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(1) NURSING FACILITY.—The term ‘‘nursing fa-
cility’’ has the meaning given such term in section 
1919(a) of the Social Security Act (42 U.S.C. 
1396r(a)). 
(2) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(3) SKILLED
NURSING
FACILITY.—The term 
‘‘skilled nursing facility’’ has the meaning given such 
term in section 1819(a) of the Social Security Act (42 
U.S.C. 1395(a)). 
(e) AUTHORIZATION OF APPROPRIATIONS.—There are 
authorized to be appropriated such sums as may be nec-
essary to carry out this section. 
(f) REPORT.—Not later than 9 months after the com-
pletion of the demonstration project, the Secretary shall sub-
mit to Congress a report on such project, together with rec-
ommendations for such legislation and administrative ac-
tion as the Secretary determines appropriate. 
PART III—IMPROVING STAFF TRAINING 
SEC. 6121. DEMENTIA AND ABUSE PREVENTION TRAINING. 
(a) SKILLED NURSING FACILITIES.— 
(1) IN GENERAL.—Section 1819(f)(2)(A)(i)(I) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395i– 
3(f)(2)(A)(i)(I)) is amended by inserting ‘‘(including, 
in the case of initial training and, if the Secretary 
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determines appropriate, in the case of ongoing train-
ing, dementia management training, and patient 
abuse prevention training’’ before ‘‘, (II)’’. 
(2) CLARIFICATION
OF
DEFINITION
OF
NURSE 
AIDE.—Section 1819(b)(5)(F) of the Social Security 
Act (42 U.S.C. 1395i–3(b)(5)(F)) is amended by add-
ing at the end the following flush sentence: 
‘‘Such term includes an individual who provides 
such services through an agency or under a con-
tract with the facility.’’. 
(b) NURSING FACILITIES.— 
(1) IN GENERAL.—Section 1919(f)(2)(A)(i)(I) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396r(f)(2)(A)(i)(I)) is amended by inserting ‘‘(in-
cluding, in the case of initial training and, if the Sec-
retary determines appropriate, in the case of ongoing 
training, dementia management training, and pa-
tient abuse prevention training’’ before ‘‘, (II)’’. 
(2) CLARIFICATION
OF
DEFINITION
OF
NURSE 
AIDE.—Section 1919(b)(5)(F) of the Social Security 
Act (42 U.S.C. 1396r(b)(5)(F)) is amended by adding 
at the end the following flush sentence: 
‘‘Such term includes an individual who provides 
such services through an agency or under a con-
tract with the facility.’’. 
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(c) EFFECTIVE DATE.—The amendments made by this 
section shall take effect 1 year after the date of the enact-
ment of this Act. 
Subtitle 
C—Nationwide 
Program 
for National and State Back-
ground Checks on Direct Patient 
Access Employees of Long-term 
Care Facilities and Providers 
SEC. 6201. NATIONWIDE PROGRAM FOR NATIONAL AND 
STATE BACKGROUND CHECKS ON DIRECT PA-
TIENT 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 facili-
ties or providers to conduct background checks on prospec-
tive 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 modifica-
tions, the Secretary shall carry out the nationwide program 
under similar terms and conditions as the pilot program 
under section 307 of the Medicare Prescription Drug, Im-
provement, and Modernization Act of 2003 (Public Law 
108–173; 117 Stat. 2257), including the prohibition on hir-
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ing 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 section 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 
agreement did not require the State to con-
duct background checks under the program 
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established under subsection (a) of such sec-
tion 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 CRITERIA.— 
The selection criteria required under subsection 
(c)(3)(B) of such section 307 shall not apply. 
