lease1 that has lockable access and egress1 and that includes living1 sleeping1 bathing1 and cooking areas over which an individual with an ,,ltss disability or the individual's family member has domain and control2 or 7iii7 that is a group or shared residence-- 7,i7 in which no more than #d unrelated individuals with an ,,ltss disability reside2 7,,ii7 for which each individual with an ,,ltss disability living at the residence owns1 rents1 or occupies the residence under a legally enforceable agreement under which the individual has1 at a minimum1 the same responsibilities and protections as tenants have under applicable landlord-tenant law2 7,,iii7 in which each individual with an ,,ltss disability living at the residence-- 7aa7 has privacy in the individual's sleeping unit1 including a lockable entrance door controlled by the individual2 7bb7 shares a sleeping unit only if such individual and the individual sharing the unit choose to do so1 and if individuals in the residence so choose1 they also have a choice of roommates within the residence2 7cc7 has the freedom to furnish and decorate the individual's sleeping or living unit as permitted under the lease or other agreement2 7dd7 has the freedom and support to control the individual's own schedules and activities2 and 7ee7 is able to have visitors of the individual's choosing at any time2 and 7,,iv7 that is physically accessible to the individual with an ,,ltss disability living at the residence4 7#d7 ,dwelling ,the term dwelling has the meaning given the term in section #hjb of the ,fair ,housing ,act 7#db ,u4,s4,c4 #cfjb74 7#e7 ,health-related tasks ,the term health-related tasks means specific nonacute tasks1 typically regulated by ,states as medical or nursing tasks that an individual with a disability may require to live in the community1 including-- 7,a7 administration of medication2 7,b7 assistance with use1 operation1 and maintenance of a ventilator2 and 7,c7 maintenance and use of a gastrostomy tube1 a catheter1 or a stable ostomy4 7#f7 ,individual with a disability ,the term individual with a disability means an individual who is a person with a disability1 as defined in section #c of the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abajb74 7#g7 ,individual with an ltss disability ,the term individual with an ,,ltss disability means an individual with a disability who-- 7,a7 in order to live in the community and lead an independent life requires assistance in accomplishing-- 7i7 activities of daily living2 7ii7 instrumental activities of daily living2 7iii7 health-related tasks2 or 7iv7 other functions1 tasks1 or activities related to an activity or task described in clause 7i71 7ii71 or 7iii72 and 7,b7 7i7 is currently in an institutional placement2 or 7ii7 is at risk of institutionalization if the individual does not receive community-based long-term services and supports4 7#h7 ,instrumental activities of daily living 7,a7 ,in general ,the term instrumental activities of daily living means one or more activities related to living independently in the community1 including activities related to-- 7i7 nutrition1 such as preparing meals or special diets1 monitoring to prevent choking or aspiration1 or assisting with special utensils2 7ii7 household chores and environmental maintenance tasks2 7iii7 communication and interpersonal skills1 such as-- 7,i7 using the telephone or other communications devices2 7,,ii7 forming and maintaining interpersonal relationships2 or 7,,iii7 securing opportunities to participate in group support or peer-to-peer support arrangements2 7iv7 travel and community participation1 such as shopping1 arranging appointments1 or moving around the community2 7v7 care of others1 such as raising children1 taking care of pets1 or selecting caregivers2 or 7vi7 management of personal property and personal safety1 such as-- 7,i7 taking medication2 7,,ii7 handling or managing money2 or 7,,iii7 responding to emergent situations or unscheduled needs requiring an immediate response4 7,b7 ,assistance ,the term assistance used with respect to instrumental activities of daily living1 includes support provided to an individual by another person due to confusion1 dementia1 behavioral symptoms1 or cognitive1 intellectual1 mental1 or emotional disabilities1 including support to-- 7i7 help the individual identify and set goals1 overcome fears1 and manage transitions2 7ii7 help the individual with executive functioning1 decisionmaking1 and problem solving2 7iii7 provide reassurance to the individual2 and 7iv7 help the individual with orientation1 memory1 and other activities related to independent living4 7#i7 ,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 