the suitability of the employee for employ-
ment. 
‘‘(ii) IMMUNITY FROM LIABILITY.—A 
skilled nursing facility that, in denying em-
ployment for an applicant, reasonably and 
in good faith relies upon credible informa-
tion about such applicant provided by a 
criminal history background check shall 
not be liable in any action brought by such 
applicant based on the employment deter-
mination resulting from the information. 
‘‘(iii) PROHIBITION ON CHARGING EM-
PLOYEES
FEES
FOR
CONDUCTING
BACK-
GROUND CHECKS.—A skilled nursing facil-
ity shall not charge a prospective direct pa-
tient access employee a fee for the screen-
ing or criminal history background check 
conducted under this paragraph. 
‘‘(E) PENALTIES.— 
‘‘(i) IN GENERAL.— 
‘‘(I) STATE PENALTIES.—Subject 
to subclause (II), a skilled nursing fa-
cility that violates the provisions of 
this paragraph shall be subject to 
such penalties as the State determines 
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appropriate to enforce the require-
ments of this paragraph. A skilled 
nursing facility shall report to the 
Secretary on a quarterly basis any 
penalties imposed by the State under 
the preceding sentence. 
‘‘(II) EXCLUSION FROM PARTICI-
PATION.—In any case where the Sec-
retary determines that a State is not 
sufficiently enforcing the requirements 
of this paragraph, the Secretary may 
exclude a skilled nursing facility lo-
cated within the State that violates 
the provisions of this paragraph from 
participating in the programs under 
this title and title XIX (in accordance 
with the procedures of section 1128). 
‘‘(ii) KNOWING RETENTION OF WORK-
ER.—In addition to any penalty under 
clause (i), a skilled nursing facility that 
knowingly continues to employ a direct pa-
tient access employee in violation of sub-
paragraph (A) or (B) shall be subject to a 
civil penalty in an amount not to exceed 
$5,000 for the first such violation, and 
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$10,000 for the second and each subse-
quent violation within any 5-year period. 
‘‘(F) DEFINITIONS.—In this paragraph: 
‘‘(i) CONVICTION
FOR
A
RELEVANT 
CRIME.—The term ‘conviction for a rel-
evant crime’ means any Federal or State 
criminal conviction for— 
‘‘(I) any offense described in sec-
tion 1128(a); and 
‘‘(II) such other types of of-
fenses, including violent crimes, as the 
State may specify. 
‘‘(ii) DISQUALIFYING INFORMATION.— 
The term ‘disqualifying information’ means 
information about a conviction for a rel-
evant crime or a finding of substantiated 
patient or resident abuse. 
‘‘(iii) DIRECT
PATIENT
ACCESS
EM-
PLOYEE.—The term ‘direct patient access 
employee’ means any individual who has 
access to a patient or resident of a skilled 
nursing facility through employment or 
through a contract with such facility and 
has duties that involve (or may involve) 
one-on-one contact with a patient or resi-
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dent of the facility, as determined by the 
State for purposes of this paragraph. Such 
term does not include a volunteer unless 
the volunteer has duties that are equiva-
lent to the duties of a direct patient access 
employee and those duties involve (or may 
involve) one-on-one contact with a patient 
or resident of the facility.’’. 
(B) CONFORMING
AMENDMENT.—Section 
1819(e) of the Social Security Act (42 U.S.C. 
1395i–3(e)) is amended by adding at the end 
the following new paragraph: 
‘‘(6) SCREENING OF DIRECT PATIENT ACCESS 
EMPLOYEES.—Beginning on January 1, 2011, the 
State must— 
‘‘(A) have procedures in place for the con-
duct of screening and criminal history back-
ground checks under subparagraph (A) of sub-
section (b)(9), in accordance with the require-
ments of subparagraph (C) of such subsection; 
‘‘(B) be responsible for monitoring compli-
ance with the procedures and requirements of 
such subsection; 
‘‘(C) as appropriate, provide for a provi-
sional period of employment of a direct patient 
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access employee under clause (ii) of subpara-
graph (B) of such subsection, including proce-
dures to ensure that a skilled nursing facility 
provides direct on-site supervision of the em-
ployee in accordance with clause (iii) of such 
subparagraph; 
‘‘(D) provide an independent process by 
which a provisional employee or an employee 
may appeal or dispute the accuracy of the infor-
mation obtained in a background check per-
formed under such subsection; and 
‘‘(E) designate a single State agency as re-
sponsible for— 
‘‘(i) overseeing the coordination of any 
State and national criminal history back-
ground checks requested by a skilled nurs-
ing facility utilizing a search of State and 
Federal criminal history records, including 
a fingerprint check of such records; 
‘‘(ii) reviewing, using appropriate pri-
vacy and security safeguards, the results of 
any State or national criminal history 
background checks conducted regarding a 
prospective direct patient access employee 
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to determine whether the employee has any 
conviction for a relevant crime; 
‘‘(iii) immediately reporting to the 
skilled nursing facility that requested the 
criminal history background checks the re-
sults of such review; and 
‘‘(iv) in the case of an employee with 
a conviction for a relevant crime that is 
subject to reporting under section 1128E 
of the Social Security Act (42 U.S.C. 
