[Congressional Record Volume 147, Number 83 (Thursday, June 14, 2001)]
[Senate]
[Pages S6333-S6337]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. KOHL (for himself and Mr. Reid):
  S. 1054. 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; to the Committee on Finance.
  Mr. KOHL. Mr. President, I rise today to re-introduce the Patient 
Abuse Prevention Act. I am pleased to be joined in this effort by 
Senator Reid, who has worked tirelessly with me on this important 
legislation.
  There is absolutely no excuse for abuse or neglect of the elderly and 
disabled at the hands of those who are supposed to care for them. Our 
parents and grandparents made our country what it is today, and they 
deserve to live with dignity and the highest quality care.
  Unfortunately, this is not always the case. We know that the majority 
of caregivers are dedicated, professional, and do their best under 
difficult circumstances. But we also know that too often, the elderly 
are starved, shamed, abused, neglected and exploited by the very people 
charged with their care. And the systems that are in place today are 
not enough to protect them.
  It is estimated that more than 43 percent of Americans over the age 
of 65 will likely spend time in a nursing home. The number of people 
needing long-term care services will continue to increase as the Baby 
Boom generation ages. While most long-term care workers do an excellent 
job, it only takes a few abusive staff to cast a dark shadow over what 
should be a healing environment.
  A disturbing number of cases have been reported where workers with 
criminal backgrounds have been cleared to work in direct patient care, 
and have subsequently abused patients in their care. In 1997, the 
Milwaukee Journal-Sentinel ran a series of articles describing this 
problem, which led my home State of Wisconsin to pass a criminal 
background check law for health care workers. The legislation I 
introduce today follows their example and builds on their efforts.
  Current State and National safeguards are inadequate to screen out 
abusive workers. All States are required to maintain registries of 
abusive nurse aides. But nurse aides are not the only workers involved 
in abuse, and other workers are not tracked at all. Even worse, there 
is no system to coordinate information about abusive nurse aides 
between States. A known abuser in Iowa would have little trouble moving 
to Wisconsin and continuing to work with patients there.
  In addition, there is no Federal requirement that long-term care 
facilities conduct criminal background checks on prospective employees. 
People with violent criminal backgrounds, people who have already been 
convicted of murder, rape, and assault, could easily get a job in a 
nursing home or other health care setting without their past ever being 
discovered.
  Our legislation will go a long way toward solving this problem. 
First, it will create a National Registry of abusive long-term care 
employees. States will be required to submit information from their 
current State registries to the National Registry. Facilities will be 
required to check the National Registry before hiring a prospective 
worker. Any worker with a substantiated finding of patient abuse will 
be prohibited from working in long-term care.
  Second, the bill provides a second line of defense to protect 
patients from violent criminals. If the National Registry does not 
contain information about a prospective worker, the facility is then 
required to initiate an FBI background check. Any conviction for 
patient abuse or a relevant violent crime would bar that applicant from 
working with patients.
  There is clear evidence that this is needed. In 1998, at my request, 
the Senate Special Committee on Aging held a hearing that focused on 
how easy it is for known abusers to find work in long-term care and 
continue to prey on patients. At that hearing, the HHS Inspector 
General presented a report which found that, in the two States they 
studied, between 5-10 percent of employees currently working in nursing 
homes had serious criminal convictions in their past. They also found 
that among aides who had abused patients, 15-20 percent of them had at 
least one conviction in their past.
  But even more compelling, we heard from Richard Meyer of 
Libertyville, Illinois, whose 92-year old mother was raped by a nursing 
home worker who had a previous conviction for child sexual abuse. A 
criminal background check could have prevented this tragedy. But even 
more appalling, there is nothing in current law that prevents her 
assailant from travelling 50 miles to my home town of Milwaukee and 
finding another job in a home health agency.
  There's no greater illustration of the need for background checks 
than this. But for those who need more hard data, there is more 
evidence. In 1998, I offered an amendment which became law that allowed 
long-term care providers to voluntarily use the FBI system for 
background checks. So far, 7 percent of those checks have come back 
with criminal convictions, including rape and kidnapping.
  Clearly, this is a critical tool that long-term care providers should 
have, they don't want abusive caregivers working for them any more than 
families do. The current voluntary system was a good first step, but if 
we're serious about protecting our seniors, and I believe that every 
Member of the Senate is, then we have to do more than make it 
voluntary. We should make it a national priority to require all long-
term care providers who participate in Medicare and Medicaid to conduct 
these checks. And we should make the investment necessary to cover the 
costs of the checks, just like we reimburse providers for other costs 
of providing care to Medicare and Medicaid beneficiaries. This is a 
common-sense, inexpensive step we can take to protect patients by 
helping long-term care providers thoroughly screen potential 
caregivers.
  I realize that this legislation will not solve all instances of 
abuse. We still need to do more to stop abuse from occurring in the 
first place. But this bill will ensure that those who have already 
abused an elderly or disabled patient, and those who have committed 
violent crimes against people in the past, are kept away from 
vulnerable patients.
  I want to repeat that I strongly believe that most long-term care 
providers and their staff work hard to deliver the highest quality 
care. However, it is imperative that Congress act immediately to get 
rid of those that don't. When a patient checks into a nursing home or 
hospice, or receives home health care, they should not have to give up 
their right to be free from abuse, neglect, or mistreatment.
  This bill is the product of collaboration and input from the health 
care industry, patient and employee advocates who all have the same 
goal I do: protecting patients in long-term care. I look forward to 
continuing to work with my colleagues, the Administration, and the 
health care industry in

