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[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1195 Introduced in House (IH)]

<DOC>

117th CONGRESS
  1st Session
                                H. R. 1195

 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

                           February 22, 2021

Mr. Courtney (for himself, Mr. Scott of Virginia, Mr. Bacon, Ms. Adams, 
 Mr. Young, Mr. Khanna, Mr. Fitzpatrick, and Mr. Cole) introduced the 
 following bill; which was referred to the Committee on Education and 
 Labor, 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, social workers, psychiatric, home health, and 
        personal care aides are all at increased risk for injury caused 
        by workplace violence. The Bureau of Labor Statistics reported 
        that in 2019, rates of violence and injury caused by persons in 
        these workplaces ranged from 3.8 times to as high as 82 times 
        the average American workplace.
            (3) The Bureau of Labor Statistics reports that health care 
        and social service workers suffered 73 percent of all workplace 
        violence injuries caused by persons in 2018 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 54 percent 
        between 2001 and 2018. Due to under-reporting, actual injury 
        rates from workplace violence are widely recognized to be 
        higher than reported levels.
            (6) Violence in health care settings has adverse impacts on 
        workers and patients, compromising quality of care.
            (7) 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.
            (8) Studies have found that proper staff training, 
        appropriate staffing levels, sufficient resources, and the use 
        of evidence based interventions (such as effective 
        communication with patients using de-escalation techniques and 
        noncoercive use of medications) can reduce the risks to the 
        safety of both patients and staff, using least-restrictive 
        measures.
            (9) 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 an effective and 
        ongoing violence prevention program that provides protection of 
        workers from workplace violence.
            (10) 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.
            (11) 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.
            (12) 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. The Trump 
        administration failed to meet any of its deadlines to move the 
        workplace violence rulemaking forward. It normally takes OSHA 
        ten to twenty years to finalize a major OSHA standard. 
        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 issue an 
        interim final standard on workplace violence prevention--
                    (A) to require certain employers in the health care 
                and social service sectors, and certain employers in 
                sectors that conduct activities similar to the 
                activities in the health care and social service 
                sectors, to develop and implement a comprehensive 
                workplace violence prevention plan and carry out other 
                activities or requirements described in section 103 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) Inapplicable provisions of law and executive order.--
        The following provisions of law and Executive orders shall not 
        apply to the issuance 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.
                    (C) Subchapter I of chapter 35 of title 44, United 
                States Code (commonly referred to as the ``Paperwork 
                Reduction Act'').
            (3) Notice and comment.--Notwithstanding paragraph (2)(B), 
        the Secretary shall, prior to issuing the interim final 
        standard under this subsection, provide notice in the Federal 
        Register of the interim final standard and a 30-day period for 
        public comment.
            (4) Effective date of interim standard.--The interim final 
        standard shall--
                    (A) take effect on a date that is not later than 30 
                days after issuance, 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.
            (5) Failure to promulgate.--If an interim final standard 
        described in paragraph (1) is not issued 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 issued by the Secretary that meets the 
        requirements of paragraph (1).
    (b) Final Standard.--
            (1) Proposed 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 standard on workplace 
        violence prevention--
                    (A) for the purposes described in subsection 
                (a)(1)(A); and
                    (B) that shall include, at a minimum, requirements 
                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 issue 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.--
                    (A) In general.--The term ``covered facility'' 
                includes the following:
                            (i) 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.
                            (ii) Any residential treatment facility, 
                        including any nursing home, skilled nursing 
                        facility, hospice facility, and long-term care 
                        facility.
                            (iii) Any non-residential treatment or 
                        service setting.
                            (iv) Any medical treatment or social 
                        service setting or clinic at a correctional or 
                        detention facility.
                            (v) Any community care setting, including a 
                        community-based residential facility, group 
                        home, and mental health clinic.
                            (vi) Any psychiatric treatment facility.
                            (vii) Any drug abuse or substance use 
                        disorder treatment center.
                            (viii) Any independent freestanding 
                        emergency centers.
                            (ix) Any facility described in clauses (i) 
                        through (viii) 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 
                        (as such section is in effect on the date of 
                        enactment of this Act).
                            (x) Any other facility the Secretary 
                        determines should be covered under the 
                        standards promulgated under section 101.
                    (B) Exclusion.--The term ``covered facility'' does 
                not include an office of a physician, dentist, 
                podiatrist, or any other health practitioner that is 
                not physically located within a covered facility 
                described in clauses (i) through (x) of subparagraph 
                (A).
