[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[S. 1122 Introduced in Senate (IS)]







105th CONGRESS
  1st Session
                                S. 1122

 To establish a national registry of abusive and criminal patient care 
   workers and to require criminal background checks of patient care 
                                workers.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 31, 1997

   Mr. Kohl (for himself, Mr. Grassley, and Mr. Reid) introduced the 
 following bill; which was read twice and referred to the Committee on 
                                Finance

_______________________________________________________________________

                                 A BILL


 
 To establish a national registry of abusive and criminal patient care 
   workers and to require criminal background checks of patient care 
                                workers.

    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 NATIONAL REGISTRY OF ABUSIVE WORKERS.

    (a) In General.--The Secretary shall establish, under the health 
care fraud and abuse data collection program established under section 
1128E of the Social Security Act (42 U.S.C. 1320a-7e), a registry to be 
known as the ``National Registry of Abusive Workers'' (hereafter 
referred to in this section as the ``Registry'') to collect and 
maintain data on covered health care workers (as defined in subsection 
(e)) who have been the subject of reports of patient abuse.
    (b) Submission of Information by State Registries.--Each State 
registry under sections 1819(e)(2) and 1919(e)(2) of the Social 
Security Act (42 U.S.C. 1395i-3(e)(2) and 1396r(e)(2)) shall submit to 
the Registry any existing or newly acquired information contained in 
the State registry concerning covered health care workers who have been 
the subject of confirmed findings of patient abuse.
    (c) Submission of Information by State.--Each State shall report to 
the Registry any existing or newly acquired information concerning the 
identity of any covered health care worker who has been found to have 
committed an abusive act involving a patient, including the identity of 
any such worker who has been convicted of a Federal or State crime as 
described in section 1128(a)(2)(A) of the Social Security Act (42 
U.S.C. 1320a-7(a)(2)(A)). The State shall provide such workers with a 
right to issue a statement concerning the submission of information to 
the Registry under this subsection. Any information disclosed 
concerning a finding of an abusive act shall also include disclosure of 
any statement submitted by a worker in the registry relating to the 
finding or a clear and accurate summary of such a statement.
    (d) Submission of Information by Facilities.--Each covered health 
care facility shall report to the State concerning a covered health 
care worker who has been found to have engaged in an act of patient 
abuse. The State shall, in accordance with the procedures described in 
part 483 of title 42, Code of Federal Regulations (as in effect on July 
1, 1995), conduct an investigation with respect to a report under this 
subsection to determine the validity of such a report.
    (e) Background Check.--
            (1) Requirements.--
                    (A) In general.--Each covered health care facility 
                (as defined in subsection (f)), prior to employing a 
                covered health care worker, shall--
                            (i) in the case of a covered health care 
                        worker who has not otherwise undergone a 
                        criminal background check as part of the 
                        licensing requirements of a State, as 
                        determined under regulations promulgated by the 
                        Secretary, provide for the conduct by the State 
                        of a criminal background check (through an 
                        existing State database (if any) and through 
                        the Integrated Automated Fingerprint 
                        Identification System) concerning such worker, 
                        and provide the worker with prior written 
                        notice of the requirement for such a background 
                        check;
                            (ii) obtain from a covered health care 
                        worker prior to employment a written 
                        certification that such worker does not have a 
                        criminal record, and that a finding of abuse 
                        has not been made relating to such worker, that 
                        would preclude such worker from carrying out 
                        duties that require direct patient care; and
                            (iii) in the case of all such workers, 
                        contact the State health care worker registries 
                        established under sections 1819(e)(2) and 
                        1919(e)(2) which shall also contact the 
                        Registry for information concerning the worker.
                    (B) Imposition of fees.--A State may assess a 
                covered health care facility a fee for the conduct of a 
                criminal background check under subparagraph (A)(i) in 
                an amount that does not exceed the actual cost of the 
conduct of the background check. Such a facility may recover from the 
covered health care worker involved a fee in an amount equal to not 
more than 50 percent of the amount of the fee assessed by the State for 
the criminal background check.
                    (C) Effective date.--The requirement in 
                subparagraph (A)(i) shall become applicable on January 
                1, 1999, or on such earlier date as the Director of the 
                Federal Bureau of Investigation determines that the 
                Integrated Automated Fingerprint Identification System 
                has become operational.
            (2) Probationary employment.--Each covered health care 
        facility shall provide a probationary period of employment for 
        a covered health care worker pending the completion of the 
        background checks required under paragraph (1)(A). Such 
        facility shall maintain direct supervision of the covered 
        health care worker during the worker's probationary period of 
        employment.
            (3) Penalty.--
                    (A) In general.--A covered health care facility 
                that violates paragraph (1) or (2) 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.
                    (B) Knowing retention of worker.--In addition to 
                any civil penalty under subparagraph (A), a covered 
                health care facility that--
                            (i) knowingly continues to employ a covered 
                        health care worker in violation of paragraph 
                        (1) or (2) in a position involving direct 
                        patient care; or
                            (ii) knowingly fails to report a covered 
                        health care worker who has been determined to 
                        have committed patient abuse;
                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 section:
            (1) Covered health care facility.--The term ``covered 
        health care facility'' means--
                    (A) with respect to application under the medicare 
                program under title XVIII of the Social Security Act 
                (42 U.S.C. 1395 et seq.), a provider of services, as 
                defined in section 1861(u) of such Act (other than a 
                fund for purposes of sections 1814(g) and 1835(e));
                    (B) with respect to application under the medicaid 
                program under title XIX of the Social Security Act (42 
                U.S.C. 1396 et seq.), any nursing facility, home health 
                agency, community-based residential facility, adult day 
                care center, adult family home, assisted living 
                facility, hospice program, hospital, treatment 
                facility, personal care worker agency, supportive home 
                care worker agency, board and care facility, or any 
                other entity that receives assistance or benefits under 
                the medicaid program under that title;
                    (C) a facility of the National Institutes of 
                Health;
                    (D) a facility of the Indian Health Service;
                    (E) a health center under section 330 of the Public 
                Health Service Act (42 U.S.C. 254b); and
                    (F) a hospital or other patient care facility owned 
                or operated under the authority of the Department of 
                Veterans Affairs or the Department of Defense.
            (2) Covered health care worker.--The term ``covered health 
        care worker'' means any individual that has direct contact with 
        a patient of a covered health care facility under an employment 
        or other contract, or under a volunteer agreement, with such 
        facility. Such term includes individuals who are licensed or 
        certified by the State to provide such services, and non-
        licensed individuals providing such services as defined by the 
        Secretary including nurse assistants, nurses aides, home health 
        aides, and personal care workers and attendants.
            (3) Patient abuse.--The term ``patient abuse'' means any 
        incidence of abuse, neglect, mistreatment, or misappropriation 
        of property of a patient of a covered health care facility. The 
        terms ``abuse'', ``neglect'', ``mistreatment'', and 
        ``misappropriation of property'' shall have the meanings given 
        such terms in part 483 of title 42, Code of Federal 
        Regulations.
            (4) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
    (g) Consultation.--In carrying out this section the Secretary shall 
consult with the Director of the Federal Bureau of Investigation.
    (h) Regulations.--Not later than 6 months after the date of 
enactment of this Act, the Secretary shall promulgate regulations to 
carry out this section. With respect to subsections (b) and (c), the 
regulations shall call for the submission of information to the 
Registry not later than 30 days after the date of a conviction or on 
which a finding is made.

