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[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 1445 Introduced in Senate (IS)]

106th CONGRESS
  1st Session
                                S. 1445

  To amend titles XVIII and XIX of the Social Security Act to prevent 
 abuse of recipients of long-term care services under the Medicare and 
                           Medicaid programs.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             July 27, 1999

  Mr. Kohl (for himself and Mr. Reid) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL

 
  To amend titles XVIII and XIX of the Social Security Act to prevent 
 abuse of recipients of long-term care services under the Medicare and 
                           Medicaid programs.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Patient Abuse Prevention Act''.

SEC. 2. ESTABLISHMENT OF PROGRAM TO PREVENT ABUSE OF NURSING FACILITY 
              RESIDENTS.

    (a) Nursing Facility and Skilled Nursing Facility Requirements.--
            (1) Medicaid program.--Section 1919(b) of the Social 
        Security Act (42 U.S.C. 1396r(b)) is amended by adding at the 
        end the following:
            ``(8) Screening of nursing facility workers.--
                    ``(A) Background checks on applicants.--Subject to 
                subparagraph (B)(ii), before hiring a nursing facility 
                worker, a nursing facility shall--
                            ``(i) give the worker written notice that 
                        the facility is required to perform background 
                        checks with respect to applicants;
                            ``(ii) require, as a condition of 
                        employment, that such worker--
                                    ``(I) provide a written statement 
                                disclosing any conviction for a 
                                relevant crime or finding of patient or 
                                resident abuse;
                                    ``(II) provide a statement signed 
                                by the worker authorizing the facility 
                                to request the search and exchange of 
                                criminal records;
                                    ``(III) provide in person a copy of 
                                the worker's fingerprints; and
                                    ``(IV) provide any other 
                                identification information the 
                                Secretary may specify in regulation;
                            ``(iii) initiate a check of the data 
                        collection system established under section 
                        1128E in accordance with regulations 
                        promulgated by the Secretary to determine 
                        whether such system contains any disqualifying 
                        information with respect to such worker; and
                            ``(iv) if that system does not contain any 
                        such disqualifying information--
                                    ``(I) request that the State 
                                initiate a State and national criminal 
                                background check on such worker in 
                                accordance with the provisions of 
                                subsection (e)(8); and
                                    ``(II) furnish to the State the 
                                information described in subclauses 
                                (II) through (IV) of clause (ii) not 
                                more than 7 days (excluding Saturdays, 
                                Sundays, and legal public holidays 
                                under section 6103(a) of title 5, 
                                United States Code) after completion of 
                                the check against the system initiated 
                                under clause (iii).
                    ``(B) Prohibition on hiring of abusive workers.--
                            ``(i) In general.--A nursing facility may 
                        not knowingly employ any nursing facility 
                        worker who has any conviction for a relevant 
                        crime or with respect to whom a finding of 
                        patient or resident abuse has been made.
                            ``(ii) Provisional employment.--After 
                        complying with the requirements of clauses (i), 
                        (ii), and (iii) of subparagraph (A), a nursing 
                        facility may provide for a provisional period 
                        of employment for a nursing facility worker 
                        pending completion of the check against the 
                        data collection system described under 
                        subparagraph (A)(iii) and the background check 
                        described under subparagraph (A)(iv). Such 
                        facility shall maintain direct supervision of 
                        the worker during the worker's provisional 
                        period of employment.
                    ``(C) Reporting requirements.--A nursing facility 
                shall report to the State any instance in which the 
                facility determines that a nursing facility worker has 
                committed an act of resident neglect or abuse or 
                misappropriation of resident property in the course of 
                employment by the facility.
                    ``(D) Use of information.--
                            ``(i) In general.--A nursing facility that 
                        obtains information about a nursing facility 
                        worker pursuant to clauses (iii) and (iv) of 
                        subparagraph (A) may use such information only 
                        for the purpose of determining the suitability 
                        of the worker for employment.
                            ``(ii) Immunity from liability.--A nursing 
                        facility that, in denying employment for an 
                        applicant (including during the period 
                        described in subparagraph (B)(ii)), reasonably 
                        relies upon information about such applicant 
                        provided by the State pursuant to subsection 
                        (e)(8) or section 1128E shall not be liable in 
                        any action brought by such applicant based on 
                        the employment determination resulting from the 
                        information.
