[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7141 Introduced in House (IH)]

<DOC>






115th CONGRESS
  2d Session
                                H. R. 7141

 To direct the Secretary of Labor to issue an occupational safety and 
health standard that requires covered employers within the health care 
and social service industries to develop and implement a comprehensive 
      workplace violence prevention plan, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 16, 2018

Mr. Courtney (for himself, Ms. Bonamici, Mr. Brady of Pennsylvania, Ms. 
 DeLauro, Ms. Norton, Ms. Jackson Lee, Mr. Khanna, Ms. Schakowsky, Mr. 
Scott of Virginia, Mr. Takano, Ms. Wilson of Florida, Ms. Shea-Porter, 
 Mr. Sires, Mr. DeSaulnier, Mr. Larson of Connecticut, Mr. Payne, Mr. 
Himes, Mr. Pocan, Mr. Cicilline, Ms. Esty of Connecticut, Mr. Norcross, 
and Mr. Espaillat) introduced the following bill; which was referred to 
 the Committee on Education and the Workforce, and in addition to the 
Committees on Energy and Commerce, and Ways and Means, 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 direct the Secretary of Labor to issue an occupational safety and 
health standard that requires covered employers within the health care 
and social service industries to develop and implement a comprehensive 
      workplace violence prevention plan, 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 ``Workplace Violence Prevention for 
Health Care and Social Service Workers Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) In a 2016 report entitled, ``Workplace Safety and 
        Health: Additional Efforts Needed to Help Protect Health Care 
        Workers from Workplace Violence'', the Government 
        Accountability Office reported over 730,000 cases of health 
        care workplace assaults over the 5-year span from 2009 through 
        2013, based on Bureau of Justice Statistics data.
            (2) The health care and social service industries 
        experience the highest rates of injuries caused by workplace 
        violence. Nurses and nursing, psychiatric, home health, and 
        personal care aides all are at high risk.
            (3) The Bureau of Labor Statistics reports that health care 
        and social service workers suffered 69 percent of all workplace 
        violence injuries caused by persons in 2016 and are nearly 5 
        times as likely to suffer a workplace violence injury than 
        workers overall.
            (4) According to a survey of 3,500 American emergency 
        physicians conducted by the American College of Emergency 
        Physicians, 47 percent of emergency room doctors have been 
        physically assaulted at work, and 8 in 10 report that this 
        violence is affecting patient care.
            (5) Workplace violence in health care and social service 
        sectors is increasing. Bureau of Labor Statistics data show 
        that private sector injury rates of workplace violence in 
        health care and social service sectors increased by 63 percent 
        between 2006 and 2016. Due to under-reporting, actual injury 
        rates from workplace violence are widely recognized to be 
        higher than reported levels.
            (6) Violence against workers in health care settings is 
        most commonly due to assaults by patients or clients, or 
        persons accompanying patients or clients.
            (7) The Occupational Safety and Health Administration has 
        issued ``Guidelines for Preventing Workplace Violence for 
        Healthcare and Social Service Workers'', however, this guidance 
        is not enforceable. Absent an enforceable standard, employers 
        lack mandatory requirements to implement a violence prevention 
        program, and workers lack sufficient protection from workplace 
        violence.
            (8) Studies have demonstrated that workplace violence 
        prevention programs tailored to the needs of specific work 
        areas and State-based workplace violence prevention legislation 
        are strongly associated with reductions in workplace violence. 
        Proper staff training, appropriate staffing levels, sufficient 
        resources, and the use of evidence-based practices in the 
        provision of services (such as effective communication with 
        patients using de-escalation techniques) can reduce risks to 
        the safety of both patients and staff.
            (9) Nine States have mandated that certain types of health 
        care facilities implement workplace violence prevention 
        programs. On April 1, 2018, the Division of Occupational Safety 
        and Health of the State of California issued a comprehensive 
        standard (``Workplace Violence Prevention in Health Care'') 
        that requires health care facilities to implement a workplace 
        violence prevention plan.
            (10) Employer organizations have challenged the 
        Occupational Safety and Health Administration's authority to 
        utilize the General Duty Clause of the Occupational Safety and 
        Health Act of 1970 to enforce against workplace violence 
        hazards, arguing that Congress did not intend to cover 
        workplace violence under such clause when the Act was enacted 
        in 1970.
            (11) The Occupational Safety and Health Administration 
        (OSHA) received two petitions for rulemaking in July of 2016, 
        calling on OSHA to promulgate a violence prevention standard 
        for health care and social service sectors. On December 6, 
        2016, OSHA issued a Request for Information (RFI) soliciting 
        information on this issue. On January 10, 2017, OSHA conducted 
        a public meeting to receive stakeholder input and to supplement 
        the online comments submitted in response to the RFI. At that 
        meeting, OSHA announced it accepted the petitions and would 
        develop a Federal standard to prevent workplace violence in 
        health care and social service settings. In the spring of 2017, 
        the workplace violence prevention standard was removed from 
        active consideration and placed on the Department of Labor's 
        ``long-term agenda''. Subsequently, it was placed back on the 
        regulatory agenda. OSHA's efforts to move forward with 
        rulemaking have been halting and inconsistent. Therefore, 
        legislation is necessary to ensure the timely development of a 
        standard to protect workers in health care and social service 
        settings.

