I
105TH CONGRESS
2D SESSION
H. R. 4686
To amend titles XI, XVIII, and XIX of the Social Security Act to permit
paid staff other than nurse aides and licensed health professionals to
provide feeding and hydration assistance to residents in nursing facilities
participating in the Medicare and Medicaid Programs (and to provide
special training requirements for such staff), and to establish a program
to ensure that such facilities do not employ individuals who have a
history of patient or resident abuse or have been convicted of certain
crimes.
IN THE HOUSE OF REPRESENTATIVES
OCTOBER 2, 1998
Mr. KENNEDY of Massachusetts (for himself, Mr. BARRETT of Wisconsin, Mr.
HASTINGS of Florida, Mr. COSTELLO, Mr. FILNER, Mr. WAXMAN, Ms.
KILPATRICK, Mr. STARK, Mr. KENNEDY of Rhode Island, Mr. NEAL of
Massachusetts, Ms. SLAUGHTER, Mr. SANDLIN, Mr. UNDERWOOD, Mr.
MEEHAN, and Ms. ROYBAL-ALLARD) introduced the following bill; which
was referred to the Committee on Commerce, and in addition to the Com-
mittee on Ways and Means, for a period to be subsequently determined
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 XI, XVIII, and XIX of the Social Security
Act to permit paid staff other than nurse aides and
licensed health professionals to provide feeding and hy-
dration assistance to residents in nursing facilities par-
ticipating in the Medicare and Medicaid Programs (and
to provide special training requirements for such staff),
and to establish a program to ensure that such facilities
HR 4686 IH
do not employ individuals who have a history of patient
or resident abuse or have been convicted of certain
crimes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
That this Act may be cited as the ‘‘Long-Term Care Pa-
tient Protection Act of 1998’’.
SEC. 2. SPECIAL REQUIREMENTS FOR INDIVIDUALS PRO-
VIDING FEEDING AND HYDRATION ASSIST-
ANCE TO NURSING FACILITY RESIDENTS AND
SKILLED NURSING FACILITY PATIENTS.
(a) MEDICAID PROGRAM.—Section 1919 of the Social
Security Act is amended—
(1) in subsection (b)—
(A) in paragraph (5)(F)—
(i) by striking the period and insert-
ing ’’, or’’; and
(ii) by adding at the end the following
new clause:
‘‘(iii) who is described in paragraph
(8)(B).’’; and
(B) by adding at the end the following new
paragraph:
‘‘(8) REQUIRED
TRAINING
OF
FEEDING
AND
HYDRATION ASSISTANTS.—
HR 4686 IH
‘‘(A) IN
GENERAL.—A nursing facility
must not use on a full-time or other paid basis
any individual as a feeding and hydration as-
sistant in the facility unless the individual—
‘‘(i) has completed a feeding and hy-
dration assistance training and competency
evaluation program approved by the State
under subsection (e)(8), and
‘‘(ii) is competent to provide feeding
and hydration services.
‘‘(B) FEEDING
AND
HYDRATION
ASSIST-
ANT
DEFINED.—In this paragraph, the term
‘feeding and hydration assistant’ means any in-
dividual who assists residents in a nursing facil-
ity to eat or drink but does not otherwise pro-
vide any nursing or nursing-related services to
such residents, but does not include an individ-
ual—
‘‘(i) who is a licensed health profes-
sional (as defined in paragraph (5)(G)) or
a registered dietician,
‘‘(ii) who volunteers to provide such
services without monetary compensation,
or
HR 4686 IH
‘‘(iii) who is a nurse aide (as defined
in paragraph (5)(F)).’’;
(2) in subsection (e), by adding at the end the
following new paragraph:
‘‘(8) SPECIFICATION AND REVIEW OF FEEDING
AND HYDRATION ASSISTANCE TRAINING AND COM-
PETENCY
EVALUATION
PROGRAMS.—The 
State
must—
‘‘(A) specify those training and competency
evaluation programs that the State approves for
purposes of subsection (b)(8) and that meet the
requirements 
established 
under 
subsection
(f)(10), which shall at a minimum include
training concerning—
‘‘(i) recommended amounts of food
and hydration,
‘‘(ii) methods of providing food and
hydration, and
‘‘(iii) recognition of symptoms of mal-
nutrition and dehydration; and
‘‘(B) provide for the review and reapproval
of such programs, at a frequency and using a
methodology consistent with the requirements
established under subsection (f)(10)(B).
