[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1313 Introduced in House (IH)]







106th CONGRESS
  1st Session
                                H. R. 1313

  To amend title XI of the Social Security Act to restrict the use of 
 physical and chemical restraints and seclusion in certain facilities 
    receiving Medicare or Medicaid funds, to require recording and 
 reporting of information on that use and on sentinel events occurring 
              in those facilities, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 25, 1999

  Ms. DeGette (for herself, Mr. Stark, Ms. DeLauro, Mrs. Morella, Mr. 
 Waxman, Ms. Kilpatrick, Mr. George Miller of California, Mr. Brown of 
Ohio, Mr. Sanders, Mr. Lantos, Mr. Martinez, Ms. Eddie Bernice Johnson 
 of Texas, Mr. Rangel, Mr. Crowley, Mrs. Capps, Ms. Pelosi, Mr. Ford, 
Mr. McGovern, Mr. Wynn, Ms. Schakowsky, Mr. Cummings, and Ms. Berkley) 
 introduced the following bill; which was referred to the Committee on 
  Ways and Means, and in addition to the Committee on Commerce, 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 title XI of the Social Security Act to restrict the use of 
 physical and chemical restraints and seclusion in certain facilities 
    receiving Medicare or Medicaid funds, to require recording and 
 reporting of information on that use and on sentinel events occurring 
              in those facilities, and for other purposes.

    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 ``Patient Freedom from Restraint Act 
of 1999''.

SEC. 2. LIMITATION ON USE OF PHYSICAL AND CHEMICAL RESTRAINTS AND 
              SECLUSION IN CERTAIN MEDICARE OR MEDICAID FUNDED 
              TREATMENT FACILITIES.

    (a) In General.--Part B of title XI of the Social Security Act is 
amended by adding at the end the following new section:

``limitation on use of restraints and seclusion in certain medicare and 
                  medicaid funded treatment facilities

