U.S. Department of Health and Human Services

Office of Inspector General

National Background Check 

Program for Long-Term-Care 

Providers: Assessment of State 

Programs Concluded in 2019

Suzanne Murrin

Deputy Inspector General for Evaluation and Inspections 

September 2020, OEI-07-20-00180 
Report found at: https://oig.hhs.gov/oei/reports/oei-07-20-00180.asp

U.S. Department of Health and Human Services 

Office of Inspector General 

Report in Brief

September 2020, OEI-07-20-00180 

Why OIG Did This Review

Background checks for employees 

are an important safety measure 

that can help protect some of the 

most vulnerable populations. 

More than 13 million beneficiaries 

are served by long-term-care 

facilities each year, including the 

elderly, individuals in hospice care, 

and individuals with intellectual 

disabilities. 

The National Background Check 

Program (Program), enacted by 

legislation in 2010, assists States 

and territories (States) in 

developing and improving 

systems to conduct Federal and 

State background checks. 

Included in this legislation is a 

mandate that the Office of 

Inspector General (OIG) produce 

an evaluation of the Program 

within 180 days of Program 

completion. This report is the 

fourth in a series to supplement 

the mandated evaluation. In 

future work, we will assess the 

final four States to conclude the 

Program and the Program overall.

How OIG Did This Review

We reviewed grant-monitoring 

documents and financial reports 

to determine the extent to which 

the 4 States that concluded 

participation in 2019 had 

implemented 13 selected Program 

requirements. Additionally, we 

surveyed program staff from the 

four States to collect information 

on their experiences with their 

respective background check 

programs.

National Background Check Program for 

Long-Term-Care Providers: Assessment of State 

Programs Concluded in 2019 

The National Background Check Program Key Takeaway (Program) provides grants to States to develop 

Three of the four States programs for conducting background checks of 

were unable to prospective long-term-care employees via States 

implement all selected and Federal criminal history records. The 

Program requirements, beneficiaries served by long-term-care providers 

and three States did not include some of the most vulnerable populations. 

report sufficient data to Four States concluded their participation in the 

accurately assess program in 2019: Hawaii, Ohio, Oregon, and 

Program outcomes. Puerto Rico.

What OIG Found

OIG found that of the 4 States that concluded their participation in the Program 

in 2019, 3 States—Hawaii, Oregon, and Puerto Rico—did not implement all 13 

selected Program requirements during the grant period. These States had 

varying degrees of State-level legal requirements and practical infrastructure for 

conducting background checks that affected their ability to implement select 

Program requirements. Primarily, these States lacked existing legislative 

authority and encountered challenges in coordinating between State-level 

departments. Two States needed to seek legislative authority to implement 

select Program requirements and develop needed infrastructure. One State 

needed to amend existing legislation to implement one Program requirement. 

The two States that needed to seek legislative authority also encountered 

challenges in coordinating with their respective State criminal justice authorities 

to implement background-check requirements. One State had existing 

legislative authority and implemented all 13 selected Program requirements. 

OIG found that three of the four States—Ohio, Oregon, and Puerto Rico—did 

not report sufficient data to accurately assess Program outcomes. Unless all 

participating States consistently report quality data, Program outcomes cannot 

be accurately assessed. 

What OIG Recommends and How the Agency Responded

The Centers for Medicare & Medicaid Services (CMS) should continue to 

implement OIG’s prior recommendation for it to take appropriate actions to 

encourage States to obtain the necessary legislative authority to fully implement 

Program requirements. Given this report’s findings, CMS should assist 

participating States to address the challenge of coordinating between Statelevel departments and require participating States to consistently submit data 

that allow for CMS and each State to calculate determinations of ineligibility. 

CMS concurred with both recommendations.
TABLE OF CONTENTS

BACKGROUND 1 

Objective 1 

Methodology 5 

FINDINGS 6 

Three of the four States that concluded the Program in 2019 did not implement all 6 

requirements, primarily because of not having existing legislative authority and 

challenges with coordination

Three of the four States did not report sufficient data to accurately assess Program 9 

outcomes

RECOMMENDATIONS 11

Assist participating States in addressing the challenge of coordination between 11

State-level departments

Require that participating States consistently submit data that allow for CMS and each 12

State to calculate determinations of ineligibility

AGENCY COMMENTS AND OIG RESPONSE 13

DETAILED METHODOLOGY 14 

APPENDICES 16 

A. Mandate for National Background Check Program Evaluation and Report 16 

B. State Expenditures for the National Background Check Program 17 

C. Related OIG Reports 18 

D. Beginning and Ending Dates of States’ Respective Programs 21 

E. State-by-State Implementation of Selected Program Requirements 22 

F. Agency Comments 27 

ACKNOWLEDGMENTS AND CONTACT 29 

ABOUT THE OFFICE OF INSPECTOR GENERAL 30

ENDNOTES 31 
National Background Check Program for Long-Term-Care Providers: Assessment of State Programs 

Concluded in 2019 OEI-07-20-00180 Background | 1

BACKGROUND

Objective

To assess the implementation of States’ National Background Check Programs for 

Long-Term-Care Providers concluded in 2019.1, 2

The beneficiaries served by long-term-care providers include some of the most 

vulnerable populations.3

 Among these beneficiaries are the elderly, individuals in 

hospice care, and individuals with intellectual disabilities.4

 Over 13 million of these 

beneficiaries are served through long-term-care services in nursing homes and by 

other providers such as home health, hospice, and personal care service agencies.5

Patient abuse, patient neglect, and misappropriation of property (i.e., theft) have been 

identified as widespread problems that cause harm to vulnerable beneficiaries 

receiving long-term-care services.6, 7, 8

 Studies have shown that some nurse aides 

who were convicted of abuse, neglect, or theft had previous criminal convictions that 

could have been detected through background checks.9, 10 The development of 

thorough background checks can provide protections for beneficiaries who rely on 

long-term-care services.

National Background Check Program 

The National Background Check Program (Program) is a voluntary grant program that 

was enacted by legislation in 2010 to assist States in developing and improving 

systems to conduct Federal and State background checks.11, 12 This legislation 

included the mandate for OIG to produce an evaluation of the Program within 180 

days of Program completion.13 As groups of States concluded the Program, OIG has 

published reports assessing their implementation of it. These reports—three in 

total—serve as supplements to the mandated evaluation.14, 15, 16 They are designed to 

provide recommendations and support to the Centers for Medicare & Medicaid 

Services (CMS) as it assists States that are continuing in the Program. This report is 

the fourth in a series of five reports; the fifth report will be the mandated report. See 

Appendix A for the reporting mandate for OIG. 

