but not later than 2 hours after forming the 
suspicion; and 
‘‘(B) do not result in serious bodily injury, 
the individual shall report the suspicion not 
later than 24 hours after forming the suspicion. 
‘‘(c) PENALTY.—
‘‘(1) IN GENERAL.—If an individual described 
in subsection (b) violates subsection (b)—
‘‘(A) the individual shall be fined not more 
than $200,000 or subject to a civil money pen-
alty of not more than $200,000; or 
‘‘(B) the Secretary shall classify the indi-
vidual as an excluded individual, for a period of 
not more than 3 years. 
‘‘(2) INCREASED HARM.—If an individual de-
scribed in subsection (b) violates subsection (b), and 
the violation exacerbates the harm to the victim of 
the crime or results in harm to another person—
‘‘(A) the individual shall be fined not more 
than $200,000 or subject to a civil money pen-
alty of not more than $200,000; and 
‘‘(B) the Secretary shall classify the indi-
vidual as an excluded individual, for a period of 
not more than 3 years.
‘‘(3) EXCLUDED INDIVIDUAL.—During any pe-
riod for which an individual is classified as an ex-
cluded individual under this paragraph, an entity 
that employs the individual shall be ineligible to re-
ceive funds under the medicare program under title 
XVIII or the medicaid program under title XIX. 
‘‘(4) 
EXTENUATING
CIRCUMSTANCES.—The 
Secretary may take into account the financial bur-
den on providers with underserved populations in de-
termining the penalty. 
‘‘(d) REGULATIONS.—The Secretary, after consulting 
with the Attorney General, shall issue regulations to carry 
out this section. 
‘‘CHAPTER 2—IMPROVING THE QUALITY 
OF LONG-TERM CARE 
‘‘SEC. 2241. GRANTS AND INCENTIVES TO ENHANCE LONG-
TERM CARE STAFFING. 
‘‘(a) GENERAL AUTHORITY.—The Administrator of 
the Centers for Medicare & Medicaid Services (in this sec-
tion referred to as the ‘Administrator’) shall carry out ac-
tivities, including activities described in subsection (b) and 
(c), to provide incentives for individuals to train for, seek, 
and maintain employment providing direct care in a long-
term care facility.
‘‘(b) SPECIFIC PROGRAMS TO ENHANCE TRAINING, 
RECRUITMENT, AND RETENTION OF STAFF.—
‘‘(1) COORDINATION
WITH
OTHER
PROGRAMS 
TO RECRUIT AND TRAIN LONG-TERM CARE STAFF.—
The Administrator shall coordinate activities with 
the Secretary of Labor and the Assistant Secretary 
for the Administration for Children and Families, in 
order to provide incentives to participants in pro-
grams carried out under section 403(a)(5) and part 
A of title IV to train for and seek employment pro-
viding direct care in a long-term care facility. 
‘‘(2) CAREER LADDERS AND WAGE OR BENEFIT 
INCREASES TO INCREASE STAFFING IN LONG-TERM 
CARE FACILITIES.—
‘‘(A) IN
GENERAL.—The Administrator 
shall make grants to eligible entities to carry 
out programs through which the entities—
‘‘(i) offer, to employees who provide 
direct care in a long-term care facility, 
continuing training and varying levels of 
certification, based on observed clinical 
care practices and the amount of time the 
employees spend providing direct care; and 
‘‘(ii) provide, or make arrangements 
with employers to provide, bonuses or
other increased compensation or benefits to 
employees who achieve certification under 
such a program.
‘‘(B) APPLICATION.—To be eligible to re-
ceive a grant under this paragraph, an entity 
shall submit an application to the Adminis-
trator at such time, in such manner, and con-
taining such information as the Administrator 
may require. 
‘‘(c) SPECIFIC PROGRAMS TO IMPROVE MANAGE-
MENT PRACTICES.—
‘‘(1) IN
GENERAL.—The Administrator shall 
make grants to eligible organizations to enable the 
organizations to provide training and technical as-
sistance to eligible persons (including administra-
tors, directors of nursing, staff developers, and 
charge nurses) who establish or implement manage-
ment practices for long-term care facilities. 
‘‘(2) USE OF FUNDS.—An organization that re-
ceives a grant under paragraph (1) shall use funds 
made available through the grant—
‘‘(A) to provide training and technical as-
sistance regarding management practices, that 
are for employees that provide direct care in a 
long-term care facility, and that are dem-
onstrated to promote retention of those employ-
ees, such as—
‘‘(i) the establishment of basic human 
resource policies that reward high perform-
ance, including policies that provide for im-
proved wages and benefits on the basis of 
job reviews; 
‘‘(ii) the establishment of motivational 
and thoughtful work organization prac-
tices; 
‘‘(iii) the creation of a workplace cul-
ture that respects and values caregivers 
and their needs; 
‘‘(iv) the promotion of a workplace 
culture that respects the rights of residents 
of a long-term care facility and results in 
improved care for the residents; and 
‘‘(v) the establishment of other pro-
grams that promote the provision of high 
quality care, such as a continuing edu-
cation program that provides additional 
hours of training, including on-the-job 
training, for employees who are certified 
nurse aides; or
‘‘(B) to disseminate training materials for 
the training described in subparagraph (A), and 
to provide the materials to the National Elder 
Justice 
Library 
established 
in 
section 
2221(a)(4), so that the materials are available 
to other providers of such training. 
‘‘(3) APPLICATION.—To be eligible to receive a 
grant under this subsection, an organization shall 
submit an application to the Administrator at such 
time, in such manner, and containing such informa-
tion as the Administrator may require. 
‘‘(d) EVALUATING PROGRAMS.—After the first pro-
grams developed under this section have been completed, 
the Administrator shall evaluate the outcomes of such pro-
grams in determining which future applications to fund. 
‘‘(e) ACCOUNTABILITY MEASURES.—The Adminis-
trator shall develop accountability measures to assure that 
funds made available under this section benefit the staff 
who are the intended beneficiaries of the programs pro-
vided under this section, to promote increases and stability 
in the long-term care workforce. 
‘‘(f) COMPLIANCE WITH APPLICABLE LAWS.—In 
order to receive funds under this section, an eligible entity 
shall comply with all applicable laws, regulations, and 
guidelines.
‘‘SEC. 2242. COLLABORATIVE EFFORTS TO ENHANCE COM-
MUNICATION ON PROMOTING QUALITY OF 
AND PREVENTING ABUSE AND NEGLECT IN 
LONG-TERM CARE. 
‘‘(a) IN GENERAL.—The Director of the Agency for 
Healthcare Research and Quality (in this section referred 
to as the ‘Director’), after consultation with the Attorney 
General, may establish pilot projects to improve long-term 
care. In carrying out the projects, the Director shall make 
grants to eligible partnerships to develop collaborative and 
innovative approaches to improve the quality of, including 
preventing abuse and neglect in, long-term care. 