                            ``(iii) Criminal penalty.--Whoever 
                        knowingly violates the provisions of clause (i) 
                        shall be fined in accordance with title 18, 
                        United States Code, imprisoned for not more 
                        than 2 years, or both.
                    ``(E) Civil penalty.--
                            ``(i) In general.--A nursing facility that 
                        violates the provisions of this paragraph shall 
                        be subject to a civil penalty in an amount not 
                        to exceed--
                                    ``(I) for the first such violation, 
                                $2,000; and
                                    ``(II) for the second and each 
                                subsequent violation within any 5-year 
                                period, $5,000.
                            ``(ii) Knowing retention of worker.--In 
                        addition to any civil penalty under clause (i), 
                        a nursing facility that--
                                    ``(I) knowingly continues to employ 
                                a nursing facility worker in violation 
                                of subparagraph (A) or (B); or
                                    ``(II) knowingly fails to report a 
                                nursing facility worker under 
                                subparagraph (C); shall be subject to a 
civil penalty in an amount not to exceed $5,000 for the first such 
violation, and $10,000 for the second and each subsequent violation 
within any 5-year period.
                    ``(F) Definitions.--In this paragraph:
                            ``(i) Conviction for a relevant crime.--The 
                        term `conviction for a relevant crime' means 
                        any Federal or State criminal conviction for--
                                    ``(I) any offense described in 
                                paragraphs (1) through (4) of section 
                                1128(a); and
                                    ``(II) such other types of offenses 
                                as the Secretary may specify in 
                                regulations, taking into account the 
                                severity and relevance of such 
                                offenses, and after consultation with 
                                representatives of long-term care 
                                providers, representatives of long-term 
                                care employees, consumer advocates, and 
                                appropriate Federal and State 
                                officials.
                            ``(ii) Disqualifying information.--The term 
                        `disqualifying information' means information 
                        about a conviction for a relevant crime or a 
                        finding of patient or resident abuse.
                            ``(iii) Finding of patient or resident 
                        abuse.--The term `finding of patient or 
                        resident abuse' means any substantiated finding 
                        by a State agency under subsection (g)(1)(C) or 
                        a Federal agency that a nursing facility worker 
                        has committed--
                                    ``(I) an act of patient or resident 
                                abuse or neglect or a misappropriation 
                                of patient or resident property; or
                                    ``(II) such other types of acts as 
                                the Secretary may specify in 
                                regulations.
                            ``(iv) Nursing facility worker.--The term 
                        `nursing facility worker' means any individual 
                        (other than any volunteer) that has direct 
                        access to a patient of a nursing facility under 
                        an employment or other contract, or both, with 
                        such facility. Such term includes individuals 
                        who are licensed or certified by the State to 
                        provide such services, and nonlicensed 
                        individuals providing such services, as defined 
                        by the Secretary, including nurse assistants, 
                        nurse aides, home health aides, and personal 
                        care workers and attendants.''.
            (2) Medicare program.--Section 1819(b) of the Social 
        Security Act (42 U.S.C. 1395i-3(b)) is amended by adding at the 
        end the following:
            ``(8) Screening of skilled nursing facility workers.--
                    ``(A) Background checks on applicants.--Subject to 
                subparagraph (B)(ii), before hiring a skilled nursing 
                facility worker, a skilled nursing facility shall--
                            ``(i) give the worker written notice that 
                        the facility is required to perform background 
                        checks with respect to applicants;
                            ``(ii) require, as a condition of 
                        employment, that such worker--
                                    ``(I) provide a written statement 
                                disclosing any conviction for a 
                                relevant crime or finding of patient or 
                                resident abuse;
                                    ``(II) provide a statement signed 
                                by the worker authorizing the facility 
                                to request the search and exchange of 
                                criminal records;
                                    ``(III) provide in person a copy of 
                                the worker's fingerprints; and
                                    ``(IV) provide any other 
                                identification information the 
                                Secretary may specify in regulation;
                            ``(iii) initiate a check of the data 
                        collection system established under section 
                        1128E in accordance with regulations 
                        promulgated by the Secretary to determine 
                        whether such system contains any disqualifying 
                        information with respect to such worker; and
                            ``(iv) if that system does not contain any 
                        such disqualifying information--
                                    ``(I) request that the State 
                                initiate a State and national criminal 
                                background check on such worker in 
                                accordance with the provisions of 
                                subsection (e)(6); and
                                    ``(II) furnish to the State the 
                                information described in subclauses 
                                (II) through (IV) of clause (ii) not 
                                more than 7 days (excluding Saturdays, 
                                Sundays, and legal public holidays 
                                under section 6103(a) of title 5, 
                                United States Code) after completion of 
                                the check against the system initiated 
                                under clause (iii).