    ``Sec. 1164. (a) Freedom From Restraints and Seclusion.--As a 
condition of participation or receipt of funds under the medicare 
program under title XVIII or under a State medicaid program under title 
XIX, a covered facility (as defined in subsection (b)) shall--
            ``(1) protect and promote the right of each resident or 
        patient to be free from physical or mental abuse, corporal 
        punishment, involuntary seclusion, and any physical or chemical 
        restraints (as defined in subsection (g)) imposed for purposes 
        of discipline or convenience;
            ``(2) meet the requirements of subsection (d) (relating to 
        recording and reporting on the use of restraints and seclusion 
        and sentinel events);
            ``(3) provide for annual training of all staff with direct 
        resident or patient care responsibility on the proper use of 
        restraints and seclusion, their alternatives, and techniques 
        and methods to identify and defuse potential emergency 
        situations; and
            ``(4)(A) make available to each resident or patient, and to 
        the guardian of each such resident or patient, a statement of 
        their rights to freedom from restraints and seclusion as 
        required by this section and information on the purpose of the 
        appropriate protection and advocacy agencies (as defined in 
        subsection (g)(4)) and their addresses and telephone numbers; 
        and
            ``(B) clearly and conspicuously post such information in 
        the facility.
    ``(b) Covered Facility Defined.--For purposes of this section, the 
term `covered facility` means any of the following:
            ``(1) A facility that provides inpatient or residential 
        psychiatric treatment or treatment of mental illness (including 
        a psychiatric hospital, as defined in section 1861(f), and an 
        institution for mental diseases, as defined in section 
        1905(i)).
            ``(2) An intermediate care facility for the mentally 
        retarded (as defined in section 1905(d)).
            ``(3) A facility that provides residential treatment for 
        children.
    ``(c) Requirements Relating to Restraints and Seclusion.--
            ``(1) General limitations.--
                    ``(A) In general.--A covered facility may only 
                impose restraints and seclusion--
                            ``(i) to ensure the immediate physical 
                        safety of the resident or patient or others; 
                        and
                            ``(ii) only upon the written order of a 
                        physician that specifies the duration (not to 
                        exceed 2 consecutive hours) and circumstances 
                        under which the restraints and seclusion are to 
                        be used.
                    ``(B) Emergency exception.--Subparagraph (A)(ii) 
                shall not apply in emergency circumstances specified by 
                the Secretary during the period before a written order 
                can reasonably be obtained.
            ``(2) Prohibition of use of standing orders.--Written 
        orders for such restraints or seclusion shall never be written 
        as a standing order.
            ``(3) Use as last resort.--A covered facility may only use 
        restraints and seclusion as an emergency safety measure and as 
        a last resort and only after other less restrictive approaches 
        have failed.
            ``(4) Least restrictive manner.--A covered facility shall 
        use restraints and seclusion only in the least restrictive 
        manner possible, to protect the resident or patient or others 
        from harm, and must remove or end restraints and seclusion at 
        the earliest possible time.
            ``(5) No simultaneous use.--A covered facility may not use 
        restraints and seclusion simultaneously.
    ``(d) Recording and Reporting Requirements.--In accordance with the 
protocol established under subsection (e)(1)--
            ``(1) Recording uses of restraint and seclusion in patient 
        records.--
                    ``(A) In general.--Each covered facility shall 
                record and maintain, as part of a resident's or 
                patient's medical record, the following information on 
                each incident in which restraints or seclusion are used 
                with respect to a resident or patient of the facility:
                            ``(i) The uses of restraint and seclusion, 
                        including the type of restraint or seclusion 
                        used and the time and duration of its use.
                            ``(ii) The rationale for restraint or 
                        seclusion and types of less restrictive 
                        alternatives that were tried or considered.
                            ``(iii) Evidence of treatment planning to 
                        reduce the probability of future incidents that 
                        would lead to use of restraint or seclusion.
                    ``(B) Availability to p&a agencies.--Each covered 
                facility shall make available the information recorded 
                under subparagraph (A) for inspection by staff of the 
                appropriate protection and advocacy agencies.
            ``(2) Submission of periodic reports on overall use of 
        restraints and seclusion.--Each covered facility shall submit 
        to the Secretary and to the appropriate protection and advocacy 
        agencies a report that specifies the number of times restraints 
        or seclusion were used during the reporting period. Such report 
        shall be submitted on a periodic basis specified by the 
        Secretary, but in no case less often than annually.
            ``(3) Submission of reports on all sentinel events.--
                    ``(A) In general.--Each covered facility shall 
                submit to the appropriate protection and advocacy 
                agency a report on--
                            ``(i) each sentinel event (as defined in 
                        subsection (g)(6)) that occurs respecting a 
                        resident or patient, including only the name of 
                        the resident or patient and a general 
                        description of the event; and
                            ``(ii) if information is available to the 
                        facility, information on the death of any 
                        individual who died within 14 days after the 
                        date of discharge from the facility.
                    ``(B) Deadline for submission.--Each report under 
                subparagraph (A)(i) shall be submitted within 7 days of 
                the date of the incident involved and each report under 
                subparagraph (A)(ii) shall be submitted within 7 days 
                of receipt of information concerning the death of the 
                former resident or patient.
                    ``(C) Annual report.--Each covered facility shall 
