I 
110TH CONGRESS 
1ST SESSION H. R. 3078 
To amend titles XVIII and XIX of the Social Security Act to require screen-
ing, including national criminal history background checks, of direct 
patient access employees of skilled nursing facilities, nursing facilities, 
and other long-term care facilities and providers, and to provide for 
nationwide expansion of the pilot program for National and State back-
ground checks on direct patient access employees of long-term care 
facilities or providers. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 18, 2007 
Mr. MAHONEY of Florida (for himself, Mr. EMANUEL, Mrs. BOYDA of Kansas, 
and Mr. KLEIN of Florida) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce, and in addition to 
the Committees on Ways and Means and the Judiciary, for a period to 
be subsequently determined by the Speaker, in each case for consider-
ation 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 require screening, including national criminal history 
background checks, of direct patient access employees 
of skilled nursing facilities, nursing facilities, and other 
long-term care facilities and providers, and to provide 
for nationwide expansion of the pilot program for Na-
tional and State background checks on direct patient 
access employees of long-term care facilities or providers. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Patient Safety and 
Abuse Prevention Act of 2007’’. 
SEC. 2. FINDINGS AND PURPOSES. 
(a) FINDINGS.—Congress makes the following find-
ings: 
(1) Frail elders are a highly vulnerable popu-
lation who often lack the ability to give consent or 
defend themselves. Since the best predictor of future 
behavior is past behavior, individuals with histories 
of abuse pose a definite risk to patients and resi-
dents of long-term care facilities. 
(2) Every month, there are stories in the media 
of health care employees who commit criminal mis-
conduct on the job and are later found, through a 
background check conducted after the fact, to have 
a history of convictions for similar crimes. 
(3) A 2006 study conducted by the Department 
of Health and Human Services determined that— 
(A) criminal background checks are a valu-
able tool for employers during the hiring proc-
ess; 
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(B) the use of criminal background checks 
during the hiring process does not limit the pool 
of potential job applicants; 
(C) ‘‘a correlation exists between criminal 
history and incidences of abuse’’; and 
(D) the long-term care industry supports 
the practice of conducting background checks 
on potential employees in order to reduce the 
likelihood of hiring someone who has potential 
to harm residents. 
(4) In 2005, the Michigan Attorney General 
found that 10 percent of employees who were then 
providing services to frail elders had criminal back-
grounds. 
(5) In 2004, the staffs of State Adult Protec-
tive Services agencies received more than 500,000 
reports of elder and vulnerable adult abuse, and an 
ombudsman report concluded that more than 15,000 
nursing home complaints involved abuse, including 
nearly 4,000 complaints of physical abuse, more 
than 800 complaints of sexual abuse, and nearly 
1,000 complaints of financial exploitation; 
(6) The Department of Health and Human 
Services has determined that while 41 States now 
require criminal background checks on certified 
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nurse aides prior to employment, only half of those 
(22) require criminal background checks at the Fed-
eral level. 
(b) PURPOSES.—The purposes of this Act are to— 
(1) create a coordinated, nationwide system of 
State criminal background checks that would greatly 
enhance the chances of identifying individuals with 
problematic backgrounds who move across State 
lines; 
(2) stop individuals who have a record of sub-
stantiated abuse, or a serious criminal record, from 
preying on helpless elders and individuals with dis-
abilities; and 
(3) provide assurance to long-term care employ-
ers and the residents they care for that potentially 
abusive workers will not be hired into positions of 
providing services to the extremely vulnerable resi-
dents of our Nation’s long-term care facilities. 
SEC. 3. NATIONWIDE EXPANSION OF PILOT PROGRAM FOR 
NATIONAL 
AND 
STATE 
BACKGROUND 
CHECKS ON DIRECT PATIENT ACCESS EM-
PLOYEES OF LONG-TERM CARE FACILITIES 
OR PROVIDERS. 
Section 307 of the Medicare Prescription Drug, Im-
provement, and Modernization Act of 2003 (42 U.S.C. 