                    ``(B) Prohibition on hiring of abusive workers.--
                            ``(i) In general.--A skilled nursing 
                        facility may not knowingly employ any skilled 
                        nursing facility worker who has any conviction 
                        for a relevant crime or with respect to whom a 
                        finding of patient or resident abuse has been 
                        made.
                            ``(ii) Provisional employment.--After 
                        complying with the requirements of clauses (i), 
                        (ii), and (iii) of subparagraph (A), a skilled 
                        nursing facility may provide for a provisional 
                        period of employment for a skilled nursing 
                        facility worker pending completion of the check 
                        against the data collection system described 
                        under subparagraph (A)(iii) and the background 
                        check described under subparagraph (A)(iv). 
                        Such facility shall maintain direct supervision 
                        of the covered individual during the worker's 
                        provisional period of employment.
                    ``(C) Reporting requirements.--A skilled nursing 
                facility shall report to the State any instance in 
                which the facility determines that a skilled nursing 
                facility worker has committed an act of resident 
                neglect or abuse or misappropriation of resident 
                property in the course of employment by the facility.
                    ``(D) Use of information.--
                            ``(i) In general.--A skilled nursing 
                        facility that obtains information about a 
                        skilled nursing facility worker pursuant to 
                        clauses (iii) and (iv) of subparagraph (A) may 
                        use such information only for the purpose of 
                        determining the suitability of the worker for 
                        employment.
                            ``(ii) Immunity from liability.--A skilled 
                        nursing facility that, in denying employment 
                        for an applicant (including during the period 
                        described in subparagraph (B)(ii)), reasonably 
                        relies upon information about such applicant 
                        provided by the State pursuant to subsection 
                        (e)(6) or section 1128E shall not be liable in 
                        any action  brought by such applicant based on 
the employment determination resulting from the information.
                            ``(iii) Criminal penalty.--Whoever 
                        knowingly violates the provisions of clause (i) 
                        shall be fined in accordance with title 18, 
                        United States Code, imprisoned for not more 
                        than 2 years, or both.
                    ``(E) Civil penalty.--
                            ``(i) In general.--A skilled nursing 
                        facility that violates the provisions of this 
                        paragraph shall be subject to a civil penalty 
                        in an amount not to exceed--
                                    ``(I) for the first such violation, 
                                $2,000; and
                                    ``(II) for the second and each 
                                subsequent violation within any 5-year 
                                period, $5,000.
                            ``(ii) Knowing retention of worker.--In 
                        addition to any civil penalty under clause (i), 
                        a skilled nursing facility that--
                                    ``(I) knowingly continues to employ 
                                a skilled nursing facility worker in 
                                violation of subparagraph (A) or (B); 
                                or
                                    ``(II) knowingly fails to report a 
                                skilled nursing facility worker under 
                                subparagraph (C);
                        shall be subject to a civil penalty in an 
                        amount not to exceed $5,000 for the first such 
                        violation, and $10,000 for the second and each 
                        subsequent violation within any 5-year period.
                    ``(F) Definitions.--In this paragraph:
                            ``(i) Conviction for a relevant crime.--The 
                        term `conviction for a relevant crime' means 
                        any Federal or State criminal conviction for--
                                    ``(I) any offense described in 
                                paragraphs (1) through (4) of section 
                                1128(a); and
                                    ``(II) such other types of offenses 
                                as the Secretary may specify in 
                                regulations, taking into account the 
                                severity and relevance of such 
                                offenses, and after consultation with 
                                representatives of long-term care 
                                providers, representatives of long-term 
                                care employees, consumer advocates, and 
                                appropriate Federal and State 
                                officials.
