I 
109TH CONGRESS 
2D SESSION 
H. R. 6161 
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 emer-
gency or natural disaster by requiring nursing long-term care facilities 
to establish disaster emergency and evacuation plans. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 25, 2006 
Ms. GINNY BROWN-WAITE of Florida (for herself, Mr. KIRK, and Mr. 
FITZPATRICK of Pennsylvania) 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 de-
termined 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 employ-
ees and the right to a safe environment during an emer-
gency or natural disaster by requiring nursing long-term 
care facilities to establish disaster emergency and evacu-
ation plans. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Senior Safety and Dig-
nity Act of 2006’’. 
SEC. 2. SECURING RIGHT TO RECEIVE CARE FROM A CRED-
IBLE CAREGIVER BY REQUIRING PERFORM-
ANCE OF BACKGROUND CHECKS ON DIRECT 
ACCESS EMPLOYEES OF LONG-TERM CARE 
FACILITIES OR PROVIDERS. 
(a) ADDITION TO NURSING HOME PATIENTS’ BILL 
OF RIGHTS OF RIGHT TO RECEIVE CARE FROM A CRED-
IBLE
CAREGIVER.—Sections 
1819(c)(1)(A) 
and 
1919(c)(1)(A) of the Social Security Act (42 U.S.C. 
1395i–3(c)(1)(A), 1396r(c)(1)(A)) are each amended— 
(1) by redesignating clause (xi) as clause (xiii); 
and 
(2) by inserting after clause (x) the following 
new clause: 
‘‘(xi) RECEIPT OF CARE FROM CRED-
IBLE
CAREGIVER.—The right to receive 
care from a credible caregiver.’’. 
(b) SCREENING OF SKILLED NURSING FACILITY AND 
NURSING FACILITY EMPLOYEE APPLICANTS.— 
(1) 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: 
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‘‘(9) SCREENING OF SKILLED NURSING FACIL-
ITY WORKERS.— 
‘‘(A) BACKGROUND
CHECKS
ON
APPLI-
CANTS.—Before hiring a skilled nursing facility 
worker, a skilled nursing facility shall conduct 
a background check on the employee in accord-
ance with such procedures as the Secretary 
shall establish. 
‘‘(B) PROHIBITION ON HIRING OF ABUSIVE 
WORKERS.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), a skilled nursing facility may not 
knowingly employ any skilled nursing facil-
ity worker who has any disqualifying infor-
mation 
(as 
defined 
in 
subparagraph 
(F)(ii)). 
‘‘(ii) PROVISIONAL EMPLOYMENT.—A 
skilled nursing facility may provide for a 
provisional period of employment for a 
skilled nursing facility worker pending 
completion of the background check re-
quired under subparagraph (A). Such facil-
ity shall maintain direct supervision of the 
covered individual during the worker’s pro-
visional period of employment. 
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‘‘(C) PROCEDURES.—The procedures es-
tablished by the Secretary under subparagraph 
(A) shall— 
‘‘(i) provide a process by which a 
skilled nursing facility worker may appeal 
or dispute the accuracy of the information 
obtained in a background check conducted 
under this paragraph; 
‘‘(ii) take into account the needs of 
skilled nursing facilities that serve a low 
volume of patients (as determined by the 
Secretary) with respect to providing super-
vision for provisional employees who are 
awaiting the results of a background check 
conducted under this paragraph; and 
‘‘(iii) provide for the reimbursement 
of nursing facilities for 100 percent of the 
costs incurred by such facilities in com-
plying with the requirements of this sec-
tion. 
‘‘(D) 
IMMUNITY
FROM
LIABILITY.—A 
skilled nursing facility that, in denying employ-
ment for an applicant, reasonably relies upon 
information about such applicant provided by 
the criminal background check shall not be lia-
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ble in any action brought by such applicant 
based on the employment determination result-
ing from the information. 