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1395aa note) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(h) NATIONWIDE EXPANSION PROGRAM.— 
‘‘(1) IN GENERAL.—Beginning on the date of 
enactment of the Patient Safety and Abuse Preven-
tion Act of 2007, the Secretary shall expand the 
pilot program under this section to be conducted on 
a nationwide basis (in this subsection, such ex-
panded pilot program shall be referred to as the ‘na-
tionwide expansion program’). Except for the fol-
lowing modifications, the provisions of this section 
shall apply to the nationwide expansion program: 
‘‘(A) AGREEMENTS.— 
‘‘(i) 
NEWLY
PARTICIPATING 
STATES.—The Secretary shall enter into 
agreements with each State— 
‘‘(I) that the Secretary has not 
entered into an agreement with under 
subsection (c)(1); 
‘‘(II) that agrees to conduct 
background checks under the nation-
wide expansion program on a State-
wide basis; and 
‘‘(III) that submits an applica-
tion to the Secretary containing such 
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information and at such time as the 
Secretary may specify. 
‘‘(ii) CERTAIN
PREVIOUSLY
PARTICI-
PATING
STATES.—The 
Secretary 
shall 
enter into agreements with each State— 
‘‘(I) that the Secretary has en-
tered into an agreement with under 
subsection (c)(1) in the case where 
such agreement did not require the 
State to conduct background checks 
under the pilot program established 
under subsection (a) on a Statewide 
basis; 
‘‘(II) that agrees to conduct 
background checks under the nation-
wide expansion program on a State-
wide basis; and 
‘‘(III) that submits an applica-
tion to the Secretary containing such 
information and at such time as the 
Secretary may specify. 
‘‘(B) NONAPPLICATION OF SELECTION CRI-
TERIA.—The selection criteria required under 
subsection (c)(3)(B) shall not apply. 
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‘‘(C) REQUIRED FINGERPRINT CHECK AS 
PART
OF
CRIMINAL
HISTORY
BACKGROUND 
CHECK.—The procedures established under sub-
section (b)(1) shall require that the facility or 
provider obtain State and national criminal his-
tory background checks on the prospective em-
ployee utilizing a search of State and Federal 
criminal history records and including a finger-
print check using the Integrated Automated 
Fingerprint Identification System of the Fed-
eral Bureau of Investigation. 
‘‘(D) PAYMENTS.— 
‘‘(i) 
NEWLY
PARTICIPATING 
STATES.— 
‘‘(I) IN
GENERAL.—As part of 
the application submitted by a State 
under subparagraph (A)(i)(III), the 
State shall guarantee, with respect to 
the costs to be incurred by the State 
in carrying out the nationwide expan-
sion program, that the State will 
make available (directly or through 
donations from public or private enti-
ties) a particular amount of non-Fed-
eral contributions. 
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‘‘(II) 
FEDERAL
MATCH.—The 
payment amount to each State that 
the Secretary enters into an agree-
ment with under subparagraph (A)(i) 
shall be 3 times the amount that the 
State guarantees to make available 
under subclause (I), except that in no 
case may the payment amount exceed 
$3,000,000. 
‘‘(ii) 
PREVIOUSLY
PARTICIPATING 
STATES.— 
‘‘(I) IN
GENERAL.—As part of 
the application submitted by a State 
under subparagraph (A)(ii)(III), the 
State shall guarantee, with respect to 
the costs to be incurred by the State 
in carrying out the nationwide expan-
sion program, that the State will 
make available (directly or through 
donations from public or private enti-
ties) a particular amount of non-Fed-
eral contributions. 
‘‘(II) 
FEDERAL
MATCH.—The 
payment amount to each State that 
the Secretary enters into an agree-
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ment with under subparagraph (A)(ii) 
shall be 3 times the amount that the 
State guarantees to make available 
under subclause (I), except that in no 
case may the payment amount exceed 
$1,500,000. 
‘‘(iii) NO RESERVATION FOR EVALUA-
TION.—There shall be no reservation of 
any portion of the payment amount pro-
vided under clauses (i) or (ii) for con-
ducting an evaluation. 
‘‘(E) EVALUATIONS AND REPORT.— 
‘‘(i) EVALUATIONS.—The Inspector 
General of the Department of Health and 
Human Services shall conduct an annual 
evaluation of the nationwide expansion 
program in each of calendar years 2008 
and 2009. 
