H.R. 6766

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6766 Introduced in House (IH)]

<DOC>

119th CONGRESS
1st Session
H. R. 6766

To amend titles XVIII and XIX of the Social Security Act to require 
skilled nursing facilities, nursing facilities, intermediate care 
facilities for the intellectually disabled, and inpatient 
rehabilitation facilities to permit essential caregivers access during 
any period in which regular visitation is restricted.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

December 16, 2025

Ms. Tenney (for herself, Mr. Larson of Connecticut, Mr. Fitzpatrick, 
Mr. Mann, Mr. Ciscomani, and Mr. Mills) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
of such provisions as fall within the jurisdiction of the committee 
concerned

_______________________________________________________________________

A BILL

To amend titles XVIII and XIX of the Social Security Act to require 
skilled nursing facilities, nursing facilities, intermediate care 
facilities for the intellectually disabled, and inpatient 
rehabilitation facilities to permit essential caregivers access during 
any period in which regular visitation is restricted.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Essential Caregivers Act of 2025''.

SEC. 2. FINDINGS.

Congress finds the following:
(1) According to the National Center for Health Statistics 
of the Centers for Disease Control and Prevention, an estimated 
1,300,000 individuals resided in nursing homes in 2020 at the 
onset of the COVID-19 pandemic, and nearly half of all nursing 
home residents were living with a diagnosis of Alzheimer's or 
other related dementia.
(2) Regulations issued pursuant to subtitle C of title IV 
of the Omnibus Budget Reconciliation Act of 1987 (commonly 
known as the ``Nursing Home Reform Act of 1987'') (Public Law 
100-203) established basic rights and services for residents of 
nursing homes, including ``the right to a dignified existence, 
self-determination, and communication with and access to 
persons and services inside and outside the facility''.
(3) In March of 2020, the Centers for Medicare & Medicaid 
Services instructed nursing facilities to restrict visitation 
for all visitors and non-essential healthcare personnel and 
cancel communal dining and group activities. Long-term care 
ombudsman program representatives and State surveyors were 
among those whose access to long-term care facilities was 
prohibited or extremely restricted despite reopening guidance 
released by the Centers for Medicare & Medicaid Services in May 
of 2020.
(4) Many long-term care residents declined dramatically or 
died prematurely from ``failure to thrive'' in isolation.
(5) According to the National Consumer Voice for Quality 
Long-Term Care, in the first year of the COVID-19 pandemic, 1 
in 5 healthcare workers resigned, retired, or were fired. This 
exacerbated the longstanding problem of staff shortages that 
already existed. Lack of staff, combined with the forced 
absence of families, many of whom provided informal care and 
support to residents, resulted in a significant decline in 
residents' health and well-being. During the pandemic, pressure 
ulcers in nursing home residents rose by 31 percent, the number 
of residents experiencing significant weight loss rose by 49 
percent, the number of residents reporting feeling down, 
depressed, or hopeless rose by 40 percent, and the number of 
residents prescribed antipsychotic medications rose by 77.5 
percent.
(6) According to the Department of Health and Human 
Services, loneliness and isolation, such as that experienced by 
long-term care residents during the COVID-19 pandemic, 
represent profound threats to an individual's health and well-
being.
(7) Essential caregivers provide supplemental care for 
their loved one, regardless of staff shortages, staff turnover, 
or emergencies. Essential caregivers support residents and 
advocate on their behalf.

SEC. 3. RIGHT TO ESSENTIAL CAREGIVERS; ACCESS TO ESSENTIAL CAREGIVERS 
DURING PERIODS WHEN VISITATION IS OTHERWISE RESTRICTED.