accomplishing1 acquiring the means or ability to accomplish1 maintaining1 or enhancing-- 7,a7 activities of daily living2 7,b7 instrumental activities of daily living2 7,c7 health-related tasks2 or 7,d7 other functions1 tasks1 or activities related to an activity or task described in subparagraph 7,a71 7,b71 or 7,c74 7#aj7 ,,ltss insurance provider ,the term ,,ltss insurance provider means a public or private entity that-- 7,a7 provides funds for long-term services and supports2 and 7,b7 is engaged in commerce or in an industry or activity affecting commerce4 7#aa7 ,public entity 7,a7 ,in general ,the term public entity means an entity that-- 7i7 provides or funds institutional placements for individuals with ,,ltss disabilities2 and 7ii7 is-- 7,i7 a ,state or local government2 or 7,,ii7 any department1 agency1 entity administering a special purpose district1 or other instrumentality1 of a ,state or local government4 7,b7 ,interstate commerce ,for purposes of subparagraph 7,a71 a public entity shall be considered to be a person engaged in commerce or in an industry or activity affecting commerce4 7b7 ,rule of construction ,nothing in subsection 7a77#b7 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 store1 retail establishment1 restaurant1 bank1 park1 concert venue1 theater1 or workplace4 #d4 ,discrimination 7a7 ,in general ,no public entity or ,,ltss insurance provider shall deny an individual with an ,,ltss disability who is eligible for institutional placement1 or otherwise discriminate against that individual in the provision of1 community-based long-term services and supports that enable the individual to live in the community and lead an independent life4 7b7 ,specific prohibitions ,for purposes of this ,act1 discrimination by a public entity or ,,ltss insurance provider includes-- 7#a7 the imposition or application of eligibility criteria or another policy that prevents or tends to prevent an individual with an ,,ltss disability1 or any class of individuals with ,,ltss disabilities1 from receiving a community-based long-term service or support2 7#b7 the imposition or application of a policy or other mechanism1 such as a service or cost cap1 that prevent or tends to prevent an individual with an ,,ltss disability1 or any class of individuals with ,,ltss disabilities1 from receiving a community-based long-term service or support2 7#c7 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 disability1 or any class of individuals with ,,ltss disabilities2 7#d7 the imposition or application of a policy1 rule1 regulation1 or restriction that interferes with the opportunity for an individual with an ,,ltss disability1 or any class of individuals with ,,ltss disabilities1 to live in the community and lead an independent life1 which may include a requirement that an individual with an ,,ltss disability receive a service or support 7such as day services or employment services7 in a congregate or disability-specific setting2 7#e7 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 support2 7#f7 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 life2 7#g7 a failure to provide community-based services and supports1 on an intermittent1 short-term1 or emergent basis1 that assist an individual with an ,,ltss disability to live in the community and lead an independent life2 7#h7 the imposition or application of a policy1 such as a requirement that an individual utilize informal support1 that restricts1 limits1 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 life2 7#i7 a failure to implement a formal procedure and a mechanism to ensure that-- 7,a7 individuals with ,,ltss disabilities are offered the alternative of community-based long-term services and supports prior to institutionalization2 and 7,b7 if selected by an individual with an ,,ltss disability1 the community-based long-term services and supports described in subparagraph 7,a7 are provided2 7#aj7 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 supports2 and 7#aa7 a failure to make a reasonable modification in a policy1 practice1 or procedure1 when such modification is necessary to allow an individual with an ,,ltss disability to receive a community-based long-term service or support4 7c7 ,additional prohibition ,for purposes of this ,act1 discrimination by a public entity also includes a failure to ensure that there is sufficient availability of affordable1 accessible1 and integrated housing to allow an individual with an ,,ltss disability to choose to live in the community and lead an independent life1 including the availability of an option to live in housing where the receipt of ,,ltss is not tied to tenancy4 