,i  #aag? ,,congress  #a/ ,session  ,h4 
,r4 #cgcc  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,june #d1 #bjba ,ms4  
,t5ney 7= h]self1 ,mr4 ,l>son (         
,connecticut1 ,ms4 ,/efanik1 ,mr4       
,ru!r=d1 ,ms4 ,h]rell1 ,mr4 ,caw?orn1   
,ms4 ,spanb]g]1 ,mr4 ,budd1 ,mr4 ,van   
,drew1 & ,mr4 ,coh57 introduc$ ! foll[+ 
bill2 :i* 0 ref]r$ to ! ,committee on   
,en]gy & ,comm]ce1 & 9 addition to !    
,committee on ,ways & ,means1 = a p]iod 
to be subsequ5tly det]m9$ by ! ,speak]1 
9 ea* case = consid]ation ( su*         
provisions z fall )9 ! jurisdiction ( ! 
committee conc]n$  ,a ,,bill  ,to am5d  
titles ,,xviii & ,,xix ( ! ,social      
,security ,act to require skill$ nurs+  
facilities1 nurs+ facilities1 int]m$iate
 c>e facilities = ! intellectually      
disabl$1 & inpati5t rehabilitation      
facilities to p]mit ess5tial c>egiv]s   
access dur+ any public heal? em]g5cy "u 
! ,m$ic>e & ,m$icaid programs4  #a4     
,%ort title ,?is ,act may be cit$ z !   
,ess5tial ,c>egiv]s ,act ( #bjba4  #b4  

,"r to ess5tial c>egiv]s ,dur+ a public 
heal? em]g5cy decl>$ by ! ,secret>y (   
,heal? & ,human ,s]vices "u section #cai
 ( ! ,public ,heal? ,s]vice ,act1 a     
resid5t ( any skill$ nurs+ facility 7z  
def9$ 9 section #ahai7;a7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#acie;i-#c7;a7771 nurs+ facility 7z     
def9$ 9 section #aiai7;a7 ( su* ,act    
7#db ,u4,s4,c4 #acifr7a7771 inpati5t    
rehabilitation facility describ$ 9      
section #ahhf7;a77#a77,z7 ( su* ,act    
7#db ,u4,s4,c4 #acie;cc7a77#a77,z771 or 
int]m$iate c>e facility = !             
intellectually disabl$ 7z def9$ 9       
section #aije7;d7 ( su* ,act 7#db       
,u4,s4,c4 #acif;d7d77 has ! "r to       
designate two ess5tial c>egiv]s to h    
access to & provide assi/ance & support 
to ! resid5t at any "t not)/&+ any waiv]
 made "u section #aace ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acbj;b-#e74 ,! resid5t may *ange :o is 
designat$ z an ess5tial c>egiv]4  #c4   
,requir+ facilities to p]mit ess5tial   

c>egiv]s access dur+ any public heal?   
em]g5cy  7a7 ,skill$ nurs+ facilities2  
nurs+ facilities ,section #ahai7;c7 &   
#aiai7;c7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acie;i-#c7;c71          
#acifr7c77 are ea* am5d$-- 7#a7 9       
p>agraph 7#c7--  7,a7 9 subp>agraph     
7,d71 by /rik+ & at ! end2  7,b7 9      
subp>agraph 7,e71 by /rik+ ! p]iod &    
ins]t+ 2 &2 &  7,c7 by add+ at ! end !  
foll[+ new subp>agraph3  7,f7 implem5t &
 ma9ta91 dur+ any public heal? em]g5cy  
decl>$ by ! ,secret>y "u section #cai ( 
! ,public ,heal? ,s]vice ,act on or aft]
 ! date ( ! enactm5t ( ?is subp>agraph =
 ! area 9 :i* su* facility is locat$ &  
not)/&+ any waiv] made "u section #aace1
 ! ess5tial c>egiv]s program describ$ 9 
p>agraph 7#g74  2 &  7#b7 by add+ at !  
end ! foll[+ new p>agraph3  7#g7        
,ess5tial c>egiv]s program  7,a7 ,9     
g5]al ,= purposes subp>agraph 7,f7 (    
p>agraph 7#c71 ! ess5tial c>egiv]s      
program describ$ 9 ?is p>agraph is a    
program implem5t$ by a facility describ$