HR 4686 IH
The failure of the Secretary to establish require-
ments under subsection (f)(10) shall not relieve any
State of its responsibility under this paragraph.’’;
and
(3) in subsection (f), by adding at the end the
following new paragraph:
‘‘(10) REQUIREMENTS FOR FEEDING AND HY-
DRATION ASSISTANCE TRAINING AND EVALUATION
PROGRAMS.—For purposes of subsections (b)(8) and
(e)(8), the Secretary shall establish—
‘‘(A) requirements for the approval of feed-
ing and hydration assistance training and com-
petency evaluation programs; and
‘‘(B) requirements respecting the minimum
frequency and methodology to be used by a
State in reviewing such programs’ compliance
with the requirements for such programs.’’.
(b) MEDICARE PROGRAM.—Section 1819 of such Act
is amended—
(1) in subsection (b)—
(A) in paragraph (5)(F)—
(i) by striking ‘‘or’’ at the end of
clause (i);
(ii) by striking the period at the end
of clause (ii) and inserting ‘‘, or’’; and
HR 4686 IH
(iii) by adding at the end the follow-
ing new clause:
‘‘(iii) who is described in paragraph
(8)(B).’’; and
(B) by adding at the end the following new
paragraph:
‘‘(8) REQUIRED
TRAINING
OF
FEEDING
AND
HYDRATION ASSISTANTS.—
‘‘(A) IN GENERAL.—A skilled nursing fa-
cility must not use on a full-time or other paid
basis any individual as a feeding and hydration
assistant in the facility unless the individual—
‘‘(i) has completed a feeding and hy-
dration assistance training and competency
evaluation program approved by the State
under subsection (e)(6), and
‘‘(ii) is competent to provide feeding
and hydration services.
‘‘(B) FEEDING
AND
HYDRATION
ASSIST-
ANT
DEFINED.—In this paragraph, the term
‘feeding and hydration assistant’ means any in-
dividual that assists residents in a skilled nurs-
ing facility to eat or drink but does not other-
wise provide any nursing or nursing-related
HR 4686 IH
services to such residents, but does not include
an individual—
‘‘(i) who is a licensed health profes-
sional (as defined in paragraph (5)(G)) or
a registered dietician,
‘‘(ii) who volunteers to provide such
services without monetary compensation,
or
‘‘(iii) who is a nurse aide (as defined
in paragraph (5)(F)).’’;
(2) in subsection (e), by adding at the end the
following new paragraph:
‘‘(6) SPECIFICATION AND REVIEW OF FEEDING
AND HYDRATION ASSISTANCE TRAINING AND COM-
PETENCY
EVALUATION
PROGRAMS.—The 
State
must—
‘‘(A) specify those training and competency
evaluation programs that the State approves for
purposes of subsection (b)(8) and that meet the
requirements 
established 
under 
subsection
(f)(8), which shall at a minimum include train-
ing concerning—
‘‘(i) recommended amounts of food
and hydration,
HR 4686 IH
‘‘(ii) methods of providing food and
hydration, and
‘‘(iii) recognition of symptoms of mal-
nutrition and dehydration; and
‘‘(B) provide for the review and reapproval
of such programs, at a frequency and using a
methodology consistent with the requirements
established under subsection (f)(8)(B).
The failure of the Secretary to establish require-
ments under subsection (f)(8) shall not relieve any
State of its responsibility under this paragraph.’’;
and
(3) in subsection (f), by adding at the end the
following new paragraph:
‘‘(8) REQUIREMENTS FOR FEEDING AND HY-
DRATION ASSISTANCE TRAINING AND EVALUATION
PROGRAMS.—For purposes of subsections (b)(8) and
(e)(6), the Secretary shall establish—
‘‘(A) requirements for the approval of feed-
ing and hydration assistance training and com-
petency evaluation programs; and
‘‘(B) requirements respecting the minimum
frequency and methodology to be used by a
State in reviewing such programs’ compliance
with the requirements for such programs.’’.
HR 4686 IH
SEC. 3. ESTABLISHMENT OF PROGRAM TO PREVENT ABUSE
OF NURSING FACILITY RESIDENTS.
