[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 958 Introduced in Senate (IS)]
108th CONGRESS
1st Session
S. 958
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 SENATE OF THE UNITED STATES
April 30, 2003
Mr. Kohl (for himself, Mr. Reid, Mr. Nelson of Florida, Mr.
Rockefeller, Mrs. Lincoln, Ms. Landrieu, Mr. Bingaman, Mr. Miller, and
Mr. Breaux) introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
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 Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Patient Abuse Prevention Act''.
SEC. 2. ESTABLISHMENT OF PROGRAM TO PREVENT ABUSE OF NURSING FACILITY
RESIDENTS.
(a) Screening of Skilled Nursing Facility and Nursing Facility
Employee Applicants.--
(1) 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 facility workers.--
``(A) Background checks on applicants.--Subject to
subparagraph (B)(ii), before 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 applicants;
``(ii) require, as a condition of
employment, that such worker--
``(I) provide a written statement
disclosing any conviction for a
relevant 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 to the
facility a copy of the worker's
fingerprints or thumb print, depending
upon available technology; and
``(IV) provide any other
identification information the
Secretary may specify in regulation;
``(iii) initiate a check of the data
collection system established under section
1128E in accordance with regulations
promulgated by the Secretary to determine
whether such system contains any disqualifying
information with respect to such worker; and
``(iv) if that system does not contain any
such disqualifying information--
``(I) request through the
appropriate State agency that the State
initiate a State and national criminal
background check on such worker in
accordance with the provisions of
subsection (e)(6); and
``(II) submit to such State agency
the information 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 initiated
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 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 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 subparagraph (A)(iii) and the background
check described under subparagraph (A)(iv).
Such facility shall maintain direct supervision
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 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 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 purpose of
determining the suitability of the worker for
employment.
``(ii) Immunity from liability.--A skilled
nursing facility that, in denying employment
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)(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 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 worker.--In
addition to any civil penalty under clause (i),
a skilled nursing facility that--
``(I) knowingly continues to employ
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 relevant 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
regulations, taking into account the
severity and relevance of such
offenses, and after consultation with
representatives of long-term care
providers, representatives 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 relevant crime or a
finding of patient or resident abuse.
``(iii) Finding of patient or resident
abuse.--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 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
regulations.
``(iv) Skilled nursing facility worker.--
The term `skilled nursing facility worker'
means any individual (other than a volunteer)
that has 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,
including nurse assistants, nurse aides, home
health aides, and personal care workers and
attendants.''.
(2) 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 workers.--
``(A) Background checks on applicants.--Subject to
subparagraph (B)(ii), before 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 applicants;
``(ii) require, as a condition of
employment, that such worker--
``(I) provide a written statement
disclosing any conviction for a
relevant 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 to the
facility a copy of the worker's
fingerprints or thumb print, depending
upon available technology; and
``(IV) provide any other
identification information the
Secretary may specify in regulation;
``(iii) initiate a check of the data
collection system established under section
1128E in accordance with regulations
promulgated by the Secretary to determine
whether such system contains any disqualifying
information with respect to such worker; and
``(iv) if that system does not contain any
such disqualifying information--
``(I) request through the
appropriate State agency that the State
initiate a State and national criminal
background check on such worker in
accordance with the provisions of
subsection (e)(8); and
``(II) submit to such State agency
the information 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 initiated
under clause (iii).
``(B) Prohibition on hiring of abusive workers.--
``(i) In general.--A nursing facility may
not knowingly employ any nursing facility
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
described 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 instance 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 information only
for the purpose of determining the suitability
of the worker for employment.
``(ii) Immunity from liability.--A nursing
facility that, in denying employment 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 paragraph 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 worker.--In
addition to any civil penalty under clause (i),
a nursing facility that--
``(I) knowingly continues to employ
a nursing facility worker in violation
of subparagraph (A) or (B); or
``(II) knowingly fails to report a
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 relevant 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
regulations, taking into account the
severity and relevance of such
offenses, and after consultation with
representatives of long-term care
providers, representatives 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 relevant crime or a
finding of patient or resident abuse.
