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National Background Check Program for Long Term Care Providers: Assessment of State Programs Concluded in 2017 and 2018


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 11 of the 12 States that concluded Program participation in 2017 and 2018. (The 12th State did not submit closeout documents in time to be included in this study.) This report also provides information for CMS to assist other States that continue to participate in the Program. Seven States had ongoing grants after the reviewed closeout period. In future work, we will assess these States and the overall Program.


We reviewed grant-monitoring documents and financial reports to determine the extent to which 11 States that concluded participation between 2017 and 2018 had implemented 13 selected Program requirements. Additionally, we surveyed the 11 States to collect information on their experiences with their respective background check programs.


The 11 States that concluded their participation in the Program in 2017 and 2018 varied as to the degree to which they were able to implement Program requirements. Two States implemented all selected Program requirements. Nine States did not implement all the selected Program requirements, primarily because of a lack of legislative authority for certain Program requirements. Five of these nine States implemented most of the selected Program requirements; four of the nine States implemented only some of the selected Program requirements.

Of the background checks conducted, over 25,000 resulted in determinations of ineligibility for prospective employees. The number of determinations of ineligibility varied among the States, as did the rates of determinations of ineligibility (from 0 percent to 3 percent). None of the States provided evidence of unintended consequences associated with conducting background checks, such as a reduction in the available workforce for long-term-care facilities or providers.


The findings of this report are consistent with our previous assessments of the Program and provide further support for one open OIG recommendation. We strongly encourage the Centers for Medicare & Medicaid Services (CMS) to implement this open recommendation: take appropriate actions to encourage States to obtain the necessary legislative authority to fully implement Program requirements. We are not offering any new recommendations at this time.