(a) Medicare Skilled Nursing Facilities.--Section 1819(c)(3) of the 
Social Security Act (42 U.S.C. 1395i-3(c)(3)) is amended--
(1) by redesignating subparagraphs (A) through (E) as 
clauses (i) through (v), respectively;
(2) by striking ``A skilled nursing facility must--'' and 
inserting the following:
``(A) In general.--A skilled nursing facility 
must--''; and
(3) by adding at the end the following new subparagraph:
``(B) Access to essential caregivers during 
emergency periods when visitation is otherwise 
restricted.--
``(i) Designation of essential caregiver.--
Each skilled nursing facility must recognize 
the right of each resident of such facility 
to--
``(I) designate and have access to 
essential caregivers for such resident 
at all times, including during any 
period of emergency in which regular 
visitation is restricted by order of a 
Federal, State, or local authority or 
by other operation of law; and
``(II) amend such designation at 
any time.
``(ii) Presumption of designation.--For 
purposes of clause (i), in the case of a 
resident who is unable, by reason of cognitive 
or mental disability, to make an election 
described in such clause, the resident 
representative (as defined in section 483.5 of 
title 42, Code of Federal Regulations) of such 
resident may make such designation for such 
resident.
``(iii) Access to essential caregivers 
during emergency periods when visitation is 
otherwise restricted.--During a period of 
emergency in which regular visitation is 
restricted by order of a Federal, State, or 
local authority or by other operation of law, 
including any period in which a waiver or 
modification of requirements pursuant to 
section 1135 is in effect, a skilled nursing 
facility must--
``(I) not deny in-person access to 
a resident by an essential caregiver of 
the resident except as provided in this 
subparagraph;
``(II) allow at least 1 essential 
caregiver to have access to and provide 
assistance to such resident at such 
facility every day and at any time;
``(III) enforce the agreement 
described in clause (vii)(II) with 
respect to an essential caregiver; and
``(IV) provide reasonable 
accommodations to protect the rights of 
a roommate co-living with a resident 
who has an essential caregiver.
``(iv) Restrictions on access.--
``(I) In general.--During a period 
of emergency in which regular 
visitation is restricted by order of a 
Federal, State, or local authority or 
by other operation of law, including 
any period in which a waiver or 
modification of requirements pursuant 
to section 1135 is in effect, a skilled 
nursing facility--
``(aa) may, subject to item 
(bb), deny access to a resident 
by an essential caregiver of 
the resident for--

``(AA) an initial 
period of not longer 
than 7 days; and

``(BB) one 
additional period of 
not longer than 7 days 
(in addition to the 
initial period 
described in subitem 
(AA)) if the department 
of health or other 
applicable agency of 
the State in which the 
facility is located 
approves the denial of 
access for such 
additional period; and

``(bb) must allow access to 
a resident who is in end-of-
life care or a resident in 
decline or distress, as defined 
by the Secretary.
``(II) Rule of application.--For 
purposes of subclause (I), a period of 
emergency in which regular visitation 
is restricted by order of a Federal, 
State, or local authority or by other 
operation of law shall begin on the 
date that such order or other operation 
of law takes effect and shall end on 
the date that such order or other 
operation of law expires or is 
otherwise terminated. During any such 
period, the maximum number of days for 
which a skilled nursing facility may 
deny access to a resident by an 
essential caregiver of the resident is 
7 total days (or, subject to the 
approval of the department of health or 
other applicable agency of the State in 
which the facility is located, 14 total 
days).
``(v) Compliance and notification.--
``(I) Authority.--No essential 
caregiver who upholds the agreement 
described in clause (vii)(II) shall be 
denied access to the skilled nursing 
facility of the resident involved.
``(II) Notification.--If an 
essential caregiver fails to comply 
with an agreement with a skilled 
nursing facility described in clause 
(vii)(II), the facility must first 
provide a warning to the essential 
caregiver and resident in writing 
citing specific issues of non-
compliance and providing clear guidance 
for corrective measures.
``(III) Enforcement.--If an 
essential caregiver or resident, after 
receiving a notification of 
noncompliance described in subclause 
(II), fails to take corrective action, 
the essential caregiver may 
subsequently be denied access to the 
resident. In such cases, the facility 
shall provide to such caregiver and 
such resident (or health care proxy of 
such resident), not later than 24 hours 
after such denial of access occurs, a 
written explanation as to why such 
caregiver was denied access to such 
resident. Such explanation must include 
the resident's and caregiver's options 
for appeal under the processes 
established under clause (vi).
``(vi) Options for residents and caregivers 
to appeal denials of access.--
``(I) In general.--Not later than 2 
years after the date of enactment of 
this subparagraph, the Secretary shall 
issue a final rule establishing a 
process for residents and caregivers to 
appeal denials of access to the State 
survey agency.
``(II) Appeals process.--The State 
survey agency shall--
``(aa) receive appeals from 
residents and essential 
caregivers challenging a 
decision by a skilled nursing 
facility to deny access under 
clause (v); and
``(bb) begin investigating 
such appeals not later than 2 
business days after receiving 
such appeals.
``(III) Burden of proof.--During an 
appeal received under the appeals 
process established under subclause 
(I), if a skilled nursing facility 
defends a decision to deny access to an 
essential caregiver under clause (v) on 
the basis that the essential caregiver 
violated the agreement described in 
clause (vii)(II), the skilled nursing 
facility shall have the burden of proof 
in demonstrating that the essential 
caregiver violated such agreement.
``(IV) Resolution of appeals.--
``(aa) Determination.--With 
respect to an appeal received 
under the appeals process 
established under subclause 
(I), the State survey agency 
shall make a determination as 
to whether a skilled nursing 
facility violated a requirement 
or prohibition of this 
subparagraph within 48 hours of 
commencing its investigation.
``(bb) Violations.--If the 
agency determines that a 
facility has violated such a 
requirement or prohibition, the 
agency shall--

