I 

110TH CONGRESS 

1ST SESSION H. R. 1476 

To amend titles XVIII and XIX of the Social Security Act to expand the 

nursing home patients’ bill of rights to include the right to receive 

care from a credible caregiver by requiring background checks on direct 

access employees and the right to a safe environment during an emergency or natural disaster by requiring nursing long-term care facilities 

to establish disaster emergency and evacuation plans. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 12, 2007 

Ms. GINNY BROWN-WAITE of Florida (for herself, Mr. KIRK, Mr. FEENEY, 

Mr. BOUSTANY, Mr. SHAYS, Mrs. BIGGERT, Mrs. MILLER of Michigan, 

Mr. PORTER, Mr. GINGREY, Mr. CHABOT, Mr. GILCHREST, Mr. BARTLETT of Maryland, Mr. UPTON, and Mr. ROSKAM) introduced the following bill; which was referred to the Committee on Ways and Means, 

and in addition to the Committee on Energy and Commerce, 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 amend titles XVIII and XIX of the Social Security Act 

to expand the nursing home patients’ bill of rights to 

include the right to receive care from a credible caregiver 

by requiring background checks on direct access employees and the right to a safe environment during an emergency or natural disaster by requiring nursing long-term 

care facilities to establish disaster emergency and evacuation plans. 


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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 ‘‘Senior Safety and Dig5 nity Act of 2007’’. 

6 SEC. 2. SECURING RIGHT TO RECEIVE CARE FROM A CRED7 IBLE CAREGIVER BY REQUIRING PERFORM8 ANCE OF BACKGROUND CHECKS ON DIRECT 

9 ACCESS EMPLOYEES OF LONG-TERM CARE 

10 FACILITIES OR PROVIDERS. 

11 (a) ADDITION TO NURSING HOME PATIENTS’ BILL

12 OF RIGHTS OF RIGHT TO RECEIVE CARE FROM A CRED13 IBLE CAREGIVER.—Sections 1819(c)(1)(A) and 

14 1919(c)(1)(A) of the Social Security Act (42 U.S.C. 

15 1395i–3(c)(1)(A), 1396r(c)(1)(A)) are each amended— 

16 (1) by redesignating clause (xi) as clause (xiii); 

17 and 

18 (2) by inserting after clause (x) the following 

19 new clause: 

20 ‘‘(xi) RECEIPT OF CARE FROM CRED21 IBLE CAREGIVER.—The right to receive 

22 care from a credible caregiver.’’. 

23 (b) SCREENING OF SKILLED NURSING FACILITY AND

24 NURSING FACILITY EMPLOYEE APPLICANTS.— 


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1 (1) MEDICARE PROGRAM.—Section 1819(b) of 

2 the Social Security Act (42 U.S.C. 1395i–3(b)) is 

3 amended by adding at the end the following: 

4 ‘‘(9) SCREENING OF SKILLED NURSING FACIL5 ITY WORKERS.— 

6 ‘‘(A) BACKGROUND CHECKS ON APPLI7 CANTS.—Before hiring a skilled nursing facility 

8 worker, a skilled nursing facility shall conduct 

9 a background check on the employee in accord10 ance with such procedures as the Secretary 

11 shall establish. 

12 ‘‘(B) PROHIBITION ON HIRING OF ABUSIVE

13 WORKERS.— 

14 ‘‘(I) IN GENERAL.—Subject to clause 

15 (ii), a skilled nursing facility may not 

16 knowingly employ any skilled nursing facil17 ity worker who has any disqualifying infor18 mation (as defined in subparagraph 

19 (F)(ii)). 

20 ‘‘(ii) PROVISIONAL EMPLOYMENT.—A 

21 skilled nursing facility may provide for a 

22 provisional period of employment for a 

23 skilled nursing facility worker pending 

24 completion of the background check re25 quired under subparagraph (A). Such facilVerDate Aug 31 2005 19:47 Mar 16, 2007 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1476.IH H1476

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1 ity shall maintain direct supervision of the 

2 covered individual during the worker’s pro3 visional period of employment. 