SEC. 3. EXCLUSION OF CERTAIN INDIVIDUALS FROM PARTICIPATION IN 
              PROGRAMS.

    (a) Mandatory Lifetime Exclusion.--Section 1128(a) of the Social 
Security Act (42 U.S.C. 1320a-7(a)) is amended by adding at the end the 
following:
            ``(5) Criminal conviction.--Any individual or entity that 
        has been--
                    ``(A) convicted, under Federal or State law, of a 
                criminal offense involving a crime against bodily 
                security, including homicide, battery, endangerment of 
                safety, sexual assault, child or elder abuse, and 
                spousal abuse; or
                    ``(B) found to have--
                            ``(i) knowingly continued to employ an 
                        individual described in subparagraph (A) in a 
                        position involving direct patient care; or
                            ``(ii) knowingly failed to report an 
                        individual who has been determined to have 
                        committed a crime described in subparagraph 
                        (A).''.
    (b) Permissive Exclusion.--
            (1) In general.--Section 1128(b) of the Social Security Act 
        (42 U.S.C. 1320a-7(b)) is amended--
                    (A) in subsection (b), by adding at the end the 
                following:
            ``(16) Finding relating to patient abuse.--Any individual 
        or entity that--
                    ``(A) is or has been the subject of a specific 
                documented finding of patient abuse by a State (as 
                determined under procedures utilized by a State under 
                section 1819(e)(2) or 1919(e)(2)); or
                    ``(B) has been found to have--
                            ``(i) knowingly continued to employ an 
                        individual described in subparagraph (A) in a 
                        position involving direct patient care; or
                            ``(ii) knowingly failed to report an 
                        individual who has been determined to have 
                        committed patient abuse as described in 
                        subparagraph (A).''; and
                    (B) in subsection (c)(3), by adding at the end the 
                following:
            ``(G) In the case of an exclusion of an individual or 
        entity under subsection (b)(16), the period of exclusion shall 
        be determined in accordance with regulations promulgated by the 
        Secretary based on the severity of the conduct that is the 
        subject of the exclusion.''.
            (2) Regulations.--Not later than 6 months after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services shall promulgate regulations to establish periods of 
        exclusion for purposes of section 1128(c)(3)(G) of the Social 
        Security Act.
    (c) Exclusions Apply to Any Entity Eligible for Federal 
Reimbursement.--Section 1128 of the Social Security Act (42 U.S.C. 
1320a-7) is amended by adding at the end the following:
    ``(j) Applicability of Certain Exclusions.--The exclusion (or 
direction to exclude) an individual or entity under subsections (a)(2) 
and (b)(16) shall provide that such individual or entity is excluded 
from working for or on behalf of any entity that is eligible for 
reimbursement under a Federal health care program, as defined in 
section 1128B(f).''.

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.
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