,i  #aah? ,,congress  #b;d ,session  ,h4
 ,r4 #hcca  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,may #h1 #bjbd,ms4    
,t5ney 7= h]self1 ,mr4 ,l>son (         
,connecticut1 ,mr4 ,fitzpatrick1 ,mr4   
,smi? ( ,nebraska1 ,mr4 ,ru!r=d1 ,mr4   
,van ,ord51 ,ms4 ,wild1 ,mr4 ,c>ey1 ,mr4
 ,lawl]1 ,mr4 ,cleav]1 ,ms4 ,lee (      
,nevada1 ,mr4 ,ciscomani1 ,mr4 ,bacon1  
,mr4 ,davis ( ,nor? ,c>ol9a1 ,mr4 ,coh51
 & ,mr4 ,langwor?y7 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 p]iod 9 :i* regul>      

visitation is re/rict$4  #a4 ,%ort title
 ,?is ,act may be cit$ z ! ,ess5tial    
,c>egiv]s ,act ( #bjbd4  #b4 ,f9d+s     
,congress f9ds ! foll[+3  7#a7 ,accord+ 
to ! ,national ,c5t] = ,heal? ,/ati/ics 
( ! ,c5t]s = ,disease ,control &        
,prev5tion1 an e/imat$ #a1cjj1jjj       
individuals resid$ 9 nurs+ homes 9 #bjbj
 at ! onset ( ! ,,covid-#ai p&emic &    
ne>ly half ( all nurs+ home resid5ts 7  
liv+ ) a diagnosis ( ,alzheim]'s or o!r 
relat$ dem5tia4  7#b7 ,regulations issu$
 pursuant to ! ,nurs+ ,home ,re=m ,act (
 #aihg e/abli%$ basic rights & s]vices =
 resid5ts ( nurs+ homes1 includ+ ! "r to
 a dignifi$ exi/5ce1 self-det]m9ation1 &
 communication ) & access to p]sons &   
s]vices inside & outside ! facility4    
7#c7 ,9 ,m>* ( #bjbj1 ! ,c5t]s = ,m$ic>e
  ,m$icaid ,s]vices in/ruct$ nurs+      
facilities to re/rict visitation = all  
visitors & non-ess5tial heal?c>e        
p]sonnel & cancel communal d9+ & gr\p   
activities4 ,long-t]m c>e ombudsman     
program repres5tatives & ,/ate surveyors

 7 among ^? ^: access to long-t]m c>e   
facilities 0 prohibit$ or extremely     
re/rict$ despite reop5+ guidance releas$
 by ! ,c5t]s = ,m$ic>e  ,m$icaid        
,s]vices 9 ,may ( #bjbj4  7#d7 ,_m      
long-t]m c>e resid5ts decl9$            
dramatically or di$ prematurely f       
failure to ?rive 9 isolation4  7#e7     
,accord+ to ! ,national ,consum] ,voice 
= ,quality ,long-,t]m ,c>e1 9 ! fir/ ye>
 ( ! ,,covid-#ai p&emic1 #a 9 #e        
heal?c>e work]s resign$1 retir$1 or 7   
fir$4 ,?is exac]bat$ ! long/&+ problem (
 /aff %ortages t already exi/$4 ,lack ( 
/aff1 comb9$ ) ! =c$ abs5ce ( families1 
_m ( :om provid$ in=mal c>e & support to
 resid5ts1 result$ 9 a significant      
decl9e 9 resid5ts' heal? & well-be+4    
,dur+ ! p&emic1 pressure ulc]s 9 nurs+  
home resid5ts rose by #ca p]c5t1 ! numb]
 ( resid5ts exp]i5c+ significant weight 
loss rose by #di p]c5t1 ! numb] (       
resid5ts report+ feel+ d[n1 depress$1 or
 hopeless rose by #dj p]c5t1 & ! numb] (
 resid5ts prescrib$ antipsy*otic        