SEC. 3. TABLE OF CONTENTS.

    The table of contents for this Act is as follows:

Sec. 1. Short title.
Sec. 2. Findings.
Sec. 3. Table of contents.
            TITLE I--WORKPLACE VIOLENCE PREVENTION STANDARD

Sec. 101. Workplace violence prevention standard.
Sec. 102. Scope and application.
Sec. 103. Requirements for workplace violence prevention standard.
Sec. 104. Rules of construction.
Sec. 105. Other definitions.
            TITLE II--AMENDMENTS TO THE SOCIAL SECURITY ACT

Sec. 201. Application of the workplace violence prevention standard to 
                            certain facilities receiving Medicare 
                            funds.

            TITLE I--WORKPLACE VIOLENCE PREVENTION STANDARD

SEC. 101. WORKPLACE VIOLENCE PREVENTION STANDARD.

    (a) Interim Final Standard.--
            (1) In general.--Not later than 1 year after the date of 
        enactment of this Act, the Secretary of Labor shall promulgate 
        an interim final standard on workplace violence prevention--
                    (A) to require certain employers in the healthcare 
                and social service sectors, and certain employers in 
                sectors that conduct activities similar to the 
                activities in the healthcare and social service 
                sectors, to develop and implement a comprehensive 
                workplace violence prevention plan to protect health 
                care workers, social service workers, and other 
                personnel from workplace violence; and
                    (B) that shall, at a minimum, be based on the 
                Guidelines for Preventing Workplace Violence for 
                Healthcare and Social Service Workers published by the 
                Occupational Safety and Health Administration of the 
                Department of Labor in 2015 and adhere to the 
                requirements of this title.
            (2) Applicability of other statutory requirements.--The 
        following shall not apply to the promulgation of the interim 
        final standard under this subsection:
                    (A) The requirements applicable to occupational 
                safety and health standards under section 6(b) of the 
                Occupational Safety and Health Act of 1970 (29 U.S.C. 
                655(b)).
                    (B) The requirements of chapters 5 and 6 of title 
                5, United States Code, and titles 2 and 42, United 
                States Code.
            (3) Effective date of interim standard.--The interim final 
        standard shall--
                    (A) take effect on a date that is not later than 30 
                days after promulgation, except that such interim final 
                standard may include a reasonable phase-in period for 
                the implementation of required engineering controls 
                that take effect after such date;
                    (B) be enforced in the same manner and to the same 
                extent as any standard promulgated under section 6(b) 
                of the Occupational Safety and Health Act of 1970 (29 
                U.S.C. 655(b)); and
                    (C) be in effect until the final standard described 
                in subsection (b) becomes effective and enforceable.
            (4) Failure to promulgate.--If an interim final standard 
        described in paragraph (1) is not promulgated not later than 1 
        year of the date of enactment of this Act, the provisions of 
        this title shall be in effect and enforced in the same manner 
        and to the same extent as any standard promulgated under 
        section 6(b) of the Occupational Safety and Health Act (29 
        U.S.C. 655(b)) until such provisions are superseded in whole by 
        an interim final standard promulgated by the Secretary that 
        meets the requirements of paragraph (1).
    (b) Final Standard.--
            (1) Proposed final standard.--Not later than 2 years after 
        the date of enactment of this Act, the Secretary of Labor 
        shall, pursuant to section 6 of the Occupational Safety and 
        Health Act (29 U.S.C. 655), promulgate a proposed final 
        standard on workplace violence prevention--
                    (A) for the purposes described in subsection 
                (a)(1)(A); and
                    (B) that shall include, at a minimum, the elements 
