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, in-
cluding 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 FACIL-
ITY 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
EM-
PLOYEE 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 nurs-
ing facility employees with re-
spect to whom the State has
made a finding described in sub-
paragraph (B)’’;
(III) in subparagraph (B), by
striking ‘‘involving an individual listed
in the registry’’ and inserting ‘‘involv-
ing a nursing facility employee’’; and
(IV) in subparagraph (C), by
striking ‘‘nurse aide’’ and inserting
‘‘nursing facility employee or appli-
cant for employment’’; and
(ii) in subsection (g)(1)—
(I) in subparagraph (C)—
(aa) in the first sentence, by
striking ‘‘nurse aide’’ and insert-
ing ‘‘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 ap-
pears 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 re-
quest by a nursing facility pursuant to sub-
section (b)(8) that is accompanied by the infor-
mation 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 sub-
section (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 re-
ceipt of a submission pursuant to subparagraph
(A), the Attorney General shall direct a search
of the records of the Federal Bureau of Inves-
tigation for any criminal history records cor-
responding to the fingerprints or other positive
identification information submitted. The Attor-
ney General shall provide any corresponding in-
formation resulting from the search to the
State.
‘‘(C) STATE REPORTING OF INFORMATION
TO NURSING FACILITY.—Upon receipt of the in-
formation provided by the Attorney General
pursuant to subparagraph (B), the State
shall—
‘‘(i) review the information to deter-
mine whether the individual has any con-
viction 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 in-
dividual to the database established under
section 1128E.
‘‘(D) FEES FOR PERFORMANCE OF CRIMI-
NAL BACKGROUND CHECKS.—
‘‘(i) AUTHORITY TO CHARGE FEES.—
‘‘(I) ATTORNEY GENERAL.—The
Attorney General may charge a fee to
any State requesting a search and ex-
change 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 ac-
tual cost of such activities or $50.
Such fees shall be available to the At-
torney General, or, in the Attorney
General’s discretion, to the Federal
Bureau of Investigation, until ex-
pended.
‘‘(II) 
STATE.—A 
State 
may
charge a nursing facility a fee for ini-
tiating 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 sub-
paragraph (C). The amount of such
fee shall not exceed the actual cost of
such activities.
‘‘(ii) PROHIBITION ON CHARGING AP-
PLICANTS 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 regula-
tions under this title, the Attorney Gen-
eral, in consultation with the Secretary,
may promulgate such regulations as are
necessary to carry out the Attorney Gen-
eral’s responsibilities under this paragraph
and subsection (b)(8), including regula-
tions regarding the security, confiden-
tiality, accuracy, use, destruction, and dis-
semination of information, audits and rec-
ordkeeping, and the imposition of fees.
‘‘(ii) APPEAL PROCEDURES.—The At-
torney General, in consultation with the
Secretary, shall promulgate such regula-
tions as are necessary to establish proce-
dures by which an applicant or employee
may appeal or dispute the accuracy of the
information obtained in a background
check conducted under this paragraph. Ap-
peals 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 ap-
plicant or employee has not been updated
to reflect changes in the applicant’s or em-
ployee’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 NURS-
ING 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 ‘‘involv-
ing a skilled nursing facility em-
ployee’’; 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 insert-
ing ‘‘skilled nursing facility em-
ployee’’; and
(bb) in the third sentence,
by striking ‘‘nurse aide’’ each
place it appears and inserting
‘‘skilled 
nursing 
facility 
em-
ployee’’; and
(II) in subparagraph (D), by
striking ‘‘nurse aide’’ each place it ap-
pears 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 re-
quest by a skilled nursing facility pursuant to
subsection (b)(8) that is accompanied by the in-
formation 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 sub-
section (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 re-
ceipt of a submission pursuant to subparagraph
(A), the Attorney General shall direct a search
of the records of the Federal Bureau of Inves-
tigation for any criminal history records cor-
responding to the fingerprints or other positive
identification information submitted. The Attor-
ney General shall provide any corresponding in-
formation 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 deter-
mine whether the individual has any con-
viction for a relevant crime (as defined in
subsection (b)(8)(F)(i));
‘‘(ii) report to the skilled nursing fa-
cility 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 in-
dividual to the database established under
section 1128E.