m$ications rose by #gg4e p]c5t4  7#f7   
,accord+ to ! ,dep>tm5t ( ,heal? &      
,human ,s]vices1 lonel9ess & isolation1 
su* z t exp]i5c$ by long-t]m c>e        
resid5ts dur+ ! ,,covid-#ai p&emic1     
repres5t pr(\nd ?reats to an            
individual's heal? & well-be+4  7#g7    
,ess5tial ,c>egiv]s provide supplem5tal 
c>e = _! lov$ "o1 reg>dless ( /aff      
%ortages1 /aff turnov]1 or em]g5cies4   
,ess5tial ,c>egiv]s support resid5ts &  
advocate on _! behalf4  #c4 ,"r to      
ess5tial c>egiv]s2 access to ess5tial   
c>egiv]s dur+ p]iods :5 visitation is   
o!rwise re/rict$  7a7 ,m$ic>e skill$    
nurs+ facilities ,section #ahai7;c77#c7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acie;i-#c7;c77#c77 is am5d$--
  7#a7 by r$esignat+ subp>agraphs 7,a7  
?r\gh 7,e7 z clauses 7i7 ?r\gh 7v71     
respectively2  7#b7 by /rik+ ,a skill$  
nurs+ facility mu/-- & ins]t+ ! foll[+3 
7,a7 ,9 g5]al ,a skill$ nurs+ facility  
%all--  2 &  7#c7 by add+ at ! end !    
foll[+ new subp>agraph3  7,b7 ,access to

 ess5tial c>egiv]s dur+ em]g5cy p]iods  
:5 visitation is o!rwise re/rict$  7i7  
,designation ( ess5tial c>egiv] ,ea*    
skill$ nurs+ facility %all recognize !  
"r ( ea* resid5t ( su* facility to--    
7,i7 designate & h access to ess5tial   
c>egiv]s = su* resid5t at all times1    
includ+ dur+ any p]iod ( em]g5cy 9 :i*  
regul> visitation is re/rict$ by ord] ( 
a ,f$]al1 ,/ate1 or local au?ority or by
 o!r op]ation ( law2 &  7,,ii7 am5d su* 
designation at any "t4  7ii7            
,presumption ( designation ,= purposes (
 clause 7i71 9 ! case ( a resid5t :o is 
unable1 by reason ( cognitive or m5tal  
disability1 to make an election describ$
 9 su* clause1 ! resid5t repres5tative  
7z def9$ 9 section #dhc4e ( title #db1  
,code ( ,f$]al ,regulations7 ( su*      
resid5t %all be p]mitt$ to make su*     
designation = su* resid5t4  7iii7       
,access to ess5tial c>egiv]s dur+       
em]g5cy p]iods :5 visitation is o!rwise 
re/rict$ ,dur+ a p]iod ( em]g5cy 9 :i*  
regul> visitation is re/rict$ by ord] ( 

a ,f$]al1 ,/ate1 or local au?ority or by
 o!r op]ation ( law1 includ+ any p]iod 9
 :i* a waiv] or modification (          
requirem5ts pursuant to section #aace is
 9 effect1 a skill$ nurs+ facility      
%all-- 7,i7 n d5y 9-p]son access to a   
resid5t by an ess5tial c>egiv] ( !      
resid5t except z provid$ 9 ?is          
subp>agraph2  7,,ii7 all[ at lea/ #a    
ess5tial c>egiv] to h access to &       
provide assi/ance to su* resid5t at su* 
facility e day & at any "t2 &  7,,iii7  
en=ce ! agreem5t describ$ 9 clause      
7vii77,,iii7 ) respect to an ess5tial   
c>egiv]4  7iv7 ,re/rictions on access   
7,i7 ,9 g5]al ,dur+ a p]iod ( em]g5cy 9 
:i* regul> visitation is re/rict$ by    
ord] ( a ,f$]al1 ,/ate1 or local        
au?ority or by o!r op]ation ( law1      
includ+ any p]iod 9 :i* a waiv] or      
modification ( requirem5ts pursuant to  
section #aace is 9 effect1 a skill$     
nurs+ facility may d5y access to a      
resid5t by an ess5tial c>egiv] ( !      
resid5t =-- 7aa7 an initial p]iod ( n   