``(AA) require the 
facility to allow 
immediate access to the 
essential caregiver in 
question;

``(BB) require the 
facility to establish a 
corrective action plan 
to prevent the 
recurrence of such 
violation within a 7-
day period of receiving 
notice from the agency; 
and

``(CC) impose a 
civil money penalty in 
an amount to be 
determined by the 
agency (not to exceed 
$5,000) if such 
facility fails to 
implement the 
corrective action plan 
within the 7-day period 
specified in subitem 
(BB).

``(vii) Definition of essential 
caregiver.--For purposes of this subparagraph, 
the term `essential caregiver' means, with 
respect to a resident of a skilled nursing 
facility, an individual who--
``(I) is designated by or on behalf 
of the resident pursuant to clause (i) 
or clause (ii); and
``(II) agrees to follow all safety 
protocols established by such facility, 
which shall be clearly specified in 
writing and may be no more restrictive 
than the safety protocols (including 
safety standards and entry 
requirements) applicable to staff of 
such facility.''.
(b) Medicaid Nursing Facilities.--Section 1919(c)(3) of the Social 
Security Act (42 U.S.C. 1396r(c)(3)) is amended--
(1) by redesignating subparagraphs (A) through (E) as 
clauses (i) through (v), respectively;
(2) by striking ``A nursing facility must--'' and inserting 
the following:
``(A) In general.--A nursing facility must--''; and
(3) by adding at the end the following new subparagraph:
``(B) Access to essential caregivers during 
emergency periods when visitation is otherwise 
restricted.--
``(i) Designation of essential caregiver.--
Each nursing facility must recognize the right 
of each resident of such facility to--
``(I) designate and have access to 
essential caregivers for such resident 
at all times, including during any 
period of emergency in which regular 
visitation is restricted by order of a 
Federal, State, or local authority or 
by other operation of law; and
``(II) amend such designation at 
any time.
``(ii) Presumption of designation.--For 
purposes of clause (i), in the case of a 
resident who is unable, by reason of cognitive 
or mental disability, to make an election 
described in such clause, the resident 
representative (as defined in section 483.5 of 
title 42, Code of Federal Regulations) of such 
resident may be permitted to make such 
designation for such resident.
``(iii) Access to essential caregivers 
during emergency periods when visitation is 
otherwise restricted.--During a period of 
emergency in which regular visitation is 
restricted by order of a Federal, State, or 
local authority or by other operation of law, 
including any period in which a waiver or 
modification of requirements pursuant to 
section 1135 is in effect, a nursing facility 
must--
``(I) not deny in-person access to 
a resident by an essential caregiver of 
the resident except as provided in this 
subparagraph;
``(II) allow at least 1 essential 
caregiver to have access to and provide 
assistance to such resident at such 
facility every day and at any time;
``(III) enforce the agreement 
described in clause (vii)(II) with 
respect to an essential caregiver; and
``(IV) provide reasonable 
accommodations to protect the rights of 
a roommate co-living with a resident 
who has an essential caregiver.
``(iv) Restrictions on access.--
``(I) In general.--During a period 
of emergency in which regular 
visitation is restricted by order of a 
Federal, State, or local authority or 
by other operation of law, including 
any period in which a waiver or 
modification of requirements pursuant 
to section 1135 is in effect, a nursing 
facility--
``(aa) may, subject to item 
(bb), deny access to a resident 
by an essential caregiver of 
the resident for--