            (2) Covered services.--
                    (A) In general.--The term ``covered service'' 
                includes the following services and operations:
                            (i) Any services and operations provided in 
                        any field work setting, including home health 
                        care, home-based hospice, and home-based social 
                        work.
                            (ii) Any emergency services and transport, 
                        including such services provided by 
                        firefighters and emergency responders.
                            (iii) Any services described in clauses (i) 
                        and (ii) 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 
                        (as such section is in effect on the date of 
                        enactment of this Act).
                            (iv) Any other services and operations the 
                        Secretary determines should be covered under 
                        the standards promulgated under section 101.
                    (B) Exclusion.--The term ``covered service'' does 
                not include child day care services.
            (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 (in this section referred to as the 
        ``Plan'') for covered employees at each covered facility and 
        for covered employees performing a covered service on behalf of 
        such employer, which meets the following:
                    (A) Plan development.--Each Plan shall--
                            (i) be developed and implemented with the 
                        meaningful participation of direct care 
                        employees, other employees, and employee 
                        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, complexity, 
                        and type 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 and 
                        the individual's position 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, or 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 any violent incident 
                                investigation described in paragraph 
                                (2) and any 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;
                                    (IV) to provide medical care or 
                                first aid to affected employees; and
                                    (V) to provide employees with 
                                information about available trauma and 
                                related counseling.
                            (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 the 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--
                                    (I) ensuring the 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; and
                                    (II) determining which covered 
                                employer or covered employers shall be 
                                responsible for implementing and 
                                complying with the provisions of the 
                                standard applicable to the working 
                                conditions over which such employers 
                                have control.
                            (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 shall include 
                information on the Plan, including identified workplace 
                violence hazards, work practice control measures, 
                reporting procedures, record keeping requirements, 
                response procedures, anti-retaliation policies, and 
                employee rights.
                    (B) Additional hazard recognition training shall be 
                provided for supervisors and managers to ensure they--
                            (i) can recognize high-risk situations; and
                            (ii) do not assign employees to situations 
                        that predictably compromise the safety of such 
                        employees.
                    (C) Additional training shall be provided for each 
                such covered employee whose job circumstances have 
                changed, within a reasonable timeframe after such 
                change.
                    (D) Applicable training shall be provided under 
                this paragraph for each new covered employee prior to 
                the employee's job assignment.
                    (E) All training shall provide such employees 
                opportunities to ask questions, give feedback on 
                training, and request additional instruction, 
                clarification, or other followup.
                    (F) All training shall be provided in-person and by 
                an individual with knowledge of workplace violence 
                prevention and of the Plan, except that any annual 
                training described in subparagraph (A) provided to an 
                employee after the first year such training is provided 
                to such employee may be conducted by live video if in-
                person training is impracticable.
                    (G) All training shall be 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 for not less than 5 years--
                                    (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)(I) 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 (as such 
                        section is in effect on the date of enactment 
                        of this Act), 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 (as such part is in 
                        effect on the date of enactment of this Act); 
                        and
                            (II) ensure that any such records and logs 
                        that may be copied, transmitted electronically, 
                        or otherwise removed from the employer's 
                        control for purposes of this clause omit any 
                        element of personal identifying information 
                        sufficient to allow identification of any 
                        patient, resident, client, or other individual 
                        alleged to have committed a violent incident 
                        (including the individual's name, address, 
                        electronic mail address, telephone number, or 
                        social security number, or other information 
                        that, alone or in combination with other 
                        publicly available information, reveals such 
                        individual's identity).
                    (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, and the names and job 
                                titles of involved employees;
                                    (III) the nature and extent of 
                                injuries to covered employees;
