HR9641-119

What This Bill Does

The Essential Caregivers Act of 2026 would require covered residential health facilities to operate an essential-caregiver program whenever they suspend regular visitation. The requirement would apply through Medicare and Medicaid participation rules for skilled nursing facilities and nursing facilities and would be extended to long-term care hospitals, inpatient rehabilitation facilities, and the covered Medicaid institutions referenced in section 1905(d) of the Social Security Act.

Each resident could choose two essential caregivers for in-person access and change that choice at any time. If cognitive decline or mental disability prevents a resident from making the choice, the resident's authorized representative could do so. A caregiver would have to agree to written physical-safety and infection-control rules that are no more restrictive than the rules applied to facility staff.

HHS guidance could allow a facility to withhold in-person access for the first seven days of a visitation suspension, but the facility would have to provide audiovisual contact during that period. Guidance could also protect a roommate's rights, restrict a caregiver who shows symptoms of a serious infectious disease until a negative test, deny access for failure to follow safety protocols, and limit access to one selected caregiver at a time. Those exceptions would not permit a facility to deny or time-limit access for a resident with an active Medicare hospice election.

Complaints that a nursing facility violated the essential-caregiver requirement would receive priority from the state survey and certification agency. The complainant would have to be notified of the investigation outcome within three days after the complaint is received. The bill would also exclude these visitation requirements from the HHS Secretary's emergency waiver authority, so they could not be waived through that statutory path during an emergency.

HHS would have to issue implementing regulations within 18 months of enactment. The statutory amendments would begin applying one year after enactment, six months before the regulatory deadline. The bill provides no new appropriation, reimbursement adjustment, staffing subsidy, or technology grant for facility implementation.

Who Benefits and How

Residents of covered facilities gain protected in-person access to trusted caregivers during lockdowns and other periods when ordinary visitors are excluded. Hospice patients receive stronger protection because facilities cannot deny or shorten essential-caregiver visits for them. Residents with cognitive or mental disabilities gain access through a representative's election, and selected family members or other caregivers receive a defined route into the facility. Roommates retain protection through reasonable accommodations, while complainants gain an expedited investigation and response.

Who Bears the Burden and How

Covered nursing facilities, long-term care hospitals, rehabilitation facilities, and Medicaid institutions must create election procedures, maintain caregiver records, write safety protocols, provide audiovisual access during any allowed seven-day exclusion, and permit visits under the statutory limits. State survey agencies must prioritize covered complaints and report outcomes within three days. HHS must issue guidance and regulations, and facilities bear implementation, infection-control, staffing, space, technology, and documentation costs without new federal funding. Essential caregivers must comply with the facility's lawful safety rules and may be excluded while symptomatic or noncompliant.

Key Provisions

• Requires essential-caregiver programs whenever regular facility visitation is suspended.
• Provides each resident a changeable election of two essential caregivers.
• Limits initial, infection-control, roommate, and simultaneous-access restrictions.
• Prohibits denial or time limits for essential-caregiver access to hospice residents.
• Requires priority complaint investigation and notice of the outcome within three days.
• Protects the visitation requirements from the specified emergency waiver authority.
• Directs HHS to issue regulations within 18 months.
• Applies the amendments beginning one year after enactment.