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S3491119th CongressWALLET

Black Lung Benefits Improvement Act of 2025

Sponsored By: Senator Kaine, Tim [D-VA]

Introduced

Summary

**This bill would guarantee each resident the right to designate and have access to one or more *essential caregivers* in Medicare skilled nursing facilities and Medicaid nursing facilities, including during periods when visitation is restricted.** It would set clear limits on when facilities can deny access and create a fast appeals and state oversight process to enforce those rights.

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  • Residents and families: Residents could name one or more essential caregivers and a representative can name a caregiver for residents with cognitive impairment. Facilities must allow at least one caregiver daily and permit access at all times during emergency visitation restrictions, with special rules for end-of-life and decline or distress situations.
  • Facilities and staff: Facilities must put written safety protocols in place that are no more restrictive than staff rules. A facility may initially deny access for up to 7 days and extend denial up to 7 more days only with State survey agency approval, for a 14-day cap during any single emergency.
  • State oversight and appeals: The State survey agency must accept appeals and start investigations within two business days, decide within 48 hours of starting an investigation, order immediate access if violations are found, require corrective action within 7 days, and may impose civil money penalties up to $5,000 for failure to comply. The Secretary would issue a final rule on appeals within two years and the law would take effect two years after enactment.

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Bill Overview

Analyzed Economic Effects

3 provisions identified: 2 benefits, 0 costs, 1 mixed.

Faster appeals for caregiver denials

If enacted, the Secretary would issue a final rule within two years to set up an appeals process. State survey agencies would have to begin investigating appeals within two business days and decide within 48 hours of starting. If the agency finds a violation, the facility would have to allow immediate access, adopt a corrective action plan within 7 days, and the agency could fine the facility up to $5,000 if it fails to implement the plan.

Residents can name essential caregivers

If enacted, residents in skilled nursing facilities would be able to designate one or more essential caregivers. A resident representative could name a caregiver for residents with cognitive or mental disability. Caregivers would need to follow the facility's written safety protocols, which could not be stricter than rules for staff. The same designation and access rules would apply to inpatient rehabilitation units on the same campus and to ICF/IID institutions.

Caregiver access during emergency restrictions

If enacted, during emergency periods when visitation is restricted (starting two years after enactment) facilities would generally have to allow in-person access by essential caregivers. They would have to permit at least one essential caregiver daily and allow access at any time, and provide reasonable accommodations for roommates. Facilities could not deny access except after a written warning and for narrow reasons. A facility could deny access initially for no more than 7 days, and only extend for another 7 days with State agency approval. Facilities would still have to allow access for residents in end-of-life care or who are in decline or distress.

Sponsors & CoSponsors

Sponsor

Kaine, Tim [D-VA]

VA • D

Cosponsors

  • Sen. Warner, Mark R. [D-VA]

    VA • D

    Sponsored 12/16/2025

  • Sen. Fetterman, John [D-PA]

    PA • D

    Sponsored 12/16/2025

Roll Call Votes

No roll call votes available for this bill.

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