``(iii) Finding of patient or resident
abuse.--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 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
regulations.
``(iv) Nursing facility worker.--The term
`nursing facility worker' means any individual
(other than a volunteer) that has 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 licensed 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 personal
care workers and attendants.''.
(3) Federal responsibilities.--
(A) Development of standard federal and state
background check form.--The Secretary of Health and
Human Services, in consultation with the Attorney
General and representatives of appropriate State
agencies, shall develop a model form that an applicant
for employment at a nursing facility may complete and
Federal and State agencies may use to conduct the
criminal background checks required under sections
1819(b)(8) and 1919(b)(8) of the Social Security Act
(42 U.S.C. 1395i-3(b), 1396r(b)) (as added by this
section).
(B) Periodic evaluation.--The Secretary of Health
and Human Services, in consultation with the Attorney
General, periodically shall evaluate the background
check system imposed under sections 1819(b)(8) and
1919(b)(8) of the Social Security Act (42 U.S.C. 1395i-
3(b), 1396r(b)) (as added by this section) and shall
implement changes, as necessary, based on available
technology, to make the background check system more
efficient and able to provide a more immediate response
to long-term care providers using the system.
(4) No preemption of stricter state laws.--Nothing in
section 1819(b)(8) or 1919(b)(8) of the Social Security Act (42
U.S.C. 1395i-3(b)(8), 1396r(b)(8)) (as so added) shall be
construed to supersede any provision of State law that--
(A) specifies a relevant crime for purposes of
prohibiting the employment of an individual at a long-
term care facility (as defined in section 1128E(g)(6)
of the Social Security Act (as added by section 3(f) of
this Act) that is not included in the list of such
crimes specified in such sections or in regulations
promulgated by the Secretary of Health and Human
Services to carry out such sections; or
(B) requires a long-term care facility (as so
defined) to conduct a background check prior to
employing an individual in an employment position that
is not included in the positions for which a background
check is required under such sections.
(5) Technical amendments.--Effective as if included in the
enactment of section 941 of the Medicare, Medicaid, and SCHIP
Benefits Improvement and Protection Act of 2000 (114 Stat.
2763A-585), as enacted into law by section 1(a)(6) of Public
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
redesignating the paragraph (8) added by such section as
paragraph (9).
(b) Federal and State Requirements Concerning Background Checks.--
(1) Medicare.--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 request by a
skilled nursing facility pursuant to subsection (b)(8)
that is accompanied by the information 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 subsection (b)(8)(F)(ii)), shall
immediately 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 receipt of a submission pursuant to
subparagraph (A), the Attorney General shall direct a
search of the records of the Federal Bureau of
Investigation for any criminal history records
corresponding to the fingerprints and other positive
identification information submitted. The Attorney
General shall provide any corresponding 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 determine
whether the individual has any conviction for a
relevant crime (as defined in subsection
(b)(8)(F)(i));
``(ii) immediately report to the skilled
nursing facility in writing 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 individual
to the database established under section
1128E.
``(D) Fees for performance of criminal background
checks.--
``(i) Authority to charge fees.--
``(I) Attorney general.--The
Attorney General may charge a fee to
any State requesting a search and
exchange 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 actual
cost of such activities or $50. Such
fees shall be available to the Attorney
General, or, in the Attorney General's
discretion, to the Federal Bureau of
Investigation until expended.
``(II) State.--A State may charge a
skilled nursing facility a fee for
initiating 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 subparagraph (C). The
amount of such fee shall not exceed the
actual cost of such activities.
``(ii) Prohibition on charging applicants
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 regulations
under this title, the Attorney General, in
consultation 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
confidentiality, accuracy, use, destruction,
and dissemination of information, audits and
recordkeeping, and the imposition of fees.
