,,ii #aaith ,,congress #b;d ,session ,s4 #dhfe ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #bc1 #bjbf,mr4 ,bennet 7for himself1 ,mr4 ,whitehouse1 ,mr4 ,heinrich1 ,mr4 ,markey1 ,ms4 ,baldwin1 ,ms4 ,hirono1 ,mr4 ,hickenlooper1 ,mr4 ,merkley1 ,mr4 ,lujn1 ,mr4 ,wyden1 ,mr4 ,kaine1 ,mr4 ,reed1 ,ms4 ,warren1 and ,mr4 ,booker7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,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 ,latonya ,reeves ,freedom ,act of #bjbf4 #b4 ,purposes ,the purposes of this ,act are-- 7#a7 to clarify and strengthen the integration mandate of the ,americans with ,disabilities ,act of #aiij1 held by the ,supreme ,court in ,olmstead v4 ,l4,c41 #ebg ,u4,s4 #eha 7#aiii7 in a manner that accelerates and improves ,state compliance2 7#b7 to affirm that every individual who is eligible for long-term services and supports has a federally protected right to be integrated into that individual's community and receive community-based long-term services and supports2 7#c7 to ensure that ,states and ,,ltss insurance providers 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 home2 7#d7 to ensure that individuals with disabilities have maximum control over the services and supports that allow them to live in the community2 7#e7 to ensure that long-term services and supports are provided in a manner that allows individuals with disabilities to lead an independent life2 7#f7 to establish a comprehensive 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 setting1 if they choose that transition2 and 7#g7 to identify and address disparities in the provision of community-based long-term services and supports4 #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-based2 services or supports ,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 ,community-based2 setting ,the term community-based1 when used in reference to a setting1 means a setting described in subparagraph 7,a7 or 7,b7 of paragraph 7#c74 7#e7 ,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#f7 ,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#g7 ,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#h7 ,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#i7 ,institution2 institutionalization 7,a7 ,institution ,the term institution means-- 7i7 a skilled nursing facility 7as defined in section #ahai7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#c7;a7772 7ii7 a nursing facility 7as defined in section #aiai7;a7 of such ,act 7#db ,u4,s4,c4 #acifr7a7772 7iii7 a long-term care hospital 7as described in section #ahhf7;d77#a77;,b77iv7 of such ,act 7#db ,u4,s4,c4 #acieww7d77#a77;,b77iv7772 7iv7 a facility described in section #aije7;d7 of such ,act 7#db ,u4,s4,c4 #acif;d7d772 7v7 an institution which is a psychiatric hospital 7as defined in section #ahfa7;f7 of such ,act 7#db ,u4,s4,c4 #aciex7f777 or that provides in-patient psychiatric services in a residential setting specified by the ,secretary2 7vi7 an institution described in section #aije7;i7 of such ,act 7#db ,u4,s4,c4 #acif;d7i772 and 7vii7 any congregate setting that is not community-based or that has the effect of isolating individuals with disabilities from the community4 7,b7 ,institutionalization ,the term institutionalization1 used with respect to an individual with an ,,ltss disability1 refers to the individual living or receiving services or supports in a setting that is not community-based4 7#aj7 ,instrumental activities of daily living ,the term instrumental activities of daily living means one or more activities related to living independently in the community1 including activities related to-- 7,a7 nutrition1 such as preparing meals or special diets1 monitoring to prevent choking or aspiration1 or assisting with special utensils2 7,b7 household chores and environmental maintenance tasks2 7,c7 communication and interpersonal skills1 such as-- 7i7 using the telephone or other communications devices2 7ii7 forming and maintaining interpersonal relationships2 or 7iii7 securing opportunities to participate in group support or peer-to-peer support arrangements2 7,d7 travel and community participation1 such as shopping1 arranging appointments1 or moving around the community2 7,e7 care of others1 such as raising children1 taking care of pets1 or selecting caregivers2 or 7,f7 management of personal property and personal safety1 such as-- 7i7 taking medication2 7ii7 handling or managing money2 or 7iii7 responding to emergent situations or unscheduled needs requiring an immediate response4 7#aa7 ,long-term service or support 7,a7 ,in general ,the terms long-term service or support and ,,ltss mean assistance1 equipment1 technology1 or other support1 provided to an individual with a disability in accomplishing1 acquiring the means or ability to accomplish1 maintaining1 or enhancing-- 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 7iii74 7,b7 ,assistance ,in subparagraph 7,a71 the term assistance 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 communicate needs1 overcome fears1 and manage transitions2 7ii7 help the individual with executive functioning1 decisionmaking1 self-expression1 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#ab7 ,,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#ac7 ,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 7a7 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 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 support2 and 7#ab7 a failure to ensure that an individual with an ,,ltss disability has access to affordable1 accessible1 and integrated housing1 that allows the individual to live in the community and lead an independent life1 including access to an option to live in housing where the receipt of ,,ltss is not tied to tenancy4 7c7 ,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 7,b7 to limit the rights of an individual with a disability under any provision of law other than this section2 7,c7 to require that an individual with an ,,ltss disability live or receive services or supports in a more integrated setting if the individual chooses a less integrated setting2 or 7,d7 to establish a right for an individual with an ,,ltss disability to remain in a specific institution2 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 investigate and take enforcement action for violations of this ,act4 7#b7 ,department of ,health and ,human ,services ,the ,secretary of ,health and ,human ,services1 through the ,administrator1 shall-- 7,a7 review1 and approve or disapprove1 transition plans submitted by public entities1 under section #f7;b77#aj72 7,b7 establish a task force to identify socio-demographic1 geographic1 and other factors that are barriers that prevent individuals with ,,ltss disabilities from receiving community-based long-term services and supports or from being able to choose alternatives in the community to institutionalization and identify other disparities in the availability and provision of community-based long-term services and supports1 which task force shall be responsible for-- 7i7 overseeing studies regarding the nature and extent of those barriers and disparities and the impact that those barriers and disparities have on the institutionalization of individuals with ,,ltss disabilities2 and 7ii7 submitting to ,congress not later than #b years after the date of