‘‘(ii) REPORTS.—Not later than 6 
months after completion of the second year 
of the nationwide expansion program, the 
Inspector General of the Department of 
Health and Human Services shall submit a 
report to Congress containing the results 
of the annual evaluations conducted under 
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clause (i), together with recommendations 
for the implementation of the requirements 
of sections 1819(b)(9) and 1919(b)(9) of 
the Social Security Act, as added by sec-
tion (3)(a) of the Patient Safety and 
Abuse Prevention Act of 2007. 
‘‘(2) FUNDING.— 
‘‘(A) NOTIFICATION.—The Secretary shall 
notify the Secretary of the Treasury of the 
amount necessary to carry out the nationwide 
expansion program under this subsection for 
the period of fiscal years 2008 through 2010, 
except that in no case shall such amount exceed 
$156,000,000. 
‘‘(B) TRANSFER OF FUNDS.—Out of any 
funds in the Treasury not otherwise appro-
priated, the Secretary of the Treasury shall 
provide for the transfer to the Secretary of the 
amount specified as necessary to carry out the 
nationwide expansion program under subpara-
graph (A).’’. 
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SEC. 4. BACKGROUND CHECKS ON DIRECT PATIENT AC-
CESS EMPLOYEES OF LONG-TERM CARE FA-
CILITIES AND PROVIDERS. 
(a) SCREENING OF SKILLED NURSING FACILITY AND 
NURSING FACILITY EMPLOYEE APPLICANTS.— 
(1) MEDICARE PROGRAM.— 
(A) IN GENERAL.—Section 1819(b) of the 
Social Security Act (42 U.S.C. 1395i–3(b)) is 
amended by adding at the end the following 
new paragraph: 
‘‘(9) SCREENING OF DIRECT PATIENT ACCESS 
EMPLOYEES.— 
‘‘(A) SCREENING AND CRIMINAL HISTORY 
BACKGROUND CHECKS ON APPLICANTS.— 
‘‘(i) SCREENING.—Beginning on Jan-
uary 1, 2011, before hiring a direct patient 
access employee, a skilled nursing facility 
shall screen the employee for any disquali-
fying information in accordance with such 
procedures as the State shall establish 
through a search of— 
‘‘(I) State-based abuse and ne-
glect registries and databases, includ-
ing the abuse and neglect registries 
and databases of another State in the 
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case where a prospective employee 
previously resided in that State; and 
‘‘(II) criminal records and the 
records of any proceedings that may 
contain 
disqualifying 
information 
about applicants, such as proceedings 
conducted by State professional licens-
ing and disciplinary boards and State 
medicaid fraud control units. 
‘‘(ii) 
CRIMINAL
HISTORY
BACK-
GROUND CHECKS.—As part of such screen-
ing, the skilled nursing facility shall re-
quest that the State agency designated 
under subsection (e)(6)(E) oversee the co-
ordination of a State and national criminal 
history background check that utilizes a 
search of State and Federal criminal his-
tory records and includes a fingerprint 
check using the Integrated Automated Fin-
gerprint Identification System of the Fed-
eral Bureau of Investigation. 
‘‘(iii) USE
OF
PROCEDURES
PRE-
VIOUSLY
ESTABLISHED.—Nothing in this 
paragraph shall be construed as preventing 
a State from using procedures established 
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for purposes of the pilot program for Na-
tional and State background checks on di-
rect patient access employees of long-term 
care facilities or providers under section 
307 of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 
2003, or the nationwide expansion pro-
gram under subsection (h) of such section, 
to satisfy the requirements of paragraph 
(6). 
‘‘(B) PROHIBITION ON HIRING OF ABUSIVE 
WORKERS.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), a skilled nursing facility may not 
knowingly employ any direct patient access 
employee who has any disqualifying infor-
mation 
(as 
defined 
in 
subparagraph 
(F)(ii)). 
