ployee, 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 pur-
pose. 
(7) ALARM.—The term ‘‘alarm’’ means a me-
chanical, electrical, or electronic device that does not 
rely upon an employee’s vocalization in order to alert 
others. 
(8) DANGEROUS
WEAPON.—The term ‘‘dan-
gerous weapon’’ means an instrument capable of in-
flicting death or serious bodily injury, regardless of 
whether such instrument was designed for that pur-
pose. 
(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 work-
place or creates a barrier between a covered 
employee and the hazard. 
(B) INCLUSIONS.—For purposes of reduc-
ing workplace violence hazards, the term ‘‘engi-
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neering controls’’ includes electronic access con-
trols to employee occupied areas, weapon detec-
tors (installed or handheld), enclosed work-
stations with shatter-resistant glass, deep serv-
ice counters, separate rooms or areas for high- 
risk patients, locks on doors, removing access to 
or securing items that could be used as weap-
ons, 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-cir-
cuit television monitoring and video recording, 
sight-aids, and personal alarm devices. 
(10) ENVIRONMENTAL RISK FACTORS.— 
(A) IN
GENERAL.—The term ‘‘environ-
mental risk factors’’ means factors in the cov-
ered facility or area in which a covered service 
is performed that may contribute to the likeli-
hood or severity of a workplace violence inci-
dent. 
(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 bar-
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riers 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, includ-
ing— 
(A) a patient’s psychiatric condition, treat-
ment and medication status, 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 expe-
rience confusion or disorientation, to be non-re-
sponsive to instruction, or to behave unpredict-
ably. 
(12) 
SECRETARY.—The 
term 
‘‘Secretary’’ 
means the Secretary of Labor. 
(13) WORK PRACTICE CONTROLS.— 
(A) IN GENERAL.—The term ‘‘work prac-
tice controls’’ means procedures and rules that 
are used to effectively reduce workplace violence 
hazards. 
(B) INCLUSIONS.—The term ‘‘work prac-
tice controls’’ includes assigning and placing 
sufficient numbers of staff to reduce patient- 
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specific Type 2 workplace violence hazards, pro-
vision of dedicated and available safety per-
sonnel such as security guards, employee train-
ing on workplace violence prevention method 
and techniques to de-escalate and minimize vio-
lent behavior, and employee training on proce-
dures 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 FACILI-
TIES RECEIVING MEDICARE FUNDS. 
(a) IN GENERAL.—Section 1866 of the Social Secu-
rity 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 other-
wise subject to the Occupational Safety and Health 
Act of 1970 (or a State occupational safety and 
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health plan that is approved under 18(b) of such 
Act) and skilled nursing facilities that are not other-
wise subject to such Act (or such a State occupa-
tional safety and health plan), to comply with the 
Workplace Violence Prevention Standard (as pro-
mulgated 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 sub-
section (a)(1)(Z) (relating to the Workplace Vi-
olence Prevention Standard)’’ after ‘‘Blood-
borne Pathogens Standard)’’; and 
(B) in subparagraph (B)— 
(i) by striking ‘‘(a)(1)(U)’’ and insert-
ing ‘‘(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. 
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(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 stand-
ard on workplace violence prevention required under sec-
tion 101. 
Æ 
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