                contained in the interim final standard promulgated 
                under subsection (a).
            (2) Final standard.--Not later than 42 months after the 
        date of enactment of this Act, the Secretary shall promulgate a 
        final standard on such proposed standard that shall--
                    (A) provide no less protection than any workplace 
                violence standard adopted by a State plan that has been 
                approved by the Secretary under section 18 of the 
                Occupational Safety and Health Act of 1970 (29 U.S.C. 
                667); and
                    (B) be effective and enforceable in the same manner 
                and to the same extent as any standard promulgated 
                under section 6(b) of the Occupational Safety and 
                Health Act of 1970 (29 U.S.C. 655(b)).

SEC. 102. SCOPE AND APPLICATION.

    In this title:
            (1) Covered facility.--The term ``covered facility'' 
        includes the following:
                    (A) Any hospital, including any specialty hospital, 
                in-patient or outpatient setting, or clinic operating 
                within a hospital license, or any setting that provides 
                outpatient services.
                    (B) Any residential treatment facility, including 
                any nursing home, skilled nursing facility, hospice 
                facility, and long-term care facility.
                    (C) Any non-residential treatment or service 
                setting.
                    (D) Any medical treatment or social service setting 
                or clinic at a correctional or detention facility.
                    (E) Any community care setting, including a 
                community-based residential facility, group home, and 
                mental health clinic.
                    (F) Any psychiatric treatment facility.
                    (G) Any drug abuse or substance use disorder 
                treatment center.
                    (H) Any independent freestanding emergency centers.
                    (I) Any facility described in subparagraphs (A) 
                through (H) operated by a Federal Government agency and 
                required to comply with occupational safety and health 
                standards pursuant to section 1960 of title 29, Code of 
                Federal Regulations.
                    (J) Any other facility the Secretary determines 
                should be covered under the standards promulgated under 
                section 101.
            (2) Covered services.--The term ``covered service'' 
        includes the following services and operations:
                    (A) Any services and operations provided in any 
                field work setting, including home health care, home-
                based hospice, and home-based social work.
                    (B) Any emergency services and transport, including 
                such services provided by firefighters and emergency 
                responders.
                    (C) Any services described in subparagraphs (A) and 
                (B) performed by a Federal Government agency and 
                required to comply with occupational safety and health 
                standards pursuant to section 1960 of title 29, Code of 
                Federal Regulations.
                    (D) Any other services and operations the Secretary 
                determines should be covered under the standards 
                promulgated under section 101.
            (3) Covered employer.--
                    (A) In general.--The term ``covered employer'' 
                includes a person (including a contractor, 
                subcontractor, a temporary service firm, or an employee 
                leasing entity) that employs an individual to work at a 
                covered facility or to perform covered services.
                    (B) Exclusion.--The term ``covered employer'' does 
                not include an individual who privately employs, in the 
                individual's residence, a person to perform covered 
                services for the individual or a family member of the 
                individual.
            (4) Covered employee.--The term ``covered employee'' 
        includes an individual employed by a covered employer to work 
        at a covered facility or to perform covered services.