4 ‘‘(C) PROCEDURES.—The procedures es5 tablished by the Secretary under subparagraph 

6 (A) shall— 

7 ‘‘(I) provide a process by which a 

8 skilled nursing facility worker may appeal 

9 or dispute the accuracy of the information 

10 obtained in a background check conducted 

11 under this paragraph; 

12 ‘‘(ii) take into account the needs of 

13 skilled nursing facilities that serve a low 

14 volume of patients (as determined by the 

15 Secretary) with respect to providing super16 vision for provisional employees who are 

17 awaiting the results of a background check 

18 conducted under this paragraph; and 

19 ‘‘(iii) provide for the reimbursement 

20 of nursing facilities for 100 percent of the 

21 costs incurred by such facilities in com22 plying with the requirements of this sec23 tion. 

24 ‘‘(D) IMMUNITY FROM LIABILITY.—A 

25 skilled nursing facility that, in denying employVerDate Aug 31 2005 19:47 Mar 16, 2007 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1476.IH H1476

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1 ment for an applicant, reasonably relies upon 

2 information about such applicant provided by 

3 the criminal background check shall not be lia4 ble in any action brought by such applicant 

5 based on the employment determination result6 ing from the information. 

7 ‘‘(E) CIVIL PENALTY.— 

8 ‘‘(I) IN GENERAL.—A skilled nursing 

9 facility that violates the provisions of this 

10 paragraph shall be subject to a civil pen11 alty in an amount not to exceed— 

12 ‘‘(I) for the first such violation, 

13 $2,000; and 

14 ‘‘(II) for the second and each 

15 subsequent violation within any 5-year 

16 period, $5,000. 

17 ‘‘(ii) KNOWING RETENTION OF WORK18 ER.—In addition to any civil penalty under 

19 clause (I), a skilled nursing facility that 

20 knowingly continues to employ a skilled 

21 nursing facility worker in violation of sub22 paragraph (A) or (B) shall be subject to a 

23 civil penalty in an amount not to exceed 

24 $5,000 for the first such violation, and 


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1 $10,000 for the second and each subse2 quent violation within any 5-year period. 

3 ‘‘(F) DEFINITIONS.—In this paragraph: 

4 ‘‘(I) CONVICTION FOR A RELEVANT

5 CRIME.—The term ‘conviction for a rel6 evant crime’ means any Federal or State 

7 criminal conviction for— 

8 ‘‘(I) any offense described in sec9 tion 1128(a); and 

10 ‘‘(II) such other types of offenses 

11 as the Secretary may specify in regu12 lations. 

13 ‘‘(ii) DISQUALIFYING INFORMATION.— 

14 The term ‘disqualifying information’ means 

15 information about a conviction for a rel16 evant crime or a finding of patient or resi17 dent abuse. 

18 ‘‘(iii) SKILLED NURSING FACILITY

19 WORKER.—The term ‘skilled nursing facil20 ity worker’ means any individual that has 

21 direct access to a patient of a skilled nurs22 ing facility under an employment or other 

23 contract, or both, with such facility. Such 

24 term includes individuals who are licensed 

25 or certified by the State to provide longVerDate Aug 31 2005 19:47 Mar 16, 2007 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1476.IH H1476

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1 term care services, and nonlicensed individ2 uals providing such services, as defined by 

3 the Secretary, including nurse assistants, 

4 nurse aides, home health aides, and per5 sonal care workers and attendants.’’. 

6 (2) MEDICAID PROGRAM.—Section 1919(b) of 

7 the Social Security Act (42 U.S.C. 1396r(b)) is 

8 amended by adding at the end the following new 

9 paragraph: 

10 ‘‘(9) SCREENING OF NURSING FACILITY WORK11 ERS.— 

12 ‘‘(A) BACKGROUND CHECKS ON APPLI13 CANTS.—Before hiring a nursing facility work14 er, a nursing facility shall conduct a back15 ground check on the employee in accordance 

16 with such procedures as the Secretary shall es17 tablish. 

18 ‘‘(B) PROHIBITION ON HIRING OF ABUSIVE

19 WORKERS.— 

20 ‘‘(I) IN GENERAL.—Subject to clause 

21 (ii), a nursing facility may not knowingly 

22 employ any nursing facility worker who 

23 has any disqualifying information (as de24 fined in subparagraph (F)(ii)). 


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1 ‘‘(ii) PROVISIONAL EMPLOYMENT.—A 

2 nursing facility may provide for a provi3 sional period of employment for a nursing 

4 facility worker pending completion of the 

5 background check required under subpara6 graph (A). Such facility shall maintain di7 rect supervision of the covered individual 

8 during the worker’s provisional period of 

9 employment. 