The Program provides States with funding for 3 years to identify efficient, effective, 

and economical procedures for conducting background checks of prospective 

employees who will provide care to vulnerable beneficiaries in their State.17 States are 

eligible to receive up to $3 million in Federal funding. States are required to match 

the Federal funding by spending $1 of their own funds for every $3 of Federal funds 

spent.18 States can request three additional 1-year extensions for the Program 

if needed, but these extensions do not come with additional Federal funding. See 
National Background Check Program for Long-Term-Care Providers: Assessment of State Programs 

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Appendix B for information related to Federal grant awards and State matching funds 

for the States in this evaluation.

In addition to providing funding, CMS provides technical assistance and an 

assessment of States’ progress. CMS provides these services through its technical 

assistance contractor (Contractor).19 The Contractor works directly with States to 

develop their respective programs by offering support in all aspects of Program 

implementation. Additionally, the Contractor monitors States’ progress towards 

Program implementation by reviewing what are collectively known as “monitoring 

documents” (i.e., project narratives, Federal Financial Reports (FFRs), cost 

expenditures, and grantee data files) and related documentation during Program 

participation. 

Selected Requirements for Participating States 

States participating in the Program must meet a variety of broad statutory and 

Program requirements (collectively referred to as “Program requirements”) that guide 

them in developing systems for conducting background checks. States have some 

flexibility in how they implement Program requirements. For example, States must 

define “direct patient access employees,” but each State has flexibility in determining 

which types of prospective employees to include in its Program. The requirements 

evaluated in this report identify the types of prospective employees who should 

receive background checks, the sources that are used for conducting background 

checks, and the continuous monitoring of employees’ criminal histories. See below 

for the list of 13 selected Program requirements evaluated in this report.20 

• Determine which individuals are direct patient access employees. 

• Require all prospective direct patient access employees to undergo background 

checks.

• Include the nine facility and provider types defined by the Program.

• Identify disqualifying offenses.

• Establish a Statewide program.

• Collect applicants’ fingerprints for Federal/State checks.

• Conduct checks of Federal criminal history. 

• Conduct checks of State criminal history. 

• Conduct checks of State abuse/neglect registry for applicants’ current States of 

residence.

• Conduct checks of State abuse/neglect registry for applicants’ prior States of 

residence.

• Conduct search of records of any proceedings in the State that may contain 

disqualifying information.
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• Notify facilities and providers of convictions identified through continuous 

monitoring. 21 

• Report convictions to required databases.22 

Required Types of Background Checks. To conduct thorough background checks, 

States must include several types of background checks in their Program 

implementation.23 The required checks include the following: (1) a search of any 

databases and abuse registries of all known States in which the prospective employee 

lived;24 (2) a check of State criminal history records; (3) a fingerprint-based check of 

Federal Bureau of Investigation (FBI) criminal history records;

25, 26 and (4) a search of 

the records of any proceedings in the State that may contain disqualifying 

information about the prospective employee.27, 28

Care Settings That Require Background Checks. Participating States must 

implement all required background checks for prospective employees among the 

following nine types of long-term-care facilities or providers:

• skilled nursing facilities;

• nursing facilities;

• home health agencies;

• providers of hospice care;

• long-term-care hospitals;

• providers of personal care services;

• providers of adult day care;

• residential care providers that arrange for long-term-care services or provide 

long-term-care services; and

• intermediate-care facilities for individuals with intellectual disabilities.29

State Considerations With Implementing Requirements. States enter the Program 

with varying degrees of practical infrastructure and State-level legal requirements for 

conducting background checks. The infrastructure needed for conducting 

background checks often includes:

• technology for conducting checks of registries, State records, and Federal 

records; 

• program knowledge of management and development of a background check 

program; 

• a Statewide system;

• State funding;

• policies and procedures for conducting background checks and making 

determinations of ineligibility;

• techniques for determining ineligibility;
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•

• coordination with law enforcement.

Some States enter the Program in a developmental stage, seeking to establish 

infrastructure with the goal of becoming operational, while other States enter the 

Program in the operational stage, seeking to improve functional systems. For 

example, States in the developmental stage may not have a Statewide system for 

conducting any of the required checks. In contrast, States in the operational stage 

may already have much of the needed infrastructure and conduct many of the 

required checks. 

States may require new or amended State legislation to implement Program 

requirements regardless of the level of pre-existing infrastructure that States have 

when they enter the Program.30 States in the developmental stage may need to 

obtain legislative authority to build Program infrastructure, while States in the 

operational stage may need to seek updated legislative authority to improve existing 

infrastructure. A State has flexibility in determining the appropriate order of seeking 

legislation and developing its program. One State might begin building program 

infrastructure (e.g., information systems) while working with its legislature to obtain 

the authority to conduct background checks. Another State might decide to obtain 

legislative authority before building any program infrastructure. 

Required Quarterly Reporting of Data. States are required to submit quarterly 

reports to CMS’ Contractor that include data to track the types and outcomes of 

background checks that are conducted.31 The data file that each State submits to the 

Contractor should contain cumulative data from registry checks, State criminal history 

records, and FBI criminal history records (e.g., provider type, fingerprint collection 

date, employment eligibility determination, employment eligibility determination 

date). The Contractor provides States in the Program with guidance and technical 

assistance regarding the data elements that should be contained in the file and as 

needed, for submitting their data. Additionally, in collaboration with the Contractor, 

CMS fully developed a Background Check System (BCS) that States can use to collect 

and report data that meets reporting requirements. Some States enter the Program 

with an existing system for collecting and reporting data, while other States enter the 

Program without an established system. States with existing systems may need to 

modify their system to meet Program reporting requirements or may choose to 

implement the BCS. 

Related Reports

OIG has published several evaluations and issued multiple recommendations to CMS 

regarding the importance of background checks. OIG released its first report specific 

to the Program in 2016 with two recommendations: for CMS to (1) continue to work 

with participating States to fully implement their background check programs, and 

(2) improve required reporting by States to ensure that CMS can conduct effective 

oversight.32 CMS implemented these recommendations by doing the following: 

(1) providing States with individual technical assistance, data review, and data 

the ability to collect, share, and secure data; and
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validation, and developing the National Background Check Program Interim Progress 

Report; and (2) providing States with assigned project officers, a technical assistance 

contractor, teleconferences, and a website. In 2019, OIG released its second and third 

Program-specific reports with a recommendation that CMS take appropriate action to 

encourage participating States to obtain necessary authorities to fully implement 

Program requirements.33, 34 CMS continues to work with States to implement this 

recommendation by encouraging States to take advantage of technical assistance 

available from the Contractor. See Appendix C for additional detail and descriptions 

of related work.

