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OIG Report on Background Checks for Long-Term Care Employees

The Patient Protection and Affordable Care Act (ACA) provides grants to States to facilitate implementation of background check programs to screen prospective long-term care employees. The ACA also requires the Department of Health and Human Services Office of Inspector General (OIG) to conduct an evaluation of the grant program, known as the National Background Check Program, after its completion. The OIG issued an interim report describing the overall implementation status and States’ results from the first 4 years of program operation. Interim reporting provides CMS with useful information to enhance ongoing program administration and operations. OIG also plans to issue a final evaluation of the grant program after its completion.

The OIG reviewed reports from each of the 25 States participating in the grant program. Each State submitted a report to CMS detailing implementation milestones, expenditures, and overall progress from each program’s inception through September 30, 2014. OIG also reviewed data from the 14 States that reported on the number background checks completed. CMS permits States to determine when their programs are sufficiently implemented and ready to begin reporting data.

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In examining the 4 years this grant program has been operating, CMS found that each of the 25 States receiving grants are achieving varying degrees of program implementation. The degree of implementation varies based on State-specific forces. For example, some States have not obtained legislation permitting the conduction of background checks. Other States have yet to implement sufficient processes and infrastructure for collecting fingerprints and monitoring criminal history information after employment begins. Only 6 of the 25 participating States have submitted sufficient levels of data for CMS to calculate what percentage of prospective employees were disqualified because of background checks. CMS calculated that, in these 6 States, 3 percent of prospective employees were disqualified from employment because of their background check. Of the remaining 19 States, 11 States were not submitting data reports yet and 8 States had data gaps preventing the calculation of disqualification rates.

The OIG called for CMS to continue working with participating States so each State can each achieve both a fully-implemented background check program and a satisfactory data reporting capability. Data reporting is fundamental to CMS’s ability to conduct effective oversight of the grant program. Though the OIG did not address every facet of a meaningful and fully-implemented program, it’s important to acknowledge that background checks have to begin with sanction-screening against the OIG’s List of Excluded Individuals and Entities (LEIE). A number of vendors provide search engine tools to expedite this essential step in the background check process. Additionally, some vendors will perform the screening and hit-resolution, which often prove to be the most time consuming part of the background check process.

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