Regulations

(a) Issuance of regulations Not later than 2 years after the date of enactment of this Act, the Attorney General shall issue, in accordance with section 553 of title 5, United States Code, final regulations to carry out this Act, which shall include the regulations described in subsection (b). (b) Required contents of regulations (1) Protected individuals The regulations shall require each public entity and LTSS insurance provider to offer, and, if accepted, 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 provider. (2) 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 (for purposes of enabling the Attorney General to consult with the Administrator) with an assurance that the public entity or LTSS insurance provider— (A) ensures that individuals with LTSS disabilities receive assistance through hands-on assistance, training, cueing, and safety monitoring, including access to backup systems, with— (i) activities of daily living; (ii) instrumental activities of daily living; (iii) health-related tasks; or (iv) other functions, tasks, or activities related to an activity or task described in clause (i), (ii), or (iii); (B) coordinates, conducts, performs, provides, or funds discharge planning from acute and rehabilitation facilities, and other institutions, to promote individuals with LTSS disabilities living in the most integrated setting chosen by the individuals; (C) issues, conducts, performs, provides, 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 served; (D) issues, conducts, performs, provides, or funds policies and programs to support informal caregivers who provide services for individuals with LTSS disabilities; and (E) ensures that individuals with all types of LTSS disabilities are able to live in the community and lead an independent life, including ensuring that the individuals have maximum control over the services and supports that the individuals receive, choose the setting in which the individuals receive those services and supports, and exercise control and direction over their own lives. (3) Public participation (A) 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 hearing, providing an opportunity for public comment, and consulting with individuals with LTSS disabilities, in preparing the public entity or LTSS insurance provider’s self-evaluation under paragraph (5) and transition plan under paragraph (10). (B) Process In carrying out a public participation process under subparagraph (A), a public entity or LTSS insurance provider shall ensure that the process meets the requirements of subparagraphs (A) and (C) of section 1115(d)(2) of the Social Security Act (42 U.S.C. 1315(d)(2)), except that— (i) the reference to at the State level shall be disregarded; and (ii) the reference to an application shall be considered to be a reference to the self-evaluation or plan involved. (4) 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 subsection. (5) Self-evaluation (A) In general The regulations issued under this section shall require each public entity and each LTSS insurance provider, not later than 36 months after the date of enactment of this Act, to evaluate current services, policies, and practices, and the effects thereof, that do not or may not meet the requirements of this Act and, to the extent modification of any such services, policies, and practices is required to meet the requirements of this Act, make the necessary modifications. The self-evaluation shall include— (i) collection of baseline information, including the numbers of individuals with LTSS disabilities in various institutional and community-based settings served by the public entity or LTSS insurance provider, including demographic data that— (I) specifies whether the individuals are women, veterans, or members of a racial and ethnic minority group, as defined in section 1707 of the Public Health Service Act (42 U.S.C. 300u–6); and (II) 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 Census; (ii) a review of community capacity, in communities served by the public entity or LTSS insurance provider, in providing community-based long-term services and supports; (iii) an assessment of the availability of accessible, 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 community; (iv) 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 comprehensive, are accessible, are not duplicative of existing (as of the date of the identification) services and supports, meet the needs of persons who are likely to require assistance in order to live, or lead a life, as described in section 4(a), and are culturally competent, high-quality services and supports, 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 served; (v) 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 fair, coherent system that affords individuals reasonable and timely access to culturally competent, community-based long-term services and supports; and (vi) a review of all agents, subcontractors, or other instrumentalities funded by the public entity or LTSS insurance provider to authorize or provide LTSS, to ensure that the agents, subcontractors, or other instrumentalities comply with this Act. (B) Additional requirements Public entities and LTSS insurance providers shall— (i) provide the self-evaluation described in subparagraph (A) to the Attorney General; (ii) make the self-evaluation described in subparagraph (A) available on the public internet website of the entity; and (iii) keep the self-evaluation described in subparagraph (A) on file, and may be required to produce such self-evaluation in the event of a review, investigation, or action described in section 8. (6) Housing The regulations issued under this section shall require a public entity and require an LTSS insurance provider, who funds or provides housing and housing services to review