Healthcare providers and organizations must maintain compliance with relevant Federal health care laws and regulations. Employers are held responsible for having programs and policies to ensure they do not employ or contract with excluded or sanctioned individuals.
The U.S. Department of Health and Human Services Office of Inspector General (OIG) prohibits healthcare companies from hiring anyone sanctioned from participating in federal programs such as Medicare and Medicaid.
The Centers for Medicare and Medicaid Services (CMS) has awarded more than $65 million to 28 States to design comprehensive national background check programs for employees that have direct access to patients. The CMS program's purpose to provide a framework for states to develop an efficient and effective procedure for conducting background checks. The program is administered by the Centers for Medicare & Medicaid Services (CMS), in consultation with the Department of Justice (DOJ) and the Federal Bureau of Investigation (FBI).
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) established a Background Check Pilot Program. The purpose of the pilot program was to “identify efficient, effective, and economical procedures” for conducting State and national criminal background checks on prospective “direct patient access employees,” as defined in the statute.
The pilot was administered by the Centers for Medicare & Medicaid Services (CMS), in consultation with the Department of Justice (DOJ) and Federal Bureau of Investigations (FBI). The pilot program operated from January 2005 through September 2007.
Pilot States CMS selected seven states to participate in the Background Check Pilot Program. The states represented a mix of rural and urban areas and included ethnically and culturally diverse populations. The pilot states included:
In 2010, the Patient Protection and Affordable Care Act (P.L. 111-148) became Federal law.
Section 6201 the Patient Protection and Affordable Care Act (PPACA) requires the Secretary of Health and Human Services to establish a nationwide program to identify efficient, effective, and economical procedures for long term care facilities or providers to conduct background checks on prospective "direct patient access" employees on a nationwide basis.
This program is an extension of the pilot program that was established under Section 307 of the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA). The nationwide program is open to States that did not participate in the Background Check Pilot Program established under MMA.
The Act requires that each State participating in the nationwide program must make a determination as to whether an employee has direct patient access. A “direct patient access” employee is defined as any individual who works at a long-term care facility or provider of services and provides direct care, treatment, or services to patients (as determined by the State participating in the nationwide program).
To engage in the nationwide program and receive the federal funding, a State must:
If a State participates in the nationwide program, all of the following types of long-term care facilities and providers within the State will be required to conduct background checks on prospective “direct patient access” employees in compliance with the Act:
The Act does not require a background check for an individual who volunteers at a long-term care facility or provider of services.
A State may delay the implementation of the nationwide program for up to one year after entering into the agreement with HHS if the State can demonstrate good cause why it cannot fully
HHS will work with interested States to develop agreements for conducting background checks on a State basis. The agreement between HHS and a State must include the following elements:
States that participate in the NBCP must require HHAs to conduct the following background checks. HHAs that want to receive federal funding must conduct these checks even if it’s not required by their state.
Background checks even play a crucial role in determining if an applicant can be trusted. In fact, healthcare screening is purposely designed to serve this purpose.
Also, periodic criminal checks occur and tend to be a good idea for those in long-term positions where they have contact with patients. They can be used as an ongoing process when doubts arise regarding staff members. Some health agencies in fact conduct a thorough screening of current employees every two years to deter fraud and protect the safety of patients.
At Orange Tree, we create custom background check packages designed for your industry and business needs. We know the many challenges that you face during the hiring process and can help you decide what background checks are best to meet your unique hiring goals.
Want to learn more about how our team can be of service to your organization? Schedule a call today.
The foregoing is not legal advice, express or implied. We recommend you seek the advice of your own legal counsel for all aspects of employment law.