(a) NURSING FACILITY AND SKILLED NURSING FA-
CILITY REQUIREMENTS.—
(1) MEDICAID PROGRAM.—Section 1919(b), as
amended by section 2(a), is amended by adding after
paragraph (8) 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 an individual, a nursing facility
shall—
‘‘(i) give the individual 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 individual—
‘‘(I) provide a written statement
disclosing any conviction for a rel-
evant crime or finding of patient or
resident abuse;
‘‘(II) provide a statement signed
by the individual authorizing the facil-
HR 4686 IH
ity to request the search and exchange
of criminal records;
‘‘(III) provide in person a copy of
the individual’s fingerprints; and
‘‘(IV) provide any other identi-
fication information the Secretary
may specify in regulation;
‘‘(iii) initiate a check of the registry
under section 1128F in accordance with
regulations promulgated by the Secretary
to determine whether such registry con-
tains any disqualifying information with
respect to such individual; and
‘‘(iv) if such registry does not contain
any such disqualifying information—
‘‘(I) request that the State initi-
ate a State and national criminal
background check on such individual
in accordance with the provisions of
subsection (e)(9); and
‘‘(II) furnish to the State the in-
formation described in subclauses (II)
through (IV) of clause (ii) not more
than 7 days (excluding Saturdays,
Sundays, and legal public holidays
HR 4686 IH
under section 6103(a) of title 5,
United States Code) after completion
of the check against the registry initi-
ated under clause (iii).
‘‘(B) PROHIBITION ON HIRING OF ABUSIVE
WORKERS.—
‘‘(i) IN GENERAL.—A nursing facility
may not knowingly employ any individual
who has any conviction for a relevant
crime or with respect to whom a finding of
patient or resident abuse has been made.
‘‘(ii) PROBATIONARY EMPLOYMENT.—
After complying with the requirements of
clauses (i), (ii), and (iii) of subparagraph
(A), a nursing facility may provide for a
probationary period of employment (not to
exceed 90 days) for an individual pending
completion of the check against the reg-
istry described under subparagraph (A)(iii)
and the background check described under
subparagraph (A)(iv). Such facility shall
maintain supervision of the individual dur-
ing the individual’s probationary period of
employment.
HR 4686 IH
‘‘(C) 
REPORTING
REQUIREMENTS.—A
nursing facility shall report to the State any in-
stance, in which the facility determines that an
individual has committed an act of resident ne-
glect or abuse or misappropriation of resident
property in the course of employment by the fa-
cility.
‘‘(D) USE OF INFORMATION.—
‘‘(i) IN GENERAL.—A nursing facility
that obtains information about an individ-
ual pursuant to clauses (iii) and (iv) of
subparagraph (A) may use such informa-
tion only for the purpose of determining
the suitability of the individual for employ-
ment.
‘‘(ii) IMMUNITY FROM LIABILITY.—A
nursing facility that, in denying employ-
ment for an applicant, reasonably relies
upon information about an individual pro-
vided by the State pursuant to subsection
(e)(9) shall not be liable in any action
brought by the individual based on the em-
ployment determination resulting from the
incompleteness or inaccuracy of the infor-
mation.
HR 4686 IH
‘‘(iii) CRIMINAL
PENALTY.—Whoever
knowingly violates the provisions of sub-
paragraph (D)(i) shall be fined in accord-
ance with title 18, United States Code, im-
prisoned for not more than 2 years, or
both.
‘‘(E) DEFINITIONS.—As used in this para-
graph—
‘‘(i) the term ‘conviction for a relevant
crime’ means any State or Federal crimi-
nal 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;
‘‘(ii) the term ‘finding of patient or
resident abuse’ means any substantiated
finding by a State agency under subsection
(g)(1)(C) or a Federal agency that an indi-
vidual has committed—
‘‘(I) an act of patient or resident
abuse or neglect or a misappropriation
of patient or resident property; or
HR 4686 IH
‘‘(II) such other types of acts as
the Secretary may specify in regula-
tions; and
‘‘(iii) the term ‘disqualifying informa-
tion’ means information about a conviction
for a relevant crime or a finding of patient
or resident abuse.’’.
(2) MEDICARE PROGRAM.—Section 1819(b), as
amended by section 2(b), is amended by adding after
paragraph (8) 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 an individual, a skilled nursing facil-
ity shall—
‘‘(i) give the individual 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 individual—
‘‘(I) provide a written statement
disclosing any conviction for a rel-
HR 4686 IH
evant crime or finding of patient or
resident abuse;
‘‘(II) provide a statement signed
by the individual authorizing the facil-
ity to request the search and exchange
of criminal records;
‘‘(III) provide in person a copy of
the individual’s fingerprints; and
‘‘(IV) provide any other identi-
fication information the Secretary
may specify in regulation;
‘‘(iii) initiate a check of the registry
under section 1128F in accordance with
regulations promulgated by the Secretary
to determine whether such registry con-
tains any disqualifying information with
respect to such individual; and
‘‘(iv) if such registry does not contain
any such disqualifying information—
‘‘(I) request that the State initi-
ate a State and national criminal
background check on such individual
in accordance with the provisions of
subsection (e)(7); and
HR 4686 IH
‘‘(II) furnish to the State the in-
formation described in subclauses (II)
through (IV) of clause (ii) not more
than 7 days (excluding Saturdays,
Sundays, and legal public holidays
under section 6103(a) of title 5,
United States Code) after completion
of the check against the registry initi-
ated under clause (iii).
