I

106TH CONGRESS

1ST SESSION H. R. 1984

To prevent the abuse of elderly people.

IN THE HOUSE OF REPRESENTATIVES

MAY 27, 1999

Mr. CROWLEY (for himself, Ms. SLAUGHTER, Mrs. CLAYTON, Ms. KILPATRICK, Ms. EDDIE BERNICE JOHNSON of Texas, and Mr. BENTSEN)

introduced the following bill; which was referred to the Committee on

Education and the Workforce, and in addition to the Committees on the

Judiciary, Banking and Financial Services, Ways and Means, Commerce,

and Armed Services, for a period to be subsequently determined by the

Speaker, in each case for consideration of such provisions as fall within

the jurisdiction of the committee concerned

A BILL

To prevent the abuse of elderly people.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Elderly Protection

5 Act’’.
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1 TITLE I—FEDERAL PROHIBITION

2 OF VIOLENCE AGAINST THE

3 ELDERLY AND ADDITIONAL

4 ASSISTANCE FOR PROGRAMS

5 TO COMBAT THAT VIOLENCE

6 SEC. 101. FEDERAL PROHIBTION OF VIOLENCE AGAINST

7 THE ELDERLY.

8 (a) IN GENERAL.—Title 18, United States Code, is

9 amended by inserting after chapter 27 the following new

10 chapter:

11 ‘‘‘‘CHAPTER 28—ELDER ABUSE

‘‘Sec.

‘‘571. Elder abuse.

12 ‘‘§ 571. Elder abuse

13 ‘‘(a) Whoever, in a circumstance described in sub14 section (b), willfully, because of a senior’s age, causes bod15 ily or psychological injury to that senior, or attempts to

16 cause bodily injury to that senior shall be punished as pro17 vided in subsection (c).

18 ‘‘(b) The circumstances referred to in subsection (a)

19 are any of the following:

20 ‘‘(1) The defendant or the victim are travelling

21 in interstate or foreign commerce at the time of the

22 offense or in connection with the offense.
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1 ‘‘(2) The defendant or the victim use an instru2 mentality of interstate or foreign commerce at the

3 time of the offense or in connection with the offense.

4 ‘‘(3) The offense is in or affect interstate or

5 foreign commerce.

6 ‘‘(c) A person who violates subsection (a) shall be

7 fined under this title or imprisoned not more than 10

8 years, or both, except that if death results from the of9 fense, or the victim of the offense was kidnapped or sub10 jected to an actual or attempted act that would constitute

11 aggravated sexual abuse as defined in section 2241 had

12 that act occurred in a Federal prison, the maximum term

13 of imprisonment is any term or years of for life.

14 ‘‘(d) In this section, the term ‘senior’ means a person

15 who has attained the age of 62 years.’’.

16 (b) CLERICAL AMENDMENT.—The table of chapters

17 for part I of title 18, United States Code, is amended by

18 adding after the item relating to chapter 27 the following

19 new item:

‘‘28. Elder abuse ................................................................................. 571’’.

20 (c) AUTHORIZATION OF APPROPRIATIONS.—In addi21 tion to any other authorization of appropriations for this

22 purpose, there are authorized to be appropriated such

23 sums as may be necessary for additional personnel and

24 other resources for the enforcement of section 571 of title

25 18, United States Code.
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1 TITLE II—DOMESTIC VIOLENCE

2 PREVENTION

3 SEC. 201. AUTHORIZATION OF APPROPRIATIONS.

4 The budget authority under section 5(c) of the

5 United States Housing Act of 1937 for assistance under

6 subsections (b) and (o) of section 8 of such Act is author7 ized to be increased by $50,000,000 on or after October

8 1, 1998, and by such sums as may be necessary on or

9 after October 1, 1999.

10 SEC. 202. USE OF AMOUNTS FOR HOUSING ASSISTANCE

11 FOR VICTIMS OF DOMESTIC VIOLENCE.

12 Amounts available pursuant to section 201 shall be

13 made available by the Secretary of Housing and Urban

14 Development only to public housing agencies and qualified

15 nonprofit organizations only for use for providing tenant16 based rental assistance on behalf of families victimized by

17 domestic violence who have left or are leaving a residence

18 as a result of the domestic violence.

