Background checks for employees of long-term care (LTC) facilities are an important safety measure that can help protect some of the facilities’ most vulnerable populations. The National Background Check Program, enacted by legislation in 2010, provides grants to states and territories to assist them in developing and improving systems to conduct federal and state background checks of prospective LTC employees.
Included in this legislation is a mandate that the Office of Inspector General (OIG) produce an evaluation of the program within 180 days of program completion. This interim review allows for the Centers for Medicare & Medicaid Services (CMS) to assist the states in fully implementing the program requirements.
OIG found that Idaho and Mississippi lacked state legislative authority to implement some program requirements. Both states encountered challenges with coordination between state-level departments responsible for seeking legislative authority. Additionally, Mississippi and Idaho did not consistently report federal and state funds on required quarterly financial reports; this made it difficult for CMS to determine the ongoing cost of program implementation.
OIG found additional concerns with Mississippi. Even though Mississippi had conducted background checks during the first years of participation in the program, they were unable to submit required data to CMS to calculate determinations of ineligibility.
OIG recommends that CMS continue to implement their prior recommendations to take appropriate actions to (1) encourage states to obtain the necessary legislative authority from the state to fully implement program requirements, and (2) require participating states to consistently submit data that allows CMS and each state to calculate determinations of ineligibility. In addition, they recommend that CMS ensure that participating states submit accurate quarterly reports. CMS agreed with this recommendation.
The complete report can be read here: https://oig.hhs.gov/oei/reports/OEI-07-20-00181.pdf.
Issue:
Long-term care requirements include conducting extensive background checks on all employees. These background checks should be comprehensive to ensure that each new hire is qualified and permitted to be employed in a healthcare facility. After hire, it is essential that government databases such as the OIG’s List of Excluded Individuals and Entities (LEIE) are periodically monitored to confirm that no current employee has received a criminal conviction or been placed on an exclusion list after their initial screening. Routine monitoring will help ensure that employees are legally permitted to provide healthcare services in a facility that receives government funds such as Medicare and Medicaid.
Discussion Points:
- Review your policies and procedures for conducting background checks on all new employees prior to their start date, and for ongoing monitoring of current employees. Update your policies as needed.
- Train appropriate staff on your policy and procedures for background checks. Train all staff about their responsibility to report immediately any legal action or placement on the OIG’s LEIE that may deem them ineligible to work in a long-term care facility. Document that the trainings occurred, and file each signed document in the employee’s education file.
- Periodically audit to ensure that all preemployment checks have been completed and that regular monitoring is ongoing.