long] ?an #g days2 &  7bb7 "o additional
 p]iod ( n long] ?an #g days 79 addition
 to ! initial p]iod describ$ 9 item     
7aa77 if ! dep>tm5t ( heal? ( ! ,/ate 9 
:i* ! facility is locat$ approves !     
d5ial ( access = su* additional p]iod4  
7,,ii7 ,rule ( application ,= purposes (
 subclause 7,i71 a p]iod ( em]g5cy 9 :i*
 regul> visitation is re/rict$ by ord] (
 a ,f$]al1 ,/ate1 or local au?ority or  
by o!r op]ation ( law %all beg9 on !    
date t su* ord] or o!r op]ation ( law   
takes effect & %all end on ! date t su* 
ord] or o!r op]ation ( law expires or is
 o!rwise t]m9at$4 ,dur+ any su* p]iod1 !
 maximum numb] ( days = :i* a skill$    
nurs+ facility may d5y access to a      
resid5t by an ess5tial c>egiv] ( !      
resid5t is #g total days 7or1 subject to
 ! approval ( ! dep>tm5t ( heal? ( !    
,/ate 9 :i* ! facility is locat$1 #ad   
total days74  7v7 ,compliance &         
notification  7,i7 ,au?ority ,no        
ess5tial c>egiv] :o upholds ! agreem5t  
describ$ 9 clause 7vii77,,iii7 %all be  

d5i$ access to ! skill$ nurs+ facility (
 ! resid5t involv$4  7,,ii7             
,notification ,if an ess5tial c>egiv]   
fails to comply ) an agreem5t ) a skill$
 nurs+ facility describ$ 9 clause       
7vii77,,iii71 ! 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,,iii7 ,en=cem5t
 ,if an ess5tial c>egiv] or resid5t1    
aft] receiv+ a notification (           
noncompliance describ$ 9 subclause      
7,,ii71 fails to take corrective action1
 ! ess5tial c>egiv] may subsequ5tly be  
d5i$ access to ! resid5t4 ,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*  
d5ial ( access occurs1 a writt5         
explanation z to :y su* c>egiv] 0 d5i$  
access to su* resid5t4 ,su* explanation 
mu/ include ! resid5t's & c>egiv]'s     
options = appeal "u ! processes e/abli%$
 "u clause 7vi74  7vi7 ,options =       

resid5ts & c>egiv]s to appeal d5ials (  
access  7,i7 ,9 g5]al ,n lat] ?an #b    
ye>s aft] ! date ( enactm5t ( ?is       
subp>agraph1 ! ,secret>y %all issue a   
f9al rule e/abli%+ a process = resid5ts 
& c>egiv]s to appeal d5ials ( access4   
7,,ii7 ,appeals process ,! ag5cy        
responsible = ov]see+ ! appeals process 
e/abli%$ "u subclause 7,i7 %all-- 7aa7  
receive appeals f resid5ts & ess5tial   
c>egiv]s *all5g+ a decision by a skill$ 
nurs+ facility to d5y access "u clause  
7v72 &  7bb7 inve/igate all su* appeals 
)9 #dh h\rs ( receipt4  7,,iii7 ,burd5 (
 pro( ,dur+ an appeal receiv$ "u !      
appeals process e/abli%$ "u subclause   
7,i71 if a skill$ nurs+ facility def5ds 
a decision to d5y access to an ess5tial 
c>egiv] "u clause 7v7 on ! basis t !    
ess5tial c>egiv] violat$ ! agreem5t     
describ$ 9 clause 7vii77,,iii71 ! skill$
 nurs+ facility %all h ! burd5 ( pro( 9 
demon/rat+ t ! ess5tial c>egiv] violat$ 
su* agreem5t4  7,,iv7 ,resolution (     
appeal ,) respect to an appeal receiv$  

"u ! appeals process e/abli%$ "u        
subclause 7,i71 ! ag5cy responsible =   
ov]see+ ! appeal %all make a det]m9ation
 z to :e!r a skill$ nurs+ facility      
violat$ a requirem5t or prohibition (   
?is subp>agraph )9 #dh h\rs ( comm5c+   
its inve/igation4 ,if ! ag5cy det]m9es t
 a facility has violat$ su* a requirem5t
 or prohibition ! ag5cy %all-- 7aa7     
require ! facility to all[ imm$iate     
access to ! ess5tial c>egiv] 9 "q2  7bb7
 require ! facility to e/abli% a        
corrective action plan to prev5t !      
recurr5ce ( su* violation )9 a #g-;day  
p]iod ( receiv+ notice f ! ag5cy2 &     
7cc7 impose a civil money p5alty 9 an   
am\nt to be det]m9$ by ! ag5cy 7n to    
exce$ #e1jjj7 if su* facility fails to  
implem5t ! corrective action plan ) !   
#g-;day p]iod specifi$ 9 item 7bb74     
7vii7 ,def9ition ( ess5tial c>egiv] ,=  
purposes ( ?is subp>agraph1 ! t]m       
ess5tial c>egiv] means1 ) respect to a  
resid5t ( a skill$ nurs+ facility1 an   
individual :o-- 7,i7 is designat$ by or 