Methodology

For each of the four State programs that concluded in 2019, we evaluated the State’s

ability to implement 13 selected Program requirements during its grant participation 

for all facility and provider types, as defined by the Program.35 

Data Collection. We obtained data from several sources to conduct our analysis. 

From CMS, we collected monitoring documents (i.e., project narratives, Federal 

Financial Reports (FFRs), cost expenditures and grantee data files) submitted by States 

related to their implementation of Program requirements. From State officials in the 

four States, we collected survey responses regarding Program outcomes and 

effectiveness. We verified with State officials that the data we obtained from these 

sources were consistent with State records. 

We collected data from the four States to assist in preparation of the congressionally 

mandated report that will evaluate all participating States following the end of the 

Program. We surveyed the States about practices that they found to be the most 

appropriate, efficient, and effective for conducting background checks. 

Data Analysis. We used State surveys and CMS’s monitoring documents to assess 

States’ progress in meeting the requirements. We evaluated the number and rate of 

background checks that resulted in determinations of ineligibility for employment 

during the States grant participation. Additionally, we evaluated each States’ 

expenditures for the Program and the cost of individual background checks.

Standards

We conducted this study in accordance with the Quality Standards for Inspection and 

Evaluation issued by the Council of the Inspectors General on Integrity and Efficiency. 
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FINDINGS

Three of the four States that concluded the Program in 

2019 did not implement all requirements, primarily 

because of not having existing legislative authority and 

challenges with coordination 

Background checks can provide protections from abuse, neglect, and theft for 

beneficiaries who rely on long-term-care services. Three States—Hawaii, Puerto Rico, 

and Oregon—were unable to implement all selected Program requirements, primarily 

because of not having existing State legislative authority and because of challenges 

with coordination between State-level departments. Hawaii and Puerto Rico entered 

the Program seeking to obtain legislative authority and develop Program 

infrastructure. While developing the capacity to conduct background checks, each 

State experienced challenges in coordinating between departments within the State. 

Oregon entered the Program seeking to obtain legislative authority to improve and 

expand the infrastructure of its existing background check system. Ohio entered the 

Program with capacity to conduct manual background checks. The State already had 

existing legislative authority and the department responsible for conducting 

background checks did not need to coordinate with other departments to implement 

all selected Program requirements during the grant period.

States were unable to implement Program requirements and 

develop needed infrastructure because of not having existing 

legislative authority 

State legislation is needed to provide the authority and build the infrastructure to 

implement Program requirements; however, three States—Hawaii, Puerto Rico, and 

Oregon—needed to seek or amend legislation. Hawaii and Puerto Rico each needed 

to seek legislative authority to implement select Program requirements and develop 

needed infrastructure. Oregon needed to amend existing legislation to implement 

one Program requirement. 

Hawaii was unable to implement 4 of the 13 selected Program requirements primarily 

because of not having existing legislative authority. The State was able to obtain 

legislative authority for three of the four unimplemented requirements—requiring all 

prospective direct patient access employees to undergo background checks; including 

all nine facility and provider types; and establishing a Statewide program—a month 

after Hawaii’s participation in the grant ended. The legislation needed to implement 

notification to facilities and providers of convictions identified through continuous 

monitoring was still in progress as of December 2019. 
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Puerto Rico entered the Program without legislative authority or a centralized system 

or for conducting background checks. Prior to 2015, the Puerto Rico Department of 

Health did not have legislative authority to conduct checks of criminal histories for 

employees in any of the facilities or provider types defined by the Program. The 

facilities and providers were responsible for conducting their own name-based 

background checks through local law enforcement. A Puerto Rican law enacted in 

2015 gave the Department of Health the authority to conduct background checks by 

collecting fingerprints for all nine facilities and provider types required by the 

Program. This change in law allowed Puerto Rico to begin the process of developing 

the needed infrastructure for its first statewide background check system. 

Oregon was unable to implement 1 of the 13 selected Program requirements because 

it needed to amend existing legislative authority. The State was unable to amend the 

legislation to meet the FBI’s requirement for language to notify facilities and providers 

of convictions identified through continuous monitoring. 

For two States, challenges with coordinating between 

departments further limited their ability to conduct background 

checks and impeded implementation of Program requirements 

After developing the needed infrastructure to conduct background checks, two 

States—Hawaii and Puerto Rico—encountered further challenges in becoming 

operational because of challenges in coordinating with their respective State criminal 

justice authorities.

Hawaii was unable to coordinate with its Criminal Justice Data Center to implement 

one of the selected Program requirements within the timeframe of the grant. Delays 

in coordination added to the time needed to implement the Program requirement 

and further delayed the State’s ability to notify facilities and providers of convictions 

identified through continuous monitoring.

Puerto Rico’s challenges in coordinating between departments affected the State’s 

ability to become operational and implement 10 of the selected Program 

requirements. Puerto Rico experienced delays and technical difficulties as it 

developed its program and worked with its Department of Justice to receive approval 

from the FBI to conduct noncriminal background checks. The Department of Health 

experienced delays while waiting for the Department of Justice to set up its new 

background check platform and to negotiate with the FBI for clearance to transmit 

civil fingerprints. In addition to these delays, technical difficulties occurred when the 

Department of Health and the Department of Justice began integrating their 

background check systems. Currently, Puerto Rico has the needed infrastructure in 

place to be able to begin conducting background checks once the systems are fully 

integrated. 
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See Exhibit 1 for information on each State’s implementation status for each of the 

13 selected Program requirements. Appendix E provides additional details in State 

“scorecards.” 

Exhibit 1: States varied in their ability to implement the selected Program 

requirements. 

Selected Program Requirements HI OH OR PR

Determine which individuals are “direct patient 

access employees.”

Require all prospective direct patient access 

employees to undergo background checks.

Include the nine facility and provider types defined 

by the Program.

Identify disqualifying offenses.

Establish a Statewide program.

Collect applicant fingerprints.

(For State and Federal checks)

Conduct checks of:

State criminal history.

Federal criminal history. ɫ ɫ

Conduct checks of State abuse/neglect registry for:

Applicant’s States of residence

Applicant’s prior State(s) of residence

Conduct search of records of any proceedings in 

the State that may contain disqualifying 

information.

Notify facilities and providers of convictions 

identified through continuous monitoring.

Report convictions to required databases. N/A*

Meets grant requirements Meets grant requirement with exceptions Does not meet grant requirements

Source: OIG analysis of States’ implementation of selected Program requirements, 2020.

