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National Background Check Program for Long Term Care Providers: Assessment of State Programs Concluded Between 2013 and 2016


Background checks are an important safety measure that can help protect the 9 million beneficiaries who rely on long-term-care services each year for safe, dependable care. These checks can prevent individuals with disqualifying histories (e.g., convictions for patient abuse, patient neglect, and theft from patients) from being hired to care for beneficiaries. The National Background Check Program (Program) provides grants to States to develop systems to conduct background checks of State and Federal criminal history records for prospective long-term-care employees.

Congress mandates that OIG evaluate various aspects of Program implementation. This report provides an assessment of States that concluded Program participation prior to 2017, and it also provides information for CMS to assist States that continue to participate in the Program.


We reviewed grant-monitoring documents and financial reports to determine the extent to which the 10 States that concluded participation between 2013 and 2016 had implemented selected Program requirements. Additionally, we surveyed the 10 States to collect information on their experiences with their respective background check programs.


The 10 States that had concluded their participation in the Program by 2016 varied as to the degree to which they achieved implementation of Program requirements. Seven of these 10 States implemented all or most of the selected requirements. Three States did not have the necessary authority through State legislation and could not fully implement background check programs.

Of the background checks that 8 of the 10 States conducted, nearly 80,000 resulted in determinations of ineligibility for prospective employees. The number of determinations of ineligibility and rates of ineligibility varied among the States (i.e., from less than 1 percent to 8 percent). None of the States reported a reduction in available workforce for long-term-care facilities or providers as a result of the Program.


To better protect beneficiaries from potential harm, CMS should take appropriate action to encourage participating States to obtain necessary authorities to fully implement Program requirements. CMS stated that it concurred with our recommendation.