‘‘(b) ELIGIBLE PARTNERSHIPS.—To be eligible to re-
ceive a grant under this section, a partnership shall be 
a multidisciplinary community partnership, such as a 
partnership consisting of representatives in a community 
of nursing facility providers, advocates for residents of 
long-term care facilities, State Long-Term Care Ombuds-
men, surveyors, the State agency with responsibility for 
adult protective services, the State agency with responsi-
bility for licensing long-term care facilities, law enforce-
ment agencies, courts, family councils, residents, certified 
nurse aides, registered nurses, physicians, and other ap-
propriate entities and individuals. 
‘‘(c) APPLICATION.—To be eligible to receive a grant 
under this section, a partnership shall submit an applica-
tion to the Director at such time, in such manner, and 
containing such information as the Director may require. 
‘‘SEC. 2243. COLLABORATIVE EFFORTS TO DEVELOP CON-
SENSUS AROUND THE MANAGEMENT OF CER-
TAIN QUALITY-RELATED FACTORS. 
‘‘(a) IN GENERAL.—The Director of the Agency for 
Healthcare Research and Quality (in this section referred 
to as the ‘Director’), after consultation with the Attorney 
General and the Advisory Board established under section 
2214, may make grants to eligible entities to establish 
multidisciplinary panels to address, and develop consensus 
on, subjects relating to improving the quality of long-term 
care. The Director shall make a limited number of such 
grants, including at least 1 grant for the establishment 
of such a panel to address, and develop consensus on, 
methods of managing resident-to-resident abuse in long-
term care. 
‘‘(b) USE
OF FUNDS.—An entity that receives a 
grant under this section shall—
‘‘(1) establish a multidisciplinary panel to ad-
dress a specific subject; and 
‘‘(2) ensure that the panel uses the funds made 
available through the grant to establish a goal with 
respect to the subject, examine relevant research and 
data, identify best practices with respect to the sub-
ject, determine the best way to carry out those best 
practices in a practical and feasible manner, and de-
termine an effective manner of distributing informa-
tion on the subject. 
‘‘(c) APPLICATION.—To be eligible to receive a grant 
under this section, an entity shall submit an application 
to the Director at such time, in such manner, and con-
taining such information as the Director may require. 
‘‘CHAPTER 3—INCREASING CONSUMER 
INFORMATION ABOUT LONG-TERM CARE 
‘‘SEC. 2251. LONG-TERM CARE CONSUMER CLEARING-
HOUSE. 
‘‘(a) IN GENERAL.—The Director of the Office of 
Elder Justice in the Department of Health and Human 
Services, in coordination with the Director of the Agency 
for Healthcare Research and Quality and the Adminis-
trator of the Centers for Medicare & Medicaid Services, 
shall establish a long-term care consumer clearinghouse in 
the Department of Health and Human Services. 
‘‘(b) INFORMATION.—The clearinghouse shall be es-
tablished as part of the Elder Justice Resource Center (es-
tablished under section 2221) and shall provide com-
prehensive detailed information, in a consumer-friendly 
form, to consumers about choices relating to long-term 
care providers, such as information (including links to
websites and other resources that provide information) 
about—
‘‘(1) obtaining the services of, and employing, 
caregivers who provide long-term care at an individ-
ual’s home; and 
‘‘(2) options for residential long-term care, such 
as—
‘‘(A)(i) the type of care provided by nurs-
ing facilities; and 
‘‘(ii) the type of care provided by group 
homes and other residential long-term care fa-
cilities that are not nursing facilities; 
‘‘(B) the benefits available through the 
programs carried out under titles XVIII and 
XIX of the Social Security Act (42 U.S.C. 1395 
et seq. and 1396 et seq.); and 
‘‘(C) the care available through specific 
long-term care facilities, including data on the 
satisfaction level of residents of, and families of 
residents of, the facilities. 
‘‘(c) PROVIDERS.—In providing information on long-
term care providers under this section, the clearinghouse 
shall provide information (from States and other sources) 
on assisted living facilities, board and care facilities, con-
gregate care facilities, home health care providers, and 
other long-term care providers. 
‘‘SEC. 2252. CONSUMER INFORMATION ABOUT THE CON-
TINUUM OF RESIDENTIAL LONG-TERM CARE 
FACILITIES. 
‘‘(a) STUDY.—
‘‘(1) IN GENERAL.—The Director of the Agency 
for Healthcare Research and Quality, after consulta-
tion with the Director of the Office of Elder Justice 
in the Department of Health and Human Services 
and the Director of the Office of Elder Justice in 
the Department of Justice shall, directly or through 
a grant, conduct a study on consumer concerns re-
lating to residential long-term care facilities, other 
than nursing facilities. 
‘‘(2) SPECIFIC TOPICS.—The entity conducting 
the study shall—
‘‘(A) develop definitions for classes of the 
residential long-term care facilities described in 
paragraph (1); and 
‘‘(B) collect information on the prices of, 
level of services provided by, oversight and en-
forcement provisions of, and admission and dis-
charge criteria of, the facilities.
‘‘(b) REPORT.—The Director of the Agency for 
Healthcare Research and Quality shall prepare a report 
containing the results of the study, and submit the report 
to the Elder Justice Coordinating Council established 
under section 2213, the Committee on Ways and Means 
of the House of Representatives, and the Special Com-
mittee on Aging of the Senate. 
‘‘Subtitle D—Administration 
‘‘SEC. 2261. EVALUATIONS. 
‘‘(a) GRANTS.—
‘‘(1) IN GENERAL.—In making a grant under a 
provision of this title (other than this section), the 
granting authority shall—
‘‘(A) require the recipient of the grant 
to—
‘‘(i) reserve a portion of the funds 
made available through the grant; and 
‘‘(ii) use the reserved funds to conduct 
an evaluation of the other activities carried 
out through the grant; or 
‘‘(B)(i) reserve a portion of the funds 
available for the grant; and 
‘‘(ii) use the reserved funds to provide as-
sistance to an eligible entity to conduct an eval-
uation of the activities carried out through the 
grant. 
‘‘(2) USE OF FUNDS.—A recipient of a grant 
described in paragraph (1)(A), or assistance de-
scribed in paragraph (1)(B)(ii), shall use the funds 
made available through the grant, or the assistance, 
respectively, to conduct a validated evaluation of the 
effectiveness of the activities described in subpara-
graph (A) or (B), respectively, of paragraph (1). 
‘‘(3) APPLICATIONS.—
‘‘(A) SUBMISSION.—
‘‘(i) GRANTS
FOR
PROJECTS
CON-
TAINING EVALUATIONS.—To be eligible to 
receive a grant for which the granting au-
thority requires the reservation described 
in paragraph (1)(A)(i), an entity shall in-
clude a proposal for the evaluation in the 
application submitted for the grant. 
‘‘(ii) 
ASSISTANCE
FOR
EVALUA-
TIONS.—To be eligible to receive assistance 
under paragraph (1)(B)(ii), an entity shall 
submit an application to the granting au-
thority at such time, in such manner, and 
containing such information as the grant-
ing authority may require, including a pro-
posal for the evaluation. 