*In Hawaii, convictions are reported to the required databases by the Department of the Attorney General. 

ɫ In Ohio, checks of Federal criminal history are mandatory for any prospective employee not able to provide proof of residency 

for 5 years. In Oregon, about 40 percent of prospective employees are receiving checks of Federal criminal history.
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Three of the four States did not report sufficient data to 

accurately assess Program outcomes 

CMS is responsible for conducting oversight of the grants that States receive to 

implement the Program, but without the consistent reporting of sufficient data 

(e.g., cumulative data, all required data elements) from all participating States, 

Program outcomes cannot be accurately assessed. Three of the four States that 

completed the Program in 2019 either failed to submit data for all the types of 

background checks that they conducted or submitted data to CMS that was not 

usable to determine Program outcomes. Although Hawaii conducted background 

checks for employees in only two facility and provider types, it did submit to CMS 

cumulative data on the results of registry, State, and Federal background checks for 

employees in these care settings during the Program. See Exhibit 2 for an analysis of 

data submitted by the States to CMS. 

Oregon entered the Program with an existing system for collecting and reporting data 

for the State’s purposes; however, the system was not configured to report the data 

elements required by the Program. The State asked its vendor to configure the 

existing system to report the data elements required by the Program, but the State 

ultimately decided to replace the existing system with the CMS- and 

Contractor-provided BCS. The BCS had not been implemented by Program 

completion; however, it was scheduled to be implemented by summer 2020. Oregon 

submitted data to sufficiently calculate ineligibility determinations using its existing 

system for only 9 months in 2014. 

Although Ohio submitted data from the start of its participation in the Program, the 

data did not include all required data elements. The data that were reported were 

limited to data gathered from registry checks and did not include data from State and 

Federal background checks. Determinations of ineligibility could not be calculated 

because of the lack of data in the fields for final overall fitness determination and final 

fitness determination notification.

Puerto Rico used Program resources to develop all new infrastructure needed to 

conduct background checks. Despite the progress in Puerto Rico’s development 

during the Program, it did not conduct any background checks during the grant 

period and therefore did not have any determinations of ineligibility to report.
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Exhibit 2: Only two States provided the numbers of background checks 

conducted and determinations of ineligibility made during Program 

participation.

State Completed 

Checks

Checks With

Determinations 

of Ineligibility 

Percentage 

Determined 

Ineligible

Hawaii 820 12 1.46%

Ohio* N/A N/A N/A

Oregon** 44,637 1,434 3.21%

Puerto Rico*** N/A N/A N/A

 Total**** 45,457 1,446 N/A

Source: OIG analysis of State background-check data, 2020.

*Ohio’s data was missing variables needed to calculate determinations of ineligibility.

**Oregon’s data reflects completed checks from January 2, 2014, until October 29, 2014. 

***Puerto Rico did not conduct background checks during the grant period. 

****The percentage determined ineligible is represented as N/A since the data that the 

States report are not comparable. 
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RECOMMENDATIONS

By preventing prospective employees with disqualifying offenses from being 

employed by long-term-care facilities and providers, background checks can help 

protect beneficiaries who rely on long-term-care services from abuse, neglect, and 

theft. By implementing the 13 selected Program requirements, States are better able 

to ensure that the prospective employees who need background checks are being 

screened, that multiple sources are used to conduct checks, and that criminal records 

are being continuously monitored. When States consistently report quality data, CMS 

and each State can calculate the determinations of ineligibility that are occurring as a 

result of the State’s background check program. This could provide a more complete 

picture of the effectiveness of the State’s background check program.

The findings of this report are consistent with our previous assessments of the 

Program. They provide further support for one open OIG recommendation and 

illustrate that CMS could do more to ensure that Program requirements are 

implemented. 

To address previous OIG recommendations, CMS made efforts to assist States with 

their unique needs in implementing Program requirements and reporting of required 

data. CMS’ efforts included identifying potential barriers; providing States with 

targeted technical assistance; and sharing examples of lessons learned and best 

practices. CMS developed the “National Background Check Program Interim Progress 

Report” tool to evaluate States’ progress towards implementation of Program 

requirements and began reviewing and validating quarterly data submitted by States. 

Additionally, to address previous issues, such as coordination between State-level 

departments, CMS developed a resource library and yearly in-person training 

meetings. CMS continues to provide this assistance to States through the Contractor. 

Despite CMS’ efforts in these areas, it could do more to ensure that States are 

implementing Program requirements and that States consistently follow CMS 

guidance. In addition, CMS should continue to work towards implementing the 

recommendation that OIG made in a prior report for it to take appropriate actions to 

encourage States to obtain the necessary authority to fully implement Program 

requirements.36 In this report, we make two additional recommendations.

We recommend that CMS: 

Assist participating States in addressing the challenge of 

coordination between State-level departments. 

For the three States that continue participation in the Program, CMS should use the 

“National Background Check Program Interim Progress Report” to evaluate States’ 
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progress towards implementation of Program requirements and, as necessary, 

to provide States with targeted technical assistance to develop a strategy for 

addressing the challenge of coordination between departments within the State.

Require that participating States consistently submit data that 

allow for CMS and each State to calculate determinations of 

ineligibility.

For the three States that continue participation in the Program, CMS should ensure 

that they submit data sufficient to allow for the calculation of determinations of 

ineligibility. CMS can accomplish this by informing States when data do not meet the 

minimum data standards and providing States with technical assistance to resubmit 

data according to the set standards. Specifically, the States’ quarterly reports should 

include cumulative data for the following data fields: record identifier, final overall 

fitness determination, and final fitness determination notification date. 
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AGENCY COMMENTS AND OIG RESPONSE

CMS concurred with both of our recommendations.

In response to the first recommendation, CMS stated that it has created the National 

Background Check Program Resource Library and has provided States with 

consultation and guidance, as needed, to address their challenge of coordination 

between State-level departments. For the three States that continue participation in 

the Program, CMS will assist States in developing a strategy for addressing their 

individual coordination challenges based on lessons learned. Additionally, CMS will 

also encourage States to use the resources available to them from CMS and the 

Contractor. 

In response to the second recommendation, CMS stated that it plans to encourage 

the three States continuing in the Program to install and utilize the Background Check 

System developed by CMS or modify their current system in order to meet the 

Program’s data-reporting requirements. Also, CMS will proactively inform States 

when their data do not meet the minimum data standards and provide States with 

additional technical expert assistance to address necessary modifications to resubmit 

data according to the standard.

OIG appreciates that CMS is already taking steps to implement our recommendations. 