19 SEC. 203. TRANSITIONAL COMPENSATION.

20 Section 1059 of title 10, United States Code, is

21 amended—

22 (1) in subsection (e)(1)(A), by inserting ‘‘that

23 includes dependent-abuse as an underlying or prin24 cipal factor’’ after ‘‘for a dependent-abuse offense’’;
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1 (2) in subsection (e)(1)(B), by inserting ‘‘un2 derlying, partial, or principal’’ before ‘‘basis’’; and

3 (3) in subsection (g)(2), by striking ‘‘the Sec4 retary may not resume such payments’’ and insert5 ing ‘‘the Secretary may resume such payments if the

6 Secretary determines that there was ongoing abuse.

7 Any such determination as to such a resumption of

8 payments shall be reviewed by the Secretary on a

9 case-by-case basis.’’.

10 SEC. 204. HEALTH BENEFITS.

11 Paragraph (1) of section 1076(e) of title 10, United

12 States Code, is amended to read as follows:

13 ‘‘(1) The administering Secretary shall furnish

14 an abused dependent of a former member of a uni15 formed service described in paragraph (4), during

16 that period that the abused dependent is in receipt

17 of transitional compensation under section 1059 of

18 this title, with medical and dental care, including

19 mental health services, in facilities of the uniformed

20 services in accordance with the same eligibility and

21 benefits as were applicable for that abused depend22 ent during the period of active service of the former

23 member.’’.
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1 SEC. 205. DOMESTIC VIOLENCE SHELTERS AND PROGRAMS

2 FOR OLDER INDIVIDUALS.

3 Section 422(b) of the Older Americans Act of 1965

4 (42 U.S.C. 3035a(b)) is amended—

5 (1) by striking ‘‘and’’ at the end of paragraph

6 (11);

7 (2) by striking the period at the end of para8 graph (12) and inserting a semicolon; and

9 (3) by adding at the end the following:

10 ‘‘(13) expand access to domestic violence shel11 ters and programs for older individuals and encour12 age the use of senior housing, nursing homes, or

13 other suitable facilities or services when appropriate

14 as emergency short-term shelters or measures for

15 older individuals who are the victims of elder abuse,

16 including domestic violence, and sexual assault,

17 against older individuals; and

18 ‘‘(14) promote research on legal, organizational,

19 or training impediments to providing services to

20 older individuals through shelters, such as impedi21 ments to provision of the services in coordination

22 with delivery of health care or senior services.’’.

23 SEC. 206. AUTHORIZATION OF APPROPRIATIONS.

24 (a) OMBUDSMAN PROGRAM.—Section 702(a) of the

25 Older Americans Act of 1965 (42 U.S.C. 3058a(a)) is

26 amended to read as follows:
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1 ‘‘(a) OMBUDSMAN PROGRAM.—There are authorized

2 to be appropriated to carry out chapter 2 such sums as

3 may be necessary without fiscal year limitation.’’.

4 (b) ELDER ABUSE PREVENTION PROGRAM.—Section

5 702(b) of the Older Americans Act of 1965 (42 U.S.C.

6 3058a(b)) is amended to read as follows:

7 ‘‘(b) PREVENTION OF ELDER ABUSE, NEGLECT, AND

8 EXPLOITATION.—There are authorized to be appropriated

9 to carry out chapter 3 such sums as may be necessary

10 without fiscal year limitation.’’.

11 SEC. 207. COMMUNITY INITIATIVES AND OUTREACH.

12 Title VII of the Older Americans Act of 1965 (42

13 U.S.C. 3058 et seq.) is amended—

14 (1) by redesignating subtitle C as subtitle D;

15 (2) by redesignating sections 761 through 764

16 as sections 771 through 774, respectively; and

17 (3) by inserting after subtitle B the following:

18 ‘‘Subtitle C—Community Initiatives

19 and Outreach

20 ‘‘SEC. 761. COMMUNITY INITIATIVES TO COMBAT ELDER

21 ABUSE, NEGLECT, AND EXPLOITATION.

22 ‘‘The Secretary shall make grants to nonprofit pri23 vate organizations to support projects in local commu24 nities, involving diverse sectors of each community, to co25 ordinate activities concerning intervention in and preven-
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1 tion of elder abuse, neglect, and exploitation, including do2 mestic violence, and sexual assault, against older individ3 uals.

4 ‘‘SEC. 762. OUTREACH TO OLDER INDIVIDUALS.

5 ‘‘The Secretary shall make grants to develop and im6 plement outreach programs directed toward assisting older

7 individuals who are victims of elder abuse, neglect, and

8 exploitation (including domestic violence, and sexual as9 sault, against older individuals), including programs di10 rected toward assisting the individuals in senior housing

11 complexes and senior centers.

12 ‘‘SEC. 763. AUTHORIZATION OF APPROPRIATIONS.

13 ‘‘There are authorized to be appropriated to carry out

14 this subtitle such sums as may be necessary without fiscal

15 year limitation.’’.

