The Centers for Medicare & Medicaid Services should do more to help states fully implement background checks for long-term care employees, recommends a report released Thursday by the Department of Health and Human Services Office of Inspector General.

CMS concurred with the recommendation.

Enacted by legislation in 2010, the National Background Check 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 for nine types of long-term-care facilities or providers:

  • providers of personal care services,
  • residential care providers that arrange for long-term-care services or provide long-term-care services,
  • skilled nursing facilities,
  • nursing facilities,
  • providers of adult day care,
  • home health agencies,
  • providers of hospice care,
  • long-term-care hospitals and
  • intermediate-care facilities for individuals with intellectual disabilities.

The OIG reviewed grant-monitoring documents and financial reports and collected additional information to determine the extent to which the 10 states that concluded participation between 2013 and 2016 had implemented certain program requirements.

According to the 40-page report:

  • Alaska, Washington, D.C., Florida, New Mexico and Rhode Island implemented all program requirements and, in fact, conducted background checks for more than the required nine types of facilities and providers.
  • Delaware and Connecticut implemented most of the selected program requirements.
  • Illinois, Maryland and Missouri did not have legislative authority to meet program requirements.
  • Alaska had the highest rate of determinations of ineligibility, at 8%.
  • Florida conducted the greatest number of background checks, resulting in the greatest number of determinations of ineligibility, 64,374.
  • Florida, Illinois, Alaska and New Mexico had the greatest percentages of determinations of ineligibility.
  • The background check programs in Washington, D.C., Connecticut, Rhode Island and Delaware resulted in the lowest rates of determinations of ineligibility of prospective employees.
  • Missouri and Maryland did not report determinations of ineligibility during the grant period.

The OIG suggested that CMS schedule future grant payments based on implementation of requirements or issue deficiency notices. The OIG also recommended that CMS continue to provide technical assistance to participating states that have challenges to implementing aspects of the program.

CMS Administrator Seema Verma said CMS concurs with the recommendation, according to a letter from her included in the report.

“CMS will look at ways to encourage grantee states to fully implement program requirements,” she wrote.

The agency will monitor grant funds, require states to report data on key elements of their grant activities and provide technical assistance to states in all aspects of implementation, the report authors said. “Additionally, CMS is working to establish the National Forum for Background Checks to serve as a resource to support states with the sustainability of their programs.”