We encourage CMS to use the “National Background Check Program Interim Progress 

Report” to evaluate States’ progress towards implementation of Program 

requirements. We also encourage CMS to continue to require that States meet 

minimum data standards. For instance, CMS should require that States’ quarterly 

reports include cumulative data for the following data fields: record identifier, final 

overall fitness determination, and final fitness determination notification date. 

For the full text of CMS’ comments, see Appendix F. 
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Scope

We evaluated four States that concluded Program participation in 2019: Hawaii, Ohio, 

Oregon, and Puerto Rico. See Appendix B for a listing of all States that have 

participated in the Program or are continuing in the Program. 

Congress directed OIG to analyze the most appropriate, efficient, and effective 

procedures for conducting background checks, as well as to assess the Program cost. 

We will reserve these analyses for the final rollup report once all States have 

completed the Program, which could occur as late as 2024. See Appendix A for the 

reporting mandate.

Data Collection 

CMS Grant Monitoring Documents. We obtained from CMS the reports and 

documents submitted by States related to their implementation of the National 

Background Check Program (Program). We collected from CMS and the technical 

assistance contractor (Contractor) the monitoring documents that they received from 

each State that concluded its Program participation. We obtained the source 

amounts for Program funding from the Federal Financial Reports (FFRs), and we 

obtained Program costs from the Contractor. 

Surveys of State Officials. As each State’s Program concluded, we surveyed State 

officials regarding the overall operation of the State’s Program and the State’s 

experience with the Program. We followed up with each State to verify survey 

responses and clarify any responses that were unclear. 

Operation of State’s Program. We surveyed States regarding the implementation of 

Program requirements during the grant period. See this report’s background for the 

list of the 13 Program requirements evaluated in this report. 

States’ experience with the Program. We surveyed States regarding their experience 

with the Program. We asked States about challenges that they faced in implementing 

program requirements. A full summary of States experiences will be included in the 

final mandated report. 

DETAILED METHODOLOGY
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Data Analysis

We reviewed the documents that we obtained from CMS, the Contractor, and State 

officials to evaluate States’ participation and progress in the Program during their 

respective grant periods. We evaluated States’ implementation of 13 

selected Program requirements to identify which prospective employees should 

receive checks; the sources that are used for conducting checks; and the continuous 

monitoring of employees’ criminal histories. We also reviewed the number of 

background checks that States conducted and analyzed the rates of determinations of 

ineligibility for prospective employees. Additionally, we reviewed the financial reports 

to identify the overall Program costs, including startup cost, administrative cost, and 

total costs.
National Background Check Program for Long-Term-Care Providers: Assessment of State Programs 

Concluded in 2019 OEI-07-20-00180 Appendix A | 16

APPENDIX A

Mandate for National Background Check Program Evaluation 

and Reports

P.L. No. 111-148, § 6201(a)(7)

§ 6201(a)(7) EVALUATION AND REPORT.— 

(A) EVALUATION.— 

(i) IN GENERAL.—The Inspector General of the Department of Health 

and Human Services shall conduct an evaluation of the nationwide 

program. 

(ii) INCLUSION OF SPECIFIC TOPICS.—The evaluation conducted under 

clause (i) shall include the following:

(I) A review of the various procedures implemented by participating 

States for long-term care facilities or providers, including staffing 

agencies, to conduct background checks of direct patient access 

employees under the nationwide program and identification of the 

most appropriate, efficient, and effective procedures for conducting 

such background checks.

(II) An assessment of the costs of conducting such background 

checks (including start up and administrative costs).

(III) A determination of the extent to which conducting such 

background checks leads to any unintended consequences, 

including a reduction in the available workforce for long-term care 

facilities or providers.

(IV) An assessment of the impact of the nationwide program on 

reducing the number of incidents of neglect, abuse, and 

misappropriation of resident property to the extent practicable.

(V) An evaluation of other aspects of the nationwide program, as 

determined appropriate by the Secretary.

(B) REPORT.—Not later than 180 days after the completion of the 

nationwide program, the Inspector General of the Department of Health 

and Human Services shall submit a report to Congress containing the 

results of the evaluation conducted under subparagraph (A).
National Background Check Program for Long-Term-Care Providers: Assessment of State Programs 

Concluded in 2019 OEI-07-20-00180 Appendix B | 17

APPENDIX B

State Expenditures for the National Background Check Program

APPENDIX C

State Federal Funds State Funds Total

Hawaii $795,742 $328,999 $1,124,741

Ohio $1,365,464 $455,244 $1,820,708

Oregon $2,870,209 $1,000,000 $3,870,209

Puerto Rico* $1,982,788 $2,327,920 $4,310,708

 Total* $7,014,203 $4,112,163 $11,126,366

Source: Final Federal Financial Reports (FFRs) 

* Puerto Rico received an extension for submitting its final FFR. The source here is Puerto Rico’s 

expenditures from the State’s last quarterly reports submitted during the Program. 

**Results are rounded.
National Background Check Program for Long-Term-Care Providers: Assessment of State Programs 

Concluded in 2019 OEI-07-20-00180 Appendix C | 18

APPENDIX C

Related OIG Reports

NOTE: This current report and four of the seven reports listed below—i.e., our 

August 2019 report (OEI-07-18-00290), our April 2019 report (OEI-07-16-00160), our 

2016 report (OEI-07-10-00420), and our 2012 report (OEI-07-10-00421)—all examine 

the same grant program. The 2016 and 2012 reports refer to it by slightly different 

names.

National Background Check Program for Long-Term-Care Providers: Assessment of 

State Programs Concluded in 2017 and 2018 (OEI-07-18-00290)

In August 2019, OIG published an evaluation of the 11 States that concluded Program 

participation in 2017 and 2018. These 11 States varied as to the degree to which they 

were able to implement Program requirements. Two States implemented all selected 

Program requirements. Nine States did not implement all the selected Program 

requirements, primarily because of a lack of legislative authority for certain Program 

requirements. We encouraged CMS to implement an open recommendation from the 

April 2019 report—namely, to take appropriate actions to encourage States to obtain 

the necessary legislative authority to fully implement Program requirements. We did 

not offer any new recommendations. 

National Background Check Program for Long-Term-Care Providers: Assessment of 

State Programs Concluded Between 2013 and 2016 (OEI-07-16-00160)

In April 2019, OIG published an evaluation of the National Background Check 

Program for Long-Term-Care Providers for the 10 States that concluded their 

participation by 2016. These 10 States varied as to the degree to which they 

implemented Program requirements. Seven of the States implemented all or most of 

the selected requirements. Three States did not have the necessary authority through 

State legislation and could not fully implement background check programs.

