Sec. 3. Definitions and rule
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In this Act: The term activities of daily living has the meaning given the term in section 441.505 of title 42, Code of Federal Regulations (or a successor regulation). The term Administrator means— the Administrator of the Administration for Community Living; or another designee of the Secretary of Health and Human Services. The term community-based , when used in reference to services or supports, 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 life, and that are delivered in whichever setting the individual with an LTSS disability has chosen out of the following settings with the following qualities:
In the case of a dwelling or a nonresidential setting (such as a setting in which an individual with an LTSS disability receives day services and supported employment), a dwelling or setting— that, as a matter of infrastructure, environment, amenities, location, services, and features, is integrated into the greater community and supports, for each individual with an LTSS disability who receives services or supports at the setting— full access to the greater community (including access to opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community); and 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 supports; that the individual has selected as a meaningful choice from among nonresidential setting options, including nondisability-specific settings; in which an individual has rights to privacy, dignity, and respect, and freedom from coercion and restraint; that, as a matter of infrastructure, environment, amenities, location, services, and features, optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices, including choices about daily activities, physical environment, and persons with whom the individual interacts; and that, as a matter of infrastructure, environment, amenities, location, services, and features, facilitates individual choice regarding the provision of services and supports, and who provides those services and supports.
In the case of a dwelling, a dwelling— that is owned by an individual with an LTSS disability or the individual’s family member; that is leased to the individual with an LTSS disability under an individual lease, that has lockable access and egress, and that includes living, sleeping, bathing, and cooking areas over which an individual with an LTSS disability or the individual’s family member has domain and control; or that is a group or shared residence— in which no more than 4 unrelated individuals with an LTSS disability reside; for which each individual with an LTSS disability living at the residence owns, rents, or occupies the residence under a legally enforceable agreement under which the individual has, at a minimum, the same responsibilities and protections as tenants have under applicable landlord-tenant law; in which each individual with an LTSS disability living at the residence— has privacy in the individual’s sleeping unit, including a lockable entrance door controlled by the individual; shares a sleeping unit only if such individual and the individual sharing the unit choose to do so, and if individuals in the residence so choose, they also have a choice of roommates within the residence; has the freedom to furnish and decorate the individual’s sleeping or living unit as permitted under the lease or other agreement; has the freedom and support to control the individual’s own schedules and activities; and is able to have visitors of the individual’s choosing at any time; and that is physically accessible to the individual with an LTSS disability living at the residence.
The term dwelling has the meaning given the term in section 802 of the Fair Housing Act ( 42 U.S.C. 3602 ). The term health-related tasks means specific nonacute tasks, typically regulated by States as medical or nursing tasks that an individual with a disability may require to live in the community, including— administration of medication; assistance with use, operation, and maintenance of a ventilator; and maintenance and use of a gastrostomy tube, a catheter, or a stable ostomy.
The term individual with a disability means an individual who is a person with a disability, as defined in section 3 of the Americans with Disabilities Act of 1990 ( 42 U.S.C. 12102 ). The term individual with an LTSS disability means an individual with a disability who— in order to live in the community and lead an independent life requires assistance in accomplishing— activities of daily living; instrumental activities of daily living; health-related tasks; or other functions, tasks, or activities related to an activity or task described in clause (i), (ii), or (iii); and is currently in an institutional placement; or is at risk of institutionalization if the individual does not receive community-based long-term services and supports.
The term instrumental activities of daily living means one or more activities related to living independently in the community, including activities related to— nutrition, such as preparing meals or special diets, monitoring to prevent choking or aspiration, or assisting with special utensils; household chores and environmental maintenance tasks; communication and interpersonal skills, such as— using the telephone or other communications devices; forming and maintaining interpersonal relationships; or securing opportunities to participate in group support or peer-to-peer support arrangements; travel and community participation, such as shopping, arranging appointments, or moving around the community; care of others, such as raising children, taking care of pets, or selecting caregivers; or management of personal property and personal safety, such as— taking medication; handling or managing money; or responding to emergent situations or unscheduled needs requiring an immediate response.
The term assistance used with respect to instrumental activities of daily living, includes support provided to an individual by another person due to confusion, dementia, behavioral symptoms, or cognitive, intellectual, mental, or emotional disabilities, including support to— help the individual identify and set goals, overcome fears, and manage transitions; help the individual with executive functioning, decisionmaking, and problem solving; provide reassurance to the individual; and help the individual with orientation, memory, and other activities related to independent living.
The terms long-term service or support and LTSS mean the assistance provided to an individual with a disability in accomplishing, acquiring the means or ability to accomplish, maintaining, or enhancing— activities of daily living; instrumental activities of daily living; health-related tasks; or other functions, tasks, or activities related to an activity or task described in subparagraph (A), (B), or (C). The term LTSS insurance provider means a public or private entity that— provides funds for long-term services and supports; and is engaged in commerce or in an industry or activity affecting commerce.
The term public entity means an entity that— provides or funds institutional placements for individuals with LTSS disabilities; and is— a State or local government; or any department, agency, entity administering a special purpose district, or other instrumentality, of a State or local government. For purposes of subparagraph (A), a public entity shall be considered to be a person engaged in commerce or in an industry or activity affecting commerce. Nothing in subsection (a)(2) 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 store, retail establishment, restaurant, bank, park, concert venue, theater, or workplace.
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