I
105TH CONGRESS
2D SESSION
H. R. 4789
To require criminal and abusive work history background checks for direct
care employees in nursing facilities, home health agencies, and hospice
programs under the Medicare and Medicaid Programs, and for other
purposes.
IN THE HOUSE OF REPRESENTATIVES
OCTOBER 10, 1998
Mr. WELLER (for himself and Mr. NEY) introduced the following bill; which
was referred to the Committee on Commerce, and in addition to the Com-
mittee on Ways and Means, 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 require criminal and abusive work history background
checks for direct care employees in nursing facilities,
home health agencies, and hospice programs under the
Medicare and Medicaid Programs, and for other pur-
poses.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Elderly and Disabled Protection Act of 1998’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Requiring background checks for direct care employees in nursing facili-
ties, home health agencies, and hospice programs.
Sec. 3. Expanded role of State direct care employee registries; national registry
coordination system; procedures for background checks.
Sec. 4. Definitions.
SEC. 2. REQUIRING BACKGROUND CHECKS FOR DIRECT
CARE EMPLOYEES IN NURSING FACILITIES,
HOME HEALTH AGENCIES, AND HOSPICE
PROGRAMS.
(a) REQUIREMENTS.—
(1) IN
GENERAL.—A covered facility in a
State—
(A) may not employ (directly or through
an agency) any individual as a direct care em-
ployee unless the facility has requested from the
State direct care employee registry a back-
ground check;
(B) may not employ such an individual or
continue such employment if the report on such
background check reveals that the individual
has been convicted of a disqualifying crime; and
(C) shall report to such registry docu-
mented findings of patient abuse by a direct
care employee.
(2) EMPLOYMENT PENDING REPORT.—Nothing
in this subsection shall be construed as preventing a
covered facility from—
(A) seeking a background check on pro-
spective direct care employees before they are
employed; or
(B) employing direct care employees dur-
ing the period in which a background check has
been sought under paragraph (1)(A) and before
a report on such check has been provided to the
facility under paragraph (1)(B).
(b) PENALTIES.—In addition to any other sanctions
provided under law—
(1) IN GENERAL.—A covered facility that vio-
lates subsection (a)(1)(A) shall be subject to a civil
penalty in an amount not to exceed—
(A) for the first such violation, $2,000;
and
(B) for the second and each subsequent
violation within any 5-year period, $5,000.
(2) KNOWING RETENTION OF WORKER.—In ad-
dition to any civil penalty under paragraph (1), a
covered facility that—
(A) knowingly continues to employ a direct
care 
employee 
in 
violation 
of 
subsection
(a)(1)(B); or
(B) knowingly fails to submit a report re-
quired under subsection (a)(1)(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 viola-
tion within any 5-year period.
(c) ENFORCEMENT THROUGH MEDICARE AND MED-
ICAID PROGRAMS.—
(1) NURSING FACILITIES.—
(A) 
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 new paragraph:
‘‘(8) REQUIREMENT FOR BACKGROUND CHECKS
FOR DIRECT CARE PERSONNEL.—A skilled nursing
facility shall comply with the requirements of section
2(a) of the Elderly and Disabled Protection Act of
1998 with respect to any direct care employee it em-
ploys.’’.
(B) 
MEDICAID
PROGRAM.—Section
1919(b) of such Act (42 U.S.C. 1396r(b)) is