7d7 ,construction ,nothing in this section-- 7#a7 shall be construed-- 7,a7 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 section2 or 7,b7 to limit the rights of an individual with a disability under any provision of law other than this section2 7#b7 shall be construed to affect the scope of obligations imposed by any other provision of law2 or 7#c7 shall be construed to prohibit a public entity or ,,ltss insurance provider from using managed care techniques1 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 supports1 as prohibited by this ,act4 #e4 ,administration 7a7 ,authority and responsibility 7#a7 ,department of justice ,the ,attorney ,general shall-- 7,a7 investigate and take enforcement action for violations of this ,act2 and 7,b7 enforce section #f7;c74 7#b7 ,department of health and human services ,the ,secretary of ,health and ,human ,services1 through the ,administrator1 shall-- 7,a7 conduct studies regarding the nature and extent of institutionalization of individuals with ,,ltss disabilities in representative communities1 including urban1 suburban1 and rural communities1 throughout the ,united ,states2 7,b7 publish and disseminate reports1 recommendations1 and information derived from such studies1 including an annual report to ,congress1 specifying-- 7i7 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 ,act2 7ii7 obstacles that remain in the effort to achieve the provision of community-based long-term services and supports for all individuals with ,,ltss disabilities2 and 7iii7 recommendations for further legislative or executive action2 7,c7 cooperate with1 and provide grants for technical assistance to1 ,federal1 ,state1 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 supports2 7,d7 implement educational and conciliatory activities to further the purposes of this ,act2 and 7,e7 refer information on violations of this ,act to the ,attorney ,general for investigation and enforcement action under this ,act4 7b7 ,cooperation of executive departments and agencies ,each ,federal agency and1 in particular1 each ,federal agency covered by ,executive ,order #acbag 7#ff ,fed4 ,reg4 #ccaee2 relating to community-based alternatives for individuals with disabilities71 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 ,act4 #f4 ,regulations 7a7 ,issuance of regulations ,not later than #bd months after the date of enactment of this ,act1 the ,attorney ,general and the ,secretary of ,health and ,human ,services shall issue1 in accordance with section #eec of title #e1 ,united ,states ,code1 final regulations to carry out this ,act1 which shall include the regulations described in subsection 7b74 7b7 ,required contents of regulations 7#a7 ,eligible recipients of service ,the regulations shall require each public entity and ,,ltss insurance provider to offer1 and1 if accepted1 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 provider4 7#b7 ,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-- 7,a7 ensures that individuals with ,,ltss disabilities receive assistance through hands-on assistance1 training1 cueing1 and safety monitoring1 including access to backup systems1 with-- 7i7 activities of daily living2 7ii7 instrumental activities of daily living2 7iii7 health-related tasks2 or 7iv7 other functions1 tasks1 or activities related to an activity or task described in clause 7i71 7ii71 or 7iii72 7,b7 coordinates1 conducts1 performs1 provides1 or funds discharge planning from acute1 rehabilitation1 and long-term facilities to promote individuals with ,,ltss disabilities living in the most integrated setting chosen by the individuals2 7,c7 issues1 conducts1 performs1 provides1 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 served2 7,d7 issues1 conducts1 performs1 provides1 or funds policies and programs to support informal caregivers who provide services for individuals with ,,ltss disabilities2 and 7,e7 ensures that individuals with all types of ,,ltss disabilities are able to live in the community and lead an independent life1 including ensuring that the individuals have maximum control over the services and supports that the individuals receive1 choose the setting in which the individuals receive those services and supports1 and exercise control and direction over their own lives4 7#c7 ,public participation 7,a7 ,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 7#e7 and transition plan under paragraph 7#aj74 7,b7 ,,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 hearing1 providing an opportunity for public comment1 and consulting with individuals with ,,ltss disabilities1 in preparing the ,,ltss insurance provider's self-evaluation under paragraph 7#e74 7,c7 ,process ,in carrying out a public participation process under subparagraph 7,a7 or 7,b71 a public entity or ,,ltss insurance provider shall ensure that the process meets the requirements of subparagraphs 7,a7 and 7,c7 of section #aaae7;d77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae7;d77#b771 except that-- 7i7 the reference to at the ,state level shall be disregarded2 and 7ii7 the reference to an application shall be considered to be a reference to the self-evaluation or plan involved4 7#d7 ,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 subsection4 7#e7 ,self-evaluation 7,a7 ,in general ,the regulations issued under this section shall require each public entity and each ,,ltss insurance provider1 not later than #cj months after the date of enactment of this ,act1 to evaluate current services1 policies1 and practices1 and the effects thereof1 that do not or may not meet the requirements of this ,act and1 to the extent modification of any such services1 policies1 and practices is required to meet the requirements of this ,act1 make the necessary modifications4 ,the self-evaluation shall include-- 7i7 collection of baseline information1 including the numbers of individuals with ,,ltss disabilities in various institutional and community-based settings served by the public entity or ,,ltss insurance provider2 7ii7 a review of community capacity1 in communities served by the entity or provider1 in providing community-based long-term services and supports2 7iii7 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 comprehensive1 are accessible1 are not duplicative of existing 7as of the date of the identification7 services and supports1 meet the needs of persons who are likely to require assistance in order to live1 or lead a life1 as described in section #d7;a71 and are high-quality services and supports1 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 served2 and 7iv7 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 fair1 coherent system that affords individuals reasonable and timely access to community-based long-term services and supports4 7,b7 ,public entity ,a public entity1 including an ,,ltss insurance provider that is a public entity1 shall-- 7i7 include in the self-evaluation described in subparagraph 7,a7-- 7,i7 an assessment of the availability of accessible1 affordable transportation across the ,state involved and whether transportation barriers prevent individuals from receiving long-term services and supports in the most integrated setting2 and 7,,ii7 an assessment of the availability of integrated employment opportunities in the jurisdiction served by the public entity for individuals with ,,ltss disabilities2 and 7ii7 provide the self-evaluation described in subparagraph 7,a7 to the ,attorney ,general and the ,administrator4 7,c7 ,,ltss insurance provider ,an ,,ltss insurance provider shall keep the self-evaluation described in subparagraph 7,a7 on file1 and may be required to produce such self-evaluation in the event of a review1 investigation1 or action described in section #h4 7#f7 ,additional requirement for public entities ,the regulations issued under this section shall require a public entity1 in conjunction with the housing agencies serving the jurisdiction served by the public entity1 to review and improve community capacity1 in all communities throughout the entirety of that jurisdiction1 in providing affordable1 accessible1 and integrated housing1 including an evaluation of available units1 unmet need1 and other identifiable barriers to the provision of that housing4 ,in carrying out that improvement1 the public entity1 in conjunction with such housing agencies1 shall-- 7,a7 ensure1 and assure the ,administrator and the ,attorney ,general that there is1 sufficient availability of affordable1 accessible1 and integrated housing in a setting that is not a disability-specific residential setting or a setting where services are tied to tenancy1 in order to provide individuals with ,,ltss disabilities a meaningful choice in their housing2 7,b7 in order to address the need for affordable1 accessible1 and integrated housing-- 7i7 in the case of such a housing agency1 establish relationships with ,state and local housing authorities2 and 7ii7 in the case of the public entity1 establish relationships with ,state and local housing agencies1 including housing authorities2 7,c7 establish1 where needed1 necessary preferences and set-asides in housing programs for individuals with ,,ltss disabilities who are transitioning from or avoiding institutional placement2 7,d7 establish a process to fund necessary home modifications so that individuals with ,,ltss disabilities can