                            ``(ii) Disqualifying information.--The term 
                        `disqualifying information' means information 
                        about a conviction for a relevant crime or a 
                        finding of patient or resident abuse.
                            ``(iii) Finding of patient or resident 
                        abuse.--The term `finding of patient or 
                        resident abuse' means any substantiated finding 
                        by a State agency under subsection (g)(1)(C) or 
                        a Federal agency that a skilled nursing 
                        facility worker has committed--
                                    ``(I) an act of patient or resident 
                                abuse or neglect or a misappropriation 
                                of patient or resident property; or
                                    ``(II) such other types of acts as 
                                the Secretary may specify in 
                                regulations.
                            ``(iv) Skilled nursing facility worker.--
                        The term `skilled nursing facility worker' 
                        means any individual (other than any volunteer) 
                        that has direct access to a patient of a 
                        skilled nursing facility under an employment or 
                        other contract, or both, with such facility. 
                        Such term includes individuals who are licensed 
                        or certified by the State to provide such 
                        services, and nonlicensed individuals providing 
                        such services, as defined by the Secretary, 
                        including nurse assistants, nurse aides, home 
                        health aides, and personal care workers and 
                        attendants.''.
    (b) State Requirements.--
            (1) Medicaid program.--
                    (A) Expansion of state registry to collect 
                information about nursing facility employees other than 
                nurse aides.--Section 1919 of the Social Security Act 
                (42 U.S.C. 1396r) is amended--
                            (i) in subsection (e)(2)--
                                    (I) in the paragraph heading, by 
                                striking ``Nurse aide registry'' and 
                                inserting ``Nursing facility employee 
                                registry'';
                                    (II) in subparagraph (A)--
                                            (aa) by striking ``By not 
                                        later than January 1, 1989, 
                                        the'' and inserting ``The'';
                                            (bb) by striking ``a 
                                        registry of all individuals'' 
                                        and inserting ``a registry of 
                                        (I) all individuals''; and
                                            (cc) by inserting before 
                                        the period ``, and (II) all 
                                        other nursing facility 
                                        employees with respect to whom 
                                        the State has made a finding 
                                        described in subparagraph 
                                        (B)'';
                                    (III) in subparagraph (B), by 
                                striking ``involving an individual 
                                listed in the registry'' and inserting 
                                ``involving a nursing facility 
                                employee''; and
                                    (IV) in subparagraph (C), by 
                                striking ``nurse aide'' and inserting 
                                ``nursing facility employee or 
                                applicant for employment''; and
                            (ii) in subsection (g)(1)--
                                    (I) in subparagraph (C)--
                                            (aa) in the first sentence, 
                                        by striking ``nurse aide'' and 
                                        inserting ``nursing facility 
                                        employee''; and
                                            (bb) in the third sentence, 
                                        by striking ``nurse aide'' each 
                                        place it appears and inserting 
                                        ``nursing facility employee''; 
                                        and
                                    (II) in subparagraph (D), by 
                                striking ``nurse aide'' each place it 
                                appears and inserting ``nursing 
                                facility employee''.
                    (B) Federal and state requirement to conduct 
                background checks.--Section 1919(e) of the Social 
                Security Act (42 U.S.C. 1396r(e)) is amended by adding 
                at the end the following:
            ``(8) Federal and state requirements concerning criminal 
        background checks on nursing facility employees.--
                    ``(A) In general.--Upon receipt of a request by a 
                nursing facility pursuant to subsection (b)(8) that is 
                accompanied by the information described in subclauses 
                (II) through (IV) of subsection (b)(8)(A)(ii), a State, 
                after checking appropriate State records and finding no 
                disqualifying information (as defined in subsection 
                (b)(8)(F)(ii)), shall submit such request and 
                information to the Attorney General and shall request 
                the Attorney General to conduct a search and exchange 
                of records with respect to  the individual as described 
in subparagraph (B).
                    ``(B) Search and exchange of records by attorney 
                general.--Upon receipt of a submission pursuant to 
                subparagraph (A), the Attorney General shall direct a 
                search of the records of the Federal Bureau of 
                Investigation for any criminal history records 
                corresponding to the fingerprints or other positive 
                identification information submitted. The Attorney 
                General shall provide any corresponding information 
                resulting from the search to the State.