1320a–7e), reporting the existence of such 
conviction to the database established 
under that section; 
‘‘(F) have a system in place for deter-
mining and levying appropriate penalties for 
violations of the provisions of such subsection; 
‘‘(G) have a system in place for deter-
mining which individuals are direct patient ac-
cess employees for purposes of subparagraph 
(F)(iii) of such subsection; 
‘‘(H) as appropriate, specify offenses, in-
cluding violent crimes, for purposes of subpara-
graph (F)(i)(II) of such subsection; and 
‘‘(I) develop ‘rap back’ capability such 
that, if a direct patient access employee of a 
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skilled nursing facility is convicted of a crime 
following the initial criminal history background 
check conducted with respect to such employee, 
and the employee’s fingerprints match the 
prints on file with the State law enforcement 
department, the department will immediately 
inform the State agency designated under sub-
paragraph (E).’’. 
(2) MEDICAID PROGRAM.— 
(A) IN GENERAL.—Section 1919(b) of the 
Social Security Act (42 U.S.C. 1396r(b)) is 
amended by adding at the end the following 
new paragraph: 
‘‘(9) SCREENING OF DIRECT PATIENT ACCESS 
EMPLOYEES.— 
‘‘(A) SCREENING AND CRIMINAL HISTORY 
BACKGROUND CHECKS ON APPLICANTS.— 
‘‘(i) SCREENING.—Beginning on Jan-
uary 1, 2011, before hiring a direct patient 
access employee, a nursing facility shall 
screen the employee for any disqualifying 
information in accordance with such proce-
dures as the State shall establish through 
a search of— 
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ccoleman on PROD1PC69 with BILLS
‘‘(I) State-based abuse and ne-
glect registries and databases, includ-
ing the abuse and neglect registries 
and databases of another State in the 
case where a prospective employee 
previously resided in that State; and 
‘‘(II) criminal records and the 
records of any proceedings that may 
contain 
disqualifying 
information 
about applicants, such as proceedings 
conducted by State professional licens-
ing and disciplinary boards and State 
medicaid fraud control units. 
‘‘(ii) 
CRIMINAL
HISTORY
BACK-
GROUND CHECKS.—As part of such screen-
ing, the nursing facility shall request that 
the State agency designated under sub-
section (e)(6)(E) oversee the coordination 
of a State and national criminal history 
background check that utilizes a search of 
State and Federal criminal history records 
and includes a fingerprint check using the 
Integrated Automated Fingerprint Identi-
fication System of the Federal Bureau of 
Investigation. 
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‘‘(iii) USE
OF
PROCEDURES
PRE-
VIOUSLY
ESTABLISHED.—Nothing in this 
paragraph shall be construed as preventing 
a State from using procedures established 
for purposes of the pilot program for Na-
tional and State background checks on di-
rect patient access employees of long-term 
care facilities or providers under section 
307 of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 
2003, or the nationwide expansion pro-
gram under subsection (h) of such section, 
to satisfy the requirements of paragraph 
(6). 
‘‘(B) PROHIBITION ON HIRING OF ABUSIVE 
WORKERS.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), a nursing facility may not knowingly 
employ any direct patient access employee 
who has any disqualifying information (as 
defined in subparagraph (F)(ii)). 