‘‘(E) CIVIL PENALTY.— 
‘‘(i) IN GENERAL.—A skilled nursing 
facility that violates the provisions of this 
paragraph shall be subject to a civil pen-
alty in an amount not to exceed— 
‘‘(I) for the first such violation, 
$2,000; and 
‘‘(II) for the second and each 
subsequent violation within any 5-year 
period, $5,000. 
‘‘(ii) KNOWING RETENTION OF WORK-
ER.—In addition to any civil penalty under 
clause (i), a skilled nursing facility that 
knowingly continues to employ a skilled 
nursing facility worker 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 
$10,000 for the second and each subse-
quent violation within any 5-year period. 
‘‘(F) DEFINITIONS.—In this paragraph: 
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‘‘(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 offenses 
as the Secretary may specify in regu-
lations. 
‘‘(ii) DISQUALIFYING INFORMATION.— 
The term ‘disqualifying information’ means 
information about a conviction for a rel-
evant crime or a finding of patient or resi-
dent abuse. 
‘‘(iii) SKILLED
NURSING
FACILITY 
WORKER.—The term ‘skilled nursing facil-
ity worker’ means any individual that has 
direct access to a patient of a skilled nurs-
ing facility 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 long- 
term care services, and nonlicensed individ-
uals providing such services, as defined by 
the Secretary, including nurse assistants, 
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nurse aides, home health aides, and per-
sonal care workers and attendants.’’. 
(2) MEDICAID PROGRAM.—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 NURSING FACILITY WORK-
ERS.— 
‘‘(A) BACKGROUND
CHECKS
ON
APPLI-
CANTS.—Before hiring a nursing facility work-
er, a nursing facility shall conduct a back-
ground check on the employee in accordance 
with such procedures as the Secretary shall es-
tablish. 
‘‘(B) PROHIBITION ON HIRING OF ABUSIVE 
WORKERS.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), a nursing facility may not knowingly 
employ any nursing facility worker who 
has any disqualifying information (as de-
fined in subparagraph (F)(ii)). 
‘‘(ii) PROVISIONAL EMPLOYMENT.—A 
nursing facility may provide for a provi-
sional period of employment for a nursing 
facility worker pending completion of the 
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background check required under subpara-
graph (A). Such facility shall maintain di-
rect supervision of the covered individual 
during the worker’s provisional period of 
employment. 
‘‘(C) PROCEDURES.—The procedures es-
tablished by the Secretary under subparagraph 
(A) shall— 
‘‘(i) provide a process by which a 
nursing facility worker may appeal or dis-
pute the accuracy of the information ob-
tained in a background check conducted 
under this paragraph; 
‘‘(ii) take into account the needs of 
nursing facilities that serve a low volume 
of patients (as determined by the Sec-
retary) with respect to providing super-
vision for provisional employees who are 
awaiting the results of a background check 
conducted under this paragraph; and 
‘‘(iii) provide for the reimbursement 
of nursing facilities for 100 percent of the 
costs incurred by such facilities in com-
plying with the requirements of this sec-
tion. 
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‘‘(D) 
IMMUNITY
FROM
LIABILITY.—A 
nursing facility that, in denying employment for 
an applicant, reasonably relies upon information 
about such applicant provided by the criminal 
background check shall not be liable in any ac-
tion brought by such applicant based on the 
employment determination resulting from the 
information. 
‘‘(E) CIVIL PENALTY.— 
‘‘(i) IN GENERAL.—A nursing facility 
that violates the provisions of this para-
graph shall be subject to a civil penalty in 
an amount not to exceed— 
‘‘(I) for the first such violation, 
$2,000; and 
‘‘(II) for the second and each 
subsequent violation within any 5-year 
period, $5,000. 
‘‘(ii) KNOWING RETENTION OF WORK-
ER.—In addition to any civil penalty under 
clause (i), a nursing facility that knowingly 
continues to employ a nursing facility 
worker 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 
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such violation, and $10,000 for the second 
and each subsequent 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 offenses 
as the Secretary may specify in regu-
lations. 