‘‘(B) REVIEW AND ASSISTANCE.—An em-
ployee of the National Institute on Aging, and 
a private expert, with expertise in evaluation 
methodology shall review each proposal de-
scribed in clause (i) or (ii) of subparagraph (A), 
and determine whether the methodology de-
scribed in the proposal is adequate to gather 
meaningful information. If the employee and 
expert determine that the methodology is inad-
equate, the employee and expert shall rec-
ommend that the granting authority deny the 
application for the grant described in subpara-
graph (A)(i), or the assistance described in sub-
paragraph (B)(ii), as appropriate, or make rec-
ommendations for how the application should 
be amended. If the granting authority denies 
the application on the basis of the proposal, the 
granting authority shall inform the applicant 
why the application was denied, and offer as-
sistance to the applicant in modifying the pro-
posal. 
‘‘(b) OTHER GRANTS.—The granting authority shall 
make grants to appropriate entities to conduct validated
evaluations of activities, to reduce elder abuse, neglect, 
and exploitation, that are not funded under this title. 
‘‘(c) CONDITION OF PARTICIPATION.—As a condition 
of participation in any grant under this title, individuals, 
facilities, and other entities shall agree to be subject to 
sections 3729 through 3733 of title 31, United States 
Code and other applicable laws. 
‘‘SEC. 2262. HUMAN SUBJECT RESEARCH. 
‘‘(a) IN GENERAL.—For purposes of the application 
of subpart A of part 46 of title 45, Code of Federal Regu-
lations to research conducted under this title, the term ‘le-
gally authorized representative’ means, unless otherwise 
provided by law, the individual, or judicial or other body 
authorized under the applicable law to consent to medical 
treatment on behalf of another person. 
‘‘(b) GUIDELINES.—The Secretary of Health and 
Human Services, through the Director of the National In-
stitute on Aging, after consultation with the Director of 
the Office for Human Research Protections and the Excel-
lence Advisory Committee established under section 
2222(b)(5), shall promulgate guidelines to assist research-
ers working in the area of elder abuse, neglect, and exploi-
tation, with issues relating to human subject protections.
‘‘SEC. 2263. REGULATIONS. 
‘‘The Secretary may issue such regulations as may 
be necessary to carry out this title. 
‘‘SEC. 2264. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There are authorized to be appropriated to carry out 
this title such sums as may be necessary for each of fiscal 
years 2004 through 2010.’’. 
SEC. 102. PATIENT ABUSE PREVENTION. 
(a) ESTABLISHMENT
OF PROGRAM TO PREVENT 
ABUSE OF NURSING FACILITY RESIDENTS.—
(1) SCREENING OF SKILLED NURSING FACILITY 
AND NURSING FACILITY EMPLOYEE APPLICANTS.—
(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: 
‘‘(8) SCREENING OF SKILLED NURSING FACIL-
ITY WORKERS.—
‘‘(A) BACKGROUND
CHECKS
ON
APPLI-
CANTS.—Subject to subparagraph (B)(ii), be-
fore hiring a skilled nursing facility worker, a 
skilled nursing facility shall—
‘‘(i) give the worker written notice 
that the facility is required to perform
background checks with respect to appli-
cants;
‘‘(B) PROHIBITION ON HIRING OF ABUSIVE 
WORKERS.—
‘‘(i) IN GENERAL.—A skilled nursing 
facility may not knowingly employ any 
skilled nursing facility worker who has any 
conviction for a relevant crime. 
‘‘(ii) PROVISIONAL
EMPLOYMENT.—
After complying with the requirements of 
clauses (i) and (ii) of subparagraph (A), a 
skilled nursing facility may provide for a 
provisional period of employment for a 
skilled nursing facility worker pending 
completion of the check against the back-
ground check described under subpara-
graph (A)(iii). Subject to clause (iii), such 
facility shall maintain direct supervision of 
the covered individual during the worker’s 
provisional period of employment. 
‘‘(iii) EXCEPTION FOR SMALL RURAL 
SKILLED
NURSING
FACILITIES.—In the 
case of a small rural skilled nursing facility 
(as defined by the Secretary), the Sec-
retary shall provide, by regulation after 
consultation with providers of skilled nurs-
ing facility services and entities rep-
resenting beneficiaries of such services, for 
an appropriate level of supervision with re-
spect to any provisional employees em-
ployed by the facility in accordance with 
clause (ii). Such regulation should encour-
age the provision of direct supervision of 
such employees whenever practicable with 
respect to such a facility and if such super-
vision would not impose an unreasonable 
cost or other burden on the facility. 
‘‘(C) 
REPORTING
REQUIREMENTS.—A 
skilled nursing facility shall report to the State 
any instance in which the facility determines 
that a skilled nursing facility worker has com-
mitted an act of resident neglect or abuse or 
misappropriation of resident property in the 
course of employment by the facility. 
‘‘(D) USE OF INFORMATION.—
‘‘(i) IN GENERAL.—A skilled nursing 
facility that obtains information about a 
skilled nursing facility worker pursuant to 
subparagraph (A)(iii) may use such infor-
mation only for the purpose of determining 
the suitability of the worker for employ-
ment.
‘‘(ii) IMMUNITY FROM LIABILITY.—A 
skilled nursing facility that, in denying em-
ployment for an applicant (including dur-
ing the period described in subparagraph 
(B)(ii)), reasonably relies upon information 
about such applicant provided by the State 
pursuant to subsection (e)(6) shall not be 
liable in any action brought by such appli-
cant based on the employment determina-
tion resulting from the information. 
‘‘(iii) CRIMINAL
PENALTY.—Whoever 
knowingly violates the provisions of clause 
(i) shall be fined in accordance with title 
18, United States Code, imprisoned for not 
more than 2 years, or both. 
‘‘(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—
‘‘(I) knowingly continues to em-
ploy a skilled nursing facility worker 
in violation of subparagraph (A) or 
(B); or 
‘‘(II) knowingly fails to report a 
skilled nursing facility worker under 
subparagraph (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 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 
paragraphs (1) through (4) of section 
1128(a); and 
‘‘(II) such other types of offenses 
as the Secretary may specify in regu-
lations, taking into account the sever-
ity and relevance of such offenses, and 
after consultation with representatives 
of long-term care providers, represent-
atives of long-term care employees, 
consumer advocates, and appropriate 
Federal and State officials. 
‘‘(ii) DISQUALIFYING INFORMATION.—
The term ‘disqualifying information’ means 
information about a conviction for a rel-
evant crime. 
‘‘(iii) SKILLED
NURSING
FACILITY 
WORKER.—The term ‘skilled nursing facil-
ity worker’ means any individual (other 
than a volunteer) that has access to a pa-
tient of a skilled nursing facility under an 
employment or other contract, or both, 
with such facility. Such term includes indi-
viduals who are licensed or certified by the 
State to provide such services, and non-
licensed individuals providing such services, 
as defined by the Secretary, including 
nurse assistants, nurse aides, home health 
aides, and personal care workers and at-
tendants.’’.