‘‘(ii) PROVISIONAL
EMPLOYMENT.— 
Subject to clause (iii), the State may per-
mit a nursing facility to provide for a pro-
visional period of employment (not to ex-
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ccoleman on PROD1PC69 with BILLS
ceed 30 days) for a direct patient access 
employee— 
‘‘(I) pending completion of the 
screening and background check re-
quired under subparagraph (A); and 
‘‘(II) in the case where the em-
ployee has appealed the results of 
such screening and background check, 
pending completion of the appeals 
process. 
‘‘(iii) 
SUPERVISION.—The 
facility 
shall maintain direct on-site supervision of 
the employee during such provisional pe-
riod of employment. 
‘‘(C) PROCEDURES.— 
‘‘(i) IN
GENERAL.—The procedures 
established by the State under subpara-
graph (A) shall be designed to accomplish 
the following: 
‘‘(I) Give a prospective direct pa-
tient access employee notice that the 
nursing facility is required to perform 
background checks with respect to 
new employees, including a fingerprint 
check as part of the national criminal 
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history background check conducted 
under subparagraph (A)(ii) in the 
case of any new employee who does 
not have a certificate indicating that a 
fingerprint check has been completed 
and has not found any disqualifying 
information (as described in subclause 
(V)) 
‘‘(II) Require, as a condition of 
employment, that the employee— 
‘‘(aa) 
provide 
a 
written 
statement disclosing any disquali-
fying information; 
‘‘(bb) provide a statement 
signed by the employee author-
izing the facility to request a 
background check that includes a 
search of the registries and data-
bases described in clause (i)(I) of 
subparagraph 
(A) 
and 
the 
records described in clause (i)(II) 
of such subparagraph and a 
criminal 
history 
background 
check conducted in accordance 
with clause (ii) of such subpara-
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graph that includes a fingerprint 
check using the Integrated Auto-
mated Fingerprint System of the 
Federal Bureau of Investigation; 
‘‘(cc) provide the facility 
with a rolled set of the employ-
ee’s fingerprints or submit to 
being fingerprinted; and 
‘‘(dd) 
provide 
any 
other 
identification 
information 
the 
State may require. 
‘‘(III) Require the nursing facil-
ity to check any available registries 
that would be likely to contain dis-
qualifying information about a pro-
spective employee, including the reg-
istries and databases described in sub-
clause (I) of subparagraph (A)(i) and 
the records described in clause (II) of 
such subparagraph. 
‘‘(IV) Provide a prospective di-
rect patient access employee the op-
portunity to request a copy of the re-
sults of the background check con-
ducted with respect to such employee 
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and to correct any errors by providing 
appropriate documentation to the 
State and the nursing facility. 
‘‘(V) Upon completion of a fin-
gerprint check as part of the national 
criminal history background check 
conducted with respect to a direct pa-
tient access employee under subpara-
graph (A)(ii), provide the nursing fa-
cility and the direct patient access em-
ployee with a certificate indicating 
that such fingerprint check has been 
completed and no disqualifying infor-
mation was found. Such certificate 
shall— 
‘‘(aa) be valid for 2 years; 
and 
‘‘(bb) in the case where such 
direct patient access employee is 
hired by any other nursing facil-
ity located in the State during 
such 2-year period, satisfy the re-
quirement that such facility have 
a fingerprint check conducted as 
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part of such national criminal 
history background check. 
‘‘(ii) ELIMINATION OF UNNECESSARY 
CHECKS.—The procedures established by 
the State under subparagraph (A) shall 
permit a nursing facility to terminate the 
background check at any stage at which 
the facility obtains disqualifying informa-
tion regarding a prospective direct patient 
access employee. 
‘‘(iii) DEVELOPMENT OF MODEL FORM 
OF CERTIFICATE.—The Secretary shall de-
velop a model form of the certificate de-
scribed in clause (i)(V) that States may 
use to satisfy the requirements of such 
clause. 
‘‘(D) USE
OF
INFORMATION; IMMUNITY 
FROM LIABILITY.— 
‘‘(i) USE OF INFORMATION.—A nurs-
ing facility that obtains information about 
a direct patient access employee pursuant 
to screening or a criminal history back-
ground check shall use such information 
only for the purpose of determining the 
suitability of the employee for employment. 
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‘‘(ii) IMMUNITY FROM LIABILITY.—A 
nursing facility that, in denying employ-
ment for an applicant, reasonably and in 
good faith relies upon credible information 
about such applicant provided by a crimi-
nal history background check shall not be 
liable in any action brought by such appli-
cant based on the employment determina-
tion resulting from the information. 
