Sec. 2. Long-term care provider criminal background check. 
Sec. 3. Expansion of state register to collect information about long-term care 
provider employees other than nurse aides. 
Sec. 4. Inclusion of abusive workers in the database established as part of Na-
tional Health Care Fraud and Abuse Data Collection Program. 
Sec. 5. Prevention and training demonstration project. 
Sec. 6. Improved background check system. 
Sec. 7. State funding.
SEC. 2. LONG-TERM CARE PROVIDER CRIMINAL BACK-
GROUND CHECK. 
(a) IN GENERAL.—Title XI of the Social Security Act 
is amended by inserting after section 1134 the following 
new sections: 
‘‘SCREENING OF LONG-TERM CARE WORKERS 
‘‘SEC. 1134A. (a) BACKGROUND CHECKS ON APPLI-
CANTS.—Subject to subsection (b)(2), before hiring a 
long-term care worker, a long-term care provider shall—
‘‘(1) give the worker written notice that the 
provider is required to perform background checks 
with respect to applicants; 
‘‘(2) require, as a condition of employment, that 
such worker—
‘‘(A) provide a written statement disclosing 
any conviction for a relevant crime or finding of 
patient or resident abuse; 
‘‘(B) provide a statement signed by the 
worker authorizing the provider to request the 
search and exchange of criminal records;
‘‘(C) provide a copy of the worker’s finger-
prints; 
‘‘(D) provide the worker’s social security 
account number (or taxpayer identification 
number) and date of birth; and 
‘‘(E) provide any other identification infor-
mation the Secretary may specify in regulation; 
‘‘(3) initiate a check of the registry under sec-
tions 1819(e)(2) and 1919(e)(2) in accordance with 
regulations promulgated by the Secretary to deter-
mine whether such system contains any disqualifying 
information with respect to such worker; and 
‘‘(4) if that system does not contain any such 
disqualifying information—
‘‘(A) request that the State initiate a State 
and national criminal background check on 
such worker in accordance with the provisions 
of section 1134B; and 
‘‘(B) furnish to the State the information 
described in subparagraphs (B) through (D) of 
paragraph (2) not more than 7 working days 
after completion of the check against the sys-
tem initiated under paragraph (3). 
‘‘(b) PROHIBITION ON HIRING OF ABUSIVE WORK-
ERS.—
‘‘(1) IN GENERAL.—A long-term care provider 
may not knowingly employ any long-term care work-
er who has any conviction for a relevant crime or 
with respect to whom a finding of patient or resident 
abuse has been made. 
‘‘(2) PROVISIONAL EMPLOYMENT.—
‘‘(A) IN GENERAL.—After complying with 
the requirements of paragraph (1), (2), and (3) 
of subsection (a), a long-term care provider may 
provide for a provisional period of employment 
for a long-term care worker pending completion 
of the check against the data collection system 
described under subsection (a)(3) and the back-
ground check described under subsection (a)(4). 
Such provider shall maintain direct supervision 
(or, in the case of home health care settings, 
active monitoring or oversight) of the worker 
during the worker’s provisional period of em-
ployment. 
‘‘(B) ACTIVE MONITORING OR OVERSIGHT 
DEFINED.—For purposes of subparagraph (A),
the term ‘active monitoring or oversight’ means 
a good faith effort by the home health agency 
supervisor to ensure the safety of the bene-
ficiary through efforts such as making follow-
up phone calls and unannounced visits. 
‘‘(3) LIMITATION OF LIABILITY.—
‘‘(A) IN GENERAL.—A long-term care pro-
vider that, in denying employment for an appli-
cant (including during the period described in 
subsection (b)(2)), reasonably relies upon infor-
mation about such applicant provided by the 
State under section 1134B shall not be liable in 
any action brought by such applicant relating to 
the employment determination resulting from 
the use of such information. 