SEC. 103. REQUIREMENTS FOR WORKPLACE VIOLENCE PREVENTION STANDARD.

    Each standard described in section 101 shall include, at a minimum, 
the following requirements:
            (1) Workplace violence prevention plan.--Not later than 6 
        months after the date of promulgation of the interim final 
        standard under section 101(a), a covered employer shall 
        develop, implement, and maintain an effective written workplace 
        violence prevention plan for covered employees at each covered 
        facility controlled by the employer and for covered employees 
        performing a covered service on behalf of such employer, which 
        meet the following:
                    (A) Plan development.--Each Plan shall--
                            (i) be developed and implemented with the 
                        meaningful participation of direct care 
                        employees and, where applicable, employee 
                        representatives and collective bargaining 
                        representatives, for all aspects of the Plan;
                            (ii) be tailored and specific to conditions 
                        and hazards for the covered facility or the 
                        covered service, including patient-specific 
                        risk factors and risk factors specific to each 
                        work area or unit; and
                            (iii) be suitable for the size and 
                        complexity of operations at the covered 
                        facility or for the covered service, and remain 
                        in effect at all times.
                    (B) Plan content.--Each Plan shall include 
                procedures and methods for the following:
                            (i) Identification of the individual 
                        responsible for implementation of the Plan.
                            (ii) With respect to each work area and 
                        unit at the covered facility or while covered 
                        employees are performing the covered service, 
                        risk assessment and identification of workplace 
                        violence risks and hazards to employees exposed 
                        to such risks and hazards (including 
                        environmental risk factors and patient-specific 
                        risk factors), which shall be--
                                    (I) informed by past violent 
                                incidents specific to such covered 
                                facility or such covered service; and
                                    (II) conducted with, at a minimum--
                                            (aa) direct care employees;
                                            (bb) where applicable, the 
                                        representatives of such 
                                        employees; and
                                            (cc) the employer.
                            (iii) Hazard prevention, engineering 
                        controls, and work practice controls to correct 
                        hazards in a timely manner applying industrial 
                        hygiene principles of the hierarchy of 
                        controls, which--
                                    (I) may include security and alarm 
                                systems, adequate exit routes, 
                                monitoring systems, barrier protection, 
                                established areas for patients and 
                                clients, lighting, entry procedures, 
                                staffing and working in teams, and 
                                systems to identify and flag clients 
                                with a history of violence; and
                                    (II) shall ensure that employers 
                                correct, in a timely manner, hazards 
                                identified in the annual report 
                                described in paragraph (5).
                            (iv) Reporting, incident response, and 
                        post-incident investigation procedures, 
                        including procedures--
                                    (I) for employees to report 
                                workplace violence risks, hazards, and 
                                incidents;
                                    (II) for employers to respond to 
                                reports of workplace violence;
                                    (III) for employers to perform a 
                                post-incident investigation and 
                                debriefing of all reports of workplace 
                                violence with the participation of 
                                employees and their representatives; 
                                and
                                    (IV) to provide medical care or 
                                first aid to affected employees.
                            (v) Procedures for emergency response, 
                        including procedures for threats of mass 
                        casualties and procedures for incidents 
                        involving a firearm or a dangerous weapon.
                            (vi) Procedures for communicating with and 
                        training of covered employees on workplace 
                        violence hazards, threats, and work practice 
                        controls, the employer's plan, and procedures 
                        for confronting, responding to, and reporting 
                        workplace violence threats, incidents, and 
                        concerns, and employee rights.
                            (vii) Procedures for coordination of risk 
                        assessment efforts, Plan development, and 
                        implementation of the Plan with other employers 
                        who have employees who work at the covered 