on behalf ( ! resid5t pursuant to clause
 7i7 or clause 7ii72  7,,ii7 w provide  
assi/ance to su* resid5t1 :i* may       
include assi/ance ) activities ( daily  
liv+ or provid+ emotional support or    
companion%ip to su* resid5t2 &  7,,iii7 
agrees to foll[ all safety protocols    
e/abli%$ by su* facility1 :i* %all be   
cle>ly specifi$ 9 writ+ & may be no m   
re/rictive ?an ! safety protocols       
7includ+ safety /&>ds & entry           
requirem5ts7 applicable to /aff ( su*   
facility4  4  7b7 ,m$icaid nurs+        
facilities ,section #aiai7;c77#c7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acifr7c77#c77 is am5d$-- 7#a7 by       
r$esignat+ subp>agraphs 7,a7 ?r\gh 7,e7 
z clauses 7i7 ?r\gh 7v71 respectively2  
7#b7 by /rik+ ,a nurs+ facility mu/-- & 
ins]t+ ! foll[+3  7,a7 ,9 g5]al ,a nurs+
 facility %all--  2 &  7#c7 by add+ at !
 end ! foll[+ new subp>agraph3  7,b7    
,access to ess5tial c>egiv]s dur+       
em]g5cy p]iods :5 visitation is o!rwise 
re/rict$  7i7 ,designation ( ess5tial   

c>egiv] ,ea* nurs+ facility %all        
recognize ! "r ( ea* resid5t ( su*      
facility to--  7,i7 designate & h access
 to ess5tial c>egiv]s = su* resid5t at  
all times1 includ+ dur+ any p]iod (     
em]g5cy 9 :i* regul> visitation is      
re/rict$ by ord] ( a ,f$]al1 ,/ate1 or  
local au?ority or by o!r op]ation ( law2
 &  7,,ii7 am5d su* designation at any  
"t4  7ii7 ,presumption ( designation ,= 
purposes ( clause 7i71 9 ! case ( a     
resid5t :o is unable1 by reason (       
cognitive or m5tal disability1 to make  
an election describ$ 9 su* clause1 !    
resid5t repres5tative 7z def9$ 9 section
 #dhc4e ( title #db1 ,code ( ,f$]al     
,regulations7 ( su* resid5t %all be     
p]mitt$ to make su* designation = su*   
resid5t4  7iii7 ,access to ess5tial     
c>egiv]s dur+ em]g5cy p]iods :5         
visitation is o!rwise re/rict$ ,dur+ a  
p]iod ( em]g5cy 9 :i* regul> visitation 
is re/rict$ by ord] ( a ,f$]al1 ,/ate1  
or local au?ority or by o!r op]ation (  
law1 includ+ any p]iod 9 :i* a waiv] or 

modification ( requirem5ts pursuant to  
section #aace is 9 effect1 a nurs+      
facility %all--  7,i7 n d5y 9-p]son     
access to a resid5t by an ess5tial      
c>egiv] ( ! resid5t except z provid$ 9  
?is subp>agraph2  7,,ii7 all[ at lea/ #a
 ess5tial c>egiv] to h access to &      
provide assi/ance to su* resid5t at su* 
facility e day & at any "t2 &  7,,iii7  
en=ce ! agreem5t describ$ 9 clause      
7vii77,,iii7 ) respect to an ess5tial   
c>egiv]4  7iv7 ,re/rictions on access   
7,i7 ,9 g5]al ,dur+ a p]iod ( em]g5cy 9 
:i* regul> visitation is re/rict$ by    
ord] ( a ,f$]al1 ,/ate1 or local        
au?ority or by o!r op]ation ( law1      
includ+ any p]iod 9 :i* a waiv] or      
modification ( requirem5ts pursuant to  
section #aace is 9 effect1 a nurs+      
facility may d5y access to a resid5t by 
an ess5tial c>egiv] ( ! resid5t =--     
7aa7 an initial p]iod ( n long] ?an #g  
days2 &  7bb7 "o additional p]iod ( n   
long] ?an #g days 79 addition to !      
initial p]iod describ$ 9 item 7aa77 if !

