I
107TH CONGRESS
2D SESSION
H. R. 3933
To amend titles XVIII and XIX of the Social Security Act to prevent abuse
of recipients of long-term care services under the Medicare and Medicaid
programs.
IN THE HOUSE OF REPRESENTATIVES
MARCH 12, 2002
Mr. CARSON of Oklahoma introduced the following bill; which was referred to
the Committee on Energy and 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 XVIII and XIX of the Social Security Act
to prevent abuse of recipients of long-term care services
under the Medicare and Medicaid programs.
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 Abuse Preven-
tion Act’’.
SEC. 2. 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) of
the Social Security Act (42 U.S.C. 1396r(b)) is
amended by adding at the end the following new
paragraph:
‘‘(8) 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 or finding of patient or
resident abuse;
‘‘(II) provide a statement signed
by the worker authorizing the facility
to request the search and exchange of
criminal records;
‘‘(III) provide in person a copy of
the worker’s fingerprints or thumb
print, depending upon available tech-
nology; and
‘‘(IV) provide any other identi-
fication information the Secretary
may specify in regulation;
‘‘(iii) initiate a check of the data col-
lection system established under section
1128E in accordance with regulations pro-
mulgated by the Secretary to determine
whether such system contains any disquali-
fying information with respect to such
worker; and
‘‘(iv) if that system does not contain
any such disqualifying information—
‘‘(I) request that the State ini-
tiate a State and national criminal
background check on such worker in
accordance with the provisions of sub-
section (e)(8); 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
under section 6103(a) of title 5,
United States Code) after completion
of the check against the system initi-
ated under clause (iii).
‘‘(B) PROHIBITION ON HIRING OF ABUSIVE
WORKERS.—
‘‘(i) IN GENERAL.—A nursing facility
may not knowingly employ any nursing fa-
cility worker who has any conviction for a
relevant crime or with respect to whom a
finding of patient or resident abuse has
been made.
‘‘(ii) PROVISIONAL
EMPLOYMENT.—
After complying with the requirements of
clauses (i), (ii), and (iii) of subparagraph
(A), a nursing facility may provide for a
provisional period of employment for a
nursing facility worker pending completion
of the check against the data collection
system 
described 
under 
subparagraph
(A)(iii) and the background check de-
scribed under subparagraph (A)(iv). Such
facility shall maintain direct supervision of
the worker during the worker’s provisional
period of employment.
‘‘(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
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 clauses (iii) and
(iv) of subparagraph (A) may use such in-
formation only for the purpose of deter-
mining 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) or section
1128E shall not be liable in any action
brought by such applicant based on the
employment determination 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 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:
‘‘(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 or a finding of patient or resi-
dent abuse.
‘‘(iii) FINDING OF PATIENT OR RESI-
DENT ABUSE.—The term ‘finding of pa-
tient or resident abuse’ means any sub-
stantiated finding by a State agency under
subsection (g)(1)(C) or a Federal agency
that 
a 
nursing 
facility 
worker 
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.
‘‘(iv) NURSING FACILITY WORKER.—
The term ‘nursing facility worker’ means
any individual (other than any volunteer)
that has direct access to a patient of a
nursing facility under an employment or
other contract, or both, with such facility.
Such term includes individuals who are li-
censed or certified by the State to provide
such services, and nonlicensed individuals
providing such services, as defined by the
Secretary, 
including 
nurse 
assistants,
nurse aides, home health aides, and per-
sonal care workers and attendants.’’.
(2) 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;
‘‘(ii) require, as a condition of employ-
ment, that such worker—
‘‘(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 worker authorizing the facility
to request the search and exchange of
criminal records;
‘‘(III) provide in person a copy of
the worker’s fingerprints or thumb
print, depending upon available tech-
nology; and
‘‘(IV) provide any other identi-
fication information the Secretary
may specify in regulation;
‘‘(iii) initiate a check of the data col-
lection system established under section
1128E in accordance with regulations pro-
mulgated by the Secretary to determine
whether such system contains any disquali-
fying information with respect to such
worker; and
‘‘(iv) if that system does not contain
any such disqualifying information—
‘‘(I) request that the State ini-
tiate a State and national criminal
background check on such worker in
accordance with the provisions of sub-
section (e)(6); 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
under section 6103(a) of title 5,
United States Code) after completion
of the check against the system initi-
ated under clause (iii).
‘‘(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 or with re-
spect to whom a finding of patient or resi-
dent abuse has been made.
‘‘(ii) PROVISIONAL
EMPLOYMENT.—
After complying with the requirements of
clauses (i), (ii), and (iii) 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 data
collection system described under subpara-
graph (A)(iii) and the background check
described under subparagraph (A)(iv).
Such facility shall maintain direct super-
vision of the covered individual during the
worker’s provisional period of employment.
‘‘(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
clauses (iii) and (iv) of subparagraph (A)
may use such information only for the pur-
pose of determining the suitability of the
worker for employment.
‘‘(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) or section
1128E shall not be liable in any action
brought by such applicant based on the
employment determination 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 or a finding of patient or resi-
dent abuse.
‘‘(iii) FINDING OF PATIENT OR RESI-
DENT ABUSE.—The term ‘finding of pa-
tient or resident abuse’ means any sub-
stantiated finding by a State agency under
subsection (g)(1)(C) or a Federal agency
that a skilled nursing facility worker 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.
