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National Background Check Program for Long Term Care Providers: Assessment of State Programs Concluded in 2019


Background checks of employees are an important safety measure that can help protect some of the most vulnerable populations. More than 13 million beneficiaries are served by long-term-care facilities each year, including the elderly, individuals in hospice care, and individuals with intellectual disabilities.

The National Background Check Program (Program), enacted by legislation in 2010, assists States in developing and improving systems to conduct Federal and State background checks. Included in this legislation is a mandate that OIG produce an evaluation of the Program within 180 days of Program completion. This report is the fourth in a series to supplement the mandated evaluation. In future work, we will assess the final four States to conclude the Program and the Program overall.


We reviewed grant-monitoring documents and financial reports to determine the extent to which the 4 States that concluded participation in 2019 had implemented 13 selected Program requirements. Additionally, we surveyed program staff from the four States to collect information on their experiences with their respective background check programs.


OIG found that of the 4 States that concluded their participation in the Program in 2019, 3 States-Hawaii, Oregon, and Puerto Rico-did not implement all 13 selected Program requirements during the grant period. These States had varying degrees of State-level legal requirements and practical infrastructure for conducting background checks that affected their ability to implement select Program requirements. Primarily, these States lacked existing legislative authority and encountered challenges in coordinating between State-level departments. Two States needed to seek legislative authority to implement select Program requirements and develop needed infrastructure. One State needed to amend existing legislation to implement one Program requirement. The two States that needed to seek legislative authority also encountered challenges in coordinating with their respective State criminal justice authorities to implement background check requirements. One State had existing legislative authority and implemented all 13 selected Program requirements.

OIG found that three of the four States-Ohio, Oregon, and Puerto Rico-did not report sufficient data to accurately assess Program outcomes. Unless all participating States consistently report quality data, Program outcomes cannot be accurately assessed.


CMS should continue to implement OIG's prior recommendation for it to take appropriate actions to encourage States to obtain the necessary legislative authority to fully implement Program requirements. Given this report's findings, CMS should assist participating States to address the challenge of coordinating between State-level departments and require participating States to consistently submit data that allow for CMS and each State to calculate determinations of ineligibility. CMS concurred with both recommendations.