In this evaluation, OIG recommended that CMS take appropriate action to encourage 

participating States to obtain necessary authorities to fully implement Program 

requirements. CMS concurred with this recommendation and continues working to 

implement this recommendation by providing supporting pre-legislative research, 

assisting States in developing revised legislative language, and provided technical 

assistance to develop and promote effective legislation.

National Background Check Program for Long-Term-Care Employees: Interim 

Report (OEI-07-10-00420)

In 2016, OIG published an evaluation of the National Background Check Program for 

Long-Term-Care Employees that described the overall State implementation status 

during the first 4 years of the Program. The 25 States participating in the grant 

Program reported having achieved varying levels of implementation. Fifteen States 
National Background Check Program for Long-Term-Care Providers: Assessment of State Programs 

Concluded in 2019 OEI-07-20-00180 Appendix C | 19

did not conduct continuous monitoring of criminal convictions. Thirteen States did 

not obtain legislation that would enable them to conduct background checks. Ten 

States had not implemented processes to collect fingerprints. The study provided 

CMS with information to assist in its ongoing administration of the Program.

In this evaluation, OIG recommended that CMS continue working with States to fully 

implement their background check programs. Additionally, OIG recommended that 

CMS continue working with participating States to improve the quality of their 

required data reporting to ensure that CMS can conduct effective oversight of the 

program. CMS concurred with both recommendations and implemented the first 

recommendation by providing States with individual technical assistance, data review, 

and data validation. CMS implemented the second recommendation by providing 

States with assigned project officers, a technical assistance contractor, 

teleconferences, and a website. 

Home Health Agencies Conducted Background Checks of Varying Types 

(OEI-07-14-00130)

In 2015, OIG published an evaluation of the varying types of background checks 

conducted by home health agencies (HHAs); we reviewed selected employees whose 

convictions were likely to disqualify them from HHA employment. We found that 

4 percent of HHA employees had at least one criminal conviction. FBI criminal history 

records were not detailed enough to enable us to definitively determine whether 

employees with criminal convictions should have been disqualified from HHA 

employment.

State Requirements for Conducting Background Checks on Home Health Agency 

Employees (OEI-07-14-00131)

In 2014, OIG published an evaluation of State requirements for conducting 

background checks on HHA employees and surveyed State officials about their 

respective background check programs. The evaluation found that 41 States required 

HHAs to conduct background checks on prospective employees. Of the 10 States 

that had no requirements for background checks, 4 States reported that they planned 

to implement such requirements in the future. Thirty-five States specified convictions 

that disqualified individuals from employment, and 16 States allowed an individual 

who had been disqualified from employment to apply to have his/her conviction(s) 

waived.
National Background Check Program for Long-Term-Care Providers: Assessment of State Programs 

Concluded in 2019 OEI-07-20-00180 Appendix C | 20

Criminal Convictions for Nurse Aides with Substantiated Findings of Abuse, 

Neglect, and Misappropriation (OEI-07-10-00422)

In 2012, OIG published an evaluation that found nurse aides with substantiated 

findings of abuse, neglect, and/or misappropriation of property also had previous 

criminal convictions that could have been detected through background checks. 

Nineteen percent of nurse aides with substantiated findings had at least one 

conviction in their criminal history records prior to their substantiated finding. 

Among these nurse aides, the most common conviction (53 percent) was for crimes 

against property (e.g., burglary, shoplifting, and writing bad checks). 

Nationwide Program for National and State Background Checks for Long-TermCare Employees—Results of Long-Term-Care Provider Administrator Survey 

(OEI-07-10-00421)

In 2012, OIG conducted an evaluation of the nationwide Program for national and 

State background checks that surveyed long-term-care provider administrators. We 

found that 94 percent of administrators conducted background checks on prospective 

employees. Twenty-three percent of surveyed administrators believed that their 

organizations’ background check procedures reduced the pool of prospective 

employees.

Nursing Facilities’ Employment of Individuals with Criminal Convictions 

(OEI-07-09-00110)

In 2011, OIG published an evaluation of individuals with criminal convictions 

employed in nursing home facilities that found 92 percent of nursing facilities 

employed at least one individual with at least one criminal conviction. Overall, 

5 percent of nursing facility employees had at least one criminal conviction. In this 

evaluation, a national survey of nursing home facility administrators found that almost 

all facilities conducted some form of background check. 

OIG full reports can be found at www.oig.hhs.gov. 
National Background Check Program for Long-Term-Care Providers: Assessment of State Programs 

Concluded in 2019 OEI-07-20-00180 Appendix D | 21

APPENDIX D

Beginning and Ending Dates of States’ Respective Programs

State Grant Award Date Scheduled Grant 

End Date*

Actual Grant End 

Date

Delaware 9/30/2010 9/29/2013

Illinois 12/31/2010 12/30/2014

Maryland 1/31/2013 1/30/2016

Alaska 9/30/2010 9/29/2016

Connecticut 9/30/2010 9/29/2016

Florida 9/30/2010 9/29/2016

Missouri 9/30/2010 9/29/2016

Rhode Island 9/30/2010 9/29/2016

District of Columbia 12/31/2010 12/30/2016

New Mexico 12/31/2010 12/30/2016

California 2/1/2011 1/31/2017

Oklahoma 4/5/2011 4/4/2017

Kentucky 5/20/2011 5/19/2017

Michigan 5/20/2013 5/19/2017

Utah 7/11/2011 7/10/2017

North Carolina 7/13/2011 7/12/2017

Maine 10/1/2011 9/30/2017

Nevada 10/1/2011 9/30/2017

West Virginia 10/1/2011 9/30/2017

Georgia 7/25/2012 7/24/2018

Minnesota 8/30/2012 7/31/2018

Hawaii* 12/17/2012 12/16/2018

Ohio 4/22/2013 4/21/2019

Oregon 7/29/2013 7/28/2019

Puerto Rico** 12/17/2012 12/16/2019

Kansas 7/1/2015 6/30/2021

Idaho*** 6/1/2018 5/31/2021

Mississippi*** 6/1/2018 5/31/2021

Wisconsin**** 6/1/2018 6/26/2020

Source: CMS Notice of Award and the CMS technical assistance contractor (Contractor) website. Dates reflect 

schedule as of July 8, 2020.

* Hawaii concluded participation in December 2018 and had 90 days following Program participation to submit its 

closeout documents. Since its closeout documents were not due until 2019, Hawaii is included with the evaluation 

of the 2019 States.

** Puerto Rico was awarded an additional 1-year extension in 2018 because of natural disasters experienced by the 

State.