``(ii) Appeal procedures.--The Attorney
General, in consultation with the Secretary,
shall promulgate such regulations as are
necessary to establish procedures by which an
applicant or employee may appeal or dispute the
accuracy of the information obtained in a
background check conducted under this
paragraph. Appeals 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
applicant or employee has not been updated to
reflect changes in the applicant's or
employee'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) Medicaid.--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 request by a
nursing facility pursuant to subsection (b)(8) that is
accompanied by the information 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 subsection
(b)(8)(F)(ii)), shall immediately 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 receipt of a submission pursuant to
subparagraph (A), the Attorney General shall direct a
search of the records of the Federal Bureau of
Investigation for any criminal history records
corresponding to the fingerprints and other positive
identification information submitted. The Attorney
General shall provide any corresponding information
resulting from the search to the State.
``(C) State reporting of information to nursing
facility.--Upon receipt of the information provided by
the Attorney General pursuant to subparagraph (B), the
State shall--
``(i) review the information to determine
whether the individual has any conviction for a
relevant crime (as defined in subsection
(b)(8)(F)(i));
``(ii) immediately report to the nursing
facility in writing 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 individual
to the database established under section
1128E.
``(D) Fees for performance of criminal background
checks.--
``(i) Authority to charge fees.--
``(I) Attorney general.--The
Attorney General may charge a fee to
any State requesting a search and
exchange 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 actual
cost of such activities or $50. Such
fees shall be available to the Attorney
General, or, in the Attorney General's
discretion, to the Federal Bureau of
Investigation, until expended.
``(II) State.--A State may charge a
nursing facility a fee for initiating
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 subparagraph
(C). The amount of such fee shall not
exceed the actual cost of such
activities.
``(ii) Prohibition on charging applicants
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 regulations
under this title, the Attorney General, in
consultation with the Secretary, may promulgate
such regulations as are necessary to carry out
the Attorney General's responsibilities under
this paragraph and subsection (b)(8), including
regulations regarding the security,
confidentiality, accuracy, use, destruction,
and dissemination of information, audits and
recordkeeping, and the imposition of fees.
``(ii) Appeal procedures.--The Attorney
General, in consultation with the Secretary,
shall promulgate such regulations as are
necessary to establish procedures by which an
applicant or employee may appeal or dispute the
accuracy of the information obtained in a
background check conducted under this
paragraph. Appeals 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
applicant or employee has not been updated to
reflect changes in the applicant's or
employee'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) 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 preventive abuse provisions
to any provider of services or other entity providing home health or
long-term care services
``Sec. 1897. (a) In General.--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, hospice care (including
routine home care and other services included in hospice care under
this title), 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 (in this section referred to as a `medicare
beneficiary').
``(b) Supervision of Provisional Employees.--
``(1) In general.--With respect to an entity that provides
home health services, such entity shall be considered to have
satisfied the requirements of section 1819(b)(8)(B)(ii) or
1919(b)(8)(B)(ii) if the entity meets such requirements for
supervision of provisional employees of the entity as the
Secretary shall, by regulation, specify in accordance with
paragraph (2).
``(2) Requirements.--The regulations required under
paragraph (1) shall provide the following:
``(A) Supervision of a provisional employee shall
consist of ongoing, good faith, verifiable efforts by
the supervisor of the provisional employee to conduct
monitoring and oversight activities to ensure the
safety of a medicare beneficiary.
``(B) For purposes of subparagraph (A), monitoring
and oversight activities may include (but are not
limited to) the following:
``(i) Follow-up telephone calls to the
medicare beneficiary.
``(ii) Unannounced visits to the medicare
beneficiary's home while the provisional
employee is serving the medicare beneficiary.
``(iii) To the extent practicable, limiting
the provisional employee's duties to serving
only those medicare beneficiaries in a home or
setting where another family member or resident
of the home or setting of the medicare
beneficiary is present.''.
(2) Medicaid.--Section 1902(a) of the Social Security Act
(42 U.S.C. 1396a) is amended--
(A) in paragraph (64), by striking ``and'' at the
end;
(B) in paragraph (65), by striking the period and
inserting ``; and''; and
(C) 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,
hospice care (including routine home care and other services included
in hospice care under title XVIII), 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 and section 1897(b) (in
the same manner as such section applies to a medicare beneficiary).''.