 dep>tm5t ( heal? ( ! ,/ate 9 :i* !     
facility is locat$ approves ! d5ial (   
access = su* additional p]iod4  7,,ii7  
,rule ( application ,= purposes (       
subclause 7,i71 a p]iod ( em]g5cy 9 :i* 
regul> visitation is re/rict$ by ord] ( 
a ,f$]al1 ,/ate1 or local au?ority or by
 o!r op]ation ( law %all beg9 on ! date 
t su* ord] or o!r op]ation ( law takes  
effect & %all end on ! date t su* ord]  
or o!r op]ation ( law expires or is     
o!rwise t]m9at$4 ,dur+ any su* p]iod1 ! 
maximum numb] ( days = :i* a nurs+      
facility may d5y access to a resid5t by 
an ess5tial c>egiv] ( ! resid5t is #g   
total days 7or1 subject to ! approval ( 
! dep>tm5t ( heal? ( ! ,/ate 9 :i* !    
facility is locat$1 #ad total days74    
7v7 ,compliance & notification  7,i7    
,au?ority ,no ess5tial c>egiv] :o       
upholds ! agreem5t describ$ 9 clause    
7vii77,,iii7 %all be d5i$ access to !   
nurs+ facility ( ! resid5t involv$4     
7,,ii7 ,notification ,if an ess5tial    
c>egiv] fails to comply ) an agreem5t ) 

a nurs+ facility describ$ 9 clause      
7vii77,,iii71 ! 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,,iii7 ,en=cem5t
 ,if an ess5tial c>egiv] or resid5t1    
aft] receiv+ a notification (           
noncompliance describ$ 9 subclause      
7,,ii71 fails to take corrective action1
 ! ess5tial c>egiv] may subsequ5tly be  
d5i$ access to ! resid5t4 ,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*  
d5ial ( access occurs1 a writt5         
explanation z to :y su* c>egiv] 0 d5i$  
access to su* resid5t4 ,su* explanation 
mu/ include ! resid5t's & c>egiv]'s     
options = appeal "u ! processes e/abli%$
 "u clause 7vi74  7vi7 ,options =       
resid5ts & c>egiv]s to appeal d5ials (  
access  7,i7 ,9 g5]al ,n lat] ?an #b    
ye>s aft] ! date ( enactm5t ( ?is       
subp>agraph1 ! ,secret>y %all issue a   

f9al rule e/abli%+ a process = resid5ts 
& c>egiv]s to appeal d5ials ( access4   
7,,ii7 ,appeals process ,! ag5cy        
responsible = ov]see+ ! appeals process 
e/abli%$ "u subclause 7,i7 %all--  7aa7 
receive appeals f resid5ts & ess5tial   
c>egiv]s *all5g+ a decision by a nurs+  
facility to d5y access "u clause 7v72 & 
7bb7 inve/igate all su* appeals )9 #dh  
h\rs ( receipt4  7,,iii7 ,burd5 ( pro(  
,dur+ an appeal receiv$ "u ! appeals    
process e/abli%$ "u subclause 7,i71 if a
 nurs+ facility def5ds a decision to d5y
 access to an ess5tial c>egiv] "u clause
 7v7 on ! basis t ! ess5tial c>egiv]    
violat$ ! agreem5t describ$ 9 clause    
7vii77,,iii71 ! nurs+ facility %all h ! 
burd5 ( pro( 9 demon/rat+ t ! ess5tial  
c>egiv] violat$ su* agreem5t4  7,,iv7   
,resolution ( appeal ,) respect to an   
appeal receiv$ "u ! appeals process     
e/abli%$ "u subclause 7,i71 ! ag5cy     
responsible = ov]see+ ! appeal %all make
 a det]m9ation z to :e!r a nurs+        
facility violat$ a requirem5t or        