‘‘(B) PROHIBITION ON HIRING OF ABUSIVE
WORKERS.—
‘‘(i) IN GENERAL.—A skilled nursing
facility may not knowingly employ any in-
dividual who has any conviction for a rel-
evant crime or with respect to whom a
finding of patient or resident abuse has
been made.
‘‘(ii) PROBATIONARY EMPLOYMENT.—
After complying with the requirements of
clauses (i), (ii), and (iii) of subparagraph
(A), a skilled nursing facility may provide
for a probationary period of employment
(not to exceed 90 days) for an individual
pending completion of the check against
the registry described under subparagraph
HR 4686 IH
(A)(iii) and the background check de-
scribed under subparagraph (A)(iv). Such
facility shall maintain supervision of the
individual during the individuals’s proba-
tionary period of employment.
‘‘(C) 
REPORTING
REQUIREMENTS.—A
skilled nursing facility shall report to the State
any instance in which the facility determines
that an individual has committed an act of resi-
dent 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 an
individual pursuant to clauses (iii) and (iv)
of subparagraph (A) may use such infor-
mation only for the purpose of determining
the suitability of the individual for employ-
ment.
‘‘(ii) IMMUNITY FROM LIABILITY.—A
skilled nursing facility that, denying em-
ployment for an applicant, reasonably re-
lies upon information about an individual
provided by the State pursuant to sub-
HR 4686 IH
section (e)(9) shall not be liable in any ac-
tion brought by the individual based on the
employment determination resulting from
the incompleteness or inaccuracy of the in-
formation.
‘‘(iii) CRIMINAL
PENALTY.—Whoever
knowingly violates the provisions of sub-
paragraph (D)(i) shall be fined in accord-
ance with title 18, United States Code, im-
prisoned for not more than 2 years, or
both.
‘‘(E) DEFINITIONS.—As used in this para-
graph—
‘‘(i) the term ‘conviction for a relevant
crime’ means any State or Federal crimi-
nal 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;
‘‘(ii) the term ‘finding of patient or
resident abuse’ means any substantiated
finding by a State agency under subsection
HR 4686 IH
(g)(1)(C) or a Federal agency that an indi-
vidual has committed—
‘‘(I) an act of patient or resident
abuse or neglect or a misappropriation
of patient or resident property; or
‘‘(II) such other types of acts as
the Secretary may specify in regula-
tions; and
‘‘(iii) the term ‘disqualifying informa-
tion’ means information about a conviction
for a relevant crime or a finding of patient
or resident abuse.’’.
(b) STATE REQUIREMENTS.—
(1) MEDICAID PROGRAM.—
(A) EXPANSION OF STATE REGISTRY TO
COLLECT INFORMATION ABOUT NURSING FACIL-
ITY EMPLOYEES OTHER THAN NURSE AIDES.—
Section 1919, as amended by section 2(a), is
amended—
(i) in subsection (e)(2)—
(I) in the paragraph heading, by
striking ‘‘NURSE
AIDE
REGISTRY’’
and inserting ‘‘NURSING
FACILITY
EMPLOYEE REGISTER’’;
(II) in subparagraph (A)—
HR 4686 IH
(aa) by striking ‘‘By not
later than January 1, 1989, the’’
and inserting ‘‘The’’;
(bb) by striking ‘‘a registry
of all individuals’’ and inserting
‘‘a registry of (I) all individuals’’;
and
(cc) by inserting before the
period ‘‘, and (II) all other nurs-
ing facility employees with re-
spect to whom the State has
made a finding described in sub-
paragraph (B)’’;
(III) in subparagraph (B), by
striking ‘‘involving an individual listed
in the registry’’ and inserting ‘‘involv-
ing a nursing facility employee’’; and
(IV) in subparagraph (C), by
striking ‘‘nurse aide’’ and inserting
‘‘nursing facility employee or appli-
cant for employment’’; and
(ii) in subsection (g)(1)—
(I) in subparagraph (C)—
(aa) in the first sentence, by
striking ‘‘nurse aide’’ and insert-
HR 4686 IH
ing ‘‘nursing facility employee’’;
and
(bb) in the third sentence,
by striking ‘‘nurse aide’’ each
place it appears and inserting
‘‘nursing facility employee’’; and
(II) in subparagraph (D), by
striking ‘‘nurse aide’’ each place it ap-
pears and inserting ‘‘nursing facility
employee’’.
