This legislation, titled the Essential Caregivers Act of 2025, aims to ensure that residents in various long-term care settings maintain access to designated essential caregivers, particularly during emergencies when general visitation is restricted. It amends titles XVIII and XIX of the Social Security Act, applying to skilled nursing facilities , nursing facilities , intermediate care facilities for the intellectually disabled , and inpatient rehabilitation facilities . The bill establishes a resident's right to designate an essential caregiver , who must be granted access at all times, including during periods of emergency or restricted visitation. For residents with cognitive or mental disabilities, a resident representative can make this designation. Facilities must allow at least one essential caregiver daily access to provide assistance, and this access cannot be denied except under specific, limited circumstances. Access denial is permitted for an initial period of up to 7 days, with a possible extension to 14 days if approved by the relevant State health agency. However, access cannot be denied for residents in end-of-life care or those experiencing decline or distress. Essential caregivers must agree to follow facility safety protocols, which cannot be more restrictive than those for staff. The bill outlines a clear process for addressing non-compliance by essential caregivers, requiring written warnings and guidance before access can be denied. If access is denied, the facility must provide a written explanation within 24 hours, detailing appeal options. The Secretary of Health and Human Services is mandated to establish an appeals process within two years, allowing residents and caregivers to challenge denials with the State survey agency. State survey agencies must investigate appeals within two business days and make a determination within 48 hours of commencing investigation. If a facility is found in violation, it must immediately allow caregiver access, establish a corrective action plan, and may face a civil money penalty of up to $5,000 if the plan is not implemented. The legislation explicitly states that it does not grant new authority for state or local officials, or facilities, to restrict visitation beyond existing powers.