text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Freedom From Restraint Act of 
  1999''.
  
  SEC. 2. INDIVIDUALS' RIGHT TO FREEDOM FROM RESTRAINT AND REPORTING OF 
                SENTINEL EVENTS UNDER MEDICARE.
  
      (a) In General.--Part D of title XVIII of the Social Security Act 
  (42 U.S.C. 1395x et seq.) is amended by adding at the end the 
  following:
  
   ``individuals' freedom from restraint and reporting of sentinel events
  
      ``Sec. 1897. (a) Definitions.--In this section:
              ``(1) Provider of services.--The term `provider of 
          services' has the meaning given that term in section 1861(u), 
          except that for purposes of this section the term includes a 
          psychiatric hospital but does not include a home health agency.
              ``(2) Sentinel event.--The term `sentinel event' means an 
          unexpected occurrence involving an individual in the care of a 
          provider of services for treatment for a psychiatric or 
          psychological illness that results in death or serious physical 
          or psychological injury that is unrelated to the natural course 
          of the individual's illness or underlying condition.
      ``(b) Protection of Right To Be Free From Restraints.--A provider 
  of services eligible to be paid under this title for providing services 
  to an individual entitled to benefits under part A or enrolled under 
  part B (including an individual provided with a Medicare+Choice plan 
  offered by a Medicare+Choice organization under part C) shall--
              ``(1) protect and promote the right of each such individual 
          to be free from physical or mental abuse, corporal punishment, 
          involuntary seclusion, and any physical or chemical restraints 
          imposed for purposes of discipline or convenience;
              ``(2) impose restraints--
                      ``(A) only to ensure the physical safety of the 
                  individual or other individuals in the care or custody 
                  of the provider; and
                      ``(B) only upon the written order of a physician 
                  that specifies the duration and circumstances under 
                  which the restraints are to be used (except in 
                  emergency circumstances specified by the Secretary 
                  until such an order could reasonably be obtained); and
              ``(2) submit the reports required under subsection (c).
      ``(c) Reports.--
              ``(1) Reports to agencies or entities with oversight 
          authority.--
                      ``(A) In general.--A provider of services shall 
                  report each sentinel event that occurs to an individual 
                  while the individual is in the care or custody of the 
                  provider to--
                              ``(i) in the case of a provider of services 
                          participating in the program established under 
                          this title or the medicaid program under title 
                          XIX as a result of accreditation by a national 
                          accrediting body, the national accrediting body 
                          for that provider; and
                              ``(ii) in the case of all other providers 
                          of services, the Secretary or, upon agreement 
                          between the Secretary and the relevant State, 
                          the State agency designated by the Secretary.
                      ``(B) Investigation and further reporting of 
                  sentinel events.--Upon receipt of a report made 
                  pursuant to subparagraph (A), the agency or entity with 
                  oversight authority shall--
                              ``(i) ensure that the provider--
                                      ``(I) conducts an investigation of 
                                  the sentinel event reported;
                                      ``(II) determines the root cause or 
                                  causes of the sentinel event; and
                                      ``(III) establishes a time-limited 
                                  plan or strategy, that allows the 
                                  agency or entity with oversight 
                                  authority to review and approve the 
                                  analyses and any corrective actions 
                                  proposed or made by the provider of 
                                  services, to correct the problem or 
                                  problems that resulted in the sentinel 
                                  event, and to lead to risk reduction; 
                                  and
                              ``(ii) prepare and submit the reports 
                          required under paragraph (2).
              ``(2) Reports to the secretary.--
                      ``(A) In general.--Subject to subparagraph (D), the 
                  agency or entity with oversight authority shall submit 
                  a report containing the information described in 
                  subparagraph (B) to the Secretary in such form and 
                  manner, and by such date, as the Secretary prescribes.
                      ``(B) Information to be reported.--
                              ``(i) In general.--The report submitted 
                          under subparagraph (A) shall be submitted to 
                          the Secretary at regular intervals, but not 
                          less frequently than annually, and shall 
                          include--
                                      ``(I) a description of the sentinel 
                                  events occurring during the period 
                                  covered by the report;
                                      ``(II) a description of any 
                                  corrective action taken by the 
                                  providers of services with respect to 
                                  the sentinel events or any other 
                                  measures necessary to prevent similar 
                                  sentinel events from occurring in the 
                                  future;
                                      ``(III) proposed systems changes 
                                  identified as a result of analysis of 
                                  events from multiple providers; and
                                      ``(IV) such additional information 
                                  as the Secretary determines to be 
                                  essential to ensure compliance with the 
                                  requirements of this section.
                              ``(ii) Information excluded.--The report 
                          submitted under subparagraph (A) shall not 
                          identify any individual provider of services, 
                          practitioner, or individual.
                      ``(C) Additional reporting requirements when a 
                  provider has been identified as having a pattern of 
                  poor performance.--
                              ``(i) In general.--In addition to the 
                          report required under subparagraph (A), the 
                          agency or entity with oversight authority shall 
                          report to the Secretary the name and address of 
                          any provider of services with a pattern of poor 
                          performance.
                              ``(ii) Determination of pattern.--The 
                          agency or entity with oversight authority shall 
                          determine if a pattern of poor performance 
                          exists with respect to a provider of services 
                          in accordance with the definition of pattern of 
                          poor performance developed by the Secretary 
                          under clause (iii).
                              ``(iii) Development of definition.--The 
                          Secretary, in consultation with national 
                          accrediting organizations and others, shall 
                          develop a definition to identify a provider of 
                          services with a pattern of poor performance.
                      ``(D) Authority to waive reporting requirement.--