‘‘(iv) SKILLED
NURSING
FACILITY
WORKER.—The term ‘skilled nursing facil-
ity worker’ means any individual (other
than any volunteer) that has direct access
to a patient of a skilled nursing facility
under an employment or other contract, or
both, with such facility. Such term includes
individuals who are licensed or certified by
the State to provide such services, and
nonlicensed 
individuals 
providing 
such
services, as defined by the Secretary, in-
cluding nurse assistants, nurse aides, home
health aides, and personal care workers
and attendants.’’.
(3) TECHNICAL AMENDMENTS.—Effective as if
included in the enactment of section 941 of the
Medicare, Medicaid, and SCHIP Benefits Improve-
ment and Protection Act of 2000 (114 Stat. 2763A–
585), as enacted into law by section 1(a)(6) of Pub-
lic 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 redesig-
nating the paragraph (8) added by such section as
paragraph (9).
(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 of the Social Security Act (42
U.S.C. 1396r) is amended—
(i) in subsection (e)(2)—
(I) in the paragraph heading, by
striking ‘‘NURSE AIDE REGISTRY’’ and
inserting ‘‘NURSING
FACILITY
EM-
PLOYEE REGISTRY’’;
(II) in subparagraph (A)—
(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-
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)—
(aa) in the subparagraph
heading, by striking ‘‘NURSE
AIDE
REGISTRY’’ and inserting
‘‘NURSING
FACILITY
EMPLOYEE
REGISTRY’’; and
(bb) 
by 
striking 
‘‘nurse
aide’’ each place it appears and
inserting ‘‘nursing facility em-
ployee’’.
(B) FEDERAL AND STATE REQUIREMENT
TO CONDUCT BACKGROUND CHECKS.—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 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-
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));
‘‘(ii) report to the nursing facility the
results of such review; and
‘‘(iii) in the case of an individual with
a conviction for a relevant crime, report
the existence of such conviction of such in-
dividual to the database established under
section 1128E.
‘‘(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
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, in 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.
‘‘(ii) APPEAL PROCEDURES.—The At-
torney General, in 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
‘‘(iii) the cost of responding to 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 of the Social Security
Act (42 U.S.C. 1395i–3) 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’’;
(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
(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)—
(aa) in the subparagraph
heading, by striking ‘‘NURSE
AIDE
REGISTRY’’ and inserting
‘‘NURSING
FACILITY
EMPLOYEE
REGISTRY’’; and
(bb) 
by 
striking 
‘‘nurse
aide’’ each place it appears and
inserting ‘‘nursing facility em-
ployee’’.
(B) FEDERAL AND STATE REQUIREMENT
TO CONDUCT BACKGROUND CHECKS.—Section
1819(e) of the Social Security Act (42 U.S.C.
1395i–3(e)) is amended by adding at the end
the following:
‘‘(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 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-
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));
‘‘(ii) report to the skilled nursing fa-
cility the results of such review; and
‘‘(iii) in the case of an individual with
a conviction for a relevant crime, report
the existence of such conviction of such in-
dividual to the database established under
section 1128E.
‘‘(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 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-
tions under this title, the Attorney Gen-
eral, in 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)(9), 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, in 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
‘‘(iii) the cost of responding to such
requests.’’.
(c) APPLICATION TO OTHER ENTITIES PROVIDING
HOME HEALTH OR LONG-TERM CARE SERVICES.—
(1) MEDICAID.—Section 1902(a) of the Social
Security Act (42 U.S.C. 1396a) is amended—
(A) in paragraph (65), by striking the pe-
riod and inserting ‘‘; and’’; and
(B) 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 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.’’.
(2) 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 following:
‘‘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. 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 eligible to be paid under
this title for providing home health services or long-term
care services to an individual entitled to benefits 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).’’.
(d) REIMBURSEMENT OF REASONABLE COSTS FOR
BACKGROUND CHECKS.—The Secretary of Health and
Human Services shall factor into any payment system
under titles XVIII and XIX of the Social Security Act the
reasonable costs of the requirements of sections
1819(b)(8) and 1919(b)(8) of such Act, as added by this
section, incurred by any entity subject to such require-
ments.
SEC. 3. INCLUSION OF ABUSIVE WORKERS IN THE DATA-
BASE ESTABLISHED AS PART OF NATIONAL
HEALTH CARE FRAUD AND ABUSE DATA COL-
LECTION PROGRAM.
(a) INCLUSION OF ABUSIVE ACTS WITHIN A LONG-
TERM
CARE
FACILITY
OR
PROVIDER.—Section
1128E(g)(1)(A) of the Social Security Act (42 U.S.C.
1320a–7e(g)(1)(A)) is amended—
(1) by redesignating clause (v) as clause (vi);
and
(2) by inserting after clause (iv), the following:
‘‘(v) A finding of abuse or neglect of
a patient or a resident of a long-term care
facility, or misappropriation of such a pa-
tient’s or resident’s property.’’.
(b) COVERAGE OF LONG-TERM CARE FACILITY OR
PROVIDER EMPLOYEES.—Section 1128E(g)(2) of the So-
cial Security Act (42 U.S.C. 1320a–7e(g)(2)) is amended
by inserting ‘‘, and includes any individual of a long-term
care facility or provider (other than any volunteer) that
has direct access to a patient or resident of such a facility
under an employment or other contract, or both, with the
facility or provider (including individuals who are licensed
or certified by the State to provide services at the facility
or through the provider, and nonlicensed individuals, as
defined by the Secretary, providing services at the facility