16 SEC. 208. ESTABLISHMENT, FOR CERTAIN HEALTH PROFES17 SIONS PROGRAMS, OF PROVISIONS REGARD18 ING IDENTIFICATION AND REFERRAL FOR

19 ELDER ABUSE AND NEGLECT.

20 (a) TITLE VII PROGRAMS; PREFERENCES IN FINAN21 CIAL AWARDS.—Section 791 of the Public Health Service

22 Act (42 U.S.C. 295j) as amended in title VIII of this Act,

23 is amended by redesignating subsection (d) as subsection

24 (e) and by inserting after subsection (c) the following sub25 section:
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1 ‘‘(d) PREFERENCES REGARDING TRAINING IN IDEN2 TIFICATION AND REFERRAL OF VICTIMS OF ELDER

3 ABUSE AND NEGLECT.—

4 ‘‘(1) IN GENERAL.—In the case of a health pro5 fessions entity specified in paragraph (2), the Sec6 retary shall, in making awards of grants or contracts

7 under this title, give preference to any such entity

8 (if otherwise a qualified applicant for the award in9 volved) that has in effect the requirement that, as a

10 condition of receiving a degree or certificate (as ap11 plicable) from the entity, each student have had sig12 nificant training (such as training conducted in ac13 cordance with curricula or programs authorized

14 under section 411(f) of the Older Americans Act of

15 1965 (42 U.S.C. 3031(f))), in carrying out the fol16 lowing functions as a provider of health care:

17 ‘‘(A) Identifying victims of elder abuse and

18 neglect, including domestic violence, and sexual

19 assault, against older individuals, and maintain20 ing complete medical records that include docu21 mentation of the examination, treatment given,

22 and referrals made, and recording the location

23 and nature of the victim’s injuries.

24 ‘‘(B) Examining and treating such victims,

25 within the scope of the health professional’s dis-
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1 cipline, training, and practice, including, at a

2 minimum, providing medical advice regarding

3 the dynamics and nature of elder abuse and ne4 glect.

5 ‘‘(C) Referring the victims to public and

6 nonprofit private entities that provide services

7 for such victims.

8 ‘‘(2) RELEVANT HEALTH PROFESSIONS ENTI9 TIES.—For purposes of paragraph (1), a health pro10 fessions entity specified in this paragraph is any en11 tity that is a school of medicine, a school of osteo12 pathic medicine, a graduate program in mental

13 health practice, a school of nursing (as defined in

14 section 298b), a program for the training of physi15 cian assistants, or a program for the training of al16 lied health professionals.

17 ‘‘(3) REPORT TO CONGRESS.—Not later than 2

18 years after the date of the enactment of the Elder

19 Abuse Identification and Referral Act of 1998, the

20 Secretary shall submit to the Committee on Com21 merce of the House of Representatives, and the

22 Committee on Labor and Human Resources of the

23 Senate, a report specifying—

24 ‘‘(A) the health professions entities that

25 are receiving preference under paragraph (1);
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1 ‘‘(B) the number of hours of training re2 quired by the entities for purposes of such

3 paragraph;

4 ‘‘(C) the extent of clinical experience so re5 quired; and

6 ‘‘(D) the types of courses through which

7 the training is being provided.

8 ‘‘(4) DEFINITIONS.—In this subsection:

9 ‘‘(A) IN GENERAL.—The terms ‘abuse’,

10 ‘neglect’, ‘domestic violence’, and ‘older indi11 vidual’ have the meanings given the terms in

12 section 102 of the Older Americans Act of 1965

13 (42 U.S.C. 3002).

14 ‘‘(B) ELDER ABUSE AND NEGLECT.—The

15 term ‘elder abuse and neglect’ means abuse and

16 neglect of an older individual.

17 ‘‘(C) SEXUAL ASSAULT.—The term ‘sexual

18 assault’ has the meaning given the term in sec19 tion 2003 of the Omnibus Crime Control and

20 Safe Streets Act of 1968 (42 U.S.C. 3796gg–

21 2).’’.

