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National Background Check Program for Long Term Care Employees: Interim Report


Long-term-care employees provide essential care to patients in settings such as nursing facilities, home health agencies, and hospices. Ensuring that these employees have undergone a minimum level of screening helps protect the safety of beneficiaries in these settings. The Patient Protection and Affordable Care Act (ACA) provides grants to States to implement background check programs for prospective long-term-care employees. The ACA also requires OIG to conduct an evaluation of this grant program-known as the National Background Check Program-after its completion. This interim report describes the overall implementation status and States' results from the first 4 years of the program, and provides CMS with information that may assist its ongoing administration of this program. OIG also plans to issue a final evaluation of the grant program after its completion.


We reviewed reports that each of the 25 States participating in the grant program submitted to CMS. These reports contained data on implementation milestones and expenditures and reflected each State's progress from program inception through September 30, 2014. The earliest program inception date was September 30, 2010. We also reviewed the data that 14 States provided regarding the number of background checks completed. CMS permits States to determine when their programs are sufficiently implemented to begin submitting background check data.


Four years into the grant program, the 25 States that are receiving grants reported having achieved varying levels of program implementation. Specifically, some States have not obtained legislation that would enable them to conduct background checks. Other States have not yet implemented processes to collect fingerprints and monitor criminal history information after individuals begin employment. Only 6 of the 25 States have submitted to CMS data sufficient to calculate the percentage of prospective employees who were disqualified because of their background checks. In these six States, 3 percent of prospective employees were disqualified from employment. Of the remaining 19 States, 11 States were not yet submitting data reports and 8 States had data gaps that prevented the calculation of disqualification rates.


We recommend that CMS continue to work with participating States to fully implement their background check programs and to improve required reporting to ensure that CMS can conduct effective oversight of the grant program. CMS concurred with both of our recommendations.