***Idaho and Mississippi have the option of extending their grant periods to 2024. Extensions may be 

granted closer to States’ respective grant end dates.

****Wisconsin withdrew from the Program early. 
National Background Check Program for Long-Term-Care Providers: Assessment of State Programs 

Concluded in 2019 OEI-07-20-00180 Appendix E | 22

APPENDIX E

State-by-State Implementation of Selected Program 

Requirements

This appendix summarizes State-by-State implementation of selected Program 

requirements, as drawn from CMS documents (e.g., financial and progress reports) 

submitted by States. We also highlight information specific to individual State 

programs, such as facility and provider types included in the background check 

programs; State and Federal funding for the Program; numbers of checks; and rates of 

determinations of ineligibility. Additionally, we note the cost of individual checks in 

each State, which varies in many cases as a result of States’ flexibility in program setup 

(e.g., screening vendors can set their fees, and States can set administrative fees). 

This appendix also lists State-reported Program costs as defined by CMS. Startup 

(developmental) costs are expenses associated with developing a program or 

system—generally, one-time or setup costs. Administrative (operational and 

incremental) costs are ongoing expenses necessary to operate a program (e.g., staff 

and maintenance) and recurring expenses to process background checks (e.g., fees for 

State police, vendor fees, etc.).
National Background Check Program for Long-Term-Care Providers: Assessment of State Programs 

Concluded in 2019 OEI-07-20-00180 Appendix E | 23
National Background Check Program for Long-Term-Care Providers: Assessment of State Programs 

Concluded in 2019 OEI-07-20-00180 Appendix E | 24
National Background Check Program for Long-Term-Care Providers: Assessment of State Programs 

Concluded in 2019 OEI-07-20-00180 Appendix E | 25
National Background Check Program for Long-Term-Care Providers: Assessment of State Programs 

Concluded in 2019 OEI-07-20-00180 Appendix E | 26
National Background Check Program for Long-Term-Care Providers: Assessment of State Programs 

Concluded in 2019 OEI-07-20-00180 Appendix F | 27

APPENDIX F 

Agency Comments
National Background Check Program for Long-Term-Care Providers: Assessment of State Programs 

Concluded in 2019 OEI-07-20-00180 Appendix F | 28
National Background Check Program for Long-Term-Care Providers: Assessment

of State Programs Concluded in 2019 OEI-07-20-00180 Acknowledgments and Contact | 29

Acknowledgments

Andrea Staples served as the team leader for this study, and Haley Lubeck served as 

the lead analyst. Others in the Office of Evaluation and Inspections who conducted 

the study include William Ash. Office of Evaluation and Inspections staff who 

provided support include Kevin Farber, Christine Moritz, and Michael Novello. 

This report was prepared under the direction of Brian Whitley, Regional Inspector 

General for Evaluation and Inspections in the Kansas City regional office, and 

Jennifer King, Deputy Regional Inspector General.

Contact

To obtain additional information concerning this report, contact the Office of Public 

Affairs at Public.Affairs@oig.hhs.gov. OIG reports and other information can be found 

on the OIG website at oig.hhs.gov. 

Office of Inspector General

U.S. Department of Health and Human Services

330 Independence Avenue, SW

Washington, DC 20201

ACKNOWLEDGMENTS AND CONTACT
National Background Check Program for Long-Term-Care Providers: Assessment of State Programs 

Concluded in 2019 – OEI-07-20-00180 About OIG | 30

The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-

452, as amended, is to protect the integrity of the Department of Health and Human 

Services (HHS) programs, as well as the health and welfare of beneficiaries served by 

those programs. This statutory mission is carried out through a nationwide network 

of audits, investigations, and inspections conducted by the following operating 

components:

The Office of Audit Services (OAS) provides auditing services for HHS, 

either by conducting audits with its own audit resources or by overseeing audit work 

done by others. Audits examine the performance of HHS programs and/or its 

grantees and contractors in carrying out their respective responsibilities and are 

intended to provide independent assessments of HHS programs and operations. 

These audits help reduce waste, abuse, and mismanagement and promote economy 

and efficiency throughout HHS.

The Office of Evaluation and Inspections (OEI) conducts national 

evaluations to provide HHS, Congress, and the public with timely, useful, and reliable 

information on significant issues. These evaluations focus on preventing fraud, waste, 

or abuse and promoting economy, efficiency, and effectiveness of departmental 

programs. To promote impact, OEI reports also present practical recommendations 

for improving program operations.

The Office of Investigations (OI) conducts criminal, civil, and administrative 

investigations of fraud and misconduct related to HHS programs, operations, and 

beneficiaries. With investigators working in all 50 States and the District of Columbia, 

OI utilizes its resources by actively coordinating with the Department of Justice and 

other Federal, State, and local law enforcement authorities. The investigative efforts 

of OI often lead to criminal convictions, administrative sanctions, and/or civil 

monetary penalties.

The Office of Counsel to the Inspector General (OCIG) provides 

general legal services to OIG, rendering advice and opinions on HHS programs and 

operations and providing all legal support for OIG’s internal operations. OCIG 

represents OIG in all civil and administrative fraud and abuse cases involving HHS 

programs, including False Claims Act, program exclusion, and civil monetary penalty 

cases. In connection with these cases, OCIG also negotiates and monitors corporate 

integrity agreements. OCIG renders advisory opinions, issues compliance program 

guidance, publishes fraud alerts, and provides other guidance to the health care 

industry concerning the anti-kickback statute and other OIG enforcement authorities.

ABOUT THE OFFICE OF INSPECTOR GENERAL
National Background Check Program for Long-Term-Care Providers: Assessment of State Programs 

Concluded in 2019 OEI-07-20-00180 Endnotes | 31

1 Hawaii concluded participation in December 2018 and had 90 days following Program participation to submit closeout 

documents. Since the State’s closeout documents were not due until 2019, Hawaii is included with the evaluation of the 2019 

States.

2 The National Background Check Program uses the term “State” as defined under 45 CFR 74.2. Thus, Puerto Rico is referred to 

as a “State” instead of a commonwealth in this report.

3 CMS, Nationwide Program for National and State Background Checks for Direct Patient Access Employees of Long Term Care 

Facilities and Providers, Ninth Announcement CFDA #93.506 (CMS-1A1-13-002), May 2013, p. 5. 

4 Ibid.

5 Summation by OIG’s Division of Data Analytics regarding unique beneficiaries receiving services in 2019 from each of the care 

settings covered by the Program. 

6 CMS, Nationwide Program for National and State Background Checks for Direct Patient Access Employees of Long Term Care 

Facilities and Providers, Ninth Announcement CFDA #93.506 (CMS-1A1-13-002), May 2013, p. 5. 