and improve community capacity in providing affordable, accessible, and integrated housing, including conducting an evaluation of available units, unmet need, and other identifiable barriers to the provision of that housing. In carrying out that improvement, the public entity or LTSS insurance provider shall— (A) ensure, and assure the Attorney General and the Administrator that there is, sufficient availability of affordable, accessible, and integrated housing in a setting that is not a disability-specific residential setting or a setting where services are tied to tenancy, in order to provide individuals with LTSS disabilities a meaningful choice in their housing; (B) establish relationships with State and local housing authorities in order to address the need for affordable, accessible, and integrated housing; (C) establish, where needed, necessary preferences and set-asides in housing programs for individuals with LTSS disabilities who are transitioning from or avoiding institutional placement; (D) establish a process to fund necessary home modifications so that individuals with LTSS disabilities can live independently; and (E) ensure, and assure the Attorney General and the Administrator, that funds and programs implemented or overseen by the public entity or LTSS insurance provider are targeted toward affordable, accessible, 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 met. (7) 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 Act, including the investigation of any complaint communicated to the entity or provider that alleges a violation of this Act. Each public entity and LTSS insurance provider shall make available to all interested individuals the name, office address, and telephone number of the employee designated pursuant to this paragraph. (8) 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 Act. (9) Provision of service by others The regulations issued under this section shall require each public entity or LTSS insurance provider submitting a self-evaluation under paragraph (5) to identify, as part of the transition plan described in paragraph (10), any other entity that is, or acts as, an agent, subcontractor, or other instrumentality of the public entity or LTSS insurance provider with regards to a service, support, policy, or practice described in such plan or self-evaluation. (10) Transition plans The regulations issued under this section shall require each public entity, and each LTSS insurance provider, that is not able to demonstrate full compliance with this Act through its self-evaluation, not later than 54 months after the date of enactment of this Act. The regulations shall require that public entity or LTSS insurance provider to submit to the Administrator and, on approval by the Administrator, begin implementing a transition plan for carrying out this Act that establishes the achievement of the requirements of this Act, as soon as practicable, but in no event later than 12 years after the date of enactment of this Act. The transition plan shall— (A) establish measurable objectives to address the barriers to community living identified in the self-evaluation under paragraph (5); (B) establish specific annual targets for the transition of individuals with LTSS disabilities, and shifts in funding, from institutional settings to integrated community-based services and supports, and related programs; (C) describe specific efforts to support individuals with LTSS disabilities to avoid unwanted institutionalization through the provision of LTSS; (D) 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 (regardless of whether the entity or provider began carrying out the objectives of this Act prior to the date of enactment of this Act); and (E) describe the steps taken to ensure that the transition plan addresses the needs of individuals from all sociodemographic and geographic backgrounds. (11) Annual reporting (A) In general The regulations issued under this section shall establish annual reporting requirements for each public entity or LTSS insurance provider covered by this section. (B) Progress on objectives, targets, and efforts The regulations issued under this section shall require each public entity or LTSS insurance provider that has submitted a transition plan, 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 objectives, specific annual targets, and specific efforts described in paragraph (10). (c) Review of transition plans (1) General rule The Administrator shall review a transition plan submitted in accordance with subsection (b)(10), not later than 90 days after receiving the plan, for the purpose of determining whether such plan meets the requirements of this Act, including the regulations issued under this section. (2) Disapproval If the Administrator determines that a transition plan reviewed under this subsection fails to meet the requirements of this Act, the Administrator shall disapprove the transition plan and notify the public entity or LTSS insurance provider that submitted the transition plan of, and the reasons for, such disapproval. (3) Modification of disapproved plan Not later than 90 days after the date of disapproval of a transition plan under this subsection, 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 Administrator. Not later than 90 days after receiving the modified plan, the Administrator shall review the plan and, on approval by the Administrator, the public entity or LTSS insurance provider shall begin implementing the plan. (d) Rule of construction Nothing in subsection (b)(10) or (c) or any other provision of this Act shall be construed to limit the rights, protections, or requirements of any other Federal law, relating to integration of individuals with disabilities into the community and enabling those individuals to live in the most integrated setting.