                        facility or who are performing the covered 
                        service.
                            (viii) Procedures for conducting the annual 
                        evaluation under paragraph (6).
                    (C) Availability of plan.--Each Plan shall be made 
                available at all times to the covered employees who are 
                covered under such Plan.
            (2) Violent incident investigation.--
                    (A) In general.--As soon as practicable after a 
                workplace violence incident, risk, or hazard of which a 
                covered employer has knowledge, the employer shall 
                conduct an investigation of such incident, risk, or 
                hazard under which the employer shall--
                            (i) review the circumstances of the 
                        incident, risk, or hazard, and whether any 
                        controls or measures implemented pursuant to 
                        the Plan of the employer were effective; and
                            (ii) solicit input from involved employees, 
                        their representatives, and supervisors, about 
                        the cause of the incident, risk, or hazard, and 
                        whether further corrective measures (including 
                        system-level factors) could have prevented the 
                        incident, risk, or hazard.
                    (B) Documentation.--A covered employer shall 
                document the findings, recommendations, and corrective 
                measures taken for each investigation conducted under 
                this paragraph.
            (3) Training and education.--With respect to the covered 
        employees covered under a Plan of a covered employer, the 
        employer shall provide training and education to such employees 
        who may be exposed to workplace violence hazards and risks, 
        which meet the following requirements:
                    (A) Annual training and education includes 
                information on the Plan, including identified workplace 
                violence hazards, work practice control measures, 
                reporting procedures, record keeping requirements, 
                response procedures, and employee rights.
                    (B) Additional hazard recognition training for 
                supervisors and managers to ensure they can recognize 
                high-risk situations and do not assign employees to 
                situations that predictably compromise their safety.
                    (C) Additional training for each such covered 
                employee whose job circumstances has changed, within a 
                reasonable timeframe after such change.
                    (D) New employee training prior to assignment.
                    (E) All training provides such employees 
                opportunities to ask questions, give feedback on such 
                training, and request additional instruction, 
                clarification, or other follow up.
                    (F) All training is provided in-person and by an 
                individual with knowledge of workplace violence 
                prevention and of the Plan.
                    (G) All training is appropriate in content and 
                vocabulary to the language, educational level, and 
                literacy of such covered employees.
            (4) Recordkeeping and access to plan records.--
                    (A) In general.--Each covered employer shall--
                            (i) maintain at all times--
                                    (I) records related to each Plan of 
                                the employer, including workplace 
                                violence risk and hazard assessments, 
                                and identification, evaluation, 
                                correction, and training procedures;
                                    (II) a violent incident log 
                                described in subparagraph (B) for 
                                recording all workplace violence 
                                incidents; and
                                    (III) records of all incident 
                                investigations as required under 
                                paragraph (2)(B); and
                            (ii) make such records and logs available, 
                        upon request, to covered employees and their 
                        representatives for examination and copying in 
                        accordance with section 1910.1020 of title 29, 
                        Code of Federal Regulations, and in a manner 
                        consistent with HIPAA privacy regulations 
                        (defined in section 1180(b)(3) of the Social 
                        Security Act (42 U.S.C. 1320d-9(b)(3))) and 
                        part 2 of title 42, Code of Federal 
                        Regulations.
                    (B) Violent incident log description.--Each violent 
                incident log shall--
                            (i) be maintained by a covered employer for 
                        each covered facility controlled by the 
                        employer and for each covered service being 
                        performed by a covered employee on behalf of 
                        such employer;
                            (ii) be based on a template developed by 
                        the Secretary not later than 1 year after the 
                        date of enactment of this Act;
                            (iii) include, at a minimum, a description 
                        of--
                                    (I) the violent incident (including 
                                environmental risk factors present at 
                                the time of the incident);
                                    (II) the date, time, and location 
                                of the incident, names and job titles 
                                of involved employees;