22 (b) TITLE VIII PROGRAMS; PREFERENCES IN FI23 NANCIAL AWARDS.—Section 860 of the Public Health

24 Service Act (42 U.S.C. 298b–7) as amended by title VIII

25 of this Act is amended by adding at the end the following:
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1 ‘‘(g) PREFERENCES REGARDING TRAINING IN IDEN2 TIFICATION AND REFERRAL OF VICTIMS OF ELDER

3 ABUSE AND NEGLECT.—

4 ‘‘(1) IN GENERAL.—In the case of a health pro5 fessions entity specified in paragraph (2), the Sec6 retary shall, in making awards of grants or contracts

7 under this title, give preference to any such entity

8 (if otherwise a qualified applicant for the award in9 volved) that has in effect the requirement that, as a

10 condition of receiving a degree or certificate (as ap11 plicable) from the entity, each student have had sig12 nificant training (such as training conducted in ac13 cordance with curricula or programs authorized

14 under section 411(g) of the Older Americans Act of

15 1965 (42 U.S.C. 3031(f))), in carrying out the fol16 lowing functions as a provider of health care:

17 ‘‘(A) Identifying victims of elder abuse and

18 neglect, including domestic violence, and sexual

19 assault, against older individuals, and maintain20 ing complete medical records that include docu21 mentation of the examination, treatment given,

22 and referrals made, and recording the location

23 and nature of the victim’s injuries.

24 ‘‘(B) Examining and treating such victims,

25 within the scope of the health professional’s dis-
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1 cipline, training, and practice, including, at a

2 minimum, providing medical advice regarding

3 the dynamics and nature of elder abuse and ne4 glect.

5 ‘‘(C) Referring the victims to public and

6 nonprofit private entities that provide services

7 for such victims.

8 ‘‘(2) RELEVANT HEALTH PROFESSIONS ENTI9 TIES.—For purposes of paragraph (1), a health pro10 fessions entity specified in this paragraph is any en11 tity that is a school of nursing or other public or

12 nonprofit private entity that is eligible to receive an

13 award described in such paragraph.

14 ‘‘(3) REPORT TO CONGRESS.—Not later than 2

15 years after the date of the enactment of the Elder

16 Abuse Identification and Referral Act of 1998, the

17 Secretary shall submit to the Committee on Com18 merce of the House of Representatives, and the

19 Committee on Labor and Human Resources of the

20 Senate, a report specifying—

21 ‘‘(A) the health professions entities that

22 are receiving preference under paragraph (1);

23 ‘‘(B) the number of hours of training re24 quired by the entities for purposes of such

25 paragraph;
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1 ‘‘(C) the extent of clinical experience so re2 quired; and

3 ‘‘(D) the types of courses through which

4 the training is being provided.’’.

5 (c) CONFORMING AMENDMENT.—Section 411(f) of

6 the Older Americans Act of 1965 (as added by section

7 605–4) is amended by adding at the end the following:

8 ‘‘(3) In carrying out paragraph (1), the Secretary

9 shall provide information about the curricula and training

10 programs to entities described in sections 791(d)(2) and

11 860(f)(2) of the Public Health Service Act (42 U.S.C.

12 295j(c)(2) and 298b–7(f)(2)) that seek grants or con13 tracts under title VII or VIII of such Act.’’.

14 TITLE III—ELDERLY AND

15 DISABLED PROTECTION

16 SEC. 301. SHORT TITLE; TABLE OF CONTENTS.

17 (a) SHORT TITLE.—This title may be cited as the

18 ‘‘Elderly and Disabled Protection Act of 1999’’.

19 (b) TABLE OF CONTENTS.—The table of contents of

20 this title is as follows:

Sec. 301. Short title; table of contents.

Sec. 302. Requiring background checks for direct care employees in nursing facilities, home health agencies, and hospice programs.

Sec. 303. Expanded role of State direct care employee registries; national registry coordination system; procedures for background checks.

Sec. 304. Definitions.
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1 SEC. 302. REQUIRING BACKGROUND CHECKS FOR DIRECT

2 CARE EMPLOYEES IN NURSING FACILITIES,

3 HOME HEALTH AGENCIES, AND HOSPICE

4 PROGRAMS.

5 (a) REQUIREMENTS.—

6 (1) IN GENERAL.—A covered facility in a

7 State—

8 (A) may not employ (directly or through

9 an agency) any individual as a direct care em10 ployee unless the facility has requested from the

11 State direct care employee registry a back12 ground check;

13 (B) may not employ such an individual or

14 continue such employment if the report on such

15 background check reveals that the individual

16 has been convicted of a disqualifying crime; and

17 (C) shall report to such registry docu18 mented findings of patient abuse by a direct

19 care employee.

20 (2) EMPLOYMENT PENDING REPORT.—Nothing

21 in this subsection shall be construed as preventing a

22 covered facility from—

23 (A) seeking a background check on pro24 spective direct care employees before they are

25 employed; or
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1 (B) employing direct care employees dur2 ing the period in which a background check has

3 been sought under paragraph (1)(A) and before

4 a report on such check has been provided to the

5 facility under paragraph (1)(B).

