1. State of Minnesota National Background Check Program (NBCP) Program Overview and Technical Assistance
Presentation to the
Minnesota Department of Human Services
December 6, 2012

2. Contents
Program Implementation Support
Program Fundamentals
Program Goals
Long Term Care Facility/Provider Definition
State Awards to Date
Program Drivers and Requirements– Historical and Current (ACA 6201)
Roles of various State agencies
Minnesota Initial Technical Assistance Needs
Next Steps

3. Program Implementation Support
CNA
Non-profit, public interest research and analysis institution
Awarded separate contract from Centers for Medicaid Medicare Services (CMS) to help States
Working with all grantee states
Provided support to states in NBCP pilot study

4. Program Fundamentals
Created under the Patient Protection and Affordable Care Act of 2010
Intended to help States protect vulnerable populations from abuse
Managed by US Department of Health and Human Services (HHS) CMS
Grant program in effect from 2010 through 2015

5. Program Goals
Purpose of grant to identify efficient, effective, and economical procedures for States to conduct State and Federal background checks
Establishes framework for standardized nationwide program for States to conduct fingerprint-based background checks on all prospective direct access employees of long term care facilities and providers

6. Long Term Care Facility/Provider Definition
Term ‘‘long-term care facility or provider’’ means facilities or providers that receive payment for services under title XVIII or XIX of the Social Security Act. In Minnesota this would include:
Skilled nursing facilities
Advantage waiver assisted living facilities (if any)
Nursing facilities
Intermediate care facility for the developmentally disabled
Home health agencies
Hospice agencies
Other facilities or providers of long-term care services under such titles as the State determines appropriate
Long-term care hospitals
Providers of personal care services under Medicare & Medicaid

7. State Awards to Date Awarded October 2010 Alaska Florida Connecticut
Missouri
Delaware
Rhode Island
Awarded May 2011
Oklahoma Utah
Kentucky North Carolina
Awarded January 2011
California
District of Columbia
Illinois
New Mexico
Awarded September 2011
Maine
Nevada
West Virginia
Awarded Aug-Sep 2012
Georgia
Minnesota

8. Program Drivers – History and Findings
20% of applicants in NBCP pilot ( ) withdrew or were disqualified in NBCP Pilot
HHS Office of Inspector General (OIG) report on Nursing Facilities’ Employment of Individuals with Criminal Convictions (2009 – 2011)
Evidence of insufficiency of existing background checks
Summary of findings in next three slides
Subsequent OIG report on criminal convictions of CNAs with administrative findings
Summary of findings follows

9. HHS OIG Report Findings – Convictions

10. HHS OIG Report Findings – Crimes

11. HHS OIG Report Findings – Jobs

12. HHS OIG CNA Conviction Report Findings
Study compared the rate and types of convictions for nurse aides with substantiated findings in 2010 for abuse, neglect and misappropriation.
FINDINGS:
19% of nurse aides (300 of 1,611) who received substantiated findings of abuse, neglect, or misappropriation in 2010 had at least one conviction prior to their substantiated findings;
The number of convictions of the 300 nurse aides ranged from 1 to 14, totaling 622 convictions; an average of 2.1 convictions per nurse aide;
The most common conviction (53 percent) was for crimes against property (e.g., burglary, shoplifting, and writing bad checks). Crimes against persons had the second highest number of convictions with 14.3%.

13. Program Drivers – Current
The Patient Protection and Affordable Care Act became law on March 23, 2010
Expands requirements of background check
Requires fingerprint-based search of
State and Federal criminal history
Abuse/neglect registries Federal, current State, and prior States if any
Records of any disqualifying information, such as professional licensing board
Rap back capability for on-going monitoring of criminal convictions

14. State Requirements Under the Act
Conduct applicant screening and criminal background checks in accordance with nationwide program
Monitor compliance by long term care facilities
Establish a policy for a provisional employment period
Provide independent appeal or dispute process
Designate single State agency oversight of program
Define direct access employees
Specify disqualifying offenses
Describe and test methods that reduce duplicative fingerprinting, including development of rap back capability for on-going criminal history notification
[Section 6201(a)(4)(B) of the PPACA]

15. Key State Agencies for NBCP Implementations

16. Role of CSO/SIB
Assist grantee agency to establish procedures and infrastructure for fingerprint-based state and federal criminal history checks
Security of CHRI, ROI forms, MOU for services
Coordinate request for ORI
All fingerprints submitted under this authority must have the program-designated ORI and include “CMS NBCP 6201” as the reason fingerprinted (CJIS letter to CSO/SIB, August 26, 2011).
Disseminate criminal history responses to grantee agency
Establish fee structure and payment mechanisms for fingerprint-based state and federal criminal history checks as appropriate

17. Role of IT Organization
Facilitate any project approvals and architecture reviews for background check system upgrades or replacements
Establish IT infrastructure for testing, staging, and production of upgraded or replacement system.
Installations and version management on testing and production
Operations and maintenance, and corresponding SLA
Perform and test any data migration to upgraded or replacement system
Facilitate network permissions as appropriate for automated interfaces to registries or other systems

18. Typical Areas of Technical Assistance (TA)
Initiation
Current program comparison with NBCP provisions
Identify opportunities for improvement
Legislative support
Stakeholder outreach and support
Program development support (process development and automation)
Registry checking
Fingerprint integration
Criminal history report review
Rap back
Notifications
Cost and payment
Applicant and employment tracking
Integration support with fingerprint vendor, CSO/SIB, courts, registry

19. TA Areas for Minnesota
Initial TA call and TA assessment report identified areas
Legislative support
Fingerprint tracking and live scan integration
Rap back development
NetStudy gap assessment and recommendation
Other TA tasks and areas may be requested throughout State grant period

20. Objectives for initial site visit
Familiarization
Current business processes, organizational environment, systems, plans, resources, needs
CORE background check system, other State experiences, related TA initiatives and resources
Agree on initial priorities, actions and timelines
This visit is for discussion, questions, and planning

21. Questions?