10 ‘‘(C) PROCEDURES.—The procedures es11 tablished by the Secretary under subparagraph 

12 (A) shall— 

13 ‘‘(I) provide a process by which a 

14 nursing facility worker may appeal or dis15 pute the accuracy of the information ob16 tained in a background check conducted 

17 under this paragraph; 

18 ‘‘(ii) take into account the needs of 

19 nursing facilities that serve a low volume 

20 of patients (as determined by the Sec21 retary) with respect to providing super22 vision for provisional employees who are 

23 awaiting the results of a background check 

24 conducted under this paragraph; and 


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1 ‘‘(iii) provide for the reimbursement 

2 of nursing facilities for 100 percent of the 

3 costs incurred by such facilities in com4 plying with the requirements of this sec5 tion. 

6 ‘‘(D) IMMUNITY FROM LIABILITY.—A 

7 nursing facility that, in denying employment for 

8 an applicant, reasonably relies upon information 

9 about such applicant provided by the criminal 

10 background check shall not be liable in any ac11 tion brought by such applicant based on the 

12 employment determination resulting from the 

13 information. 

14 ‘‘(E) CIVIL PENALTY.— 

15 ‘‘(I) IN GENERAL.—A nursing facility 

16 that violates the provisions of this para17 graph shall be subject to a civil penalty in 

18 an amount not to exceed— 

19 ‘‘(I) for the first such violation, 

20 $2,000; and 

21 ‘‘(II) for the second and each 

22 subsequent violation within any 5-year 

23 period, $5,000. 

24 ‘‘(ii) KNOWING RETENTION OF WORK25 ER.—In addition to any civil penalty under 


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1 clause (I), a nursing facility that know2 ingly continues to employ a nursing facility 

3 worker in violation of subparagraph (A) or 

4 (B) shall be subject to a civil penalty in an 

5 amount not to exceed $5,000 for the first 

6 such violation, and $10,000 for the second 

7 and each subsequent violation within any 

8 5-year period. 

9 ‘‘(F) DEFINITIONS.—In this paragraph: 

10 ‘‘(I) CONVICTION FOR A RELEVANT

11 CRIME.—The term ‘conviction for a rel12 evant crime’ means any Federal or State 

13 criminal conviction for— 

14 ‘‘(I) any offense described in sec15 tion 1128(a); and 

16 ‘‘(II) such other types of offenses 

17 as the Secretary may specify in regu18 lations. 

19 ‘‘(ii) DISQUALIFYING INFORMATION.— 

20 The term ‘disqualifying information’ means 

21 information about a conviction for a rel22 evant crime or a finding of patient or resi23 dent abuse. 

24 ‘‘(iii) NURSING FACILITY WORKER.— 

25 The term ‘nursing facility worker’ means 


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1 any individual that has direct access to a 

2 patient of a nursing facility under an em3 ployment or other contract, or both, with 

4 such facility. Such term includes individ5 uals who are licensed or certified by the 

6 State to provide long-term care services, 

7 and nonlicensed individuals providing such 

8 services, as defined by the Secretary, in9 cluding nurse assistants, nurse aides, home 

10 health aides, and personal care workers 

11 and attendants.’’. 

12 (3) EFFECTIVE DATE.—The amendments made 

13 by this subsection and subsection (a) shall take ef14 fect on the date that is 1 year after the date on 

15 which the evaluation is completed under subsection 

16 (d)(1). 

17 (c) APPLICATION TO OTHER LONG-TERM CARE FA18 CILITIES OR PROVIDERS.— 

19 (1) MEDICARE.—Part E of title XVIII of the 

20 Social Security Act (42 U.S.C. 1395x et seq.) is 

21 amended by adding at the end the following: 

22 ‘‘APPLICATION OF SKILLED NURSING FACILITY PREVEN23 TIVE ABUSE PROVISIONS TO LONG-TERM CARE FA24 CILITIES AND PROVIDERS

25 ‘‘SEC. 1898. (a) IN GENERAL.—The provisions of 

26 section 1819(b)(9) shall apply to a long-term care facility 


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1 or provider (as defined in subsection (b)) in the same man2 ner as such provisions apply to a skilled nursing facility. 

3 ‘‘(b) LONG-TERM CARE FACILITY OR PROVIDER.— 

4 In this section, the term ‘long-term care facility or pro5 vider’ means the following facilities or providers which re6 ceive payment for services under this title or title XIX: 

7 ‘‘(1) A home health agency. 

8 ‘‘(2) A provider of hospice care. 

9 ‘‘(3) A long-term care hospital. 

