Disability Integration Act of 2019

II 116TH CONGRESS 1ST SESSION S. 117 To prohibit discrimination against individuals with disabilities who need long- term services and supports, and for other purposes. IN THE SENATE OF THE UNITED STATES JANUARY 15, 2019 Mr. SCHUMER (for himself, Mr. GARDNER, Ms. BALDWIN, Mr. BENNET, Mr. BLUMENTHAL, Ms. CANTWELL, Mr. CASEY, Mr. COONS, Ms. DUCKWORTH, Mrs. GILLIBRAND, Ms. HARRIS, Ms. HASSAN, Mr. JONES, Mr. LEAHY, Mr. MARKEY, Mrs. MURRAY, Mr. VAN HOLLEN, Ms. WAR- REN, Mr. TESTER, Mr. SANDERS, Mr. DURBIN, Mr. BOOKER, Mr. MERKLEY, and Ms. SMITH) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To prohibit discrimination against individuals with disabil- ities who need long-term services and supports, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Disability Integration 4 Act of 2019’’. 5 SEC. 2. FINDINGS AND PURPOSES. 6 (a) FINDINGS.—Congress finds the following: 7 VerDate Sep 11 2014 20:26 Jan 24, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S117.IS S117 khammond on DSKBBV9HB2PROD with BILLS 2 •S 117 IS (1) In enacting the Americans with Disabilities 1 Act of 1990 (referred to in this Act as the ‘‘ADA’’), 2 Congress— 3 (A) recognized that ‘‘historically, society 4 has tended to isolate and segregate individuals 5 with disabilities, and, despite some improve- 6 ments, such forms of discrimination against in- 7 dividuals with disabilities continue to be a seri- 8 ous and pervasive social problem’’; and 9 (B) intended that the ADA assure ‘‘full 10 participation’’ and ‘‘independent living’’ for in- 11 dividuals with disabilities by addressing ‘‘dis- 12 crimination against individuals with disabilities 13 [that] persists in critical areas’’, including insti- 14 tutionalization. 15 (2) While Congress expected that the ADA’s in- 16 tegration mandate would be interpreted in a manner 17 that ensures that individuals who are eligible for in- 18 stitutional placement are able to exercise a right to 19 community-based long-term services and supports, 20 that expectation has not been fulfilled. 21 (3) The holdings of the Supreme Court in 22 Olmstead v. L.C., 527 U.S. 581 (1999), and com- 23 panion cases, have clearly articulated that individ- 24 uals with disabilities have a civil right under the 25 VerDate Sep 11 2014 20:26 Jan 24, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S117.IS S117 khammond on DSKBBV9HB2PROD with BILLS 3 •S 117 IS ADA to participate in society as equal citizens. How- 1 ever, many States still do not provide sufficient com- 2 munity-based long-term services and supports to in- 3 dividuals with disabilities to end segregation in insti- 4 tutions. 5 (4) The right to live in the community is nec- 6 essary for the exercise of the civil rights that the 7 ADA was intended to secure for all individuals with 8 disabilities. The lack of adequate community-based 9 services and supports has imperiled the civil rights 10 of all individuals with disabilities, and has under- 11 mined the very promise of the ADA. It is, therefore, 12 necessary to recognize in statute a robust and fully 13 articulated right to community living. 14 (5) States, with a few exceptions, continue to 15 approach decisions regarding long-term services and 16 supports from social welfare and budgetary perspec- 17 tives, but for the promise of the ADA to be fully re- 18 alized, States must approach these decisions from a 19 civil rights perspective. 20 (6) States have not consistently planned to en- 21 sure sufficient services and supports for individuals 22 with disabilities, including those with the most sig- 23 nificant disabilities, to enable individuals with dis- 24 abilities to live in the most integrated setting. As a 25 VerDate Sep 11 2014 20:26 Jan 24, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S117.IS S117 khammond on DSKBBV9HB2PROD with BILLS 4 •S 117 IS result, many individuals with disabilities who reside 1 in institutions are prevented from residing in the 2 community and individuals with disabilities who are 3 not in institutions find themselves at risk of institu- 4 tional placement. 5 (7) The continuing existence of unfair and un- 6 necessary institutionalization denies individuals with 7 disabilities the opportunity to live and participate on 8 an equal basis in the community and costs the 9 United States billions of dollars in unnecessary 10 spending related to perpetuating dependency and 11 unnecessary confinement. 12 (b) PURPOSES.