(3) REQUIRED FINGERPRINT CHECK AS PART OF 
CRIMINAL HISTORY BACKGROUND CHECK.—The proce-
dures established under subsection (b)(1) of such sec-
tion 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 appropriate, efficient, 
and effective that utilize a search of State-based 
abuse and neglect registries and databases, in-
cluding the abuse and neglect registries of an-
other State in the case where a prospective em-
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ployee previously resided in that State, State 
criminal history records, the records of any pro-
ceedings in the State that may contain disquali-
fying information about prospective employees 
(such as proceedings conducted by State profes-
sional licensing and disciplinary boards and 
State Medicaid Fraud Control Units), and Fed-
eral criminal history records, including a finger-
print check using the Integrated Automated Fin-
gerprint Identification System of the Federal 
Bureau of Investigation; 
(B) require States to describe and test meth-
ods that reduce duplicative fingerprinting, in-
cluding providing for the development of ‘‘rap 
back’’ capability by the State such that, if a di-
rect patient access employee of a long-term care 
facility or provider is convicted of a crime fol-
lowing the initial criminal history background 
check conducted with respect to such employee, 
and the employee’s fingerprints match the prints 
on file with the State law enforcement depart-
ment, the department will immediately inform 
the State and the State will immediately inform 
the long-term care facility or provider which em-
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ploys the direct patient access employee of such 
conviction; and 
(C) require that criminal history back-
ground checks conducted under the nationwide 
program remain valid for a period of time speci-
fied by the Secretary. 
(4) STATE REQUIREMENTS.—An agreement en-
tered into under paragraph (1) shall require that a 
participating State— 
(A) be responsible for monitoring compli-
ance with the requirements of the nationwide 
program; 
(B) have procedures in place to— 
(i) conduct screening and criminal his-
tory background checks under the nation-
wide program in accordance with the re-
quirements of this section; 
(ii) monitor compliance by long-term 
care facilities and providers with the proce-
dures and requirements of the nationwide 
program; 
(iii) as appropriate, provide for a pro-
visional period of employment by a long- 
term care facility or provider of a direct 
patient access employee, not to exceed 60 
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days, pending completion of the required 
criminal history background check and, in 
the case where the employee has appealed 
the results of such background check, pend-
ing completion of the appeals process, dur-
ing which the employee shall be subject to 
direct on-site supervision (in accordance 
with procedures established by the State to 
ensure that a long-term care facility or pro-
vider furnishes such direct on-site super-
vision); 
(iv) provide an independent process by 
which a provisional employee or an em-
ployee may appeal or dispute the accuracy 
of the information obtained in a back-
ground check performed under the nation-
wide program, including the specification of 
criteria for appeals for direct patient access 
employees found to have disqualifying infor-
mation which shall include consideration of 
the passage of time, extenuating cir-
cumstances, demonstration of rehabilitation, 
and relevancy of the particular disquali-
fying information with respect to the cur-
rent employment of the individual; 
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(v) provide for the designation of a 
single State agency as responsible for— 
(I) overseeing the coordination of 
any State and national criminal his-
tory background checks requested by a 
long-term care facility or provider (or 
the designated agent of the long-term 
care facility or provider) utilizing a 
search of State and Federal criminal 
history records, including a fingerprint 
check of such records; 
(II) overseeing the design of ap-
propriate privacy and security safe-
guards for use in the review of the re-
sults of any State or national criminal 
history background checks conducted 
regarding a prospective direct patient 
access employee to determine whether 
the employee has any conviction for a 
relevant crime; 
(III) immediately reporting to the 
long-term care facility or provider that 
requested the criminal history back-
ground check the results of such review; 
and 
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(IV) in the case of an employee 
with a conviction for a relevant crime 
that is subject to reporting under sec-
tion 1128E of the Social Security Act 
(42 U.S.C. 1320a–7e), reporting the ex-
istence of such conviction to the data-
base established under that section; 
(vi) determine which individuals are 
direct patient access employees (as defined 
in paragraph (6)(B)) for purposes of the 
nationwide program; 
(vii) as appropriate, specify offenses, 
including convictions for violent crimes, for 
purposes of the nationwide program; and 
(viii) describe and test methods that re-
duce duplicative fingerprinting, including 
providing for the development of ‘‘rap back’’ 
capability such that, if a direct patient ac-
cess employee of a long-term care facility or 
provider is convicted of a crime following 
the initial criminal history background 
check conducted with respect to such em-
ployee, and the employee’s fingerprints 
match the prints on file with the State law 
enforcement department— 
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(I) the department will imme-
diately inform the State agency des-
ignated under clause (v) and such 
agency will immediately inform the fa-
cility or provider which employs the 
direct patient access employee of such 
conviction; and 
(II) the State will provide, or will 
require the facility to provide, to the 
employee a copy of the results of the 
criminal history background check con-
ducted with respect to the employee at 
no charge in the case where the indi-
vidual requests such a copy. 
