[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.
                                 <all>