 9 su* p>agraph "u :i* su* facility     
%all--  7i7 all[ ea* resid5t ( su*      
facility ! unqualifi$ ability to elect n
 m ?an #b ess5tial c>egiv]s 7z def9$ 9  
subp>agraph 7,d77 to h access to1 &     
provide assi/ance 7z describ$ 9         
subp>agraph 7,c77i77 to1 su* resid5t at 
su* facility1 & all[ ea* su* resid5t to 
am5d su* election at any "t2  7ii7 p]mit
 ea* su* c>egiv] s elect$ by su* resid5t
 to provide su* assi/ance to su* resid5t
 at su* facility = #ab h\rs e day 7or1 9
 ! case su* c>e is end-(-life c>e1 = an 
unlimit$ numb] ( h\rs e day72 &  7iii7  
en=ce ! agreem5t describ$ 9 subp>agraph 
7,c77ii7 ) respect to an ess5tial       
c>egiv]4  7,b7 ,presumption ( election  
,= purposes ( subp>agraph 7,a71 9 ! case
 ( a resid5t :o is unable1 by reason (  
physical or m5tal disability1 to make an
 election describ$ 9 su* subp>agraph1 ! 
resid5t repres5tative 7z def9$ 9 section
 #dhc4e ( title #db1 ,code ( ,f$]al     
,regulations7 ( su* resid5t %all be     
p]mitt$ to make su* election = su*      

resid5t4  7,c7 ,ess5tial c>egiv] def9$  
,= purposes ( ?is p>agraph1 ! t]m       
ess5tial c>egiv] means1 ) respect to a  
resid5t ( a facility describ$ 9         
subp>agraph 7,a71 an individual :o-- 7i7
 w provide assi/ance consi/+ (          
activities ( daily liv+1 emotional      
support1 or companion%ip to su* resid5t2
 &  7ii7 agrees to foll[ all safety     
protocols e/abli%$ by su* facility1 :i* 
%all be cle>ly specifi$ 9 writ+ & be !  
same z su* protocols 7includ+ safety    
/&>ds & entry requirem5ts7 applicable to
 /aff ( su* facility4  4  7b7           
,int]m$iate c>e facilities = !          
intellectually disabl$ ,section         
#aije7;d7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acif;d7d77 is am5d$--   
7#a7 9 p>agraph 7#b71 by /rik+ & at !   
end2  7#b7 9 p>agraph 7#c71 by /rik+ !  
p]iod & ins]t+ 2 &2 &  7#c7 by add+ at !
 end ! foll[+ new p>agraph3  7#d7 !     
in/itution implem5ts & ma9ta9s1 dur+ any
 public heal? em]g5cy decl>$ by !       
,secret>y on or aft] ! date ( ! enactm5t

 ( ?is p>agraph "u section #cai ( !     
,public ,heal? ,s]vice ,act = ! area 9  
:i* su* in/itution is locat$ & not)/&+  
any waiv] made "u section #aace1 !      
ess5tial c>egiv]s program describ$ 9    
section #aiai7;c77#g7 9 ! same mann] z  
if su* in/itution 7 a nurs+ facility4  4
  7c7 ,inpati5t rehabilitation          
facilities ,section #ahff7;a77#a7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acie;cc7a77#a77 is am5d$-- 7#a7 9      
subp>agraph 7,x71 by /rik+ & at ! end2  
7#b7 9 subp>agraph 7,y71 by /rik+ !     
p]iod at ! end & ins]t+ 1 &2 &  7#c7 by 
ins]t+ aft] subp>agraph 7,y7 ! foll[+   
new subp>agraph3  7,z7 9 ! case ( an    
inpati5t rehabilitation facility t is   
locat$ on ! same campus 7z def9$ by !   
,secret>y7 z a skill$ nurs+ facility1   
nurs+ facility 7z def9$ 9 section       
#aiai7;a771 or int]m$iate c>e facility =
 ! intellectually disabl$ 7z describ$ 9 
section #aije7;d771 to e/abli% & ma9ta91
 dur+ any public heal? em]g5cy decl>$ by
 ! ,secret>y on or aft] ! date ( !      

enactm5t ( ?is p>agraph "u section #cai 
( ! ,public ,heal? ,s]vice ,act = ! area
 9 :i* su* in/itution is locat$ &       
not)/&+ any waiv] made "u section #aace1
 ! ess5tial c>egiv]s program describ$ 9 
section #ahai7;c77#g7 9 ! same mann] z  
if su* in/itution 7 a skill$ nurs+      
facility4  4  7d7 ,compliance &         
notification  7#a7 ,au?ority ,no c>egiv]
 :o meets ! def9ition ( an ess5tial     
c>egiv] 9 clause 7i7 ( p>agraph         
7#g77;,c7 ( ei!r section #ahai7;c7 &    
#aiai7;c7 ( ! ,social ,security ,act &  
:o upholds ! agreem5t describ$ 9 clause 
7ii7 ( su* p>agraph %all be d5i$ access 
to ! skill$ nurs+ facility 7z def9$ 9   
section #ahai7;a7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acie;i-#c7;a7771   
nurs+ facility 7z def9$ 9 section       
#aiai7;a7 ( su* ,act 7#db ,u4,s4,c4     
#acifr7a7771 inpati5t rehabilitation    
facility describ$ 9 section             
#ahhf7;a77#a77,z7 ( su* ,act 7#db       
,u4,s4,c4 #acie;cc7a77#a77,z771 or      
int]m$iate c>e facility = !             