7 OIG, Criminal Convictions for Nurse Aides with Substantiated Findings of Abuse, Neglect, and Misappropriation, 

OEI-07-10-00422, October 2012. 

8 OIG, Vulnerabilities in Medicare Hospice Program Affect Quality Care and Program Integrity: An OIG Portfolio, 

OEI-02-16-00570, July 2018.

9 Ibid.

10 Office of Disability, Aging, and Long-Term Care Policy, Ensuring A Qualified Long-Term Care Workforce: From PreEmployment Screens to On-the-Job Monitoring, May 2006. Accessed at 

https://aspe.hhs.gov/system/files/pdf/74676/LTCWqual.pdf on September 14, 2006.

11 The National Background Check Program was named in legislation as the Nationwide Program for National and State 

Background Checks on direct Patient Access Employees of Long-term Care Facilities and Providers. In this report we refer to it 

as the “National Background Check Program” or “Program”.

12 P.L. No. 111-148, § 6201.

13 P.L. No. 111-148, § 6201(a)(7).

14 OIG, National Background Check Program for Long-Term-Care Employees: Interim Report, OEI-07-10-00420, January 2016.

15 OIG, National Background Check Program for Long-Term-Care Providers: Assessment of State Programs Concluded Between 

2013 and 2016, OEI-07-16-00160, April 2019. 

16 OIG, National Background Check Program for Long-Term-Care Providers: Assessment of State Programs Concluded in 2017 

and 2018, OEI-07-18-00290, August 2019. 

17 CMS, Nationwide Program for National and State Background Checks for Direct Patient Access Employees of Long Term Care 

Facilities and Providers, Ninth Announcement CFDA #93.506 (CMS-1A1-13-002), May 2013, p. 6. 

18 Ibid. 

ENDNOTES
National Background Check Program for Long-Term-Care Providers: Assessment of State Programs 

Concluded in 2019 OEI-07-20-00180 Endnotes | 32

19 CMS, Nationwide Program for National and State Background Checks for Direct Patient Access Employees of Long Term Care 

Facilities and Providers, Ninth Announcement CFDA #93.506 (CMS-1A1-13-002), May 2013, p. 5.

20 P.L. No. 111-148, § 6201(a).

21 P.L. No. 111-148, § 6201(a)(4)(B)(viii). Continuous monitoring means that if an employee receives a criminal conviction 

subsequent to the pre-employment background check, the State’s law enforcement informs the State agency. In turn, the 

State agency informs the facility or provider that has hired the employee with the conviction. Once a State has implemented 

continuous monitoring of criminal convictions, there is no further need for employers to conduct future periodic criminal 

background checks on employees.

22 P.L. No. 111-148, § 6201(a)(4)(B)(v)(IV). A prospective employee who is determined ineligible shall be reported to the 

appropriate State or local agency. 

23 P.L. No. 111-148, § 6201(a)(3)(A).

24 The grant solicitation document that CMS published defines “registries” as any State-based databases and nurse aide 

registries that identify those who have been approved by State requirements to provide care to residents or patients in longterm-care facilities or by providers of long-term-care services. These registries may include—but are not limited to—registries 

that list physicians, nurses, psychologists, and other professionals who are considered direct patient access employees. In 

addition, other registries or databases may include the Medicare Exclusion Database, the Fraud Investigation Database, the 

Healthcare Integrity and Protection Data Bank, or the National Practitioner Data Bank. CMS, Ninth Announcement CFDA 

#93.506 (CMS-1A1-13-002), May 2013, p. 50. 

25 CMS established regulations that prohibit long-term-care facilities and providers from employing individuals found guilty of 

abuse, neglect, or misappropriation of patient funds. “In 1998, Congress enacted [P.L.] 105-277, which allows long term care 

facilities to request the [FBI] search its fingerprint database for criminal history matches.” CMS, Ninth Announcement CFDA 

#93.506 (CMS-1A1-13-002), May 2013, p. 5. 

26 42 U.S.C., § 1320a-7. This statute prevents facilities that receive Federal health care dollars from hiring individuals who have 

been excluded by the Secretary. Some of these convictions lead to mandatory exclusion. Others are “permissive”—allowing 

the Secretary discretion as to whether to exclude the person even if he or she has a conviction. These apply to both Federal

and State convictions.

27 P.L. No. 111-148, § 6201(a)(3)(A). Participating States must ensure that background checks include checks of (1) State 

criminal history records for relevant States and (2) the records of any proceedings that may contain disqualifying information, 

such as the proceedings of licensing and disciplinary boards and State Medicaid Fraud Control Units. 

28 Criteria for disqualification are based on Federal and State laws. Federal regulation prohibits Medicare and Medicaid nursing 

facilities from employing individuals who have been found guilty by a court of law of abusing, neglecting, or mistreating 

residents, or who have had a finding entered into the State nurse aide registry concerning abuse, neglect, or mistreatment of 

residents or misappropriation of residents’ property (42 CFR, § 483.13(c)(1)(ii)). State laws vary with regard to the types of

convictions that disqualify prospective employees from employment in long-term care.

29 P.L. No. 111-148, § 6201(a)(6)(E).

30 CMS, Availability of Technical Assistance for Grantee States. Accessed at https://www.bgcheckinfo.org/about-nbcp/technicalassistance-overview on April 6, 2020.

31 CMS, Nationwide Program for National and State Background Checks for Direct Patient Access Employees of Long Term Care 

Facilities and Providers, Ninth Announcement CFDA #93.506 (CMS-1A1-13-002), May 2013, p. 20. 

32 OIG, National Background Check Program for Long-Term-Care Employees: Interim Report, OEI-07-10-00420, January 2016.
National Background Check Program for Long-Term-Care Providers: Assessment of State Programs 

Concluded in 2019 OEI-07-20-00180 Endnotes | 33

33 OIG, National Background Check Program for Long-Term-Care Providers: Assessment of State Programs Concluded Between 

2013 and 2016, OEI-07-16-00160, April 2019. 

34 OIG, National Background Check Program for Long-Term-Care Providers: Assessment of State Programs Concluded in 2017 

and 2018, OEI-07-18-00290, August 2019. 

35 Hawaii concluded participation in December 2018 and had 90 days following Program participation to submit closeout 

documents. Since the State’s closeout documents were not due until 2019, Hawaii is included with the evaluation of the 2019 

States.

36 OIG, National Background Check Program for Long-Term-Care Providers: Assessment of State Programs Concluded between 

2013 and 2016, OEI-07-16-00160, April 2019.