‘‘(ii) PROVISIONAL
EMPLOYMENT.— 
Subject to clause (iii), the State may per-
mit a skilled nursing facility to provide for 
a provisional period of employment (not to 
exceed 30 days) for a direct patient access 
employee— 
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‘‘(I) pending completion of the 
screening and background check re-
quired under subparagraph (A); and 
‘‘(II) in the case where the em-
ployee has appealed the results of 
such screening and background check, 
pending completion of the appeals 
process. 
‘‘(iii) 
SUPERVISION.—The 
facility 
shall maintain direct on-site supervision of 
the employee during such provisional pe-
riod of employment. 
‘‘(C) PROCEDURES.— 
‘‘(i) IN
GENERAL.—The procedures 
established by the State under subpara-
graph (A) shall be designed to accomplish 
the following: 
‘‘(I) Give a prospective direct pa-
tient access employee notice that the 
skilled nursing facility is required to 
perform background checks with re-
spect to new employees, including a 
fingerprint check as part of the na-
tional criminal history background 
check conducted under subparagraph 
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(A)(ii) in the case of any new em-
ployee who does not have a certificate 
indicating that a fingerprint check has 
been completed and has not found any 
disqualifying 
information 
(as 
de-
scribed in subclause (V)). 
‘‘(II) Require, as a condition of 
employment, that the employee— 
‘‘(aa) 
provide 
a 
written 
statement disclosing any disquali-
fying information; 
‘‘(bb) provide a statement 
signed by the employee author-
izing the facility to request a 
background check that includes a 
search of the registries and data-
bases described in clause (i)(I) of 
subparagraph 
(A) 
and 
the 
records described in clause (i)(II) 
of such subparagraph and a 
criminal 
history 
background 
check conducted in accordance 
with clause (ii) of such subpara-
graph that includes a fingerprint 
check using the Integrated Auto-
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mated Fingerprint System of the 
Federal Bureau of Investigation; 
‘‘(cc) provide the facility 
with a rolled set of the employ-
ee’s fingerprints or submit to 
being fingerprinted; and 
‘‘(dd) 
provide 
any 
other 
identification 
information 
the 
State may require. 
‘‘(III) Require the skilled nursing 
facility to check any available reg-
istries that would be likely to contain 
disqualifying information about a pro-
spective employee, including the reg-
istries and databases described in sub-
clause (I) of subparagraph (A)(i) and 
the records described in clause (II) of 
such subparagraph. 
‘‘(IV) Provide a prospective di-
rect patient access employee the op-
portunity to request a copy of the re-
sults of the background check con-
ducted with respect to such employee 
and to correct any errors by providing 
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appropriate documentation to the 
State and the facility. 
‘‘(V) Upon completion of a fin-
gerprint check as part of the national 
criminal history background check 
conducted with respect to a direct pa-
tient access employee under subpara-
graph (A)(ii), provide the skilled nurs-
ing facility and the direct patient ac-
cess employee with a certificate indi-
cating that such fingerprint check has 
been completed and no disqualifying 
information was found. Such certifi-
cate shall— 
‘‘(aa) be valid for 2 years; 
and 
‘‘(bb) in the case where such 
direct patient access employee is 
hired by any other skilled nursing 
facility located in the State dur-
ing such 2-year period, satisfy 
the requirement that such facility 
have a fingerprint check con-
ducted as part of such national 
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criminal 
history 
background 
check. 
‘‘(ii) ELIMINATION OF UNNECESSARY 
CHECKS.—The procedures established by 
the State under subparagraph (A) shall 
permit a skilled nursing facility to termi-
nate the background check at any stage at 
which the facility obtains disqualifying in-
formation regarding a prospective direct 
patient access employee. 
‘‘(iii) DEVELOPMENT OF MODEL FORM 
OF CERTIFICATE.—The Secretary shall de-
velop a model form of the certificate de-
scribed in clause (i)(V) that States may 
use to satisfy the requirements of such 
clause. 
‘‘(D) USE
OF
INFORMATION; IMMUNITY 
FROM LIABILITY.— 
‘‘(i) USE OF INFORMATION.—A skilled 
nursing facility that obtains information 
about a direct patient access employee pur-
suant to screening or a criminal history 
background check shall use such informa-
tion only for the purpose of determining 
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