                                    (III) identification of the alleged 
                                individual who committed the violence, 
                                in a manner consistent with HIPAA 
                                privacy regulations (defined in section 
                                1180(b)(3) of the Social Security Act 
                                (42 U.S.C. 1320d-9(b)(3))) and part 2 
                                of title 42, Code of Federal 
                                Regulations;
                                    (IV) the nature and extent of 
                                injuries to covered employees;
                                    (V) the type of violent incident 
                                (such as type 1 violence, type 2 
                                violence, type 3 violence, or type 4 
                                violence); and
                                    (VI) how the incident was abated;
                            (iv) not later than 7 days after the 
                        employer learns of such incident, contain a 
                        record of each violent incident, which is 
                        updated to ensure completeness of such record;
                            (v) be maintained for not less than 5 
                        years; and
                            (vi) in the case of a violent incident 
                        involving a privacy concern case, protect the 
                        identity of employees in a manner consistent 
                        with section 1904.29(b) of title 29, Code of 
                        Federal Regulations.
                    (C) Annual summary.--
                            (i) Covered employers.--Each covered 
                        employer shall prepare an annual summary of 
                        each violent incident log for the preceding 
                        calendar year that shall--
                                    (I) with respect to each covered 
                                facility, and each covered service, for 
                                which such a log has been maintained, 
                                include the total number of violent 
                                incidents, the number of recordable 
                                injuries related to such incidents, and 
                                the total number of hours worked by the 
                                covered employees for such preceding 
                                year;
                                    (II) be completed on a form 
                                provided by the Secretary;
                                    (III) be posted for three months 
                                beginning February 1 of each year in a 
                                manner consistent with the requirements 
                                of section 1904 of title 29, Code of 
                                Federal Regulations, relating to the 
                                posting of summaries of injury and 
                                illness logs;
                                    (IV) be located in a conspicuous 
                                place or places where notices to 
                                employees are customarily posted; and
                                    (V) not be altered, defaced, or 
                                covered by other material.
                            (ii) Secretary.--Not later than 1 year 
                        after the promulgation of the interim final 
                        standard under section 101(a), the Secretary 
                        shall make available a platform for the 
                        electronic submission of annual summaries 
                        required under this paragraph.
            (5) Annual report.--Not later than February 15 of each 
        year, each covered employer shall report to the Secretary, the 
        frequency, quantity, and severity of workplace violence, and 
        any incident response and post-incident investigation 
        (including abatement measures for the incidents) set forth in 
        the annual summary of the violent incident log described in 
        paragraph (4)(C).
            (6) Annual evaluation.--Each covered employer shall conduct 
        an annual written evaluation, conducted with the full, active 
        participation of covered employees and employee 
        representatives, of--
                    (A) the implementation and effectiveness of the 
                Plan, including a review of the violent incident log; 
                and
                    (B) compliance with training required by each 
                standard described in section 101, and specified in the 
                Plan.
            (7) Anti-retaliation.--
                    (A) Policy.--Each covered employer shall adopt a 
                policy prohibiting any person (including an agent of 
                the employer) from discriminating or retaliating 
                against any employee for reporting, or seeking 
                assistance or intervention from, a workplace violence 
                incident, threat, or concern to the employer, law 
                enforcement, local emergency services, or a government 
                agency, or participating in an incident investigation.
                    (B) Prohibition.--No covered employer shall 
                discriminate or retaliate against any employee for 
                reporting, or seeking assistance or intervention from, 
                a workplace violence incident, threat, or concern to 
                the employer, law enforcement, local emergency 
                services, or a government agency, or for exercising any 
                other rights under this paragraph.
                    (C) Enforcement.--This paragraph shall be enforced 
                in the same manner and to the same extent as any 
                standard promulgated under section 6(b) of the 
                Occupational Safety and Health Act (29 U.S.C. 655(b)).