10 ‘‘(4) A provider of personal care services. 

11 ‘‘(5) A residential care provider that arranges 

12 for, or directly provides, long-term care services. 

13 ‘‘(6) An intermediate care facility for the men14 tally retarded (as defined in section 1905(d)).’’. 

15 (2) MEDICAID.—Section 1902(a) of the Social 

16 Security Act (42 U.S.C. 1396a) is amended— 

17 (A) in paragraph (69), by striking ‘‘and’’ 

18 at the end; 

19 (B) in paragraph (70), by striking the pe20 riod and inserting ‘‘; and’’; and 

21 (C) by inserting after paragraph (70) the 

22 following: 

23 ‘‘(71) provide that the provisions of section 

24 1919(b)(9) apply to a long-term care facility or pro25 vider (as defined in section 1898(b)) in the same 


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1 manner as such provisions apply to a nursing facil2 ity.’’. 

3 (3) EFFECTIVE DATE.—The amendments made 

4 by this subsection shall take effect on the date that 

5 is 1 year after the date on which the evaluation is 

6 completed under subsection (d)(1). 

7 (d) NATIONAL CRIMINAL BACKGROUND CHECK PRO8 GRAM.— 

9 (1) COMPLETION OF PILOT PROGRAM EVALUA10 TION.—Not later than the date that is 6 months 

11 after the completion of the pilot program for na12 tional and State background checks on direct patient 

13 access employees of long-term care facilities or pro14 viders established under section 307 of the Medicare 

15 Prescription Drug, Improvement, and Modernization 

16 Act of 2003 (Public Law 108–173), the Secretary 

17 shall complete the evaluation required under sub18 section (e) of such section of such Act. 

19 (2) ESTABLISHMENT.— 

20 (A) IN GENERAL.—Not later than the date 

21 that is 1 year after the completion of the eval22 uation of the program described in paragraph 

23 (1), the Secretary, in consultation with the At24 torney General, shall establish a national crimi25 nal background check program in order to preVerDate Aug 31 2005 19:47 Mar 16, 2007 Jkt 059200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H1476.IH H1476

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1 vent abuse of nursing facility and skilled nurs2 ing facility residents and individuals receiving 

3 home health care services and other long-term 

4 care services under the medicare or medicaid 

5 programs, taking into account the findings and 

6 recommendations contained in the evaluation. 

7 (B) USE IN CONDUCTING REQUIRED BACK8 GROUND CHECKS.—The national criminal back9 ground check program shall be made available 

10 to a long-term care facility or provider for the 

11 purpose of conducting criminal background 

12 checks, including the criminal background 

13 checks required under sections 1819(b)(9) and 

14 1919(b)(9) of the Social Security Act (42 

15 U.S.C. 1395i–3(b), 1396r(b)) (as added by sub16 section (a)). 

17 (C) CONDUCT OF BACKGROUND CHECKS

18 BY THE FEDERAL BUREAU OF INVESTIGA19 TION.—The Secretary, in consultation with the 

20 Attorney General, shall establish procedures for 

21 the background checks to be conducted by the 

22 Federal Bureau of Investigation, in cooperation 

23 with appropriate State and Federal agencies. 

24 (D) CONSULTATION.—In establishing the 

25 national criminal background check program, 


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1 the Secretary shall consult with appropriate in2 terested parties, including— 

3 (I) representatives of long-term care 

4 facilities or providers; 

5 (ii) representatives of employees of 

6 long-term care facilities or providers; 

7 (iii) consumers of long-term care serv8 ices; 

9 (iv) consumer advocates; and 

10 (v) appropriate Federal and State of11 ficials. 

12 (3) DEFINITIONS.—In this subsection: 

13 (A) LONG-TERM CARE FACILITY OR PRO14 VIDER.—The term ‘‘long-term care facility or 

15 provider’’ means the following facilities or pro16 viders which receive payment for services under 

17 title XVIII or XIX of the Social Security Act: 

18 (I) A nursing facility (as defined in 

19 subparagraph (B)). 

20 (ii) A skilled nursing facility (as de21 fined in subparagraph )). 

22 (iii) A home health agency. 

23 (iv) A provider of hospice care (as de24 fined in section 1861(dd)(1) of the Social 

25 Security Act) (42 U.S.C. 1395x(dd)(1)). 


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1 (v) A long-term care hospital (as de2 scribed in section 1886(d)(1)(B)(iv) of 

3 such Act) (42 U.S.C. 