6 (b) PENALTIES.—In addition to any other sanctions

7 provided under law—

8 (1) IN GENERAL.—A covered facility that vio9 lates subsection (a)(1)(A) shall be subject to a civil

10 penalty in an amount not to exceed—

11 (A) for the first such violation, $2,000;

12 and

13 (B) for the second and each subsequent

14 violation within any 5-year period, $5,000.

15 (2) KNOWING RETENTION OF WORKER.—In ad16 dition to any civil penalty under paragraph (1), a

17 covered facility that—

18 (A) knowingly continues to employ a direct

19 care employee in violation of subsection

20 (a)(1)(B); or

21 (B) knowingly fails to submit a report re22 quired under subsection (a)(1)(C);

23 shall be subject to a civil penalty in an amount not

24 to exceed $5,000 for the first such violation, and
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1 $10,000 for the second and each subsequent viola2 tion within any 5-year period.

3 (c) ENFORCEMENT THROUGH MEDICARE AND MED4 ICAID PROGRAMS.—

5 (1) NURSING FACILITIES.—

6 (A) MEDICARE PROGRAM.—Section

7 1819(b) of the Social Security Act (42 U.S.C.

8 1395i–3(b)) is amended by adding at the end

9 the following new paragraph:

10 ‘‘(8) REQUIREMENT FOR BACKGROUND CHECKS

11 FOR DIRECT CARE PERSONNEL.—A skilled nursing

12 facility shall comply with the requirements of section

13 2(a) of the Elderly and Disabled Protection Act of

14 1998 with respect to any direct care employee it em15 ploys.’’.

16 (B) MEDICAID PROGRAM.—Section

17 1919(b) of such Act (42 U.S.C. 1396r(b)) is

18 amended by adding at the end the following

19 new paragraph:

20 ‘‘(8) REQUIREMENT FOR BACKGROUND CHECKS

21 FOR DIRECT CARE PERSONNEL.—A nursing facility

22 shall comply with the requirements of section 2(a) of

23 the Elderly and Disabled Protection Act of 1998

24 with respect to any direct care employee it em25 ploys.’’.
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1 (2) HOME HEALTH AGENCIES AND HOSPICE

2 PROGRAMS.—

3 (A) MEDICARE PROGRAM.—

4 (i) HOME HEALTH AGENCIES.—Sec5 tion 1891(a) of such Act (42 U.S.C.

6 1395bbb(a)) is amended by adding at the

7 end the following:

8 ‘‘(7) The agency complies with the requirements

9 of section 2(a) of the Elderly and Disabled Protec10 tion Act of 1998 with respect to any direct care em11 ployee it employs.’’.

12 (ii) HOSPICE PROGRAMS.—Section

13 1861(dd)(2)(G) of such Act (42 U.S.C.

14 1395x(dd)(2)(G)) is amended by inserting

15 before the period at the end the following:

16 ‘‘, including compliance with the require17 ments of section 2(a) of the Elderly and

18 Disabled Protection Act of 1998 with re19 spect to any direct care employee it em20 ploys’’.

21 (B) MEDICAID PROGRAM.—Section

22 1902(a)(57) of such Act (42 U.S.C.

23 1396a(a)(57)) is amended—

24 (i) by inserting ‘‘(A)’’ after ‘‘(57)’’;

25 and
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1 (ii) by adding at the end the fol2 lowing:

3 ‘‘(B) provide that each provider of home health

4 care or personal care services and each hospice pro5 gram receiving funds under the plan shall comply

6 with the requirements of section 2(a) of the Elderly

7 and Disabled Protection Act of 1998 with respect to

8 any direct care employee it employs;’’.

9 (d) EFFECTIVE DATES.—The requirements of sub10 section (a) shall apply with respect to a covered facility—

11 (1) beginning as of such date (specified by the

12 Secretary and not later than 60 days after the date

13 the Secretary has established the national registry

14 coordination system under section 3(b)), with re15 spect to the hiring of individuals as a direct care em16 ployee by the facility on and after such date; and

17 (2) as of 1 year after the date described in

18 paragraph (1), with respect to individuals first em19 ployed as such an employee before the date de20 scribed in such paragraph.

21 SEC. 303. EXPANDED ROLE OF STATE DIRECT CARE EM22 PLOYEE REGISTRIES; NATIONAL REGISTRY

23 COORDINATION SYSTEM; PROCEDURES FOR

24 BACKGROUND CHECKS.

25 (a) EXPANDED ROLE OF REGISTRY.—
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1 (1) IN GENERAL.—Each State shall expand its

2 direct care employee registry established under sec3 tions 1819(e)(2) and 1919(e)(2) of the Social Secu4 rity Act to carry out the following functions:

5 (A) RECEIPT OF REQUESTS.—The registry

6 shall provide for the receipt of requests for

7 background checks described in section 2(a)(1).