‘‘(iii) PROHIBITION ON CHARGING EM-
PLOYEES
FEES
FOR
CONDUCTING
BACK-
GROUND CHECKS.—A nursing facility shall 
not charge a prospective direct patient ac-
cess employee a fee for the screening or 
criminal history background check con-
ducted under this paragraph. 
‘‘(E) PENALTIES.— 
‘‘(i) IN GENERAL.— 
‘‘(I) STATE PENALTIES.—Subject 
to subclause (II), a nursing facility 
that violates the provisions of this 
paragraph shall be subject to such 
penalties as the State determines ap-
propriate to enforce the requirements 
of this paragraph. A nursing facility 
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ccoleman on PROD1PC69 with BILLS
shall report to the Secretary on a 
quarterly basis any penalties imposed 
by the State under the preceding sen-
tence. 
‘‘(II) EXCLUSION FROM PARTICI-
PATION.—In any case where the Sec-
retary determines that a State is not 
sufficiently enforcing the requirements 
of this paragraph, the Secretary may 
exclude a nursing facility located with-
in the State that violates the provi-
sions of this paragraph from partici-
pating in the programs under this 
title and title XVIII (in accordance 
with the procedures of section 1128). 
‘‘(ii) KNOWING RETENTION OF WORK-
ER.—In addition to any penalty under 
clause (i), a nursing facility that knowingly 
continues to employ a direct patient access 
employee in violation of subparagraph (A) 
or (B) 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 with-
in any 5-year period. 
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‘‘(F) DEFINITIONS.—In this paragraph: 
‘‘(i) CONVICTION
FOR
A
RELEVANT 
CRIME.—The term ‘conviction for a rel-
evant crime’ means any Federal or State 
criminal conviction for— 
‘‘(I) any offense described in sec-
tion 1128(a); and 
‘‘(II) such other types of of-
fenses, including violent crimes, as the 
State may specify. 
‘‘(ii) DISQUALIFYING INFORMATION.— 
The term ‘disqualifying information’ means 
information about a conviction for a rel-
evant crime or a finding of substantiated 
patient or resident abuse. 
‘‘(iii) DIRECT
PATIENT
ACCESS
EM-
PLOYEE.—The term ‘direct patient access 
employee’ means any individual who has 
access to a patient or resident of a nursing 
facility through employment or through a 
contract with such facility and has duties 
that involve (or may involve) one-on-one 
contact with a patient or resident of the 
facility, as determined by the State for 
purposes of this paragraph. Such term 
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does not include a volunteer unless the vol-
unteer has duties that are equivalent to the 
duties of a direct patient access employee 
and those duties involve (or may involve) 
one-on-one contact with a patient or resi-
dent of the facility.’’. 
(B) CONFORMING
AMENDMENT.—Section 
1919(e) of the Social Security Act (42 U.S.C. 
1396r(e)) is amended by adding at the end the 
following new paragraph: 
‘‘(8) SCREENING OF DIRECT PATIENT ACCESS 
EMPLOYEES.—Beginning on January 1, 2011, the 
State must— 
‘‘(A) have procedures in place for the con-
duct of screening and criminal history back-
ground checks under subparagraph (A) of sub-
section (b)(9), in accordance with the require-
ments of subparagraph (C) of such subsection; 
‘‘(B) be responsible for monitoring compli-
ance with the procedures and requirements of 
such subsection; 
‘‘(C) as appropriate, provide for a provi-
sional period of employment of a direct patient 
access employee under clause (ii) of subpara-
graph (B) of such subsection, including proce-
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dures to ensure that a nursing facility provides 
direct on-site supervision of the employee in ac-
cordance with clause (iii) of such subparagraph; 
‘‘(D) provide an independent process by 
which a provisional employee or an employee 
may appeal or dispute the accuracy of the infor-
mation obtained in a background check per-
formed under such subsection; and 
‘‘(E) designate a single State agency as re-
sponsible for— 
‘‘(i) overseeing the coordination of any 
State and national criminal history back-
ground checks requested by a nursing fa-
cility utilizing a search of State and Fed-
eral criminal history records, including a 
fingerprint check of such records; 
‘‘(ii) reviewing, using appropriate pri-
vacy and security safeguards, the results of 
any State or national criminal history 
background checks conducted regarding a 
prospective direct patient access employee 
to determine whether the employee has any 
conviction for a relevant crime; 
‘‘(iii) immediately reporting to the 
nursing facility that requested the criminal 
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history background checks the results of 
such review; and 
‘‘(iv) in the case of an employee with 
a conviction for a relevant crime that is 
subject to reporting under section 1128E 
of the Social Security Act (42 U.S.C. 