(B) STATE AND FEDERAL REQUIREMENT
TO
CONDUCT
BACKGROUND
CHECKS.—Section
1919(e), as amended by section 2(a), is amend-
ed by adding at the end the following new para-
graph:
‘‘(9) STATE
AND
FEDERAL
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)(9) that is accompanied by the infor-
mation described in subclauses (II) through
(IV) of subsection (b)(9)(A)(ii), a State, after
checking appropriate State records and finding
no disqualifying information (as defined in sub-
HR 4686 IH
section (b)(9)(E)), shall submit such request
and information to the Attorney General and
shall request the Attorney General to conduct
a search and exchange of records with respect
to the individual as described in subparagraph
(B).
‘‘(B) 
SEARCH
AND
EXCHANGE
OF
RECORDS BY ATTORNEY GENERAL.—Upon re-
ceipt of a submission pursuant to subparagraph
(A), the Attorney General shall direct a search
of the records of the Federal Bureau of Inves-
tigation for any criminal history records cor-
responding to the fingerprints or other positive
identification information submitted. The Attor-
ney General shall provide any corresponding in-
formation resulting from the search to the
State.
‘‘(C) STATE REPORTING OF INFORMATION
TO NURSING FACILITY.—Upon receipt of the in-
formation provided by the Attorney General
pursuant to subparagraph (B), the State
shall—
‘‘(i) review the information to deter-
mine whether the individual has any con-
HR 4686 IH
viction for a relevant crime (as defined in
subsection (b)(9)(E)); and
‘‘(ii) report to the nursing facility 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)(9) 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
HR 4686 IH
(b)(9), including fees charged by the
Attorney General, and for performing
the review and report required by sub-
paragraph (C). The amount of such
fee shall not exceed the actual cost of
such activities.
‘‘(ii) TREATMENT OF FEES FOR PUR-
POSES OF COST REPORTS.—An entity may
not include a fee assessed pursuant to this
subparagraph as an allowable item on a
cost report under this title or title XVIII.
‘‘(iii) 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.—In addition to the
Secretary’s authority to promulgate regulations
under this title, the Attorney General, in con-
sultation with the Secretary, may promulgate
such regulations as are necessary to carry out
the Attorney General’s responsibilities under
this paragraph and subsection (b)(9), including
regulations regarding the security, confidential-
HR 4686 IH
ity, accuracy, use, destruction, and dissemina-
tion of information, audits and recordkeeping,
and the imposition of fees.
‘‘(F) REPORT.—Not later than 2 years
after the date of enactment of the ‘‘Long-Term
Care Patient Protection Act of 1998’’, the At-
torney General shall submit a report to Con-
gress on the number of requests for searches
and exchanges of records made under this sec-
tion and the disposition of such requests.’’.
(2) MEDICARE PROGRAM.—
(A) EXPANSION OF STATE REGISTRY TO
COLLECT INFORMATION ABOUT SKILLED NURS-
ING FACILITY EMPLOYEES OTHER THAN NURSE
AIDES.—Section 1819, as amended by section
2(b), is amended—
(i) in subsection (e)(2)—
(I) in the paragraph heading, by
striking ‘‘NURSE AIDE REGISTRY’’ and
inserting ‘‘SKILLED
NURSING
CARE
EMPLOYEE REGISTRY’’;
(II) in subparagraph (A)—
(aa) by striking ‘‘By not
later than January 1, 1989, the’’
and inserting ‘‘The’’;
HR 4686 IH
(bb) by striking ‘‘a registry
of all individuals’’ and inserting
‘‘a registry of (I) all individuals’’;
and
(cc) by inserting before the
period ‘‘, and (II) all other
skilled nursing facility employees
with respect to whom the State
has made a finding described in
subparagraph (B)’’;
(III) in subparagraph (B), by
striking ‘‘involving an individual listed
in the registry’’ and inserting ‘‘involv-
ing a skilled nursing facility em-
ployee’’; and
(IV) in subparagraph (C), by
striking ‘‘nurse aide’’ and inserting
‘‘skilled nursing facility employee or
applicant for employment’’; and
(ii) in subsection (g)(1)—
(I) in subparagraph (C)—
(aa) in the first sentence, by
striking ‘‘nurse aide’’ and insert-
ing ‘‘skilled nursing facility em-
ployee’’; and
HR 4686 IH
(bb) in the third sentence,
by striking ‘‘nurse aide’’ each
place it appears and inserting
‘‘skilled 
nursing 
facility 
em-
ployee’’; and
(II) in subparagraph (D), by
striking ‘‘nurse aide’’ each place it ap-
pears and inserting ‘‘skilled nursing
facility employee’’.