‘‘(B) DAMAGES
ACTIONS.—In a tort or 
other civil action for damages that is brought 
as the result of an injury, death, or loss to per-
son or property caused by an individual who a 
long-term care provider employs in a position 
that involves providing direct care to older 
adults, the following shall apply: 
‘‘(i) If the long-term care provider em-
ployed the individual in good faith and rea-
sonable reliance on the report of a criminal 
records check requested under this section, 
the provider shall not be found negligent 
solely because of its reliance on the report,
even if the information in the report is de-
termined later to have been incomplete or 
inaccurate. 
‘‘(ii) If the long-term care provider 
employed the individual in good faith on a 
provisional basis pursuant to subsection 
(b)(2), the provider shall not be found neg-
ligent solely because it employed the indi-
vidual prior to receiving the report of a 
criminal records check requested under 
this section. 
‘‘(c) REPORTING REQUIREMENTS.—A long-term care 
provider shall report to the State agency responsible for 
surveys and certification of such providers any instance 
in which the provider determines that a long-term care 
worker has committed an act of resident neglect or abuse 
or misappropriation of resident property in the course of 
employment by the provider. 
‘‘(d) USE OF INFORMATION.—
‘‘(1) IN GENERAL.—A long-term care provider 
that obtains information about a long-term care 
worker pursuant to paragraphs (3) and (4) of sub-
section (a) may use such information only for the 
purpose of determining the suitability of the worker 
for employment.
‘‘(2) IMMUNITY FROM LIABILITY.—A long-term 
care provider that, in denying employment for an 
applicant (including during the period described in 
subsection (b)(2)) reasonably relies upon information 
about such applicant provided by the State pursuant 
to section 1134B or section 1919(e)(2) shall not be 
liable in any action brought by such applicant based 
on the employment determination resulting from the 
information. 
‘‘(e) CIVIL PENALTY.—
‘‘(1) IN GENERAL.—A long-term care provider 
that violates the provisions of this section shall be 
subject to a civil penalty in an amount not to ex-
ceed—
‘‘(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 
addition to any civil penalty under paragraph (1), a 
long-term care provider that—
‘‘(A) knowingly continues to employ a 
long-term care worker in violation of subsection 
(a) or (b); or
‘‘(B) knowingly fails to report a long-term 
care worker under subsection (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. 
‘‘(f) DEFINITIONS.—In this section and section 
1134B: 
‘‘(1) CONVICTION FOR A RELEVANT CRIME.—
The term ‘conviction for a relevant crime’ means any 
Federal or State criminal conviction for—
‘‘(A) any offense described in paragraphs 
(1) through (4) of section 1128(a); and 
‘‘(B) such other types of offenses as the 
Secretary may specify in regulations, taking 
into account the severity and relevance of such 
offenses and the time frame of when such an 
offense is committed and after consultation 
with representatives of long-term care pro-
viders, representatives of long-term care em-
ployees, consumer advocates, and appropriate 
Federal and State officials. 
‘‘(2) DISQUALIFYING INFORMATION.—The term 
‘disqualifying information’ means information about
a conviction for a relevant crime or a finding of pa-
tient or resident abuse. 
‘‘(3) FINDING
OF
PATIENT
OR
RESIDENT 
ABUSE.—The term ‘finding of patient or resident 
abuse’ means any substantiated finding by a State 
agency under section 1919(g)(1)(C) or a Federal 
agency that a long-term care worker has com-
mitted—
‘‘(A) an act of patient or resident abuse or 
neglect or a misappropriation of patient or resi-
dent property; or 
‘‘(B) such other types of acts as the Sec-
retary may specify in regulations. 
‘‘(4) LONG-TERM CARE PROVIDER.—The term 
‘long-term care provider’ means—
‘‘(A) a nursing facility (as defined in sec-
tion 1919(a)); 
‘‘(B) a skilled nursing facility (as defined 
in section 1819(a)), and includes a hospital-
based skilled nursing facility; 
‘‘(C) a home health agency (as defined in 
section 1861(o));
‘‘(D) a hospice program (as defined in sec-
tion 1861(dd) and section 1905(o));
‘‘(E) an assisted living facility (as defined 
under section 232(b)(6) of the National Hous-
ing Act (12 U.S.C. 1751w(b)(6)); and 
‘‘(F) any other facility (including any in-
termediate care facility for the mentally re-
tarded) that provides, or is a provider of, long-
term care services, hospice services, assisted liv-
ing services, or home health services and that 
receives payment for such services under title 
XVIII or title XIX; 
and includes an agency that provides under contract 
temporary staff to a long-term care provider. 