(B) 
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.—Subject to subparagraph (B)(ii), be-
fore hiring a nursing facility worker, a nursing 
facility shall—
‘‘(i) give the worker written notice 
that the facility is required to perform 
background checks with respect to appli-
cants; 
‘‘(ii) require, as a condition of employ-
ment, that such worker—
‘‘(I) provide a written statement 
disclosing any conviction for a rel-
evant crime; 
‘‘(II) provide a statement signed 
by the worker authorizing the facility 
to request the search and exchange of 
criminal records; 
‘‘(III) provide in person to the 
facility a copy of the worker’s finger-
prints or thumb print, depending 
upon available technology; and 
‘‘(IV) provide any other identi-
fication information the Secretary 
may specify in regulation; and 
‘‘(iii) request through the appropriate 
State agency that the State initiate a State 
and national criminal background check on 
such worker in accordance with the provi-
sions of subsection (e)(8) and submit to 
such State agency the information de-
scribed in subclauses (II) through (IV) of 
clause (ii). 
‘‘(B) PROHIBITION ON HIRING.—
‘‘(i) IN GENERAL.—A nursing facility 
may not knowingly employ any nursing fa-
cility worker who has any conviction for a 
relevant crime. 
‘‘(ii) PROVISIONAL
EMPLOYMENT.—
After complying with the requirements of 
clauses (i) and (ii) of subparagraph (A), a 
nursing facility may provide for a provi-
sional period of employment for a nursing 
facility worker pending completion of the 
check against the background check de-
100
scribed under subparagraph (A)(iii). Sub-
ject to clause (iii), such facility shall main-
tain direct supervision of the worker dur-
ing the worker’s provisional period of em-
ployment. 
‘‘(iii) EXCEPTION FOR SMALL RURAL 
NURSING
FACILITIES.—In the case of a 
small rural nursing facility (as defined by 
the Secretary), the Secretary shall provide, 
by regulation after consultation with pro-
viders of nursing facility services and enti-
ties representing beneficiaries of such serv-
ices, for an appropriate level of supervision 
with respect to any provisional employees 
employed by the facility in accordance with 
clause (ii). Such regulation should encour-
age the provision of direct supervision of 
such employees whenever practicable with
respect to such a facility and if such super-
vision would not impose an unreasonable 
cost or other burden on the facility. 
‘‘(C) 
REPORTING
REQUIREMENTS.—A 
nursing facility shall report to the State any in-
stance in which the facility determines that a 
nursing facility worker has committed an act of
101
resident neglect or abuse or misappropriation of 
resident property in the course of employment 
by the facility. 
‘‘(D) USE OF INFORMATION.—
‘‘(i) IN GENERAL.—A nursing facility 
that obtains information about a nursing 
facility worker pursuant to subparagraph 
(A)(iii) may use such information only for 
the purpose of determining the suitability 
of the worker for employment. 
‘‘(ii) IMMUNITY FROM LIABILITY.—A 
nursing facility that, in denying employ-
ment for an applicant (including during 
the period described in subparagraph 
(B)(ii)), reasonably relies upon information 
about such applicant provided by the State 
pursuant to subsection (e)(8) shall not be 
liable in any action brought by such appli-
cant based on the employment determina-
tion resulting from the information. 
‘‘(iii) CRIMINAL
PENALTY.—Whoever 
knowingly violates the provisions of clause 
(i) shall be fined in accordance with title 
18, United States Code, imprisoned for not 
more than 2 years, or both.
102
‘‘(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—
‘‘(I) knowingly continues to em-
ploy a nursing facility worker in viola-
tion of subparagraph (A) or (B); or
‘‘(II) knowingly fails to report a 
nursing facility worker under subpara-
graph (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 violation within any 
5-year period. 
‘‘(F) DEFINITIONS.—In this paragraph:
103
‘‘(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 
paragraphs (1) through (4) of section 
1128(a); and 
‘‘(II) such other types of offenses 
as the Secretary may specify in regu-
lations, taking into account the sever-
ity and relevance of such offenses, and 
after consultation with representatives 
of long-term care providers, represent-
atives of long-term care employees, 
consumer advocates, and appropriate 
Federal and State officials. 
‘‘(ii) DISQUALIFYING INFORMATION.—
The term ‘disqualifying information’ means 
information about a conviction for a rel-
evant crime. 
‘‘(iii) NURSING FACILITY WORKER.—
The term ‘nursing facility worker’ means 
any individual (other than a volunteer) 
that has access to a patient of a nursing 
facility under an employment or other con-
104
tract, or both, with such facility. Such 
term includes individuals who are licensed 
or certified by the State to provide such 
services, and nonlicensed individuals pro-
viding such services, as defined by the Sec-
retary, including nurse assistants, nurse 
aides, home health aides, and personal care 
workers and attendants.’’. 
(C) FEDERAL RESPONSIBILITIES.—
(i) 
DEVELOPMENT
OF
STANDARD 
FEDERAL AND STATE BACKGROUND CHECK 
FORM.—The Secretary of Health and 
Human Services, after consultation with 
the Attorney General and representatives 
of appropriate State agencies, shall develop 
a model form that an applicant for employ-
ment at a nursing facility may complete 
and Federal and State agencies may use to 
conduct the criminal background checks 
required under sections 1819(b)(8) and 
1919(b)(8) of the Social Security Act (42 
U.S.C. 1395i–3(b)(8), 1396r(b)(8)) (as 
added by this section). 
(ii) 
PERIODIC
EVALUATION.—The 
Secretary of Health and Human Services,
105
after consultation with the Attorney Gen-
eral, periodically shall evaluate the back-
ground check system imposed under sec-
tions 1819(b)(8) and 1919(b)(8) of the So-
cial Security Act (42 U.S.C. 1395i–
3(b)(8), 1396r(b)(8)) (as added by this 
section) and shall implement changes, as 
necessary, based on available technology, 
to make the background check system 
more efficient and able to provide a more 
immediate response to long-term care pro-
viders using the system. 
(D) NO PREEMPTION OF STRICTER STATE 
LAWS.—Nothing in section 1819(b)(8) or 
1919(b)(8) of the Social Security Act (42 
U.S.C. 1395i–3(b)(8), 1396r(b)(8)) (as so
added) shall be construed to supersede any pro-
vision of State law that—
(i) specifies a relevant crime for pur-
poses of prohibiting the employment of an 
individual at a long-term care facility that 
is not included in the list of such crimes 
specified in such sections or in regulations 
promulgated by the Secretary of Health
106
and Human Services to carry out such sec-
tions; or 
(ii) requires a long-term care facility 
(as so defined) to conduct a background 
check prior to employing an individual in 
an employment position that is not in-
cluded in the positions for which a back-
ground check is required under such sec-
tions. 
(E) TECHNICAL AMENDMENTS.—Effective 
as if included in the enactment of section 941 
of the Medicare, Medicaid, and SCHIP Benefits 
Improvement and Protection Act of 2000 (114 
Stat. 2763A–585), as enacted into law by sec-
tion 1(a)(6) of Public Law 106–554, sections 
1819(b) and 1919(b) of the Social Security Act 
(42 U.S.C. 1395i–3(b), 1396r(b)), as amended 
by such section 941 (as so enacted into law) are 
each amended by redesignating the paragraph 
(8) added by such section as paragraph (9). 