(B) STATE AND FEDERAL REQUIREMENT
TO
CONDUCT
BACKGROUND
CHECKS.—Section
1819(e), as amended by section 2(b), is amend-
ed by adding at the end the following new para-
graph:
‘‘(7) STATE
AND
FEDERAL
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)(9) that is accompanied by the in-
formation described in subclauses (II) through
(IV) of subsection (b)(9)(A)(ii), a State, after
checking appropriate State records and finding
no disqualifying information (as defined in sub-
section (b)(9)(E)), shall submit such request
HR 4686 IH
and information to the Attorney General and
shall request the Attorney General to conduct a
search and exchange of records with respect to
the individual as described in subparagraph
(B).
‘‘(B) 
SEARCH
AND
EXCHANGE
OF
RECORDS BY ATTORNEY GENERAL.—Upon re-
ceipt of a submission pursuant to subparagraph
(A), the Attorney General shall direct a search
of the records of the Federal Bureau of Inves-
tigation for any criminal history records cor-
responding to the fingerprints or other positive
identification information submitted. The Attor-
ney General shall provide any corresponding in-
formation resulting from the search to the
State.
‘‘(C) STATE REPORTING OF INFORMATION
TO NURSING FACILITY.—Upon receipt of the in-
formation provided by the Attorney General
pursuant to subparagraph (B), the State
shall—
‘‘(i) review the information to deter-
mine whether the individual has any con-
viction for a relevant crime (as defined in
subsection (b)(9)(E)); and
HR 4686 IH
‘‘(ii) report to the skilled nursing fa-
cility 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)(9) for
conducting the search and providing
the records. The amount of such fee
shall not exceed the lesser of the ac-
tual cost of such activities or $50.
Such fees shall be available to the At-
torney General, or, in the Attorney
General’s discretion, to the Federal
Bureau of Investigation, until ex-
pended.
‘‘(II) 
STATE.—A 
State 
may
charge a skilled nursing facility a fee
for initiating the criminal background
check under this paragraph and sub-
section (b)(9), including fees charged
by the Attorney General, and for per-
HR 4686 IH
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) TREATMENT OF FEES FOR PUR-
POSES OF COST REPORTS.—An entity may
not include a fee assessed pursuant to this
subparagraph as an allowable item on a
cost report under this title or title XIX.
‘‘(iii) 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.—In addition to the
Secretary’s authority to promulgate regulations
under this title, the Attorney General, in con-
sultation with the Secretary, may promulgate
such regulations as are necessary to carry out
the Attorney General’s responsibilities under
this paragraph and subsection (b)(9), including
regulations regarding the security, confidential-
ity, accuracy, use, destruction, and dissemina-
HR 4686 IH
tion of information, audits and recordkeeping,
and the imposition of fees.
‘‘(F) REPORT.—Not later than 2 years
after the date of enactment of the ‘Long-Term
Care Patient Protection Act of 1998’, the At-
torney General shall submit a report to Con-
gress on the number of requests for searches
and exchanges of records made under this sec-
tion and the disposition of such requests.’’.
(c) ESTABLISHMENT
OF NATIONAL REGISTRY
OF
ABUSIVE NURSING FACILITY WORKERS.—Title XI of the
Social Security Act is amended by adding after section
1128E the following new section:
‘‘NATIONAL REGISTRY OF ABUSIVE NURSING FACILITY
WORKERS
‘‘SEC. 1128F. (a) IN GENERAL.—The Secretary shall
establish a national data collection program for the report-
ing of information described in subsection (b), with access
as set forth in subsection (c), and shall maintain a data-
base of the information collected under this section.
‘‘(b) REPORTING
OF INFORMATION.—Each State
shall report the information collected pursuant to sections
1819(e)(2)(B) and 1919(e)(2)(B) in such form and man-
ner as the Secretary may prescribe by regulation.
‘‘(c) ACCESS TO REPORTED INFORMATION.—