                    ``(C) State reporting of information to nursing 
                facility.--Upon receipt of the information provided by 
                the Attorney General pursuant to subparagraph (B), the 
                State shall--
                            ``(i) review the information to determine 
                        whether the individual has any conviction for a 
                        relevant crime (as defined in subsection 
                        (b)(8)(F)(i));
                            ``(ii) report to the nursing facility the 
                        results of such review; and
                            ``(iii) in the case of an individual with a 
                        conviction for a relevant crime, report the 
                        existence of such conviction of such individual 
                        to the database established under section 
                        1128E.
                    ``(D) Fees for performance of criminal background 
                checks.--
                            ``(i) Authority to charge fees.--
                                    ``(I) Attorney general.--The 
                                Attorney General may charge a fee to 
                                any State requesting a search and 
                                exchange of records pursuant to this 
                                paragraph and subsection (b)(8) for 
                                conducting the search and providing the 
                                records. The amount of such fee shall 
                                not exceed the lesser of the actual 
                                cost of such activities or $50. Such 
                                fees shall be available to the Attorney 
                                General, or, in the Attorney General's 
                                discretion, to the Federal Bureau of 
                                Investigation, until expended.
                                    ``(II) State.--A State may charge a 
                                nursing facility a fee for initiating 
                                the criminal background check under 
                                this paragraph and subsection (b)(8), 
                                including fees charged by the Attorney 
                                General, and for performing the review 
                                and report required by subparagraph 
                                (C). The amount of such fee shall not 
                                exceed the actual cost of such 
                                activities.
                            ``(ii) Prohibition on charging applicants 
                        or employees.--An entity may not impose on an 
                        applicant for employment or an employee any 
                        charges relating to the performance of a 
                        background check under this paragraph.
                    ``(E) Regulations.--
                            ``(i) In general.--In addition to the 
                        Secretary's authority to promulgate regulations 
                        under this title, the Attorney General, in 
                        consultation with the Secretary, may promulgate 
                        such regulations as are necessary to carry out 
                        the Attorney General's responsibilities under 
                        this paragraph and subsection (b)(8), including 
                        regulations regarding the security, 
                        confidentiality, accuracy, use, destruction, 
                        and dissemination of information, audits and 
                        recordkeeping, and the imposition of fees.
                            ``(ii) Appeal procedures.--The Attorney 
                        General, in consultation with the Secretary, 
                        shall promulgate such regulations as are 
                        necessary to establish procedures by which an 
                        applicant or employee may appeal or dispute the 
                        accuracy of the information obtained in a 
                        background check conducted under this 
                        paragraph. Appeals shall be limited to 
                        instances in which an applicant or employee is 
                        incorrectly identified as the subject of the 
                        background check, or when information about the 
                        applicant or employee has not been updated to 
                        reflect changes in the applicant's or 
                        employee's criminal record.
                    ``(F) Report.--Not later than 2 years after the 
                date of enactment of this paragraph, the Attorney 
                General shall submit a report to Congress on--
                            ``(i) the number of requests for searches 
                        and exchanges of records made under this 
                        section;
                            ``(ii) the disposition of such requests; 
                        and
                            ``(iii) the cost of responding to such 
                        requests.''.
            (2) Medicare program.--
                    (A) Expansion of state registry to collect 
                information about skilled nursing facility employees 
                other than nurse aides.--Section 1819 of the Social 
                Security Act (42 U.S.C. 1395i-3) is amended--
                            (i) in subsection (e)(2)--
                                    (I) in the paragraph heading, by 
                                striking ``Nurse aide registry'' and 
                                inserting ``Skilled nursing care 
                                employee registry'';
                                    (II) in subparagraph (A)--
                                            (aa) by striking ``By not 
                                        later than January 1, 1989, 
                                        the'' and inserting ``The'';
                                            (bb) by striking ``a 
                                        registry of all individuals'' 
                                        and inserting ``a registry of 
                                        (I) all individuals''; and
                                            (cc) by inserting before 
                                        the period ``, and (II) all 
                                        other skilled nursing facility 
                                        employees with respect to whom 
                                        the State has made a finding 
                                        described in subparagraph 
                                        (B)'';
                                    (III) in subparagraph (B), by 
                                striking ``involving an individual 
                                listed in the registry'' and inserting 
                                ``involving a skilled nursing facility 
                                employee''; and
                                    (IV) in subparagraph (C), by 
                                striking ``nurse aide'' and inserting 
                                ``skilled nursing facility employee or 
                                applicant for employment''; and
                            (ii) in subsection (g)(1)--
                                    (I) in subparagraph (C)--
                                            (aa) in the first sentence, 
                                        by striking ``nurse aide'' and 
                                        inserting ``skilled nursing 
                                        facility employee''; and
                                            (bb) in the third sentence, 
                                        by striking ``nurse aide'' each 
                                        place it appears and inserting 
                                        ``skilled nursing facility 
                                        employee''; and
                                    (II) in subparagraph (D), by 
                                striking ``nurse aide'' each place it 
                                appears and inserting ``skilled nursing 
                                facility employee''.