(2) FEDERAL AND STATE REQUIREMENTS CON-
CERNING BACKGROUND CHECKS.—
(A) MEDICARE.—Section 1819(e) of the 
Social Security Act (42 U.S.C. 1395i–3(e)) is 
amended by adding at the end the following:
107
‘‘(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 immediately 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 and other posi-
tive identification information submitted. The 
Attorney 
General 
shall 
provide 
any 
cor-
108
responding information 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)); and 
‘‘(ii) immediately report to the skilled 
nursing facility in writing the results of 
such review. 
‘‘(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-
109
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-
110
tions under this title, the Attorney Gen-
eral, after 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 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, after 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.
111
‘‘(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.’’. 
(B) MEDICAID.—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 immediately submit
112
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 and other posi-
tive 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 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)); and
113
‘‘(ii) immediately report to the nurs-
ing facility in writing the results of such 
review. 
‘‘(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
114
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, after 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.
115
‘‘(ii) APPEAL PROCEDURES.—The At-
torney General, after 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
116
‘‘(iii) the cost of responding to such 
requests.’’. 
(3) APPLICATION
TO
OTHER
ENTITIES
PRO-
VIDING HOME HEALTH OR LONG-TERM CARE SERV-
ICES.—
(A) 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 fol-
lowing: 
‘‘APPLICATION OF SKILLED NURSING FACILITY PREVEN-
TIVE
ABUSE
PROVISIONS
TO
ANY
PROVIDER
OF 
SERVICES
OR
OTHER
ENTITY
PROVIDING
HOME 
HEALTH OR LONG-TERM CARE SERVICES 
‘‘SEC. 1897. (a) IN GENERAL.—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 eligi-
ble to be paid under this title for providing home health 
services, hospice care (including routine home care and 
other services included in hospice care under this title), 
or long-term care services to an individual entitled to bene-
fits under part A or enrolled under part B, including an 
individual provided with a Medicare+Choice plan offered 
by a Medicare+Choice organization under part C (in this 
section referred to as a ‘medicare beneficiary’). 
‘‘(b) SUPERVISION OF PROVISIONAL EMPLOYEES.—
117
‘‘(1) IN GENERAL.—With respect to an entity 
that provides home health services, such entity shall 
be considered to have satisfied the requirements of 
section 1819(b)(8)(B)(ii) or 1919(b)(8)(B)(ii) if the 
entity meets such requirements for supervision of 
provisional employees of the entity as the Secretary 
shall, by regulation, specify in accordance with para-
graph (2). 
‘‘(2) REQUIREMENTS.—The regulations re-
quired under paragraph (1) shall provide the fol-
lowing: 
‘‘(A) Supervision of a provisional employee 
shall consist of ongoing, good faith, verifiable 
efforts by the supervisor of the provisional em-
ployee to conduct monitoring and oversight ac-
tivities to ensure the safety of a medicare bene-
ficiary. 
‘‘(B) For purposes of subparagraph (A), 
monitoring and oversight activities may include 
(but are not limited to) the following: 
‘‘(i) Follow-up telephone calls to the 
medicare beneficiary. 
‘‘(ii) Unannounced visits to the medi-
care beneficiary’s home while the provi-
118
sional employee is serving the medicare 
beneficiary. 
‘‘(iii) To the extent practicable, lim-
iting the provisional employee’s duties to 
serving only those medicare beneficiaries in 
a home or setting where another family 
member or resident of the home or setting 
of the medicare beneficiary is present. 
‘‘(C) In promulgating such regulations, the 
Secretary shall take into account the staffing 
and geographic issues faced by small rural enti-
ties (as defined by the Secretary) that provide 
home health services, hospice care (including 
routine home care and other services included 
in hospice care under this title), or other long-
term care services. Such regulations should en-
courage the provision of monitoring and over-
sight activities whenever practicable with re-
spect to such an entity, and if such activities 
would not impose an unreasonable cost or other 
burden on the entity.’’. 
(B) MEDICAID.—Section 1902(a) of the 
Social Security Act (42 U.S.C. 1396a) is 
amended—
119
(i) in paragraph (64), by striking 
‘‘and’’ at the end; 
(ii) in paragraph (65), by striking the 
period and inserting ‘‘; and’’; and 
(iii) by inserting after paragraph (65) 
the following: 
‘‘(66) provide that any entity that is eligible to 
be paid under the State plan for providing home 
health services, hospice care (including routine home 
care and other services included in hospice care 
under title XVIII), or long-term care services for 
which medical assistance is available under the State 
plan to individuals requiring long-term care complies 
with the requirements of subsections (b)(8) and 
(e)(8) of section 1919 and section 1897(b) (in the 
same manner as such section applies to a medicare 
beneficiary).’’. 
(b) PREVENTION AND TRAINING DEMONSTRATION 
PROJECT.—
(1) 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
120
managers and staff of hospital and health care fa-
cilities. 
(2) ELIGIBILITY.—To be eligible to receive a 
grant under paragraph (1), an entity shall be a pub-
lic or private nonprofit entity and prepare and sub-
mit 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. 
(3) USE OF FUNDS.—Amounts received under a 
grant under this subsection shall be used to—
(A) examine ways to improve collaboration 
between State health care survey and provider 
certification agencies, long-term care ombuds-
man programs, the long-term care industry, 
and local community members; 
(B) examine patient care issues relating to 
regulatory oversight, community involvement, 
and facility staffing and management with a
focus on staff training, staff stress manage-
ment, and staff supervision; 
(C) examine the use of patient abuse pre-
vention training programs by long-term care en-
tities, including the training program developed 
by the National Association of Attorneys Gen-
121
eral, and the extent to which such programs are 
used; and 
(D) identify and disseminate best practices 
for preventing and reducing patient abuse. 
(4) AUTHORIZATION
OF
APPROPRIATIONS.—
There are authorized to be appropriated to carry out 
this subsection such sums as may be necessary. 
(c) SENSE OF THE SENATE REGARDING THE ESTAB-
LISHMENT OF A NATIONAL BACKGROUND CHECK SYSTEM 
FOR LONG-TERM CARE EMPLOYEES.—
(1) FINDINGS.—The Senate makes the fol-
lowing findings: 
(A) Nearly 1,500,000 Americans reside in 
17,000 nursing homes throughout the Nation, 
and the vast majority of nursing homes partici-
pate in the medicare and medicaid programs. 
(B) 
The 
Federal 
Government 
spent 
$82,100,000,000 through the medicare and 
medicaid programs in fiscal year 2000 for long-
term care services. 
(C) The impending retirement of the baby 
boom generation will greatly increase the de-
mand and need for quality long-term care, and 
it is incumbent on Congress and the President 
to ensure that medicare and medicaid bene-
122
ficiaries are protected from abuse, neglect, and 
mistreatment. 