—The purposes of this Act are— 13 (1) to clarify and strengthen the ADA’s inte- 14 gration mandate in a manner that accelerates State 15 compliance; 16 (2) to clarify that every individual who is eligi- 17 ble for long-term services and supports has a feder- 18 ally protected right to be meaningfully integrated 19 into that individual’s community and receive commu- 20 nity-based long-term services and supports; 21 (3) to ensure that States provide long-term 22 services and supports to individuals with disabilities 23 in a manner that allows individuals with disabilities 24 to live in the most integrated setting, including the 25 VerDate Sep 11 2014 20:26 Jan 24, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S117.IS S117 khammond on DSKBBV9HB2PROD with BILLS 5 •S 117 IS individual’s own home, have maximum control over 1 their services and supports, and ensure that long- 2 term services and supports are provided in a manner 3 that allows individuals with disabilities to lead an 4 independent life; 5 (4) to establish a comprehensive State planning 6 requirement that includes enforceable, measurable 7 objectives that are designed to transition individuals 8 with all types of disabilities at all ages out of institu- 9 tions and into the most integrated setting; and 10 (5) to establish a requirement for clear and uni- 11 form annual public reporting by States that includes 12 reporting about— 13 (A) the number of individuals with disabil- 14 ities who are served in the community and the 15 number who are served in institutions; and 16 (B) the number of individuals with disabil- 17 ities who have transitioned from an institution 18 to a community-based living situation, and the 19 type of community-based living situation into 20 which those individuals have transitioned. 21 SEC. 3. DEFINITIONS AND RULE. 22 (a) DEFINITIONS.—In this Act: 23 (1) ACTIVITIES OF DAILY LIVING.—The term 24 ‘‘activities of daily living’’ has the meaning given the 25 VerDate Sep 11 2014 20:26 Jan 24, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S117.IS S117 khammond on DSKBBV9HB2PROD with BILLS 6 •S 117 IS term in section 441.505 of title 42, Code of Federal 1 Regulations (or a successor regulation). 2 (2) ADMINISTRATOR.—The term ‘‘Adminis- 3 trator’’ means— 4 (A) the Administrator of the Administra- 5 tion for Community Living; or 6 (B) another designee of the Secretary of 7 Health and Human Services. 8 (3) COMMUNITY-BASED.—The term ‘‘commu- 9 nity-based’’, when used in reference to services or 10 supports, means services or supports that are pro- 11 vided to an individual with an LTSS disability to en- 12 able that individual to live in the community and 13 lead an independent life, and that are delivered in 14 whichever setting the individual with an LTSS dis- 15 ability has chosen out of the following settings with 16 the following qualities: 17 (A) In the case of a dwelling or a nonresi- 18 dential setting (such as a setting in which an 19 individual with an LTSS disability receives day 20 services and supported employment), a dwelling 21 or setting— 22 (i) that, as a matter of infrastructure, 23 environment, amenities, location, services, 24 and features, is integrated into the greater 25 VerDate Sep 11 2014 20:26 Jan 24, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S117.IS S117 khammond on DSKBBV9HB2PROD with BILLS 7 •S 117 IS community and supports, for each indi- 1 vidual with an LTSS disability who re- 2 ceives services or supports at the setting— 3 (I) full access to the greater com- 4 munity (including access to opportuni- 5 ties to seek employment and work in 6 competitive integrated settings, en- 7 gage in community life, control per- 8 sonal resources, and receive services 9 in the community); and 10 (II) access to the greater commu- 11 nity to the same extent as access to 12 the community is enjoyed by an indi- 13 vidual who is not receiving long-term 14 services or supports; 15 (ii) that the individual has selected as 16 a meaningful choice from among nonresi- 17 dential setting options, including nondis- 18 ability-specific settings; 19 (iii) in which an individual has rights 20 to privacy, dignity, and respect, and free- 21 dom from coercion and restraint; 22 (iv) that, as a matter of infrastruc- 23 ture, environment, amenities, location, 24 services, and features, optimizes, but does 25 VerDate Sep 11 2014 20:26 Jan 24, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S117.IS S117 khammond on DSKBBV9HB2PROD with BILLS 8 •S 117 IS not regiment, individual initiative, auton- 1 omy, and independence in making life 2 choices, including choices about daily ac- 3 tivities, physical environment, and persons 4 with whom the individual interacts; and 5 (v) that, as a matter of infrastructure, 6 environment, amenities, location, services, 7 and features, facilitates individual choice 8 regarding the provision of services and 9 supports, and who provides those services 10 and supports. 