H. R. 4365—96
freely, not including devices, such as orthopedically pre-
scribed devices, surgical dressings or bandages, protective
helmets, or any other methods that involves the physical
holding of a resident for the purpose of conducting routine
physical examinations or tests or to protect the resident
from falling out of bed or to permit the resident to partici-
pate in activities without the risk of physical harm to
the resident (such term does not include a physical escort);
and
‘‘(B) a drug or medication that is used as a restraint
to control behavior or restrict the resident’s freedom of
movement that is not a standard treatment for the resi-
dent’s medical or psychiatric condition.
‘‘(2) SECLUSION.—The term ‘seclusion’ means a behavior
control technique involving locked isolation. Such term does
not include a time out.
‘‘(3) PHYSICAL ESCORT.—The term ‘physical escort’ means
the temporary touching or holding of the hand, wrist, arm,
shoulder or back for the purpose of inducing a resident who
is acting out to walk to a safe location.
‘‘(4) TIME
OUT.—The term ‘time out’ means a behavior
management technique that is part of an approved treatment
program and may involve the separation of the resident from
the group, in a non-locked setting, for the purpose of calming.
Time out is not seclusion.
‘‘SEC. 592. REPORTING REQUIREMENT.
‘‘(a) IN GENERAL.—Each facility to which the Protection and
Advocacy for Mentally Ill Individuals Act of 1986 applies shall
notify the appropriate agency, as determined by the Secretary,
of each death that occurs at each such facility while a patient
is restrained or in seclusion, of each death occurring within 24
hours after the patient has been removed from restraints and
seclusion, or where it is reasonable to assume that a patient’s
death is a result of such seclusion or restraint. A notification
under this section shall include the name of the resident and
shall be provided not later than 7 days after the date of the
death of the individual involved.
‘‘(b) FACILITY.—In this section, the term ‘facility’ has the
meaning given the term ‘facilities’ in section 102(3) of the Protection
and Advocacy for Mentally Ill Individuals Act of 1986 (42 U.S.C.
10802(3)).’’.
‘‘SEC. 593. REGULATIONS AND ENFORCEMENT.
‘‘(a) TRAINING.—Not later than 1 year after the date of the
enactment of this part, the Secretary, after consultation with appro-
priate State and local protection and advocacy organizations, physi-
cians, facilities, and other health care professionals and patients,
shall promulgate regulations that require facilities to which the
Protection and Advocacy for Mentally Ill Individuals Act of 1986
(42 U.S.C. 10801 et seq.) applies, to meet the requirements of
subsection (b).
‘‘(b) REQUIREMENTS.—The regulations promulgated under sub-
section (a) shall require that—
‘‘(1) facilities described in subsection (a) ensure that there
is an adequate number of qualified professional and supportive
staff to evaluate patients, formulate written individualized,
H. R. 4365—97
comprehensive treatment plans, and to provide active treatment
measures;
‘‘(2) appropriate training be provided for the staff of such
facilities in the use of restraints and any alternatives to the
use of restraints; and
‘‘(3) such facilities provide complete and accurate notifica-
tion of deaths, as required under section 592(a).
‘‘(c) ENFORCEMENT.—A facility to which this part applies that
fails to comply with any requirement of this part, including a
failure to provide appropriate training, shall not be eligible for
participation in any program supported in whole or in part by
funds appropriated to any Federal department or agency.’’.
SEC. 3208. REQUIREMENT RELATING TO THE RIGHTS OF RESIDENTS
OF CERTAIN NON-MEDICAL, COMMUNITY-BASED FACILI-
TIES FOR CHILDREN AND YOUTH.
Title V of the Public Health Service Act (42 U.S.C. 290aa
et seq.), as amended by section 3207, is further amended by adding
at the end the following:
‘‘PART I—REQUIREMENT RELATING TO THE
RIGHTS OF RESIDENTS OF CERTAIN NON-
MEDICAL, 
COMMUNITY-BASED 
FACILITIES
FOR CHILDREN AND YOUTH
‘‘SEC. 595. REQUIREMENT RELATING TO THE RIGHTS OF RESIDENTS
OF CERTAIN NON-MEDICAL, COMMUNITY-BASED FACILI-
TIES FOR CHILDREN AND YOUTH.
‘‘(a) PROTECTION OF RIGHTS.—
‘‘(1) IN GENERAL.—A public or private non-medical, commu-
nity-based facility for children and youth (as defined in regula-
tions to be promulgated by the Secretary) that receives support
in any form from any program supported in whole or in part
with funds appropriated under this Act shall protect and pro-
mote the rights of each resident of the facility, including the
right to be free from physical or mental abuse, corporal punish-
ment, and any restraints or involuntary seclusions imposed
for purposes of discipline or convenience.
‘‘(2) NONAPPLICABILITY.—Notwithstanding this part, a
facility that provides inpatient psychiatric treatment services
for individuals under the age of 21, as authorized and defined
in subsections (a)(16) and (h) of section 1905 of the Social
Security Act, shall comply with the requirements of part H.
‘‘(3) APPLICABILITY OF MEDICAID PROVISIONS.—A non-med-
ical, community-based facility for children and youth funded
under the Medicaid program under title XIX of the Social
Security Act shall continue to meet all existing requirements
for participation in such program that are not affected by
this part.