(5) PAYMENTS.— 
(A) NEWLY PARTICIPATING STATES.— 
(i) IN GENERAL.—As part of the appli-
cation submitted by a State under para-
graph (1)(A)(iii), the State shall guarantee, 
with respect to the costs to be incurred by 
the State in carrying out the nationwide 
program, that the State will make available 
(directly or through donations from public 
or private entities) a particular amount of 
non-Federal contributions, as a condition of 
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receiving the Federal match under clause 
(ii). 
(ii) FEDERAL MATCH.—The payment 
amount to each State that the Secretary en-
ters into an agreement with under para-
graph (1)(A) shall be 3 times the amount 
that the State guarantees to make available 
under clause (i), except that in no case may 
the payment amount exceed $3,000,000. 
(B) PREVIOUSLY PARTICIPATING STATES.— 
(i) IN GENERAL.—As part of the appli-
cation submitted by a State under para-
graph (1)(B)(iii), the State shall guarantee, 
with respect to the costs to be incurred by 
the State in carrying out the nationwide 
program, that the State will make available 
(directly or through donations from public 
or private entities) a particular amount of 
non-Federal contributions, as a condition of 
receiving the Federal match under clause 
(ii). 
(ii) FEDERAL MATCH.—The payment 
amount to each State that the Secretary en-
ters into an agreement with under para-
graph (1)(B) shall be 3 times the amount 
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that the State guarantees to make available 
under clause (i), except that in no case may 
the payment amount exceed $1,500,000. 
(6) DEFINITIONS.—Under the nationwide pro-
gram: 
(A) CONVICTION FOR A RELEVANT CRIME.— 
The term ‘‘conviction for a relevant crime’’ 
means any Federal or State criminal conviction 
for— 
(i) any offense described in section 
1128(a) of the Social Security Act (42 
U.S.C. 1320a–7); or 
(ii) such other types of offenses as a 
participating State may specify for pur-
poses of conducting the program in such 
State. 
(B) 
DISQUALIFYING
INFORMATION.—The 
term ‘‘disqualifying information’’ means a con-
viction for a relevant crime or a finding of pa-
tient or resident abuse. 
(C) FINDING
OF
PATIENT
OR
RESIDENT 
ABUSE.—The term ‘‘finding of patient or resi-
dent abuse’’ means any substantiated finding by 
a State agency under section 1819(g)(1)(C) or 
1919(g)(1)(C) of the Social Security Act (42 
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U.S.C. 1395i–3(g)(1)(C), 1396r(g)(1)(C)) or a 
Federal agency that a direct patient access em-
ployee 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 a par-
ticipating State may specify for purposes of 
conducting the program in such State. 
(D) DIRECT PATIENT ACCESS EMPLOYEE.— 
The term ‘‘direct patient access employee’’ means 
any individual who has access to a patient or 
resident of a long-term care facility or provider 
through employment or through a contract with 
such facility or provider and has duties that in-
volve (or may involve) one-on-one contact with a 
patient or resident of the facility or provider, as 
determined by the State for purposes of the na-
tionwide program. Such term does not include a 
volunteer unless the volunteer has duties that are 
equivalent to the duties of a direct patient access 
employee and those duties involve (or may in-
volve) one-on-one contact with a patient or resi-
dent of the long-term care facility or provider. 