live independently2 and 7,e7 ensure1 and assure the ,administrator and the ,attorney ,general1 that funds and programs implemented or overseen by the public entity or in the public entity's jurisdiction are targeted toward affordable1 accessible1 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 met4 7#g7 ,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 ,act1 including the investigation of any complaint communicated to the entity or provider that alleges a violation of this ,act4 ,each public entity and ,,ltss insurance provider shall make available to all interested individuals the name1 office address1 and telephone number of the employee designated pursuant to this paragraph4 7#h7 ,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 ,act4 7#i7 ,provision of service by others ,the regulations issued under this section shall require each public entity submitting a self-evaluation under paragraph 7#e7 to identify1 as part of the transition plan described in paragraph 7#aj71 any other entity that is1 or acts as1 an agent1 subcontractor1 or other instrumentality of the public entity with regards to a service1 support1 policy1 or practice described in such plan or self-evaluation4 7#aj7 ,transition plans ,the regulations issued under this section shall require each public entity1 not later than #db months after the date of enactment of this ,act1 to submit to the ,administrator1 and begin implementing1 a transition plan for carrying out this ,act that establishes the achievement of the requirements of this ,act1 as soon as practicable1 but in no event later than #ab years after the date of enactment of this ,act4 ,the transition plan shall-- 7,a7 establish measurable objectives to address the barriers to community living identified in the self-evaluation under paragraph 7#e72 7,b7 establish specific annual targets for the transition of individuals with ,,ltss disabilities1 and shifts in funding1 from institutional settings to integrated community-based services and supports1 and related programs2 7,c7 describe specific efforts to support individuals with ,,ltss disabilities to avoid unwanted institutionalization through the provision of ,,ltss2 and 7,d7 describe the manner in which the public entity has obtained or plans to obtain necessary funding and resources needed for implementation of the plan 7regardless of whether the entity began carrying out the objectives of this ,act prior to the date of enactment of this ,act74 7#aa7 ,annual reporting 7,a7 ,in general ,the regulations issued under this section shall establish annual reporting requirements for each public entity covered by this section4 7,b7 ,progress on objectives1 targets1 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 objectives1 specific annual targets1 and specific efforts described in paragraph 7#aj74 7#ab7 ,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 ,act4 7c7 ,review of transition plans 7#a7 ,general rule ,the ,administrator shall review a transition plan submitted in accordance with subsection 7b77#aj7 for the purpose of determining whether such plan meets the requirements of this ,act1 including the regulations issued under this section4 7#b7 ,disapproval ,if the ,administrator determines that a transition plan reviewed under this subsection fails to meet the requirements of this ,act1 the ,administrator shall disapprove the transition plan and notify the public entity that submitted the transition plan of1 and the reasons for1 such disapproval4 7#c7 ,modification of disapproved plan ,not later than #ij days after the date of disapproval of a transition plan under this subsection1 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 ,administrator1 and commence implementation of1 such modified transition plan4 7#d7 ,incentives 7,a7 ,determination ,for #aj years after the issuance of the regulations described in subsection 7a71 the ,secretary of ,health and ,human ,services shall annually determine whether each ,state1 or each other public entity in the ,state1 is complying with the transition plan or modified transition plan the ,state or other public entity submitted1 and obtained approval for1 under this section4 ,notwithstanding any other provision of law1 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 plan1 the ,secretary shall make the increase described in subparagraph 7,b74 7,b7 ,increase in ,,fmap ,on making the determination described in subparagraph 7,a7 for a public entity 7including a ,state71 the ,secretary of ,health and ,human ,services shall1 as described in subparagraph 7,c71 increase by #e percentage points the ,,fmap 7but shall in no event increase the ,,fmap above #ajj percent7 