‘‘(ii) DISQUALIFYING INFORMATION.— 
The term ‘disqualifying information’ means 
information about a conviction for a rel-
evant crime or a finding of patient or resi-
dent abuse. 
‘‘(iii) NURSING FACILITY WORKER.— 
The term ‘nursing facility worker’ means 
any individual that has direct access to a 
patient of a nursing facility under an em-
ployment or other contract, or both, with 
such facility. Such term includes individ-
uals who are licensed or certified by the 
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State to provide long-term care 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.’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection and subsection (a) shall take ef-
fect on the date that is 1 year after the date on 
which the evaluation is completed under subsection 
(d)(1). 
(c) 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) IN
GENERAL.—The provisions of section 
1819(b)(9) shall apply to a long-term care facility or pro-
vider (as defined in subsection (b)) in the same manner 
as such provisions apply to a skilled nursing facility. 
‘‘(b) LONG-TERM CARE FACILITY OR PROVIDER.— 
In this section, the term ‘long-term care facility or pro-
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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 residential care provider that arranges 
for, or directly provides, long-term care services. 
‘‘(6) 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), by striking the pe-
riod and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (70) 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 the date that 
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is 1 year after the date on which the evaluation is 
completed under subsection (c)(1). 
(d) NATIONAL CRIMINAL BACKGROUND CHECK PRO-
GRAM.— 
(1) COMPLETION OF PILOT PROGRAM EVALUA-
TION.—Not later than the date that is 6 months 
after the completion of the pilot program for na-
tional and State background checks on direct patient 
access employees of long-term care facilities or pro-
viders established under section 307 of the Medicare 
Prescription Drug, Improvement, and Modernization 
Act of 2003 (Public Law 108–173), the Secretary 
shall complete the evaluation required under sub-
section (e) of such section of such Act. 
(2) ESTABLISHMENT.— 
(A) IN GENERAL.—Not later than the date 
that is 1 year after the completion of the eval-
uation of the program described in paragraph 
(1), the Secretary, in consultation with the At-
torney General, shall establish a national crimi-
nal background check program in order to pre-
vent abuse of nursing facility and skilled nurs-
ing facility residents and individuals receiving 
home health care services and other long-term 
care services under the medicare or medicaid 
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programs, taking into account the findings and 
recommendations contained in the evaluation. 
(B) USE IN CONDUCTING REQUIRED BACK-
GROUND CHECKS.—The national criminal back-
ground check program shall be made available 
to a long-term care facility or provider for the 
purpose of conducting criminal background 
checks, including the criminal background 
checks required under sections 1819(b)(9) and 
1919(b)(9) of the Social Security Act (42 
U.S.C. 1395i–3(b), 1396r(b)) (as added by sub-
section (a)). 
(C) CONDUCT
OF
BACKGROUND
CHECKS 
BY
THE
FEDERAL
BUREAU
OF
INVESTIGA-
TION.—The Secretary, in consultation with the 
Attorney General, shall establish procedures for 
the background checks to be conducted by the 
Federal Bureau of Investigation, in cooperation 
with appropriate State and Federal agencies. 
(D) CONSULTATION.—In establishing the 
national criminal background check program, 
the Secretary shall consult with appropriate in-
terested parties, including— 
(i) representatives of long-term care 
facilities or providers; 
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(ii) representatives of employees of 
long-term care facilities or providers; 
(iii) consumers of long-term care serv-
ices; 
(iv) consumer advocates; and 
(v) appropriate Federal and State of-
ficials. 
(3) DEFINITIONS.—In this subsection: 
(A) LONG-TERM CARE FACILITY OR PRO-
VIDER.—The term ‘‘long-term care facility or 
provider’’ means the following facilities or pro-
viders which receive payment for services under 
title XVIII or XIX of the Social Security Act: 
(i) A nursing facility (as defined in 
subparagraph (B)). 
(ii) A skilled nursing facility (as de-
fined in subparagraph (C)). 
(iii) A home health agency. 