(3) Expansion of state nurse aide registry.--
(A) Medicare.--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 ``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 the following: ``,
(ii) all other skilled nursing
facility employees with respect
to whom the State has made a
finding described in
subparagraph (B), and (iii) any
employee of any provider of
services or any other entity
that is eligible to be paid
under this title for providing
home health services, hospice
care (including routine home
care and other services
included in hospice care under
this title), or long-term care
services and with respect to
whom the entity has reported to
the State a finding of patient
neglect or abuse or a
misappropriation of patient
property''; and
(III) in subparagraph (C), by
striking ``a nurse aide'' and inserting
``an individual''; and
(ii) in subsection (g)(1)--
(I) by striking the first sentence
of subparagraph (C) and inserting the
following: ``The State shall provide,
through the agency responsible for
surveys and certification of skilled
nursing facilities under this
subsection, for a process for the
receipt and timely review and
investigation of allegations of neglect
and abuse and misappropriation of
resident property by a nurse aide or a
skilled nursing facility employee of a
resident in a skilled nursing facility,
by another individual used by the
facility in providing services to such
a resident, or by an individual
described in subsection
(e)(2)(A)(iii).'';
(II) in the fourth sentence of
subparagraph (C), by inserting ``or
described in subsection
(e)(2)(A)(iii)'' after ``used by the
facility'';
(III) in subparagraph (D)--
(aa) in the subparagraph
heading, by striking ``nurse
aide'';
(bb) in clause (i), in the
matter preceding subclause (I),
by striking ``a nurse aide''
and inserting ``an
individual''; and
(cc) in clause (i)(I), by
striking ``nurse aide'' and
inserting ``individual''.
(B) Medicaid.--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 ``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 the following: ``,
(ii) all other nursing facility
employees with respect to whom
the State has made a finding
described in subparagraph (B),
and (iii) any employee of an
entity that is eligible to be
paid under the State plan for
providing home health services,
hospice care (including routine
home care and other services
included in hospice care under
title XVIII), or long-term care
services and with respect to
whom the entity has reported to
the State a finding of patient
neglect or abuse or a
misappropriation of patient
property''; and
(III) in subparagraph (C), by
striking ``a nurse aide'' and inserting
``an individual''; and
(ii) in subsection (g)(1)--
(I) by striking the first sentence
of subparagraph (C) and inserting the
following: ``The State shall provide,
through the agency responsible for
surveys and certification of nursing
facilities under this subsection, for a
process for the receipt and timely
review and investigation of allegations
of neglect and abuse and
misappropriation of resident property
by a nurse aide or a nursing facility
employee of a resident in a nursing
facility, by another individual used by
the facility in providing services to
such a resident, or by an individual
described in subsection
(e)(2)(A)(iii).''; and
(II) in the fourth sentence of
subparagraph (C), by inserting ``or
described in subsection
(e)(2)(A)(iii)'' after ``used by the
facility''; and
(III) in subparagraph (D)--
(aa) in the subparagraph
heading, by striking ``nurse
aide''; and
(bb) in clause (i), in the
matter preceding subclause (I),
by striking ``a nurse aide''
and inserting ``an
individual''; and
(cc) in clause (i)(I), by
striking ``nurse aide'' and
inserting ``individual''.
(d) Reimbursement of Costs for Background Checks.--The Secretary of
Health and Human Services shall reimburse nursing facilities, skilled
nursing facilities, and other entities for costs incurred by the
facilities and entities in order to comply with the requirements
imposed under sections 1819(b)(8) and 1919(b)(8) of such Act (42 U.S.C.
1395i-3(b)(8), 1396r(b)(8)), as added by this section.
SEC. 3. INCLUSION OF ABUSIVE WORKERS IN THE DATABASE ESTABLISHED AS
PART OF NATIONAL HEALTH CARE FRAUD AND ABUSE DATA
COLLECTION 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
patient's or resident's property.''.