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 7#db ,u4,s4,c4 #acif et seq47 or a waiver of such plan-- 7i7 that-- 7,i7 are identified by a public entity or ,,ltss insurance provider under subsection 7b77#e77;,a77iii72 7,,ii7 resulted from shifts in funding identified by a public entity under subsection 7b77#aj77;,b72 or 7,,iii7 are environmental modifications to achieve the affordable1 accessible1 integrated housing identified by a public entity under subsection 7b77#f77;,e72 and 7ii7 are described by the ,state in a request to the ,secretary of ,health and ,human ,services for the increase4 7,c7 ,period of increase ,the ,secretary of ,health and ,human ,services shall increase the ,,fmap described in subparagraph 7,b7-- 7i7 beginning with the first quarter that begins after the date of the determination2 and 7ii7 ending with the quarter in which the next annual determination under subparagraph 7,a7 occurs4 7,d7 ,additional condition for payment 7i7 ,state report ,as a condition for the receipt of a payment based on an increase described in subparagraph 7,b7 with respect to amounts to be expended by the ,state for medical assistance consisting of home and community-based services described in subparagraph 7,b71 the ,state shall report to the ,secretary1 for the reporting year1 the amount of funds expended by the ,state for home and community-based services 7as defined in subparagraph 7,e77ii77 in that year4 ,the ,state shall make the report in a format developed or approved by the ,secretary4 7ii7 ,reduction in payment if failure to maintain effort ,if the amount reported under clause 7i7 by a ,state with respect to a reporting year is less than the amount reported under clause 7i7 with respect to the previous fiscal year or fiscal year #bjai1 whichever was the greater reported amount1 the ,secretary shall provide for a reduction in the payment to the ,state based on the increase4 7,e7 ,definitions ,in this paragraph3 7i7 ,,fmap ,the term ,,fmap means the ,federal medical assistance percentage for a ,state determined under section #aije7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7b77 without regard to any increases in that percentage applicable under other subsections of that section or any other provision of law1 including this section4 7ii7 ,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 7#db ,u4,s4,c4 #acif et seq47 or a waiver of such plan3 7,i7 ,home and community-based services provided under subsection 7c71 7d71 or 7i7 of section #aiae of the ,social ,security ,act 7#db ,u4,s4,c4 #acifn74 7,,ii7 ,home health care services4 7,,iii7 ,personal care services4 7,,iv7 ,services described in section #aije7;a77#bf7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77#bf77 7relating to ,,pace program services74 7,v7 ,self-directed personal assistance services provided in accordance with section #aiae7;j7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifn7j774 7,,vi7 ,community-based attendant services and supports provided in accordance with section #aiae7k7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifn7k774 7,,vii7 ,rehabilitative services1 within the meaning of section #aije7;a77#ac7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77#ac774 7iii7 ,reporting year ,the term reporting year means the most recent fiscal year preceding the date of a report under subparagraph 7,d77i74 7d7 ,rule of construction ,nothing in subsection 7b77#aj7 or 7c7 or any other provision of this ,act shall be construed to limit the rights1 protections1 or requirements of any other ,federal law1 relating to integration of individuals with disabilities into the community and enabling those individuals to live in the most integrated setting4 #g4 ,exemptions for religious organizations ,this ,act shall not prohibit a religious organization1 association1 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 organization1 association1 or society4 #h4 ,enforcement 7a7 ,civil action 7#a7 ,in general ,a civil action for preventive relief1 including an application for a permanent or temporary injunction1 restraining order1 or other order1 may be instituted by an individual described in paragraph 7#b7 in an appropriate ,federal district court4 7#b7 ,aggrieved individual 7,a7 ,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 ,act1 or who has reasonable grounds for believing that such individual is about to be subjected to such a violation4 7,b7 ,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-- 7i7 is an individual with an ,,ltss disability2 and 7ii7 is being subjected to1 or about to be subjected to1 such a violation 7including a violation of section #d7;b77#aa774 7#c7 ,appointment of attorney2 