11 (B) In the case of a dwelling, a dwelling— 12 (i) that is owned by an individual with 13 an LTSS disability or the individual’s fam- 14 ily member; 15 (ii) that is leased to the individual 16 with an LTSS disability under an indi- 17 vidual lease, that has lockable access and 18 egress, and that includes living, sleeping, 19 bathing, and cooking areas over which an 20 individual with an LTSS disability or the 21 individual’s family member has domain 22 and control; or 23 (iii) that is a group or shared resi- 24 dence— 25 VerDate Sep 11 2014 20:26 Jan 24, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S117.IS S117 khammond on DSKBBV9HB2PROD with BILLS 9 •S 117 IS (I) in which no more than 4 un- 1 related individuals with an LTSS dis- 2 ability reside; 3 (II) for which each individual 4 with an LTSS disability living at the 5 residence owns, rents, or occupies the 6 residence under a legally enforceable 7 agreement under which the individual 8 has, at a minimum, the same respon- 9 sibilities and protections as tenants 10 have under applicable landlord-tenant 11 law; 12 (III) in which each individual 13 with an LTSS disability living at the 14 residence— 15 (aa) has privacy in the indi- 16 vidual’s sleeping unit, including a 17 lockable entrance door controlled 18 by the individual; 19 (bb) shares a sleeping unit 20 only if such individual and the 21 individual sharing the unit choose 22 to do so, and if individuals in the 23 residence so choose, they also 24 VerDate Sep 11 2014 20:26 Jan 24, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S117.IS S117 khammond on DSKBBV9HB2PROD with BILLS 10 •S 117 IS have a choice of roommates with- 1 in the residence; 2 (cc) has the freedom to fur- 3 nish and decorate the individual’s 4 sleeping or living unit as per- 5 mitted under the lease or other 6 agreement; 7 (dd) has the freedom and 8 support to control the individ- 9 ual’s own schedules and activi- 10 ties; and 11 (ee) is able to have visitors 12 of the individual’s choosing at 13 any time; and 14 (IV) that is physically accessible 15 to the individual with an LTSS dis- 16 ability living at the residence. 17 (4) DWELLING.—The term ‘‘dwelling’’ has the 18 meaning given the term in section 802 of the Fair 19 Housing Act (42 U.S.C. 3602). 20 (5) HEALTH-RELATED TASKS.—The term 21 ‘‘health-related tasks’’ means specific nonacute 22 tasks, typically regulated by States as medical or 23 nursing tasks that an individual with a disability 24 may require to live in the community, including— 25 VerDate Sep 11 2014 20:26 Jan 24, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S117.IS S117 khammond on DSKBBV9HB2PROD with BILLS 11 •S 117 IS (A) administration of medication; 1 (B) assistance with use, operation, and 2 maintenance of a ventilator; and 3 (C) maintenance and use of a gastrostomy 4 tube, a catheter, or a stable ostomy. 5 (6) INDIVIDUAL WITH A DISABILITY.—The term 6 ‘‘individual with a disability’’ means an individual 7 who is a person with a disability, as defined in sec- 8 tion 3 of the Americans with Disabilities Act of 9 1990 (42 U.S.C. 12102). 10 (7) INDIVIDUAL WITH AN LTSS DISABILITY.— 11 The term ‘‘individual with an LTSS disability’’ 12 means an individual with a disability who— 13 (A) in order to live in the community and 14 lead an independent life requires assistance in 15 accomplishing— 16 (i) activities of daily living; 17 (ii) instrumental activities of daily liv- 18 ing; 19 (iii) health-related tasks; or 20 (iv) other functions, tasks, or activi- 21 ties related to an activity or task described 22 in clause (i), (ii), or (iii); and 23 (B)(i) is currently in an institutional place- 24 ment; or 25 VerDate Sep 11 2014 20:26 Jan 24, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S117.IS S117 khammond on DSKBBV9HB2PROD with BILLS 12 •S 117 IS (ii) is at risk of institutionalization if the 1 individual does not receive community-based 2 long-term services and supports. 3 (8) INSTRUMENTAL ACTIVITIES OF DAILY LIV- 4 ING.— 5 (A) IN GENERAL.—The term ‘‘instru- 6 mental activities of daily living’’ means one or 7 more activities related to living independently in 8 the community, including activities related to— 9 (i) nutrition, such as preparing meals 10 or special diets, monitoring to prevent 11 choking or aspiration, or assisting with 12 special utensils; 13 (ii) household chores and environ- 14 mental maintenance tasks; 15 (iii) communication and interpersonal 16 skills, such as— 17 (I) using the telephone or other 18 communications devices; 19 (II) forming and maintaining 20 interpersonal relationships; or 21 (III) securing opportunities to 22 participate in group support or peer- 23 to-peer support arrangements; 24 VerDate Sep 11 2014 20:26 Jan 24, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S117.IS S117 khammond on DSKBBV9HB2PROD with BILLS 13 •S 117 IS (iv) travel and community participa- 1 tion, such as shopping, arranging appoint- 2 ments, or moving aroun [Text truncated for display. 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