‘‘(5) LONG-TERM
CARE
WORKER.—The term 
‘long-term care worker’ means any individual (other 
than a volunteer) that has direct access to a patient 
of a long-term care provider under an employment 
or other contract, or both, with such provider. Such 
term includes an individual who is licensed or cer-
tified by the State to provide such services, and a 
nonlicensed individual providing such services, as de-
fined by the Secretary, including a nurse assistant, 
nurse aide, home health aide, and personal care 
worker and attendant.
‘‘FEDERAL AND STATE REQUIREMENTS TO CONDUCT 
BACKGROUND CHECKS 
‘‘SEC. 1134B. (a) IN GENERAL.—Upon receipt of a 
request by a long-term care provider pursuant to section 
1134A that is accompanied by the information described 
in subparagraph (B) through (D) of section 1134A(a)(2), 
a State, after checking appropriate State records and find-
ing no disqualifying information (as defined in section 
1134A(f)(2)), 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 subsection (b). 
‘‘(b) SEARCH AND EXCHANGE OF RECORDS BY AT-
TORNEY GENERAL.—Upon receipt of a submission pursu-
ant to subsection (a), the Attorney General shall direct 
a search of the records of the Federal Bureau of Investiga-
tion for any criminal history records corresponding to the 
fingerprints and other positive identification information 
submitted. The Attorney General shall provide any cor-
responding information resulting from the search to the 
State. 
‘‘(c) STATE REPORTING OF INFORMATION TO LONG-
TERM CARE PROVIDER.—Upon receipt of the information 
provided by the Attorney General pursuant to subsection 
(b), the State shall—
‘‘(1) review the information to determine wheth-
er the individual has any conviction for a relevant 
crime (as defined section 1134A(f)(1)) or has a find-
ing of patient or resident abuse; 
‘‘(2) report to the long-term care provider the 
results in writing of such review by indicating 
whether a long-term care worker has any conviction 
for a relevant crime or has a finding of patient or 
resident abuse; and 
‘‘(3) in the case of an individual with a convic-
tion for a relevant crime, report the existence of 
such conviction of such individual to the registry re-
ferred to in sections 1818(e)(2) and 1919(e)(2). 
‘‘(d) FEES FOR PERFORMANCE OF CRIMINAL BACK-
GROUND CHECKS.—
‘‘(1) NO
CHARGE
TO
PROVIDERS
OR
WORK-
ERS.—A State shall not charge a long-term care 
provider or a prospective long-term care worker a fee 
for initiating the criminal background check under 
this section or section 1134A, including fees charged 
by the Attorney General, and for performing the re-
view and report required by subsection (c). 
‘‘(2) FUNDING.—A State may apply under sec-
tion 7 of the Senior Safety Protection Act of 2003 
for funding to perform criminal background checks.
‘‘(e) REGULATIONS.—
‘‘(1) IN
GENERAL.—In addition to the Sec-
retary’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 re-
sponsibilities under this section and section 1134A, 
including regulations regarding the security, con-
fidentiality, accuracy, use, destruction, and dissemi-
nation of information, audits and recordkeeping, and 
the imposition of fees. 
‘‘(2) APPEAL
PROCEDURES.—The Attorney 
General, in consultation with the Secretary, shall 
promulgate such regulations as are necessary to es-
tablish procedures by which an applicant or em-
ployee may appeal or dispute the accuracy of the in-
formation obtained in a background check conducted 
under this section or section 1134A. Appeals shall 
be limited to instances in which an applicant or em-
ployee is incorrectly identified as the subject of the 
background check, or when information about the 
applicant or employee has not been updated to re-
flect changes in the applicant’s or employee’s crimi-
nal record.