8 (B) CONDUCT OF BACKGROUND

9 CHECKS.—Upon receipt of such a request with

10 respect to an individual, the registry, in coordi11 nation with the national registry coordination

12 system established by the Secretary under sub13 section (b) and in accordance with this section,

14 shall provide for the performance of (or the col15 lection of information concerning) a background

16 check (including a criminal background check

17 and an abusive work history background check)

18 requested under section 2(a) and for the sub19 mittal of a background check report (as defined

20 in paragraph (2)) on such check to the request21 ing facility.

22 (C) PROVISION OF INFORMATION TO NA23 TIONAL REGISTRY COORDINATION SYSTEM.—

24 The registry shall provide for the reporting to

25 the national registry coordination system of—
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1 (i) a criminal background check sum2 mary (as defined in paragraph (3)) on any

3 individual on whom it obtains a criminal

4 background check under subsection (c)(3);

5 and

6 (ii) the identity of any individual for

7 whom the registry has documented find8 ings of patient abuse and such additional

9 information as the State registry involved

10 may disclose concerning such findings.

11 (2) BACKGROUND CHECK REPORT DEFINED.—

12 For purposes of this section, the term ‘‘background

13 check report’’ means, with respect to a background

14 check concerning an individual, a statement con15 taining the following:

16 (A) Whether the individual has been con17 victed of a disqualifying crime.

18 (B) Whether there are documented find19 ings of patient abuse by the individual in a

20 State direct care employee registry and, if so,

21 such additional information as the State reg22 istry involved may disclose concerning such

23 findings.
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1 Such report shall not include information from the

2 criminal background check other than the informa3 tion described in subparagraph (A).

4 (3) CRIMINAL BACKGROUND CHECK SUMMARY

5 DEFINED.—For purposes of this section, the term

6 ‘‘criminal background check summary’’ means, with

7 respect to a criminal background check concerning

8 an individual, the following information:

9 (A) The identity of the individual.

10 (B) The date of the criminal background

11 check.

12 (C) Whether the check revealed that—

13 (i) the individual had not been con14 victed of any crime,

15 (ii) the individual has been convicted

16 of a national disqualifying crime, or

17 (iii) the individual has been convicted

18 of a crime that is not a national disquali19 fying crime.

20 (4) CONFORMING MEDICARE AND MEDICAID

21 AMENDMENTS.—Sections 1819(e)(2) and 1919(e)(2)

22 of the Social Security Act (42 U.S.C. 1395i–3(e)(2),

23 1396r(e)(2)) are each amended—

24 (A) in subparagraph (C), by striking ‘‘A

25 State’’ and inserting ‘‘Subject to section 3(e) of
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1 the Elderly and Disabled Protection Act of

2 1998, a State’’, and

3 (B) by adding at the end the following new

4 subparagraph:

5 ‘‘(D) EXPANDED FUNCTIONS.—Effective

6 not later than 90 days after the date of the es7 tablishment of the national registry coordina8 tion system under section 3(b) of the Elderly

9 and Disabled Protection Act of 1998, the State

10 shall—

11 ‘‘(i) modify the operations of its reg12 istry so it performs the functions required

13 under section 3(a) of such Act; and

14 ‘‘(ii) provide for the specification of a

15 State agency that is separate from the reg16 istry and that will be responsible for the

17 performance of criminal background checks

18 under such section.’’.

19 (b) NATIONAL REGISTRY COORDINATION SYSTEM.—

20 (1) ESTABLISHMENT.—The Secretary shall es21 tablish methods by which State direct care registries

22 can pool and share information regarding individuals

23 concerning criminal background check summaries

24 and the existence of documented findings of patient

25 abuse.
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1 (2) DEADLINE FOR ESTABLISHING SYSTEM.—

2 The Secretary shall provide for the establishment of

3 the national registry coordination system by not

4 later than 1 year after the date of the enactment of

5 this Act.

6 (3) CONSULTATION WITH FBI ON CRIMINAL

7 BACKGROUND CHECKS.—In carrying out this Act

8 with respect to criminal background checks, the Sec9 retary shall consult with the Director of the Federal

10 Bureau of Investigation.

11 (c) PROCEDURES FOR CRIMINAL BACKGROUND

12 CHECKS.—A registry shall carry out its responsibilities

13 under subsection (a)(1)(B), in relation to a criminal back14 ground check with respect to an individual, in a manner

15 consistent with the following:

16 (1) DETERMINATION OF WHETHER RECENT

17 CRIMINAL BACKGROUND CHECK DONE.—The reg18 istry shall determine whether the registry (or,

19 through the national registry coordination system,

20 the direct care employee registry of another State)

21 has obtained a criminal background check on the in22 dividual within the previous year.