(D) On July 30, 2001, the minority staff 
of the special investigations division of the 
Committee on Government Reform of the 
House of Representatives issued a report which 
found that in the past 2 years, over 30 percent 
of nursing homes in the United States were 
cited for a physical, sexual, or verbal abuse vio-
lation that had the potential to harm residents, 
and nearly 10 percent of nursing homes had 
violations that caused actual harm to residents. 
(E) Although the majority of long-term 
care facilities do an excellent job in caring for 
elderly and disabled patients, incidents of abuse 
and neglect and mistreatment do occur at an 
unacceptable rate and are not limited to nurs-
ing homes alone. 
(F) Without a national background check 
system to screen applicants for employment, all 
long-term care providers, including nursing fa-
cilities, home health, home care, and hospice 
providers, are at risk for hiring workers with a 
history of abuse and violence.
123
(G) A March 2002 report by the General 
Accounting Office found that few prosecutions 
and criminal convictions result from allegations 
of abuse in nursing homes. 
(H) Federal law requires all States to 
maintain a nurse aide registry which includes 
any substantiated findings of abuse committed 
by nurse aides in nursing homes. 
(I) In March 2002, the General Account-
ing Office testified before the Special Com-
mittee on Aging of the Senate that the existing 
State registries contained significant gaps be-
cause many nursing home employees are not in-
cluded in the registries and the registries do not 
track abuses committed in other States. 
(J) A 1998 report from the Office of the 
Inspector General of the Department of Health 
and Human Services entitled ‘‘Safeguarding 
Long-Term Care Residents’’ recommended es-
tablishing a national registry of abusive long-
term care workers to be checked by all long-
term care facilities before hiring an employee. 
(2) SENSE OF THE SENATE.—It is the Sense of 
the Senate that Congress should pass legislation 
that will—
124
(A) require the Secretary of Health and 
Human Services to establish a national registry 
of abusive long-term care workers that will in-
corporate abuse information from all existing 
State nurse aide registries, and expand infor-
mation included in the State registries and the 
national registry to include abuse information 
about all employees of all long-term care pro-
viders that receive funding through the medi-
care or medicaid programs (42 U.S.C. 1395 et 
seq.; 1396 et seq.); 
(B) require all long-term care providers, 
before hiring a potential employee, to conduct 
checks of both the national registry and crimi-
nal conviction records maintained by the Fed-
eral Bureau of Investigation, and prohibit long-
term care providers from hiring potential em-
ployees with relevant abuse and criminal his-
tories; 
(C) require the Secretary of Health and 
Human Services and the Attorney General to 
develop an efficient system for long-term care 
providers to use to check both the national reg-
istry and the criminal conviction records main-
125
tained by the Federal Bureau of Investigation 
before hiring an employee; and 
(D) ensure adequate safeguards to protect 
the privacy and accuracy of information regard-
ing applicants for employment being checked 
through the national registry and the criminal 
conviction records maintained by the Federal 
Bureau of Investigation. 
(d) EFFECTIVE DATE.—
(1) IN GENERAL.—Except as provided in para-
graph (2), this section and the amendments made by 
this section shall take effect on the date that is 6 
months after the effective date of final regulations 
promulgated to carry out this section and such 
amendments. 
(2) SENSE
OF
THE
SENATE.—Subsection (c) 
shall take effect on the date of enactment of this 
section.
SEC. 103. INCREASING THE NUMBER OF HEALTH CARE 
PROFESSIONALS WITH GERIATRIC TRAINING. 
Section 338C of the Public Health Service Act (42 
U.S.C. 254m) is amended by adding at the end the fol-
lowing: 
‘‘(e) For purposes of this section and section 338B, 
the term ‘obligated service’, with respect to an individual
126
who has entered into a written contract with the Secretary 
under section 338B, includes any period in which the indi-
vidual is enrolled and participating in an accredited (as 
determined by the Secretary) educational program that 
provides geriatric training. Upon the completion of such 
training, such individual, after consultation with the Sec-
retary, shall provide geriatric services as appropriate dur-
ing the remainder of such individual’s period of obligated 
service.’’. 
SEC. 104. SUPPORTING THE LONG-TERM CARE OMBUDS-
MAN PROGRAM. 
Section 712(h) of the Older Americans Act of 1965 
(42 U.S.C. 3058g(h)) is amended—
(1) in paragraph (8), by striking ‘‘; and’’ and 
inserting a semicolon; 
(2) in paragraph (9), by striking the period and 
inserting ‘‘; and’’; and 
(3) by adding at the end the following:
‘‘(10) make grants, in consultation with the Di-
rector of the Office of Elder Justice in the Depart-
ment of Health and Human Services and the Direc-
tor of the Office of Elder Justice in the Department 
of Justice, to eligible entities with relevant expertise 
and experience to conduct evaluations and pilot 
studies relating to various programs and methods
127
carried out by the Office of the State Long-Term 
Care Ombudsman or a local Ombudsman entity 
under section 307(a)(9) or this chapter, or to pro-
vide support (such as an ombudsman resource cen-
ter).’’.
SEC. 105. ESTABLISHMENT OF OFFICE OF ADULT PROTEC-
TIVE SERVICES. 
(a) IN GENERAL.—Part A of title XI of the Social 
Security Act (42 U.S.C. 1301 et seq.) is amended by add-
ing at the end the following: 
‘‘OFFICE OF ADULT PROTECTIVE SERVICES 
‘‘SEC. 1150A. (a) IN GENERAL.—There is estab-
lished within the Department of Health and Human Serv-
ices, within the Administration on Children and Families, 
the Office of Adult Protective Services (in this section re-
ferred to as the ‘Office’). The Office shall be headed by 
a Director, who shall be appointed by the Secretary. 
‘‘(b) DUTIES.—The Office shall—
‘‘(1) provide necessary funding and support to 
State and local adult protective services offices that 
investigate reports of abuse, neglect, and exploi-
tation of elders; 
‘‘(2) annually collect and disseminate data re-
lating to the abuse, exploitation, and neglect of el-
derly individuals in coordination with the Centers for
128
Disease Control and Prevention efforts to collect na-
tional data under section 2221(b); 
‘‘(3) develop and disseminate best practices re-
garding, and provide training on, carrying out pro-
tective services for elders; 
‘‘(4) in conjunction with the necessary experts, 
conduct research related to the provision of such 
protective services; 
‘‘(5) provide technical assistance to States and 
other entities that provide or fund the provision of 
such protective services, including through grants 
made under title XX; 
‘‘(6) participate in the Intra-Agency Elder Jus-
tice Steering Committee established under section 
2212; and 
‘‘(7) coordinate activities with the Office of 
Elder Justice established under section 2211 and 
with other Federal and State agencies that have re-
sponsibility for issues related to elder justice. 
‘‘(c) APPROPRIATIONS.—There are appropriated such 
sums as may be necessary to carry out this section.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section take effect 90 days after the date of enactment 
of the Elder Justice Act.
129
SEC. 106. ASSURING SAFETY OF RESIDENTS WHEN NURS-
ING FACILITIES CLOSE. 