1320a–7e), reporting the existence of such 
conviction to the database established 
under that section; 
‘‘(F) have a system in place for deter-
mining and levying appropriate penalties for 
violations of the provisions of such subsection; 
‘‘(G) have a system in place for deter-
mining which individuals are direct patient ac-
cess employees for purposes of subparagraph 
(F)(iii) of such subsection; 
‘‘(H) as appropriate, specify offenses, in-
cluding violent crimes, for purposes of subpara-
graph (F)(i)(II) of such subsection; and 
‘‘(I) develop ‘rap back’ capability such 
that, if a direct patient access employee of a 
nursing facility is convicted of a crime following 
the initial criminal history background check 
conducted with respect to such employee, and 
the employee’s fingerprints match the prints on 
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file with the State law enforcement department, 
the department will immediately inform the 
State agency designated under subparagraph 
(E).’’. 
(b) APPLICATION TO OTHER LONG-TERM CARE FA-
CILITIES OR PROVIDERS.— 
(1) MEDICARE.—Part E 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 PREVEN-
TIVE ABUSE PROVISIONS TO LONG-TERM CARE FA-
CILITIES AND PROVIDERS 
‘‘SEC. 1898. (a) The provisions of section 1819(b)(9) 
shall apply to a long-term care facility or provider (as de-
fined in subsection (b)) in the same manner as such provi-
sions apply to a skilled nursing facility. 
‘‘(b) LONG-TERM CARE FACILITY OR PROVIDER.— 
In this section, the term ‘long-term care facility or pro-
vider’ means the following facilities or providers which re-
ceive payment for services under this title or title XIX: 
‘‘(1) A home health agency. 
‘‘(2) A provider of hospice care. 
‘‘(3) A long-term care hospital. 
‘‘(4) A provider of personal care services. 
‘‘(5) A provider of adult day care. 
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‘‘(6) A residential care provider that arranges 
for, or directly provides, long-term care services, in-
cluding an assisted living facility that provides a 
level of care established by the Secretary. 
‘‘(7) An intermediate care facility for the men-
tally retarded (as defined in section 1905(d)).’’. 
(2) MEDICAID.—Section 1902(a) of the Social 
Security Act (42 U.S.C. 1396a) is amended— 
(A) in paragraph (69), by striking ‘‘and’’ 
at the end; 
(B) in paragraph (70)(B)(iv), by striking 
the period at the end and inserting ‘‘; and’’; 
and 
(C) 
by 
inserting 
after 
paragraph 
(70)(B)(iv) the following: 
‘‘(71) provide that the provisions of section 
1919(b)(9) apply to a long-term care facility or pro-
vider (as defined in section 1898(b)) in the same 
manner as such provisions apply to a nursing facil-
ity.’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on January 1, 
2011. 
(c) PAYMENTS.— 
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(1) PROCEDURES TO REIMBURSE COSTS OF NA-
TIONAL BACKGROUND CHECK.— 
(A) 
IN
GENERAL.—The 
Secretary 
of 
Health and Human Services shall establish pro-
cedures to reimburse the costs of conducting 
national criminal history background checks 
under sections 1819(b)(9), 1919(b)(9), 1898, 
and 1902(a)(71) of the Social Security Act, as 
added by subsections (a)(1), (a)(2), (b)(1), and 
(b)(2), respectively, through the following mech-
anisms, in such proportion as the Secretary de-
termines appropriate: 
(i) By providing payments to skilled 
nursing facilities and long-term care facili-
ties or providers for costs incurred as are 
attributable to the conduct of such na-
tional criminal history background checks 
under such section 1819(b)(9). 
(ii) By making a payment, from sums 
appropriated 
therefore, 
under 
section 
1903(a) of the Social Security Act (42 
U.S.C. 1396b(a)) to each State which has 
a plan approved under title XIX of the So-
cial Security Act (42 U.S.C. 1396 et seq.), 
for each quarter, beginning with the quar-
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