(iv) A provider of hospice care (as de-
fined in section 1861(dd)(1) of the Social 
Security Act) (42 U.S.C. 1395x(dd)(1)). 
(v) A long-term care hospital (as de-
scribed in section 1886(d)(1)(B)(iv) of 
such 
Act) 
(42 
U.S.C. 
1395ww(d)(1)(B)(iv)). 
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(vi) A provider of personal care serv-
ices. 
(vii) A residential care provider that 
arranges for, or directly provides, long- 
term care services. 
(viii) An intermediate care facility for 
the mentally retarded (as defined in sec-
tion 1905(d) of such Act) (42 U.S.C. 
1396d(d)). 
(B) NURSING FACILITY.—The term ‘‘nurs-
ing facility’’ has the meaning given such term 
in section 1919(a) of the Social Security Act 
(42 U.S.C. 1396r(a)). 
(C) SKILLED
NURSING
FACILITY.—The 
term ‘‘skilled nursing facility’’ has the meaning 
given such term in 1819(a) of the Social Secu-
rity Act (42 U.S.C. 1395i–3(a)). 
SEC. 3. SECURING THE RIGHT TO A SAFE ENVIRONMENT IN 
LONG-TERM CARE FACILITIES DURING AN 
EMERGENCY OR NATURAL DISASTER BY RE-
QUIRING THESE FACILITIES TO ESTABLISH 
DISASTER EMERGENCY AND EVACUATION 
PLANS. 
(a) ADDITION TO NURSING HOME PATIENTS’ BILL 
OF RIGHTS OF RIGHT TO A SAFE ENVIRONMENT DURING 
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AN
EMERGENCY
OR
NATURAL
DISASTER.—Sections 
1819(c)(1)(A) and 1919(c)(1)(A) of the Social Security 
Act (42 U.S.C. 1395i–3(c)(1)(A), 1396r(c)(1)(A)), as 
amended by section 2(a), are each amended by inserting 
after clause (xi) the following new clause: 
‘‘(xii) SAFE
ENVIRONMENT
DURING 
EMERGENCY OR NATURAL DISASTER.—The 
right to a safe environment during an 
emergency or natural disaster.’’. 
(b) 
APPLICATION
UNDER
MEDICARE.—Section 
1819(d)(4) of such Act (42 U.S.C. 1395i–3(d)(4)) is 
amended— 
(1) by redesignating subparagraph (B) as sub-
paragraph (C); and 
(2) by inserting after subparagraph (A) the fol-
lowing new subparagraph: 
‘‘(B) DISASTER EMERGENCY AND EVACU-
ATION
PLANS.—A 
skilled 
nursing 
facility 
must— 
‘‘(i) have a clear and pre-established 
disaster plan to ensure the safety of all its 
patients during an emergency or natural 
disaster and possible evacuation; and 
‘‘(ii) inform residents and next-of-kin 
regarding such plan and the location of 
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possible evacuation in case of an emer-
gency or disaster.’’. 
(c) MEDICAID.—Section 1919(d)(4) of such Act (42 
U.S.C. 1396r(d)(4)) is amended— 
(1) by redesignating subparagraph (B) as sub-
paragraph (C); and 
(2) by inserting after subparagraph (A) the fol-
lowing new subparagraph: 
‘‘(B) DISASTER EMERGENCY AND EVACU-
ATION PLANS.—A nursing facility must— 
‘‘(i) have a clear and pre-established 
disaster plan to ensure the safety of all its 
patients during an emergency or natural 
disaster and possible evacuation; and 
‘‘(ii) inform residents and next-of-kin 
regarding such plan and the location of 
possible evacuation in case of an emer-
gency or disaster.’’. 
(d) APPLICATION TO OTHER LONG-TERM CARE FA-
CILITIES.—Section 1898(a) of such Act, as added by sec-
tion 2(c)(1), is amended by inserting ‘‘and section 
1819(d)(4)(B)’’ after ‘‘section 1819(b)(1)’’. 
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(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply as of the date that is one year 
after the date of the enactment of this Act. 
Æ 
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