                  The Secretary may waive the requirement to submit a 
                  report required under this paragraph (but not a report 
                  regarding a sentinel event that resulted in death 
                  required under paragraph (3)) upon consideration of the 
                  severity of the sentinel event.
              ``(3) Additional reporting requirements for sentinel events 
          resulting in death.--In addition to the report required under 
          paragraph (1), a provider of services shall report any sentinel 
          event resulting in death to--
                      ``(A) the Secretary or the Secretary's designee;
                      ``(B) the State Attorney General or, upon agreement 
                  with the State Attorney General, to the appropriate law 
                  enforcement agency;
                      ``(C) the State agency responsible for licensing 
                  the provider of services; and
                      ``(D) the State protection and advocacy system 
                  established pursuant to part C of title I of the 
                  Developmental Disabilities Assistance and Bill of 
                  Rights Act (42 U.S.C. 6041 et seq.) for the State in 
                  which the event occurred.
              ``(4) Responsibilities of the agency or entity with 
          oversight authority.--Upon receipt of a report of a sentinel 
          event that resulted in death, the agency or entity with 
          oversight authority shall, in addition to the requirements of 
          paragraph (2)--
                      ``(A) determine whether the death was related to 
                  the use of restraints or seclusion; and
                      ``(B) notify the Secretary of the determination.
              ``(5) Sanctions for failure to report.--
                      ``(A) In general.--The Secretary shall establish 
                  sanctions, including intermediate sanctions, as 
                  appropriate, for failure of a provider of services or 
                  an agency or entity with oversight authority to submit 
                  the reports and information required under this 
                  subsection.
                      ``(B) Removal of agency or entity with oversight 
                  authority.--The Secretary, after notice to an agency or 
                  entity with oversight authority of a provider of 
                  services, as determined in paragraph (1), and 
                  opportunity to comply, may remove the agency or entity 
                  of such authority if the agency or entity refuses to 
                  submit the reports and information required under this 
                  subsection.
              ``(6) Liability for reporting.--An individual, provider of 
          services, agency, or entity shall be liable with respect to any 
          information contained in a report required under this 
          subsection if the individual, provider of services, agency, or 
          entity had knowledge of the falsity of the information 
          contained in the report at the time the report was submitted 
          under this subsection. Nothing in the preceding sentence shall 
          be construed as limiting the liability of an individual, 
          provider of services, agency, or entity for damages relating to 
          the occurrence of a sentinel event, including a sentinel event 
          that results in death.
              ``(7) Nondisclosure of analysis.--Notwithstanding any other 
          provision of law or regulation, the root cause analysis 
          developed under this subsection shall be kept confidential and 
          shall not be subject to disclosure or discovery in a civil 
          action.
      ``(d) Establishment or Designation of Sentinel Events Database.--
              ``(1) In general.--Not later than 1 year after the date of 
          enactment of this section, the Secretary shall establish or 
          designate a database of information using the reports submitted 
          under paragraphs (2) and (3) of subsection (c) (in this 
          subsection referred to as the `Sentinel Events Database').
              ``(2) Contents.--
                      ``(A) In general.--Subject to subparagraph (B), the 
                  Sentinel Events Database shall include the following:
                              ``(i) The name and address of any provider 
                          of services that is the subject of a report 
                          submitted under subsection (c)(3), if the 
                          agency or entity with oversight authority has 
                          determined that the death was related to the 
                          use of restraints or seclusion.
                              ``(ii) The information reported by the 
                          agency or entity under subparagraphs (B) and 
                          (C) of subsection (c)(2).
                      ``(B) Confidentiality.--The Secretary shall 
                  establish procedures to ensure that the privacy of 
                  individuals whose treatment is the subject of a report 
                  submitted under paragraph (2) or (3) of subsection (c) 
                  is protected.
              ``(3) Procedures for entry of information.--
                      ``(A) In general.--The Secretary shall--
                              ``(i) prior to entry of information in the 
                          Sentinel Events Database, disclose the 
                          information to the provider of services that is 
                          the subject of the information; and
                              ``(ii) establish procedures to--
                                      ``(I) resolve disputes regarding 
                                  the accuracy of the information; and
                                      ``(II) ensure the accuracy of the 
                                  information.
                      ``(B) No delay of sanctions.--Any sanction to be 
                  imposed by the Secretary against a provider of services 
                  or an agency or entity with oversight authority in 
                  relation to a sentinel event shall not be delayed as a 
                  result of a dispute regarding the accuracy of 
                  information to be entered into the database.
              ``(4) Access to the database.--
                      ``(A) Availability.--The Secretary shall establish 
                  procedures for making the information maintained in the 
                  Sentinel Events Database related to a sentinel event 
                  resulting in death, and any reports of sentinel 
                  injuries arising from those providers of services with 
                  a pattern of poor performance identified in accordance 
                  with subsection (c)(2)(C), available to Federal and 
                  State agencies, national accrediting bodies, health 
                  care researchers, and the public.
                      ``(B) Internet access.--In addition to any other 
                  procedures that the Secretary develops under 
                  subparagraph (A), the information in the Sentinel 
                  Events Database shall be accessible through the 
                  Internet.
                      ``(C) Fees for disclosure.--
                              ``(i) In general.--Subject to clause (ii), 
                          the Secretary may establish or approve 
                          reasonable fees for disclosing information 
                          maintained in the Sentinel Events Database.
                              ``(ii) No fee for federal agencies.--No fee 
                          shall be charged to a Federal agency for access 
                          to the Sentinel Events Database.
                              ``(iii) Application of fees.--Fees 
                          collected under this clause shall be applied by 
                          the Secretary toward the cost of maintaining 
                          the Sentinel Events Database.''.
      (b) Effective Date.--
              (1) In general.--Subject to paragraph (2), the amendments 
          made by this section take effect on the date of enactment of 
          this Act.
              (2) Reporting requirements.--The reporting requirements 
          under section 1897(c) of the Social Security Act, as added by 
          subsection (a), shall apply to sentinel events occurring on and 
          after the date of enactment of this Act.
  