SEC. 104. RULES OF CONSTRUCTION.

    Notwithstanding section 18 of the Occupational Safety and Health 
Act of 1970 (29 U.S.C. 667)--
            (1) nothing in this title shall be construed to curtail or 
        limit authority of the Secretary under any other provision of 
        the law; and
            (2) the rights, privileges, or remedies of covered 
        employees shall be in addition to the rights, privileges, or 
        remedies provided under any Federal or State law, or any 
        collective bargaining agreement.

SEC. 105. OTHER DEFINITIONS.

    In this title:
            (1) Workplace violence.--
                    (A) In general.--The term ``workplace violence'' 
                means any act of violence or threat of violence, 
                without regard to intent, that occurs at a covered 
                facility or while a covered employee performs a covered 
                service.
                    (B) Exclusions.--The term ``workplace violence'' 
                does not include lawful acts of self-defense or defense 
                of others.
                    (C) Inclusions.--The term ``workplace violence'' 
                includes--
                            (i) the threat or use of physical force 
                        against a covered employee that results in or 
                        has a high likelihood of resulting in injury, 
                        psychological trauma, or stress, without regard 
                        to whether the covered employee sustains an 
                        injury, psychological trauma, or stress; and
                            (ii) an incident involving the threat or 
                        use of a firearm or a dangerous weapon, 
                        including the use of common objects as weapons, 
                        without regard to whether the employee sustains 
                        an injury, psychological trauma, or stress.
            (2) Type 1 violence.--The term ``type 1 violence''--
                    (A) means workplace violence directed at a covered 
                employee at a covered facility or while performing a 
                covered service by an individual who has no legitimate 
                business at the covered facility or with respect to 
                such covered service; and
                    (B) includes violent acts by any individual who 
                enters the covered facility or worksite where a covered 
                service is being performed with the intent to commit a 
                crime.
            (3) Type 2 violence.--The term ``type 2 violence'' means 
        workplace violence directed at a covered employee by customers, 
        clients, patients, students, inmates, or any individual for 
        whom a covered facility provides services or for whom the 
        employee performs covered services.
            (4) Type 3 violence.--The term ``type 3 violence'' means 
        workplace violence directed at a covered employee by a present 
        or former employee, supervisor, or manager.
            (5) Type 4 violence.--The term ``type 4 violence'' means 
        workplace violence directed at a covered employee by an 
        individual who is not an employee, but has or is known to have 
        had a personal relationship with such employee.
            (6) Threat of violence.--The term ``threat of violence'' 
        means a statement or conduct that causes a person to fear for 
        his or her safety because there is a reasonable possibility the 
        person might be physically injured, and that serves no 
        legitimate purpose.
            (7) Alarm.--The term ``alarm'' means a mechanical, 
        electrical, or electronic device that does not rely upon an 
        employee's vocalization in order to alert others.
            (8) Dangerous weapon.--The term ``dangerous weapon'' means 
        an instrument capable of inflicting death or serious bodily 
        injury, regardless of whether such instrument was designed for 
        that purpose.
            (9) Engineering controls.--
                    (A) In general.--The term ``engineering controls'' 
                means an aspect of the built space or a device that 
                removes a hazard from the workplace or creates a 
                barrier between a covered employee and the hazard.
                    (B) Inclusions.--For purposes of reducing workplace 
                violence hazards, the term ``engineering controls'' 
                includes electronic access controls to employee 
                occupied areas, weapon detectors (installed or 
                handheld), enclosed workstations with shatter-resistant 
                glass, deep service counters, separate rooms or areas 
                for high-risk patients, locks on doors, removing access 
                to or securing items that could be used as weapons, 
                furniture affixed to the floor, opaque glass in patient 
                rooms (which protects privacy, but allows the health 
                care provider to see where the patient is before 
                entering the room), closed-circuit television 
                monitoring and video recording, sight-aids, and 
                personal alarm devices.
            (10) Environmental risk factors.--
                    (A) In general.--The term ``environmental risk 
                factors'' means factors in the covered facility or area 
                in which a covered service is performed that may 
                contribute to the likelihood or severity of a workplace 
                violence incident.
                    (B) Clarification.--Environmental risk factors may 
                be associated with the specific task being performed or 
                the work area, such as working in an isolated area, 
                poor illumination or blocked visibility, and lack of 
                physical barriers between employees and persons at risk 
                of committing workplace violence.
            (11) Patient-specific risk factors.--The term ``patient-
        specific risk factors'' means factors specific to a patient 
        that may increase the likelihood or severity of a workplace 
        violence incident, including a patient's mental status, 
        treatment and medication status, history of violence as known 
        to a covered employee at a covered facility or while performing 
        a covered service, use of drugs or alcohol as known to a 
        covered employee at a covered facility or while performing a 
        covered service, and any other conditions or disease processes 
        that may cause the patient to experience confusion or 
        disorientation, to be non-responsive to instruction, or to 
        behave unpredictably.
            (12) Secretary.--The term ``Secretary'' means the Secretary 
        of Labor.
            (13) Work practice controls.--
                    (A) In general.--The term ``work practice 
                controls'' means procedures and rules that are used to 
                effectively reduce workplace violence hazards.
                    (B) Inclusions.--The term ``work practice 
                controls'' includes assigning and placing sufficient 
                numbers of staff to reduce patient-specific Type 2 
                workplace violence hazards, provision of dedicated and 
                available safety personnel such as security guards, 
                employee training on workplace violence prevention 
                method and techniques to de-escalate and minimize 
                violent behavior, and employee training on procedures 
                for response in the event of a workplace violence 
                incident and for post-incident response.