(a) MEDICARE.—Section 1819(c)(2) of the Social Se-
curity Act (42 U.S.C. 1395i–3(c)(2)) is amended by add-
ing at the end the following: 
‘‘(D) NOTIFICATION
OF
FACILITY
CLO-
SURE.—
‘‘(i) IN GENERAL.—A skilled nursing 
facility shall—
‘‘(I) submit to the Secretary and 
the appropriate State regulatory agen-
cy written notification of an impend-
ing closure not later than the date 
that is 60 days prior to the date of 
such closure; 
‘‘(II) include in the notice a plan 
for the transfer and adequate reloca-
tion of the residents prior to closure, 
including assurances that residents 
will not be transferred to facilities 
providing substandard care for which 
administrative or law enforcement ac-
tion is pending; and 
‘‘(III) not later than 10 days 
after the facility closure, submit to the 
Secretary and the appropriate State
130
agency information identifying where 
residents of the closed facility were 
transferred and on what date. 
‘‘(ii) SANCTIONS.—Any person owning 
a skilled nursing facility that fails to com-
ply with the requirements of clause (i) 
shall be subject to—
‘‘(I) a civil monetary penalty of 
up to $1,000,000; 
‘‘(II) exclusion from participation 
in the programs under this Act (in ac-
cordance with the procedures of sec-
tion 1128); and 
‘‘(III) any other applicable civil 
monetary penalties and assessments. 
‘‘(iii) PROCEDURE.—A civil monetary 
penalty or assessment authorized under
clause (ii) shall be imposed against a per-
son in the same manner as a civil mone-
tary penalty, assessment, or exclusion is 
imposed under section 1128A.’’. 
(b) MEDICAID.—Section 1919(c)(2) of the Social Se-
curity Act (42 U.S.C. 1396r(c)(2)) is amended by adding 
at the end the following:
131
‘‘(G) NOTIFICATION
OF
FACILITY
CLO-
SURE.—
‘‘(i) IN GENERAL.—A nursing facility 
shall—
‘‘(I) submit to the Secretary and 
the appropriate State regulatory agen-
cy written notification of an impend-
ing closure not later than the date 
that is 60 days prior to the date of 
such closure; 
‘‘(II) include in the notice a plan 
for the transfer and adequate reloca-
tion of the residents prior to closure, 
including assurances that residents 
will not be transferred to facilities 
providing substandard care for which 
administrative or law enforcement ac-
tion is pending; and 
‘‘(III) not later than 10 days 
after the facility closure submit to the 
Secretary and the appropriate State 
agency information identifying where 
residents of the closed facility were 
transferred and on what date.
132
‘‘(ii) SANCTIONS.—Any person owning 
a nursing facility that fails to comply with 
the requirements of clause (i) shall be sub-
ject to—
‘‘(I) a civil monetary penalty of 
up to $1,000,000; 
‘‘(II) exclusion from participation 
in the programs under this Act (in ac-
cordance with the procedures of sec-
tion 1128); and 
‘‘(III) any other applicable civil 
monetary penalties and assessments. 
‘‘(iii) PROCEDURE.—A civil monetary 
penalty or assessment authorized under 
clause (ii) shall be imposed against a per-
son in the same manner as a civil mone-
tary penalty, assessment, or exclusion is 
imposed under section 1128A.’’.
(c) REGULATIONS.—The Secretary, after consulting 
with the Attorney General, shall issue regulations to carry 
out this section.
133
TITLE II—DEPARTMENT OF 
JUSTICE 
SEC. 201. DEFINITIONS; RULE. 
(a) DEFINITIONS.—In this title the terms ‘‘abuse’’, 
‘‘elder’’, ‘‘elder justice’’, ‘‘exploitation’’, ‘‘fiduciary’’, 
‘‘grant’’, ‘‘granting authority’’, ‘‘guardianship’’, ‘‘know-
ingly’’, ‘‘law enforcement’’, ‘‘neglect’’, ‘‘serious bodily in-
jury’’, ‘‘social’’, ‘‘State’’, and ‘‘vulnerable adult’’ have the 
meanings given such terms in title XXII of the Social Se-
curity Act. 
(b) RULE.—The Attorney General may determine, in 
an appropriate case, that a provision of this title that ap-
plies to elders also applies to vulnerable adults. 
SEC. 202. MODEL STATE LAWS AND PRACTICES. 
(a) IN GENERAL.—The Attorney General, after con-
sultation with the Secretary of Health and Human Serv-
ices, shall—
(1) conduct a study and prepare a report of the 
findings of that study of State laws and practices re-
lating to elder abuse, neglect, and exploitation and 
provide such report or periodic reports to the Elder 
Justice Resource Center established under section 
2221 of the Social Security Act, to be made avail-
able to the public; and
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(2) not later than 2 years after the date of en-
actment of this Act, submit to the Chairman and 
Ranking Member of the Special Committee on Aging 
of the Senate, and the Speaker and Minority leader 
of the House of Representatives a report that—
(A) provides recommendations on a com-
prehensive description and comparative analysis 
of the State laws and practices; and 
(B) provides recommended models for 
State laws and practices based on an analysis 
of the most effective State laws and practices, 
including recommendations with respect to the 
definitions referred to in subsection (b)(1). 
(b) STATE LAWS AND PRACTICES.—The Attorney 
General shall examine State laws and practices under sub-
section (a) on issues including—
(1) definitions of ‘‘elder’’, ‘‘abuse’’, ‘‘neglect’’, 
and ‘‘exploitation’’, and related terms; 
(2) mandatory reporting laws, with respect to—
(A) who is a mandated reporter; 
(B) to whom must they report and within 
what timeframe; and 
(C) any consequences for nonreporting; 
(3) evidentiary, procedural, sentencing, choice 
of remedies, and data retention issues relating to
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pursuing cases relating to elder abuse, neglect, and 
exploitation; 
(4) laws requiring immediate reporting of all 
nursing home deaths to the county coroner or to 
some other individual or entity; 
(5) fiduciary laws, including guardianship and 
power of attorney laws; 
(6) laws that permit or encourage banks and 
bank employees to prevent and report suspected 
elder abuse, neglect, and exploitation; 
(7) laws that may impede research on elder 
abuse, neglect, and exploitation; 
(8) practices relating to the enforcement of laws 
relating to elder abuse, neglect, and exploitation; and 
(9) practices relating to other aspects of elder 
justice. 
SEC. 203. OFFICE OF ELDER JUSTICE OF THE DEPARTMENT 
OF JUSTICE. 
(a) ESTABLISHMENT.—There is established within 
the Department of Justice under the Assistant Attorney 
General, Office of Justice Programs, an Office of Elder 
Justice. 
(b) DIRECTOR.—
(1) APPOINTMENT.—The President, with the 
advice and consent of the Senate, shall appoint a Di-
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rector of the Office of Elder Justice, from among in-
dividuals with experience and expertise in elder jus-
tice issues, to manage the Office of Elder Justice es-
tablished under this section. 