‘‘(b) REQUIREMENTS.—
‘‘(1) IN GENERAL.—Physical restraints and seclusion may
only be imposed on a resident of a facility described in sub-
section (a) if—
‘‘(A) the restraints or seclusion are imposed only in
emergency circumstances and only to ensure the immediate
physical safety of the resident, a staff member, or others
H. R. 4365—98
and less restrictive interventions have been determined
to be ineffective; and
‘‘(B) the restraints or seclusion are imposed only by
an individual trained and certified, by a State-recognized
body (as defined in regulation promulgated by the Sec-
retary) and pursuant to a process determined appropriate
by the State and approved by the Secretary, in the preven-
tion and use of physical restraint and seclusion, including
the needs and behaviors of the population served, relation-
ship building, alternatives to restraint and seclusion, de-
escalation methods, avoiding power struggles, thresholds
for restraints and seclusion, the physiological and psycho-
logical impact of restraint and seclusion, monitoring phys-
ical signs of distress and obtaining medical assistance,
legal issues, position asphyxia, escape and evasion tech-
niques, time limits, the process for obtaining approval for
continued restraints, procedures to address problematic
restraints, documentation, processing with children, and
follow-up with staff, and investigation of injuries and com-
plaints.
‘‘(2) INTERIM PROCEDURES RELATING TO TRAINING AND CER-
TIFICATION.—
‘‘(A) IN
GENERAL.—Until such time as the State
develops a process to assure the proper training and certifi-
cation of facility personnel in the skills and competencies
referred in paragraph (1)(B), the facility involved shall
develop and implement an interim procedure that meets
the requirements of subparagraph (B).
‘‘(B) REQUIREMENTS.—A procedure developed under
subparagraph (A) shall—
‘‘(i) ensure that a supervisory or senior staff person
with training in restraint and seclusion who is com-
petent to conduct a face-to-face assessment (as defined
in regulations promulgated by the Secretary), will
assess the mental and physical well-being of the child
or youth being restrained or secluded and assure that
the restraint or seclusion is being done in a safe
manner;
‘‘(ii) ensure that the assessment required under
clause (i) take place as soon as practicable, but in
no case later than 1 hour after the initiation of the
restraint or seclusion; and
‘‘(iii) ensure that the supervisory or senior staff
person continues to monitor the situation for the dura-
tion of the restraint and seclusion.
‘‘(3) LIMITATIONS.—
‘‘(A) IN GENERAL.—The use of a drug or medication
that is used as a restraint to control behavior or restrict
the resident’s freedom of movement that is not a standard
treatment for the resident’s medical or psychiatric condition
in nonmedical community-based facilities for children and
youth described in subsection (a)(1) is prohibited.
‘‘(B) PROHIBITION.—The use of mechanical restraints
in non-medical, community-based facilities for children and
youth described in subsection (a)(1) is prohibited.
‘‘(C) LIMITATION.—A non-medical, community-based
facility for children and youth described in subsection (a)(1)
H. R. 4365—99
may only use seclusion when a staff member is continuously
face-to-face monitoring the resident and when strong
licensing or accreditation and internal controls are in place.
‘‘(c) RULE OF CONSTRUCTION.—
‘‘(1) IN GENERAL.—Nothing in this section shall be con-
strued as prohibiting the use of restraints for medical immo-
bilization, adaptive support, or medical protection.
‘‘(2) CURRENT LAW.—This part shall not be construed to
affect or impede any Federal or State law or regulations that
provide greater protections than this part regarding seclusion
and restraint.
‘‘(d) DEFINITIONS.—In this section:
‘‘(1) 
MECHANICAL
RESTRAINT.—The 
term 
‘mechanical
restraint’ means the use of devices as a means of restricting
a resident’s freedom of movement.
‘‘(2) PHYSICAL ESCORT.—The term ‘physical escort’ means
the temporary touching or holding of the hand, wrist, arm,
shoulder or back for the purpose of inducing a resident who
is acting out to walk to a safe location.
‘‘(3) PHYSICAL
RESTRAINT.—The term ‘physical restraint’
means a personal restriction that immobilizes or reduces the
ability of an individual to move his or her arms, legs, or
head freely. Such term does not include a physical escort.
‘‘(4) SECLUSION.—The term ‘seclusion’ means a behavior
control technique involving locked isolation. Such term does
not include a time out.
‘‘(5) TIME
OUT.—The term ‘time out’ means a behavior
management technique that is part of an approved treatment
program and may involve the separation of the resident from
the group, in a non-locked setting, for the purpose of calming.
Time out is not seclusion.
‘‘SEC. 595A. REPORTING REQUIREMENT.
‘‘Each facility to which this part applies shall notify the appro-
priate State licensing or regulatory agency, as determined by the
Secretary—
‘‘(1) of each death that occurs at each such facility. A
notification under this section shall include the name of the
resident and shall be provided not later than 24 hours after
the time of the individuals death; and
‘‘(2) of the use of seclusion or restraints in accordance
with regulations promulgated by the Secretary, in consultation
with the States.
‘‘SEC. 595B. REGULATIONS AND ENFORCEMENT.
‘‘(a) TRAINING.—Not later than 6 months after the date of
the enactment of this part, the Secretary, after consultation with
appropriate State, local, public and private protection and advocacy
organizations, health care professionals, social workers, facilities,
and patients, shall promulgate regulations that—
‘‘(1) require States that license non-medical, community-
based residential facilities for children and youth to develop
licensing rules and monitoring requirements concerning
behavior management practice that will ensure compliance with
Federal regulations and to meet the requirements of subsection
(b);
‘‘(2) require States to develop and implement such licensing
rules and monitoring requirements within 1 year after the