I
103D CONGRESS
1ST SESSION
H. R. 1044
To amend title XVIII of the Social Security Act to provide for the enforce-
ment of standards relating to the rights of patients in certain medical
facilities.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 23, 1993
Mrs. BYRNE introduced the following bill; which was referred jointly to the
Committees on Ways and Means and Energy and Commerce
A BILL
To amend title XVIII of the Social Security Act to provide
for the enforcement of standards relating to the rights
of patients in certain medical facilities.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
That (a)(1) sections 1861(e)(9) and 1861(j)(15) of the
Social Security Act (relating to qualifications of hospitals
and skilled nursing facilities) are each amended by strik-
ing out ‘‘health and safety’’ and inserting in lieu thereof
‘‘health, safety, and rights’’.
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(2) Section 1864(c) of such Act is amended by strik-
ing out ‘‘health and safety of patients’’ and inserting in
lieu thereof ‘‘the health, safety, and rights of patients’’.
(b) Part C of title XVIII of such Act is amended by
adding after section 1881 the following new sections:
‘‘RIGHTS OF PATIENTS OF CERTAIN LONG-TERM CARE
FACILITIES
‘‘SEC. 1882. (a) In prescribing standards under sub-
sections (e)(9) and (j)(15) of section 1861 with respect
to the rights of individuals (hereinafter in this section and
section 1883 referred to as ‘patients’) furnished services
in an institution which has (as determined by the Sec-
retary) an average duration-of-stay of more than 30 days
(such an institution hereinafter in this section and section
1183 referred to as a ‘facility’), the Secretary shall—
‘‘(1) require the governing board of the facility
to establish written policies, consistent with the
rights set forth in subsection (b), regarding the
rights and responsibilities of patients and, through
the administrator of the facility, to develop and ad-
here to procedures for implementing such policies;
‘‘(2) require the facility to make these policies
and procedures available to the public, patients,
guardians, and relatives of patients, and to any rel-
ative or other person serving as a representative
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payee of a patient pursuant to section 205(j) of this
Act; and
‘‘(3) require the staff of the facility to be
trained and involved in the implementation of these
policies and procedures.
‘‘(b) A facility’s policies and procedures regarding
rights of patients of the facility must at least ensure that
the following patients’ rights are provided:
‘‘(1) INFORMATION
ON
PATIENT
RIGHTS.—A
patient’s right to be fully informed, as evidenced by
the patient’s written acknowledgment, before or at
the time of admission and during stay of these
rights and of all rules and regulations governing pa-
tient conduct and responsibility.
‘‘(2) 
INFORMATION
ON
SERVICES
AND
CHARGES.—A patient’s right (A) to be fully in-
formed, and given a written statement before or at
the time of admission and during stay, of services
available in the facility and of related charges for
such services, including any charges for services not
covered under this title or title XIX or not covered
by the facility’s basic per diem rate, and (B) to be
informed in writing at least 30 days in advance of
any changes in the availability of services or in the
charges for these services.
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‘‘(3) INFORMATION ON AND PARTICIPATION IN
MEDICAL TREATMENT.—A patient’s right (A) to be
fully informed by a physician of the patient’s medi-
cal condition, unless medically contraindicated for a
specified and limited period of time (as documented,
by a physician, in the patient’s medical record), (B)
to be afforded the opportunity to participate in the
planning of his medical treatment, and (C) to refuse
to participate in experimental research.
‘‘(4) CONDITIONS
OF
TRANSFER
OR
DIS-
CHARGE.—A patient’s right (A) to be transferred
within the facility or discharged from the facility
only for medical reasons, for his welfare or that of
other patients, or for nonpayment of his stay (except
as prohibited by this title or title XIX), (B) to be
informed before admission of the causes for such a
transfer or discharge, (C) to be given 30 days’ ad-
vance notice of such a transfer or discharge (except
for emergencies threatening the health or safety of
the patient), and (D) to be given sufficient prepara-
tion and orientation to ensure safe and orderly
transfer or discharge and adjustment and to have
this preparation and orientation documented in his
medical record.
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‘‘(5) GRIEVANCES.—A patient’s right to be as-
sisted, throughout his period of stay, in his exercise
of his rights as a patient and as a citizen, and to
this end the patient’s right to file complaints under
section 1883, voice grievances, and recommend
changes in policies and service to the staff of the fa-
cility and to outside representatives of his choice (in-
cluding representatives of governmental agencies ad-
ministering the programs under this title and title
XIX) free from restraint, interference, coercion, dis-
crimination, or reprisal.
‘‘(6) MANAGEMENT OF PERSONAL FINANCIAL
AFFAIRS.—A patient’s right to manage his personal
financial affairs or be given, at least quarterly, an
itemized accounting of financial transactions made
on his behalf whenever the facility accepts his writ-
ten delegation of this responsibility for any period of
time in conformance with State law.
‘‘(7) 
FREEDOM
FROM
ABUSE
AND
RE-
STRAINTS.—A patient’s right—
‘‘(A) to be free from mental and physical
abuse, and
‘‘(B) to be free from chemical and physical
restraints, except (i) as authorized in writing by
a physician for a specified and limited period of
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time, or (ii) in emergencies when necessary to
protect the patient from injury to himself or to
others (in which case notice of the use of such
restraints, and an explanation of the cir-
cumstances thereof, shall be promptly provided
to the attending physician and noted in the pa-
tient’s medical record).
