Essential Caregivers Act of 2021
This bill requires skilled nursing facilities, nursing facilities, intermediate care facilities for the intellectually disabled, and nearby inpatient rehabilitation facilities to establish an essential caregivers program during a public health emergency.
Under the program, facilities must allow each resident to select up to two essential caregivers to provide daily living assistance, emotional support, or companionship during the emergency. Facilities must afford such caregivers 12 hours of access to residents each day (or unlimited access for end-of-life care), and caregivers must agree to follow facility protocols for staff safety. Facilities may deny access to caregivers who violate protocols, subject to certain notification requirements; the Centers for Medicare & Medicaid Services must establish an appeals process relating to such decisions and may take specified enforcement actions against facilities that violate the bill's requirements.
[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3733 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 3733
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 public health emergency under the Medicare and Medicaid programs.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 4, 2021
Ms. Tenney (for herself, Mr. Larson of Connecticut, Ms. Stefanik, Mr.
Rutherford, Ms. Herrell, Mr. Cawthorn, Ms. Spanberger, Mr. Budd, Mr.
Van Drew, and Mr. Cohen) 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 public health emergency under the Medicare and Medicaid programs.
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 2021''.
SEC. 2. RIGHT TO ESSENTIAL CAREGIVERS.
During a public health emergency declared by the Secretary of
Health and Human Services under section 319 of the Public Health
Service Act, a resident of any skilled nursing facility (as defined in
section 1819(a) of the Social Security Act (42 U.S.C. 1395i-3(a))),
nursing facility (as defined in section 1919(a) of such Act (42 U.S.C.
1396r(a))), inpatient rehabilitation facility described in section
1886(a)(1)(Z) of such Act (42 U.S.C. 1395cc(a)(1)(Z)), or intermediate
care facility for the intellectually disabled (as defined in section
1905(d) of such Act (42 U.S.C. 1396d(d)) has the right to designate two
essential caregivers to have access to and provide assistance and
support to the resident at any time notwithstanding any waiver made
under section 1135 of the Social Security Act (42 U.S.C. 1320b-5). The
resident may change who is designated as an essential caregiver.
SEC. 3. REQUIRING FACILITIES TO PERMIT ESSENTIAL CAREGIVERS ACCESS
DURING ANY PUBLIC HEALTH EMERGENCY.
(a) Skilled Nursing Facilities; Nursing Facilities.--Section
1819(c) and 1919(c) of the Social Security Act (42 U.S.C. 1395i-3(c),
1396r(c)) are each amended--
(1) in paragraph (3)--
(A) in subparagraph (D), by striking ``and'' at the
end;
(B) in subparagraph (E), by striking the period and
inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(F) implement and maintain, during any public
health emergency declared by the Secretary under
section 319 of the Public Health Service Act on or
after the date of the enactment of this subparagraph
for the area in which such facility is located and
notwithstanding any waiver made under section 1135, the
essential caregivers program described in paragraph
(7).''; and
(2) by adding at the end the following new paragraph:
``(7) Essential caregivers program.--
``(A) In general.--For purposes subparagraph (F) of
paragraph (3), the essential caregivers program
described in this paragraph is a program implemented by
a facility described in such paragraph under which such
facility shall--
``(i) allow each resident of such facility
the unqualified ability to elect not more than
2 essential caregivers (as defined in
subparagraph (D)) to have access to, and
provide assistance (as described in
subparagraph (C)(i)) to, such resident at such
facility, and allow each such resident to amend
such election at any time;
``(ii) permit each such caregiver so
elected by such resident to provide such
assistance to such resident at such facility
for 12 hours every day (or, in the case such
care is end-of-life care, for an unlimited
number of hours every day); and
``(iii) enforce the agreement described in
subparagraph (C)(ii) with respect to an
essential caregiver.
``(B) Presumption of election.--For purposes of
subparagraph (A), in the case of a resident who is
unable, by reason of physical or mental disability, to
make an election described in such subparagraph, the
resident representative (as defined in section 483.5 of
title 42, Code of Federal Regulations) of such resident
shall be permitted to make such election for such
resident.