enactment of this ,act a report on the nature and extent of those barriers and disparities1 including a description of legislative or executive action to address the barriers and disparities2 and 7,c7 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 #b years after the date of enactment of this ,act1 the ,attorney ,general 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 ,protected individuals ,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 7for purposes of enabling the ,attorney ,general to consult with the ,administrator7 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 acute and rehabilitation facilities1 and other institutions1 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 ,in general ,the regulations issued under this section shall require each public entity and ,,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 public entity or ,,ltss insurance provider's self-evaluation under paragraph 7#e7 and transition plan under paragraph 7#aj74 7,b7 ,process ,in carrying out a public participation process under subparagraph 7,a71 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 or ,,ltss insurance provider 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 #cf 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 provider1 including demographic data that-- 7,i7 specifies whether the individuals are women1 veterans1 or members of a racial and ethnic minority group1 as defined in section #agjg of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f72 and 7,,ii7 is disaggregated by race in a manner that captures all the racial groups specified in the ,american ,community ,survey conducted by the ,bureau of the ,census2 7ii7 a review of community capacity1 in communities served by the public entity or ,,ltss insurance provider1 in providing community-based long-term services and supports2 7iii7 an assessment of the availability of accessible1 affordable transportation and whether transportation barriers prevent individuals served by the public entity or ,,ltss insurance provider from receiving long-term services and supports in the community2 7iv7 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 culturally competent1 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 7v7 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 culturally competent1 community-based long-term services and supports2 and 7vi7 a review of all agents1 subcontractors1 or other instrumentalities funded by the public entity or ,,ltss insurance provider to authorize or provide ,,ltss1 to ensure that the agents1 subcontractors1 or other instrumentalities comply with this ,act4 7,b7 ,additional requirements ,public entities and ,,ltss insurance providers shall-- 7i7 provide the self-evaluation described in subparagraph 7,a7 to the ,attorney ,general2 7ii7 make the self-evaluation described in subparagraph 7,a7 available on the public internet of the entity or provider2 and 7iii7 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 ,housing ,the regulations issued under this section shall require a public entity1 and require an ,,ltss insurance provider1 who funds or provides housing and housing services to review and improve community capacity in providing affordable1 accessible1 and integrated housing1 including conducting an evaluation of available units1 unmet need1 and other identifiable barriers to the provision of that housing4 ,in carrying out that improvement1 the public entity or ,,ltss insurance provider shall-- 7,a7 ensure1 and assure the ,attorney ,general and the ,administrator 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 housing1 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 ,attorney ,general and the ,administrator1 that funds and programs implemented or overseen by the public entity or ,,ltss insurance provider are targeted toward affordable1 accessible1 integrated housing for individuals with an ,,ltss disability who have the lowest income levels 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 regard 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 and each ,,ltss insurance provider1 that is not able to demonstrate full compliance with this ,act through its self-evaluation1 not later than #ed months after the date of enactment of this ,act4 ,the regulations shall require that public entity or ,,ltss insurance provider to submit to the ,administrator and1 on approval by the ,administrator1 begin implementing 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 7,d7 describe the manner in which the public entity or ,,ltss insurance provider has obtained or plans to obtain necessary funding and resources needed for implementation of the plan 7regardless of whether the entity or provider began carrying out the objectives of this ,act prior to the date of enactment of this ,act72 and 7,e7 describe the steps taken to ensure that the transition plan addresses the needs of individuals from all sociodemographic and geographic backgrounds4 7#aa7 ,annual reporting 7,a7 ,in general ,the regulations issued under this section shall establish annual reporting requirements for each public entity or ,,ltss insurance provider covered by this section4 7,b7 ,progress on objectives1 targets1 and efforts ,the regulations issued under this section shall require each public entity or ,,ltss insurance provider that has submitted a transition plan1 to make publicly available on the entity's website an annual report on the progress the public entity or ,,ltss insurance provider has made during the previous year in meeting the measurable objectives1 specific annual targets1 and specific efforts described in paragraph 7#aj74 7c7 ,review of transition plans 7#a7 ,general rule ,the ,administrator shall review a transition plan submitted in accordance with subsection 7b77#aj71 not later than #ij days after receiving the plan1 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 or ,,ltss insurance provider 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 or ,,ltss insurance provider that submitted the transition plan shall modify the transition plan to meet the requirements of this section and shall submit the modified plan to the ,administrator4 ,not later than #ij days after receiving the modified plan1 the ,administrator shall review the plan and1 on approval by the ,administrator1 the public entity or ,,ltss insurance provider shall begin implementing the plan4 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 district court of the ,united ,states not earlier than #b years after the date of enactment of this ,act4 7#b7 ,aggrieved individual 7,a7 ,in general ,this ,act provides the remedies and procedures set forth in this section 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 7including an individual acting on their behalf7 shall have standing to institute a civil action under this subsection if the individual makes a prima facie showing that the individual with a disability-- 7i7 is an individual with an ,,ltss disability2 and 7ii7 is being subjected to1 or has the reasonable grounds described in subparagraph 7,a7 concerning1 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 plaintiff 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 plaintiff 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 plaintiff-- 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