                    (B) Federal and state requirement to conduct 
                background checks.--Section 1819(e) of the Social 
                Security Act (42 U.S.C. 1395i-3(e)) is amended by 
                adding at the end the following:
            ``(6) Federal and state requirements concerning criminal 
        background checks on skilled nursing facility employees.--
                    ``(A) In general.--Upon receipt of a request by a 
                skilled nursing facility pursuant to subsection (b)(8) 
                that is accompanied by the information described in 
                subclauses (II) through (IV) of subsection 
                (b)(8)(A)(ii), a State, after checking appropriate 
                State records and finding no disqualifying information 
                (as defined in subsection (b)(8)(F)(ii)), shall submit 
                such request and information to the Attorney General 
                and shall request the Attorney General to conduct a 
                search and exchange of records with respect to the 
                individual as described in subparagraph (B).
                    ``(B) Search and exchange of records by attorney 
                general.--Upon receipt of a submission pursuant to 
                subparagraph (A), the Attorney General shall direct a 
                search of the records of the Federal Bureau of 
                Investigation for any criminal history records 
                corresponding to the fingerprints or other positive 
                identification information submitted. The Attorney 
                General shall provide any corresponding information 
                resulting from the search to the State.
                    ``(C) State reporting of information to skilled 
                nursing facility.--Upon receipt of the information 
                provided by the Attorney General pursuant to 
                subparagraph (B), the State shall--
                            ``(i) review the information to determine 
                        whether the individual has any conviction for a 
                        relevant crime (as defined in subsection 
                        (b)(8)(F)(i));
                            ``(ii) report to the skilled nursing 
                        facility the results of such review; and
                            ``(iii) in the case of an individual with a 
                        conviction for a relevant crime, report the 
                        existence of such conviction of such individual 
                        to the database established under section 
                        1128E.
                    ``(D) Fees for performance of criminal background 
                checks.--
                            ``(i) Authority to charge fees.--
                                    ``(I) Attorney general.--The 
                                Attorney General may charge a fee to 
                                any State requesting a search and 
                                exchange of records pursuant to this 
                                paragraph and subsection (b)(8) for 
                                conducting the search and providing the 
                                records. The amount of such fee shall 
                                not exceed the lesser of the actual 
                                cost of such activities or $50. Such 
                                fees shall be available to the Attorney 
                                General, or, in the Attorney General's 
                                discretion, to the Federal Bureau of 
                                Investigation until expended.
                                    ``(II) State.--A State may charge a 
                                skilled nursing facility a fee for 
                                initiating the criminal background 
                                check under this paragraph and 
                                subsection (b)(8), including fees 
                                charged by the Attorney General, and 
                                for performing the review and report 
                                required by subparagraph (C). The 
                                amount of such fee shall not exceed the 
                                actual cost of such activities.
                            ``(ii) Prohibition on charging applicants 
                        or employees.--An entity may not impose on an 
                        applicant for employment or an employee any 
                        charges relating to the performance of a 
                        background check under this paragraph.
                    ``(E) Regulations.--
                            ``(i) In general.--In addition to the 
                        Secretary's authority to promulgate regulations 
                        under this title, the Attorney General, in 
                        consultation with the Secretary, may promulgate 
                        such regulations as are necessary to carry out 
                        the Attorney General's responsibilities under 
                        this paragraph and subsection (b)(9), including 
                        regulations regarding the security 
                        confidentiality, accuracy, use, destruction, 
                        and dissemination of information, audits and 
                        recordkeeping, and the imposition of fees.