23 (2) USE OF PREVIOUS BACKGROUND CHECK.—

24 If there has been such a check done within such pe25 riod, if the check revealed that—
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1 (A) the individual had not been convicted

2 of any crime, the registry need not request a

3 new criminal background check and may as4 sume that the individual has not been convicted

5 of any disqualifying crime;

6 (B) the individual has been convicted of a

7 national or state disqualifying crime, the reg8 istry need not request a new criminal back9 ground check and shall treat the individual as

10 having been convicted of a disqualifying crime;

11 or

12 (C) the individual has been convicted of a

13 crime that is not a national or state disquali14 fying crime and the State has disqualifying

15 crimes that are other than national disquali16 fying crimes, the registry shall request a crimi17 nal background check as provided under para18 graph (3).

19 (3) REQUESTING STATE CRIMINAL BACK20 GROUND CHECK AGENCY TO OBTAIN CRIMINAL

21 BACKGROUND CHECK.—If there has not been such a

22 check done within such period or in the case de23 scribed in paragraph (2)(C), the registry shall re24 quest the State criminal background check agency of

25 the State—
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1 (A) to perform a criminal background

2 check on the individual;

3 (B) to determine, on the basis of such

4 check, whether the individual—

5 (i) has not been convicted of any

6 crime;

7 (ii) has been convicted of a national

8 disqualifying crime; or

9 (iii) has been convicted of a crime

10 that is a State disqualifying crime; and

11 (C) to submit to the registry a criminal

12 background check summary on the individual.

13 (4) APPLICATION OF CERTAIN PROCEDURES

14 FOR CRIMINAL BACKGROUND CHECKS.—Under regu15 lations of the Secretary, the following provisions in

16 section 3 of the National Child Protection Act of

17 1993 (Public Law 103–209) shall apply to criminal

18 background checks required of a direct care em19 ployee with respect to a covered facility to be per20 formed under this Act in the same manner as they

21 apply to providers with respect to qualified entities:

22 (A) Subsection (a)(2) (relating to access to

23 records and timeliness of response).

24 (B) Subsection (b) (relating to guidelines

25 on background checks), other than paragraph
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1 (1)(B), except that denial of unsupervised ac2 cess under paragraph (1)(E) shall be treated

3 for purposes of this section as a denial of unsu4 pervised access to patients in covered facilities

5 and determinations under paragraph (4) shall

6 be made only with respect to crimes relating to

7 patient abuse.

8 (C) Subsection (c) (relating to authority of

9 Attorney General).

10 (D) Subsection (d) (relating to limitation

11 on liability).

12 (d) PROCEDURES FOR ABUSIVE WORK HISTORY

13 BACKGROUND CHECKS.—A registry shall carry out its re14 sponsibilities under subsection (a)(1)(B), in relation to

15 abusive work history background check with respect to an

16 individual, in a manner consistent with the following:

17 (1) INCLUSION OF INFORMATION ON DOCU18 MENTED FINDINGS OF PATIENT ABUSE.—The reg19 istry shall maintain a list of all individuals in the

20 State who are (or were) direct care employees and

21 with respect to whom there are specific documented

22 findings of patient abuse, as well as any brief state23 ment of the individual disputing the findings. Such

24 findings shall be made available in the same manner
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1 as findings described in sections 1819(c)(2)(B) and

2 1919(c)(2)(B) of the Social Security Act.

3 (2) FORWARDING INFORMATION ON INDIVID4 UALS WITH DOCUMENTED FINDINGS OF PATIENT

5 ABUSE.—If the registry has a documented finding

6 described in paragraph (1) with respect to an indi7 vidual, the registry—

8 (A) shall provide the national registry co9 ordination system with—

10 (i) information on the identity of the

11 individual and the State;

12 (ii) information on the fact that such

13 a finding was made; and

14 (iii) such additional information re15 specting the finding as the Secretary may

16 require; and

17 (B) shall provide, to another State direct

18 care employee registry that requests informa19 tion on an individual for whom such a docu20 mented finding has been made through the sys21 tem, information respecting the finding.

22 (e) FEES.—A State may assess a covered facility a

23 fee for the conduct of a background check under section

24 2(a) in an amount that does not exceed the actual cost

25 to the State of obtaining the criminal background check
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1 and the abusive work history background check on an indi2 vidual. Such a facility may recover all of the fee from the

3 individual involved.