4 1395ww(d)(1)(B)(iv)). 

5 (vi) A provider of personal care serv6 ices. 

7 (vii) A residential care provider that 

8 arranges for, or directly provides, long9 term care services. 

10 (viii) An intermediate care facility for 

11 the mentally retarded (as defined in sec12 tion 1905(d) of such Act) (42 U.S.C. 

13 1396d(d)). 

14 (B) NURSING FACILITY.—The term ‘‘nurs15 ing facility’’ has the meaning given such term 

16 in section 1919(a) of the Social Security Act 

17 (42 U.S.C. 1396r(a)). 

18 (C) SKILLED NURSING FACILITY.—The 

19 term ‘‘skilled nursing facility’’ has the meaning 

20 given such term in 1819(a) of the Social Secu21 rity Act (42 U.S.C. 1395i–3(a)). 


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1 SEC. 3. SECURING THE RIGHT TO A SAFE ENVIRONMENT IN 

2 LONG-TERM CARE FACILITIES DURING AN 

3 EMERGENCY OR NATURAL DISASTER BY RE4 QUIRING THESE FACILITIES TO ESTABLISH 

5 DISASTER EMERGENCY AND EVACUATION 

6 PLANS. 

7 (a) ADDITION TO NURSING HOME PATIENTS’ BILL

8 OF RIGHTS OF RIGHT TO A SAFE ENVIRONMENT DURING

9 AN EMERGENCY OR NATURAL DISASTER.—Sections 

10 1819(c)(1)(A) and 1919(c)(1)(A) of the Social Security 

11 Act (42 U.S.C. 1395i–3(c)(1)(A), 1396r(c)(1)(A)), as 

12 amended by section 2(a), are each amended by inserting 

13 after clause (xi) the following new clause: 

14 ‘‘(xii) SAFE ENVIRONMENT DURING

15 EMERGENCY OR NATURAL DISASTER.—The 

16 right to a safe environment during an 

17 emergency or natural disaster.’’. 

18 (b) APPLICATION UNDER MEDICARE.—Section 

19 1819(d)(4) of such Act (42 U.S.C. 1395i–3(d)(4)) is 

20 amended— 

21 (1) by redesignating subparagraph (B) as sub22 paragraph (C); and 

23 (2) by inserting after subparagraph (A) the fol24 lowing new subparagraph: 


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1 ‘‘(B) DISASTER EMERGENCY AND EVACU2 ATION PLANS.—A skilled nursing facility 

3 must— 

4 ‘‘(I) have a clear and pre-established 

5 disaster plan to ensure the safety of all its 

6 patients during an emergency or natural 

7 disaster and possible evacuation; and 

8 ‘‘(ii) inform residents and next-of-kin 

9 regarding such plan and the location of 

10 possible evacuation in case of an emer11 gency or disaster.’’. 

12 (c) MEDICAID.—Section 1919(d)(4) of such Act (42 

13 U.S.C. 1396r(d)(4)) is amended— 

14 (1) by redesignating subparagraph (B) as sub15 paragraph (C); and 

16 (2) by inserting after subparagraph (A) the fol17 lowing new subparagraph: 

18 ‘‘(B) DISASTER EMERGENCY AND EVACU19 ATION PLANS.—A nursing facility must— 

20 ‘‘(I) have a clear and pre-established 

21 disaster plan to ensure the safety of all its 

22 patients during an emergency or natural 

23 disaster and possible evacuation; and 

24 ‘‘(ii) inform residents and next-of-kin 

25 regarding such plan and the location of 


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1 possible evacuation in case of an emer2 gency or disaster.’’. 

3 (d) APPLICATION TO OTHER LONG-TERM CARE FA4 CILITIES.— 

5 (1) MEDICARE.—Section 1898(a) of such Act, 

6 as added by section 2(c)(1), is amended by inserting 

7 ‘‘and section 1819(d)(4)(B)’’ after ‘‘section 

8 1819(b)(9)’’. 

9 (2) MEDICAID.—Section 1902(a)(71) of such 

10 Act, as inserted by section 2(c)(2)(C), is amended by 

11 inserting ‘‘and section 1919(d)(4)(B)’’ after ‘‘section 

12 1919(b)(9)’’. 

13 (e) EFFECTIVE DATE.—The amendments made by 

14 this section shall apply as of the date that is one year 

15 after the date of the enactment of this Act. 

Æ 


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