no fees1 costs1 or security ,upon application by the complainant described in paragraph 7#b7 and in such circumstances as the court may determine to be just1 the court may appoint an attorney for the complainant and may authorize the commencement of such civil action without the payment of fees1 costs1 or security4 7#d7 ,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 ,act4 7b7 ,damages and injunctive relief ,if the court finds that a violation of this ,act has occurred or is about to occur1 the court may award to the complainant-- 7#a7 actual and punitive damages2 7#b7 immediate injunctive relief to prevent institutionalization2 7#c7 as the court determines to be appropriate1 any permanent or temporary injunction 7including an order to immediately provide or maintain community-based long-term services or supports for an individual to prevent institutionalization or further institutionalization71 temporary restraining order1 or other order 7including an order enjoining the defendant from engaging in a practice that violates this ,act or ordering such affirmative action as may be appropriate72 and 7#d7 in an appropriate case1 injunctive relief to require the modification of a policy1 practice1 or procedure1 or the provision of an alternative method of providing ,,ltss1 to the extent required by this ,act4 7c7 ,attorney's fees2 liability of ,united ,states for costs ,in any action commenced pursuant to this ,act1 the court1 in its discretion1 may allow the party bringing a claim or counterclaim under this ,act1 other than the ,united ,states1 a reasonable attorney's fee as part of the costs1 and the ,united ,states shall be liable for costs to the same extent as a private person4 7d7 ,enforcement by attorney general 7#a7 ,denial of rights 7,a7 ,duty to investigate ,the ,attorney ,general shall investigate alleged violations of this ,act1 and shall undertake periodic reviews of the compliance of public entities and ,,ltss insurance providers under this ,act4 7,b7 ,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-- 7i7 any public entity or ,,ltss insurance provider1 including a group of public entities or ,,ltss insurance providers1 is engaged in a pattern or practice of violations of this ,act2 or 7ii7 any individual1 including a group1 has been subjected to a violation of this ,act and the violation raises an issue of general public importance4 7#b7 ,authority of court ,in a civil action under paragraph 7#a77;,b71 the court-- 7,a7 may grant any equitable relief that such court considers to be appropriate1 including1 to the extent required by this ,act-- 7i7 granting temporary1 preliminary1 or permanent relief2 and 7ii7 requiring the modification of a policy1 practice1 or procedure1 or the provision of an alternative method of providing ,,ltss2 7,b7 may award such other relief as the court considers to be appropriate1 including damages to individuals described in subsection 7a77#b71 when requested by the ,attorney ,general2 and 7,c7 may1 to vindicate the public interest1 assess a civil penalty against the public entity or ,,ltss insurance provider in an amount-- 7i7 not exceeding #ajj1jjj for a first violation2 and 7ii7 not exceeding #bjj1jjj for any subsequent violation4 7#c7 ,single violation ,for purposes of paragraph 7#b77;,c71 in determining whether a first or subsequent violation has occurred1 a determination in a single action1 by judgment or settlement1 that the public entity or ,,ltss insurance provider has engaged in more than one violation of this ,act shall be counted as a single violation4 #i4 ,construction ,for purposes of construing this ,act-- 7#a7 section #d7;b77#aa7 shall be construed in a manner that takes into account its similarities with section #cjb7;b77#b77;,a77ii7 of the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abahb7;b77#b77;,a77ii772 7#b7 the first sentence of section #f7;b77#e77;,a7 shall be construed in a manner that takes into account its similarities with section #ce4aje7;a7 of title #bh1 ,code of ,federal ,regulations 7as in effect on the day before the date of enactment of this ,act72 7#c7 section #g shall be construed in a manner that takes into account its similarities with section #hjg7;a7 of the ,civil ,rights ,act of #aifh 7#db ,u4,s4,c4 #cfjg7;a772 7#d7 section #h7;a77#b7 shall be construed in a manner that takes into account its similarities with section #cjh7;a77#a7 of the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abahh7;a77#a772 and 7#e7 section #h7;d77#a77;,b7 shall be construed in a manner that takes into account its similarities with section #cjh7;b77#a77;,b7 of the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abahh7;b77#a77;,b774