‘‘(D) FEES FOR PERFORMANCE OF CRIMI-
NAL BACKGROUND CHECKS.—
‘‘(i) AUTHORITY TO CHARGE FEES.—
‘‘(I) ATTORNEY GENERAL.—The
Attorney General may charge a fee to
any State requesting a search and ex-
change 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 ac-
tual cost of such activities or $50.
Such fees shall be available to the At-
torney General, or, in the Attorney
General’s discretion, to the Federal
Bureau of Investigation until ex-
pended.
‘‘(II) 
STATE.—A 
State 
may
charge a skilled nursing facility a fee
for initiating the criminal background
check under this paragraph and sub-
section (b)(8), including fees charged
by the Attorney General, and for per-
forming the review and report re-
quired by subparagraph (C). The
amount of such fee shall not exceed
the actual cost of such activities.
‘‘(ii) PROHIBITION ON CHARGING AP-
PLICANTS 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 regula-
tions under this title, the Attorney Gen-
eral, in consultation with the Secretary,
may promulgate such regulations as are
necessary to carry out the Attorney Gen-
eral’s responsibilities under this paragraph
and subsection (b)(9), including regula-
tions regarding the security confidentiality,
accuracy, use, destruction, and dissemina-
tion of information, audits and record-
keeping, and the imposition of fees.
‘‘(ii) APPEAL PROCEDURES.—The At-
torney General, in consultation with the
Secretary, shall promulgate such regula-
tions as are necessary to establish proce-
dures by which an applicant or employee
may appeal or dispute the accuracy of the
information obtained in a background
check conducted under this paragraph. Ap-
peals 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 ap-
plicant or employee has not been updated
to reflect changes in the applicant’s or em-
ployee’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 pe-
riod 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 avail-
able 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 PREVEN-
TIVE
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 indi-
vidual 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 or-
ganization 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 require-
ments.
SEC. 3. INCLUSION OF ABUSIVE NURSING FACILITY WORK-
ERS 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 pa-
tient’s or resident’s property.’’.
(b) COVERAGE OF LONG-TERM CARE FACILITY EM-
PLOYEES.—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 pa-
tient or resident of such a facility under an employment
or other contract, or both, with the facility (including indi-
viduals who are licensed or certified by the State to pro-
vide services at the facility, and nonlicensed individuals,
as defined by the Secretary, providing services at the facil-
ity, 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 insert-
ing ‘‘, 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 add-
ing at the end the following:
‘‘(3) MANDATORY
CHECK
OF
DATABASE
BY
LONG-TERM CARE FACILITIES.—A long-term care fa-
cility 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 pa-
tient 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 serv-
ices 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 fol-
lowing:
‘‘(6) LONG-TERM
CARE
FACILITY.—The term
‘long-term care facility’ means a skilled nursing fa-
cility (as defined in section 1819(a)), a nursing facil-
ity (as defined in section 1919(a)), a home health
agency, a hospice facility, an intermediate care facil-
ity 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 amend-
ments 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 hos-
pital 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 be-
tween State health care survey and provider certifi-
cation agencies, long-term care ombudsman pro-
grams, the long-term care industry, and local com-
munity members;
(2) examine patient care issues relating to regu-
latory oversight, community involvement, and facility
staffing and management with a focus on staff
training, staff stress management, and staff super-
vision;
(3) examine the use of patient abuse prevention
training programs by long-term care entities, includ-
ing 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 nec-
essary 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 regu-
lations are in effect, to any individual applying for employ-
ment 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 enact-
ment, 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.
Æ