prohibition ( ?is subp>agraph )9 #dh    
h\rs ( comm5c+ its inve/igation4 ,if !  
ag5cy det]m9es t a facility has violat$ 
su* a requirem5t or prohibition ! ag5cy 
%all--  7aa7 require ! facility to all[ 
imm$iate access to ! ess5tial c>egiv] 9 
"q2  7bb7 require ! facility to e/abli% 
a corrective action plan to prev5t !    
recurr5ce ( su* violation )9 a #g-;day  
p]iod ( receiv+ notice f ! ag5cy2 &     
7cc7 impose a civil money p5alty 9 an   
am\nt to be det]m9$ by ! ag5cy 7n to    
exce$ #e1jjj7 if su* facility fails to  
implem5t ! corrective action plan ) !   
#g-;day p]iod specifi$ 9 item 7bb74     
7vii7 ,def9ition ( ess5tial c>egiv] ,=  
purposes ( ?is subp>agraph1 ! t]m       
ess5tial c>egiv] means1 ) respect to a  
resid5t ( a nurs+ facility1 an          
individual :o--  7,i7 is designat$ by or
 on behalf ( ! resid5t pursuant to      
clause 7i7 or clause 7ii72  7,,ii7 w    
provide assi/ance to su* resid5t1 :i*   
may include assi/ance ) ( activities (  
daily liv+ or provid+ emotional support 

or companion%ip to su* resid5t2 &       
7,,iii7 agrees to foll[ all safety      
protocols e/abli%$ by su* facility1 :i* 
%all be cle>ly specifi$ 9 writ+ & may be
 no m re/rictive ?an ! safety protocols 
7includ+ safety /&>ds & entry           
requirem5ts7 applicable to /aff ( su*   
facility4  4  7c7 ,int]m$iate c>e       
facilities = ! intellectually disabl$   
,section #aije7;d7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acif;d7d77 is     
am5d$--  7#a7 9 p>agraph 7#b71 by /rik+ 
& at ! end2  7#b7 9 p>agraph 7#c71 by   
/rik+ ! p]iod & ins]t+ 2 &2 &  7#c7 by  
add+ at ! end ! foll[+ new p>agraph3    
7#d7 ! in/itution complies ) !          
requirem5ts relat+ to ! designation (1 &
 access to resid5ts by1 ess5tial        
c>egiv]s describ$ 9 section             
#aiai7;c77#c77;,b7 9 ! same mann] z if  
su* in/itution 7 a nurs+ facility4  4   
7d7 ,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 comply ) !       
requirem5ts relat+ to ! designation (1 &
 access to resid5ts by1 ess5tial        
c>egiv]s describ$ 9 section             
#ahai7;c77#c77;,b7 9 ! same mann] z if  
su* in/itution 7 a skill$ nurs+         
facility4  4  7e7 ,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]s71 promulgate regulations to    
c>ry out ?is ,act & ! am5dm5ts made by  

?is ,act4  7f7 ,rules ( con/ruction     
7#a7 ,no new au?ority = ,/ate & local   
(ficials to re/rict visitation at nurs+ 
facilities ,no?+ 9 ?is section or !     
am5dm5ts made by ?is section %all be    
con/ru$ z creat+ any new au?ority =     
,/ate or local (ficials to re/rict      
visitation at nurs+ facilities4  7#b7   
,no new au?ority = nurs+ facilities to  
unilat]ally re/rict visitation ,no?+ 9  
?is section or ! am5dm5ts made by ?is   
section %all be con/ru$ z creat+ any new
 au?ority = a skill$ nurs+ facility or  
nurs+ facility 7z su* t]ms are def9$ 9  
sections #ahai & #aiai ( ! ,social      
,security ,act1 respectively 7#db       
,u4,s4,c4 #acie;i-#c1 #acifr77 to       
re/rict visitation4  7g7 ,effective date
 ,! am5dm5ts made by ?is ,act %all take 
effect on ! date t is #bd mon?s aft] !  
date ( ! enactm5t ( ?is ,act1 & %all    
apply ) respect to p]iods beg9n+ on or  
aft] su* date 9 :i* regul> visitation at
 nurs+ facilities is re/rict$ by ord] ( 
a ,f$]al1 ,/ate1 or local au?ority or by

 o!r op]ation ( law4