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(E) LONG-TERM
CARE
FACILITY
OR
PRO-
VIDER.—The term ‘‘long-term care facility or 
provider’’ means the following facilities or pro-
viders which receive payment for services under 
title XVIII or XIX of the Social Security Act: 
(i) A skilled nursing facility (as de-
fined in section 1819(a) of the Social Secu-
rity Act (42 U.S.C. 1395i–3(a))). 
(ii) A nursing facility (as defined in 
section 1919(a) of such Act (42 U.S.C. 
1396r(a))). 
(iii) A home health agency. 
(iv) A provider of hospice care (as de-
fined in section 1861(dd)(1) of such Act (42 
U.S.C. 1395x(dd)(1))). 
(v) A long-term care hospital (as de-
scribed in section 1886(d)(1)(B)(iv) of such 
Act (42 U.S.C. 1395ww(d)(1)(B)(iv))). 
(vi) A provider of personal care serv-
ices. 
(vii) A provider of adult day care. 
(viii) A residential care provider that 
arranges for, or directly provides, long-term 
care services, including an assisted living 
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facility that provides a level of care estab-
lished by the Secretary. 
(ix) An intermediate care facility for 
the mentally retarded (as defined in section 
1905(d) of such Act (42 U.S.C. 1396d(d))). 
(x) Any other facility or provider of 
long-term care services under such titles as 
the participating State determines appro-
priate. 
(7) EVALUATION AND REPORT.— 
(A) EVALUATION.— 
(i) IN GENERAL.—The Inspector Gen-
eral of the Department of Health and 
Human Services shall conduct an evalua-
tion of the nationwide program. 
(ii) INCLUSION OF SPECIFIC TOPICS.— 
The evaluation conducted under clause (i) 
shall include the following: 
(I) A review of the various proce-
dures implemented by participating 
States for long-term care facilities or 
providers, including staffing agencies, 
to conduct background checks of direct 
patient access employees under the na-
tionwide program and identification of 
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the most appropriate, efficient, and ef-
fective procedures for conducting such 
background checks. 
(II) An assessment of the costs of 
conducting such background checks (in-
cluding start up and administrative 
costs). 
(III) A determination of the ex-
tent to which conducting such back-
ground checks leads to any unintended 
consequences, including a reduction in 
the available workforce for long-term 
care facilities or providers. 
(IV) An assessment of the impact 
of the nationwide program on reducing 
the number of incidents of neglect, 
abuse, and misappropriation of resi-
dent property to the extent practicable. 
(V) An evaluation of other aspects 
of the nationwide program, as deter-
mined appropriate by the Secretary. 
(B) REPORT.—Not later than 180 days 
after the completion of the nationwide program, 
the Inspector General of the Department of 
Health and Human Services shall submit a re-
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port to Congress containing the results of the 
evaluation conducted under subparagraph (A). 
(b) FUNDING.— 
(1) NOTIFICATION.—The Secretary of Health and 
Human Services shall notify the Secretary of the 
Treasury of the amount necessary to carry out the na-
tionwide program under this section for the period of 
fiscal years 2010 through 2012, except that in no case 
shall such amount exceed $160,000,000. 
(2) TRANSFER OF FUNDS.— 
(A) IN GENERAL.—Out of any funds in the 
Treasury not otherwise appropriated, the Sec-
retary of the Treasury shall provide for the 
transfer to the Secretary of Health and Human 
Services of the amount specified as necessary to 
carry out the nationwide program under para-
graph (1). Such amount shall remain available 
until expended. 
(B) RESERVATION OF FUNDS FOR CONDUCT 
OF EVALUATION.—The Secretary may reserve not 
more than $3,000,000 of the amount transferred 
under subparagraph (A) to provide for the con-
duct 
of 
the 
evaluation 
under 
subsection 
(a)(7)(A). 
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