``(C) Essential caregiver defined.--For purposes of
this paragraph, the term `essential caregiver' means,
with respect to a resident of a facility described in
subparagraph (A), an individual who--
``(i) will provide assistance consisting of
activities of daily living, emotional support,
or companionship to such resident; and
``(ii) agrees to follow all safety
protocols established by such facility, which
shall be clearly specified in writing and be
the same as such protocols (including safety
standards and entry requirements) applicable to
staff of such facility.''.
(b) 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 implements and maintains, during any
public health emergency declared by the Secretary on or after
the date of the enactment of this paragraph under section 319
of the Public Health Service Act for the area in which such
institution is located and notwithstanding any waiver made
under section 1135, the essential caregivers program described
in section 1919(c)(7) in the same manner as if such institution
were a nursing facility.''.
(c) 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 establish and maintain, during any public health emergency
declared by the Secretary on or after the date of the enactment
of this paragraph under section 319 of the Public Health
Service Act for the area in which such institution is located
and notwithstanding any waiver made under section 1135, the
essential caregivers program described in section 1819(c)(7) in
the same manner as if such institution were a skilled nursing
facility.''.
(d) Compliance and Notification.--
(1) Authority.--No caregiver who meets the definition of an
essential caregiver in clause (i) of paragraph (7)(C) of either
section 1819(c) and 1919(c) of the Social Security Act and who
upholds the agreement described in clause (ii) of such
paragraph shall be denied access to the skilled nursing
facility (as defined in section 1819(a) of the Social Security
Act (42 U.S.C. 1395i-3(a))), nursing facility (as defined in
section 1919(a) of such Act (42 U.S.C. 1396r(a))), inpatient
rehabilitation facility described in section 1886(a)(1)(Z) of
such Act (42 U.S.C. 1395cc(a)(1)(Z)), or intermediate care
facility for the intellectually disabled (as defined in section
1905(d) of such Act (42 U.S.C. 1396d(d)) of the resident
involved.
(2) Notification.-- In the event of non-compliance with
either such clause, such 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.
(3) Enforcement.--Should the essential caregiver or
resident fail to take corrective action, they may be
subsequently denied access. 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
failure to allow access occurs, a written explanation as to why
such care-giver was not permitted to furnish such assistance to
such resident. Such explanation must include the resident's and
caregivers' options for appeal (as described in subsection
(e)).
(e) Options for Resident and Caregiver Appeal.--
(1) In general.--During any period in which any skilled
nursing facility (as defined in section 1819(a) of the Social
Security Act (42 U.S.C. 1395i-3(a))), nursing facility (as
defined in section 1919(a) of such Act (42 U.S.C. 1396r(a))),
inpatient rehabilitation facility described in section
1886(a)(1)(Z) of such Act (42 U.S.C. 1395cc(a)(1)(Z)), or
intermediate care facility for the intellectually disabled (as
defined in section 1905(d) of such Act (42 U.S.C. 1396d(d)) is
required to establish and maintain the essential caregivers
program under section 1819(c)(3)(F) of such Act, section
1919(c)(3) of such Act, or section 1905(d)(4) of such Act (as
added by subsections (a) and (b)), the Secretary of Health and
Human Services shall, not later than 15 days after the first
day of such period, establish and maintain a process to--
(A) receive appeals from residents and caregivers
challenging a decision to deny access; and
(B) investigate all such appeals within 48 hours of
receipt.
(f) Enforcement.--With respect to appeals received under paragraph
(1), the Secretary of Heath and Human Services shall make a
determination as to whether a facility described in subsection (e)(1)
violated a requirement or prohibition in this Act or in an amendment
made by this Act within 7 days of commencing its investigation. If the
Secretary determines that a facility has violated a requirement or
prohibition in this Act or in an amendment made by this Act, the
Secretary shall--
(1) 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 Secretary; and
(2) impose a civil money penalty in an amount to be
determined by the Secretary if such facility fails to implement
the corrective action plan with the 7-day period specified in
paragraph (1).
(g) 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.
<all>
Introduced in House
Introduced in House
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.
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.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
Sponsor introductory remarks on measure. (CR H3301-3304)
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