``(AA) an initial 
period of not longer 
than 7 days; and

``(BB) one 
additional period of 
not longer than 7 days 
(in addition to the 
initial period 
described in subitem 
(AA)) if the department 
of health or other 
applicable agency of 
the State in which the 
facility is located 
approves the denial of 
access for such 
additional period; and

``(bb) must allow access to 
a resident who is in end-of-
life care or a resident in 
decline or distress, as defined 
by the Secretary.
``(II) Rule of application.--For 
purposes of subclause (I), a period of 
emergency in which regular visitation 
is restricted by order of a Federal, 
State, or local authority or by other 
operation of law shall begin on the 
date that such order or other operation 
of law takes effect and shall end on 
the date that such order or other 
operation of law expires or is 
otherwise terminated. During any such 
period, the maximum number of days for 
which a nursing facility may deny 
access to a resident by an essential 
caregiver of the resident is 7 total 
days (or, subject to the approval of 
the department of health or other 
applicable agency of the State in which 
the facility is located, 14 total 
days).
``(v) Compliance and notification.--
``(I) Authority.--No essential 
caregiver who upholds the agreement 
described in clause (vii)(II) shall be 
denied access to the nursing facility 
of the resident involved.
``(II) Notification.--If an 
essential caregiver fails to comply 
with an agreement with a nursing 
facility described in clause (vii)(II), 
the facility must first provide a 
warning to the essential caregiver and 
resident in writing citing specific 
issues of non-compliance and providing 
clear guidance for corrective measures.
``(III) Enforcement.--If an 
essential caregiver or resident, after 
receiving a notification of 
noncompliance described in subclause 
(II), fails to take corrective action, 
the essential caregiver may 
subsequently be denied access to the 
resident. In such cases, the facility 
shall provide to such caregiver and 
such resident (or health care proxy of 
such resident), not later than 24 hours 
after such denial of access occurs, a 
written explanation as to why such 
caregiver was denied access to such 
resident. Such explanation must include 
the resident's and caregiver's options 
for appeal under the processes 
established under clause (vi).
``(vi) Options for residents and caregivers 
to appeal denials of access.--
``(I) In general.--Not later than 2 
years after the date of enactment of 
this subparagraph, the Secretary shall 
issue a final rule establishing a 
process for residents and caregivers to 
appeal denials of access to the State 
survey agency.
``(II) Appeals process.--The State 
survey agency shall--
``(aa) receive appeals from 
residents and essential 
caregivers challenging a 
decision by a nursing facility 
to deny access under clause 
(v); and
``(bb) begin investigating 
such appeals not later than 2 
business days after receiving 
such appeals.
``(III) Burden of proof.--During an 
appeal received under the appeals 
process established under subclause 
(I), if a nursing facility defends a 
decision to deny access to an essential 
caregiver under clause (v) on the basis 
that the essential caregiver violated 
the agreement described in clause 
(vii)(II), the nursing facility shall 
have the burden of proof in 
demonstrating that the essential 
caregiver violated such agreement.
``(IV) Resolution of appeals.--
``(aa) Determination.--With 
respect to an appeal received 
under the appeals process 
established under subclause 
(I), the State survey agency 
shall make a determination as 
to whether a nursing facility 
violated a requirement or 
prohibition of this 
subparagraph within 48 hours of 
commencing its investigation.
``(bb) Violations.--If the 
agency determines that a 
facility has violated such a 
requirement or prohibition, the 
agency shall--