                                    (IV) a classification of the 
                                perpetrator who committed the violence, 
                                including whether the perpetrator was--
                                            (aa) a patient, client, 
                                        resident, or customer of a 
                                        covered employer;
                                            (bb) a family or friend of 
                                        a patient, client, resident, or 
                                        customer of a covered employer;
                                            (cc) a stranger;
                                            (dd) a coworker, 
                                        supervisor, or manager of a 
                                        covered employee;
                                            (ee) a partner, spouse, 
                                        parent, or relative of a 
                                        covered employee; or
                                            (ff) any other appropriate 
                                        classification;
                                    (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 (as such section is in 
                        effect on the date of enactment of this Act).
                    (C) Annual summary.--
                            (i) Covered employers.--Each covered 
                        employer shall prepare and submit to the 
                        Secretary 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--
                                            (aa) the total number of 
                                        violent incidents;
                                            (bb) the number of 
                                        recordable injuries related to 
                                        such incidents; and
                                            (cc) 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 3 months 
                                beginning February 1 of each year in a 
                                manner consistent with the requirements 
                                of section 1904 of title 29, Code of 
                                Federal Regulations (as such section is 
                                in effect on the date of enactment of 
                                this Act), 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 subparagraph.
            (5) Annual report.--
                    (A) Report to secretary.--Not later than February 
                15 of each year, each covered employer shall report to 
                the Secretary, on a form provided by 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). The 
                contents of the report of the Secretary to Congress 
                shall not disclose any confidential information.
                    (B) Report to congress.--Not later than 6 months 
                after February 15 of each year, the Secretary shall 
                submit to Congress a summary of the reports received 
                under subparagraph (A).
            (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) Plan updates.--Each covered employer shall incorporate 
        changes to the Plan, in a manner consistent with paragraph 
        (1)(A)(i) and based on findings from the most recent annual 
        evaluation conducted under paragraph (6), as appropriate.
            (8) Anti-retaliation.--
                    (A) Policy.--Each covered employer shall adopt a 
                policy prohibiting any person (including an agent of 
                the employer) from the discrimination or retaliation 
                described in subparagraph (B).
                    (B) Prohibition.--No covered employer shall 
                discriminate or retaliate against any employee for--
                            (i) reporting a workplace violence 
                        incident, threat, or concern to, or seeking 
                        assistance or intervention with respect to such 
                        incident, threat, or concern from, the 
                        employer, law enforcement, local emergency 
                        services, or a local, State, or Federal 
                        government agency; or
                            (ii) 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;
            (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; and
            (3) nothing in this Act shall be construed to limit or 
        prevent health care workers, social service workers, and other 
        personnel from reporting violent incidents to appropriate law 
        enforcement.

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 lawful 
                acts of 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, or with a 
        customer, client, patient, student, inmate, or any individual 
        for whom a covered facility provides services or for whom the 
        employee performs covered services.
            (6) Threat of violence.--The term ``threat of violence'' 
        means a statement or conduct that--
                    (A) causes an individual to fear for such 
                individual's safety because there is a reasonable 
                possibility the individual might be physically injured; 
                and
                    (B) 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, without regard to 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 individuals 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) a patient's treatment and medication status, 
                and history of violence and use of drugs or alcohol; 
                and
                    (B) any conditions or disease processes of the 
                patient that may cause the patient to experience 
                confusion or disorientation, be non-responsive to 
                instruction, behave unpredictably, or engage in 
                disruptive, threatening, or violent behavior.
            (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--
                            (i) assigning and placing sufficient 
                        numbers of staff to reduce patient-specific 
                        type 2 violence hazards;
                            (ii) provision of dedicated and available 
                        safety personnel such as security guards;
                            (iii) employee training on workplace 
                        violence prevention methods and techniques to 
                        de-escalate and minimize violent behavior; and
                            (iv) 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 Workplace Violence Prevention for Health 
        Care and Social Service Workers Act).''; 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>
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