HR6766-119

What This Bill Does

The Essential Caregivers Act responds to pandemic-era nursing-home isolation by amending Medicare and Medicaid facility rules. It requires skilled nursing facilities and nursing facilities to recognize each resident right to designate essential caregivers, including through a resident representative when cognitive or mental disability prevents the resident from doing so. During emergency periods when ordinary visitation is restricted, facilities must allow at least one essential caregiver to visit every day and at any time, subject to written safety protocols no more restrictive than staff protocols and reasonable roommate accommodations. A facility may deny access for an initial period of up to 7 days and one additional 7-day period only with State approval, but must allow access for residents in end-of-life care or decline or distress. If access is denied for noncompliance, the facility must give a written warning, then a written explanation within 24 hours with appeal options. HHS must issue a final rule within 2 years establishing appeals to State survey agencies, which must begin investigation within 2 business days and decide within 48 hours after investigation starts. If a facility violates the rule, the State survey agency must require immediate access, a corrective action plan within 7 days, and may impose a civil money penalty up to $5,000 for failure to implement the plan. The bill also applies similar requirements to intermediate care facilities for individuals with intellectual disabilities and certain campus-linked inpatient rehabilitation facilities.

Who Benefits and How

Long-term care residents benefit because they gain a statutory right to designate essential caregivers who can provide in-person assistance during emergencies. Residents with dementia, cognitive disabilities, or mental disabilities benefit because resident representatives can make the designation when the resident cannot. Essential caregivers and family members benefit from daily access rights, written explanations for denials, and appeal rights. Residents in end-of-life care or decline or distress benefit most directly because the bill says they must be allowed essential-caregiver access even when emergency restrictions exist. Long-term care ombudsmen and resident advocates benefit from clearer federal standards to enforce resident isolation protections.

Who Bears the Burden and How

Skilled nursing facilities, Medicaid nursing facilities, intermediate care facilities for individuals with intellectual disabilities, and covered inpatient rehabilitation facilities must update policies, track caregiver designations, apply staff-level safety protocols, issue written warnings and denial explanations, accommodate roommates, and carry the burden of proof in appeals. HHS must conduct stakeholder consultation and promulgate implementing regulations. State survey agencies must receive appeals, start investigations within 2 business days, issue determinations within 48 hours after investigation begins, order immediate access and corrective plans, and assess penalties when facilities fail to comply. Facility administrators face civil money penalties up to $5,000 if corrective action plans are not implemented on time.

Key Provisions

• Establishes a resident right to designate and amend essential caregivers in skilled nursing and nursing facilities.
• Requires facilities to allow at least one essential caregiver daily access during emergency visitation restrictions.
• Limits denial of access to 7 days, or 14 days with State approval, and protects access for residents in end-of-life care or decline or distress.
• Requires written warnings, 24-hour denial explanations, and appeal options for residents and caregivers.
• Requires HHS to issue appeal-process regulations within 2 years and State survey agencies to investigate quickly.
• Authorizes corrective action plans and civil money penalties up to $5,000 for facility noncompliance.