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; 
(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 
VerDate Nov 24 2008 
20:45 May 03, 2009
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H2223.IH
H2223
pwalker on PROD1PC71 with BILLS
on potential employees in order to reduce the 
likelihood of hiring someone who has the poten-
tial to harm residents of long-term care facili-
ties. 
(4) A national survey of State Adult Protective 
Services agencies identified more than 500,000 re-
ports of elder and vulnerable adult abuse in 2004, 
and a national report concluded that more than 
15,000 nursing home complaints involved abuse, in-
cluding nearly 4,000 complaints of physical abuse, 
more than 800 complaints of sexual abuse, and 
nearly 1,000 complaints of financial exploitation. 
(5) The Department of Health and Human 
Services has determined that, while 41 States now 
require criminal background checks on certified 
nurse aides prior to employment, only half of those 
require criminal background checks at the Federal 
level. 
(b) PURPOSES.—The purposes of this Act are to— 
(1) lay the foundation for a coordinated, nation-
wide system of comprehensive State registry and 
criminal background checks that would greatly en-
hance the chances of identifying individuals with 
problematic backgrounds who change jobs frequently 
and move across State lines to avoid detection; 
VerDate Nov 24 2008 
20:45 May 03, 2009
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H2223.IH
H2223
pwalker on PROD1PC71 with BILLS
(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 abusive 
workers will not be hired into positions that give 
them access to extremely vulnerable individuals re-
ceiving long-term care services in health care set-
tings across the United States. 
SEC. 3. NATIONWIDE PROGRAM FOR NATIONAL AND STATE 
BACKGROUND CHECKS ON DIRECT PATIENT 
ACCESS EMPLOYEES OF LONG-TERM CARE 
FACILITIES AND PROVIDERS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall establish a program to identify efficient, ef-
fective, and economical procedures for long-term care fa-
cilities or providers to conduct background checks on pro-
spective direct patient access employees on a nationwide 
basis (in this subsection, such program shall be referred 
to as the ‘‘nationwide program’’). Except for the following 
modifications, the Secretary shall carry out the nationwide 
program under similar terms and conditions as the pilot 
program under section 307 of the Medicare Prescription 
VerDate Nov 24 2008 
02:48 May 04, 2009
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H2223.IH
H2223
pwalker on PROD1PC71 with BILLS
Drug, Improvement, and Modernization Act of 2003 (Pub-
lic Law 108–173; 117 Stat. 2257), including the prohibi-
tion on hiring abusive workers and the authorization of 
the imposition of penalties by a participating State under 
subsection (b)(3)(A) and (b)(6), respectively, of such sec-
tion 307: 
(1) AGREEMENTS.— 
(A) 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) of such section 307; 
(ii) that agrees to conduct background 
checks under the nationwide program on a 
Statewide basis; and 
(iii) that submits an application to the 
Secretary containing such information and 
at such time as the Secretary may specify. 
(B) CERTAIN PREVIOUSLY PARTICIPATING 
STATES.—The Secretary shall enter into agree-
ments with each State— 
(i) that the Secretary has entered into 
an agreement with under such subsection 
(c)(1), but only in the case where such 
VerDate Nov 24 2008 
20:45 May 03, 2009
Jkt 079200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H2223.IH
H2223
pwalker on PROD1PC71 with BILLS
agreement did not require the State to 
conduct background checks under the pro-
gram established under subsection (a) of 
such section 307 on a Statewide basis; 
(ii) that agrees to conduct background 
checks under the nationwide program on a 
Statewide basis; and 
(iii) that submits an application to the 
Secretary containing such information and 
at such time as the Secretary may specify. 
(2) NONAPPLICATION
OF
SELECTION
CRI-
TERIA.—The selection criteria required under sub-
section (c)(3)(B) of such section 307 shall not apply. 
(3) REQUIRED FINGERPRINT CHECK AS PART 
OF CRIMINAL HISTORY BACKGROUND CHECK.—The 
procedures established under subsection (b)(1) of 
such section 307 shall— 
(A) require that the long-term care facility 
or provider (or the designated agent of the 
long-term care facility or provider) obtain State 
and national criminal history background 
checks on the prospective employee through 
such means as the Secretary determines appro-
priate that utilize a search of State-based abuse 
and neglect registries and databases, including 
VerDate Nov 24 2008 
20:45 May 03, 2009
Jkt 079200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H2223.IH
H2223
pwalker on PROD1PC71 with BILLS