                            ``(ii) Appeal procedures.--The Attorney 
                        General, in consultation with the Secretary, 
                        shall promulgate such regulations as are 
                        necessary to establish procedures by which an 
                        applicant or employee may appeal or dispute the 
                        accuracy of the information obtained in a 
                        background check conducted under this 
                        paragraph. Appeals shall be limited to 
                        instances in which an applicant or employee is 
                        incorrectly identified as the subject of the 
                        background check, or when information about the 
                        applicant or employee has not been updated to 
                        reflect changes in the applicant's or 
                        employee's criminal record.
                    ``(F) Report.--Not later than 2 years after the 
                date of enactment of this paragraph, the Attorney 
                General shall submit a report to Congress on--
                            ``(i) the number of requests for searches 
                        and exchanges of records made under this 
                        section;
                            ``(ii) the disposition of such requests; 
                        and
                            ``(iii) the cost of responding to such 
                        requests.''.
    (c) Application to Other Entities Providing Long-Term Care 
Services.--
            (1) Medicaid.--Section 1902(a) of the Social Security Act 
        (42 U.S.C. 1396a) is amended--
                    (A) in paragraph (65), by striking the period and 
                inserting ``; and''; and
                    (B) by inserting after paragraph (65) the 
                following:
            ``(66) provide that any entity that is eligible to be paid 
        under the State plan for providing long-term care services for 
        which medical assistance is available under the State plan to 
        individuals requiring long-term care complies with the 
        requirements of subsections (b)(8) and (e)(8) of section 
        1919.''.
            (2) Medicare.--Part D of title XVIII of the Social Security 
        Act (42 U.S.C. 1395x et seq.) is amended by adding at the end 
        the following:

 ``application of skilled nursing facility preventive abuse provisions 
 to any provider of services or other entity providing long-term care 
                                services

    ``Sec. 1897. The requirements of subsections (b)(8) and (e)(6) of 
section 1819 shall apply to any provider of services or any other 
entity that is eligible to be paid under this title for providing long-
term care services to an individual entitled to benefits under part A 
or enrolled under  part B (including an individual provided with a 
Medicare+Choice plan offered by a Medicare+Choice organization under 
part C).''.
    (d) Reimbursement of Reasonable Costs for Background Checks.--The 
Secretary of Health and Human Services shall factor into any payment 
system under titles XVIII and XIX of the Social Security Act the 
reasonable costs of the requirements of sections 1819(b)(8) and 
1919(b)(8) of such Act, as added by this section, incurred by any 
entity subject to such requirements.

SEC. 3. INCLUSION OF ABUSIVE NURSING FACILITY WORKERS IN THE DATABASE 
              ESTABLISHED AS PART OF NATIONAL HEALTH CARE FRAUD AND 
              ABUSE DATA COLLECTION PROGRAM.

    (a) Inclusion of Abusive Acts Within a Long-Term Care Facility.--
Section 1128E(g)(1)(A) of the Social Security Act (42 U.S.C. 1320a-
7e(g)(1)(A)) is amended--
            (1) by redesignating clause (v) as clause (vi); and
            (2) by inserting after clause (iv), the following:
                            ``(v) A finding of abuse or neglect of a 
                        patient or a resident of a long-term care 
                        facility, or misappropriation of such a 
                        patient's or resident's property.''.
    (b) Coverage of Long-Term Care Facility Employees.--Section 
1128E(g)(2) of the Social Security Act (42 U.S.C. 1320a-7e(g)(2)) is 
amended by inserting ``, and includes any individual of a long-term 
care facility (other than any volunteer) that has direct access to a 
patient or resident of such a facility under an employment or other 
contract, or both, with the facility (including individuals who are 
licensed or certified by the State to provide services at the facility, 
and nonlicensed individuals, as defined by the Secretary, providing 
services at the facility, including nurse assistants, nurse aides, home 
health aides, and personal care workers and attendants)'' before the 
period.
