I
106TH CONGRESS
1ST SESSION
H. R. 2627
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
JULY 27, 1999
Mr. STARK introduced the following bill; which was referred to the Committee
on Commerce, and in addition to the Committee 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:
‘‘(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
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; 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