(b) Coverage of Long-Term Care Facility or Provider Employees.--
Section 1128E(g)(2) of the Social 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
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 or through the provider, including nurse assistants, nurse
aides, home health aides, individuals who provide home care, and
personal care workers and attendants)'' before the period.
(c) Reporting by Long-Term Care Facilities or Providers.--
(1) In general.--Section 1128E(b)(1) of the Social Security
Act (42 U.S.C. 1320a-7e(b)(1)) is amended by striking ``and
health plan'' and inserting ``, health plan, and long-term care
facility or provider''.
(2) Correction of information.--Section 1128E(c)(2) of the
Social Security Act (42 U.S.C. 1320a-7e(c)(2)) is amended by
striking ``and health plan'' and inserting ``, health plan, and
long-term care facility or provider''.
(d) Access to Reported Information.--Section 1128E(d)(1) of the
Social Security Act (42 U.S.C. 1320a-7e(d)(1)) is amended by striking
``and health plans'' and inserting ``, health plans, and long-term care
facilities or providers''.
(e) Mandatory Check of Database by Long-Term Care Facilities or
Providers.--Section 1128E(d) of the Social Security Act (42 U.S.C.
1320a-7e(d)) is amended by adding at the end the following:
``(3) Mandatory check of database by long-term care
facilities or providers.--A long-term care facility or provider
shall check the database maintained under this section prior to
hiring under an employment or other contract, or both, any
individual as an employee of such a facility or provider who
will have access to a patient or resident of 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, that will provide services at the facility or
through the provider, including nurse assistants, nurse aides,
home health aides, individuals who provide home care, and
personal care workers and attendants).''.
(f) Definition of Long-Term Care Facility or Provider.--Section
1128E(g) of the Social Security Act (42 U.S.C. 1320a-7e(g)) is amended
by adding at the end the following:
``(6) Long-term care facility or provider.--The term `long-
term care facility or provider' means a skilled nursing
facility (as defined in section 1819(a)), a nursing facility
(as defined in section 1919(a)), a home health agency, a
provider of hospice care (as defined in section 1861(dd)(1)), a
long-term care hospital (as described in section
1886(d)(1)(B)(iv)), an intermediate care facility for the
mentally retarded (as defined in section 1905(d)), or any other
facility or entity that provides, or is a provider of, long-
term care services, home health services, or hospice care
(including routine home care and other services included in
hospice care under title XVIII), and receives payment for such
services under the medicare program under title XVIII or the
medicaid program under title XIX.''.
(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out the amendments made by this section,
$10,200,000 for fiscal year 2003.
SEC. 4. PREVENTION AND TRAINING DEMONSTRATION PROJECT.
(a) Establishment.--The Secretary of Health and Human Services
shall establish a demonstration program to provide grants to develop
information on best practices in patient abuse prevention training
(including behavior training and interventions) for managers and staff
of hospital and health care facilities.
(b) Eligibility.--To be eligible to receive a grant under
subsection (a), an entity shall be a public or private nonprofit entity
and prepare and submit to the Secretary of Health and Human Services an
application at such time, in such manner, and containing such
information as the Secretary may require.
(c) Use of Funds.--Amounts received under a grant under this
section shall be used to--
(1) examine ways to improve collaboration between State
health care survey and provider certification agencies, long-
term care ombudsman programs, the long-term care industry, and
local community members;
(2) examine patient care issues relating to regulatory
oversight, community involvement, and facility staffing and
management with a focus on staff training, staff stress
management, and staff supervision;
(3) examine the use of patient abuse prevention training
programs by long-term care entities, including the training
program developed by the National Association of Attorneys
General, and the extent to which such programs are used; and
(4) identify and disseminate best practices for preventing
and reducing patient abuse.
(d) Authorization of Appropriations.--There is authorized to be
appropriated such sums as may be necessary to carry out this section.
SEC. 5. EFFECTIVE DATE.
This Act and the amendments made by the Act shall take effect on
the date that is 6 months after the effective date of final regulations
promulgated to carry out this Act and such amendments.
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