    (c) Reporting by Long-Term Care Facilities.--
            (1) In general.--Section 1128E(b)(1) of the Social Security 
        Act (42 U.S.C. 1320a-7e(b)(1)) is amended by striking ``and 
        health plan'' and inserting ``, health plan, and long-term care 
        facility''.
            (2) Correction of information.--Section 1128E(c)(2) of the 
        Social Security Act (42 U.S.C. 1320a-7e(c)(2)) is amended by 
        striking ``and health plan'' and inserting ``, health plan, and 
        long-term care facility''.
    (d) Access to Reported Information.--Section 1128E(d)(1) of the 
Social Security Act (42 U.S.C. 1320a-7e(d)(1)) is amended by striking 
``and health plans'' and inserting ``, health plans, and long-term care 
facilities''.
    (e) Mandatory Check of Database by Long-Term Care Facilities.--
Section 1128E(d) of the Social Security Act (42 U.S.C. 1320a-7e(d)) is 
amended by adding at the end the following:
            ``(3) Mandatory check of database by long-term care 
        facilities.--A long-term care facility shall check the database 
        maintained under this section prior to hiring under an 
        employment or other contract, or both, any individual as an 
        employee of such a facility who will have direct access to a 
        patient or resident of the facility (including individuals who 
        are licensed or certified by the State to provide services at 
        the facility, and nonlicensed individuals, as defined by the 
        Secretary, that will provide services at the facility, 
        including nurse assistants, nurse aides, home health aides, and 
        personal care workers and attendants).''.
    (f) Definition of Long-Term Care Facility.--Section 1128E(g) of the 
Social Security Act (42 U.S.C. 1320a-7e(g)) is amended by adding at the 
end the following:
            ``(6) Long-term care facility.--The term `long-term care 
        facility' means a skilled nursing facility (as defined in 
        section 1819(a)), a nursing facility (as defined in section 
        1919(a)), a home health agency, a hospice facility, an 
        intermediate care facility for the mentally retarded (as 
        defined in section 1905(d)), or any other facility that 
        provides long-term care services and receives payment for such 
        services under the medicare program under title XVIII or the 
        medicaid program under title XIX.''.
    (g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out the amendments made by this section, 
$10,200,000 for fiscal year 2000.

SEC. 4. PREVENTION AND TRAINING DEMONSTRATION PROJECT.

    (a) Establishment.--The Secretary of Health and Human Services 
shall establish a demonstration program to provide grants to develop 
information on best practices in patient abuse prevention training 
(including behavior training and interventions) for managers and staff 
of hospital and health care facilities.
    (b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall be a public or private nonprofit entity 
and prepare and submit to the Secretary of Health and Human Services an 
application at such time, in such manner, and containing such 
information as the Secretary may require.
    (c) Use of Funds.--Amounts received under a grant under this 
section shall be used to--
            (1) examine ways to improve collaboration between State 
        health care survey and provider certification agencies, long-
        term care ombudsman programs, the long-term care industry, and 
        local community members;
            (2) examine patient care issues relating to regulatory 
        oversight, community involvement, and facility staffing and 
        management with a focus on staff training, staff stress 
        management, and staff supervision;
            (3) examine the use of patient abuse prevention training 
        programs by long-term care entities, including the training 
        program developed by the National Association of Attorneys 
        General, and the extent to which such programs are used; and
            (4) identify and disseminate best practices for preventing 
        and reducing patient abuse.
    (d) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this section.

SEC. 5. EFFECTIVE DATE.

    The provisions of and amendments made by the Act shall apply, 
without regard to whether implementing regulations are in effect, to 
any individual applying for employment or hired for such employment--
            (1) by any skilled nursing facility (as defined in section 
        1819(a) of the Social Security Act) or any nursing facility (as 
        defined in section 1919(a) of such Act), on or after the date 
        which is 6 months after the date of enactment of this Act,
            (2) by any home health agency, on or after the date which 
        is 12 months after such date of enactment, and
            (3) by any hospice facility, any intermediate care facility 
        for the mentally retarded (as defined in section 1905(d) of the 
        Social Security Act), or any other facility that provides long-
        term care services and receives payment for such services under 
        the medicare program under title XVIII of such Act or the 
        medicaid program under title XIX of such Act, on or after the 
        date which is 18 months after such date of enactment.
                                 <all>
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