  SEC. 3. INDIVIDUALS' RIGHT TO FREEDOM FROM RESTRAINT AND REPORTING OF 
                SENTINEL EVENTS UNDER MEDICAID.
  
      (a) State Plans for Medical Assistance.--Section 1902(a) of the 
  Social Security Act (42 U.S.C. 1396a(a)) is amended--
              (1) in paragraph (65), by striking the period and inserting 
          ``; and''; and
              (2) by adding at the end the following:
              ``(66) provide that the State will ensure that any 
          congregate care provider (as defined in section 1905(v)) that 
          provides services to an individual for which medical assistance 
          is available shall--
                      ``(A) protect and promote the right of each 
                  individual to be free from physical or mental abuse, 
                  corporal punishment, involuntary seclusion, and any 
                  physical or chemical restraints imposed for purposes of 
                  discipline or convenience;
                      ``(B) impose restraints only--
                              ``(i) to ensure the physical safety of the 
                          individual or other individuals; and
                              ``(ii) upon the written order of a 
                          physician that specifies the duration and 
                          circumstances under which the restraints are to 
                          be used (except in emergency circumstances 
                          specified by the Secretary until such an order 
                          could reasonably be obtained); and
                      ``(C) submit the reports required under subsection 
                  (c) of section 1897 (relating to sentinel events) in 
                  the same manner as a provider of services under that 
                  section is required to submit such reports.''.
      (b) Definition of Congregate Care Provider.--Section 1905 of the 
  Social Security Act (42 U.S.C. 1396d) is amended by adding at the end 
  the following:
      ``(v) The term `congregate care provider' means an entity that 
  provides hospital services, nursing facility services, services of 
  intermediate care facilities for the mentally retarded, hospice care, 
  residential treatment centers for children, services in an institution 
  for mental diseases, inpatient psychiatric hospital services for 
  individuals under age 21, or congregate care services under a waiver 
  authorized under section 1915(c).''.
      (c) Effective Date.--
              (1) In general.--Subject to paragraph (2), the amendments 
          made by this section take effect on the date of enactment of 
          this Act.
              (2) Reporting requirements.--The reporting requirements 
          under section 1902(a)(66)(C) of the Social Security Act (42 
          U.S.C. 1396a(a)(66)(C)), as added by subsection (a), shall 
          apply to sentinel events occurring on and after the date of 
          enactment of this Act.
target: Allows the imposition of restraints: (1) only to ensure physical safety of the individual or others in the provider's care; and (2) only upon the written order of a physician specifying the duration and circumstances under which restraints are to be used (except in emergency circumstances specified by the Secretary of Health and Human Services until such an order could reasonably be obtained).  Requires the service provider to investigate the sentinel event reported and the appropriate agencies or entities to review and approve the provider's root cause analysis before reporting on the matter to the Secretary for use in the Sentinel Events Database.
  Directs the Secretary to establish such Database for use on the Internet, with appropriate privacy safeguards for individuals whose treatment is the subject of a report under this Act.
  Requires additional reporting in certain cases, including: (1) to the Secretary about a provider identified as having a pattern of poor performance; and (2) to the State Attorney General or the appropriate State law enforcement agency in sentinel events involving death.  Mandates sanctions for failure to report.  Bars disclosure or discovery of a root cause analysis in a civil action.
feat_title: Freedom From Restraint Act of 1999