                submit on an annual basis to the Secretary an annual 
                report on sentinel events for which reports were made 
                during the previous year under subparagraph (A).
    ``(e) Implementation.--
            ``(1) In general.--Not later than 1 year after the date of 
        the enactment of this section, the Secretary shall establish a 
        protocol for the recording and reporting of information under 
        subsection (d). To the extent feasible, the Secretary shall 
        establish the protocol in a manner that is consistent with 
        medical records recording systems and that is coordinated with 
        other applicable health care information reporting systems. The 
        Secretary shall consult with appropriate protection and 
        advocacy agencies in establishing and implementing the 
        protocol.
            ``(2) Publication of summary.--The Secretary shall compile 
        and publish on an annual basis a comprehensive summary of the 
        reports received under subsection (d)(3).
            ``(3) Establishment of guidelines for peer review 
        organizations.--The Secretary shall establish guidelines for 
        the use of utilization and quality control peer review 
        organizations (as defined in section 1152(a)) in reviewing 
        policies and procedures of covered facilities regarding the use 
        of restraints and seclusion consistent with this section.
    ``(f) Sanctions.--
            ``(1) Loss of medicare and medicaid funding.--A covered 
        facility that fails to comply with the requirements of 
        subsection (a) (including failure to provide for annual 
        training of staff in accordance with subsection (a)(3)) is 
        subject to disqualification from participation in the medicare 
        program under title XVIII and the medicaid program under title 
        XIX for such period at the Secretary may specify.
            ``(2) Civil money penalty for failure to file sentinel 
        reports.--A covered facility that fails to file a report 
        required to be made under subsection (b)(3) within the period 
        so required is subject to a civil money penalty not to exceed 
        $5,000 for each such violation. The provisions of section 1128A 
        (other than subsections (a) and (b)) shall apply to civil money 
        penalties under this subsection in the same manner as they 
        apply to a penalty or proceeding under section 1128A(a).
    ``(g) Definitions.--For purposes of this section:
            ``(1) Restraints.--The term `restraints' means any chemical 
        or physical restraint (as defined in paragraphs (2) and (3)).
            ``(2) Chemical restraint.--The term `chemical restraint' 
        means the use of any medication or biological for the purpose 
        of immobilizing the individual, inducing a state of sleep or 
        unconsciousness, or reducing the ability to move freely. Such 
        term does not include involuntary administration of medication 
        when administered pursuant to a court order or the 
        administration of medication for voluntary or emergency 
        treatment (such as anesthesia administered before a surgical 
        procedure).
            ``(3) Physical restraint.--The term `physical restraint' 
        means any mechanical or personal restriction that immobilizes 
        or reduces an individual's ability to move arms, legs, or head 
        freely. Such term does not include devices, such as 
        orthopedically prescribed appliances, surgical dressings and 
        bandages, protective helmets and supportive body bands, and 
        other physical holding when necessary for routine physical 
        examinations or tests or for orthopedic surgical or other 
        similar medical treatment purposes or when used to provide 
        support for the achievement of functional body position or 
        proper balance or to permit an individual to participate in 
        ongoing activities with the risk of physical harm.
            ``(4) Protection and advocacy agency.--The term `protection 
        and advocacy agency' means an appropriate board under the 
        protection and advocacy system established under part C of 
        title I of the Developmental Disabilities Assistance and Bill 
        of Rights Act (42 U.S.C. 6041 et seq.).
            ``(5) Seclusion.--The term `seclusion' means the 
        involuntary confinement of a resident or patient in a room from 
        which the resident or patient is physically prevented from 
        leaving.
            ``(6) Sentinel event.--The term `sentinel event' means an 
        unexpected occurrence involving a substantial impairment of the 
        physical or psychological condition of a resident or patient, 
        including any burn, laceration, or abrasion of the skin, 
        fracture of any bone, substantial hematoma, injury to any 
        internal organ, or any injury that occurs as a result of 
        repeated harm to any bodily function or organ (including the 
        skin), if the occurrence is unrelated to the natural course of 
        the individual's illness or underlying condition, and includes 
        the death of the individual in any case.''.
    (b) Effective Dates.--
            (1) Protection against use of punitive restraints and 
        seclusion.--The requirements of subsections (a)(1) and (c) of 
        section 1164 of the Social Security Act, as added by subsection 
        (a), apply to restraints and seclusion used on or after the 
        first date of the first month that begins more than 6 months 
        after the date of the enactment of this Act.
            (2) Reporting requirements.--
                    (A) Deadline for establishing protocol.--The 
                Secretary of Health and Human Services shall first 
                establish the protocol described in section 1164(e)(1) 
                of the Social Security Act, as added by subsection (a), 
                within 1 year after the date of the enactment of this 
                Act.
                    (B) Reports.--Covered facilities are first required 
                to record information and submit reports under section 
                1164(c) of the Social Security Act, as so added, for 
                restraints and seclusion used on and after a date 
                (specified by the Secretary of Health and Human 
                Services ) that is not later than 2 months after the 
                date of the establishment of the protocol under section 
                1164(e)(1) of such Act.
            (3) Annual training.--The requirement of section 1164(a)(3) 
        of the Social Security Act, as so added, applies for annual 
        periods beginning after the effective date described in 
        paragraph (1).
            (4) Posting information.--The requirement of section 
        1164(a)(4) of the Social Security Act, as so added, takes 
        effect on such date, not later than the effective date 
        described in paragraph (1), as the Secretary of Health and 
        Human Services shall specify.
                                 <all>