            TITLE II--AMENDMENTS TO THE SOCIAL SECURITY ACT

SEC. 201. APPLICATION OF THE WORKPLACE VIOLENCE PREVENTION STANDARD TO 
              CERTAIN FACILITIES RECEIVING MEDICARE FUNDS.

    (a) In General.--Section 1866 of the Social Security Act (42 U.S.C. 
1395cc) is amended--
            (1) in subsection (a)(1)--
                    (A) in subparagraph (X), by striking ``and'' at the 
                end;
                    (B) in subparagraph (Y), by striking at the end the 
                period and inserting ``; and''; and
                    (C) by inserting after subparagraph (Y) the 
                following new subparagraph:
            ``(Z) in the case of hospitals that are not otherwise 
        subject to the Occupational Safety and Health Act of 1970 (or a 
        State occupational safety and health plan that is approved 
        under 18(b) of such Act) and skilled nursing facilities that 
        are not otherwise subject to such Act (or such a State 
        occupational safety and health plan), to comply with the 
        Workplace Violence Prevention Standard (as promulgated under 
        section 101 of the Health Care Workplace Violence Prevention 
        Act of 2018).''; and
            (2) in subsection (b)(4)--
                    (A) in subparagraph (A), by inserting ``and a 
                hospital or skilled nursing facility that fails to 
                comply with the requirement of subsection (a)(1)(Z) 
                (relating to the Workplace Violence Prevention 
                Standard)'' after ``Bloodborne Pathogens Standard)''; 
                and
                    (B) in subparagraph (B)--
                            (i) by striking ``(a)(1)(U)'' and inserting 
                        ``(a)(1)(V)''; and
                            (ii) by inserting ``(or, in the case of a 
                        failure to comply with the requirement of 
                        subsection (a)(1)(Z), for a violation of the 
                        Workplace Violence Prevention standard referred 
                        to in such subsection by a hospital or skilled 
                        nursing facility, as applicable, that is 
                        subject to the provisions of such Act)'' before 
                        the period at the end.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply beginning on the date that is 1 year after the date of issuance 
of the interim final standard on workplace violence prevention required 
under section 101.
                                 <all>