[[Page S6334]]

this effort. Our nation's seniors and disabled deserve nothing less 
than our full attention.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1054

       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) Nursing Facility and Skilled Nursing Facility 
     Requirements.--
       (1) Medicaid program.--Section 1919(b) of the Social 
     Security Act (42 U.S.C. 1396r(b)) is amended by adding at the 
     end the following 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 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 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) furnish to the State 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 any volunteer) that 
     has direct access to a patient of a nursing facility under an 
     employment or other contract, or both, with such facility. 
     Such term includes individuals who are 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) 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 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 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) furnish to the State 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

[[Page S6335]]

     (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 any 
     volunteer) that has direct 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.''.
       (3) 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) State Requirements.--
       (1) Medicaid program.--
       (A) Expansion of state registry to collect information 
     about nursing facility employees other than nurse aides.--
     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 ``Nursing facility 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 ``, and (II) all other 
     nursing facility employees with respect to whom the State has 
     made a finding described in subparagraph (B)'';

       (III) in subparagraph (B), by striking ``involving an 
     individual listed in the registry'' and inserting ``involving 
     a nursing facility employee''; and
       (IV) in subparagraph (C), by striking ``nurse aide'' and 
     inserting ``nursing facility employee or applicant for 
     employment''; and

       (ii) in subsection (g)(1)--

       (I) in subparagraph (C)--

       (aa) in the first sentence, by striking ``nurse aide'' and 
     inserting ``nursing facility employee''; and
       (bb) in the third sentence, by striking ``nurse aide'' each 
     place it appears and inserting ``nursing facility employee''; 
     and

       (II) in subparagraph (D)--

       (aa) in the subparagraph heading, by striking ``nurse aide 
     registry'' and inserting ``nursing facility employee 
     registry''; and
       (bb) by striking ``nurse aide'' each place it appears and 
     inserting ``nursing facility employee''.
       (B) Federal and state requirement to conduct background 
     checks.--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 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) report to the nursing facility 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.''.
       (2) Medicare program.--
       (A) Expansion of state registry to collect information 
     about skilled nursing facility employees other than nurse 
     aides.--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

[[Page S6336]]

     ``Skilled nursing care 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 ``, and (II) all other 
     skilled nursing facility employees with respect to whom the 
     State has made a finding described in subparagraph (B)'';

       (III) in subparagraph (B), by striking ``involving an 
     individual listed in the registry'' and inserting ``involving 
     a skilled nursing facility employee''; and
       (IV) in subparagraph (C), by striking ``nurse aide'' and 
     inserting ``skilled nursing facility employee or applicant 
     for employment''; and

       (ii) in subsection (g)(1)--

       (I) in subparagraph (C)--

       (aa) in the first sentence, by striking ``nurse aide'' and 
     inserting ``skilled nursing facility employee''; and
       (bb) in the third sentence, by striking ``nurse aide'' each 
     place it appears and inserting ``skilled nursing facility 
     employee''; and

       (II) in subparagraph (D)--

       (aa) in the subparagraph heading, by striking ``nurse aide 
     registry'' and inserting ``nursing facility employee 
     registry''; and
       (bb) by striking ``nurse aide'' each place it appears and 
     inserting ``nursing facility employee''.
       (B) Federal and state requirement to conduct background 
     checks.--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 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) report to the skilled nursing facility 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.''.
       (c) Application to Other Entities Providing Home Health or 
     Long-Term Care Services.--
       (1) Medicaid.--Section 1902(a) of the Social Security Act 
     (42 U.S.C. 1396a) is amended--
       (A) in paragraph (65), by striking the period and inserting 
     ``; and''; and
       (B) 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 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.''.
       (2) 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. 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 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).''.
       (d) Reimbursement of Reasonable Costs for Background 
     Checks.--The Secretary of Health and Human Services shall 
     factor into any payment system under titles XVIII and XIX of 
     the Social Security Act the reasonable costs of the 
     requirements of sections 1819(b)(8) and 1919(b)(8) of such 
     Act, as added by this section, incurred by any entity subject 
     to such requirements.

     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 direct 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, 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

[[Page S6337]]

     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 direct 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, 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 
     hospice facility, an intermediate care facility for the 
     mentally retarded (as defined in section 1905(d)), or any 
     other facility that provides, or provider of, long-term care 
     services or home health services 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 2002.

     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.

       The provisions of and amendments made by the Act shall 
     apply, without regard to whether implementing regulations are 
     in effect, to any individual applying for employment or hired 
     for such employment--
       (1) by any skilled nursing facility (as defined in section 
     1819(a) of the Social Security Act) or any nursing facility 
     (as defined in section 1919(a) of such Act), on or after the 
     date which is 6 months after the date of enactment of this 
     Act,
       (2) by any home health agency, on or after the date which 
     is 12 months after such date of enactment, and
       (3) by any hospice facility, any intermediate care facility 
     for the mentally retarded (as defined in section 1905(d) of 
     the Social Security Act), or any other facility that provides 
     long-term care services and receives payment for such 
     services under the medicare program under title XVIII of such 
     Act or the medicaid program under title XIX of such Act, on 
     or after the date which is 18 months after such date of 
     enactment.
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