4 SEC. 304. DEFINITIONS.

5 For purposes of this Act:

6 (1) BACKGROUND CHECK; CRIMINAL BACK7 GROUND CHECK; ABUSIVE WORK HISTORY BACK8 GROUND CHECK.—

9 (A) BACKGROUND CHECK.—The term

10 ‘‘background check’’ includes a criminal back11 ground check and an abusive work history back12 ground check.

13 (B) CRIMINAL BACKGROUND CHECK.—The

14 term ‘‘criminal background check’’ means a

15 check of the criminal history record system

16 maintained by the Federal Bureau of Investiga17 tion based on fingerprint identification or any

18 other method of positive identification for the

19 purpose of determining whether an individual

20 has been convicted of a disqualifying crime.

21 (C) ABUSIVE WORK HISTORY BACKGROUND

22 CHECK.—The term ‘‘abusive work history back23 ground check’’ means, with respect to an indi24 vidual, a check of State direct care employee

25 registries for the purpose of determining wheth-
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1 er there is a documented finding that the indi2 vidual was involved in patient abuse.

3 (2) COVERED FACILITY.—The term ‘‘covered

4 facility’’ means a nursing facility (including a skilled

5 nursing facility), home health agency, or hospice

6 program which receives payment under any federally

7 funded program.

8 (3) DIRECT CARE EMPLOYEE.—

9 (A) IN GENERAL.—The term ‘‘direct care

10 employee’’ means a nurse aide, home health

11 care aide, personal care assistant, private duty

12 nurse aide, day attendant, housekeeper, library

13 attendant, laundry assistant, or similar worker

14 who performs nursing or related tasks involving

15 direct patient care in a covered facility.

16 (B) EXCLUSIONS.—Such term does not in17 clude an individual—

18 (i) who is a physician, physician as19 sistant, nurse practitioner, physical,

20 speech, or occupational therapist, physical

21 or occupational therapy assistant, reg22 istered professional nurse, licensed prac23 tical nurse, or licensed or certified social

24 worker, or registered dietitian;
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1 (ii) who volunteers to provide such

2 services without monetary compensation;

3 or

4 (iii) who meets such other require5 ments as the Secretary may specify.

6 (4) DISQUALIFYING CRIME; NATIONAL DIS7 QUALIFYING CRIME; STATE DISQUALIFYING

8 CRIME.—

9 (A) DISQUALIFYING CRIME.—The term

10 ‘‘disqualifying crime’’ means, with respect to an

11 individual applying for employment in a State,

12 a criminal offense that is a national disquali13 fying crime or a State disqualifying crime in

14 that State.

15 (B) NATIONAL DISQUALIFYING CRIME.—

16 The term ‘‘national disqualifying crime’’

17 means—

18 (i) a criminal offense described in sec19 tion 1128(a) of the Social Security Act; or

20 (ii) felony homicide, battery, or as21 sault (including sexual assault),

22 regardless of the date of conviction for the

23 crime.

24 (C) STATE DISQUALIFYING CRIME.—The

25 term ‘‘State disqualifying crime’’ means, with
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1 respect to a State, such criminal offenses (other

2 than national disqualifying crimes) as the State

3 may under law treat as a State disqualifying

4 crime for purposes of this Act and for such pe5 riod of time as the State may provide.

6 (5) NATIONAL REGISTRY COORDINATION SYS7 TEM.—The term ‘‘national registry coordination sys8 tem’’ means a system established under section 3(b).

9 (6) PATIENT ABUSE.—The term ‘‘patient

10 abuse’’ means such incidence of abuse, neglect, mis11 treatment, or misappropriation of property of an in12 dividual receiving services in a covered facility as the

13 Secretary shall specify in regulations.

14 (7) SECRETARY.—The term ‘‘Secretary’’ means

15 the Secretary of Health and Human Services.

16 (8) STATE CRIMINAL BACKGROUND CHECK

17 AGENCY.—The term ‘‘State criminal background

18 check agency’’ means, with respect to a State, the

19 State agency specified by the State to provide for

20 the conduct of criminal background checks under

21 this Act.

22 (9) STATE DIRECT CARE EMPLOYEE REG23 ISTRY.—The term ‘‘State direct care employee reg24 istry’’ means a nurse aide registry that is established

25 under sections 1819(e)(2)(A) and 1919(e)(2)(A) of
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1 the Social Security Act and that provides for func2 tions required of such a registry under section 3 of

3 this Act.

Æ