``(AA) require the 
facility to allow 
immediate access to the 
essential caregiver in 
question;

``(BB) require the 
facility to establish a 
corrective action plan 
to prevent the 
recurrence of such 
violation within a 7-
day period of receiving 
notice from the agency; 
and

``(CC) impose a 
civil money penalty in 
an amount to be 
determined by the 
agency (not to exceed 
$5,000) if such 
facility fails to 
implement the 
corrective action plan 
within the 7-day period 
specified in subitem 
(BB).

``(vii) Definition of essential 
caregiver.--For purposes of this subparagraph, 
the term `essential caregiver' means, with 
respect to a resident of a nursing facility, an 
individual who--
``(I) is designated by or on behalf 
of the resident pursuant to clause (i) 
or clause (ii); and
``(II) agrees to follow all safety 
protocols established by such facility, 
which shall be clearly specified in 
writing and may be no more restrictive 
than the safety protocols (including 
safety standards and entry 
requirements) applicable to staff of 
such facility.''.
(c) Intermediate Care Facilities for the Intellectually Disabled.--
Section 1905(d) of the Social Security Act (42 U.S.C. 1396d(d)) is 
amended--
(1) in paragraph (2), by striking ``and'' at the end;
(2) in paragraph (3), by striking the period and inserting 
``; and''; and
(3) by adding at the end the following new paragraph:
``(4) the institution complies with the requirements 
relating to the designation of, and access to residents by, 
essential caregivers described in section 1919(c)(3)(B) in the 
same manner as if such institution were a nursing facility.''.
(d) Inpatient Rehabilitation Facilities.--Section 1866(a)(1) of the 
Social Security Act (42 U.S.C. 1395cc(a)(1)) is amended--
(1) in subparagraph (X), by striking ``and'' at the end;
(2) in subparagraph (Y), by striking the period at the end 
and inserting ``, and''; and
(3) by inserting after subparagraph (Y) the following new 
subparagraph:
``(Z) in the case of an inpatient rehabilitation facility 
that is located on the same campus (as defined by the 
Secretary) as a skilled nursing facility, nursing facility (as 
defined in section 1919(a)), or intermediate care facility for 
the intellectually disabled (as described in section 1905(d)), 
to comply with the requirements relating to the designation of, 
and access to residents by, essential caregivers described in 
section 1819(c)(3)(B) in the same manner as if such institution 
were a skilled nursing facility.''.
(e) Regulations.--The Secretary of Health and Human Services shall, 
after consultation with stakeholders (including residents, family 
members, long-term care ombudsmen, other advocates of nursing home 
residents, and nursing home providers), promulgate regulations to carry 
out this Act and the amendments made by this Act.
(f) Rules of Construction.--
(1) No new authority for state and local officials to 
restrict visitation at nursing facilities.--Nothing in this 
section or the amendments made by this section shall be 
construed as creating any new authority for State or local 
officials to restrict visitation at nursing facilities.
(2) No new authority for nursing facilities to unilaterally 
restrict visitation.--Nothing in this section or the amendments 
made by this section shall be construed as creating any new 
authority for a skilled nursing facility or nursing facility 
(as such terms are defined in sections 1819 and 1919 of the 
Social Security Act, respectively (42 U.S.C. 1395i-3, 1396r)) 
to restrict visitation.
(g) Effective Date.--The amendments made by this Act shall take 
effect on the date that is 2 years after the date of enactment of this 
Act, and shall apply with respect to periods beginning on or after such 
date in which regular visitation at nursing facilities is restricted by 
order of a Federal, State, or local authority or by other operation of 
law.
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