‘‘(8) CONFIDENTIALITY
OF
TREATMENT
AND
MEDICAL RECORDS.—A patient’s right—
‘‘(A) to be assured confidential treatment
of his personal and medical records, and
‘‘(B) to approve or refuse the release of
such records to any individual outside the facil-
ity, except in the case of a transfer to another
health care institution or as required by law or
third-party payment contract.
‘‘(9) DIGNITY AND PRIVACY.—A patient’s right
to be treated with consideration, respect, and full
recognition of his dignity and individuality, including
privacy in treatment and in care for his personal
needs.
‘‘(10) 
WORK
REQUIREMENTS.—A 
patient’s
right not to be required to perform services for the
facility.
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‘‘(11) FREEDOM OF ASSOCIATION.—A patient’s
right to associate and communicate privately (in
writing or otherwise) with persons of his choice.
‘‘(12) 
PARTICIPATION
IN
ACTIVITIES
OF
CHOICE.—A patient’s right to meet with, and par-
ticipate in activities of, social, religious, and commu-
nity groups at his discretion.
‘‘(13) USE OF PERSONAL POSSESSIONS.—A pa-
tient’s right to retain and use his personal clothing
and possessions as space permits, unless to do so
would infringe upon rights of other patients, and to
be provided security in storing possessions.
‘‘(14) PRIVACY
FOR
MARRIED
PATIENTS.—A
married patient’s right to be assured privacy in vis-
its by the patient’s spouse and, if spouses are both
patients in the facility, the right of the patients to
share the same room if they so desire.
‘‘(c) The patient’s rights and responsibilities specified
in paragraphs (1) through (4) of subsection (b), as they
pertain to a patient adjudicated incompetent in accordance
with State law, devolve to the patient’s guardian, next of
kin, sponsoring agency (or agencies), or relative or other
person serving as representative payee under section
205(j) of this Act (except when the facility itself is rep-
resentative payee).
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‘‘ENFORCEMENT OF PATIENT’S RIGHTS
‘‘SEC. 1883. (a) The Secretary shall establish, by reg-
ulation, a schedule of the maximum amount of civil pen-
alties which may be imposed under this section for the
violation of each of the patient’s rights set forth in section
1882(b). No such penalty shall exceed $500 for a single
violation, except that the civil penalty for a violation of
a patient’s right, under paragraph (5) of such section, to
file a complaint under this section free from restraint, in-
terference, coercion, discrimination, or reprisal shall not
exceed $1,000. The Secretary shall define in those regula-
tions what constitutes a separate violation for purposes
of this section.
‘‘(b)(1) Any patient, or any person on behalf of such
a patient, who claims to have had a right under section
1882(b) violated by the facility may submit a complaint,
written or oral, with the appropriate enforcing agency (as
defined in subsection (f)). No such complaint with respect
to a violation shall be considered by an enforcing agency
under this section unless it is filed with the agency within
180 days after the date the alleged violation occurred.
‘‘(2) Upon receiving a complaint concerning a facility
under paragraph (1), an enforcing agency shall promptly
notify the facility of the complaint (including the date,
place, and circumstances of the alleged violation), shall in-
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vestigate the complaint (keeping confidential insofar as
possible the identity of the complainant and the name of
the patient or patients involved if the complainant is not
such a patient), and shall provide the complainant with
a written report thereon within 30 days of the date the
complaint was filed. A copy of the report of the agency,
including the complaint (with identities of the complainant
and any patients deleted), shall be made part of the
permanent files of the agency and made available to the
public.
‘‘(c)(1)(A) If, as a result of an investigation con-
ducted under subsection (b)(2), the enforcing agency de-
termines that a facility has not violated any patients’
rights under section 1882(b), the enforcing agency shall
notify the facility and the complainant of such determina-
tion.
‘‘(B) If, as a result of such an investigation, the en-
forcing agency determines that a facility has violated one
or more patients’ rights under section 1882(b), the enforc-
ing agency shall endeavor to provide appropriate adjust-
ment with respect to any such alleged violation (and to
prevent future similar violations) by informal methods of
conference, conciliation, and persuasion. Nothing said or
done during and as part of such informal endeavors may
be made public by the enforcing agency or used as evi-
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dence in a subsequent proceeding without the written con-
sent of the persons concerned. If after such endeavors (but
in a period no longer than 30 days), the enforcing agency
is not able to secure from the facility a conciliation agree-
ment or other understanding acceptable to the agency and
the complainant, the agency shall assess against the facil-
ity a civil penalty (determined in accordance with the
schedule developed under subsection (a)) by an order
made—
‘‘(i) after written notice (including notice of the
enforcing agency’s proposed order and the facility’s
opportunity to request, within 15 days after the date
the notice is received, a hearing on the proposed
order), and
‘‘(ii) after opportunity for a hearing in accord-
ance with procedures to be specified by the Sec-
retary in regulations.
‘‘(2) Such an order shall provide that the penalty
shall be paid (in accordance with subsection (d)(2)) to the
enforcing agency and the agency shall promptly make pay-
ment to patients (or heirs of patients, in the case of de-
ceased patients) in accordance with the penalties assessed
for violation of their rights. Notwithstanding any other
provision of law, civil penalties paid to any individual in
accordance with this paragraph shall not constitute in-