intellectually disabl$ 7z def9$ 9       
section #aije7;d7 ( su* ,act 7#db       
,u4,s4,c4 #acif;d7d77 ( ! resid5t       
involv$4  7#b7 ,notification ,9 ! ev5t (
 non-compliance ) ei!r su* clause1 su*  
facility mu/ fir/ provide a w>n+ to !   
ess5tial c>egiv] & resid5t 9 writ+ cit+ 
specific issues ( non-compliance &      
provid+ cle> guidance = corrective      
measures4  7#c7 ,en=cem5t ,%\ld !       
ess5tial c>egiv] or resid5t fail to take
 corrective action1 !y may be           
subsequ5tly d5i$ access4 ,9 su* cases1 !
 facility %all provide to su* c>egiv] & 
su* resid5t 7or heal? c>e proxy ( su*   
resid5t71 n lat] ?an #bd h\rs aft] su*  
failure to all[ access occurs1 a writt5 
explanation z to :y su* c>e-giv] 0 n    
p]mitt$ to furni% su* assi/ance to su*  
resid5t4 ,su* explanation mu/ include ! 
resid5t's & c>egiv]s' options = appeal  
7z describ$ 9 subsection 7e774  7e7     
,options = ,resid5t & ,c>egiv] ,appeal  
7#a7 ,9 g5]al ,dur+ any p]iod 9 :i* any 
skill$ nurs+ facility 7z def9$ 9 section

 #ahai7;a7 ( ! ,social ,security ,act   
7#db ,u4,s4,c4 #acie;i-#c7;a7771 nurs+  
facility 7z def9$ 9 section #aiai7;a7 ( 
su* ,act 7#db ,u4,s4,c4 #acifr7a7771    
inpati5t rehabilitation facility        
describ$ 9 section #ahhf7;a77#a77,z7 (  
su* ,act 7#db ,u4,s4,c4                 
#acie;cc7a77#a77,z771 or int]m$iate c>e 
facility = ! intellectually disabl$ 7z  
def9$ 9 section #aije7;d7 ( su* ,act    
7#db ,u4,s4,c4 #acif;d7d77 is requir$ to
 e/abli% & ma9ta9 ! ess5tial c>egiv]s   
program "u section #ahai7;c77#c77;,f7 ( 
su* ,act1 section #aiai7;c77#c7 ( su*   
,act1 or section #aije7;d77#d7 ( su*    
,act 7z add$ by subsections 7a7 & 7b771 
! ,secret>y ( ,heal? & ,human ,s]vices  
%all1 n lat] ?an #ae days aft] ! fir/   
day ( su* p]iod1 e/abli% & ma9ta9 a     
process to-- 7,a7 receive appeals f     
resid5ts & c>egiv]s *all5g+ a decision  
to d5y access2 &  7,b7 inve/igate all   
su* appeals )9 #dh h\rs ( receipt4  7f7 
,en=cem5t ,) respect to appeals receiv$ 
"u p>agraph 7#a71 ! ,secret>y ( ,hea? & 

,human ,s]vices %all make a det]m9ation 
z to :e!r a facility describ$ 9         
subsection 7e77#a7 violat$ a requirem5t 
or prohibition 9 ?is ,act or 9 an       
am5dm5t made by ?is ,act )9 #g days (   
comm5c+ its inve/igation4 ,if !         
,secret>y det]m9es t a facility has     
violat$ a requirem5t or prohibition 9   
?is ,act or 9 an am5dm5t made by ?is    
,act1 ! ,secret>y %all--  7#a7 require !
 facility to e/abli% a corrective action
 plan to prev5t ! recurr5ce ( su*       
violation )9 a #g-;day p]iod ( receiv+  
notice f ! ,secret>y2 &  7#b7 impose a  
civil money p5alty 9 an am\nt to be     
det]m9$ by ! ,secret>y if su* facility  
fails to implem5t ! corrective action   
plan ) ! #g-;day p]iod specifi$ 9       
p>agraph 7#a74  7g7 ,regulations ,!     
,secret>y ( ,heal? & ,human ,s]vices    
%all1 aft] consultation ) /akehold]s    
7includ+ resid5ts1 family memb]s1       
long-t]m c>e ombudsm51 o!r advocates (  
nurs+ home resid5ts1 & nurs+ home       
provid]s1 promulgate regulations to c>ry

 out ?is ,act4