(2) DUTIES.—The Director of the Office of 
Elder Justice shall—
(A)(i) develop objectives, priorities, policy, 
and a long-term plan for elder justice programs 
and activities relating to prevention, detection, 
training, treatment, evaluation, intervention, re-
search, and improvement of the elder justice 
system in the United States; 
(ii) implement the overall policy and a 
strategy to carry out the plan described in 
clause (i); and 
(iii) hire personnel to assist the director in 
carrying out the policy, program, and adminis-
trative activities related to the duties under 
clauses (i) and (ii); 
(B) provide advice to the Attorney General 
on elder justice issues; and 
(C) coordinate activities with the Senior 
Counsel on Elder Justice. 
(3) REPORTING RELATIONSHIP.—The Director 
of the Office of Elder Justice shall have the same
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reporting relationship with the Attorney General and 
the Assistant Attorney General, Office of Justice 
Programs, as the directors of the other offices head-
ed by presidential appointees within the Office of 
Justice Programs. 
(4) COMPENSATION.—The Director shall be 
compensated at a rate that shall not exceed the rate 
established for level I of the Executive Schedule 
under section 5312 of title 5, United States Code. 
(c) SENIOR COUNSEL.—
(1) APPOINTMENT.—The Attorney General 
shall appoint a Senior Counsel on Elder Justice, 
from among individuals with experience and exper-
tise in elder justice issues. 
(2) DUTIES.—The Senior Counsel on Elder 
Justice shall—
(A) coordinate elder justice activities 
among—
(i) the Office of Elder Justice; 
(ii) other offices (including bureaus) 
within the Office of Justice Programs that 
are involved with elder justice issues;
(iii) litigating divisions with cases re-
lating to elder justice matters;
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(iv) the Executive Office of United 
States Attorneys and the United States 
Attorneys’ offices; and 
(v) any other office or division of the 
Department of Justice that the Attorney 
General considers appropriate for such co-
ordination; and 
(B) provide advice to the Attorney General 
on elder justice issues. 
(3) LOCATION.—The Senior Counsel on Elder 
Justice shall be located in—
(A) the Office of the Attorney General; 
(B) the Office of the Deputy Attorney 
General; or 
(C) the Office of the Associate Attorney 
General. 
(4) POSITION.—The position of the Senior 
Counsel on Elder Justice shall be a Senior Executive 
Service position, as defined in section 3132 of title 
5, United States Code. 
(5) STAFF.—The Senior Counsel on Elder Jus-
tice may appoint and terminate 1 full-time employee 
to enable the Senior Counsel to perform the duties 
described in paragraph (2). The Senior Counsel on 
Elder Justice may fix the compensation of the em-
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ployee in accord with chapter 51 and subchapter III 
of chapter 53 of title 5, United States Code, relating 
to classification of positions and General Schedule 
pay rates. 
(6) RELATION TO OTHER LAW.—The positions 
described in paragraphs (4) and (5), and the salary 
for the positions, shall be in addition to the total 
number of positions and the total amount of salary 
provided for in Public Law 107–77. 
SEC. 204. GRANTS UNDER THE SOCIAL SECURITY ACT. 
The Attorney General is authorized to award grants 
under subsections (a), (c)(1), (c)(2), (d), (e)(1), (f), (h), 
and (i) of section 2222 and under section 2224 of the So-
cial Security Act in accordance with such subsections. 
SEC. 205. VICTIM ADVOCACY GRANTS. 
(a) GRANTS AUTHORIZED.—The Attorney General, 
after consultation with the Secretary of Health and 
Human Services, may award grants to eligible entities to 
study the special needs of victims of elder abuse, neglect, 
and exploitation. 
(b) AUTHORIZED ACTIVITIES.—Funds awarded pur-
suant to subsection (a) shall be used for pilot programs 
that develop programs, provide training to health care, so-
cial and protective services providers, law enforcement, fi-
duciaries including guardians, judges and court personnel,
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and victim advocates, and examine special approaches de-
signed to meet the needs of victims of elder abuse, neglect, 
and exploitation. 
SEC. 206. SUPPORTING LOCAL PROSECUTORS IN ELDER 
JUSTICE MATTERS. 
(a) GRANT AUTHORIZED.—The Attorney General, 
after consultation with the Director of Office of Elder Jus-
tice in the Department of Health and Human Services, 
shall award grants to provide training, technical assist-
ance, policy development, multidisciplinary coordination, 
and other types of support to local prosecutors, handling 
elder justice-related cases, including the funding of spe-
cially designated elder justice positions or units, or fund-
ing the creation of a Center for the Prosecution of Elder 
Abuse, Neglect, and Exploitation by the American Pros-
ecutor Research Institute of the National District Attor-
neys Association, or other similarly situated entity to ad-
vise and support local prosecutors nationwide in their pur-
suit of cases involving elder abuse, neglect, and exploi-
tation. 
(b) DUTIES.—The Center created under subsection 
(a) shall, among other things—
(1) collaborate with experts in elder abuse, ne-
glect, and exploitation;
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(2) collaborate with the Advisory Board created 
by section 2214 of the Social Security Act; and 
(3) provide local prosecutors and personnel as-
sisting such prosecutors with training, technical as-
sistance, multidisciplinary teams and input, in the 
handling, prevention and prosecution of, and special 
circumstances surrounding elder abuse, neglect, and 
exploitation. 
SEC. 207. SUPPORTING STATE PROSECUTORS IN ELDER 
JUSTICE MATTERS. 
(a) IN GENERAL.—The Attorney General shall, after 
consultation with the Secretary of Health and Human 
Services, award grants to provide training, technical as-
sistance, multidisciplinary coordination, policy develop-
ment, and other types of support to State prosecutors, in-
cluding employees of State Attorneys General and Med-
icaid Fraud Control Units, handling elder justice-related 
matters. 
(b) CREATING
SPECIALIZED
POSITIONS.—Grants 
under this section may be made for—
(1) the establishment of specially designated 
elder justice positions or units; or 
(2) the creation of a position to coordinate elder 
justice-related cases, training, technical assistance, 
and policy development for State prosecutors, by the
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‘‘(C) any entity that owns, directly or indi-
rectly, a controlling interest or a 50 percent or 
greater interest in 1 or more nursing facilities. 
‘‘(2) NEGLECT.—The term ‘neglect’ means the 
failure of a caregiver (as defined in section 2201 of 
the Social Security Act) to provide the goods or 
services that are necessary to avoid physical harm, 
disability, mental anguish, or mental illness. 
‘‘(3) NURSING
FACILITY.—The term ‘nursing 
facility’ means both a nursing facility (as defined in 
section 1919(a) of the Social Security Act) and a 
skilled nursing facility as defined in section 1819(a) 
of the Social Security Act (42 U.S.C. 1395i–3(a). 
‘‘(4) PERSON.—The term ‘person’ has the same 
meaning as in section 921(a)(1) of this title. 
‘‘(b) OFFENSE.—
‘‘(1) IN GENERAL.—It shall be unlawful for any 
person or entity to, with the intent to cause injury 
or with reckless disregard for the safety of human
life, act or fail to act, if such act or omission results 
in—
‘‘(A) serious bodily injury to 1 or more 
residents of a nursing facility; and 
‘‘(B) abuse or neglect of an additional 2 or 
more residents of the same nursing facility.